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HomeMy WebLinkAbout2713DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -26 BOX 23 02713 . , . ;AV 61., I N ti fill' .. ..I :;, 6. 6 T. 6 r- .. . Li. VIE V .� , r n off No or 02713 Al PUTNAM COUNTY DEPARTMENT OF HEA f- ' CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT S PCHD CONSTRUCTION PERMIT # N - -�> -Q 0 Located at 95 "L416 OWN) Owner /Applicant Name Formerly Town or Village (:,) qrA-mAm gltcLc` -1 i-14W VL- Tax Map &L Block 2 Lot Z& 'C-01�b4 Subdivision Name oA Mailing Address 5 J 1 L A&rF— &*7E—W Subd. Lot # Date Construction Permit Issued by PCHD 0' I t O I ou uh Zip Separate Sewerage System built by C-t Oki '1 J,1JL Address 1J\4 Consisting of ',COO Gallon Septic Tank and `3-77y L+ C;F- Z4 ' w i OZ- Other Requirements: Water Supply: Public Supply From Address, or: Private Supply Drilled by ?&0 P ARigSi:Mj \1419LLCd Address PT. 52Z, Ckn�, hk� z 13L11Ul11g iypG Number of Bedrooms 3 • 'iias GZvsioa VviltrGl blilill CGiTiyliteCl: Has garbage grinder been installed? "0 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 regulations of : e Pu am County Department of Health. Date: Certified by . �` P.E. _)�_ R.A. Design Professional)�ZS ®rj Address ZA<V `4 `• i-a SZAJ� P.L. 6 SUML;C, /Cf�ICp License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. eRHF. — Date: —1 (9 � Lo:z e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 w Jai - i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES n WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # Map � Block Z Lots) �6 GPS r; r Well Owner: Name: ,ez Address: Use of Well: I - Primary 2- Secondary _Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion XCompressed air percussion Other(specify) Well Type _Screened _Open end casing -X( Open hole in bedrock _Other Casing Details Total Length _21 ft. Length below grade,Dft. Diameter in. Weight per foot lb /ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite Other Drive shoe: _ CV Yes _ No Liner: _Yes No Screen Details Diameter in Slot Size Length ft Dept to Screen ft Developed? First fir`.;.: _Yes _No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours Yield gpm Depth Date Measure from Ian surface- static (specify S6 During yield test () X14 Dept o compete we . m 5 30 Well Log If more detailed 4infCrrratir•,ri, - . _ . �. I� descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. anri $ivrara - ( _ u.l. , �J.� i .%. , /V ,( -3 vw m. 14L E ii If yield was tested at different depths during drilling list: Feet Gallons PeFMinute Pum /St ra a Tan4jqfP&at i ( Pump Tye apacity PU Depth ® Model 0 % Voltage Va'� HP l e Tank Type Volume C V Datewen Cornpleted 1Nell Dr(Iler PC Certificate# ©� NYState #� PumpIristallec3PC ,Certificate# NYkState #� Dateof ep 'rt' z' �'x Well =Driller Name 8r Address�/� �, II signature) X I r tr Pump.I stall r Name ress r 3 kr P nst r( ature) , x °<?iyi. Y !'w,.< ...,i. ... ,. .F W<.... ,k}:.ew ,,..., x, ✓tsa S n NOTE: Exact Location of well with dista es to at leas ermanent landr>1'ar o b vide o a se — ate'shPet/ Ian. White copy: HD File; Yellow copy - Building Inspe tor; Pink copy - Owner; Orange copy - ell driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH _ .�V DJVJSiON OF. FNVJR ONI_\4FNTAL EALT. CFS . . ___. _r_....... GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Frank Kolarek Owner or Purchaser of Building Jack Grace, Inc. Building Constructed by 95 South Highland Road Location- Street Residential 61. 2 26 Tax Map Block Lot (T) Putnam Valley TownNillage n/a Subdivision Name Building Type Subdivision Lot # n/a 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 The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: o 41 Day 7 Year 07 General tontractor (Owner) - Signature Jack Grace, Inc. Corporation Name (if corporation) Address: 50 Woodland Drive Garrison Signature: Title: "i"S. t� � Corporation Name (if corporation) Address: State NY Zip 10524 State Zip Form GS -97 CO R T T�'F R T ��'..'f,�, . .: , . . :. L'NP tT fA �i'i ? I �': �-RT R. ,' : `... T :. Public Health Director yce`�y Yo�� Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014. Preschool (845) 278 -6082 Fax (845) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Frank Kolarek TAX MAP NUMBER: 61.-2-26 E911 ADDRESS: 95 South Highland Road TOWN: (4) Putnam Valley AUTHORIZED TOWN OFFICIAL: (Signature) DATE: I '-�- I 'l I Q The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verfrm) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -28.00 _ .�'- e':,,�•:ra.. - .:.�, r.. ._ , . *<... �.., w .�..- ;- IyI'be'�- �H�. '`�au� van; ,._llYrector.. �..�_.-... ,.. ..�,.-:...,....�::- ,�,..:�:,.�Y <w _.,� .._ LAB #: 1.706524 CLIENT #: 60518 STAT PROC PAGE: 1 of 2 KOLAREK, FRANK JR. 95 SOUTH HIGHLAND RD GARRISON, NY 10524 DATE /TIME TAKEN:- 11/28/07 03:15 DATE /TIME RECD: 11/28/07 04:00 REPORT DATE: 12/04/07 PHONE: (914)- 420 -5712 SAMPLING SITE: 95 SOUTH HIGHLAND RD, GARRISON, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY :.DORIS JEAN VELEZ TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 11/28/07 MF T. COLIFORM 12/03/07 LEAD (IMS) 12/03/07 NITRATE NITROG 11/28/07 NITRITE NITROG 11/30/07 IRON (Fe) 11/30/07 MANGANESE (Mn) 11/30/07 SODIUM (Na) 11/28/07 pH 12/03/07 HARDNESS,TOTAL 12/03/07 ALKALINITY (AS 11/30/07 TURBIDITY (TUR RESULT NORMAL - RANGE METHOD ABSENT /100 ML ABSENT SM 18 -20 9222B <1 ppb 0 -15 ppb SM 18 -19 3113B 0.83 MG /L 0 - 10 SM18- 20450ONO3 <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 0.019 MG /L 0 -0.3 mg /l SM 18 -20 3111B 17.1 MG /L N/A SM 18 -20 3111B 7.1 UNITS 6.5 -8.5 SM18 -20 4500HB 170 MG /L N/A SM 18 -20 2340C 118 MG /L N/A SM 18 -20 2320B <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: FAX TO 369 -5242 COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS), WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 100 of their than 15 ppb and a treatment must be potential. ublic 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. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 LAB #: 1.706524 CLIENT #: 60518 STAT PROC PAGE: 2 of 2 KOLAREK, FRANK JR. 95 SOUTH HIGHLAND RD GARRISON, NY 10524 DATE/TIME TAKEN: 11/28/07 03:15 DATE/TIME REC'D: 11/28/07 04:00 REPORT DATE: 12/04/07 PHONE: (914)-420-5712 SAMPLING SITE: 95 SOUTH HIGHLAND RD, GARRISON, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY-: DORIS JEAN VELEZ TEMPERATURE..: < 4C NOTES-...: COLIFORM METH: MF ---------------------------- --------------------------------------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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. 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 ,--.',D.O,r-P',uJ.-EX-T.32,EE,S!Pi..AS .:CAL(-'IU.M;.GARBO1\TA-TE -.IN--..M-.-/'T-- ii E HA�tZD1tTESS MP,Y RANGE' F120M 0~ TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (I grain/gallon = 17.2 MG/L) SUBMITTED BY: Albert H. Pado7 ani, M.T.(ASCP Director ELAP# 10323 _.,.__BADE.Y & WATSON . LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 04 Dec 2007 TO: (Joseph S. Paravati, Jr. lAssistant Public Health Engineer Putnam County Department of Health 1 Genvea -Road , Brewster, NY 10509 We are sending: copies date description of document File No. 74-122 W. O. # 18870 RE: Certificate of Construction Compliance Kolarek South Highland Road Subd. Lot No. Tax Map 61.-2-26 Permit/Tide/PO # Sent via: US MAIL El UPS-NIGHT El MESSENGER 9 UPS-2 DAY El PICK-UP 71 UPS-3 DAY E] FAX 104-Dee-07 7 UPS-GRND F-31 107-Nov-07 ::1. IGuarantee of Subsurface Sewa ge Treatment System UPS-COD 04-_b;o-07 1 Fl 104-Dec-07 7 jApplication Fee - $300.00 17 74 104-Dec-07 71 lConstruction Permit for Sewage Treatment System 71 104-Dec-07 E911 Address Verification Form 71 128-Nov-07 Well Water Test Results, two (2) pages F-31 104-Dee-07 7 Well Completion Report F-31 107-Nov-07 ::1. IGuarantee of Subsurface Sewa ge Treatment System 'F41 04-_b;o-07 1 ISSTS"Ai-Buile'(SM96t_k0l) El I I E_ 7 1 711 REMARKS: Copies to: File Yours truly: Jason R. Snyder Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: isnyder@badey-watson.com 40 40-05 509314 622634 34142 SHERLI'TA AIMLER, MD, MS, I:AAP Commissioner of Health .... vr. -•.__- _�..^_— ._..�`•`:r:.:y.`:' a:_== :..�a.o yaw. LORE'T'TA MOLINARI, RN, IMSN ~ V Associate Commissioner of Health December 4, 2007 Neil Seidl Badey & Watson 3063 Route 9 Cold Spring, NY 10516 Dear Mr. Seidl: -_a •G� .+ - - — ROBERT J. BONDS _ - k sl• County Executive y- u..: ^^V:i.a '-.,„ -.. - - ? dr.. s.. :�..—w.r.n ..- .•...�. •1:a:aeYy era` `v.'v ��/�►� Yom ROBERT (MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Kolarek South highland Road (T) Putnam Valley, TM # 61 -2 -26 The inspection of the well and expansion area was performed today and the results were satisfactory. There are no further concerns or comments at this time. Upon submission of the construction compliance it will be reviewed. If you have any further questions, please contact me at (845) 278 -6130. JD:kly F1 0�t Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 DEC-03-2007 15:12 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH 0 GENE X I Digit UK07 ,��gjILNU Doha ....1.213/2007 F—cr FM I rumer. P. 02/02 PCHD CmUucdon Permit # PV-3-90 ....South Highland Road (T) Putnam Valley — Own&AppUcantNm=: --. Frank Kofarek IM 61 Block 2 ....Lot 26 Sutton Cunningham SubdivisionNmm: n/a Subdivision Lot # 4, system B conVieted? Yes... Data Is *%b= cwTlete? Yes Data Is system consftuMdas per plans? Yes. Yes Dab-- Is well located as per pLins? n/a 2/1712006 111512007 121312007 I certify that the *sbwn(s), as hAA at the above pmwics has been mwnxW and I Dave inspected and verified their cornpleftm M' accordar= wide the issued PL-10 Corn�sb don Permit and approved plaw andft Standards, Rides and R&guh&m offhe Pumn County DqmrtrrieM of He*t �. _ , ... .. _ --- -- 121312007... CaffiedW. FE X RA =0 �= � Addm. Bacley & Watson, P.C. 3063 Route 9, Cold Spring, NY Ija# 062505 CarnialtS: Mr. Digit we would like to request an inspection of the well, a finale walk through, and a subsequent inspection of the expansion area. SHERL.I'TA AML.ER, MD, MS, I:AAP Commissioner of Health !L ORE'TTA MOL.INARI, RN, MSN Associate Commissioner of Health November 7, 2007 Badey & Watson 3063 Route 9 Cold Spring, NY 10516 Attn: Jason To Whom It May Concern: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 R®BER'T J. B ®NDI County Fxecutive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Kolarek South Highland Road (T) Putnam Valley, T.M. # 61 -2 -26 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. v11. A well inspection still needs to be performed. Call when ready. 2. A bedroom count was also done today. L If you have any further questions, please contact me at (845) 278 -6130 ext. 2155 JD:ens Sinc ely, eph Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 NOV -05 -200? 15:09 BADEY & WATSON, PC Uv1 l z P.01i01 PUTNAM COUNTY DEPARTMENT OF HEALTH ISMS via �g DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH GENE J. Digit REQUEST FOR FINAL - INSPECTION For: Fill Date: 11/5/2406 _ Trenches __.._..... %� PCHD Construction Permit # - .... Pv-" —O _ Located: South Highland Road (T) (V) (T) Putnam Valley Owner /Applicant Name: Frank Kolarek _ TM. 61...... Block ,,,_2 Lot. 26 Formerly: Sutton Cunningham Subdivision Name: _ _ n/a Subdivision Lot # ___... n/a Is system fill completed? Yes ._..... Date: 2/17/2006 Is system complete? .__ Yes Date: _ 11/5/9007 Is system constructed as per plans? _ ...... Yes._ Is well drilled? _.. No Date: n/a Is well located as per plans? _�a Are erosion control measures in place? __...Y 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: _._._ 11152007 Certified by: PE X RA Design Professional Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY Lic. # 062505 Comments: There is some building/construction material in the expansion area that needs to be removed. Meanwhile, we would like to have the trenches inspected so they can be backiilled. Please call this office to schedule and appointment. Form FIR -99 /1 7/0 7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES MAL SITE INSPECTION Date: I l(b7/07 Inspected by: ILIWA-ft 1-5, A/,.- .I **, -11�%-, 1,4 A/_D_ )� atic C7. Town' Permit 4 py — 3 — 70 TM# Subdivision Lot 4 N�A 1. Sewage a. STS a b. Fill st 3:11 c. Natw d. Stone e, 100' f IL SewaLe a. S eptii b. 'Septi( c. 10' M d. Distr T A 2. Pj 3. .. Iv e. Jun( 6. Tr—er. 1. D 2. Distai 3. In 4. Sl 5. 1( 6. ' D 7. k, 8. Si 9. D 10- P: I. S. 2. 0 3. A 4. P 5. * F 6. C DI House/] a. H= b. Nurr IV. W ell Well locates b. Dist, c. Casio d. Surf V. Overall a. Box b. All c. Al d. Back e. Curl f curl g. Foo, h. Surf i. Ero: 2 PUTNAM COUNTY DEPARTMENT OF HEALT DIVISION OF ENVIRONMENTAL HEALTH SERVICES' CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # N -3 -' qO Located at t)�n� \' kQgL4.14 %?040 Town or Village NY- 114A-M \JACLE, -( Subdivision name a4 Subd. Lot # "4 Date Subdivision Approved Owner /Applicant Name '1FjWV- L/4fZbC Tax Map CSC e Block 2 Lot 2(-0 Renewal Revision y- Date of Previous Approval OS 10 toLp Mailing Address 5 VILLAC F— C•flj-F— WA 4 , N`A0(, 9\1 Zip 40,1400 Amount of Fee Enclosed ffl 250 a Building Type 45%0&1 i IA's. Lot Area 7 Ar- No. of Bedrooms 3 Design Flow GPD &OL-�' Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of t) CX)O gallon septic tank and Other Requirements: t - O" MI" (W �3 Flu—( To be constructed by %A-0L L-a c-4`'�J ` b0i"!5 Address CAA 5WJMCT, K0 1051Lft Water Supply: Public Supply From Address P�J ►Z�d. G i98- 115__ _......._.. _ .. ._ �.,5�7lNyC V�li�7C Ei" l:d ` t° 4 .... - or: � Private Supply Dulled by t�ddress - , _ ' �" 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 COLD 5?1?j (T R.A. Date License # oCZ505 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 discharge of domestic sanitary sewage only. By Title: Date: e Uteopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 k1'Iiim^ sih"A"711 _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type i�Q Perm ' R mom• - Well Location Street Address: Town/Village: Tax Map # uGlAr 4 (1) PJ �E--( Map (ot- Block 2 Lots) 2(B Well Owner: Name: Address: Phone #: ��` 5 �iI[11 �Caly w/�`l � ls` O�C41 l�l 10 0 5,4 104:5 3 Use of Well: )Residential _Public Supply Air /cond /heat pump _Irrigation I - Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served_ Est. of Daily usage 5cO gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ''o ?9-04%OC 'Ib A- �J&J Z�,S Oft for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes — No Is well located in a realty subdivision? ........................................... ............................... Yes _ No x Name of subdivision AA Lot No. 94 Water Well Contractor: k1PQ.M4d.( --,b)J Address: PJiA"'vl 4 Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: IjA' Town/Village 9.M° Distance to property from nearest water main: > M. Proposed well location & sources of contamination to be provided on so par sh t/plan. 6'C w� T G,.' C�4J �. 14'.►e.. '. __. -.a _ ca:�� � Date. i 1: r' - .�al�iy.�a6 ..,, 9 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 Departmel 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 ® -7 Permit Issuing Official:` Date of Expiration h1l laq Title: Permit is Non- Transf ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 4 ' � t TOWN OF PUTNAM VALLEY - T0HN_M,, _Z.4RCONF., _ _. . rn . . v . n ..... . N _ rl :- -.. --y r a. u.. TRQKAS PATTXRSQN \_•f' ._.. - ..\ . n .. . _ _ .. i . n Chairman ........ PLANNING BOARD _ i Secretary . MICHAEL J. RAIMONDI 265 Oscawana Lake Road RICHARD TULLY Vice Chairman Putnam Valley, NY 10579 -2004 EUGENE T. YETTER, JR. THE CHAZEN COMPANIES JOSEPH C. BECERRA Town Planner (845)526 -3740; Fax: (845)526 -3307 (Adhoc) INSITE ENGINEERING E -mail r)lann1n?(@,[)utnamvalley.com LAURA L. LUSSIER Town Engineer Clerk November 14, 2005 CUNNINGHAM, F. SUTTON SITE DEVELOPMENT PLAN WETLANDS PERMIT MAJOR GRADING PERMIT NEGATIVE DECLARATION OF SIGNIFICANCE SOUTH HIGHLAND ROAD TM: 61.-2-26 FILE: 61./1204/954 & 61./1005/1001 WHEREAS, the applicant is proposing a single-family residence on 6.9 ( + /-) acres of land located on South Highland Road in the Conservation (CD) Zoning District; and WHEREAS, prior to the Planning Board's review of this application, a significant amount of trees had been removed and a retaining wall associated with the septic system fill was installed; and ... . WHFRRHA.,S; the Zoning. Board of Appeals granted a sir.eline and a frontline variance on August .. _ -11, 2005; .. . .. _.. _ ,. .. _ WHEREAS, in accordance with §165-16 of the Zoning Code, a Site Development Plan is required; and WHEREAS, in accordance with Chapter 144 of the Town Code, a wetlands permit is required for buffer disturbance associated with the installation of drainage features, the installation of the sanitary sewage treatment system, retaining walls, grading and the removal of rock in the Town right-of-way; and WHEREAS, the Planning Board is requiring the applicant to remove rock outcrop from the Town right-of-way to meet sight distance requiremegs; and WHEREAS, the applicant's engineer, Badey and Watson Surveying and Engineering, P.C., has certified that the existing retaining wall associated with the septic system fill meets or exceeds design requirements to, resist lateral sliding and overturning; and Page 1 of 4 WHEREAS, the Code Enforcement Officer has determined that a Major Grading Permit is required; and WHEREAS, the Putnam County Department of Health issued a permit for the sanitary sewage treatment system on April 8, 2005; and WHEREAS, the Planning Board has determined that no security is required under §165-16C(3) of the Zoning Code; and WHEREAS, the proposed action has been determined to be an Unlisted Action, pursuant to the New York State Environmental Quality Review Act (SEQRA) 6 NYCRR Part 617.4; and WHEREAS, the applicant has submitted Parts 1 and 2 of the Full EAF, last revised October 19, 2005 and no potentially large impacts have been identified; and WHEREAS, the Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c) and determined that the proposed action will not have a significant adverse impact on the environment; and WHEREAS, the Planning Board has considered all reasonably related long-term, short-term, direct, indirect, and cumulative environmental effects associated with the proposed action including other simultaneous or subsequent actions. NOW THEREFORE BE IT RESOLVED THAT, on motion by Thomas Patterson, seconded by Richard Tully and carried, the public hearing for the Site Development Plan, Major Grading Permit and Wetlands Permit is hereby closed; and BE IT FURTHER RESOLVED THAT, on motion by Thomas Patterson, seconded by Richard - _. . . -�..; :.. s _t o, 'iZn . . -. S.,br, izic -a: ` i •,8 i,nr �� I sue ' `a n'� - _... _ �:x.ed; rhb uttu, r.d ..�g.��.�. :,, . sc.sitiC s .. _i: . c� _ o �...� BE IT FURTHER RESOLVED THAT, on motion by Thomas Patterson, seconded by Richard Tully and carried, the Putnam Valley Planning Board hereby approves the Site Development Plan prepared by Badey & Watson Surveying and Engineering P.C., last revised October 21, 2005, subject to the below listed conditions; and BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid for a period of 18 months after said Plan has been signed by the Chairman, Vice Chairman, or Secretary and may be extended once, at the request of the applicant, by the Planning Board for a period not to exceed six months; and BE IT FURTHER RESOLVED THAT, on motion by Thomas Patterson, seconded by Richard Tully and carried, the Putnam Valley Planning Board hereby issues a Wetlands Permit subject to the signing of the Site Development Plan. The Wetlands Permit shall be valid for a maximum period of three years from the signing of the Site Development Plan. All work associated with the Wetlands Permit shall be conducted in strict compliance with the Site Development Plan and shall be completed within six months following the initiation of construction; and Page 2 of 4 BE IT FURTHER RESOLVED THAT, in accordance with Chapter 144, the Planning Board, Wetlands Inspector and/or Code Enforcement Officer shall have the right to inspect the project from tnae to tiTne; and... BE IT FURTHER RESOLVED THAT, the Wetlands Permit shall automatically expire upon completion of work; and BE IT FURTHER RESOLVED THAT, on motion by Thomas Patterson, seconded by ' Richard Tully. and carried, the Putnam Valley Planning Board hereby issues a Major Grading Permit, subject to the signing of the Site Development Plan by the Chairman, Vice-Chairman or Secretary. All work associated with the Major Grading Permit shall be conducted in strict compliance with the Site Development Plan and shall be completed within six months of the signing of the Site Development Plan; and BE IT FURTHER RESOLVED THAT, the below listed conditions must be completed within 6 months of the date of this resolution. Should the below listed conditions not be completed within the allotted time frame, this resolution shall become , null and void unless an extension is requested by the applicant in writing within said 6 month period and granted by the Planning Board: 1. Submission of all applicable fees and escrow. 2. Construction escrow in the amount $1,000 shall be submitted to the Planning Board. 3. The applicant shall address any outstanding comments provided by the Town Planner, Town Engineer, or Town Wetlands Inspector. 4. The EAF shall be signed by the Planning Board Chairman. 5. At least two business days prior to the commencement of the work, the applicant shall apply to the Code Enforcement Officer for a permit to commence work, pursuant to Chapter 155, Soil Erosion and Sedimentation Control, of the Code of the Town of Putnam 6. This wetlands permit shall be prominently displayed at the project site during construction. 7. Prior to the issuance of a Building Permit, a pre-construction meeting shall be held with the applicant, contractor, Building Department, Highway Department, Wetlands Inspector, and Town Engineer. 8. Prior to the issuance of a Certificate of Occupancy, the Building Department shall confirm with'the Planning Board Clerk that all applicable fees and escrow have been paid in full. 9. In an effort to ensure compliance with the approved Plan, monthly site visits shall be conducted with the applicant, contractor, Building Department, Highway Department, Wetlands Inspector, and Town Engineer and a final site inspection shall be conducted prior to the issuance of a Certificate of Occupancy. 10. An as-built survey demonstrating compliance with the approved Site Development Plan shall be submitted to the Planning Board, Town Engineer, Town Planner, and Code Enforcement Officer prior to the issuance of a Certificate of Occupancy. 11. Final design drawings and calculations, signed and sealed by a Professional Engineer, of the retaining walls shall be submitted for review and approval by the Town Engineer. 12. Prior to the issuance of a Certificate of Occupancy, the design engineer shall submit an as- built report certifying that the walls were built in accordance with the approved design. Page 3 of 4 13. Eight original copies of the Site Development Plan, signed by a Licensed Professional Engineer and the owner of the property, shall be submitted for signature. Prior. ' I- to the a T'ow Planner addressing resolution conformance shall be submitted to the Planning Board. 14. Any other conditions that may be required by the Town of Putnam Valley Planning Board, Building Department, Highway Department, and any other department of the Town of Putnam Valley. Yea John M. Zarcone, Jr., Chairman x Michael J. Raimondi, Jr., Vice Chairman Thomas Patterson, Secretary x Nay Abstention Absent M. M Page 4 of 4 BADE, & .. WATSON - LETTER q( TRANSMITTAL x Surveying & Engineering, P.C. 3063 Route 9, :Cold Spring, New York 10516 Date: 16 Jan 2007 file No. 74 -122 W.O. # WA RE: Proposed SSTS - Renewal Kolarek TO South Highland Road Joseph S. �Paravati, Jr. Assistant Publk- Realth Engineer Putnam County Department of Health 1 Geneva Road: Brewster; NV10509 v 0 M Em NM o` =� o: description of document Subsurface Sewage Treatment S stem SD16017 R09 xc: Town of Putnam Valley Planning Board Resolution R Copies to File. Yours truly: Jason R. Snyder, Assistant Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey - watson.com 40 40-05 509314 622634 31850 Subd. Lot No. Tax Map 61. -2-26 Permitfritle/PO # Sent via: US MAIL ❑ UPS -NIGHT El MESSENGER 1:1 UPS-2-DAY PICK -UP ❑ UPS -3 DAY El FAX UPS -GRND UPS -COD description of document Subsurface Sewage Treatment S stem SD16017 R09 xc: Town of Putnam Valley Planning Board Resolution R Copies to File. Yours truly: Jason R. Snyder, Assistant Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey - watson.com 40 40-05 509314 622634 31850 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jason Snyder Badey & Watson 3063 Route 9 Cold Spring, NY 10516 Dear Mr. Snyder: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 16, 2007 ROBERT J. BONDI County Executive it ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Revision K.olarek, South Highland Rd. (T)Putnam Valley, TM #61. -2 -26 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. en neer.is _to sign, the. fill certification note. -- - _ Picase provide a copy- of a vaiiii wetia'nus Permic' from the i own of runan Valley. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at (845)278 -6130 ext. 2157 if any questions arise. Very truly yours JSP:Im Joseph S. Paravati, Jr. Asst. 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 P , DEC -20 -2006 09:35 BADEY & WATSON, PC P.02i02 PUTNAM COUNTY DEPARTMENT OF HEALTH 7T �v� rT r� T1 r� 7; T T, �, tt ENT-Al �1` !' j'Y'1W'Y' 4 � i': Y rI :/'1S ) 'IV is LC. iJ'i` -�LUi I v t�'vi�iv L , t��Al: i` i sLP:�% �i"' LETTER OF AUTHORIZATION RE: Property of Located at T/V . (T) Putnam Valley,.._ Tax.Map # Subdivision of ........__ Subdivision Lot # Gentlemen: Frank Kolarek South highland Road 61 - -_ Block 2 Lot 26 n/A n/a Filed Map # n/A Date Filed _. -_ . _ Via_- .- .... ­ This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer -�/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as; pr9mulgated..by..the ?ublic Health Director of the Putnam County Health Department, and to sign all neeessaty'papers-on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health T .:;.Ur; ��d thy; Putnam County Sapitary rode. , Countersigned: ` P.E., M # 062505 Mailing Address Badey & Watson, P.C. 3063 Route 9 Cold Spring State New York Telephone: Zip _ 10516 845- 265.9217 Very truly yours, Signed: (Owner of Property) 141t-Z Mailing Address: 5 Village Gate Way Nyack State NY Telephone:. .. (845) 353 -9045 t!.... I A Ay TOTAL .- 02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ����gi✓� i YG� "E't��° A�'F�i�i �Al� "Gr `��Ai�1�' � U�I�' A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Frank Kolarek 2. Name of project: " Kolarek" 4. Design Professional: John P. Delano, P.E. 6. Drainage Basin: Hudson River 5 Village Gate Way Nyack, NY 10960 3. Location: TN: (T) Putnam Valley 5. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 7. Type of Project: Private/Residential __ Food Service _ Commercial _ Apartments Institutional _._ Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? ----------- Yes/No No Type Status (check one)--------------------------------- - - -- -- Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? Yes/No No --------- - - - - -- 10. Has DEIS been completed and found acceptable by Lead Agency? Yes/No n/a 11. Name of Lead Agency Town of Putnam Valley Planning Board 12. Is this.-proiect ip-aQ area. under _the control of local ,planning, zoning, or, other �, ....- _: -- Yes/No Yes "Yes. _ . :...... -... --------------------------------------------------- 13. If so, have plans been submitted to such authorities? Yes/No ------------------------ 14. Has preliminary approval been granted by such authorities? n/a Date granted: Yes 11/14/2005 15. Type of Sewage Treatment System Discharge ----------------- _: surface water �/ groundwater 16. If surface water discharge, what is the stream class designation? n/a ---------------------- 17. Waters index number (surface) n/a --------------------------------------------------- 18. Is project located near a public water supply system? Yes/No No ----------------- - - - - -- — 19. If yes, name of water supply n/a Distance to water supply 20. Is project site near a public sewage collection or treatment system? Yes/No 21. Name of sewage system n/a Distance to sewage system 22. Date test holes observed 10/31/2003 23. Name of Health Inspector _ 24. Project design flow (gallons per day) n/a No n/a Joe Paravati 600 25. Is State Pollutant Discharge Ellmmatlon System (SPDES) Permit required? Yes/No 26. Has SPDES Application been submitted to local DEC office? Yes/No No n/a Form PC -97 Page 1 of 2 27. Is any portion of this project located within a designated Town or State wetland?---- Yes/No Yes 28. Wetlands ID Number n/a Is Has application been made to Town or Local DEC office? Yes/No Yes 30. Does project require a DEC Stream Disturbance Permit? Yes/No No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal,landfilling, sludge application or industrial activity? ______ ______ ______ _____ ________ __ _ ___ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? --------------------- Yes/No Yes 34. Are community water and/or sewer facilities planned to be developed within 15 ears in or adjacent to project site? _ _ _ _ _ - _ _ _ _ _ _ Yes/No No Y J P J � 35. Are any sewage treatment areas in excess of 15% slope? Yes/No Yes 36. Tax Map ID Number Ma p 61 Block 2 Lot 26 -------------------------- - - -- -- 37. Approved plans are to be returned to ------------------ ____ Applicant ®/ Design Professional ' 1voy All -ap�.r ication's ior'rcvicw aria appr -4,al vi a new " TJ t�'bC 1ocatcd'wi u i the- Y� *,A-, ��r�'rCd shah - be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or.the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1., 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 Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: Eadey & Watson, Surveying and Engineering, P.C. 3063 Route 9, Cold Spring, NY 10516 Form PC -97 Page 2 of 2 PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ' ._ :NAii i�l = •• "isH'OJEi�T�N�t�l�i liJ�7 "il�N'. '" ( "�'obe completed 6y Applicant orProjecti5ponsorj... „. -. _ ,m, ..., . __,.. � w.r,.... , - . 1.APPLICANT /SPONSOR 2. PROJECT NAME . Frank Kolarek " Kolarek" 3. PROJECT LOCATION: Municipality (T) Putnam Valley County Putnam 4. PRECISE LOCATION: Street Address and Road Intersections, Prominent landmarks etc -or provide map South Highland Road (see map provided) 5. IS PROPOSED ACTION ® New ❑ Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: Separate sewage treatment facility to service new single family dwelling with private water supply. 7. AMOUNT OF LAND AFFECTED: Initially < 2 acres Ultimately < 2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ® Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ® Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park / Forest / Open Space ❑ Other (describe) Residential housing on 2+ acre lots. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ® Yes ❑ No If yes, list agency name and permit / approval: Town of Putnam Valley Building, Driveway, Wetlands, and Major Grading Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permit / approval: Town of Putnam Valley Driveway, Wetlands, and Major Grading Permit 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑ Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N me John P. Delano; P.E: .. . Date: 12/20/2006 Signature — —�— �"�• —/ — — `Design,Professional for applicant 4/ If the action is a Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? ': �r.�•aK:�I..�iw._v -Ar Y' _-sue -'.> r- t_w.w...a. r.. .wra -r� -W Sa `s- .;.. y...�_ .aa r. ..... a .._.. �0.�1: .1 _ 7�'. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,�PART 617.6? If No, a negative declaration may be superseded by another involved agency. El Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: �D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA)? (If yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of 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 F-1 WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency 1a Title of Responsible Officer Signature of Responsible Officer in Lead A�� Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner Frank Kolarek Address 5 Village Gate Way, Nyack, NY 10960 Located at (Street) South Highland Road Tax Map 61- Block 2 Lot 26 (indicate nearest cross street) Municipality (T) Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre-soaking 11/03/03 Date of Percolation Test 11/04/03 Hole No. Run No. Time Start Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch C 1 9:27 9:39 12 19 22 3 4 C 2 9:40 9:58 18 19 22 3 6 C 3 9:59 10:22 23 19 22 3 8 C 4 10:23 10:58 35 19 22 3 12 C 5 11:01 11:38 37 19 22 3 12 D 1 9:28 9:46 18 19 22 3 6 _X D 3 10:14 10:49 35 19 22 3 12 D 4 10:51 11:28 37 19 22 3 12 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < I niu­ n., for 1-30 miAn h <, I ml for 3 60 in/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ,.�,..w'I���'�.1:.._.....>�.:� �fll�L�iv�i:•- ..:.��..,.�._�;,� .. rl�i:i�'v0��.:,;.�.. ... --._�, �- . -...�� _...�Is>�v.� _r ..... .. .K -- =��• G.L. 2" Topsoil 2" Topsoil 0.5' Dark to Light Brown Dark to Light Brown 1.0' Silty Loam w/ Large Silty Loans w/ Large 1.5' Stones & Cobbles Stones & Cobbles 2.0' I 2.5' 3.0' I 3.5' 4.0' 4.5' 5.0' 5.5' I 6.0' V V 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Not ]Encountered Indicate level at which mottling is observed bone Observed Indicate level to which water level rises after being encountered n/a Deep hole observations made by: JRS - Badey & Watson, P.C.; J.1Paravati - PCDD Date 10/31/2003 Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, _ u Ed gineering, P.C. 3063 Itoutaoldi :0516 ,. Signature: Form DD -97 (Pg. 2 of 2) tea+ is Sea° PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES swgkf SUkklmclgvw y rift S rpm Owner Frank Kolarek Address 5 Village Gate Way, Nyack, NY 10960 Located at (Street) South Highland Road Tax Map 61. Block 2 Lot 26 (indicate nearest cross street) Municipality (T) Putnam Valley Drainage Basin Hudson River Date of Pre-soaking SOIL PERCOLATION TEST DATA 2106/06 Date of Percolation Test V07/06 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch E 1 3:16 3:36 20' 1911 2211 Yt 7 E 2 3:36 4:00 24' 19#1 22" 3#0 8 E 3 4:00 4:24 24' 19't 22" 3" 8 4 5 F 1 3:18 3:37 19, 1911 22" .3" 6 3T,7 F 3 4:00 4:21 21' 19" 22't 3$1 7 4 5 2 3 4 1 5 7 NOTES: 1. Tests to be repeated at same depth until approxi atel, percolation test hole. (i.e. < I min for 1 much < submitted for review. 2. Depth measurements to be made from top of hole. rates are obtained at each nin/inch) All data to be Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G.L. 0.5' 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 7.0' 7.5' 8.0' 8.5' 9.01 10.01 Deep hole observations made by: n/a Date n/a Design Professional Name: John P. Delano, F.E. Address: Badey & Watson, !juty, eering, P.C. 3063 Rog( e" 0516 q(w, ,X0T0,4 Signature: Form DD-97 (Pg. 2 of 2) 4ot6lonal's Seal f � I � Street Location rr TM# DIVISION OF ENVIERONMMNTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 02. �310 Inspected by: <T' yea Owner Permit .# Subdivision Lot # 1. Sewage System Area a, STS area located as per approved plans .......... .. ..... .......... b.. Fill section - date of placement. 3:1 barrier Lgth. Width Avg.Dpth c. 'Natural soil not stripped ................................................... d, Stone, brush, etc., greater than 15' from STS area....:.:... e. 100' from water course/wetlands ...................................... IL Sewage System a. Septic tank size - 1,000 .... * ...... 1,250 .......... other ................ b. 'Septic* tank installed level ..... : ...................................... c. 10' minimum from foundation... ...... ............................. d. Distribution Box 1. All outlets at same elevation-water tested.......::..::.:.. 2,. Protected below frost ................................................... 3. .. Minimum 2 ft-Original soil between box & trenches e. Junction Box properly set ......................................... 6. Trenches 1. Length required Length installed 2. Distance to watercourse measured Ft.......... - 3. Installed according to plan ......................................... 4. Slope of trench acceptable 1116 - 1/32" /foot ............. S. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surfice .................. 7. Room allowed for expansion, 100% .......................... 8. Size of gravel 3/4 - I'A" diameter clean .............. 9. Depth of gravel in trench 12" minimum .................... 10. Pipe ends ca Aped ......................................... .............. . or Dosed 1. Size of pump chamber ................ ............................... 2. Overflow tank ........................ : .................................. 3. Alarm, visual/audio ­ 4. 'Pump easily accessible, ;manhole '" 'grade''' to .. 5. First box baffled .................................................... : ...... . 6. Cycle witnessed by H.D.estimated flow/cycle ........... hia.ouse/Buildin'g A. House located per approved plans b. Number of bedrooms ........................... I .......................... iv.i 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 ....................... Y.- Overall Workmanship . a. Boxes properly grouted .................................................. b. All pipes partially backfi.1led .......................................... c. All pipes flush with inside of box ... .......... .I.................... .................... 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 dischar&e_kWay,ft h. - Surface adequate... ..._ : * ........................... - - water protection i. Erosion provided ................................................ Rev. 12/02 ,_ti�.._.._„ -•.. _.:t_,..._�.._.. -_ -,: :�..:. _ . .:.............. �AA�bCV� '�3�,�.1L'1V1���+�D�$��`l:L'�L� ' �.._ __- .<, u, -.., r -..- _r , . ..,.,..._ Date: Inspected by:.�f Fill pad located per the approved plan Fill Pad Length °� Required Length Fill Pad Width Required Width s• Fill Pad Depth Required Depth Run -of -Bank Fill Quality &OV A Slope from Top to Toe Impervious Layer Installed s Erosion Control Installed aLq-f Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable " _ BADEY_ & WATSON. Z. "fVeying 'ingin "eeririg; . P C. ` 3063 Route 9, Cold Spring, New York 10516 TO: Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 We are sending: copies date description of document 01 11 6- Dec -06 7 JApplication Fee - $250.00 LETTER of TRANSMITTAL Date: 21 Dec 2006 File No. 74 -122 W.O. # 18072 RE: Proposed SSTS - NAME CHANGE 11 Kolarek South Highland Road Tax Map 61.-2-26 Permit/Tide/PO # ® 20- Dec -06 7 lConstruction Permit for Sewage Treatment System Sent via: US MAIL MESSENGER PICK -UP FAX Fl ILetter of Authorization Ol lApplication for Approval of Plans for a Wastewater Treatment System Ol 20- Dec -06 Short Environmental Assessment Form n 31- Oct -03 Des gn-Data Sheet U 1074eb -06 Ji5esign Data Sheet (perc tests taken in fill ® 20- Dec -06 Application to Construct a Water•Well ® 18- Dec -06 Subsurface Sewage Treatment S stem.. SD16017 R09 F2 04- Dec -06 7 13-Bedroom Floor Plans El REMARKS: Copies to: File Yours truly: Subd. Lot No. PV -3 -90 ❑ UPS -NIGHT 11 El UPS -2 DAY ❑ ❑ UPS -3 DAY 11 El UPS -GRND❑ UPS -COD ❑ Jason R. Snyder, Assistant Engineer Tel: (845) 265 -9217 ext*13 Fax: (845) 265 -4428 Email: jsnyder @badey- watson.com Frank Kolarek. Jr. Doris Jean Velez 40 40 -05 509314 622634 31687 FROM NEVILLE LOG HOMES {FRO DEC 15 2006 9:07/ST, 9:03/No.6828270602 P I �1�ll e Lo A DIV ISION OP NmLoc, INC. 2036HIGHWAY93 N - Vici*OR, MONTANA 59875- _,gHomes 1i W1 F,u,Ak roltt*K To. JoF f4mL%4; Fax: 5,q� Frm: Deb: Re: Lao vw0,,,j /Mzc\q OXyw Pagm; Including this page CC; 13 UMmt U Far Rev" ❑ Nows C(omat ❑ Plam Reply 13 Please Recycle psi � ti�5 ��k ? Df 800-635-7911 - 406-642-3097 - fax 406-642-3093 - inow. n e vil og. c o m FROM NEVILLE LOG HOMES I ! 11 {FRO DEC 15 2006 9;07 /ST, 9:03/No.6828270602 P 2 II II � II � I I LLI N� �0 II 1 tr �n I I�� I I�� ROE :R �- •scno SIT ' �wi ♦4 ;,.1 .j i �,�� : �4i 1, �',' ``II ♦� �' � 4 s J� 1 (/� s s � ` IDI V ISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at !S0 %.)y oI It o (4 4,L L^0 e Town or Village LT-� Pan -ltat— Vo, k-Lz— Subdivision name P J A Subd. Lot # Tax Map ( Block Z Lot ?-<o Date Subdivision Approved Renewal Revision Owner /Applicant Name j uTro ui a u o tj 4 A L%Ak- Date of Previous Approval Mailing Address 'SS i�k1P-%. AVrzaryz S&ih c—c— c �.trb i C-A. Zip 9 � 60 Amount of Fee Enclosed "/A Building Type lFesi O4.A-ra o t-- Lot Area No. of Bedrooms 3 Design Flow GPD 00 ]Fill Section Only Depth VoRume PCHD NOTIiFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 ,aaO gallon septic tank and -�S"(,IN `-°F, 0 . Other Requirements: fl 0" t� o LN � I LC- t a i - To be constructed by U Aa? q,-m (—Yga, -Ls C Sopi s Address 0—*-0 4SPR4 J 4 �J Y O�, 1 Water Suortllv: Public Supply From Address Man 'Private Supply Dhifed °by &W air i �l b � ' Address (u ' A rA ic-oC 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,, em 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. o Signed: P.E. R.A. Date l °p Address 0 cay Vi Irs o i S_-1r1JLay1Pj 1-) � ji4^ /U (f arWkicense # 0(p ',S 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 for discharge of domestic sanitary sewage only. By. �va Title: Date: /to ©lD copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BADEY &WATSON LETTER of TRANSMITTAL 3arv'-e'-y'-ing'& kh,0jiMdhk, 3063 Route 9, Cold Spring, New York 10516 Date: 01 Mar 2006 TO: Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health I Geneva Road NY 10509 We are sending: copies date description of document F 21 1 IFoundation Plans E-1 1 71 F_ El 771 1 F1 7�1 I El I 0, T­ El I El I [.7 El 1 REMARKS: Copies to: File File No. 74-122 W. O. # 16017 RE: Floor Plans Cunningham South Highland Road Cunningham Tax Map 61.-2-26 Pennit/Title/PO # Sent via: US MAIL MESSENGER PICK-UP FAX Yours truly: Subd. Lot No. ❑ UPS-NIGHT ❑ � UPS-2 DAY El 11 UPS-3 DAY � El UPS-GRND 2 UPS-COD 0 Jason R. Snyder, Assistant Engineer Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: jsnyder@badey-watson.com 40 40-05 509500 622500 29123 A Surveying & Engineering, P. C 3663 Route 9, Cold Spring, New York 10516 Date: 06 Mar 2006 File No. 74-122 W. O. # 16017 RE: Second Floor Plans Cunningham TO: South Highland Road Joseph S. Paravati, Jr. Cunningham Subd. Lot No. Assistant Public Health Engineer Tax Map 61.-2-26 Putnam County Department of Health Permit/TitleRO # I Geneva Road Sent via: Brewster, NY 10509 US MAIL UPS-NIGHT El MESSENGER El UPS-2 DAY El PICK-UP El UPS-3 DAY. El FAX El UPS-GRND & We are sending: UPS-COD ❑ copies date description of document F-21 106-Mar-06 ISecond -Floor Plan ❑ I ❑ I F-1 1 F-1 I EEL F-1 F-1 El REMARKS: Copies to: File Yours truly: Jason R. Snyder, Assistant Engineer Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: isnyder@badey-watson.com AV '�� BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: N Feb 2006 TO: Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 11 Geneva Road lBrewster, NY 10516 We are sending: copies date description of document F-21 129-Sep-05 1 13- Bedroom Floor Plans El 71 F-1 ❑ ❑ REMARKS: Copies to: File File No. 74-122 W. O. # 16017 RE: Proposed SSTS Cunningham South Highland Road Cunningham Tax Map 61.-2-26 Permit/Tide/P0 # Sent via: US MAIL MESSENGER PICK-UP FAX Yours truly: Subd. Lot No. ❑ UPS-NIGHT ❑ ❑ UPS-2 DAY ❑ ❑ UPS-3 DAY ❑ ❑ UPS-GRND R] UPS-COD ❑ Jason R. Snyder, Assistant Engineer Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: jsnyder@badey-watson.com 40 40-05 509500 622500 29076 BADEY & WATSON LETTER of TRANSMITTAL ­-SWhie�ing 3063 Route 9, Cold Spring, New York 10516 Date: 17 Feb 2006 File No. 74-122 W. O. # 16017 RE: Proposed SSTS Cunningham TO: South Highland Road Mr. Joseph S. Paravati Jr. Cunningham ? Subd. Lot No. N/A Putnam County Department of Health Tax Map 61.-2-26 1 Geneva Road Permit/Title/PO # Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT ❑ MESSENGER ❑ UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ I UPS-GRND 0 We are sending: UPS-COD copies date description of document ❑ 117-Feb-06 lConstruction Permit for Sewage Treatment System F-11 107-Feb-06 —1 IDesign Data Sheet 74 117-Feb-06 —1 ISeparate Sewage Treatment System Sheet 1 of I El 71 El —11 REMARKS: Dear Mr. Paravati, for your review. Copies to: File Yours truly: Neal A. Seidl Jr. Engineer Tel: (845) 265-9217 ext 25 Fax: (845) 265-4428 Email: nseidl@badey-watson.com FEB -22 -2006 09:13 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION . X JOSEPH [] GENE REQUEST FOR FINAL - INSPECTION Date: 2/22=06 PCHD Construction Permit # PV -3.90 a For: Fill Trenches P.01i01 Located: South Highland Road -__ (T) (V) (T) Putnam Valley Owner /Applicant. Name: _Sutton Cunningham TM 61___.. Block 2 Lot ?s_._ Formerly: N/A Is system fill completed? _ Yes Is system complete? WA Is system constructed as per plans? _ Is well drilled? No Is well located as per plans? Are erosion control measures in place? Subdivision Name: Subdivision Lot # Date: Date: N/A Date: WA Yes WA WA 2/17/2008 NIA NIA 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. 71_t!' °-DaiC:' l;eitttie Design Professional Sade & Watson, P.C. 3063 Route 9, Cold Spring, NY Address: _=- --___. _ y �__.. _......... ....._..�_...._...........__.._ Lic. # ... ,._ 082505__.. ... . Comments; ,.- Joe, the fill is in place and ready: for inpection. Form FIR -99 TOTAL P.01 FEB -22 -2006 WED 08:52 TEL:845 -278 -7921 NAME :PUTNAM COUNTY DEPARTMENT OF P. 1 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75 -A, 10NYCRR for Individual Household Sewage Treatment Systems ,GENERAL INFORMATION (Ap,plic! ant must complete) ----------------------------------------- - - - - -, Last Name First M.I. Name of Applicant _ _ _ _ _ _C_u_n_n_in_g_ham,_J_r_. _ _ _ _ _ _ _ - - - - - F. Sutton- - - - L_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - _ --- No, Street c4ffowm State Zip F_ Address ____ ______ 58 ______________ Karl Avenue _ San Anselmo CA 94960 --- - - - - - - ------------------- No. Street Ci ffowm (T) Putnam State Zi p 4 _Site Location South �ghland Road _ _ _ _ _ _ Valley_ _ _ _ _ _ _ NY -------------------------- - - - - -- ----- - - - - -- APPLICANT - DO NOT WRITE BELOW r-------------------------------------------------------------------------------- -- ---- - - - - -i 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. W, Excessive slope. ' L High groundwater. ' Inadequate depth to bedrock or impermeable layer. - f Soil unsuitable. LW Other (explain) 1.) P -fopes adein-mm -s-+ -- - - - - ------------------------------------------------------------=----------------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------- - - - - -' 2. Proposed design or conditions of waiver: 1.) Absorption area to remain in location of original PClDH approval. The existing grade is approximately ; 20% and the proposed grade of fill shall . 2.) ------------- - - - - -- , L-------------------------------------------------------------- --- ------ --- ------- -----------' 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. ; Operation of sewage system Is subject to mechanical problems. L Other (explain) ------------------------------------------------------------------- --------------------------------- 'L _, Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. may be revoked by th71ulng official for a change in conditions for which this waiver was granted. This waiver REPRESENTATIVE OF COMMISSI EA TH ORIGINAL- Local Health Agency COPY - Applicant/Design Professional DATE DOH -1326 (7/92) (GEN -152) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .�. L.- . - ::�?'E►��h '�; ..DA�';�.'����'.:_ ,:S.LL'L��S�JI�F d.!��� SR�J3�; �E-TR�A.T���-N.T� ��4ST���.- :,��.. �::�:: �:;.:uy.; r Owner Foster Sutton Cunningham Address Located at (Street) South Highland Road Tax Map 61 (indicate nearest cross street) Municipality Putnam vauey Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking 2106/06 58 Karl Avenue Block 02 Lot 26 Hudson River Date of Percolation Test 2/07/06 Vole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch E 1 3:16 - 3:36 20' 19" - 22" 3" 7 E 2 3:36 - 4:00 24' 19" - 22" 3" 8 E 3 4:00 - 4:24 24' 19" - 22" 3" 8 4 - - 5 - - F 1 3:18 - 3:37 19' 19" - 22" 3" 6 2 - 1 .. 22" 9 3" F 3 -_ -.4:00 4:21- . - _ - 21' 19" ^ - 22" 3" 7 4 - - 5 - - 1 - - 2 - - 3 - - 4 5 - -. NUES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1 -30 min/inch, < 2imin 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 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 BOLES Indicate level at which groundwater is encountered N/A Indicate level at which mottling is observed N/A Indicate level to which water level rises after being encountered N/A Deep hole observations made by: N/A Date N/A Design Professional Name: John P. Delano, PE Address: 3063 Route 9 Cold Spring, N.Y. 10516 Signature: o Design Professional's Seal Form DD -97 (Pg. 2 of 2) of P1 ` W P O C9 BR1JCT-R-:-f0L-E)Y-- Public I Health Director DEPARTMENT OF HEALTH I - Geneva Road 8rewster, New * York. 10509 MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (945) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 219 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -'6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (945) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: SITE LOCATION: DATE: , STAFF PRESENT: -flMOM' Rob M., Mike B-vk4mM�, Gene R., Bill H. isv SPECIFIC WAVIER. REQUEST: Ot4 .5 DOES 'TifE7 PROPOS91) VARIANCE REQUEST POSE A HEALTH ENVIRONMENTAL CONTAMINATION PROBLEM? YES WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES DISCUSSION- REQUEST APPROVAL OR DENIED FOR 6' (SPECWAIVER) - . ROVED' DATE NO NO HAZARD OR .DENIED }} J( 4 DWISION OF ENVIRONMENTAL HEALTH SERVICES _ .. .- .., .w! ._. .. .. r,.... -.a._ .:;y.: �.r..__...tc_.1..: .w ... .a.e:+o- _.... w..e...:r _.s.. - ..e4i- ..i� -�v_. � .. <..�....es..�.�•i.�..:i'1" -.. m.�_- .,...a_. �c'- v:wi•:. .. .�vr:: �'�.;a�wa- .�.:ii CONSTRUCTION PERMIT FOR ,� NT SYSTEM 6ZkGr19 PERMIT # 9 --3 - �� li Zo i� A,51 � �o /3 U Located at SaYzzA L SQ Town or Village (T) ` &N-9MA ALE-- Subdivision name 14 IA Subd. Lot # t /� Tax Map (a1 Block Z Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name (—�44MWGtMM Date of Previous Approval Mailing Address 5 8 V-AQI - Affif.WF— M 56L.M0, CA Zip 14 %0 Amount of Fee Enclosed Building Type 10Z "ilk!_ Lot Area q C- No. of Bedrooms 3 Design Flow GPD &CO Fill Section Only. Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COWLETED Se2arate Sewerage sy_tem to consist of r gallon septic tank and 348 I-V or- Z4 0 Abe A4 6oQp naJ Other Requirements: I' — & ROZ i iLL, To be constructed by AAQ.0u() b f ct5 z �50JJ5 Address GrXZ C-- P%QfW-.4- 4,-( 1 05140 Water Su ugly: Public Supply From Address ®�:� �L. - 'inva "te "Suppiyi)rilled by..j�Di11�1�►a�slSC;.. pl`�~ 'AAd`r"ess��isi t`�;�7~ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate 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 It IT 1 0-3 License #` (OZ505 APPROVED FOR CONSTRUCTION: This approval expires two yearrs frm 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 ermit. Appr ve for discharge of domestic sanitary s wage only. B �l Title: �' ate: 14— —04 Y� — White copy - HD F le; Y to copy - Building Inspector; Pink copy - O r; O e copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION U LICA ON TO CONSTRUCT WATER WELL _ .. _. _. •�.:F; ri �_... please print or type M4 Permit ; �° i 901:1- <I Well Location: Street Address: Town/Village Tax Grid #' 5a-nU 1�tC'-I;�I� 9Z (T) W-44" \1AU -2qMap isL Block Z. Lot(s) Well Owner: Name: Address: C�01�4 -4" �D q `Jc� 1 (�i. l�.ia .�t1s'3 .c- +N►.�, Ck C8 9f�� 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 rJ gpm # People Served Est. of Daily Usage - gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason tD&- ;, LAA%-22- d5OPLI l ( for Drilling Well Type . Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Y— Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Al'k Lot No. µa Water Well Contractor: k,-pfln r l ?�62 t. I gt-. Address: I y5-* 9 Is Public Water Supply available to site? .................................. ............................... Yes No C� _ Name of Public Water Supply: N lb Town/Village MIA Distance to property from nearest water main: 7 G,-, Proposed well location & sources of contamination to be provided on separate sheet/plan. - Date: -0 �:- : App)ican+ Sdgnature: - 11, . _ 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. I n Date of Issue 'O 4 Permi ssuin ffici : Date of Expiration – –0 Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - O*her; Orange copy - Well driller Form WP -97 LORETTA MOLINARI Public Health Director 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. December 11, 2003 ROBERT J. BONDI County Executive 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 anise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj rrwjc%., i iu Nuwioam APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1.APPLICANT /SPONSOR 2. PROJECT:NAME F. Sutton Cunningham, Jr. Cunningham 3. PROJECT- LOCATION: Municipality (T) Putnam Valley County Putnam 4. PRECISE LOCATION: Street Address and Road Intersections, Prominent landmarks etc -or provide map. South Highland Road (see map provided) 5. IS PROPOSED ACTION ® New ❑ Expansion El Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: Separate sewage treatment facility to service new single family dwelling with private water supply. 7. AMOUNT OF LAND AFFECTED: Initially -c 2 acres Ultimately <2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ® Yes ❑ No If no, describe briefly: "9."WHA1i- "iS NkEStN T LAND USE •IN'VICINI-1 Y- OF'Pk0JECT?'(Ch66ge as many as apply.) ® Residential ❑Industrial ❑Commercial —Agriculture ❑Park /Forest /Open Space ❑Other (describe) Residential housing on 2+ acre lots. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ® Yes ❑ No If yes, list agency name and permit / approval: Town of Putnam Valley - Building & Driveway Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ® No If yes, list agency name and permit / approval: 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 Na n P. Delano, P.E. Date: 11/7/2003 Signature _ - '' � ® R �e.• � ` •_ _ Design Professional for applicant If the action is a Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment ra►rc a as - amrmo a maocaamcav a j a o oe compaezea Dy a-eaa mgencyf A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? F] Yes 0 No B. WILL ACTION KECtWF COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be sup6rseded by another involved agency. , . �. _. -.. T- y�C-S 1% j�lY 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 pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENT E AREA CEA ? If yes, explain briefly: F] Yes No E. IS THERE, OR I FiEFtE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONINENTAC IMPACTS? If es ex lain: El Yes PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate..the potential impact of the proposed action on the environmental characteristics of the CEA. 1— 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. zp<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. tG1:2 /y- Name of Lead Agency e� Officer in Lead Agency ,�, q ate BADEY & WATSON 3063 Route 9, Cold Spring, New York 10516 TO: Joseph S. Paravati, Jr. Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 We are sending: LETTER of TRANSMITTAL Date: 22 Mar 2004 File No. 74.122 W. O. # 16017 RE: Permit Renewal Cunningham South Highland Road Cunningham Tax Map 61.2 -26 Permit/Titidm # copies date description of document F11 22- Mar -04 I Letter outlining revisions two 2 pages ® 22- Mar -04 Se arate Sewage Treatment System Fill Plan Sheet 1 of 2 F-11 22- Mar -04 Se arate Sewage Treatment System Sheet 2 of 2 ❑ REMARKS: your review. Copies to: File Sent via: US MAIL MESSENGER PICK -UP -FAX Yours truly: Subd. Lot No. N/A ❑ UPS -NIGHT ❑ ❑ UPS -2 DAY ❑ ❑ UPS -3 DAY UPS -GRND UPS -COD ❑ Jason R. Snyder, Assistant Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey- watson.com 40 40.05 509500 622500 23765 Oi 3063 Route 9, Cold Spring, New York 10516 (845) 265 -9217 (845) 225 -3312 Fa= (845) 265 -4428 (914) 628 -1800 (914) 739 -3577 (877) 3.141593 March 22, 2004 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 Re: Waiver Determination — Cunningham South Highland Road . (T) Putnam Malley, TM #61. -2 -26 ing and Exginee;,ing P C. Glennon J. Watson, LS. John P. Delano, PE Peter Meisler, LS. Stephen R. Miller, LS. Jennifer W. Reap, L.S. George A. Badey, L.S., Senior Consultant Mary Rice, R.L.A., Consultant Julius I. Cesare, P.E., Consultant Dear Mr. Paravati: This office has received and reviewed your comments, dated March 15, 2004, from the latest waiver meeting. Please note the following revisions for the next meeting: 1. The wall section detail has been revised, however please be advised of the following: a. Wall construction as presented can, and will be, more than adequate in supporting the proposed depth of fill. The proposed retaining wall has been designed to resist lateral sliding and overturning as per § 1806 of the New York State Building Code. b. The proposed wall is a dry stone, rubble retaining wall. It shall be constructed of boulder and stone, native to the site, and in a variety of shapes and sizes. This is to ensure that the wall is solid, sturdy and dense. If only large boulders were used, the wall would be none of these. , Owners of the records and files of Joseph S. Agnoli, Burgess & Behr, Roy Burgess, Vincent Burruano, Hudson Valley Engineering Company, Inc., James W. Irish, Jr., J. Wilbur Irish, Douglas A. Merritt, E.B. Moebus, Reynolds & Chase, Taconic Surveying & Engineering, P.C. and D. Walcutt c. Once again, the proposed retaining wall has. been checked for lateral sliding - auZl overtui'higf7 itti`struc al'aua ys s arid' constii ctatiilify have been'takeii ' into consideration in the design of the wall. d. The distance between the end of the 15% slope and the wall varies, with a minimum distance of 5 ft. A label has been provided in the wall section detail. e. The backfill material behind the wall should be clean common fill, with a unit weight of not more than 135 lbs/cf. This unit weight is the max'mum reasonable unit weight one would expect from a saturated, non - cohesive soil. A note has been provided in the wall section detail. 2. A" 100' Minimum" label, between the proposed SSTS and the stream, has been provided on the plan view. This office would like to take this time to remind the Department that this is a renewal of a previously issued Construction Permit. As such, the renewal is being proposed in the exact location as the previously approved system area. 3. The square structures shown by the stream are old concrete water-collection- boxes. They are broken -up, and serve no purpose today. 4. There are no Town or State designated wetlands associated with the length of stream shown on the plan. This determination was made upon review of the Town of Putnam Valley Freshwater Wetlands and Watercourse Map and the New York State Freshwater Wetlands Map, respectively. revisions.hayeTarlegia .qtely addressed ary.conccrMs,related.to -. ;. the approval' of the subject application. .. _ Yours very truly, BADEY & WATSON, Surveying and Engineering, P. C. f 2�. by, Jason R. Snyder Assistant Engineer JRS /jrs cc: File U: \74- 122B \SC22MR4L.doc BADEY & WATSON Surveying and Engineering PC y .. )OL LORETTA MOLINARI R.N., M.S.N. Public Health Director .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 FACSIMILE TRANSMITTAL ROBERT J. BONDI County Executive To: AleAl , 611-1 Fax: From: Joe- '1 -r V4 APK- Date: ]lie • � y � � ' raq � 6-p" Pages AA CC: ❑ Urgent V�14or Review ❑ Please Comment ❑ Please Reply CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have, received this telecopy in error, please immediately notify us by telephone (845- 278- 6130) and destroy all documents associated with this facsimile. N , LORETTA MOLINARI Public Health . Director rte'- t�.::.. ..a:.;. � - � • _ r. 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 March 15, 2004 Jason Snyder Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Dear Mr. Snyder: ROBERT J. BONDI County Executive Re: Waiver Determination — Cunningham South Highland Road, (T) Putnam Valley TM# 61. -2 -26 The Putnam County Health Department reviewed the waiver request for the above regarded project on March 11, 2004. The following determination has been made; • The Waiver request was approved. • The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. • The Waiver request was denied. An explanation has been noted below. ® The Waiver request was not voted on. Explanation noted below. 1. The following comments pertain to the design of the wall and the wall detail: a. This Department is concerned that wall construction as presented may not be adequate enough to support fill as high as 7 feet. b. Please specify material to be used in construction of wall, especially size of stone. Only large boulders should be used. c. The top of the wall should be wider than 1 foot. d. Please provide dimension between the end of the 15% slope and the wall. e. In order to support the wall, backfill material behind the wall should be provided. 2. Please provide 100 minimum label between wall and stream. 3. What are the square structures shown by the stream? Please provide label. SJ� ■ I 6 4. Are there wetlands by the stream? If so, please label and clarify and provide a 100 -foot boundary label. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, Al �seph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj SENDING CONFUSTI.ON DATE : MAR-17-2004 WED 11:43 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE : 92654428 PAGES : 3/3 START TIME : MAR-17 11:42 ELAPSED TIME : 00'48" MODE : ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... p-ocl"a-sts)'. IMNVA 4P;w bi Cdwqn . Aldn onta 0 rrimmoo ostola El • 1"!Aox jos-3d wooln o .................................................... ..................... ...... •........•..•.........••••... '.rj;t-q :MojA d 605017piL RLTV3H 110 INMU'avdac ,Pwa N)IMM IIA"d cxoe I llawl Ks•pq "N-d mytalow vil-nal .O LORETTA MOLINARI Public Health. Director 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 March 15, 2004 Jason Snyder Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Dear Mr. Snyder: ROBERT J. BONDI County Executive Re: Waiver Determination — Cunningham South Highland ]load, (T) Putnam Valley TM# 61. -2 -26 The Putnam County Health Department reviewed the waiver request for the above regarded proj.eot. on,.�!Iarrla 11- ,2004._ The following determinatiop.-has. b �nade:- ❑ The Waiver request was approved. ❑ The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. ® The Waiver request was not voted on. Explanation noted below. 1. The following comments pertain to the design of the wall and the wall detail: a. This Department is concerned that wall construction as presented may not be adequate enough to support fill as high as 7 feet. b. Please specify material to be used in construction of wall, especially size of stone. Only large boulders should be used. c. The top of the wall should be wider than 1 foot. d. Please provide dimension between the end of the 15% slope and the wall. e. In order to support the wall, backfill material behind the wall should be provided. 2. Please provide 100 minimum label between wall and stream. 3. What are the square structures shown by the stream? Please provide label. 4. Are there wetlands by the stream? If so, please label and clarify and provide a 100 -foot boundary label. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj ""ADEY & WATSON LETTER ®ff TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 26 Feb 2004 File No. 74-122 W. O. # 16017 RE: Cunningham TO: South FIIghland Road Mr. Joseph S. Paravati, Jr. Putnam County (Department of Health 1 Geneva (toad Cunningham ? Subd. Lot No. Tax Map 61.-2-26 Permit /ritleJPO # N/A Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT MESSENGER ❑ UPS -2 DAY ❑ ❑ We are sending: PICK -UP ❑ . -UPS -3 DAY FAX ❑ UPS -GRND UPS -COD ❑ W ❑ copies date description of document ❑ lCover Letter from Jason R. Snyder (2 pages) ® 26- Feb -04 ISeparate Sewage Treatment System Fill Plan Sheet 1 of 2 01 25- Feb -04 ISeparate Sewage Treatment System Fill Plan Sheet 2 of 2 E-1 1 7711 ❑ n1 r . _- r _. . _._ -... TA ❑ I — — .. ❑ 1 REMARKS: Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey - watson.com 40 40-05 509500 622500 23572 .11 V% ♦ lrm\ T t r � Ttrr ♦ PV4 P1 /\ 1\ T 3063 Route 9, Cold Spring, New York 10516 Farr (845) 265 -4428. February 26, 2004 Joseph S. Paravati, R. Assistant Public Health Engineer . Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 Re: Proposed SSTS Renewal — Cunningham South Highland Road (T) Putnam Valley, TM #61. -2 -26 Dear Mr. Paravati: (845) 265 -9217 (845) 225 -3312 (914) 628 -1800 (914) 739 -3577 (877) 3.141593 Glennon J. Watson, LS. John P. Delano, RL Peter Meisler, LS. Stephen R. Miller, LS. Jennifer W. Reap, L.S. George A. Badey, L.S., Senior Consultant Mary Rice, R.L.A., Consultant Julius I. Cesare, P.E., Consultant This office has reviewed Putnam County Department of Health comments dated Feb nary 13, 2004. Please find attached the foliowaing d6cdnlents: Four (4). copies of revised plan titled "Preliminary Design for Fill Placement Only ", sheet 1 of 2. Last revised February 26, 2004. ➢ One (1) copy of revised plan titled "Preliminary Design for Fill-Placement Only ", sheet 2 of 2. Last revised February 26, 2004. This office offers your department the following address: 1. This office acknowledges the fact that Comment #1 has been addressed. 2. Top and bottom of wall elevations have been provided in several key locations for your review. 3. The Town of Putnam Valley Planning Board will be reviewing and commenting on any and all retaining walls proposed on this lot,,as well as any other new site . development in the Town. Owners of the records and files of Joseph S. Agnoli, Burgess & Behr, Roy Burgess, Vincent Burruano, Hudson Valley Engineering Company, Inc., James W. Irish, Jr., J. Wilbur Irish, Douglas A. Merritt, E.B. Moebus, Reynolds & Chase, Taconic Surveying & Engineering, P.C. and D. Walcutt n c ^xms ..1 med t - -. • -, .. _ _ � •4 ;�. r �..a...a.. az:i�:� .�:1 kz�� J. Gia'.6�a��5..v.c any aiv r a lv u.wJ to i.i1C approval subject application. Yours truly, BADE Y i W A SON, Surve ing and ga eering, P. C by, Jason R. Snyder Jr. Engineer JRSLjrs enclosures cc: File U: \74- 122D\SC26FB4L.doc HALEY & WATSON Surveying and Engineering P. C 0 d LORETTA MOLINARI Public Health Director 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 February 13, 2004 Jason Snyder Badey & Watson 3 063 Route 9 Cold Spring, New York 10516 Dear Mr. Snyder: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Cunningham South Highland Road, (T) Putnam Valley Tax Map # 61. -2 -26 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. audruSSeU. 2. It appears that plan view grading has been fixed to match profile grading. However, review would be easier if top and bottom wall elevations were provided and labeled in the plan view. Based on the profile, it appears that the top of wall is approximately 492' (491.5). The wall sits at an elevation of about 488' with the actual bottom of the wall into the ground to an elevation of 484'. However, if a section detail were provided, an actual determination and more concise review could be performed. 3. This Department is aware that a site development plan. will be reviewed by the. Town of Putnam Valley. However, it is our opinion that they will not review and comment on a retaining wall provided specifically for the SSTS. Therefore, since the purpose of the wall is to "hold the fill for the SSTS" and provide a means of not having to "chase grade down the hill ", this Department believes we have the right to request certain items for review which pertain to the SSTS design. 4. Current application will be brought before the next waiver board meeting. However, please be advised that if you decide not to address the above comments, they may come up at the meeting and be asked for by the, board, which would delay the application at least another month. Also, new comments may arise at the meeting based on the current design, which might also delay the application at least another month. w;: • =' his =ofr' teiviii commue its 'review "upon consic a "ration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cj Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer *.:. I V 8AD EY & WATSON..*,.,.- Surveying and Engineering n C. . _ SINCE 1973 3063 Route 9, Cold Spring, New Yotk 1.0516. (8.45).265-9217 Glennon J. Watson, LS. (845) 225 -3312 John P. Delano; P.E ntSicN F=-(84.5)165-442A' (914).k&1860. Peter Meisler, Ls. (914) 739 -3577. Stephen R Miller. LS. (877)3.141593 Jennifer W. Reap, L.S. .George A. Badey, L.S., Senior Consultant Mary Rice,.R.L.A., Consultant Julius I. Cesare, P.E., Consultant February 11, 2004 Joseph S. Paravati, Jr. Assistant Public Health Engineer .Putnam County Department, of Health 1 Geneva Road. Brewster, NY 10.509 Re: Proposed SSTS Renewal - .Cunningham South Highland Road (T) Putnam Valley, TM #61. -2 -26 Dear -Mr. Paravati: This office has reviewed Putnam County Department of Health comments dated January 30; 2004. Please find.attached the following oocumerrts: Four (4) copies of a new plan titled ".Preliminary Design for Fill Placement Only ", sheet 1 of 2: ➢ One (1) copy of revised plan titled "Preliminary Design for Fill Placement Only ", sheet 2. of 2. This office would like to offer the -following comments:. . 1 Pursuant to .the request of your Department, the septic area was re- graded with.a slope of 15 %.- This:led to the maximum depth.fill to reach 4' -6 ". •Accordingly, a two (2) sheet septic set'has been provided for your review and reference. . 2. The plan and profile have been revised to show the fill pad grading at 15% up.to 10' horizontally past the last lateral, at which point the grade "breaks" to a '1:3 slope. Grading the fill. pad side slopes at. 1:3 (as per your request) will riot allow. . us to "get back on grade:" Therefore; :a retaining wall has been proposed (as per your request) so that down -slope re- grading is mininuzed'. :Please find :attached a Owners of the records and files of Joseph, S.. Agnoli, Burgess &•Behr, Roy. Burgess, Vincent Burruano, Hudson Valley Engineering Company, Inc., James W. Irish, Jr., J. Wilbur Irish, Douglas A.. Merritt, E.B. Moebus,,Reynolds & Chase, Taconic Surveying &.Engineering; P.C. and D. Walcutt W _ _ �1,� cc�Qy of..the_ the-Wavier-De Deterniinatxon ,.dated�argust.7,.20Q3. (which I believe.shoi. be January 14, 2004), indicating your design parameters. r. w.. 3. Pursuant to Putnam County Department of Health regulations concerning construction permit submission requirements for loots requiring fill greater than two feet in depth; a plan and profile of the fill section has been provided as well as a.plan and profile of the fill pad and SSTS for your reference. This is..not a site development plan. This .is a Construction Permit application forahe placement of fill greater than two feet'in depth. A. site development plan. will be prepared'in accordance with the Code of the Town of Putnam Valley following board of health approval. . 4. We believe these revisions have more. than, adequately addressed any concerns in regard .to .the subject application/wavier. In the event that the application is not . complete,' we request that this office be notified in_a timely fashion so that . appropriate action may be taken before the upcoming waiver meeting. Yours truly.. p BAD EY & WATSON, Survey' g'and Engineering, P.C. by, . Jason R. Snyder Jr. Engineer-. BADEY & WATSON' Surveying and Engineering PC. LORETTA MOLINARI Public Health Director 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 January 30, 2004 Jason Snyder Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Dear Mr. Snyder: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Cunningham South Highland Road, (T) Putnam Valley TM# 61. -2 -26 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. �.... _.. l.� , - :..Lr.- appeaxs -�hi 1.1 d�p h s so , ,Vhbr. b �wc: aiid ;�et;`� ✓iilca'iequii'Gsa G'slleec e_.. plan. 2. The plan view grading doesn't appear to match the profile grading. It appears that he plan view regrading was not completed, specifically, 10 feet of horizontal fill past the last expansion trench and any regrading at 1:3 before the stone wall is relocated. This would require the stone wall to be moved further down the hill. 3. A section detail should be provided beginning with the last trench and ending with the stone wall. Top and bottom wall elevations should be provided in the plan and section view. 4. All items must be addressed before application is brought back before the waiver board. 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. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj LORETTA MOLINARI Public Health Director August 7, 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 John Delano, PE Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Dear Mr. Delano: ROBERT J. BONDI County Executive Re: Waiver Determination — Cunningham South Highland Drive, (T) Putnam Valley TM# 61 -2 -26 The Putnam County Health Department reviewed the waiver request for the above regarded project on August 6, 2003.. The following determination has been made: 0 The Waiver request was approved. O The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of �, permit. _ ✓ e ; : - ... - 0.'- fihe Waiver request was denied. An explanation has been noted below. X The Waiver request was not voted on. Explanation noted below. 1. Proposed SSTS to be regraded to 15 %. 2. Fill for expansion area to be provided. 3. A proposed wall will be considered for side slope regrrding at 1:3. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Ve truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj BADEY &. WATSON LETTER of TRANSMITTAL Su�veying_.RL _ u¢� _!1, e.. 3063 Route 9, Cold Spring, New York 10516 Date: 22 Jan 2004 File No. 74 -122 W. O. #. 16017 RE: Proposed SSTS - REVISED Cunningham TO: South highland Road Joseph S. Paravati, Jr. Cunningham ? Subd. Lot No. N/A Assistant Public Health Engineer Tax Map 61.2 -26 Putnam County Department of Health PermiVhtle/PO # 1 Geneva Road Sent via: Brewster, NY 10509 US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX UPS -GRND O We are sending: UPS -COD copies date description of document F-11 20- Jan -04 —1 jPurnp data & info five 5 pages ® 20- Jan -04 Se crate Sewage Treatment System Sheet 1 of 1 ❑� REMARKS: Please find attached copies of the revised septic plan pursuant to your comment letter of January 14, 2004. Due to the septic area being regraded to 15%, the drop -boxes and lateral were elevated and a pump is now required. Please find attached design calculations for the proposed pump. Copies to: File Yours truly: Jason R. Snyder, Jr. Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey - watson.com 40 40-05 509500 622500 23287 C-,�U-4 VA-Uqc -. qAtQZ- . .......... 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' HP —14/3 STOW with Optional lengths are available. ■ Designed for continuous bare leads. bar Three phase: in 0 -rin g' Assures P ositive operation when fully Overload protection must sealing against contaminants submerged. be provided in starter unit. and oil leakage. • IA-2 HP —14/4 STOW with MOTORS bare leads. AGENCY LISTINGS ■Fully submerged in high- in Designed for Continuous grade turbine oil for lubrication efficient heat transfer. Operation: Pump ratings are within the motor manufacturers Tested to uL778and CSA 22.2 108 Standards and recommended working limits, cip By Canadian Standards ■ Class B insulation. can be operated continuously Assodation US File #ut38549 without damage when fully _ St hri12r ^yed. Goulds Pumps is ISO °001 R2_=er -d. METERS FEET 40 130 120 35 110 30k 100 9 90 = 25 80 V 20 70 } 60 0 15 50 ° 40 10 30 5 20 10' —►1�5 GPM DS -0 10 20 30- 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 0 5 10 15. 20 25 CAPACITY www.goulds.com m3 /hr Goulds Pumps �& ITT Industries 1 G ®U L ®S PUMPS COMPONENTS Item No. I Description 1 Impeller . F 3 Silicon carbide vs7 silicon carbide . Mechanical seal 4 Shaft 5 Motor 6 All Ball bearing heavy duty design 7 Power cable 8 0-ring 7 I! 'b' a b e Effluent Pump. MODELS PERFORMANCE RATINGS (gallons per minute) 3 Order No. HP Volts Phase Max. Am . RPM Solids Wt. (lbs.) WE15HH 4 115 1 9.8 1750 i _ %13 56 1 200 6.8 R�WE0318M 230, 4.9 RPM 115 9.8 3500 3500 6.8 3500 230 4.9 WE0511H , 1 115 14.5 i 3500 60 WE0518H 200 8.1 WE0512H 230 7.3 WE0538H 200 3 4.1 WE0532H 230 3.3 WE0534H 460 1.7. WE0511HH 115 1 14.5 WE0518HH 200 8.1 WE0512HH 230. 7.3 WE0538HH 200 3 4.1 WE0532HH 230. 3.6 WE0534HH 460 1.8 WE0718H % 200 1 11.0 70 I WE0712H 230 10:0 WE0738H 200 3 6.2 WE0732H 230 5.4 WE0734H 460 2.7 I �1dIF1i(jRH 1 ;Oil i , i4.i) WE1012H 230 12.5 WE1038H 200 3 8.1 WE1032H 230 7.0 WE1034H 460 3.5 WE1518H 1 , 200 1 17.5 80 WE1512H 230 15.7 WE1538H 200 3 10.6 WE1532H 230 9.2 WE1534H 460 4.6 WE1518HH 200 1 17.5 WE1512HH 230 15.7 WE1538HH . 200 3 10.6 WE1532HH 230 9.2 WE1534HH 460 4.6 WE2012H 2 230 .1 18.0 83 WE2038H 200 3 12.0 WE2032H 230 11.6 WE2034H 460 5.8 WE0537H 96 575 3 1.4 60 WE0537HH 1.5 WE0737H. 3/4 2.2 70 WE1037H 1 2.8 WE1537H 1 1 3.7 80 WE1537HH 3.7 WE2037H 2 4.7 83 3 Order No. WE03L WE03M WE05H WE07H WE10H WE15H WE05HH WE15HH WE20H HP 'f3 '/3 1/2 % 1 11h 'h 1''A 2 RPM 1750 1750 3500 3500 3500 3500 3500 3500 3500 5 86 - - - - - - - - 10 70 63 78 - - - 58 - - 1.5 52 .50 70 90 = - 53 - - 20 27 35 60 83 98 123 49 90 136 t 25 - - 48 76 94 117 45 87 133 0'30 - - 35 67 88 110 40 83 130 3 35 - - 20 57 82 103. 35 80 126 40 - - - 45 74' 95' 30 77 121 a 45 - - - 35 64 86 25 74 116 50 .- - - 25 53 77 - 70 110 M 55 - - - - 40 67 - 66 103 60 - - - - 30 56 - 63 96 65 - - - - 20 45 - 58 89. 70 - - - - - 35 - 55 81 75 - - - - - 25 - 51 74 80 - - - - - - - '47 66 90 - - - - - - - 37 49 100 - - - - - - - 28 30 (All dimensions are in inches. Do not use for construction purposes.) KICK -BACK Goulds Pumps and the ITT Engineered Blocks.Symbol are registered trademarks and tradenames of ITT Industries. PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT T0. CHANGE WITHOUT NOTICE. I Goulds Pumps ITT Industries t • o. MdOULDS PUMPS Friction Loss TECHNICAL PLASTIC PIPE: FRICTION LOSS (IN FEET OF HEAD) PER 10q fT. GPM GPH W. 'A" W 1" 1'h " 1' h" 2" 2'h" 3" 4" 6" 811 10" ft. 1 60. 4.25. 1.38 356 .11 2 120 15.13 4.83 1.21 .38 .10 3 . 180 31.97 1 9.96. 2.51 - .77 .21 .10 4 240 54.97 17.07 4.21 1.30 .35 .16 5 300 84.41 25.76 6.33 1.92 .51 24 6 360 36.34 8.83 2.69 .71 .33' .10 8 480 63.71 15.18 .4.58 1.19 .55 .17 10 600 1 97.52 25.98 6.88 1.78 .83 .25 .11 15 900 49.68 14.63 3.75 1.74 .52 .22. 20 1,200 86.94 25.07 6.39 1 2.94 .86 .36 .13 25 1,500 38.41 9.71 1 4.44 1.29 .54 .19 30 1,800 13.62 6.26 1.81 .75 .26 35 2,100 18.17 8.37 2.42• 1.00 .35 .09 40 2,400 23.55 10.70 3.11 1.28 .44 .12 45 2,700 29.44 13.46 3.84 .1.54 .55 .15 50 3,000 16.45 4.67 1.93 .66 .17 60 3,600 23.48 6.60 2.71 .93 .25 _ 80 4,800 11.43 4.67 1.58 Al 90 5,400 14.26 5.81 1.98 .52 100 6,000. 7.11 2.42 .63 .08 125 7,500 10.83 .3.80 .95 .13 150 9,000 5.15. 1.33 .18 .175 10,500 6.90 1.78 .23 200 12,000 8.90 2.27 .30 250 15,000 3.36 .45 .12 300 18;000 4.85 .63 .17 350 21,000 6.53 .84 .22 400 24,000 1.08 .28 500 30,000 1.66 .42 .14 550 33,000 1.98 .50 .16 600 36,000. 2.35. .59 .19 700 42,000 .79 .26' 800 48,000 1.02 .33 900 54,000 1 1,27 ,41 950 57,000 1 .46 1000 60,000 .. .50 I.: Friction TECHNICAL DATA EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR Q / IFFERENT FITTINGS Size of fittings, Inches '/�" ?/4" 1" 1'/4" 1'A" 2" 2'/ :" Y 4" 5" 6" 8" 10" 900 Ell 1.5 2.0 2.7 3.5 4.3 5.5 6.5 8.0 10.0 14.0 15 20 25 450 EII 0.8. 1.0 1.3 1.7 2.0 2.5 3.0 3.8 5.0 6.3 7.1 9.4 •12 Long Sweep Ell 1.0 1.4 1.7 2.3 2.7 3.5 4.2 5.2 7.0 9.0 11.0 14.6 Close Return Bend 3.6 5.0 .6.0 8.3 10.0 13.0 15.0 18.0 24.0 31.0 37.0 .39.0 Tee - Straight Run 1 2 2 3 3 4 5 Tee -Side Inlet or Outlet or Pitless Adapter 3.3 4.5 5.7- 7.6 9.0 12.0 14.0 17.0 22.0 27.0 31.0 40.0 Ball or Globe Valve Open 17.0 22.0 27.0 36.0 43.0 55.0 67.0 82.0 110.0 140.0 160.0 220.0 Angle Valve Open 8.4 12.0. 15.0 18.0 22.0 28.0 33.0 42.0 58.0 70.0 83.0 110.0 Gate Valve -Fully Open 0.4 .0.5 0.6 0.8 1.0 1.2 1.4 1.7 2'.3 2.9 3.5 4.5 Check Valve (Swing) 4 5 7 •9 1.1 13 16 20 26 33 39 52 65 In Line Check Valve (Spring) or Not Valve 4 6 8 12 14 19 23 32 43 58 Example: P (A) 100 ft. of 2" plastic,pipe with one (1) 90- elbow and one (1) swing check valve. 900 elbow - equivalent to 5.5 ft. of straight pipe. Swing check - equivalent to 13.0 ft _. of straight pipe DiDe - eO�iVnieili - J iii fS -jf ; rainhi 118.5 ft.= Total equivalent pipe Figure friction loss for 118.5 ft. of pipe. (B) Assume flow to be 80 GPM through 2" plastic pipe. 1. Friction loss table shows 11.43 ft. loss per 100 ft. of pipe. 2. In step (A) above we have determined total ft. of pipe to be 118.5 ft. 3. Convert 118.5 ft. to percentage f18.5 ± 100 = 1.185 4. Multiply 11.43 x 1.185 13.54455 or 13.5 ft. = Total friction loss in this system. Goulds Pumps. ,.. BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, P C_. 3 os icuiite`y; "i Co m- 'Spring;'i�lew' -York 111 16 - a -Date: ` 23 Dec 2003 ' File No. 74 -122 W.O. # 16017 RE: Proposed SSTS - REVISED Cunningham T . South Highland Road Joseph S. Paravati, Jr. Cunningham ? Subd. Lot No. N/A Assistant Public Health Engineer Tax Map 612 -26 : Putnam County Department of Health Permit/Title/P0 # 1 Geneva Road Sent via: Brewster, NY 10509 US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GRND ❑� We are sending : UPS -COD ❑ copies date description of document 0 . 15- Dec -03 Floor Plans - Revised ®. 23- Dec -03 I Separate Sewaize Treatment System Sheet 1 of 1 ❑ El I El I REMARKS: For lour review. Copies to: File Yours-truly: Jason R. Snyder, Jr. Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey- watson.com 40 40-05 509500 622500 23116 PUTNAk COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH - - I1V7DIVIDUAL WATER 09PLY & SUBSURFACE >Sk ' -tk. +: a^s.?'o" n '• - .• ,s... :, .. -$Xv aW Sil kft FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: _ �� 4 gbq /Zocic� REVIEWED.BY: RM, GR, 41, SRDATE: ' 3 TAX MAP#: (CONFIRMED) ANTS Y/ N ( REOUIRED DETAILS ON PLANS CONT'Dl TION )(_---)HOUSE SEWER - Vl' FT. 4 "0': TYPE PIPE CAST IRON U� ,�- �LETTER OF AUTHORIZATION UL_ ESIGNDATA SHEET (DDS) CORPORATE RESOLUTION Luv_/) SHORT EAF PLANS -THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION M, , UUSUBD- rMIONAPP CHECKEDN� (_j(_ )PERC RA UU QUIRED DEPTH URTAJN DRAIN REQUIRED GENERAL (_,(✓ OCATED IIN NYC WATERSHED (^ jPLANS SUBMITTED TO DEP �-ELEGATED TO PCHD L j�DEP APPROVAL, IF REQ'D ,DEEP TEST HOLES OBSERVED (�( .ERCS TO BE WITNESSED (_ jFLI�A � - APPROVAL, SSDS ADJ, LOTS (� TLANDS (TOWN/DEC PERMIT REQ'D ?) TA ON DDS PLANS & PERMIT SAME (__)RE 1969 NEIGHBOR NOTIFICATION { ( II M FLOOD ELEVATION W/I 200' SOIL TESTING LOTS>10 YEARS OLD / REQUIRED DETAILS ON PLANS (t:fJ(_)SEWAGE SYSTEM PLAN - (NORTH ARROW) L-�SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 LL)DESIGN DATA: PERC & DEEP RESULTS .(;✓_ ft_)2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING/GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES (TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# �� DATE OF DRAWING/REVISION DATUM REFERENCE (LOCATION OF WATERCOURSES, PONDS LANES WETLANDS WITHIN 200' OF P.L. UPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS j::5L� jWELI.,S ,* SSDS'S W/W 200' OF SSTS PROPERTY METES &BOUNDS - (_JEROSION CONTROL FOR - HOUSE, WELL & SSTS, EROSION CONTROL NOTE )MMENTS: (x(-)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS / FILL NOTES 1 -5 ONS FILL IN EXPANSION AREA FILL GREATER TBAN2 FEE / f 'U(-j CLAY BARRIER U( jFILL •CERTMCA TE (—J(_ )DEPTH G (_ jL )V PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROMTOE OF SLOPE TRENCH hF TRENCH PROVIDED�3? 60FT MAX. 3 70 %EXPANSION PROVIDE -D `` S `� � `!. '4 SHED STONE OR WASHED GRAVEL CL::J(_)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL PCW:"ll U20' TO FOUNDATION WALLS )100 '. TO WELL, 200' IN DLOD,150' T0, PITS L - -- )100' TO STREAM, �✓ jmot, T_L:1;A l.s,yORWA,T,.�ER'COURSE, LAKE (inc,.ez 7L i �Clwakt l,.. E_ . T1�J^t TO WATER LINE (pits - 20') ( ✓�' (J-50' INTERNIITTENT DRAINAGE COURSE ` 200'f500' RESERVOIR, ETC. 150' GALLEY SYSTEMS U10' MIN TO LEDGE QUTCROP SEPTIC TANK UU10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (-")( )MIN 15' TO PROPERTY I••11M SLOPE IN SETS AREA%r�S20 %) ,DED TO 15 %, IF REQUIRED (- jc —}PUMP NOTES (_ j(�DOSE 95% OF P UME DOSE VOLUME NOTED (�(_- jDETAIL F RCK.MAiN, (PIPE TYPE, ETC.) . (__)(_ jPTT D -BOX SHOWN &DETAILED /r / DAY STORAGE ABOVE ALARM / CUR AIN D {_J(_„)S�UNDPIPES, 5' BOTH to CD ° , '-4 %, 25' -3%,351-16/o, 100%-<I% L—)C -_)20' t�]Cg" ARGE/100' with 182 cons day discharge (�( jlO' FORATED PIPE BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 13 Nov 2003 TO: Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health I Geneva Road NY 10509 We are sending: copies date description of document 0 112-Nov-03 jApplication Fee - $300.00 File No. 74-122 W. O. # 16017 RE: Proposed SSTS Cunningham South Highland Road Cunningham ? Tax Map 61.2 -26 Permit(riddM # F�l 107-Nov-03 I Construction Permit for Sewage Treatment System Sent via: US MAIL MESSENGER PICK-UP FAX Fil I Letter of Authorization 51 1 1 FA—pplication for Approval of Plans for a Wastewater Treatment System 0 107-Nov-03 —7 Short Environmental Assessment Form F-11 31- Oct -03 I Fbes­i=Data Sheet W". 77 ---- --- F-11 107-Nov-03 JApplication to Construct a Water Well 0 128-May-03 I Floor Plans F-41 107-Nov-03 I FSeparAte Sewage Treatment System Sheet I of I REMARKS: your review. Copies to: File Yours truly: Suba. Lot No. NIA ❑ UPS-NIGHT 11 El UPS-2 DAY - El 1:1 UPS-3 DAY 1:1 El UPS-GRND 9 UPS-COD 1:3 Jason R. Snyder, Jr. Engineer Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: jsnyder@badey-watson.com 40 40-05 509500 627500 . 22808 NOV -07-2003 10:40 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : Property of F. Suftayin . Cmmingham, Jr. Located at snuff bland Road T/V M Paufnm'YalleY Tax bap # 61 Block 2 Lot 26 Subdivision of — nla Subdivision Lot # -- 0/2 Piled bap # 0/2— Date Piled n!2 Gentlemen: This letter is to authorize John P. Delano, P& a duly licensed Professional Engineer -V or registered Architect _. to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health (Director of the Putnam County Health (Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health ]Law, and the Putnam County Sanitary Code. Z"�gwmigned: Mailing Address — de-v & Win' P -C' — 3W Route 9 Cold Sprite State New York zip 10516 -- Mailing Address: 59 Karl Avenue state .,- 2ip_... 94960 Telephone: 945-265-9217 217 M, Telephone: (QS) 717.8026 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR 1. Name and address of applicant: F. Sutton Cunningham, Jr. 58 Karl Avenue San Anselmo, CA 94960 2. Name of project: Cunningham 3. Location: TN: M Putnam Valley 4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson, P.C. 6. Drainage Basin: Hudson River 3063 Route 9, Cold Spring, NY 10516 7. Type of Project: Private/Residential — Food Service — Commercial Apartments _ Institutional _ Mobile Home Park Office Building — Realty Subdivision _ Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ? ----------- Yes/No No Type Status (check one)_ - - - - - - - - - - - - - - - Type I _ Exempt ------------------ - - - - -- — Type II _ Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? Yes/No No 10. Has DEIS been completed and found acceptable by Lead Agency? Yes/No n/a 11. Name of Lead Agency Putnam county Department of.Health 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? Yes/No Yes i�avy .any v6,u 14AQ Lv'Sucuuil�li�riuCa': �t���jv'v 14. Has preliminary approval been granted by such. authorities? No Date granted:' nia 15. Type of Sewage Treatment System Discharge .................. surface water �[ groundwater 16. If surface. water discharge, what is the stream class designation? n/a - _ - - _ _ _ 7- 17. Waters index number (surface) n/a --------------------------------------------------- 18. Is project located near a public water supply system? _ Yes/No No 19. If yes,. name of water supply n/a Distance to water supply n/a 20. Is project site near a public sewage collection or treatment system? Yes/No No 21. Name of sewage syste n/a Distance to sewage system n/a 22. Date test holes obs % ve W2003, 23. Name of Health Inspector Joe Paravati 24. Project design" w ga on per ----- 600 \J--------------------------.------ 25. Is State Pollutant Discharge Elimination, System ( SPDES) Permit. required? Yes/No No 26. Has SPDES Application been submitted to local DEC office? Yes/ 'o . n/a Form PC -97 Page 1 of 2 27. Is any portion of this project located within a designated Town or State wetland?---- Yes/No No 28. Wetlands ID Number 29. Is Wetlands Permit required? Yes/No Has application been made to Town or Local DEC office? Yes/No 30. Does project require a`DEC Stream Disturbance Permit? -------- ----------- Yes/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 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? --------------------- Yes/No 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? __________ ____________________ _____Yes/No 35. Are any sewage treatment areas in excess of 15 % slope? Yes/No -------------------- - - - - -- n/a n/a No No No Yes No Yes 36. Tax Map ID Number --- _ _ Map 61 Block 2 Lot 26 37. Approved plans are to be returned to - - - - - - - - - - - - - - - - - - _ Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need - not - be _sent . in duplicate . to the DEP, although the project may require DEP approval -of iiie-SSTS -prior io-ritiai-al p-rOvU11 oy iue Deparinient. Projecis- w4iniri the- wdtersh- eU,-mdy aiso-require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1., 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 Venal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: --------------- - - - - -- 'I s & Engineering, P.C. 063 .Route 9, Cold) Spring, IY 10516. Form PC -97 Page 2 of 2 P U TN AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner F. Sutton Cunningham, Jr. Address 58 Karl Avenue, San Anselmo, CA 94960 Located at (Street) South Highland Road Tax Map 61 Block 2 Lot 26 (indicate nearest cross street) Municipality (T) Putnam valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 11/03/03 Date of Percolation Test 11/04/03 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch C 1 9:27 9:39 12 19 — 22 3 4 C 2 9:40 — 9:58 18 19 — 22 3. 6 C 3 9:59 10:22 23 19 — 22 3 8 C 4 10:23 10:58 35 19 — 22 3 12 C 5 11:01 — 11:38 37 19 — 22 3 12 D 1 9:28 — 9:46 18 19 — 22 3 6 D 2 9:48 10:13 25 19 — 22 3 8 i D 3 . _ I j ;t4.::_. _.0 :49' 1-5 D 4 10:51 .11:28 37 19 22 3 12 5 — — 1. — — 2 3 4 — — 5 — — NOTES:. 1. Tests to be repeated at same depth until apt percolation test hole. (i.e. < 1 min for 1 -30 submitted for review. 2. Depth measurements to be made frozl%& lion rates are obtained at each -60 min/inch) All data to be Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 3 HOLE NO. 4 HOLE NO. G.L. . ir! dpsoii' _ . 2 "116psoii' 0.5 Dark to Light Brown Dark to Light ]Brown 1.0' Silty Loam w/ Large Silty Loam w/ Large 1.5' Stones & Cobbles Stones & Cobbles 2.0' 2.5' 3.0' I I 3.5' 4.0' 4.5' 5:0' 5.5' 6.0' V V 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' Indicate level at which groundwater is encountered Not Encountered Indicate level at which mottling is observed None Observed Indicate level to which water level rises after being encountered n/a Deep hole observations made by: JRS - ]Badey & Watson, P.C.; J. Paravati - PCI9H Date 10/31/2003 Design Professional Name: John P. Delano, P.E. Address: Badev & Watami,,X.C. Signature: ZZ :01 ional's Seal?. Form DD-97 (Pg. 2 of 2) ,I I AM N paw V ©I h TUTNAM COUNTY DEPARTMENT OF HEALTH -71r? / °3 Y DIVISION OF ENVIRONMENTAL HEALTH .SERVICES.. INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATI,�ON Name of Project � � �" T 6( h" !'' 1-'�(T V) County Site Location- Building construction begun Af 2 Extent Is property within NYC Watershed ? ................. F Yes Pg—No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. a Hilly, .f7 Rolling Steep slope --Gentle slope Flat ' Evidence of wetlands a Low area subject to flooding E] Bodies of water w Drainage ditches .Rock outcrops r � ko 3. Property lines or comers evident ........................ ..........................:.... 0 'fie s . No •--�' �. . 4. - 'Do water courses exist on or adjoin the-property? ............................ 0 Yes ' No 5. Will these affect the design of the sewage system facilities ?............ Yes No 6. Do watershed regulations apply in this development ? ................... F--J. Yes No 7 Will extensive grading be necessary? ................ ............................:.. Yes No ill:P ,:,,�.Je u1i: a me k p( tot: ems' ..... ............................... �` Yes � o .... _ _ . _ . _.._...._ .. _ ... _... - ..b... e_.- - S� 1:� .. N 9. Do filled areas exisx within the SSTS area? ........ ........................ ...:.... 0 Yes . No If yes, what is the condition of the fill? s SECTION C. SOII.OBSERVATIONS 10. Appearance of goilj Gravel Loam Clay Hardpan Mixture 11. Observed from: 0 Borings a Bank cut Backhoe excavations / 1 Soil borings /excavations observed by TS/' (� 1� on 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............ .................... Yes a No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form'ST -1 / 2 N D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes EoNo 19. Will groundwater or surface drainage require special consideiation? ...................... Yes No 20. Will gullies, ditches, etc.- be filled and watercourses be relocated? ............................ a Yes F54No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................................................ Yes No Inspection data 7 Yes 22. Do adjacent wells and/or sewage systems exist? ............................................. ........ F. F No I v . . . 23. Additional comments fLM,4 S r-64IL7 e- (A-Z 7 24. Site observer/inspector and title 25. Date(s)-of ,observation(s)inspection(s) <7 TEST PIT PROFILES Hole# Lot# Hole # 'Lot# Hole# Lot # Depth to water X Depth to water 4J Depth to water -.Depth to ott Jin . Depth to rocklimp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 IVE 2.0 Av�- t. J_ 3.0- Ave- 4.0 64W 1.0 2.0 3.0 1.0 2.0 3.0 4.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water -Depth to water. - -Depth to water .._., TDepth •Depth tomottling • -= - . -..:. .....' - Depth to mottling to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 -.0.5 0.5 1.0 1.0 1.0 2.0 2.0. 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 . 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0' 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # . Lot ,# Depth to water De th to.water. _: Depth to „pater - -- -_ --.:.- " Depth to - mottling ~ _ I „^ Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L.... G.L. 0.5 0.5 05.. -.1:0 1.0.._...... 1.0 2.0 2.0 . 2.0 3.0. 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6:0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0, 10.0 10.0 T'ES'L' PIT PROFILES Hole # Lot # Hole # �! Lot # Hole # Lot # Depth to water t.) /1 Depth to water - �jj- Depth to mottling Depth to mottlingY tilft Depth to mottling - r . Depth to rock/imp. (o Depth to rock/imp. Depth to rock/imp.. G.L. (� 02 G.L. b _ v2 5. G.L. 0.5 - 0.5 0.5 1.0 - V4 1.0 ' % CIL 1.0 2.0 ytif �� 2.0 2.0 3.0 3.0 . 3.0 Cl/11 �. 4.0 if -vas 4,0 4.0 . 5.0 5.0 5.0 7.0 7.0 7.0 8:0 8.0 8.0 10.0, 10.0 10.0 - Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth Depth to mottling Depth -to niottlirig - _ Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. - _ .... G.L. - __ ... G.L. 1.0 . 2.0 2.0 2.0 3.0 ..._. _.__..._ _ 3.0 ..._.-- ._.... -- ._..... 3,0 _ 4.0 4.0 4.0 5.0 _ 5.0 5.0 6.0 6.0 6.0 7.0 - 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 1 'S0 k, Impervious fill distribution ibox' / 'b be � 2y e e "-M,41-27-01 W 23.57' A48-38-34 W 19.54' OeN 44-54-Sp W i8.19, N 42-11-39 1& 24.85- SEE NOTE* 3 2 0, Af Af.1 N/F RHODES OCT -27 -2003 16:50 BADEY & WATSON, PC Btku- Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 P.01/01 Associate Public Health Director Director of Patient Services ATTENTION: JOSEPH PARAVATI ❑. GENE REED All information below must be fgll completed prior to any scheduling. DATE:-..10/271200 BADEY & WNATSON, ENGINEER OR FIRM Bunreying & Engineering, P. PHONE # (84) 265 -9217 REASON: DEEPS. t+a PERCS: ❑ PUMP TEST: ❑ 1 II ROAD /STREET: South Highland Road TOWN: Putnam valley TAX MAP #: SUBDIVISION: n1a_. LOT #: -n/a OWNER: pa Bin Cunningham - NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES N 0 Proposed: SSTS. within the drainage basin of .West B;aucll oa�13o ►ds..a✓grn r.Reservoirs. _ : _ ._ _ - -- : -� .,�� --- .:.g;�posed ;SiS within Sufi feet oi'a're:�ervoir; ies�rvuir stem�� cotir3'at IaiC� - ::a-'. «. • .. ° _..�` ❑ 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ 2 Proposed SETS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Ri Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide :the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY US5 ONLY DATE TIME: _._. COMMENTS: (FIELD TEST) TOTAL P.01 -P AS1 mnw i 7i- R __._ -. TM • 4R-,- 77Q -70P4 AIAMC. 01 1 -rkinM !'rl1 1AITV rlI- 1•'1r11••ITMrI IT 1••Ir n A OCT -27 -2003 16:49 BADEY & WATSON, PC Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 OUEST FOR FIELD TESTING P.01/01 Y Associate Public Health Director Director of Patient Services ATTENTION: ® JOSEPH PARAVATI Li GENE REED All information below must be hfuftl completed prior to any scheduling. DATE: 10/27/2003 BADEY A WATSON, ENGINEER OR FIRM Surveyin & Engineering, P.C. PHONE # (M) 265.9217 REASON: DEEPS: u PERCS: o PUMP TEST: U ROAD /STREET: South Highland Road TOWN: _ Putnam Valley- ­ ­, SUBDIVISION: n/a TAX MAP #: 61.-2.26 OWNER: F. Sutton Cunningham LOT #: n/a NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL 'TESTING YES N 0 0 ro o FO Proposed SSTS within the drainage basin of West Branch or kgyO Corner Reservoirs "'r O�SC �J i' "�i►1�tiu17UV YCG[ Ul'a iesrrvurr; ieservulr si[em bI con[TOi'taYCe.' ' ' "" Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. Proposed SSTS for a Commercial Project. It is the responsibility of the design professional .to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes :to any of the'questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE; COMMENTS: (FIELD TEST) FOR COUNTY USE ONLY TIME: TOTAL P.01 JUL -17 -2003 17:07 BADEY & WATSON, PC FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 MUEST FOR FIELD TESTING ATTENTION: ® JOSEPH PARAVATI ❑ GENE REED All information below must be fully completed prior to any scheduling. BADEY & WATSON, ENGINEER OR FIRM Surveying & Engineering, P.C. G3�l�i•` INA P. 01/01 Associate Public Health Director Director of patient Services DATE: 7/17/2003 PHONE # (845) 255 -9217 DEEPS: ® PERCS: o PUMP TEST: o ROAD /STREET: Jeitemon T. Cunningham TOWN:..-,. Putnam Valley SUBDIVISION: Pi/8 n1a TAX MAP #: w... 61.2 -26 LOT #: n/a NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ��- :.. ----�. _ -Prc' d us 10 `Wah i iu - dlaiva6 41 of `ries`c$laiieii Ui "i�Gj/�i3`VlilleCl 1RC�eTVUYI'3: _ __ - ❑ &a Proposed SETS within 500 feet of a reservoir, reservoir stem or control lake. go Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ 9 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ® Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Les to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE, TIME• /rrrr T Tralr% 7 -PPS7 7 PUMM[ CODIfR DWAE'1fD0'H' OF EaALIB Dleb6n d E " Brim S.e.le.., aimed. N.T. Itat tb Pri►li Pwalt as CRATE OF CO plum M SEWAGE DENSAL STSM rem* . � 3 _ Pw- a+a.w.. o..adA .t Nalow S _ Cwla h. L, >ZeoawaL_ ❑ >te.kih n ❑ Dab of Adher 222 W is Date Subdivision yARRroved Fee Enclosed 2--Amnii;t / <5b srils 'ryes rea.� d Lot Aar 7_00 Fm s«ua. 0b LJ Depm Ydooe li =&W d Deanum -3 Drip Plow G P D 60 © PC® Nell &"= Is Required When Fm Is orlPMted SaPae�M Sewaeap 8yaMn 4 oeetelet d j d� M", Talk �d 333 6 2,V / t To he eanatt�et.d by t""""�`7 r+a&, .. W.aa Ste? 5;d ds Sop* DrMaa by be. I 0111M s q lw ..(r . � 0 C � _ 2. _�S, 3c� 1 represent that l am wholly and completely responsible for the design and location of the proposed systera(U: 11 that the separate sew di sal s stem abaisi:Aaw{Odd will be constructed as shown on the approved amendment there to and in accordance with the sandard; rules a regu ns O m calnty '•bepeitment of M.aRh. and that on completion thereof a "Cert{ficate of Construction compliance" satisfactory to the Commisskmer of Mea thwiil be submitted to the Department. and a written guarantee will be furnished . his successors. heirs of assigns by. the bulkier. that said bupd.r will place'.,4i'good operating condition any pat of Yid sewage disposal syst durins t period of two (2) Yeas immediately following the date of the Nw- ante of the appfotal of tM CatNkat. of Construction Compliance of M original stem a any rape o; 2) that the drilled west d.splb.0 above will be located es shown on the approved plan and that saki wall will be Inst Iled In ►den with b>ti Pules and ra/u ohs of /the� Putnam County Oe0 Ulm of Walsh. ✓ o.a '� Aaa..•• 2qZ � /(�S/ �k.l,:. No P.E4.A. 3736 APPROVED FOR CONSTRUCTION: This approval GXPIres two yeas from the date issued unless construction of the building .Ms been undertaken and is revocable for cause Or may be arrlli d or modified when considered necessary by the Commissioner of MMRh. Any change or alteration of construction raquku a new permit. Olr.d for disposal of domestic senitay aawag., prorate water supply Only. 0/88 Data �- -`��C. /%%a by ''�.�— Sri' -�"' �.�'` The DEPARTMENT,OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTERS CARMEL, N.Y. 10512 (914) 225 -0310 .. APPLICATION TO CONSTRUCT A WATER }WELL PCHD PERMIT 4 WELL LOCATION Ste t Address To Village C Tax Grid Number WELL OWNER ame CuuIv.1`� Mailing Addre s vase 22Z W IS- S� AM, /t4y, OPublic USE OF WELL 1 - primary 2 - secondary SIDENTIAL ® BUSINESS ® INDUSTRIAL. ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify (].INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT S 0 -t gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 0(00 gal 13 UDIACE EXISTING SUPPLY 13 TEST/ OBSERVATION C3: ADDITIONAL SUPPLY ONEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR •DRILLING ,Z/ -e WELL TYPE ODILLED ODRIVEN ODUG []GRAVEL OTHER IS WELL SITE SUBJECT ?TO FLOODING? YES 'J NO IF WELL IS LOCATED IN A REALTY SUBDIVISIONS NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ko �-e Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAM OF PUBLIC WATER SUPPLY:*. TOWN /VIL /CITY t DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: - yj LOCATION SKETCH &,WRCES OF CONTAMINATION PROVIDED TlA 316N- SEPARATE SHEET �' (date ) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 s.hall- 1> Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provide& by the Putnam County Health Department. Date of Issue: -3019 �',2. Permit Is-suing Official-­0 Date of Expiration: 19 Permit is Non - Transferrable �� copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller • • a • �a v i a• •+� DESIGN DATA S=- SUBSUFACE S9,7AGS DISPOSAL SYSTEM ~ FILE IJ�. Owner �u ` F�u�v� Address Located at (Street) l- ` ,D l "Sec. Z Block s Lot 2.)L clicate nearest cross.street), ( i , 4 �T�unicipality { c:4::' °':'�- Watershed: a: SCII, PERCOLATICN TEST DATA RDQUIRM TO BE SUBMITTED W`= APPLICATIONS-" Date of Pre- Soaking ' $ ° Date of Percolation Test :J HOLE NUMBER CLOCx TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No.. Time Ground Surface In Indies Soil Rate. Start -Stop -Min. Start Stop Drop Iri Min /.In Drop Inches Inches Inches X 2 3- 3� i .4 5 5 1: Tests to be repeated at same dept}i until, approximately equal soil rates are obtained.at each percolation test hole. All data to'be submittbd for review. 2.. Depth measurenents to be made fran top 6f hole. rev. 9/85 4 , 2 • •; 3' 4 5 1: Tests to be repeated at same dept}i until, approximately equal soil rates are obtained.at each percolation test hole. All data to'be submittbd for review. 2.. Depth measurenents to be made fran top 6f hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. l HOLE NO. ZZ. H09 NO. 29 LE I 4 60 78 88 109. 12' 131, 141 M RICT, INDICATE LEvEr, To WHICH WATER. J= RISES AFTER BEING EN=UNTERED DEEP MOLE OBSERVATIONS MADE BY: DATE: DESIGN So . il Rate Used ­87�;)Q` Ydnli" Drop: S.D. Usable Area Prbvi No. of Bedrocms 3 septic Tank Capacity a 0 gals. d Absorption Area Provided By 33 L.F. x 24" width trench OF NEIV Other Name Signature Address- 772 SEAL WE. /Os/l 4'O. THIS SPACE.17OR USE BY HEALTH DEPAR24ENT ONLY: Soil Rate Approved sq. ft/gal. CQecked by ^ Date f PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH, Division Of Environmental Health Services 110 Old Route Six .Center, Carmel, New York 10512 (914) 225-0310 Mr. Frederick A. Zenz 292 Main Street Nelsonville, New York 10516 Dear Mr. Zenz: ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr„ P.E. Director September 20, 1989.., Cunningham Highland Road P.: V. 23 -5 -2.12 Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: �1. Please show and label how sewer line and PVC pipe will be protected under driveway. Label both cleanouts on plan. It is recommended at least one drop box is located between septic tank and the first trench to decrease the flow velocity at the first J -box. !r' -i :c "Oratil �__iioT' $hCW11 profile not shown on plan. + Please provide north arrow. Please note volume of fill on plan. Proposed contours not shown. ; Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM /jp Ver�Y) truly yours, Robert Morris Assistant Public Health Engineer n. =. v t\ ..T.. _ . .... �.+T -. _•L.'.- �•ri r .d- .y�.s+.. � rt. xt _ . .. .. • .._ X PETER C. ALE XANDERSON County Executive 0 DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Mr. Frederick A. Zenz 292 Main Street Nelsonville, New York 10516 Re: Proposed SSDS: Cunningham Highland Road P. V. 23 -5 -2.12 Dear Mr. Zenz: ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director September 20, 1989 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has -been completed. Comments are offered as follows: 14""11 Please show and label how sever line and PVC pipe will be protected under to 6"Inx driveway. Label both cleanouts on plan. It is recommended at least one drop box is located between septic tank and the first trench to de�reseY flow elcit - _ - - ~-` -d `- :° °riybraulic profile- not shown on plan. Fill profile not shown on plan. *6. Please provide north arrow. 7. Please note volume of;fill on plan. 8. Proposed contours not shown. Upon receipt of a submission, revised to reflect the above comments, this application mill be considered further. Very-truly yours, 6eo hA11 Robert Morris Assistant Public Health Engineer RM /jp PU'TNAM COUNTY DEPARMaU OF HEALTH - DIVISION OF ENVIRON ERML HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS +� P FIELD INSPECTION REPORT IL _ ,._.= ;�'ii/`��1.IL�aA r ; ... , ...- ..__' >._..� /(�f•�C /;1✓��- D.H. 1 Lot - Depth to G: W. Depth to rock -d -L% Soil Descrivti< 0 ft. 3V, L"in CL' 3 ft. 6 ft. L C: h`i` ID ' 9,ft. D.H. - Deep Hole G.W. - Groundwater D.H. 2 Lot D.H. 3 Lot Depth to G. W. c1c/�v_ Depth to G.W. Depth to rock -unc•� Depth to rock 0 ft. 3 ft. 6 ft. 7' 9 ft. 12 ft. 12 ft. Soil Description Gam' • 0 3 6 9 1 DATE: FINAL SITE INSPECTION INSP.BY: YES NO House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Rom allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural-soil not stripped or SDS area unnecessarlygraded.......... .... ......... 10 ft. maintained fran property line and 20 ft. fran house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench................ 15 ft. of peripheral soil horizontally fromtrench ..... ............................... Boxes properly set......... .......... ....... could surface runoff fran driveway, roads,, ground surface,, etc., channel near SDS area.... Does lot drainage appear OK,Jn area of SDS::....•. FINAL GRADNG OF SITE ACCEP'rARr.F .................. , . APPEMLC B PUT,"iPM OF E&UT- - Dr7ISILN OF ENvZ3C.T.M-atLPL EmaL-�d LYLI�ir UAL KAI'ER SUPPLY & SUESUP = DISi -CaAL SiS'Mjc- (:JcSIP of Cam• =''F I =- I NO I i 1 0 ti-r f_ccc e: _��. .I_�- I I t --J ft. reservoi_, e:C. U I. i I I, I i _ I I I I I I I 100 L� kAZA I I o I I I Vi 1 I F --- C'TC'jT�titC I A ft. ..=41 'I notes I depth Cc' ces 1 I I 1 0 ti-r f_ccc e: _��. I I I --J ft. reservoi_, e:C. U I. I I I, I CCC'�YTS . I P__ -1i= FmoliCaticn C: r_- AL'at-- :escuum_c1 Plans - n.1 -ree sats s /•s t E..cin —s Amt_'1or =Z�t' Cpl I Dasi 1 Dct✓ s��E (cam) SUS- -cN Dew acle L."'c - Ccnss t=n t perc mss.. (_) F:_i — I Ps---- able Depth C.4 �7L E usa P�/JG^iC - 1'NV _- Wei ?_ Q/n . �? ♦l T.�� C, S1. - •T-_s_cr, P.ppr ''va- Da t- Ca Di,S Plans & P°"_!? t RECU! RED Dili. - i C C-N � � � �: - 4 P _ D C J SCX, 1C: /C-= °r:T i P'-• w P' = C__S s�C� ic �� - si3 =, ra it we_� 1 Der i 1, Se =-�_CS Li _� i= cve_ "L'C = =CA- Twc -Fcct Contours Ex S t_ 1c Dr v,e, v & Sloces C_,t Dra!ns (C_sc.1c.TGc CK) Perc & Dee'o Holes B°- r ser- L1VE or prim `1 ani `` -- ansicia E` - ar —sica n?"�.S;SnC+vi7;CraTJlt_T r_Cd,suf -. size I= P'.m.^_ Pit & D Bcx Shcwz & De ails Ecuse - No. cf Bed--=.S We'-is & SSCS's w /-J_3 200 ice. CL Pr—A Pr:,_e--ty 'Metes & Ecunc:. ECUSa Se Necesx -r_i (T G_;1 t lot) House Steer - 1/4"/=L;---. 4 "0; `Lire Dli e No Be- ; Max. Ee_ ^.-c 45° w /c? uncut SEPaRATI N DISZ =ti=, Sp:-C=- CV PT AN F? eiCS 10' to P.L., DriVcv2'T, T_es,Tcc Cf i 20' to Fcund -- ticn 6vaiis 100' to Well; 200' in D.L.O.D, 150' Pi- 100' to St= -rn, WEt=r=, u-r=e, TZ KZB (?P•C. ex-z 15' to Dr ? !1s ��*' -,3in, ITca_ , Fccu!1c 35",z ='t.C'1 .S1A,SiCrTa:�G? RIc1 ^✓S Gvct�'�C 10' t0 .eater Line 50' lIIt=r i - :? ^_L ClY° 7 n_r- 2 Seci'C `1ar}- 10' fran F- CunCr.t_cn; 1 L..� '•�, m PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at ��Jl (T) Section 2-3 Block Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 2<,z a duly licensed professional engineer or registered architect (Indicate ..to apply for a Construction-Permit-for a separate sewage system,.-to serve the above noted property in accordance with the.standards,.rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of.said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the.Public.Health Law,. and*the Putnam County Sani- tary Code. Very truly ou s,. B Signed Countersigned: Owner of Property P_ Address Address n ��Xtie..v,►sl�� �=�- 10516 Telephone Town?_. 33 Telephone'