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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 53.-3-6.2 BOX 23 02654 III km I! or 1. I 1 I 1 , �� I .i ` a 'r me � �� 14 02654 Feb.14 08 02:28p BUILDING DEPT 91452GO806 P•1 FEB -14 -2808 82:57 PM HARRY W NICHOLS 914 279 4567 P.02 SRUC6 R.- FCLEY . LORD!' A MnLTNNII'RN�' M.S.N. rvoru IlrafrA 'odraer .. Mraefar� trblto /lroM' Adarar,' ' . • .... afnbror � rasanr swka .; . . DEPATMVT OF HEALTH .. 1 Aonova Reed Brewster, New York 10304 . ar4vs.nW a�tu t��u :n•ataa rl��a� a�r,>aat • . xunue e�„t�m (rigatt•ssse .wlc pi +NU•w :t _rm�riu srt•wu , ti.�'rttNi��e'�uj71F•lat� rrwa•� tra)aFt.toa i�ola :u•�t . OWNtR5 NAM. • ..r nrr�r r TAX MAP. Nx7M$M' F-911 AbbMSr _. 3. S r'•�•'�` L.a•,e_ c ' TOWN: 1t .. �.. AUXE10RIZEDTOWN OMCLkL: �. J'.f_i' LUQ -.0 DATE:.' . n The'Puthaloa Couaty Department of Health will not issue a Ceirtiticate:of ' Construction CompHent a unless the above Corm Is completed; i.e., a legal' E911 _ addres$ h asssgaed by an atithodred towta oMclaL_.7%1s totap tg.;oe aubwitted• .... :_.._.. _. ...:. �: _ _ �ir.ttb�l?'e appiic$#3on'far'a Certirttcafe of CoasMlctio'n &mptiance.. " I -I '11114,1152i CERTIFICATE OF CONSTRUCTION COMPLL4,NCE FOR SEWAGE TREATM EN PCHD CONSTRUCTION PERMIT # P 1/ 67- 03 Located at Z3 S .e i -a kJ `--� Owner/Applicant Name J�S� ll If Formerly Mailing Address Town or V� A, 41,a, --, V--a, t r 2 := , &.4f Tax Map F3, Block Lot> Z Subdivision Name IR 1 stA Subd. Lot # 2. Date Construction Permit Issued by PCHD 5 Zip /0 3-6 Seggarate Sewerage ftstena built by , , �� ti 1��� L �, Address %v:✓ti H•e, Consisting of 0C D Gallon Septic Tank and -fGQ �� ��, g M �►1 `�o� e��K� Other Requirements: Wattt SU XP ly: Public Supply From, on yi Private Supply Drilled by Address Address :Bolding Type •. I�::S -� ;� -.Has erosion control been compacted? Number of Bedrooms 3 Has garbage grinder been installed? /Vd I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatipJs of the Putnam County Department of Health. Date: -Z6 -L'Ji Certified by Address /"t a P.E. R.A. License # SCE/ 24 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 revocatign, modification orghange is necessary. V , a, &A ..... . . . . . Title: A?0 Date: ate copy - HID File; Yellow copy - BuiW.g Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights' *i- - "N-i:,Y. 10598 (914 ) 245-2800 'Padovan1 Director` LAB #: 1.801114 CLIENT #: 54783 NON.STAT PROC PAGE: 1 of 1 N N N N N N N N N N N N N N N N N N N N N N N N N -------------- ----- - m N N N N N N-- -- ---- N N N N N N N N N N N N N N N N N CAPORALS, ROSEMARIE & DATE /TIME TAKEN: 03/05/08 08 :00 15 TOWN LINE DRIVE DATE /TIME RECD: 03/05/08 10 :15 CARMEL, NY 10512 REPORT DATE: 03/06/08 PHONE: SAMPLING SITE: 33 SUFERT LANE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE Y : KITCHEN TAP PRESERVATIVES: NONE 4COL'D BY: JOHN CAPORALE TEMPERATURE—r< 4C NOTES...: COLIFORM METH: MF N N N N N N N N N N N N N N N N N N N N N ----------------- N q N'N N N N N N N N N N N N N N N N N N NNN N N N N N N N N N N N N N N N N DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/05/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 92228 COMMENTS: PICK UP COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY:- � �U In & — AV Albert H. P dovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 1.801052 CLIENT #: 60665 NON STAT PROC PAGE: 1 of 2 LANDI RESIDENCE 15 TOWN LINE DRIVE CARMEL, NY 10512 DATE /TIME TAKEN: 02/29/08 11:20 DATE /TIME RECD: 02/29/08 12:10 REPORT DATE: 03/07/08 PHONE: (914)- 941 -723.7 SAMPLING SITE: 33 SIEFERT LANE, PUTNAM VALLEY,NY SAMPLE TYPE..: POTABLE_ : KITCHEN TAP PRESERVATIVES: NONE COLD BY: JOHN CAPORALE TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 02/29/08 MF T. COLIFORM PRESNT /100 ML ABSENT SM 18 -20 9222B 03/07/08 LEAD (IMS) <1 ppb 0 -15 ppb SM 1.8 -19 3113B 03/06/08 NITRATE NITROG 0.95 MG /L 0 - 10 SM18- 20450ONO3 02/29/08 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 03/03/08 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 03/03/08 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 03/06/08 SODIUM (Na) 4.11 MG /L N/A SM 18 -20 3111B 02/29/08 pH 6.8 UNITS 6.5 -8.5 SM18 -20 4500HB 03/03/08. HARDNESS,TOTAL 70.0 MG /L N/A SM 18 -20 2340C 03/03/08 ALKALINITY (AS 44.0 MG /L N/A SM 18 -20 2320E 03/03/08 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) - 92-/2 -/0'8 E'.' �COLf' (COIVFI ABSENT 100 /ML ABSENT COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS),(WAS NOT OF A SATISFACTORY SANITARY QUALITY ACCORDING TO 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 100 of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914).,-245-28Q.0. Albert H. Padovarii, Direct o r LAB #: 1.801052 CLIENT #: 60665 NON STAT PROC PAGE: 2 of 2 ------------ -------------------- - - - - -- ---------- --------------- --- ;------ - - - - -- LANDI RESIDENCE 15 TOWN LINE DRIVE CARMEL, NY 10512 DATE /TIME TAKEN: 02/29/08 11:20 DATE /TIME RECD: 02/29/08 12:10 REPORT DATE: 03/07/08 PHONE: (914)- 941 -7237 SAMPLING SITE: 33 SIEFERT LANE, PUTNAM VALLEY,NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: JOHN CAPORALE TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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. 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 S.QURCE .AND. TREATMENT TO WHICH THE WATER HAS BEEN - -SUBJECTED. 0 7'0' MG /L'" "` i +VERY HARD WATER : ABOVE 300 MG /L 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: Albert Padovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - - - - -- - WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # 'APSM-12.` Map Block Lot(s) Well Owner: Name: Address: d Use of Well: X Residential _Public Supply Air cond /heat pump _Irrigation I - Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion ,&Compressed air percussion —Other(specify) Well Type Screened _Open end casing X Open hole in bedrock _Other Total Length .�3Eft. Materials: Steel Plastic Other Joints: Welded X Threaded Other Casing Details Length below grade t. Seal: Cement grout Bentonite Other Diameter & in. Drive shoe: _ c Yes _ No Liner: _Yes No Weight per foot lb /ft Diameter (in) Slot Size Length (ft) Dept to Screen ft Develo ped? Screen Details First I I _Yes _No Second Hours Well Yield Test _Bailed _Pumped Compressed Air Hours Yield gpm Depth Date Measure from land su ace- static specify ft) 217 1 During yield test (ft) Depth o compete we in ft. Well Log If more detailed Depth From Surface Water Bearing Well Diameter (in) Formation Description ft. ft. g' descriptions or sieve analyses 6NhAf -Aallig are available, please attach. If yield was tested at different depths Feet Gallons Per Minute Pump /Storage Tank Information t Pump S Capacity n during drilling list: Depth Model Vol tage � 3 HP_� Tank Type 2t'7�. Volume Date Well Completetl" =Well Driller "P ' Certlflcate"�# ' NY��St # ��; , e of�R rt ' MIN YA Pum Inst�ler PC Ce a i !Nell Dnll�r (dame &Addressl,� -�� 3y v?, i ri :. R 'f• a. ,.x '�' ' :' k `. s {8 V p r. m v n n ��%Tt Pumprinstal er Name &'Address / fib. `Rte, w' '✓ .'5 �(S 5, "4 ✓ RS 5. r....4aaATn.'i x ID$.'.rol' .Q.VLitY� .a•�� ., JR�'.fx ae.b,..., 4'?n" w n w. «L a.3i�_ re �.-. - A�..n, .....wxv°. Yszvn'x. ... ar 11lle�l nlle (s g ature)' X r 'it _' Y � +MR 1 �'".:�•�.'xfF41�i5 ': TV�4 "um staller(slgnature� k �% NOTE: Exact Location of well with distances to at least two permanent landmarks to be pryvided on Aeparatb4heetlplan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 Harry W. Nichols Jr., P.E. P.O. Box 252 .r ... Brewster; NY 10509' Tel (845) 855 -9275 To: PCa() Attention: At V , J 05 r� 1405 f r9 kC,,'1' 1 Gentlemen: We enclose ( � copies of OBIV Prints O Reproducibles Date: j 1 C?- 68 Job No.: Project Lct ti • l" CC"- k t 33 pv* a VA dvci O Reports O Tracings O Specifications O Memorandum O Copy of letter O Description: Revision/Date No. A- Yew. Pic h -, _.....,..... _ ..... _.M ., _. �.. Lei _� c��h� Sent Via:.. "essenger . O Blueprinter O First Class Mail D Special Delivery O Your Messenger O Hand Delivery O Copy to Very t ly yours, Harry W. Nich6fs Jr., P.E. 0•-) r- f 71 00-IC r. Ul/ kul ,EPA I% I Lo Vf \�� / VIII AktAe-- CON W/ 70, 2' OR 49 OW P=94.01 PORCH -1 el t 0 -,5,' 'S 4'0 El 5LA9 ! +:..:..: ! ALL WALK %M5 FCLNr7 E196V MAC. OVVk 16,1-15' J (F-W CJ,- CV IM 5) 22.90' TCTRL P.01 Harry W. Nichols Jr., P.E. P.O. Box 252' Brewster, NY 10509 - - _ -- — Tel'' (945)'855 -9'115 . =. March 5, 2008 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance — Landi 33 Seifert Lane Putnam Valley, NY T.M. #53. -3 -6.2 Dear Mr. l'ar� vcLt i o Enclosed are the following: 3. 4. 5. 6. 7. Five (5) prints of Drawing S -1, "As -Built SSTS ", dated 02- 28 -08. "Certificate..of, Constructio.p Compliance -- for..S_ewage;.Treatrnent- System ",, dated 02- 28 -08. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 02- 19 -08. "Laboratory Report." "Well Completion Report." Application Fee in the amount of $300.00 payable to Putnam County Health Department. "E -911 Address Verification Form ", dated 02 -14 -08 If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nich s Jr., P.E. HWN:his W54.00 PlUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION Off'- ENVIRONMENTAL HEALTH' SER,V`ICE-S GUARANTEE OF SU13SURFACE SEWAGE TREATMENT SYSTEM 3, 2. Owner or Purchaser of Building Tax Map Block. Lot Building C,(o�nstructed by LQh� Location - Street Building Type.' ft. _ TownNillage l�isl Subdivision Name 2. Subdiv'is'ion Lot # I represent that I.. am wholly and completely responsible for the location, workmanship, material, construction and "draina'ge of the sewagereatment 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 parr -of said " -s-ysterh constructed l y * 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�util zing _.- .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 the4 failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing: the systems Dated: Month Day f %' Year y "'mot, General Contra '"ROwner) = signature y . Corporatio ame (if corpbration) Signature.,..... Title " Corporation Name (if corporation) Address: �� � s: fli yj,5 -tc� y . 4 re ci Address: I S:..� ter;. L �: ;,, c la; •Z. State Eee {( % ? � �, Zip State ; "�:�° y Zip ia�,:?.�.. Form GS -97 Y U 11V Aftl U- UPI 1 X 1)11YA1&11Y1.UN 1 Ur' tt bAL 1J1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: Street Location_ 23_ 3f:1 Fj5,gT Z Al Owner f LA N p--r ..l {own •� i; F.. _ r. _ ••� ert'# . r .��.:fi;�..:�'�� 3 .. n,..,. FM # & Subdivision Lott # L. Sewage Svstem Area a. STS area located as per approved plans .......... :................ b. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course /wetlands ..................................... IL Sewage Svstem a. Septic tank size - 1,000 .......... 1, 250 ......... other ................ b. ' Septic tank installed level ................ ............................... c l OL minimum from foundation .......... ............................... d��Distribution Boy .: 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. 'renc es ,, /'' 1. Length required `0 C7 1 Length installed 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 - 11/2' diameter clean ...................; 9. Depth of gravel in trench 12" minimum....... ......,...... 10. Pipe ends capped .................... ............................... . '-Pnmo�or.�Dose &7,:yste - .-� C?i4�.:. :. .0 1� Size of -pump chainber...........1�L�U. ............ 2. Overflow tarik ............................. ............................... 3. Alarm, visual / audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box ba$ led .......................... ............................... —-6: �G�,yycle- witnessed by H.D.estimated flow /cycle.....:....., I 46H se( , unding a. douse locatedper approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. • Well 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 • Y wr `• •� •1.13 ` J,I I�M .� + = f� Cam' )0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF, ENVIRONMENTAL.IiEATLFi S.ERV .CFS,...., FIELD ACTIVITY REPORT XT A Street Town State Zip PERSON IN CHARGE 1044 z-s PUMP TEST DOSE TEST O Q REQUIRED GALLONS ! ��l,SY _ 83, _ o 17 o '� D '.0 rJ .A �. Y EL_ START EL. STOP qg I acknowledge receipt of this report: SIGNATURE; 02/96 Title; JAN 17,2008 22:34 WATTS 19142454741 page 1 BY THIS CERTIFICATE OF CwOMPLIATNCE THE C ■■ C �zf .. t...< V, f' 1 lt'.SfCL�.�t(���•_��K�������1 \� "������ ■ ��`�Y��'P'L�irY \MM ..i....r.. ..♦ 150 White Plains Road, Suite 104, Tarrytown, NY 10591 ` CERTIFIES THAT Upon the application of: Watt's In Westchester - Domenico Priore 3602 Dane Street Shrub Oak, NY 10588 %C�t11:d st. 33 Slwitestta�,P�triarc►�lalVay, �`t '105166 Application Number: 10067248 Section: 00.53 Block:3 Lot: 6.2 Upon premises owned by: Joseph Land! - 33 Seifiert Lane Putnam Valley, NY 10566 Certificate Number: 10067248 BDC: 106 Permit Number: 1059-07 A visual Inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located Inlon the premises at: 33 Seifert lane, Putnam Valley, NY 10566 Basement, Attic. was inspected in accordance with the NYS and NFPA 70.99 and the detail of the installation, as set forth below, was founded to be in compliance therewith on the 20 Day of December 2007. Name Dote Quantity Ration Circuit Type kewplacle 2 C:tmvCniCntx Switch 3 A/C _ � 7 _ »_ .,..,,,,..... ._. `1' i •lurs • l:uminaire ' ... w incandment Air Compressor Motor 2 Ctubun Monoxide Detector I Mnmr up tp Ihp 4 Septic Alarm I Well rump I Control Panel I Carton Monoxide / Smoke Detector Combo I Visually Inspected/Not'rccted by NYEIS Smoke / Dire Alarm Septic 1huup I I lip This certificate may not be altered In any way and is validated only by the presence of a raised seat at the location indicatod. This certificate is valid for work preformed before date of irtspottion only. jrnccue 113 Wednesday. January Ib, 20OR Page I of 2 2008-01 -17 21:38 19142454741 Page 1 FEB -03 -2008 12:54 PM HARRY W NICHOLS 914 279 4567 20088."161 §4" "JC LAK SM DEVELOP 845225®33 1' ='> " . Yi4 275 4569 oo :.:.oy Twig 0 RTI�I�V NEW YORK ELECTRICAL INSPEMON SERMES z 960 Old p6t ro told, Mo iK Tanis, MV W1 effiTIMIS My upot ft 90141 ': 1Sg04t'ta IPl whow o - CamoM pf m 8 kra aw 0?06 6 ®®� �#; - l9lgdlhrt l��s;'Putnan9:Va110y,_a�li+ 90t1d® u(oW pvwvl cn tlal", 0= Wifto o Mdtnlbor OWNS ftn: 00.83 stock; 3 6 ®t: EIS IM: Irk M012 mufflw . 16:3 01' A Meal hnp n of IN oloctAwl 9040 Eat• dit pr0aalleb d*WbW AG o WORMOVeM O Nut OM- elm" ft pnmino oesotf al ttytjwn oombWq of o* Mesl dowica arA MOne, dooerlbw deaf, loc€atod Infolm the pfosism at: 3$ Go brt Lane, Pwtw w+l vailey, NY 90W ftaomaK Alice. +etas lrapogtod Wl aesordance vM ft M tam IW PA 7m W 00 4MN of eke % m mvt ftm Lateen: was founded fm bw In a wpiance Oomewft an Wo 0 gay 44 t3owmbof W, Now %ft 0108411tv MAIM IIN7 I �Isma6a ��� WEPa i t4ouspla�w 9 Caa1 W1111n� t?vr�yp b �6' I hrom • I.urttintaro ! Itpart�e Air I IuerAnr "n . .A;,Cr�type,rworlvlawr. ... _.,.. '•'" :_:...`._...Y_._ . '�. � - ,. COtb,n Uftfth; (k tumor I "'W YP 1#1hP 4 IqF)n Alarm I 16'of11RtiI¢jb 1 dlnnrur Pura 1 c aftm Mrurruid4 6Imoko tvdlectutCkmubn ! bhfu61t1' McreaW,v'f:6tOdh�I,VLIS S,m,YD ViMAtflnh j �r1id 19mrr i I lip Tmo aeRd71P.E31q aaw aal ho a6 aw 9R o" m om b calls " "N wr oo rmoneo via Mwo Mal 000 wamfew W!06 %' YI 8 evaillo b valld tv MAsmftfm9 aftm Go at Irralmetlerl amv, lm= 1e lbotm, 1rke K 2189 No I -In 26M11 17 25:313 o3 tg142�549�1 :Pa a (a 1 P.02 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �. �. _ _ _t„_ : ;;_ ... _ .:,. - • Tom.: �,h ;..: LORETTA MOLI'NARI,+RN, MSN. Associate Commissioner of Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI County Executive A ROBERTtIVtORRIS, PE Director of Environmental Health February 13, 2008 Field Inspection — Landi 33 Seifert Lane, (T) Putnam Valley TM # 53 -3 -6.2 This office has received and reviewed the most recent set of plans for the above - mentioned project. We w uld like to offer the following comments for your review and consideration. 1.. The beginning and end or all expansion trenches are to be staked in the field. The stone wall is to be survey located and shown on the plans. Based on the location of the �V expansion area, it appears a portion of the stone wall needs to be removed. . The topography in the field doesn't appear to match the approved SSTS plan. Specifically, the plan shows the last expansion trench approximately 30 feet from the top of bank in the `-I'he .proposed- locatioi�_of 'the last.trench as--ribht at the top- of•bank.. , - . -.. •_ ._ 4. Y appears the house is occu ie . This is a violation of the Putnam County Sanitary Code. vioTafio nn o ice will be sent to the owners and copies will be sent to yourself and the building inspector of Putnam Valley. The grading around the well is inadequate. The grading needs to slope away from the well. 6. The requested pump test will not be scheduled until the 5 above items are addressed to the satisfaction of this Department. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP /kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SH ERLI'TA AMLER, MD, MS, FAAP Commissioner of Health ,-.. .LORE"ITA°1b1OUNARI, RN, "M;STd.... Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. R®NDI County Executive ROBERT MORRIS, PE Director of Environmental Health CERTIFIED RETURN RECEIPT REQUESTED PLEASE REFER CORRESPONDENCE TO: Joseph Landi NAME: Joseph S. Paravati, Jr. 409 South Division St. TITLE: Assistant Public Health Engineer Peekskill, NY 10566 PHONE: (845) 278 -6130 ext. 2157 DATE: February 13, 2008 OFFICIAL NOTICE OF NON - COMPLIANCE YOU ARE HEREBY NOTIFIED that non - compliance with Article III, Section 3.26 of the Putnam County Sanitary Code as stated below: No new SSTS shall be placed in operation, nor shall any new building requiring such system be occupied, until a Certificate of Construction Compliance shall have been issued by the Department indicating that such SSTS has been constructed in compliance with terms of the approval issued and the requirements of this Code. .Specifically: New house being occupied without a Construction Compliance issued by this Department. If the violation(s) is /are not corrected by March 5, 2008 an Official Notice of Hearing will be issued.' This will make you liable for additional penalties provided by law, including prosecution on a charge of committing a violation punishable by a fine or imprisonment, or both such fine _ and im rlsonm nt a r p ' _ ,..s- prescribed= b_y- jaw,_iu..addition_to sus ,h..othe. kl,.on- s rnaybe press- �ib�d4 re- inspection will be made. It is sincerely hoped that the above - mentioned further action will be necessary and that you will cooperate by securing the correction of this condition. If you believe the above notification is incorrect, please notify this office immediately. For the Commissioner of Health Very truly yours, Sherlita Amler, MD. Commissioner of Health Y• J eph S. Paravati, Jr. ssistant Public Health Engineer JSP:kly cc: 1. Sevelowitz, BI, pIVnvironmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 m P-/ M$ E my "70 e-4 Iz. IP�6 ��% ' �. tJ v v j� } 4 7x. FEB -03 -2008 12:54.PM HARRY W NICHOLS 914 279 4567 P.O1 .r-' -•• .r a .r .>... .. ....> >>< :r. , +.er.>4r.:.•.r�:..ar. ;.,...a.,.,....r, .c, .,w••-.,(. ., e.... �zfi . .s•.z. •_ r ^ - .. � w.v .. ..... r: ...t Harry W 141chol® Jr., P.R. j P.O. Box 253 Ermter, NY 10509 S� l (945) 855"9275 .t�,l Op be- F, 6 •A^'kd O-tA t t� G"e- 40 6- s..� 17� D;o�;t -70 - 7!1 I 3 a s AV, ��o: SHERLITA AMLER, MD, MS, FAAP Commissioner. of Health. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 26, 2007 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Landi 23 Seifert Lane (T)Putnam Valley, TM #53. -3 -6.2 The above reference separate sewage treatment system can be`backfilled. The following comments must be corrected in the field. J 1. Stake beginning and end of each trench in primary area prior to backfilling 2. Appears that the expansion area can not support seven trenches. Please stake beginning and ends of each trench to prove area.. _...__. � . _ ...._.. 3: Well is in a- -pit belo -w grade -and mint be -broi ght up-to-a- 1.8' -- -- above grade. 4. It appears that the location of the septic tank and pump chamber has been relocated. Please clarify. If you have any further questions, please contact me at (845)278 -6130 ext. 2155. JD:lm Sincerely, U r oseph Digit Engineering Aide Environmental Health (845) 278 -6.130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 OCT -25 -2007 10:43 AM HARRY W NICHOLS 914 279 4567 P.01 r- S.'tC�'4 .1.. .'.�. �r [ .act ¢ •' .. _.. _.. _ _ - . _..... �-r.4S?r'+�:+ -T: -.: C• Me aJ .r/n..- v.*tz - Yom. .... � .i^n.. .r [. �:-i 4 r . . . PUTNAM COUNTY DEPARTMENT OF HEALTEr DMSIDN OF ENM. ONMENTAL HEALTS SERVICES For: Fill Trenches „ s.e' PCHD Construction Permit # c5 —0 3 , Located: �. p i' �'"' �" (T) V� A, `F V. `7 IfMrAl Owner /Applicant Name: TM Block 73 Lot a Formerly: Subdivision Name: v �4va st Subdivision Lot # Zo Is system fill completed? Is system complete? Is system constructed as per plans? Is well drilled? Is well located as per plans? -.—Y &I: Are erosion control measures in place? Date: Date, 1 0 Date: 1F�� 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: 16lam'-•- d Certified by: PE RA D640rofessioad r Comments: FOR: Q ADAM GENE a� (N) Form FIR-99 G PUTNAM COUNTY DEPARTMENT OF HEALTH G ►IVISION OF ENVIRONMENTAL HEALTH SERVIC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT it P V — O Located at 7,?3 St✓ i Pe, r LA vt Subdivision name l%L�j Su Ljkajpff Subd. Lot # Date Subdivision Approved VaN -L c a a Owner /Applicant Name Mailing Address . 461 50a+( V i v l s-i ol, S Amount of Fee Enclosed SUd Town or Village at-4at..." a G Tax Map 5- 3, Block 3_ Lot 6 � Z. Renewal L,' Revision Date of Previous Approval /0,1. 0 zip �s Building Type Lot Areas 3.37 No. of Bedrooms -4 Design Flow GPD 6'6Q Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12.5 "C gallon septic tank and -16 C Z _� Other Requirements: To be constructed by 7_8 6 Address Water Supply: Public Supply From Address .. nor:..... ..- Privafie Slipply-Drilled by...:. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date -f— 23 —0'7 License # 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 for diwjlalge of domestic sanitary sewage only. By: — Title: A,4/k�' Date: �, e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type CI Dm "Ir'7T 1 Well Location Street Address: Town/Village: Tax Map # f 235-.&J L wic l�G �"�a�+, A41`e MapS3, Block3 Lot(s) 4P .Z Well Owner: Name: `� Address: Sf- Phone #: ���I��D 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 Fj D gpm # People Servedfllg_ Est. of Daily usage 04 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin New Supply inew dwelling ) Deepen Existing Well Detailed Reason e-t� PiL►c for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes —No v" Is well located in a realty subdivision ? ............... ......................... ............................... Yes �No Name of subdivision i, j s� ����,�ts. o� Lot No. 2�- Water Well Contractor: '7-8 0 Address: Is Public Water Supply available on site .......... ............................... Yes No Name of Public Water Supply: Al Town/Village — Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate shee Ian - _. _.O _ .� .-.:. Applicant Signature:.=.- . .,, 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. 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 Commissioner of Health. 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 a y 0 ;� Permit lssuin Official: Date of Expiratio Q Title: , t� Permit is Non -Trans a able White copy - HD file; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 April 24, 2007 Harry W. Nichols Jr., P.E. ' P.O. Box 252 Brewster, NY 10509 (843).855- 9275:'' 0 Putnam County Health Department One Geneva Road Brewster, New York 10509 Att: Michael J. Budzinski, P.E. Director of Engineering i Re: SSTS Renewal - Risi - Lot # 2 23 Seifert Lane Town of Putnam Valley Mr. Joseph Landi Dear Mr. Budzinski: Enclosed are the following: 1. Five (5) prints of SS -4, "Proposed SSTS ", revised 4/23/07. . 2. "Construction Permit for Sewage Disposal. System", dated 05/23/07. _ _......_. 3. " K'Well Permit Applica6on "; "dated7(Y5 14%03 - • _....... .- ..:.__.._....__ __.. ._.... .__...__.__..........__ 4. Review Fee in the amount of $500.00. We would appreciate your review, approval and issuance of the construction Permit at your earliest convenience. Very truly yours, Harry W. Ni is Jr., P.E. HWN:gav 03- 028.02 I PUTNAM COUNTY DEPARTMENT OIF HEALTH DffVRSIION OIF ENWRONMENTAL IHIEAL'II'IHI SERWC)ES APPLICATION TO CONSTRUCT A WATER WELL Please print '& type` YC "HD'permlt # Y r Wen Location: Street Address: Town/Village Tax Grid # 2.71 SE1fT_JZT k.AOT- ?051JAK VALIT-1 Map 53. Block 3 Lot(s) 6.2 Wen Owner: Name: Address: ZOSS -91 d LAofli J104 P.rf-t(SytLL O y 105K(, Use of Wen: >(_ Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm . Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield. Sought 5- gpm # People Served C _ Est. of Daily Usage 806 gal. Reason for Replace Existing Supply Test/Observation Additional Supply llDrifling. New Supply (new dwelling) Deepen Existing Well IlDetaiRed Reason for IID>rifling Wen Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes " : No _ Name of subdivision (45 S,36A t J i st o 6 Lot No. Z Water Well Contractor: Twt�. Address: Is Public Water Supply available to site? ................... ............................... ............... Yes No. Name of Public Water Supply: Town/Village Distance to property from nearest water main: �-- Proposed well location & sources of contamination o be provided on separate s et/ lan. 48.. Date:. = - F� -U Applicant Signature: V 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. Date of Issue 71410-3. Permit Issuing Official: L , Date of Expiration �— Title: ; i Permit is Non- T>ransffefta White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 sm, � i A � J ' PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, _ BE432qOOMS 7-1 /Ll, ' -3 -- 3 ALL SUBSEQUENT PEVISIONJALTERATIONS-TO THESE MOUSE PLA MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL � w r` ,VIC, 5I NAI RE & TITLE n s T>r 44'9" VTH UJ3 0 DINING ROOM rKITCH EN "" MORNING ROOM 12'10" X 12'11" 10'3" X 12'11" 12'9" X 12'11" .. -- - - -... 27'6" LIVING ROOM 17'4" X 12'11" FAMILY ROOM FOYER 14'2" X 12'11" ,7,6. 44'0" O ' BATH BEDROOM 4 BATH BEDROOM 3 1 O 10'0'X 9'6' O 2 10 .. , , .. BEDROOM 2 14'11" X 13'0" OPEN TO FOYER BELOW The Manchester Plan No. 544 ■ 2420 SQ. FT. Large rooms provide more than adequate space in this four bedroom home featuring open foyer, .first floor laundry area, formal living and dining room's and master bedroom suite with private bath. BEDROOM 1 1 »'2' X 16'6" 14.163 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C ate-- .-! .., , � ..., .. , . SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJE T NAME -Xvsz " i,Aa�`fl� c. o 3. PROJECT LOCATION: Municipality 1-00'3 ov 90V._0AtA JXULS11 County foc 4. PRECISE LOCATION (Street address and road Intersectlons, prominent landmarks, etc., or provide map) SO,3 Siam oV S%r, firi:ttt i`Ai3 e "1 So 'P gz�- 1�2s5' off' PzzelsV u 14otico .' 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �42vQa3F� S�e��Lt ��w.�t� --I R�.�:1�eJCg Wt�� tN "Ji'vi'AJAI. SS�L'S at;�rc�.. • t f��� � t �,� at 'ate � i.L�� �..� ALL 7. AMOUNT OF LAND AFFECTED: Initially S-335 Ac • acres Ultimately S • 3 aq A C • acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR -OTHER EXISTING LAND USE RESTRICTIONS? CR Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: ._ .:.. -.:., ,....({.= :3- •..l.�e�3 ��o:3S� ��• = �'z'S11az•a�e�— '��s'i�.ic�.: .... _ :..:.. _� . _ .. ._,.a -,.:. _...._ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? to Yes ❑ No If yes, list agency(s) and permit/approvals }} Co. N7_BL-�(n 2�+ Si�JA7Ci QJi O�vA�- `r x!s o ?4. SOTVL7 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list name and permlUapproval ppagency Cg¢ti�'ic�� Ot -1w9Cr– 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PER/MIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes RNo. I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 2 Signature:— L/ v If the action is in the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with. this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate'the review process and use the FULL EAF. ❑ Yes MO B WI L; A. CT.* bI.REEEIVEGOORDINATED.REVIEW-AS PROVIDED;�.O,R UNtr tS7 .fD:ACTIOPS,IN.6.tttY�G'RR,:pART 617.6 ?... ,- If No,.a negative declaration may be supersede by another Involved agency. ❑ Yes supersede C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: / V/a" C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: A 17 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: NO 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. A/10 /Llf- C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. Al., C6. Long team,, short term, cumulative, or other effects not identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ONO --E-IS sTMERE;,ORI&THERE::LIKELY_TO BE,- CONTROVERSY ilELATEQ_TO POTENTIAL ADVERSE.-ENVIRONME- WAL,IMPACTS?_— _... - - - O es Dlo 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 bet 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 support! ng'materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary., the reasons supporting this determination: L DP J� � risible Officer in Agency Tit e o Responsible Ofticer O ficer, in L06Agency. Signature of Preparer (If differe nt from responsible of icer) a�l� Date 2 ,_: 0 ,-Harry W. Nict, Jr. RE JOB No A - .029 jiaft6ri�on Pirk; Suite 1-06- SHEET No. .3 2050 Route 22 ------ _'.; Brewster, NY 10509 COMPUTED BY bAtat-c 279-4003, Fax 279-4567 C'ONSUTI ING -SITE�tNftEt CHECKED BY""' "--"DATE"'-" ............... 1ISTR I R u TI 6 &L 430X -- 565. 60. P liA 2 chAmBER 86IMP—M ELEV, -3 .7,51 grAT Lj- Ab ic 4 4A p 1,pp- I-FAIE-r-a- -rTI/VC-57,.l, -EQImIALEN P I ma as, r a -5 bi Pi 6:.. 04 CHF-4XI LAj__ k re. 64Tr= . vAi- va q0 0;,46 7 . rcj A Q_ UJ. Z A L__ CE a x _. p) Z&O 4 .-T 0-.Um p 45. F, x 3.6 Lj F,": ss- :sin-4p 4 Erm -o rZia .... .. ....... TD H -------- 7- 7.20 = 31; 45 F TI. V A4 41 .".k- . . ..................... Harry W. Md. .s Jr., P.E. JOB No. ,3 Patterson Park, Suite 106 2050 Route 22 SHEET No. 2 'OF Z Brewster, Wlo8bb COMPUTED BY p M DATE 05 ' i r % '. 4 u, L(j 3885 FEATURES 1. Impeller 2. Casing 3. Mechanical 7– 4. Shaft 5. Motor 6. Bearings — Upper & Lower 7. Power Cable 8. 0 -Ring 0 k no �gm g'� P F1 Kill re-Im Ul - -r Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 'Breiniste �,`NY'1 X09 Telephone (845) 279 -4003 Fax (845) 279 -4567 July 25, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 Ait: Mr. Joseph S. Paravati, Jr. Assistant Public Health Engineer Re: Individual SSTS - Landi 23 Seifert Lane Putnam Valley, NY Dear Mr. Paravati: In response to the numbered paragraphs in your July 22, 2003 review letter, we note the following: 1. Reference to curtain drain removed. 2. Reference to dosing siphon revised to Pump Chamber. 3. Pump Chamber is shown after the septic tank in the profile, which runs 4. Pump Chamber Calculations revised to account for wall thickness. 5. Pump curve shows Model WE0512H. Reference to 1/3 h.p. Model deleted. 6. SSTS has been noted on the plan "to be staked by licensed surveyor ". Reflecting the above, enclosed are the following: 1. Five (5) prints of SS -1 "Proposed SSTS ", revised 07/25/03. 2. "Construction Permit ", revised 07/25/03. 3. Pump Selection and Dosing Calculations, revised 07/25/03. Kindly process this application at your earliest convenience. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:gav 03- 028.00 . ,LORE TT-A = =MOL- NAR-I -R.N.; -M:S:.V: - - Acting Public Health Director Director of Patient Services July 22, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: ROBERT J. -BONDI County Executive Re: Proposed SSTS — Landi 23 Seifert Lane, (T) Putnam Valley TM# 53- 3 -6.2, Lot # 2 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. Curtain drain is listed in the other requirements .section on the permit, but the design shows new curtain drain and none appears to be needed. Please verify. -The .;dos- ing_.sjphon.shamhei eds chamber'. 3. The pump chamber is not drawn in the right spot in the profile. 4. The calculations for the ump chamber levels did not take into account the thickness of the pump chamber walls. r 3 c¢ 5. It doesn't appear the WE0311M model can handle the total dynamic head. Please clarify. 3 6. It is recommended that the end of laterals positions be staked to ensure 10' minimum '44 "Vr or P,�P k separation distance. 1L �, This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. C l,, a.( T k I- h� JSP:cj Very ruly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer ..PUTNAM COUNTY.DEPARTMENT ORREALT.H. DIVISION-OF.-ENVIRONMENTAL-HEALTH,.SEIIV-ICES`."'.�-`-: APPLICATION FOR APPROVAL OF PLANS FOR 'A -ER,T T -T S? CST T-REA .ME. STE EMU 1. Name and address of 4pplicant: Xo5;Zeo Vk,0Jb%: .,409 S, 'bWlStop .0c ?xw04sV_%LL .0 t056K 2. Name of project: Z, ssss 3. Location TN:. U XLL's 4. -Design Professional: AAV.Q_-J 0. 14t ct%okS 12-?Z5. • Address: lose .2•Z- 6% -Drainage Basin: R 0 0 7. Type of Project: '.. Private/Residential Food Service Comm6tcial Apartiffents Institutional Mobile, Home-Plark... Office Building -Realty Subdivision Other (spppify) 8. Is this project subject to State Environmental Quality a-lity Review (SEQR)? Type .Status (check-one) ........................................................... Type I Exempt Type II:' - -Urilisted.; Y, 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... 10. Has DEIS been completed and found acceptable by Lead Agency? N. A- I l... Name of Lead Agency - Toa tj Q�JO'SIJAK JAIAT:J ..12. Js this pT!Djpct in an area under the -control of local planning, zoning, .or other . . ......... ........................................ officials, ordinances?-.-.,.,.... ............ ...... ............ 13. If so, have plans.' been submitted to such authorities? ......................................... 14. Hds*'p'reliminar'y approval been-granted by such authorities? 00 Date granted: N 4- _-15. Type of Sewage Treatment- System Discharge...;; ............. surface water x" groundwater 16. If surface water discharge,-what is the stream class designation? ............... N A 17. Waters index number (surface) ....................................................................... .40A, 1.8. .. Js project located near a public water supply system? .......................................... 19, If yes, name of water supply nJ A Distance *to WaMr supply ':� 'N A .2.0; Is ,project site near a p6b& sewage collection or treatment system? -1--. Name of sewage system - - N A Distance: to __sewage system* C 22. Date test-holes-observed' io- ic- oo 23. Name of Health Inspector A. STE t. zti A4 24. Proj.ect'desigrf 'flow (gallons.per day) ................................................................ 25. Is State Pollutant Discharge Elimination System (SPDES) Permit.reqqired?.-... tj 0 26. Has SPDES Application been submitted to local DEC office? .......................... P A Form PC-97 --' 2 -:.1 %, r,.. e�-.n: , ': ::::`e;.a ::.+:xr`::rp•:•� •- .- -.sr :e .. '::.. ..< =s,: .:.• - •. - w ......,.r Is any portion: of this proj•eQt. located within a designated Town or State wetland? - N© -- 28. Wetlands.ID. Numb. er ............... ......... . ...................................................................... 29. •Is Wetlands Permit required? ......... . .......................... . ................................. Has application been made to Town or Local DEC office? ......; ........................ Al A 30. Does project require a DEC Stream Disturbance- Termit? .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous.waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 0o 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 N0 DESCRIBE: 33. Is there a local master plan on .file with the Town or Village? .......................... Y rs 34. , Are community water and/or sewer facilities.planned to be developed :within 15 years in or adjacent to project site 35. Are any sewage treatment areas in excess of 15.% slope? . ..........................:.... 00 - -36- Tax ap l;U Number ...... ::....:::. Map ...-. n .. M .Y ........ .... .5 . a .. 37. Approved plans are to be returned to ..... Applicant ___ _Design Professional VOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall he.sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the'SS•TS prior to finalapproval by the Department. Projects withia..the watershed may also — require DEP review and approval, of other aspects of a project, such as stormwater. plan. s._or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for-review and approval. If the application is signed by a person other than the applicant shown-in Itern l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this. provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as -- a Class A misdemeanor pursuant to Section 210.45 of the Pend Law. A A n SICIVA'TURES -& OFFICIAL TITLES: 9_9 , _ L jLULL Mailing Address 0-y %0509 HEALTH PUTNAWC014 .DEPARTMENT F. DIVISION OF ENVIRONMENTAL HEALTH -SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ZOSS9" LA O'l, I Address'z-a LhaaZ 'ev"50MM 4ALLT Located at (Street) fix�k, LL. - VAo\.LotS 4�• 'ta'x Map.. s.3. ,.,.Bl6ck 3 L*6-F• 5-'Z--- (indicate nearest cross street) Municipality _'5'0'ja• A ?o Awt--'Q-Pk-LLj4 Watershed .4 ,39-50o:, V-Ldr-e SOIL, PERCOLATION TEST DATA Date of Pre-soaking i o. z-3, ots Date of-Percolation Test t -2-4.00 3 2,14 1 ik R .2- 214S -3.02. V7- a .3- -a.o3 - 3ZD V7 I Ci 3 4 5 2 3' 5 NOTES: 1. Te61616 bbrop6ited'at tame depth until, approximately equal percolation rates are obtained at each percolation test hole. (i;e; :5 I min for 1-30 inin/inch, :5 2 min for 31-60 min/inch) A.11 -data to bi7' submitted for review. 2.' Depth measurements to be made from -top.of hole. Form DD-97 .... ... .... 4 4-1 15 5 -0 --2 116 a4.-..2-2 Yj S-3 3 o zr 2t 14 20 3 2,14 1 ik R .2- 214S -3.02. V7- a .3- -a.o3 - 3ZD V7 I Ci 3 4 5 2 3' 5 NOTES: 1. Te61616 bbrop6ited'at tame depth until, approximately equal percolation rates are obtained at each percolation test hole. (i;e; :5 I min for 1-30 inin/inch, :5 2 min for 31-60 min/inch) A.11 -data to bi7' submitted for review. 2.' Depth measurements to be made from -top.of hole. Form DD-97 TEST. PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED, IN TEST HOLIES. . i i ;DEi= i i ii I i 3L 0::. _... -. �.._ OL]E AiO: Z .. HOLE NO. ...a..._ e�. ..... G.L. -- 0.5' 1.0' s n� 1.5' 2.0' s K 2.5 e 3.0' 3.5' 4.0' _. 4.5' saga 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which; groundwater 'is encountered Indicate level at which mottling is observed tip o%, Indicate level to which water level rises after being. encountered Deep hole observations made by: A. Q1,% s a L, o4 Datej o r o Design Professional Name: c_kaoi.S Address: 20go ao,) ; .2.Z �g 0 ss-f tz t3 I. doh ®-9 Signature: t, fj, j Design Professional's Seal NEW.. y ©9 MICH04 4- Q U, r , W: No.56124 ©00�OxESS1�P/ ... -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH -SERVICES. <r:::' LETTER OF AUTHORIZATION.* RE: Property of J_0S-CJ2 Located at La -,,P- TX Tax Map # 5 3, Block 3 _Lot Subdivision of A, R � s La kL-t ic,, C�n Subdivision Lot # Z- Filed Map # 21SFf 9 Date Filed.._. Vii. o 1- /200 Gentlemen: This letter is to authorize l l_a 10, , - a duly licensed Professional Engineer _for Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above- noted-property in.accordarice with the standards, rules or regulations as promulgated by the Public )health Director of.the ?uffia.m1' County Health Department, and to sign all necessary papers on my behalf in connection :withAhis matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions. of Article 145 and/or 147 of the Education_ Laws- -the Public Health, LaWj and. the-Putnam County- Sanitary Code: -Countersigne P.E., R.A., # Mailing Address L 0 5 o Qo oSf 2Z otlt.� lop-K. State . p -i i� JotZ It. * Zip 10 5 09 Telephone: 1-1 cj,-- ti 00 3 - Very truly ,yours, Signed: `t wncr of roperty) Mailing Address: 1 / •'r�:.. ^y,:.�:: iii. `GYJ ^I L I ......_�� '��i .a Zvi a f.9. +i•... State %l Zip; Telephone: q 14 3-f .. ;Z-34--g Form LA -97 e . ............ Harr y W. Nichols Jr., P.E. JOB No. 03- 026 Patterson Par• Suite 1-06 SHEET No. OF 2050 Route 22 Brewster, NY 10509 COMPUTED BY DATE '05' :,;:.14 - (&45) 279-4003, Fax 2794567 '7' �--CHECKED BY DATE --i— `CONSULTING ENGINEERS - " -FT777 I S�TAMC I:iEAD I 1) iS-rki au T16 &L -00)(-j9vik.T.- PUMP Cli-AhIRER 86 IMP —M—C-L-EV, -n c k- -_ C. 6-A- T 11-2- ap AA RRIc-rio&I I- oSs- , X 3. - ----------- -.-7,20 . .......... Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22... Brewster, NY 10509 . ($9� 279 -4003, Fax 279 -4567 CONS ULTING.- SETE•ENGINEERS- JOB No. o3 ` o2b SHEET No. 2. .'OF 'Z COMPUTED BY ri DATE 105-14-03 DATE: ,. DasIAIG- j1Q1_QA4 E ! 67SIa d le 5Y57 -814 I O Lo -- - - -- 0 L, F 50,2 log ? 1=h ._ R x 719 -' ---- G vM c� iZr nee-' Icon -- A.. 3„ p, ��V' - E00 -----...---- —F—�i � -��F� -- •� —_ - - -- --- - --�-- 5- .1 -- _— _._..- --- — --- c 11 - r- - �z - - - -- dk io'� x - �_ .. _ ...... -2 - 25 O 20 J H O F 15 10 5 0 0 10 20 ' 30 40 45 50 60 70 80 90 100 110 120 GPM I L I I 0 10 20 30 m'/h CAPACITY G ®UL ®S PUMPS, INC. SBNECA FALLS NEW YOPK 13148 METERS FEET 1 120 MODFL 3885 ■■■■■■■■■■■■■■■■■■ 110 100 30 90 25 ■■ 80 . 11 Zoe 70 = 20 F 60 O 15 40 10 30 20 5 10 0 0 0 10 20 ' 30 40 45 50 60 70 80 90 100 110 120 GPM I L I I 0 10 20 30 m'/h CAPACITY G ®UL ®S PUMPS, INC. SBNECA FALLS NEW YOPK 13148 METERS FEET 1 120 MODFL 3885 A 10 20 30 40 50 60 70 80. 90 100 110 120 GPM I L I I 0 10 20 30 MI/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 35 110 100 30 90 25 80 70 = 20 F 60 O 15 40 10 30 20 5 10 0 0 A 10 20 30 40 50 60 70 80. 90 100 110 120 GPM I L I I 0 10 20 30 MI/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 i FEATURES 1. Impeller.. 2. Casing 3. Mechanical .Seal w_ . 4. Shaft 5. Motor 6. Bearings — Upper & Lower 7. Power Cable . 8. 0 -Ring r l t < r r }Y y }Phase Max fi� M r Solids .RP t,, ,..(Lb 1750x1 f h Trt'� r . - .•.. .. i..t _ s i, SENECA, FALLS' NE( r t t i 0 M Goulds Submers9bet Pumps r r.; PERFORMANCEtRATIIdGSr ?In gallons per minute s z"N ' s WE0511 HN Series't? WE0512H WE0712H WE1012H WE1512H WE0512HH WE15121HH ' No i WE0311W,E031IM WE0532H: WE0732H WWEE10342H, WE152H WE0532HH WE03L WE0312M W 3704N WE1534H WEOS34HH WE1534HR 1'Sh�'1.rs liP',�' +l a1F7� ¢j`'.w� jL Jk L:'+;t�t R ti� 4t r,7 t N'k� y t�'J� /sy , /i �,r /ii 1 �� h1) �} r, w 5 ` >100 70 80 90r 106 114 60 10ti� ,111 .� ._. r _; ,, a 4". xM ;203 :�36 78�..9`i+ L,. _..4..77+ ? y x' 100. 42 + t68 50 67 $4 j 96 39 72 i T i' 35 a 40 61 i r �f 99 '.. 1,9 1 34 53 ' y`, s�!`" t 50� ° 7 X30 qtr 54; ul m72 18 r t 6u t i q63 fi r,;x12r� t c 60` �6' iJ 28 t e� 10"s� Y�Z} 75 a SmF A pr 1 w1 .e_,:•v 33 l 1,110 + f f F� t 1203-i . k� HE j �i t s x VD I MEN S1 ONS NMI y { 'r - �, ;•'.. y 1 t'h�"Rtl F, "t SC't dC TI ' ..(All dimenswns munches) (Do not use for construction purpos }es) f `• t f_� t•t t i W 21/2"` A 1itr5' ��i 1 u )1 u Y1 'i r ' rwT}�7 ,47v 'lip i .z'fe'w ^�� s t r •� aJ116 yR� a } 1 &'� >•t t y. a tom., 4 44T,zyy �y1 i't�j Y1pi'1,Wgy,, tT 1�hvv , < rapt X1,1 ` ZL �r- ih ` c n s } o �xx i itti1 a�tLp:.u.R�{"E 7at�r'"eka•� 3tla ' w '4�1''• `. =.t ee }r Ye l e � 1,�>r� 1 rI �t� N r # a ✓r { �' ,F v. 'fa and 1 HP 15' excepttfor model WE0712H &.WE1012H ` 16 ; 1thHP -18 ; ,. Available Certifications Sp Canadian Stand ards'Absocie4lon•' Pennsylvariia Bureau of Ailines for non =face applications . BOTE FICATIONS'A,RE SUBJECT TO CHANGEiWITHOUT,,NOTICE:' PF INTED�IN:'U.S:0''y } t r l t < r r }Y y }Phase Max fi� M r Solids .RP t,, ,..(Lb 1750x1 f h Trt'� r . - .•.. .. i..t _ s i, SENECA, FALLS' NE( r t t i 0 M Goulds Submers9bet Pumps r r.; PERFORMANCEtRATIIdGSr ?In gallons per minute s z"N ' s WE0511 HN Series't? WE0512H WE0712H WE1012H WE1512H WE0512HH WE15121HH ' No i WE0311W,E031IM WE0532H: WE0732H WWEE10342H, WE152H WE0532HH WE03L WE0312M W 3704N WE1534H WEOS34HH WE1534HR 1'Sh�'1.rs liP',�' +l a1F7� ¢j`'.w� jL Jk L:'+;t�t R ti� 4t r,7 t N'k� y t�'J� /sy , /i �,r /ii 1 �� h1) �} r, w 5 ` >100 70 80 90r 106 114 60 10ti� ,111 .� ._. r _; ,, a 4". xM ;203 :�36 78�..9`i+ L,. _..4..77+ ? y x' 100. 42 + t68 50 67 $4 j 96 39 72 i T i' 35 a 40 61 i r �f 99 '.. 1,9 1 34 53 ' y`, s�!`" t 50� ° 7 X30 qtr 54; ul m72 18 r t 6u t i q63 fi r,;x12r� t c 60` �6' iJ 28 t e� 10"s� Y�Z} 75 a SmF A pr 1 w1 .e_,:•v 33 l 1,110 + f f F� t 1203-i . k� HE j �i t s x VD I MEN S1 ONS NMI y { 'r - �, ;•'.. y 1 t'h�"Rtl F, "t SC't dC TI ' ..(All dimenswns munches) (Do not use for construction purpos }es) f `• t f_� t•t t i W 21/2"` A 1itr5' ��i 1 u )1 u Y1 'i r ' rwT}�7 ,47v 'lip i .z'fe'w ^�� s t r •� aJ116 yR� a } 1 &'� >•t t y. a tom., 4 44T,zyy �y1 i't�j Y1pi'1,Wgy,, tT 1�hvv , < rapt X1,1 ` ZL �r- ih ` c n s } o �xx i itti1 a�tLp:.u.R�{"E 7at�r'"eka•� 3tla ' w '4�1''• `. =.t ee }r Ye l e � 1,�>r� 1 rI �t� N r # a ✓r { �' ,F v. 'fa and 1 HP 15' excepttfor model WE0712H &.WE1012H ` 16 ; 1thHP -18 ; ,. Available Certifications Sp Canadian Stand ards'Absocie4lon•' Pennsylvariia Bureau of Ailines for non =face applications . BOTE FICATIONS'A,RE SUBJECT TO CHANGEiWITHOUT,,NOTICE:' PF INTED�IN:'U.S:0''y Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY_.10509 -- ... = - — = - ...Te iliorie (845) 279 -4003' Fax (845) 279 -4567 May 14, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 Aft: Robert Morris, P.E. Senior Public Health Engineer Re: Individual SSTS - Risi -Lot # 2 23 Seifert Lan e Town of Putnam Valley Dear Mr. Morns: Enclosed are the following: 1. Five (5) prints of SS -4, "Proposed SSTS ", dated 05/13/03. 2. "Short EAF ", dated 025/14/03. 3. "Application for Approval of Plans for a Wastewater Disposal System." : :..« Ctinstrlieti6r�-P'e ;:rr: }t- forsevs age- Disposal-Syste:,' -, dated 05/.14/03:. .._..._. _.....�..�. _..._ ..........._ 5. "Well Permit Application ", dated 05/14/03. 6. "Design Data Sheet." 7. "Letter of Authorization." 8. Two (2) copies of Residence Floor Plan (s), for "Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the construction Permit at your earliest convenience. 2 1A Very truly yours, Harry W. Nich s Jr., P.E. HWN:gav 03- 028.02 Vk co ®R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIVNS TRIJC'I'ION- PERMIT FOR° SEWAOE,TR EA-TMElo T SYSTEM PERMIT # i Located at S -.1 Town or Village Aulft.4'a—L V"-"// Subdivision name _Risi' S'vJ,, A&3 Subd. Lot # 2— Tax Map 'In . Block °3 Lot Date Subdivision Approved Main, Z[j p 2— jj � Owner /Applicant Name � z .a K Mailing Address ➢V�SiD ='1 S'�. Renewal Revision Date of Previous Approval Zip �v sly Amount of Fee Enclosed ;Z64 Building Type y- e- " Lot Area 43; 3'lNo. of Bedrooms __f Design Flow GPD 8(:e Fill Section Only' Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 17.,S'D gallon septic tank and Other Requirements: To be constructed by 3:8 p Address Water Supply: Public Supply From Address or: P-rivaw Supply Drilled.:by.. "% J? 1) Address: ...___..._.. _...._..._.w .__........ _...._ ._. _...__...._.__._._.... u _.. 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 s, sY tem described above will be constructed as shown on the approved amendment thereto and in accorddhce with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof,a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date q- 1-f -p'3 License # 11 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 pe it. Approved for discharge of domestic sanitary sewage only. By: Title: c ' Date: elqb3 Wh a copy' HD File; Yellow copy - Bui ding Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 JN Y PUTNAM COUNTY DEPARTMENT OF HEALTH � �ti -4cNT DIVISION OF ENVIRONMENTAL HEALTH SERVICES t ; WELL COMPLETION REPORT € Pii 4 0 Location Street Address: Town /Village: Tax Map AA0W1 A &.4 V Map Block Lot(s) IOwner: (Name: Andress: Use of Well: X Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test /monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion ACom pressed air percussion _Other(specify) Well Type Screened _Open end casing 2!� Open hole in bedrock _Other Total Length ft. Materials: X.Steel Plastic Other Casing Details Length below grade -;fit. Joints: Welded X Threaded Other Diameter & in. Seal: Cement grout Bentonite . Other Weight per foot lb/ft Drive shoe: )c Yes _ No I Liner: _Yes No Diameter (in) I Slot Size Length (ft) IDeptto Screen (ft) Developed? Screen Details First Second Well Yield Test _Bailed _Pumped_ Compressed Air Hours Depth Date easure from land surface - static (specify ft During yu 917 / Well Log Depth From Surface Well [ If more detailed ft. information Land Surface ..descriptions or.- ..- .::.... sieve analyses are available, please attach. If yield was tested Feet at different depths during drilling list: ft. Water Gallons Per Minute Yiel _Yes _No Formation Description -. / I.I. A. .. -. . �S7 Pump /Storage Tank Information Pump ) S Capacity Depth f Model Voltage Q 3 0 HP_� Tank Tvpe )( 7 fW1_ Volume _A/ NOTE: Exact Location of well with distances to at least two permanent landmarks to be pryvided on a'separatb-�heet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 QC //,? PV ti� 8C o SOLID PVC SDR-35 R b ry ALC 0 01C LAN � /47,b4v PUTNAM COUNTY DEPARTMENT OF lib QlwslpNWFEIIIAONMENFALilEALTliI ooil APPROVED AS NOTED fO CONFORMAt Ar,'LICABLE RULES AND REGULATIONS Milr►lAft. DIMENSION CHART' (in f6ef) Number 1 f9.00 80;00' 2 -9, +00 3 113,00 178.00 Ai 12).00 185,00 5 11 . a - OP 180,00 CO 11-4,00 175-.00 7 H1.00 171.00 a ) 0,T), 00 167, o0 9 1 06.00 ((03,00 105-00 159'.00 II 17700- 23-4.00 12 .17,1.00' 7-30,00 13 172,00 226,00 1-4 169,00 223.00 15 167..00 S-), 00 I r0s.00 2 1 G,00 O 0 0, kg 0 E T. ELL L 17 169,00 13,00 (n�'��DRIVEV • R P- 08