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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -69 BOX 22 1,47%. ' ' ' L L L Ir ,r I■ JL 02647 / 1 a UTNAM COUNTY DEPARTMENT OF HEALTH I� IONT OF�E- �]�Ol A4m:E- ?TAL CER KATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCIID CO STRUCTION PERMIT # P V- 6 — 9 $ Located at PEC K S h' 1 L L k/o L t a u T.o nl, - owi or Village Q91201 E L &T o M yy V9 L C t y Owner /Applicant Name JA& ypJ c- ST19 --r e J Tax Map S2 Block 3 Lot 6 9 (T) CAgrlleL. SZ- f- Ii Formerly Subdivision Name Subd. Lot # Mailing Address S_ R 1 G hI T C. O U i2 7r- &C K S K i L L, %I W yo 2 K Zip 10 S-6 6 Date Construction Permit Issued by PCHD 1f91 L , �304 1999 eo uit7- Separate Sewerage System built by W.9 (11 J c- 9Til+7'etJ Address PFC KS'1' 1 L c., /J,y! 10 s6-c Consisting of 12 SQ Gallon Septic Tank and SO O L T p F ¢ "I 01, &iZ F J'V c- f rc )Y,i 24 GE 1IEL 772e7J CH Other Requirements: Water Suanly: Public Supply From Address /S 2 Igg7ZCC7Z- S7' or: Private Supply Drilled by/UOR/r1AJJ Anl DE?-CorJ 111 C . Address PU 7-nJ A r7 l//9 Z L L-�/V, y Building Type `j� G[ t �rtiic Y 7�E S: 'Has erosion -controi'b°een "completed?--- Number of Bedrooms 3 f 1 FuTuyZ 1�as garbage grinder been installed? I certify that the system(s), as listed, serving the above pr �`s` J here co built plans (copies of which are attached), in ac dance the i��r�i1 plans and the standards, rules and regulation the Pu Cout ....l Date: Z `5 -ct Sr Certified by 7-HC Z 1 /J b 0 6 (Design Address 2 "'S ONIJ W44-SH RI-Vb Pe- 4 r Health. ✓ as shown on the as- Permit and approved P.E., R.A. # Oro 2 990 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 revo ti on, modificati or change is necessary. c By Title: Date: White copy - HD ile; ello copy - Building Inspector; Pink copy - Owner; Orang copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ _ _�'E)G.�.0 ®1hdPLE. Well Location S t Addre 0 C, T ovg& Tax Grid # P-' a��� U�►icy,/ P s-c Block Lot(s)69 Well Owner: N e: Address: Use of Well: I- primary 2- secondary Residential Public Suvvy Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment 4 Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing "ye Open hole in bedrock Other Casing Details Total length 30 ft. Length th below grade Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Other Joints: _ Welded `Threaded _ Seal: _ Cement grout' Bentonite Other Drive shoe: K Yes No Liner: Yes I-'— 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 4rgpm 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 steve analyses.. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface <� ` ^ - _ . ,.._. __ _....__ = .w..:.r ... _ :._ � .........:.:.... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3ovilz— Capacity Depth i! .s Model /O -'G5= Voltage 7-�3 0 HP s TankTypeA& Volume ®470 Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) NOT : E act location o1f-well with distances to at least two permanen arks to be provided on a separate sheet/plan. %J y 1 Well Driller's Name \o�v�'�✓ ����' t' Address Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ` - ���_��� _ Yorktown Heights, N.Y. 10598 ' (914) 245-2800 Albert H. Padovani, Director 146 CLIENT #: 10095 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ' WAYNE DATE/TIME TAKEN: 12/20/98 02:00P pEEKSKILL HOLLOW RD. DATE/TIME REC'D: 12/21/98 02:42P AM VALLEY, NY 10579 REPORT DATE: 12/23/98 PHONE: (914)-526-2341 1-SAMPLING SITE: SAM SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE BY: WAYNE STATEN - TEMPERATURE,.: .: KT COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ` DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ` 12/21/98 LEAD (IMS) <1 ppb 0-15 ppb 9101 .' 12/21198 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 COMMENTS: 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 - -_ f 41._ k��� If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ~ . n.` . ` � � ITTED BY: � - /+loe � r1. raoovanx, n°/.(A��r) ' Dip��tor ELAP# 10323 - ' i. YML ENVIRONMENTAL SERVICES 321 Kear• Street Yorktown Heights, N.Y. 10598 (914) 245--2800 Albert H. Padovani, Director LAB #: 32.809357 CLIENT #: 2173 NON STAT PROC PAGE 1 NORMAN ANDERSON INC. DATE /TIME TAKEN: 11/161"98 02:15F' 152 BARGER ST DATE /TIME RECD: 11/16/98 02:45P PUTNAM VALLEY, NY 10579 REPORT DATE: 11/20/98 PHONE: (914) -528 -1491 SAMPLING SITE: PEEKSKILL HOLLOW ROAD PARKWAY SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY COL'D BY: SARAH ANDERSON NOTE::....: HOUSE TAP N N NNNN N N N --------------- IV N N --------- N N N DATE FLAG PROCEDURE PUTNAM CNTY 11/16/98 11/16/98 11/16/98 11/16/98 11/16/98 11/16/98 -_--. 11/16/98 1- 1- /16%98.. -. 11/16/98 11/16/98 11/16/98 PROF=ILE MF "r. COL I FOR "i ✓ LEAD (I MS ) NITRITE NITROG NITRITE NITROG IRON (Fe) MANGANESE (Mn) SODIUM (Na) HARDNESS,TOTAL ALKALINITY (AS TURBIDITY (TUR PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: MF ------ ----- N --------- N NNNN N------ N RESULT NORMAL - RANGE METHOD ABSENT /100 ML ABSENT 23.3 ppb 0 -15 ppb 1.07 MG /L 0 - 10 <:0.01 MG /L N/A 1.03 MG /L 0 -0.3 mg /l 0.107 MG /L 0 -0.3 mg /l 2 -. 7.._MGJL - -_. N/A-. _ • 7.9 -"UN I TS- 50.0 MG /L N/A 52.0 MG /L N/A 13.0 NTU 0 -5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE )THE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI NEW YORK STATE AND EPA FEDERAL;_ DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /CU LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both ir--,:n 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 is suggested. 1 008 9101 9139 9146 2037 2037 9043 .a • `b YML ENVIRONMENTAL SERVICES 321 -Kean Stz eet Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert. H. Padovani, Director LAB #: 32.809357 CLIENT #: 2173 NON STAT FROC PAGE 2 NORMAN ANDERSON INC. DATE /TIME TAKEN: 11/16./98 02:15P 152 BARGER ST DATE /TIME REC'D: 11/16/98 02:45P PUTNAM VALLEY, NY 10579 REPORT DATE: 11/20/98 PHONE: (914) - 528 -1491 SAMPLING SITE: PEEKSKILL HOLLOW ROAD PARKWAY SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY COLD BY: SARAH ANDERSON NOTES...: HOUSE TAP NNNNNNNNN------ m ---- mm--------- AINAINNNNN DATE FLAG PROCEDURE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: MF ------------------------ N N N N N N N N N N N N N N N RESULT NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF PH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW PH MIGHT BE CORROSIVE TO 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 w- ........ _SOU RCE AND._.TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. VER Y. HARD 30f- Y 11G /L SOF T Wg T Ef MODERATELY 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:- A ert H. Padovani, M.T.(ASCP) Director ELAP# 10323 CRONIN ENGINEERING, PE PC The Lindy Building, Suite 200 2 JOHN WALSH BOULEVARD (914) 736-3664 FAX (914) 736-3693 J TO, Adam B. Stlebeling Assistant Pubtic Health Engineer Putnam County Dept, of Health Dept, of Environmental Services #4 Geneva Road Brewster, N.Y. 10509 WE ARE SENDING YOU Attached MR. N014111= COPIES DATE ATTENTION ADAM STIEBELING WAYNE STATEN PV-6-98 CERTIFICATE OF CONSTRUCTION COMPLIANCE PACKAGE PEEKSKILL HOLLOW ROAD TOWN OF PUTNAM VALLEY COPIES DATE Nd. DESCRIPTION 13 AS—BUILT SEPARATE SEWAGE DISPOSAL SYSTEM PLAN 3 CERTIFICATE OF CONSTRUCTION COMPLIANCE GUARANTY OF SEPARATE SEWAGE DISPOSAL SYSTEM —3 1 FOUNDATION LOCATION SURVEY MAP WELL COMPLETION REPORT —1 WATER ANALYSIS REPORT FOR APPLICATION FEE.— THESE ARE TRANSMITTEI) For approvat REMARKS mm PUTNAM COUNTY DEPARTMENT OF HEALTH DIV-ISION: -F;ENYIRON- MENTAL::HEAI.:.,T:H- SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM /ti 1%4 Z L t y 7-n i- O 7— S Z 3 �� Owner o Purchaser of Building Tax Map Block Lot Or C>4RY"le Z S - I - I I yl lJ � S-7-79 C t-L?C L v T-J /9 �1 1)Q c C y Building Constructed by �illage �Ksj,�1LL /-/0L L0C -j 0A,0 Location - Street Building Type Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and. in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act -of the.occupant of the building utilizing the: system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building}iti�g the system. f Dated: onth I2- Z Year 'M Signal Title: Gen W al C ract r Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) S R 16- H 7 Co J-10- Address: PEAJrfK1 L L Address: PcE- 6 1(fKI LL State /JC-t j 0� aj tc- Zip 16 S�_ State tJC t-J uo2K Zip ) d r66 Form GS -97 t ° 4 7 1 ]�NVIRONMENTAL HEALTH SERVICES CONISTRUCTY N PERMIT FOR SEWAGE TREATMENT SYSTEM _ y ..... - PERMIT # Located a t P E E N S K I L L tlo L L o W F� O A b t r Village C#9 K/V FL PUT V,,191-Z6- FoTJJAN VALLk% .Tqh Lo• D£- '16"N�T10, Subdivision name Subd. Lot # Tax Map -99 Bock 3 Lot 6 9 (r) Ci-) AtyF -Z 52 - I - II Date Subdivision Approved _ Renewal Revision Owner /Applicant Name V✓A y rV 4�- Date of Previous Approval Mailing Address 5" 1� I G 47- CT, fFE- KS k- (L L ; r j , _ 1 d S—G (cam Zip _ Amount of Fee Enclosed 4 900 Building TypeS�GL-- E4ajzA/ Lot Area 26.3 Ac-No. of Bedrooms 4- Design Flow GPD 2�'O Fill Section Only Depth Volume PCHD NOTIFICATIONS IS REE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12-E-0 gallon septic tank and 4'0 0 C , F OF ?e-P->= ? v c. ? t ?,C IN Z+" G-T� ra it E C._. Other Requirements: Poq CE" To be constructed by f y'Tj-) A n Cow "Tri A CTI J 6 Address L P i(E" PG EKS, K I L LL Public Supply From Address 15Z 619 A G E or: _ c Private Supply Drilled byNogi -nm �AMDt_ K` 6�J` of c Address iu° r&) '6L E'y I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and rggul&tions of the Putnam County Department of Health, and that on completion thereof a "Certificate of Constructioni ",GoffifolYahg"`' atisfacto ry to the Public Health Director will be submitted to the Department, and a written guar e i fur ed owner, his successors, heirs or assigns by the builder, that said builder will place in good ope ing ition any of laid sewage treatment system during the period of two (2) years immediately following the date f e� ss �`1►e ov 1 of the Certificate of Construction Compliance of the original system or anyr6paives thereto. Signed: Address w: Imo; �J /P.E06�9`�C`' Date 3—Z,6— s14 oFO � I kCI LL Q, y. 10566 License # 0G1-9 �3 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 necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved or discharge of domestic sanitary sewage only. h By: �� � ! L� Title: e Date: 4—Z—V White copy - HD File; Yew opy - Building Inspector; Pink copy - wner; ange copy - Design Professional Form CP -97 Street Locatil5n-,, Town T&I r .'. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Inspected by: - - Owner Permit # W-M 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lath. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .. 1,25 ...other ................ b. Septic tank installed leve ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All out ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Oriainal soil between box & trenches Junction Box - properly set... o ........... ............................... Length required � Lenath installed c'7 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 .,:_D'zptli.5 ±;gravelintrenchlT minmum :..::..::..:...::.: ..... - 10. Pipe ends capped ...................... ............................... g. Pump or Dosed Systems 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.estimated flow /cycle........... III. House/Buildin a. House located per approved plans ... ................................ b. Number of bedrooms ....................... ............................... IV. Well a. Well 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Rrncinn rnntrnl nrmArlorl Subdivision Lot # PUTNAI,. 'COUNTY DE]�AR�'I�EI�TT OIF ,�IEAILTII� _ DIVISION OF ENVIRONMENTAL H EAILTkn SERVICES ... .. G please print — ,; —P,® ONST DUCT. i� �%� L�T��; E�..�, �nt or type - PCHD Permit # WeR ]Location: Street Address: TownNillage Tax Grid # (7) L NJAr'1 UA t.C.Cy 856-WSKI LL, HOLLo j:K.t�. .* r-AFf N1EL S6c•.' tBlock 3 Lot(V) (oc) WeR Owner: Name: Address: 'T) cAt MCL s2 - ► -I I WA ylvC- S-rA T En RIGHT I C r. �E � KS I 1-4,y- I OSC Use of WeH: X Residential Public Supply Air /Cond/Heat Pump Irrigation Y- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ,� gpm # People Served Est. of Daily Usage S"00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reaso>in E kJPPL F-0 c In! CS I bC1J Cc for Drilling WeH 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: N614MAAJ AtJb KSOjJ Address: lS"2 9A96E,K S 1 'PPuTmo I�q Is Public Water Supply available to site? .. o , w o .: � k . K�...r: �,� Yes No Name of Public Water Supply: Distance to property from nearest water main: . Proposed well location & sources of contaminate to be prov d�'. Beet/ 1 ' fI LU Date: ...;�- 10.�..pphcarit Sigriatur _ r _ '- v PERMIT TO CONSTRUCT A W`�,� This permit to construct one water well as set forth above, is grante%un - visions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue J Permit Issuing O icial: Date of Expiration 4 <- Title: Permit is Non -Tra® fferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orang copy - Well driller Form WP -97 L0% PUTNAM COUNTY DEPARTMENT Of HEALTH :.._ _DIVISION_ OF. ENVIRONMENTAL. HEALTH SERVICES = LETTER OF AUTHORIZATION RE: Property of 1n1A�/ Located at �E C KX K 1 L L �J o L L 0 LJ g0 i91> Pu'rNArn vigLezY -P9?r 40T Dcs16n1A-rio1J TN e_ m (J Tax Map # 5 2— Block _ '2 , Lot 6 9 C-IQ'F;l'► eL "TqX Lo-r bjES) C JI4'T 1 ot.7 S?_ ILK: 1 La'T : 1 ( Subdivision of Subdivision Lot # . Filed Map # Date Filed Gentlemen: This letter is to authorize `f i r1i o TN y L' CR o N I /J 'rt_� a duly licensed Professional Engineer w 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 treatment and/or water supply systems `.iri cam .fontiity.with.the.provJsion:.% . ArA.i�cle_. 145. and /or_L47._,oftbgEducatiQa.Law, the Public.He,alth.�_µ:._ Law, and the Putnam Countersigned: P.E., Ink., # Mailing Address sv 1 T € ZOO State MCW yozi< Zip -JOE-cc Telephone: (9/4) %36 s S6_C 4- ery truly yours, LIAZ2 (Owner 4 Property) Mailing Address: State Telephone: �3 Spa Form LA -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road l Brewster, New York 10509 Tel: (914) 278-6130 Fax (914) 278-7921 March 18, 1998 Ken Murphy Cronic Engineering The Lindy Building 2 John Walsh Boulevard Peekskill NY 10556 Re: Wayne Staten Septic TM� 52 -1 -11 TM—r52-2-69 (T) Carmel (T) Putnam Valley Dear Mr. Murphy: BRUCE R. FOLEY Health,_ Director.---- .s This office has received and reviewed the most recent set of plans for the above mentioned project. We would �Iikei.`er the following comments for your consideration. Submission of `'Construction Permit for Sewage Treatment System" form P -97 required prior to approval. u of Short Form Environmental Assessment Form also required Brio -r to approval.. Please'consul`t Putnam tot unty Heafil llepartmen- Bulletin ST -19 Append. C "Notes ". Please use standard notes as required, additional notes may be ded in addition after standard Putnam County Health Department required notes. Please provide note on absorption trench detail that trench to start two (2) feet from distribution box. Two (2) foot separation to be solid pipe. E. For future: Minimum scale for plan to be utilized on SSTS design shall be 1 " =30'. Please also provide location map@ 1 "= 2000'. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling (' Asst. Public Health Engineer ABS:tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL, WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT - -"' STREET LOCATION � LGSr�L��c � r ��.tJ NAME OF OWNER STrrl-5v REVIEWED BY DATE 3 I °'r� TAX MAP # Y N APPLICATION WELL PERMIT _ PWS LETTER j,ElfiR OF AUTHORIZATION DESIGN DATA SHEET (DDS) RESOLUTION l4 I2 FEE - THREE SETS PLANS - TWO SETS ICE REQUEST SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED REQUIRED DEPTH PdN DRAIN REQUIRED STANDPIPES GENERAL TED IN NYC WATERSHED Y EON CONTROL:HOUSE,WELL, SSDS & DEEP HOLES LOCATED = SEIy�,TiVi OF PRIMARY & EXPANSION LOCATION MAP E WN; GRAVITY FLOW, SUFF.SIZE F ft�MPED, PIT & D BOX SHOWN & DETAILED OUSE - NO.OF BEDROOMS ELLS & SSDS'S W/IN 200' OF PROPOSED SYS. Y METES & B OUNDS K2Z ETBACK NECESSARY (TIGHT LOT) SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 451 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 0- FT. HORIZONTAL ;SL 3:1 'r GRADE FIL CS FILL NOTES FILL CERTI TION NOTE DEPTH AGES FI ROFILE & DIMENS NS SUBMITTED TO DEPOLUME GATED TO PCHD FILL IN EXPANSION AREA D P OVAL, IF REQ'D TRENCH -. E =OLES-OBSEER - •TRENCH PI-OV.IDFD.�P ..60..FT E WITNESSED, IF REQ'D LEL TO CONTOURS - X�ROVAL SSDS ADJ. LOTS 100% EXPANSION PROVIDED DS (TOWN/DEC PERMIT REQ'D ?) I DDS PLANS & PERMIT SAME NEIGHBOR NOTIFICATION FLOOD ELEVATION REQ'D PERMITS) SYSTEM PLAN - (NORTH ARROW) )RAU.I IC PROFILE GRAVITY FLOW DATA: PERC & DEEP RESULTS �PONTOURS EXISTING & PROPOSED RIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: V f ON PLAN - FROM SSTS �9 P.L., DRIVEWAY, LARGE TREES, TOP OF FILL �0 W FOUNDATION WALLS _15'WELL TO PL v TO WELL, 200' IN DLOD, 150' PITS STREAM WATERCOURSE LAKE (inc. expan) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 7,-W-.f/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 70in to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' - <I% to C D discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL IA/ LJ S FORM ST -2 JL 4.0 CONSTRUCTION PERMITS Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Department: those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet Deep or Less 1. ?nstruction Permit Application. (Appendix K) tter of Authorization for Desian Professional. (Appendix K) �. Application for Approval of Plans For A Wastewater Treatment System. Appendix K) Corporate Resolution (if corporate ownership). (Appendix K) D. ort :Environmental Assessment Form (EAF).(Appendix K) Desrgn-Data:Shect: -(Appendih-K -) -- NOTE: All submitted Department application forms shall contain original sign res (no photo copies). Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall include, as a minimum, the following: )rope rty survey with metes and bounds descriptions and major physical features. The plan shall make reference, by note, of the survey source and in the case of lots not subject to a filed map, a certified copy of a survey shall provided. A datum reference is to be provided (i.e., National Geodetic Vertical Daturp 1929, or assumed/other). ZHouse oc ation with proposed finished.: floor and basement elevations spec ed. Plan and profile of the SSTS, to include 100 percent reserve area, construct' n details of absorption system and components including septic tan istribution or junction boxes, pump pit, dosing siphon, etc. L tion of driveways. Lo tion of well or public water main and house service connection. Two -foot contours of the property. If ground is to be cut or filled, both exis ' g and proposed contours must be shown. Location of any watercourses, ponds, lakes or wetlands on, or within 200 fe of property. Accurate location of all deep test holes and percolation test holes. Omission of soil testing on lots in recently approved subdivisions will be at the disc etion of the Department. Loc!box of all existing wells and SSTS within 200 feet of proposed SSTS art s.,:or a;note,statina,that -none exist within 200 feet -. Titl indicating name and address of property owner; parcel tax map h: identification number; property location, including street and municipality; nam (address and phone number of Design Professional; date of drawing, i uding dates of any revisions; and scale. Loc nan d discharge points for gutter, footing; storm and curtain drains. Design criteria on plans to include number of bedrooms, soil percolation rate d deep test hole soil information, and sizes of SSTS components. Con ction notes pursuant to Appendix C. Space for Putnam County Health Department approval stamp (minimum 3" x 5" preferably at the lower right hand portion of the design plan. Wocation map (minimum scale of 1" = 2,000'). 1 � 12 Erosion control measures for house, well and SSTS. r. Nhen a pump pit is proposed due to insufficient elevatiO for gravity flow 0 or dosing purposes, the pump pit design/detai shall include, as a mini um, the following: - Ma k and model of pump to be used an operational characteristics. - One -da, 's storage past the high -level arm within the pump chamber. - Check val - Gate valve. - Unions - Operating and ala level or pump. - Means for pump remo for maintenance. - Pump curve should b su lied with the engineering report. - The pump operati range s uld be indicated on the pump curve. - Pump dose vol e to .be equal 75 percent of the volume available in the SSTS ' e network. - Minimum locity of 2 feet per secon to be provided in force main. - Baffled 'stribution box to be. utilized fo STS. Trenc etail for force main, specify pipe typ d rating, bedding and cov N ,tatin '=All eectYical work ayicc rrateriai for, rizp in t`ahlatio�t all comply with the National Electrical Code. " - Note stating, "All pump power and control wiring shall be made directly to the control panel without any outside splices. " - Note stating, "The pump control panel, disconnects and alarms shall be located inside the house. " Two (2) sets of house plans with title block as specified in 7.. k. above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality.' Upon approval of the Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only". 9. If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. I I 10. ell Permit Application, if required. (Appendix K) 11. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. _.... ............._ ;..., ...___. Transmittal of this notif cation should 'be sent w the contiguous property -owners by the Design Professional. 12. Fee - See Appendix L. B. Construction Permit Submission Requirements For Lots Requiring Fill Greater Than Two Feet in Depth 1 -6. Same as Section 4.0 A. 7. Same as Section 4.0 A., eXcept for d. d. Two separate plans will be required; the title box. for both plans must contain the statement, "Preliminary Design For Fill Placement Only' . i. Plan and Profile of Fill Section - Three (3) copies of this plan will be required showing the dimensions of the fill pad (i.e.. leng-th. width and depth. top and bottom slopes of periphery of the fill) depth gauge locations. well. septic tank. house and driveway locations. This plan shall not show the design of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. . All horizontal separation distances involving fill greater than 2 feet in depth are measured from the toe of the slope of the fill. The estimated volume of fill in cubic yards must be specified on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e... one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1).:copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. _.. _ _ -...._ .� ..... - .._ �T-hrs plani11 be relaine -for the reference. After a "Construction Permit' for the placement of fill is issued by the Department, a copy of the "Construction Permit', one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building Inspector in the respective municipality in order that a "Building Permit' may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that `the SSTS is constructed in accordance with the approved plans. If any significant departures from the approved plans are proposed because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Sarre as Section 4.0 A. 13. Fill must be stabilized in accordance with fill note #1, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: .,. - 15 . a. Results of a minimum of two (2) soil percolation tests in the stabilized fill.. b. Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on f4ate and does hereby certify that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is considered suitable for use in a subsurface sewage treatment system The soil percolation rate in the settled fill based on percolation tests after stabilization is min /inch. " SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) vears, old, regardless of whether the same or a new owner is involved. 5.0 CONSTRUCTION PERMIT RENEWALS h.; The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization 2. Construction Permit Application i. Plan and Profile of Fill Section - Three--(3) copies of this plan will be required showing the dimensions of the fill pad (i.e.. length. width and depth. top and bottom slopes of periphery of the fill) depth gauge locations, well, septic tank, house and driveway locations. This plan shall not show the design,.of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. All horizontal separation distances involving fill greater than 2 feet in depth are measured from the toe of the slope of the fill. The estimated volume of fill in cubic yards must be specified on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e., one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1), copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be la e4 on the lot conforming to all - applicable.. restrictive. distances.,. . This plan" will `be " retained for the Department's files for future reference. After a "Construction Permit" for the placement of fill is issued by the Department, a copy of the "Construction Permit ", one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building Inspector in the respective municipality in order that a "Building Permit' may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that `the SSTS is constructed in accordance with the approved plates. If any significant departures from the approved plans are proposed because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Same as Section 4.0 A. 13. Fill must be stabilized in accordance with fill note -41, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: 1 . a. Results of a minimum of two (2) soil percolation tests in the stabilized fill. b. Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on fdate and does hereby certify that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is .considered suitable for use in a subsurface sewage treatment system. The soil percolation rate in the settled fill based on percolation tests after stabilization is min /inch." SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) years old, regardless of whether the same or a new owner is involved. 5.0 CONSTRUCTION PERMIT RENEWALS The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization 2. Construction Permit Application 22 APPENDIX C CONSTRUCTION NOTES FOR SUBSURFACE SEWAGE TREATMENT SYSTEMS & WELL WAITER SUPPLIES SERVING SINGLE - FAMILY RESIDENCES The following notes shall be provided on all plans for individual SSTS and well water supplies. Ve Basi uired Notes ll trees within 1.0 feet of the proposed subsurface sewage treatment system (SSTS) shall be removed. SSTS to be inspected by the Licensed Design Professional and the Putnam County Health Department after construction and prior to backfill: 03. The SSTS area shall IN staked and ro ed off so that no trucks, machinery, building materials, nor excavated e s a e a owe' m the SSTS area. cam! 11 erosion control measures shall be installed prior to the start of any construction. Construction of SSTS to be in accordance with these plans, any revisions thereto, and the rules and regulations of the permit issuing governmental agency. The well is to be a drilled well, constructed in accordance with New York State Health Department Bulletin. entitled "Rural Water Supply ", pump tested for a minimum of 6 hours and have a minimum safe yield of 5 gpm. Yields less than 5 gpm will be immediately reported to the Putnam County Department of Health. 7. The SSTS design shown hereon does not provide for installation of a garbage grinder. Such installation requires additional design and the approval of the Putnam County Department of Health. _._P_ittn.aih County_ Health Department.dpprnvalis..bas-ed on the.10cati.orCof tije;SSTS,.wcll„building,. setbacks;_:::_: -: and driveways as shown on the approved drawing. Modifications are to have prior Putnam County Health Department approval. Unauthorized modifications made to this drawing after the date of Putnam County Health Department approval voids said approval. 9. Cut or fill is not permitted in the SSTS area, except if so specified on this plan. 10. After backfilling the system, the SSTS area shall be covered with a minimum of 6 inches of top soil, seeded, and mulched. 11. Occupancy of this structure will not be permitted until the Construction Compliance Application has been received and approved by the Putnam County Health Department and forwarded to the Building Inspector of the respective municipality as part of the Certificate of OccupancyApplication. 12. This plan is approved for sewage treatment and/or water supply only, and all other required permits and/or approvals are the responsibility of the permittee. 13. The Putnam County Health Department approval expires two (2) years from the date on the approval stamp and is required to be renewed on or before the expiration date. The approval is revocable for cause or may be amended or modified when considered necessary by the Department. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 March 18, 1998 Ken Murphy Cronic Engineering The Lindy Building 2 John Walsh Boulevard Peekskill NY 10566 Re: Wayne Staten Septic TM# 52 -1 -11 TM #52 -2 -69 (T) Carmel (T) Putnam Valley Dear Mr. Murphy: F BRUCE R. FOLEY Public "'H' Healfh' Director 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 consideration. A. Submission of "Construction Permit for Sewage Treatment System" form CP -97 required prior to approval. B. Submission of Short Form Environmental Assessment Form also required .--prior to'= approval: C. Please consult Putnam County Health Department Bulletin ST -19 Append. C "Notes ". Please use standard notes as required, additional notes may be added in addition after standard Putnam County Health Department required notes. D. Please provide note on absorption trench detail that trench to start two (2') feet from distribution box. Two (2) foot separation to be solid pipe. E. For future: Minimum scale for plan to be utilized on SSTS design shall be 1 " =30'. Please also provide location map @ 1 "= 2000'. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling ' Asst. Public Health Engineer ABS:tn CRONIN ENGINEERING PE PC The Lindy B ilding, Suite 200 2 JOHN WA H BOULEVARD NY 10566 (914) 736 3 64 FAX (914) 736 -3693 TO, Bit( Hedges Assistant Public Health Engineer Putnam County Dept. of Health Dept. of Environmental Services #4 Geneva Road Brewster, N.Y. 10509 i WE ARE SENDING YOU Attached l.l: lll:l. (1)I II. � \ti�lllll �l. -DATE JOB N. ATTENTION BILL HEDGES RE' WAYNE STATEN LOT 69, 11 SSDS PEEKSKILL HOLLOW ROAD TOWN OF PUTNAM VALLEY TOWN OF CARMEL COPIES DATE NO. DESCRIPTION 3 PLOT PLAN & SEPARATE SEWAGE DISPOSAL SYSTEM 2 HOUSE PLAN 1 CONSTRUCTION PERMIT APPLICATION 1 LETTER OF AUTHORIZATION 1 SOIL DATA SHEET 1 $300 CERTIFIED CHECK FOR APPLICATION FEE THESE ARE TRANSMITTED For approval REMARKS SIGNEDi ® J 1 A6•. � ' CAL 23.57 AC CAL. � �� '� C. c x,4, 63 '. S J 64 I st 4.44 AC. CAL 45 65 �� 43 s`4 44.E ' c 66 4 73 • ,P �� AC� U A:' CAL J ' . 67 `� ,r, ' i li 7 ' °/ 16.43 AC. 2 26 AC. CAL 6 ' 7.29 AC 42 S kp Vi, 4 p . X64 Z O! AC KCAL 3j a u 2rS " •V� ,g 17 99 AC. AC 3 42 a 40 f AC 2 ! 52 AC. CAL. s ZOOS AC. f 1 L ° CA ° 2960 AC CALF ~ 66 VCAL. C .,1 94 1i AC. CAL , EXEMPT .6e AC �oAa INIC STATE PARK C0MMISSION CAL STATE OF NEW YORK 52.20 TAX SCHEDULE ' s County Putnam Location Putnam Valley Section Block Code /Class: Lot School District: Assessed Valuation Land $ Total $ Assessed Owner Disposition RETURNS TM 52. -1 -11 LAND: $149100 TOTAL: $149100 CLASS 312 MAHOPAC SCHOOLS 1997 TOWN TAX $1191.27 PAID 1997/98 SCHOOL TAX $2878.00 OPEN S WATER - VACANT LAND ------------------------------------------------------------------ TM 52. -1 -12 LAND: 550000 TOTAL: $50000 CLASS 322 MAHOPAC SCHOOLS 997 TOWN TAX $399.49 PAID 997/98 SCHOOL TAX $954.08 OPEN ATER - VACANT LAND ' TM 52. -3 -69 LAND: $25000 TOTAL: $25000 CLASS 311 PUTNAM VALLEY SCHOOLS 1997 TOWN TAX $227.37 PAID 1997/98 SCHOOL TAX $476.03 OPEN WATER - VACANT LAND EXCEPT Water meter and sewer rental charges accruing since the date of the last reading. R -6 , PUTNAM CO "U NTY DEPARTMENT OF-. EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _APPLI CAT ION „FO OR APPROVAL . PLANS F�lI3::...:::; -:: A WASTEWATER TREATMENT STEM 1. Name and address of applicant: \,A1 ✓t ytJ c T E!') ,S Ki GHT G.OLYRT PEEKSkI LL/ ti,) 16,9_6>; 2. Name of project: S SAS 3. LocationdN,: Pu7T%AM VOI LEI! l�ogl: rACL 4. Design Professional:TlmoTyV L. gKoni)N 5. Address:-T4/E LJfJby 13Lh6; SUiTt 2.00 :2 -a-aHN wALsM S- eU6 6. Drainage Basin: PEEKS K t c. , lJ , I GS-16C 7. Tvpe 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A) O 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 1/4 12. Is this project in an area under the control of local planning, zoning, or other. ,. officials, ordirarces? ::::::.:.:..- ._ ..... _. .::.::. .........:........... ...::::.... �. _.. -. 13. If so, have plans been submitted to such authorities? ........ ............................... A)Q 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? .................... iobq 17. Waters index number (surface) ........................................... ............................... /i A- 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply tit �� Distance to water supply 20. Ist'prcject site near . a public sewage collection or treatment system? ................ /JO 21. Name of se .wage systeri. �' Distance to sewage system N[l4 22. Date test holes observed t 23. Name of Health Inspector /i 24. Project design flow.(gallons per day) ................................. ............................... Korn 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... IJ 26. Has SPDES Application been submitted to local DEC office? ......................... A) Iq Form PC -97 ' f2 27. Is any portion of this project located within a designated Town or State wetland? I`S d 28. Wetlands ID Number ........:................................................. ............................... N _ 29. Is Wetlands Permit required? .............................................. ............................... "C) Has application been made to Town or Local DEC office? ............................... Ji I �- 30. Does project require a DEC Stream Disturbance Permit? .. ............................... N b 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 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............................... ............................... /0 0 A)a M-111-1-0 i _ A)O 35. Are any sewage treatment areas in excess of 15 %slope? . ............................... 36. Tax Map ID Number -TOVk bF `�%N AY't U L�€y.. Map S'Z Block 3 Lot ,61 - MtJAJ 6 cnRr►X L. SE- % 5Z 7il-K 1 Zo? t 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-scat to the Department,- and need not be sent in duplicate to the DEP, aithough'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 project, such as stormwater,plans or the creation of t impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. F NEW Y I hereby affirm, under penalty of perjury, that information provi` t1 ANA to the best of my knowledge and belief. p'a statements ade r are pqu nis��r a Class A misdemeanor pursuant to S do 210. of a I W. Yt�h�yi� W SIGNATURES & OFFICIAL TITLES: .iv p - d e 55� �v.v[ @v� r �� , 2980 Cleo m I N 6N61,rJ CCR ) S N* Mailing Address: ................................... LINA LD C ' 2 Towd nL-r j &&Vb TrEtl.f e 1 L L- iJ , Y. 1 o c x' c PUTNAM COUNTY DEPARTMENT OFOEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -,3U S IUA L SEWAGE TREATINIENT SYSTEM Cou�T- Owner WA yn3 E S 1 A TQQ _Address }PEEKS K i L L, ,y. I pS6� Tu-wi9^ UALLEY -PAk hCTJ 6,00A -r1W -J Located at (Street) P45C4 CI L L } JO L LO ICJ *A.fl Tax Map .� Block 3 Lot 69 (indicate nearest cross street) CA7Zr" F_ L SEC: S2, It LI<' I., L o-r Municipality Tow,-1 oF CA F� L Drainage Basin PE E KS K ILL NO L L o W 13R.Od (t' SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. 0 Time Start - Stop Eta se Time (pllin.) De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch ;l 2 l z 3 _ 4 5 1 3 4 5 1 2 3 4. .. 5 NOTES: t. I Tests to'be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, � 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 . _ t. . _ _ _._._ .... -DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO HOLE NO. —raTso i (. Tod o 1 Z Lo Am W ct�.� V L0�✓h S to Ar, $F� D WITH GRQVtz �2. , HOLE NO.., _f �- S1LTV Lowr"I S ► �-t y c�r� V tar -}rh Indicate level at which groundwater is encountered NoNC CNC0y/Q Tc"2€ b Indicate level at which mottling is observed �j Iq Indicate level to which water level rises after being encountered 4 19 Deep hole observations made by: ?;+rl o TH Y L. G.lZG Q W 7:31�— Date Design Professional Name: Ti moTH ,/ L. c`z/,J +4 Address: 'THE- L)NA Y I3L,b G, S U I T6' 'ZOO N. EW W CRO WE S ILL.. . 0 M!� Signature: awD J�v Design Professional's Seal ~KOFE'SS,O�p�. 9 ' PUTNAM C OU NTY DEPARTMENT Of IALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _i _� =DE5I Iii DATA SREET SUBSURFACE SE'VVAGE TREAT'1VIENT SYSTEIVI S KiGHT CouiKT- Owner ln/A yn) 6 S i A 11= t J Address flFF KS K i L Z W. x. i dS6-c FU /JAM UDtCEYTAX D£- f {6isAt10v� Located at (Street) PEEKS KI LL 14OL to O 'RoA D Tax Map Block -15; Lot 169 (indicate nearest cross street) Municipality -ToW,,i OF CA F� M L Drainage Basin PEE KS K ILL UO L L oW 1.372. Uo K SOIL PERCOLATION TEST DATA Date of Pre- soaking 04KCH A 1923 8 Date of Percolation Test P74; C 4. 1 c�S Hole No. Run No. s Time Start - Stop Elapse Time (p11in.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate MinAnch �C) 1r`r 2 Zoe 235 g��2 vl� 2 3 2 4 3 �b 3 40 18 Z w 15 5 340 4-I3 �Z 1 149 1 I 3Z> � r 4 20 �. -3 to ... _. ' 3 4 3So 2 v 1 2 3 4. NOTES: J. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole: (i.e. s 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted;for review. 2. Depth measurements to be made from top of hole. j . Form DD -97 DEPTH,:: G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' �3 in 8.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NU. `...._'. HOLE NO. �. -Top So1L - Tot"'So1L Lo A:1' -S i t' o iq !2 WHOLE NO. .3 -To P's 0 1 L G i L:ry L o#gell Unrn Vj/ Tk or vEL LOAM rRAcES OT_ GAR -4VIE4. 9.0' - 10.0' Indicate level at which groundwater is encountered NoN£ EIJ co uN Indicate level at which mottling is observed ,u 1A Indicate level to which water level rises after being encountered N Deep hole observations made by: T! MoTnfy Z. clZoNjN _1117 Date Z 1$ 98 Design Professional Name: —F MG-r L . On1 l� �.]r NEW y� Address: —04C LJNI� y aL A G. S u I TE zoo Ted S 1 L L, J CC Signature: Design Professional's Seal L. CRo T � 2 � tr f{ i7 k LU Z 62980 V PROFESSko 14 -16-4 (2187) —Text 12 PRGJECT I.D. NUMBER 617.21. SEOR Appendix C State Environmental - Quality, Review:_..._ -- _.. E4,04ON`NI64AL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME q /Nc 1ScyJqG4E' lSP0 SfI L -S?'iE_ 3. PROJECT LOCATION: Municipality —row?� (D� C+gX/ylEl LU7- VAS€ Caunty PI) Tr.J4 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) SOUTH SIDE OF fiE�KSKI ZL �j0LZO W .l'ioigb Et9S?' S1Dt✓ p% 'TACdNI.C, STt T� 14f� y 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Co /j-r-'TP�UCTiO/� ES'1�E�.iC� �C,,Jiq��- lsPoSx� _� ys ; Erb �aI / -�b IJ1►`� LZ /4 26.2_7 AC>3E .•Piq CE-L. OF L .4,'-Jb_ 7. AMOUNT OF LAND AFFECTED: ` 96,?--) 26'27 Initially acres Ultimately acres 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? 79 . Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? AYes ❑ No If yes, list agency(s) and permlVapprovals ScWAGE' D )- 'j>o sA L � Wiq _T-Cl2 I U7?,JAM C ©. I)CPT. OF gE'q _ J�U l L'D 1^3 G "Pc g i't? 17- — 'PU 7;,.j L 1-f 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permll1approval 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 name: r— 96 6/0 AJEE�'!/J(�' ` ,E � C Me / Ji�t" T f �WZ?Hv Date: Signature: If the action Is in t e Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSE IENT (To be completed by tigency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No R- WILLACT.ION RECEIVE COORDINATED REVIEW AS °PROVIDED FOR UNLISTED ACTIONS IN.6- NYCRR, PART 617.6? If No, a negative declaration _ may be superseded by another lnvoI4e - egency. - _ -- ❑ Yes ❑ No - C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 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.-►5 "1'f9EliE, "OR 1S THERE' CfKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ' ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) 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. ❑ 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 Title of Responsible O icer Signature of Preparer (if different from responsible officer) a . 71 , t; L i:�t R Ik.�`.`t`.. r. - - -- P %0112-IS ______._______— __________ _ 60 ,, � n TG - d;r i,4 .r` 3 T5 4 T3 A 17 ° y EXDmT �'J y '\ Irza � ..4; AG. 's � 1` � gal'. ' � 55 'v ` _ Vii„ ^�• 1, a,• @. .n (/ a 244.11 AC. CAL oeR' 1 \ \,� ' C L fANNE91%1CK AQ' o4i=� 90 `��0.� STATE PAKK .3T � �;tr ,j Si= .''. 1 I 9� � A QS .$T - I 7°n 15.01 AC. ��' G��� a C -. a� .. BF�aN"`� �qY FI ;•. �: \ '"'a 11" AC. CAL. • ,a3E ' : 6E ro „Kn 40 41 42 PREL I M I NARY MAP 52 T` 100' I F� e ......�..... bMN R Y SCALE r. ? • �01�'n °" 11.63 AC. Qy o 53 �- AxN Iaq 49p y59 .� 4icu �2� /' 0.31 AC. j� '.I�x! AG , (f j Fd CAL.q Q / i Nrz . a1. noomm�_• - "'oa wrz a uv.._.tnr- & O9 r N..,•1 1 :1 n mrz nx mominm u�•mo u rm IA O23.57 AC. CAL. �. . .. -y EXEMPT ___ - _ __. .61'' ,a 1 ,''. • �- 126.16 AC. CAL. W zw cr1� CLARENCE L FAHESTOLN aru p• I_Ii�•: I` Sri ,' {? y �� ``a MDSSAAL STATE PAAN 43 .�' 66 1 73 �' K 59 x'� /1 / Al 52.66 AC. CAL y ti l i' �n 6''6a 4 4� Y .5 F0 � �/ Y �6'.. l� m 6 ,.r T'8424e 69 MACy /� ; 1, .a Fr`in,. hh 'Y�" uuw ro.'f ',r . � ..sw.+r..":: —�`" .. - . .msµ • .. 1 ' �t �i;�. � 61'>< �f a a 40 a N.nr 3B i• ~ s..i a 4G,`� u � '• . �;�, '� w. 37 0.04 AC.� 79 /.. TO 3r. /i 35 + <yy 20.75 AC. +'lam �� 4(, - w 20.00 AC. CAL kq, 71 {q ,, ;► 33 5/ 10.01 AC. v!�" ? 4'b 14.69 AC. CAL. t1T. 9.05 AC. -ti ' Y d;r i,4 .r` 3 T5 4 T3 A 17 ° t 76 .41 et� B.20 4t� li`� - T7 �. CAL' >✓A,t. X78 - ff ;4i' X31'4 30 AG �' FI ;•. ,a3E ' : 6E ro „Kn 40 41 42 PREL I M I NARY MAP 52 T` 100' I F� e ......�..... SCALE r. ? • �01�'n °" 51 53 S��f ?"' tum mlFIE10 Iopo TOWN OF PUTNAM VALLEY -. .a rp _�W` N nma mmoo r 62 63 a PUTNAM COUNTY, NEW YOPo( Nrz . a1. noomm�_• - "'oa wrz a uv.._.tnr- ' .k.T - -- rum w.m n n mrz nx mominm u�•mo u rm IA rtf; _ 59 y p�i ... Ygjr. :Jtw :�_ ... _. _ -.. .. _ ..sw.+r..":: —�`" .. - . .msµ • .. 1. :�`t:' IA