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Home My WebLink About2612DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -1 BOX 22 I 1 ' 6 " , T� JL I , I i "L , 02612 PUTNAM COUNTY DEPARTMENT OF HEALTH ,:, :. 1 :'D��ON`OF iLN ♦ IRO�TMENAL HEALH"i:YER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- V OC) Located at I G O W 1 G C o P ii5' gv It D Town or-Vifte 'FO 1jt" rti VA L LiE `l Owner /Applicant Name V1tJeCN j— LoN6N ►TpNO Tax Map SZ Block 3 Lot 1 Formerly Subdivision Name 'f Rn- ( T'o —3,3 N.,JJerj - �\ Subd. Lot # Mailing Address g2ol GA)ZF16Z-D AV61 �y:E+ 1fo5'KJ'KILL0 /JCW yofLY, Zip 105,66 Date Construction Permit Issued by PCHD 9 h4 O6 -?,/ �� Z�'vZC sH�'/ -In i- Separate Sewerage System built by :D t- 11,00XIA 10" IW% Address STAI'''1 FUPyII-L6, IJ•Y, 125,81 Consisting of /5'610 Gallon Septic Tank and ^y-D I L, F - 4 ' �e tF6Ex f 0 iZ n -rG D P y c.- Cl FC IM 2-4" 6'RAU4' -L - rR(EMCM Other Requirements: /4�J ft IT' 10 M A L- 10 a L. F. 01= ��. 19U L -Td Z74r --rA PTq LLGD Water Sunnly: Public Supply From Address /S--L on Private Supply Drilled byAlog `+!M' AJOi�-Rso J Address pvT ?JAr►, V,01-4C , Ni 106-7 S -SUS 6LIE7 _... - __ ._ -._. _. _.. -...p 1Building Type /�j1'?(L`fi .. Has erosion control been com feted.' " Number of Bedrooms AW4 1 Fu 7-y p_c Has garbage grinder been installed? I certify that the system(s), as listed, serving the; built plans (copies of which are attached), ns of plans and the standards, rules and regal o Date: 1-30-02- Certified by Address Z J, � L,.. YV. ;taqed essentially as shown on the as- onstruction Permit and approved rtuttent of Health. j P.E. %< R.A. a # 0 b Z-r') 8-0 F ESS�vo °' Any person occupying premises served by the above system(s)-VWITregiptly 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 revocatig rn, modification or change is necessary. / c It, 1/11" Date: _0 By: L ��' J - i � � White copy - HD File; YeUo.W copy - Building Inspector; Pink copy lOwner;-efange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Fv - -7 -66 Well Location Street Address: illage: Tax Grid # MapS ?. Block-? Lot(s) j Well Owner: N Address: Use of Well: 1- primary 2- secondary e- Aesidential ublic Supply I Air cond /heat pump I gatio Business Farm - Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _),e Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing >4 Open hole in bedrock Other Casing Details Total length 2 I ft. Length below grade / aft. Diameter in. Weight per foot lb /ft. Materials: >C Steel _ Plastic _ Other Joints: _ Welded ,/ Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: LL Yes No Liner: Yes --yNo 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 J� gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 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 1 6 U' .... _ ., .. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _ Depth S 96 Model ,l-- 7-'� Voltageo HP TankL%e §419 Volume,�_a--D , 7 Date Well Completed 1/y /0 Putnam County Certification No. q Date of Report ))"_ Z Zr ell Driller (signature) NTE: Hatt location of well with distances to at least two perman t Ian Tarks to be provtaea on a separate sneetipian. Well Driller's Name // 1 Address: Signature: �, ®.. Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owne ; Orange copy - Well driller Form WC-()7 YML ENVIRONMENTAL SERVICES 321 Kear Street Hei{}htsy (914) 245-2800 Albert H. Padovani, Director LAB #: 32.200100 CLIENT #: 1818 NON STAT PROC PAGE I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ANDERSON, NORMAN 152 BARGER ST PUTNAM VALLEY, NY 10579 DATE/TIME TAKEN: 01/07/02 01:00F DATE/TIME REC'D: 01/07/02 01,30P REPORT DATE: 01/22/02 PHONE: (914)-528-1491 SAMPLING SITE: WlCCOPEE RD, PUTNAM VALLEY.NY SAMPLE TYPE..: POTABLE - : OUTSIDE FAUCET . _ �' PRESERVAT�IVES: NONE COL 'D BY: SARAH ANDERSON TEMPERATURE..: < 4E, NOTES...: COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE PUTNAM CNTY PROFILE 01/07/02 MF T. COLIFORM 01/07/02 LEAD (INS) 01/07/02 NITRATE NITROG 01/07/02 NITRITE NITROG 01/07/02 IRON (Fe) 01/07/02 MANGANESE (Mn) 01/07/02 SODIUM (Na) 01/07/02 pH 01/07/02 HARDNESS,TOTAL 01/07/02 ALKALINITY (AS 0 1/07A02Z-�' '' NDITY'(TUA RESULT NORMAL - RANGE METHOD ABSENT 3.3 <0.2 <O.010 0.091 <0.010 16"6 7.8 36.0 60.0 -1-.7 /100 ppb MG /L MG /L MG /L MG /I MG /L UNITS MG/1 MG/L NTU ML ABSENT 0-15 ppb 0 - 1O N/A O-0.3 mg/l 0-0.3 mg/1 10OB 9lO! 9139 9146 2037 2037 N/A 6.5-8.5 9043 N/A N/A COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN�`��THE 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. �blic schools are set at Rule for Public Systems distribution points have COPPER value of 1.3 mg/L undertaken to reduce the 15 ppb. requires that no more a LEAD value of more , else water waters corrosive Fe/Mn if both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state, that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a A` .` moderately restricted diet, a maximum of 270 mg/L of Sodium �� is suggested. _ YML ENVIRONMENTAL SERVICES _ 321 Kear Street ^/orktown Heights-=h��5�8,�=��. (914) 245-2800 Albert H. Padovani, Director LAB #: 32.200100 CLIENT #: 1818 NON STAT PROC PAGE 2 ANDERSON, NORMAN DATE/TIME TAKEN: 01/07/02 01:O0P 152 BARGER ST DATE/TIME REC'D: 01/07/02 01:30P PUTNAM VALLEY, NY 10579 REPORT DATE: 01/22/02 ^ PHON& (914)-528-1491 ` SAMPLINGSITE: WICCOPEE RD, PUTNAM VALLEY,NY SAMPLE TYPE..: POTABLE : OUTSIDE FAUCET PRESERVATIVES: NONE. COL'D BY: SARAH ANDERSON TEMPERATURE..: < 4C NOTES...: '� COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~=~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE : FLAG PROCEDURE ' RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH I8 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 oH 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 A : 0-/0~MG/L VERY HARD WATER: ABOVE 300 MG/L ----MODERATELY HARD WATBQ '70-140,MG/L : 72MG/LTo1l YLLIGRON'PER LlTER`�_ HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director ELAP# 10323 BRUCE R..FOLEY . Public Health Director LORETiTry MOLINARI R.N., M.S.N.= -. - Associate Public Health Director Director of Patient Services DEPARTMENT Ur HEALTH 1 Geneva Road Brewster, New York 10509 ` Environmental Health (914) 278 - 6130 Fax (9.14) 278-7921 . Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085. Early Intervention (914) 278 - 6014 Preschool (914) 278 -6092 Fax (914) 278 - 6648 OWNERS NAME: V jIc4N i A+jD `PATfZ1 c:i& LoNcH I -rA�0 TAX MAP NUMBER: S6rc T I d!J 19 L 0 CK . 3 L or; � E911 ADDRESS: 160 W 1 c C e ri e R a ig D TOWN: a wN o r - ci T N L L (E Y AUTHORIZED TOWN OFFICIAL: ' (Signature) 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. (E911 VERFRM) a DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM- Vi ►J c trtJ *r- # 84 -r ti l c. k rr L o rj G N T-r4 N o Owner or purchaser of Building ViNct -'NT _r P&rRtci& (,.o/J6HiTl�11�10 Building Constructed by I6 a W I C_c o Pc4' RO&D Location - Street SIaGLk�. rfq/hlL. ' fZ 4;:�J110 jCL' Building Type S'2 -3 1 Tax Map Block Lot VA Town,A e LaraGHi -rANo 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 occu of the building utilizing the system. i Dated: Month Day Year �� Signature: Title: GenF Contractor (Owner) - Signature Corporation Name (if corporation) Address: 92-9 619f2r1k <,b /� ✓�i.lv� State FE+-5K,IKIL(_ , �. y. Zip /a S6' ' Corporation Nanlre(if corporation,) Address Stag Zip Form GS -97 Z0 30ad T ONI833NION3 NINOND E69E9ELOT6 ZT :ST T00Z /8T /ZT BRUCE P- I:OLEY Public Health Director DEPARTAMNT of 1 Geneva Road Brewster, New York �. LOItETfA �11d0)T+lARI RN M.S.N. Associate Publie Health Director Director of Patient Services BEALTH 10509 Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278.6558 WIC (845) 278.6678 Vim (845) 278 - 6085 Early Interrentioa (445)278-6014 Preschool (845) 278.6082 Fax (845) 278 - 664 2—. ADDI�T�I /ON APPAL P. CATION MSIDENTIAI. ONL STREET LO (fJ �GG`� /E� TOWAIV LMI� MAPS NAME (/!/✓� �hU'/� / 4 PHONE_ / /J-J PCHD9 MAMING ADDRESS,/60 GJIZ-O �r I/iJ2t�l f✓�" /o�- � � DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS �PROPOSED 0 OF.BEDROOMS —"D (FROM CERT. OF OCCUPANCY OR CERTMCATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plaits (Construction Permit) prepared by a Professional Engineer or Registered Archittct in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the folldv&g to Putnam County Hcaltlt Dopt.-, 4 G -,ra Read; Brewster; NY = - _....... _._ _. _. 10509, Phone 278 -6130. 1. Certified check or money order for S100.00.. 2. • Sketches of existiug floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *Non- professional sketches are acceptable. . ' 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of i.- Lstallation if known. babel all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USF. Comments F'eb98 BFhouseguidclincs ;/I :d 0bS9b2821216 =01 . 1261- 8L2 -St78 l8dd3a AINnoD WUNind : W0213 00:T; 2002-81 -Ndf LETTER OF TRANSMITTAL CRONIN ENGINEERING P.E., P.C. January 28, 2002 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914- 736 -3693 Putnam County Department of health 1 Geneva Road, Brewster, N.Y. 10509 RE: VINCENT LONGHITANO PCDH PV-27-00 160 WICOPEE ROAD TOWN OF PUTNAM VALLEY" THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDING YOU attached _ .._ _.._..._ 1:) -'Three copies of as- built-subsurface sewage treatment'system plan 2.) Three certificate of the construction compliance. 3:) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) Well completion report 6.) Water analysis 7 E911 address verification form 8. $200 certified check for application fee. V/ Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. /� �L ,Z �� %szz. -• Respectfully submitted, jXettM. Murphy l rojecDesigner PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMim GE TREATMENT SYSTEM PERMIT # O --' Q0 Located at -W I C CO PEE' Z D _ Town orb P(ATO AA VA (_(_F-Y Subdivision name ✓w Subd. Lot # Date Subdivision Approved Owner /Applicant Name \%d a C.6N T- 10 N G H 1 -1rA aJ Q Tax Map �52 Block 3 Lot I . Renewal Revision Date of Previous Approval WLA • Mailing Address 323 G Az1a uc i..._n ki &, BEE-KS 9 ► L L_ , Y • Zip /0.56 -d' . Amount of Fee Enclosed 3 O Building Type c n9 z tiA;- Lot Area - 106. No. of Bedrooms --T -Design Flow GPD 80C') AC. Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 100 gallon septic tank and Z}00 L. r 4" 'P\/ 0- -(','2>= F. ?u t'E 1,V 2� Gt0AJEL -T e- ) 0 H - Other Requirements: To be constructed by 47` D— fff1xo;rc4 , Address Water Supply: Public Supply From or: ✓ Private Supply Drilled by Address 0 8* y `Address° I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the segarate sewage treatments sv tem 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 Complia rrs %g to the Public Health Director will be submitted to the Department, and a written guarantee will be r, ' successors, heirs or assigns by the builder, that said builder will place in good operating condit' ma Art of saie% ag treatment system during the period of two (2) years immediately following the date of the iss ce a of Ce ificate of Construction Compliance of the original system or any r air thereto. it Signed: // ... &Zd Address f -I n l� n Yll r_� Sln w w z Date 9--/- 00 ( 0566 License # 0 6'e--q & 0 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new a 't. A ov discharge of domestic sanitary sew a only. By: Title: Date: Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professio al Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES :..APPLIC,AT.ION '1'D .CO.NSTRUC'1G` A . W:. please print or type PCHD Permit # Well Location: Street Address: Town/Vigftw Tax Grid # A 1 cc C) PEE, ZJ , PcCv0AA VAci—Ey Map 52 Block 3 Lot(s) Well Owner: Name: Address: 11- JCF'A)1 L0&HrtAN0 929 C7Azr -iIFtD Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage Gov gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓ New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ✓ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ..................................... ............................... Yes No Name of subdivision Lot No. .-- Water Well Contractor: Address: Is Public Water Supply available to site? ................................... ............................... Yes No Name of Public Water Supply: NA Town/Village .yA Distance to property from nearest water main: NIA Proposed well location & sources of contamination to be prov' separate sheet/plan. Date: Applicant Signature:- x _ - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 64L� Date of Issue Permit Issuing icial: Date of Expiration ? z ®22 Title: Permit is Non-Transferiabli White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 19 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: ti c Evil i 10 f0 G t} ► TA 90 . ,9253 CoA1-_F1EL%) 7gVF . 2. Name of project: 5S-T s. 3. Locatiorl!�V: Pt4a ntA.N1 1 %LLf -y , 4. Design Professional: T,NarN y M. 5. Address: C117 ag ("Vl fB W . 6. Drainage Basin: �� e c�� y.. I0 5 66 , 7. TVDe of Proiect: ✓ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... . ....... ......................... Type I Exempt Type II Unlisted 1z 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Ny . 10. Has DEIS been completed and found acceptable by Lead Agency? ............... A) IA . 11. Name of Lead Agency ;'' N/4 project n_an area- under- the.cionttol of lacal_.p1_anni�g, zonjng, -or other------ officials, ordinances? ......................................................... ............................... _ 13. If so, have plans been submitted to such authorities? ........ ............................... ;ND . 14. Has preliminary approval been granted by such authorities? Date granted:. — - — 15. Type of Sewage Treatment System Discharge ................. surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... N� 17. Waters index number (surface) .................................................. _� A 18. Is project located near a public water supply system? ....... ............................... I/O . 19. If yes, name of water supply Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ ND . 21. Name of sewage system NA Distance to sewage system AIA- 22. . Date test holes observed 23. Name of Health InspectorAJ�kk. ST- C -_-%,-UnJ& 24. Project design flow (gallons per day) ................................. ............................... goo 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 10D 26. Has SPDES Application been submitted to local DEC office? ......................... /vn . FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner `�I��cEr�? �o�Gr/ /T.9�/� _Address c .yf l�l�1�rU,y ioClG Located at (Street) Wkoc2o pFE 'Po A(� Tax Map 52 Block 5 Lot 1 . (indicate nearest cross - street) Municipality (1) f'uTn Am VALLE y Drainage Basin FeveA /(l 40AL-1w 0i,,. e e_a , SOIL PERCOLATION TEST DATA Date of Pre - soaking '(j 17- ID _D Date of Percolation Test 71 I A o . Hole No. Run No. Time 'Start- Stop Ela se Time (1 I n.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inc. hes Percolation Rate Min/Inch 4 5 2 r/ iJ a 4 5 1 2 :0_f/ Z' 189 i� l� U Z i `t � 4. NOTES: L,- Tests to be repeated at same depth until approximately equal percolation rates are ootamea at each a percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements..to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of V i n! e 6,NT I-... o N& H 1 rep n) 0 Located at % i cc 0 pler 2 0A D �i`V .1 1Tw� nti 1/� �� y Tax Map # 52 Block 3 Lot 1 Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize —Ft M oT H Y L ill a duly licensed Professional Engineer 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 i edi s 'on of said wastewater treatment and/or water supply systems in conformity with . isio ti le 145:andlor 147 of the Education-Law, the Public Health Law; and t�•� it �• , � e. - �1d Very truly yours, nttDerr,signed: ��F sso �.`', Signed: P•E•, Wiz•, # d 6 f- U N SS \�N�i caner of Property) Mailing Address. �Fo (N 8 W. Mailirig Address: -9-99 eev�s-/t,, L � p►l,�I�1�I State 1`f y. Zip 10 a C-G State Telephone: (-e 9-) - 734!57 066 /- Telephone: (.9(4) Form LA -97 4.181(9195) —Text 12 PROJECT LD. NUMBER .. _- _ _ 617.2O SEOR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT,48PeN90*- 2. PROJECT NAME AJLi = A, LON v J�� J�7 fl /'1 t / L 3. PROJECT LOCATION: Municipality Tit MA4 (� �+nh aTA. ,4m 4. PRECISE LOCATION (Street address and road intermflahs, prominent landmarks, etc., or provide map) LA`S" S'c Pt; are- 5. IS PRRO(�_pSED ACTION: �C.J New ❑ Expansion ModiticatloNaiteratlon 6. DESCRIBE PROJECT BRIEFLY: of 0"'o 7. AMOUNT OF LAND AFFECTED: 106-t Initlally 0 b t acres Ultimatelyacres 8. WILL PROPOSED ACTION COMPLY WITH ExisnNG ZONING On-OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY.OF PROJECT? y - Rdsidenttai - -['Industrial- �Comrrcerclal• ._.. --ClAoriPulture,. _. �RorklForest/Open sPae '[ Other Deserlbe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (MERAL, STATE qR LOCJ11)! . ❑ /'- Yes No It yes, list agency(s) and p*rmlt1apPfM13 11. DOES ANY ASP OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑Yes No It ye% list agency name and permittapproval 12. AS A RESULT OF ROPOSED ACTION WILL EXISTING P_RMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF, MY KNOWLEDGE. 1"0111 IIUsponsor name: IV92AMAod G..G . Oates .Q Signature: b _1 If the action is in the Coastal Ar®a, and you are a state agency, complete the Coastal Assessment Forth before proceeding with this assessment OVER 6' 08/23/00 WED 13:59 FAX 914 736 3693 Cronin Engineering TOWN OF PUTNAM VALLEY CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANT /SPONSOR: PROPERTY LOCATION: August 13, 2000 August 13, 2001 Vincent Longhitano 929 Garfield Avenue Mahopac, NY 10541 Wiccopee Road, Lot 1 TAX MAP #: 52 -3 -1 SIZE OF PARCEL: 106 acres ZONING: CD Q 004 PROPOSED ACTION: Construction of single family residence, septic system, driveway and well, crossing of watercourse and construction of portion of driveway within wetland buffer area MATERIALS REVIEWED:`..: I. Application Materials, file # WT -342. 2. Site Plan for Vincent and Patricia Lono3itano, as prepared by Cronin Engineering P.E., P.C., dated 08- 02 -00. CONDITIONS OF PERMIT: 1. All construction shall followed approved Site Plan as prepared by Cronin Engineering P.E., P.C., as dated 08- 02-00. 2. The stream crossing and driveway construction that is within the wetland buffer area must be completed prior to beginning the foundation of the proposed house. . rW I on L 08/23/00 WED 14:00 FAX 914 736 3693 Cronin Engineering Q 005 3. The driveway and stream crossing worts shall be inspected by the Wetlands Inspector for compliance with approved plans. Wetlands Inspector to be notified when erosion controls have been installed, prior to excavation of the stream crossing, during construction, and at the completion of driveway crossing within wetland area. 4. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 5. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in. place until final site inspections for compliance with conditions of permit have been completed. . 6. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 7. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 8. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow fiends will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation sad /or a Stop Work :®raper. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: August 13, 2000 - cc: Applicant Budding Inspector Planning Board Environmental Commission uW20a Stephen W. Coleman Town Wetlands Inspector 08/23/00 WED 13:57 FAX 914 736 3693 Cronin Engineering 61001 omit. 512 11-AM O ' HE UNDY BL DM SU M GW 2 JOHN W/A�LSHH BOULEVARD, PPEEKSI�OLpl.�WpYY 105M (PH) 914738.';884 00 014738m3 TOO Main Sbdxg g, Public Heelth Engriser fly Kedh Shuldrar Paac 914 279-7921 Pa! m 5 111 r 914- 278$130 Dow August 23,20M Rs: Ceswh bt and L,orghit m bt, SS WS CO 0 UMMA [x] For Review U Please Coarrnent 0 Moore Reply 0 Pisses Roeyde Find enclosed the Wdhnd Permtft Waiver fnxn the Town of Putnam Valley to the above fDte wx:ed pnojed& These should ow plete the mgtdren km for the Dance of the ootatimbon p amts. Please call if you have any questions or requWe addWarrat i .b., n Lion_ Thanks If this tim mmission is not dear please contact our office RUTNAM COUNTY DEPARTMENT OF REALTHi DIN ISION OF tNVIRONMENTAL HEALTH SERVICES `JT =I LfCO'IMERCIA ' ECTION A. GENERAL INFORtNIATION `ame of Project L �,c- H rAi (T)(' ::ite Location 3uildin? construction begun l �.�r Extent :property within \TYC Watershed? ................. Yes JE��, o County, J SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Q Hilly F-1 Rolling F-� Steep slope Gentle slope Flat ?. F--J Evid:nce of wetlands. F--J Low area subject to flooding Bodies of water F7 Drainage ditches F� Rock outcrops 3. Proper lines or comers evident .............................................. , ...... Yes i To 4. Do water courses exist on or adjoin the property? ............................ Yes F-� No 5. Will these affect the design of the sewage system facilities ?............ F Yes F� No b Do watershed regulations apply in this development ? ....................... a Yes No 7 lVill extensive grading be necessary? ................. ............................... 0 Yes F-� No 8. 'ill extensive fill be necessary forSSTS ?. ❑ Yesh..❑ -No,. 9. Do filled areas exist within the SSTS area? ...... ............................... F-� Yes No If yes, what is the condition of the fill? xt.1 I &-- r-r' j SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: and gravel ffLoam- F--I Clay. ,Hardpan []]"Mixture 11. Observed from: F--J Borings Bank c t ackhoe excavations 12. Soil borings /excavations observed by r on 13. Depth to groundwater ,- on 14. Depth to mottling on << 15. Are teat holes representative of primary & rese a arez; ...... ............................... es No 16. Soil percolation tests made by , s�.c�S� on 17. Soil percolation tests vritnessed by ` r on SECTION D (on back) Form ST -1 0 04/03/00 MON 08:39 FAX 914 736 3693 CRONIN ENGINEERING PE PC Post-It' Fax Note 7671 Rhone # . a Fax # Zia BRUCE R.FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road . Brewster, New York 10509 A'I I'EIMON: SAM STIEBELING 0 GENE REED AUMiate Public Health Director: Director of Patient Services AD information below Faust be fuft completed prior to any scheduling. ENGINEER OR : i6&=- LA& D HONE #. 236 — 166�k RFASON- DEEPS-X PERCS: d PUMP TESL': 0 ROAD/STREET: UW e e2 PCB tOWN: R iAl-+ E TAX Il AP #: SUBDIWSION- � LOT #: 0001 NMEP CRE'F, A FOR .IOIl�' i�F�rinEtY iviD_ WfTriTTESS iG OF SOIL, TFS�Cj YES N � °•y` p , Proposed SSTS within the drainage basin of -West asancb or-I1oydq Coa*,er, (Reservoirs.:. g roposedl SSTS within 500 feet of a reservoerr, reservoir steam or control lake. + ❑ Proposed SSTS within 200 feet of a watercourse . or a DEC wetland. q Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SETS for >a Commerical Project. It is the responsibility of the design professional to provide the above.biformation prior to soil testing. This Department will determine the NYCDEP project status (Joint or (Delegated) based on the response. If you answered ya to any of the questions, NYCDEP ,must witness the soil testing. This Department will coordinate a mutuaVy suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. 1 P i r� 12/19/2001 09:57 9147363693 CRONIN ENGINEERING 1 PAGE 01 P'UTNA,M COUM DEPARTMENT OF MULTH DIVISION OF ENVIRONMENTAL HLkLFH SERVICES ATTENTION ADAM L7 GENE ZQL]EST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCIM Construction Permit # V 2 -7 — 4 0 Located: W 1 G C O `P C a P- 4 A 0 (T) (JI) ?U M A rn VAt -4 `l' Owner /AVpjemt Name: Vi !a_T -r,4 N o TM S2 Block _ Lot 1- Formerly: SubdivisionName: PIA Subdivision Lot # N jA Is system fill completed? N f, t Is system complete? Y� f Is system constructed as per plans? Is well drilled? N-6 Is well located as per plans? N A Are erosion control measures in place? Date: Date: r Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: Dt�c�►''if~'fz I °I, 20o t Certified by: CQ4010►G��e:t'R�Nd Design Professional Address: 2 �o NN WA f_.! R NZ f/P t?4�6t<.00 L L l a CCd' Lic. # Z 01 $ 6 rf%wnv"&n#e- Form FIR-99 JZ/L$'c7/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION' OF ENVIRONNIENI TAL HEALTH SERVICES FINAL SITE R�SPECTION -- - I Owner nspe o�c- t Town Permit # TM — Subdivision Lot # 1. Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from «-ater course/ wetlands ...... ............................... II. Sewaae System a. 60tic tank size -1,000 ......... 1,250......... other ....... 1..5I2� b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Orig'innallsoil between box & trenches e. Junction Box - properly --s et ........... ............................... f. 1 renc es I . Length required- Length installed �00 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1%" diameter clean .................... 9.: Depth - of- gr.-avd in. trench..1T' minimum :...:....:............_ a 10. Pipe ends capped .................................. g. Pumo or Dosed Svstems 1. Size o pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................ ..........................:.... 6. Cycle witnessed by H.D.esfunated flow /cycle........... III. House/Building a. house located per approved plans .......................... b Number of bedrooms ........ ............................... IV. Well a. Jell located as per approved plans . ............................... b. Distance from STS area measured ' 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 watercour., g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate ... .......................:....... i. Erosion control provided ........... :..................................... :L .iuNCrio�v sox •ars 68' 45 -PC A% T END CF -21VD..'7R& 94' WES r EX.D. OF 3RD. 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