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HomeMy WebLinkAbout2756DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -20 BOX 23 r -: I I I ,i �tL A •� .1 WIN �. 4. �� f - 02756 PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWA T SYSTEM PCHD CONSTRUCTION PERMIT # ©Z_ A -91 �� D Located atq Town or Village h prm 4 Owner /Applicant Name u l wers, Tax Map Block I Lot ZO Formerly DO ae:.(3 Lail- , Subdivision Name �(�� Lo V,/000 r_'M o /�S Subd. Lot # a' f. s Mailing Address P® PJQ 47Z ► % /¢ _ ds, i-f Zip 1: 4- 7 Date Construction Permit Issued by PCHD Separate Sewerage System built by 5M12 B01 We, M Address fp DOX4LZ V��� Consisting of _�� Gallon Septic Tank and /�� 04 2, PT.t4) ice- `rFr®rr.LpG Other Requirements: 126D a L Pomp Water Supply: Public Supply From Address or: V Private Supply Drilled by rt JC6 Address 9�_ ..__.._ ..La..d.ng :, •.��..�- , r � - - Iids civaivil CuiluOl uccri COiiljllCi:ed%' ' .i'`'�_ "' g d Number of Bedrooms Has garbage grinder been installed? 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 offtPutqanY'C_4nty Department of Health. Date: 9 li 0 Z Certified by Address P.E. ✓ R.A. License # �501!�_o C 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 ve� soon as a public sanitary sewer becomes available and the approval of the private water supply shall become n 1laa'd22,�,ik(#e when a public water supply becomes available. Such approvals are - subject to modification `o'izchange judgment of the Public Health Director, such revocation, modification or change s, necessary. J ; f By: Tit'l ate: p ite copy - HD File; Yellow copy - Building Inspector; Pink copy -.Owner; Orange copy - Design Professional Form CC -97 ..�•., . •, - �;�: �� �:: i v' �` , . _ : .: -.:: _... � ... ,_ ... , . _� . _ ;�C:�T i rs = ��bli�i:ii�'tiil R.�•i.,`1'�.�:;a. - ,:,�: Public Health Director ti� 4V O�� V Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278.7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 !Early Intervention (914) 278.6014 Preschool (914) 278 -6082 Fox(914)274-6649 E911 ADDRESS NERIFICA1- 10N FORM ®WIVERS NAME: m rP 5c),Loers �.lC TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91IVERIRM) _... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN_ TAL HEALTH SERVICES _ _ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM &2 I 2J Owner or Purchaser of Building' Tax Map Block Lot T -F3 iLor=u 7.4C PO 1/e Building Constructed by Town/Village q R=� giLL 1264 -o ALPYi000 141,0115 , Location - Street Subdivision Name Coh�nldL Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the 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: Month _ Da Year O �— General Contractor (Owner) - Signa e Corporation Name (if corporation) Signature: 1 Title: -5m D vItAeo�-, Corporation Name (if corporation) Address: C6 ? Z Ptft)-1,M Q14 Address: / b " State Zip `/ 0 5q 2, State i- Zip 1054 Form GS -97 IPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT ®o¢e y Address: C� A�a n , �_ C Tax Grid # Map (`'J- Block I Lot(s)�i Well Owner: Na s ddress: � > Use of Well: fl- primary 2-secondary _� Residential Public Supply Air cond/h t pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 6 ft. Length below grade $� Diameter " in. Weight per foot alb /ft. Materials: �C Steel _ Plastic _ Other Joints: _ Welded -,e-'Threaded- Other Seal: -,A Cement grout _ Bentonite Other Drive shoe: 7-- Yes No _ Liner Yes _�,< No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield /0 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or ;sieve analyce:c 'are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface i �- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type S,j Capacity t- 4-> Depth 7-1fo i Model Voltage LLo HP Z Tank Type L- Volume S- "Ler►, Date Well Completed L9-3 Putnam County Certification No. Date of Report Well Driller (signature) NuA iE: t';xact location of wets wrtn distances to at least two petmanegt larttimarks to be provided on a separate sheet/plan. Well Driller's Name Address: /4 Signature: � ,6�4 Date: y White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights. N.Y. 05 - Albert H. Padovani, Director ` LAB #: 93.300388 CLIENT #: 56295 NON STAT PROC PAGE 1 SMP BUILDERS DATE/TIME TAKEN: 02/13/03 11:30 PO BOX 472 DATE/TIME REC'D: 02/13/03 12:00 MAHOPAC FALLS, NY 10542 REPORT DATE: 02/18/03 PHONE: (845)-628-0854 SAMPLING SITE: #4 ROCK HILL RD, PUTNAM VALLEYr NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: PAUL B. JEMPERATURE..: <4C NOTES...: COLIFORM METH" MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY P PROFILE 02/13/03 M MF T. COLIFORM A ABSENT / /100 ML A ABSENT 1 1008 02/13/03 L LEAD (INS) 1 1.1 p ppb 0 0-15 ppb 9 9101 02/13/03 N NITRATE NITROG < <0.2 M MG/L 0 0 - 10 9 9139 02/13/03 N NITRITE NITROG < <0.01 M MG/L N N/A 9 9146 02/13/03 I IRON (Fe) 0 0.110 M MG/L 0 0-0.3 mg/l 2 2037 02/13/03 M MANGANESE (Mn) 0 0.019 M MG/L 0 0-0.3 mg/l 2 2037 02/13/03 S SODIUM (Na) 8 8.84 M MG/L N N/A 02/13/03 p pH 6 6.9 U UNITS 6 6.5-8.5 9 9043 � 02/13/03 H HARDNESS,T8TAL 2 218 M MG/L N N/A 02/13/03 A ALKALINITY (AS 2 222 M MG/L N N/A . 02/13/03 T TURBIDITY (TUR 1 1.5 N NTU O O_5 N . COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCOR E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggeytyd guidelines state that for people on a sodium restricted diet4the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Y kto - 10598 Albert H. Padovani, Director | LAB #: 93.300388 CLIENT #: 56295 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SMP BUILDERS PO BOX 472 MAHOPAC FALLS, NY 10542 SAMPLING SITE: #4 ROCK HILL RD, PUTNAM : KITCHEN TAP COL'D BY: PAUL B. NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is suggested. DATE/TIME TAKEN: 02/13/03 1030 DATE/TIME REC'D: 02/13/03 12:00 REPORT DATE: 02/18/03 PHONE: (845)-628-0854 VALLEY, NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: 14F ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF- THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. ,SOFT WATER: 0-70 MG/L VERY HARD WATER A 300 MG/L '� ,.` . ` -. �'----- HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: ( Director on'' ELAP# 10322; PUTNAM COUNTY DEPARTMENT OF HEALTH t DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION -• - -'- ar.i «.i_. _ ,�, _ ,.. x.,.5.n:::, -.,'a•`sa..::;,, >n..... a r a,- r- .. .v .e...r.. ....� Date: ' !3 7�I dQ��� ..:..,.� . -.• " Sii66f Co cation 41'9! %i.� Owner MP 611;111,6-C ,�,bLw Town P te W t/w�� Permit # TM # h a -( '_10 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 ...... ............................... H. Sewage System a. Septic tankTize - 1,000 ......... 1, 250 ... ......other ................ b. Septic tank installed level .................................... :.......... c. 10' minimum from foundation ........... . ............................. d. i tribtuio Box 1. All out is at a elevation -w er tested ................. 2. Protecte low frost.: ................ .....................:......... 3. M' ' um 2 . riginal soil between box & trenches Junction Bo - properly set.... ............ 1. Lend required 0 o Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. ,Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface.................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 -1 %" diameter clean .................... .9. Depth of gravel in trench 12" minimum ................... g. gump or Dosed Systems ! �� Size o pump chain er..... 'l.P.....y... " j �. ......... 2. Overflow tank ................. .................:........, ... JJ 3. Alarm, visual/ audio .............. .............................. / 4. Pump easily accessible, in to grade................... 5. First box baffled ............:.........•.... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. ouse ui din a. ouse ocated per approved plans :............ .................... b. Number of bedrooms ................:..... ............................... TV. Wesel Well well located as per approved plans . ............................... b. Distance from STS area measured '> 100 ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .................:. ............................... b. All pipes partially backfilled.......................................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan..` f. Curtain drain outfall protected & dir.to exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 Form - �i j �t F a y ox `t � n ►� s 'i P .i is i O ' —J ' a S. �, f ► s 4 V ah'Z b i 0 q a- PUTNAM COUNTY DEPARTMENT o-F- �I1G&lj7 �,., :_x :.::,. :;i :6.;:= ::.=�, VTSi��`)�N'IItON1VIENTAL HEALTH SERVICES ATTENTION 11 ADAM M` ENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # %e Located: _ (T) (u) _ Owner /Applicant Name: aM P- � �- e� - TM .,l Q Block �._ Lot ZP Formerly: L Subdivision Name: _.t[ d, ,N Q o o Subdivision Lot # —14 0 /S" Is system fill completed? 14 Is system complete? Is system constructed as per plans. A Is well drilled? Is well located as per plans? _ Date: Date: 9 o Date: �j 60 Z-� Z Are erosion control measures in place?L 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. r �, PE~ 1 BRA Date:` �'- _(;effif ed b. .tip � y. /DesikA Professional Address: L0 bDY 95v Lic. Comments: Form FIR -99 Public Health Director DEPARTMENT *OF HEALTH 1 Geneva Road, Brewster, New York.10509 Associate Public Health Director Director of Patient Services 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 September 16, 2002 Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Field Inspection - SN 4P Builders Formerly Doebbler Rock Hill Road, (T) Putnam Valley Dear Mr. Fredriksen: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been subtnrtted_to this =De artment. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, 1 Gene D. Reed GDR: cj Environmental Health Engineering Aide 10/01/02 TUE 10:59 FAX 9146280571 PANCO PLUMBING INC IR 002 r ��rar�nnrsr� r� cPnc,Pr:.rr�r.PrJ[.� cEnci3cP tJ� rt�Ir_Tr?PrJ�rJ�c1c1'cPcJ'cP II BY THIS ERTI-FICATE OF COMPLIANCE THE ill ��/' ����� ��i�/�1�•� ��` � �,�� ���r '"��1if- ���'��•�:�•�Y;,._:;,I BUREAU OF ELECTRICITY - S 40 FULTON STREET- NEW YORK; NY 10038 5 CERTIFIES. THAT Upon the application of ALL STATE ELEC..(•BARTOLOMEO,: P.O. BOX 11 MAHOPAC, NY 10541, upon premises owned by PANNY LOUIS CIO SMP BUILDERS PO BOX 472 MAHOPAC FALLS, NY 10542 Located at ROCK HILL ROAD PUTNAM'VALLEY; TN, NY 10579• rca ion urn 1082622' - - z - Certificate:Numilw:: -1082622 ` Section: Block: Lot:. Building Permit: BDC: W106 Described as a Residential occupancy, wherein the premises electrical system consisting' of. electrical devices and wiring, described below, located in/on the- premises at ' Basement, Outside, 5 was ins ected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found:to be in compliance therewith on the' 26th Day of September, 2002. _ . - � � .ham... _ .... - '_ .. a .. .. _ .. � .- . - •id �.4.- an.._.-.',°,._. ,p�$��... - rC.. ;♦ T� , .�...,.. _. . ... -.- .. . q .' ... ... . _ _., ... �j Additional Charges S5 SEPTIC PUMP & ALARM SYSTEM 'S LIC # R1102 Alarm and Emergency Equipment �J Panel Board 1 Alarm _. - • • . C s '! "1' IF $• IW W. Ulm% seal 1 of I This certificate may-not be altered in anyway and is validated only by the presence of a raised seal at the location indicated. OCT -1 -2002 TUE 10:58 TEL :845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 BRUCE R. FOLEY . _, ... ?ice: -: '- Pe:�ltli�- •L'rrEt.��. ,. �,,.:._ . .. - ....= ....:- ..... _ . ,.... - LORETTA MOLINARI R.N., M.S.N. . � <.v ::_;, .,, - -: =riiSSUC'.fit% ^` i371G:ir' i:yc:S`S;T- "%ii'�i:tili -. •' ; .` . •� — 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 Date: 2oG >C llz4G- %V! r P, V, ]From: Gene D. Reed Putnam County (Department of Health For your review As discussed Notes/Messages Fax #• 420 _a6 a(V No. Pages l (Including cover sheet) Please respond ' t ached as requested (Tease call O2 /,;' 3; ©4 In the event of transmission/reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. SENDING CONFIRMATION DATE OCT -11 -2002 FRI 09:13 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96286520 PAGES START TIME : OCT -11 09:12 ELAPSED TIME : 00'27" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 4 k BRUCE R. FOLBY LORBTTA MOLINARI RN, MAN. PrMN NdlA Orneertv Ar.ka P.W /Iamn DNS DEPARTb ENT OF HEALTH 1 Geneva Rosh Brenda, New Vork 10S09 c..a...rmi netlat (NS)ate.aoo ra 1M>)278. 7921 Nome senior (ia5)2r8.6958 wrc (WJ278.6M %(u)278.6069 sar0' rs,w.uio (eas)m -none Pisan (145127= 1�,,(942)271.6644 FAX COVER AHEET i Date: To:r irr�UrtiGic56a�ii I+ax N: 6 b 3[i _ _ i - �i.' —� (Including cover sheet) i From: QggLV. Rtad Putnam County Department of Realth For your information Plane respond For your review Attathed an requested As discussed ! Pl ase wU NotestMessages &elP E — 02 3 ` O� �— i i i k In the event of traasmisilon/reeeptioa difiicakies, plane tontact this office at i (845) 278.6130 enm 2261. BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. ... • 13.: di:. R�.::iii ✓a'EL`:Ji`' � _ Director of Patient Services DEPART'N ENT 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 Date: %1 , .� /0 2 lk i 11dP 'LAS' Fax #: 0/%Z'5— 6S 0 No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health - Q r your information _ ]Please respond For your review Attached as requested As discussed ]Please call Notes/Messages f � ���C ��%x r In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. SENDING CONFUETION DATE : SEP-25-2002 WED 16:06 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 96286520 PAGES START TIME : SEP-25 16:06 ELAPSED TIME : 00'26" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. • BRUCE EL FOLEY LORSTrA MOUNARI ILN, KS.N. PAVO Hm" Dftctw A—dft PUNk Al- fth D4.1> blr ef padw serwm DEPARTbMM OF DFALTH I Owwm Road Bwwster, New York 10509 2-b--W IWO (241)2M-A130 Fa(N5)3"-M1 Nurq ­ 9*" (945)271-635, WIC (113)171.6671 Fa(W)VI-OM 1Adj1smvt "(PA5)272-6014 Fft"boW(SM27"M Fa(245)273.6642 F Myrg xRxET Date; 1, Co- No. Pages Zz 72 (Including cover Meet) From: Putnam County Department of Health For your Information — Flaw respond — For your review — Attached as requested — As distimied Please tall Notealmessna— aAja-l? _;QW, I . �7, ; in the event of humhniontreceptlon difficedtICS, plemc contact this offlee at (945) 279-6130 mt. 2361. 10!01/02 TUE 10:59 FAX 9148280571 PANCO PLUMBING INC P.O. FM COVER SHEET Box 472 Mahopac Falls, Imo' 10542 (845) 628 -0857 office (845) 628-0571 Fax El "Wd LJ Y AW ❑ P ¢ E) Pkmo mWiew [] For your kdbm Om l dW pops, indu ft Dover; COAdMEM►S fa 001 ..... ...... ........ . ......... ",-*"*,-**** ............ * .................... * ......... *,-",* .......... . ........ ...... ........... ............. . .......................... ... I—. ....... . ........ - J _ _ I w. ............._ .............. ......................... I ... ............ ...u..........- .......... ............................... ................ ..............I................ .................... OCT -1 -2002 TUE 10:58 TEL :845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Or ENVIRONMENTAL HEATLII SERVICES. FIELD ACTIVITY'REPORT NAME: 4hnRESs :_124?a kill, Street Town State Zip PERSON IN CHARGE F i i PUMP TEST Tlata- %O DOSE TEST REQUIRED GALLONS IT TI (A In EL. START A EEL. STOP Signature and Title RFPnRT RFrFTVFT) RY: A/1 I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. �X f 'IN PUTNAM COUNTY DEPARTMENT OF HEALTH ID SIGN OF ENVIRONMENTAL HEALTH SERVICES atu �..:•+:.�. N��.. r."_ :._.._r....w�'a .-.aY '.+. :. w. �.- .1_.•.u.v. M.:'Or�•_.. ... !!.•..y.a+n- +."a. ...1 .. Ksr...:._r.. � w. ... wnsr.l'.y�en�iA+u. - ..r,�.qr.. /�R .. • ++'Ni �M -i .1 :Y. °yy ..ti ^: is Ye CONSTRUCTION PERMIT FOR SEWA"TRE MEN T SYSTEM PERMIT # y % 0 �— Located at R aGy— H 1 L L R OA D Town or Village PuTdA FI VA L -.5 Subdivision name W I L W60 D V0ou.5Subd. Lot # L4�15 Tax Map (oZ. Block I Lot ZO Date Subdivision Approved 19 Q--2> Renewal Revision Owner /Applicant Name IVI IG 1IA FL MbE P0LEIZ Date of Previous Approval Mailing Address Kp H I Lt_ ROAD PA)T4M VALLEY Y Zip 105 Amount of Fee Enclosed 3 DO. Building Type I FA Fj I I.Y e.ES. Lot Area Z AC, No. of Bedrooms 15 Design Flow GPD I DD® Fill Section Only Depth Volume PCID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Seaparate Sewerage System to consist of 1500 gallon septic tank and C-P Z5 L.F. aF_ WN Other Requirements: P U M P E M To be constructed by Ova/ of E V Address Water SunsnYv: Public Supply From Address - _ ® )'rivate Supply Dri11ec1Yby' f 1 jf r 4 A" 7 T es PUTP AM VAI -LEY, IJ .. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the soarat� a 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 sewa ent system during the period of two (2) years immediately owing the date of the issuance of the approval offe onstruction Compliance of the original E �"AA system or y rep ' s thereto. CAP tioR sr� Signed: RA L s 4Z a " ' Date ©z5 O Address rT: C,0 f0 1 -cwl- H U ; ` ense # - APPROVED FOR CONSTRUCTION: This approval expires r $ff9 a 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 newffierinit. ApproveA for discharge of domestic sanitary sewage only. Title: Date: CX7— 7'0 2 White copy - HD ile; Yo copy - Building Inspector; Pink copy - ner; Or ge copy - Design Professional Form CP -97 Slice of PUTNAM COUNTY DEPARTMENT OF HEALTH _ .,DIVISION.OF ENVIRONMENTAL HEATLH,SE.R - ..a. FIELDlACTIVITY REPORT A T�RE444 f Street PERSON IN CHARGE A IV, Town State r Zip //� Name and Title —r i TYPE OF FACILITY: FINDINGS: V6vz i b / � �CF-A REPORT RECETVEI) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. PUTNAM COUNTY DEPARTMENT ®IF HEALTH gDlVffSRON DE ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATJFI[8 WI�IL�r _. o _pea _- print o ..tyP PCHD Permit lease riot or e Well Location: Street Address: Town/Village Tax Grid # RpcKHILL P.OAD PUT4MVALLEf Map (2. Block I Lot(s) 20 Well Owner: Name: DUEBBLE12 1fddress: RCt-,1G41LL ROAD PUT dAMVALL Y.10579 Use of Wells Residential Public Supply Air /Cond/Heat Pump Irrigation I -g rima>ry Business Farm Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served 5 Est. of Daily Usage I CoD gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason p D tJEW RES I DE �G for Drilling Well Type _� Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a reaity subdivision? ...................................... ............................... Yes X No Name of subdivision W1 LD16MC,> kI OLL6 "l�LCr-,IGP "FILEoMAP 1i Z7S Lot No. 14 5 Water Well Contractor: A►Jos9_4_z).l DP.ILUI A Address: EIA26gEQST. P9T'JAMVALLEY Is Public Water Supply available to site? ..................... :........................................... Yes No _y/ Name of Public Water Supply: t�IA Town/Village t PA Distance to property from nearest water main: �A Proposed.well location & sources of contamination to be provided on separate sheet/plan. Applicant Signature: - -.; PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. 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 wat r well driller certified by Putnam County. Date of Issue Permit I 0 ci Date of Expiration r2A_04 Title: IPelrmit is Non- Tlransfferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 f 14184 PM) —Text 12 PROJECT LD. NUMBER 617.20 SEQ 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. MICHAEL poE L Do L 3, PROJECT LOCATION: `' Mun4wity VALL9Y County L) 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) A110 05CAWA�A LA KE P-c:;)Ao 5. IS rED S ACTION: w ❑ Expansion ❑ Modiflcation/alteratbn .6. DESCRIBE PROJECT BRIEFLY: T'P,0G:'I0 �0 A S16 LE F,QMILYP- C5 IICNc��St) 5L) FAe--e_ - 5E 7. AMOUNT OF LANDDQ AFFECTED: Initially acres Ultimately acres 8- WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING (LAND USE RESTRICTIONS? <es ❑ No If No, describe briefly 9. VI(1iA713 PRESENT LAND USE IN VICINITY OF PROJECT? ;j LR'esldendal ❑ Industrw ❑ ComrneroW ❑ Agriculture - ❑ Park/ForesilOppn space. ❑_ OtJL er _ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR RINGING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE QR LOCAQ? Yes ❑No If yes, list agency(s) and pennit/approvals ToVV IJ oI= F 0TJAH \/AU F-Y 50I LC)1 1�G DEPT PL7ri4AH CWIJT( 4 i. DEPT 11. DOES ANY' /mot OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and perndt/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Cl Yes o I CEA7� Tr FTJ PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor names �' Date: 151 al 'L Signatures .jam tt -MS�wv t7 w; �� f��r if the actin y ea, and you are a state agency, complete the Coastal �Ml�r m before p roceeding with this assessment � t' PART I1--- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEgP.ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes No B. iMILI'AiCT1tiN MEL'EiVI: �.tiOril7ttJAi�D'HEiIIEW 1S PROVlDt i1 FOR 11NLIS"i'ED ACT'fONS IN 6 NYCAR,�PAR 617.6? �Ii No; a negative declaration may be superseded bother involved agency. Cl L� Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage. or flooding problems? Explain briefly: C2 Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefty: C4. A community's existing plans or goals as offictally adopted, or a change to use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent developmpnt, 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 Cl-CS? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. `t v D. WILL THE PROJECT AVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CFA? ❑ Yes ZNo _ z -4 S Cyr — C—R1�.TH , UK E-11! C:,: C ll tN0Va,T. Rc�. T ":!E �'t:NV",nC` .ACC —, ti T.'.PA�. i Dyes t ta�No If Yes, explain briefly PART III— DETERMINATION OF SiGNIFICANCE (To be completed by Agency) INSTRUC71ONS: 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 0.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 and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY ur. Then proceed directly to the FUH EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts' AND provide on attachments as necessary,Ahe reasons supporting this determination: Name or Leaa Agency _ Print r ype N me of Resp i e Officer ln,,.Le#4 Agency Title o Responsible Officer I L A Signature of R le Off in=, Agency I Signature of Preparer (if different from respons e o 1cer Date 2 RALPH G. MASTROMONACO,, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New Yorkpp 105(-20 _.•• :k 105F 1 =ui GG' "�5' �1j G /'I -LC,G�I 1 U% - - Mr. Shawn Grogan January 29, 2002 Putnam County Dept. of Health 1 Geneva Rd. Brewster, N.Y. 10509 Via US Mail Re: Proposed SSTS (TM# 62- 1 -20), Doebbler Rockhill Road, Putnam Valley Dear Shawn Please find enclosed five (5) signed and sealed copies of the drawing entitled, SSTS Plan Lot 20, Map of Blocks 'M' to 'S' & a part of 'I' of Wildwood Knolls, Rockhill Road, Town of Putnam Valley, Prepared for Michael Doebbler, dated November 12, 2001 and revised January 30, 2002. As per your review memo dated January 28, 2002, we have made the following revisions to the drawing: 1. Adjust the pump dose to provide; 75% of pipe volume per cycle. 2. Provide FEMA note on plan. 3. Provide erosion control for well and location of water service. 4. Provide distances from two property lines to well. rr�/':.�iin� 4 �����v�e- Nn/ri:»r C\\ �I I�f• -6 -'r4 ( , -tC fPyl°P- .nom ?.. 06i r _. -.. .,.. .. .... �. ... _.. 'ill 111�J l I IIG VGV G'i �i'1 {r'y ai e�iv ai'i IlJ ,I V.w. ,VV Please call me if you have any questions. rely, G. Mastromonaco RGM /soc Enclosures BRUCE R. FOLEY Public Health Director DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 Fax (845) 278 - 6648 January 28, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Ralph Mastromonaco, PE 13 Dove Court Croton on Hudson, NY 10520 01 Dear Mr. Mastromonaco: Proposed SSTS - Doebbler, Rockhill Road TM# 62.4-20, (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: Equal distribution is recommended for a pump system. The dose provided on the plans is over 150 gallons more than is required to achieve a ^/75% of pipe volume dose of 306 gallons. Please revise accordingly. ..- Pr- . RF\f1 1(111 ^v �r - �i�'. i ;'a�i "riiii ri a �� arrl' - rntP, �t'YYO n ��i� PY'Y CIC tx ,i lin ovit. ; .a ]- � e_._ l_ .d r,. __. _ . i . «ry; r a1__ s �.1 - -b - o�_w�.-__:, riw�_ 200 feet of the SSTS. 4. Provide erosion control for the proposed well and show the location of the water service / connection. Provide the distance to two property line from the proposed well. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan . Public Health Technician SR:cj PUTNADI COUNTY DEPARTNIENT OF HEALTH DMSION OF ENVIRONT fM'NTAL HEALTH LN- DIN'IDUALWATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS NANIE OF OWNER: REVIEWED BY: z I N DOCLtifE \-IS UPEP -MII' APPLICATION lZJ(-JNti'ELL PERMIT OR PWS LETTER (/)UPC -97 UULETTER OF AUTHORIZATION Lam/ L__)DESIGN DATA SHEET (DDS) UUCORPORATE RESOLUTION L!UUSHORT EXF LjL,)PLANS -THREE SETS (JL-)HOUSE PLANS - TWO SETS UUVARiA \CE REQUEST ) SUBDIVISION /f �� (/JLJLEGXL SUBDIVISION L JVJSUBDIVLSION APPROVAL CHECKED UL JPERC RATE L__)(,e-)FMLREQUIRED DEPTH ULCJCURTAL`f DRALN REQUIRED GE` 90CATED rl NYC WATE D ( -JUPL D TO EP U A _ CHD -DEP APPROVAL, IF I, C�L DEEP TEST HOLES OBSERVED -3 ' UL-JPERCS TO BE WMLiESSED ( -JL_ j/ EX- APPROVAL SSDS ADJ, LOTS L_j(- WETLANDS(TOWN/DECPERbIITREQ'D?) (LjLJDATA ON DDS PLANS & PERMIT SAME (-Z( )PRE 1969 NEIGHBORNOTIFICATI qX- :.1.- _:).�i�LFTTERBVZBA ELEVON W/I200' UL.SOIL TE5M- I G LO"S >10 YEARS OLD REQUIRED DETAILS ON PLANS LZJL__)SEWAGE SYSTEM PLAN-(NORTH ARROW) (�L-)SSDS HYDRAULIC P FILE U( JGRAVITY FLOW • - LjJUCONSTRUCTION NOTES 1 -15 UUDESIGN DATA: PERC & DEEP RESULTS (.Q(__-)2' CONTOURS_EXLSTING & PROPOSED ( j(___)DRIYEWAY & SLOPES, CUT V)(-)FOOM, G /GUTTER/CURTAINDRAINS (- J(JUSDA SOIL TYPE BOUNDARIES - ( -6( -JTITLE BLOCK; OWNERS NAME ADDRESS ... � � :... a ..... J?E� SHi.FT.� •FO;t.S, ^.� r'�R�,tt'II,::a{: STREET LOCATION: R�L GR, AS, &ATE: TAX MAP# - TM9, PEIRA; NAbIE, ADDRESS, PHONE"" (�( -JDATE OF DRAWRiG/REVISION (�L_-)DATU1N1 REFERENCE L(,( -/J( OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U(�PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ULJWELLS & SSDS'S WIIN 200' OF SSTS ( -4LJPROPERTY METES & BO OvslcGv' co'*V -Q' ' - COINIMENTS: (CONFIRMED) 'Y N (REQUIRED DETAILS ON PLANS CONT'D) ULJHOUSE SEWER -'/�' FT. 4 "0'; TYPE PIPE CAST IRON UUNO BENDS; bLAX BENDS 45° W /CLEANOUT RENEWALS UUSITENOT� CHANGE) FILL SYSTEMS (x(•-)10' HO NTAL; ST TRENCH SLOPES 3:1 TO GRADE UUFILL SPECS I OTES 1 -5 ULUFILL PROFI NSIONS (� JFILL Lr' E ANSION AREA UU CLAY B (_}UFILL CER &CIONINOTE (JLJDEPTH G UU��OL. 0:' LAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS UUSEPAR TION DISTANCE FROM TOE OF SLOPE TRElim (ELF TRENCH PROVIDED a3' tiOFT b1AX. UUPARALLEL TO CONTOURS ,! (__)100% EXPANSION PROVIDED: ( �LGEOTEjCTILE DETAIL/DUST FREE CRUSHED ST ONE OR WASHED GRAVEL COVER SEPARATION DISTANCES ON PLAN - FROM SSTS LJ10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__)20' TO FOUNDATION WALLS (,4( )l00' TO WELL, 200' IN DLOD,150' TO PITS C4L� j100' TO STREAM, WATERCOURSE, LAKE (inc. e=pan) (�Q 5 ' TO CATCH BASIN, 35' STORIYIDRAIN, PIPED WATER LJ50' h`ITERMITTENT DRARiAGE COURSE (- 0200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (�LJ10' MIl`i TO LEDGE OUTCROP ' SEPTIC TANK ✓' ( j(__)10' FR tit FOUND ON; 50' TO WELL WELL _. DI1ti1ENSI TO ERTY LINES LOCA SERVICE CONNECTION - (/)(HMV 15' TO PROPERTY LINE SLOPE (/)(SLOPE IN SSTS AREA (S20 %) (_)V)REGRADED TO 15 %, IF REQUIRED, DOSE /PUMP SYSTEMS I. 91 '-c a� UL )PUNIP NOTES UU1)OSE 75% ° OF PIPE VOLUM VOLUME NOTED (� )DETAIL FOR FORCE , (PIPE TYPE, ETC.) n (,t-)(--)PIT AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM C UUSTANDPIPES, ' B S ES, DETAIL (�(�15' bTlli to CDS= %, 20' %, ZS' -3 °J °, 35' -1 %,100 % -<1% (x(__)20' ML`i to IS E/100' with 182 cons day discharge (J(-10' hIENN to ON- PERFORATED PIPE Pump: Model .{ Narncplate Horsepower Pump; Model. Classification Service Phast" ;s volltaye 115 Starting /Locked Rotor Amps. 57.4 Full li6ad Amps. 14.5 Winding Resistance - Range High Head Effluent 96rt 7.8 =7, Ran = .65-.69 Lockcid Rotor Code Class, Insulation Near i Code Letter 230 Maximum Water Temp. 140'0:F. Powd: Cord Size 14/3 16/3 Motor Manufacturer vttt4a -iV.t T `fof Motor Split i ype� p t phase with centrifugal switch and start capacitor Motor Features Automatic reset thermal overload protection':. 4� PumE Operation - Automatic Pressure Switch No t , Fl�tat Switch Yes Pump Operation - Manual Yes Yes `t Furnished as standard equipment. Optlo"nal NOT furnished as standard equipment but the manual pump model can be Lit equipped with. Sf. ,a , rt 16/4 Polyphase Overload protection in control panel No No Yes .{ SH6:50 SubmfJ'Aible High Head Effluent Single Three 200 230 230 460 575 _ i s 3450 29.1 29.1 22 11 8.8 7.6 7.1 3.1 1.6 1.2 7.8 -7 7.8 -7 — — — 2.56 - 2.32. 2.56 - 2.32 4.91 - 4.45 20.5 - 17.7 29.7 - 27 H .s F B B L D Maximum Water Temp. 140'0:F. Powd: Cord Size 14/3 16/3 Motor Manufacturer vttt4a -iV.t T `fof Motor Split i ype� p t phase with centrifugal switch and start capacitor Motor Features Automatic reset thermal overload protection':. 4� PumE Operation - Automatic Pressure Switch No t , Fl�tat Switch Yes Pump Operation - Manual Yes Yes `t Furnished as standard equipment. Optlo"nal NOT furnished as standard equipment but the manual pump model can be Lit equipped with. Sf. ,a , rt 16/4 Polyphase Overload protection in control panel No No Yes I W-GO- I ZVZDQ I I ; wljMj.l I Mw`l - ----- - - -I-- I TOP VOEW 3 1A 7--L 4 SIDE VOEW Pump Model 9HEF 50 Boxed Weight 58 Lbs. 209 NP7. Dlachwge 1. AN dirroonsions In Inches. 2. Component dimensions may vary 1*V Inch. 3. Not W Construction proposes unless certified. 4. Dimensions and welpts m appmkirrato. . S. We memo the right to make revisforts to our products and their spedfications without notice. 6. 1 ONO! level is adjustable When Nftd YAM a wide angle Float Switch. H�J Discharp 01eigm Sill T If the pump is ordered for AUTOMATIC operation, a FLOAT SWITCH and .11E BAND are shipped loose with the pump. When installed as shown, the TURN ON and TURN OFF height is approximately the same as the float tether length. N this is 8 inches, the volume of water pumped out each time the pump runs is: E 6 OAI�gDfb°I'/ AURORA PUMP UNIT 00 66049M^L 910N^1. DIMENSIONAL OUTLINE SHED 5® I 24 inch tank diameter 15.0 Gallons 30 inch tank diameter 23.8 Gallons 36 inch tank diameter 34.6 Gallons 48 inch tank diameter 62.0 Gallons E 6 OAI�gDfb°I'/ AURORA PUMP UNIT 00 66049M^L 910N^1. DIMENSIONAL OUTLINE SHED 5® I .... + 110—;dd— I �1 b 1 1 : 104AM r- KUM Jut'tK— 1 UK011 vM OAS MIZ =1" i vw o i oc PUMP MODEL SHEF50 Nameplate Horsepower, t .50 . MATERIALS OF SERVICE Motor Housing Pump Housing Impeller Pump Shaft External Fasteners Lifting Handle O -Rings Mechanical Sea! Upper Bearing - Radial Lower Bearing - Thrust Bottom Plate Legs APPLICATIONS Solid Size Type of Oil Oil Re -fill Quantity Power Cord Size Diameter Type Separate Wires Black White Red Green Cast Iron ASTM A - 48 Class 30 Cast Iron ASTM A - 48 Class 30 Thermoplastic Stainless Steel Stainless Steel Stainless Steel Buna N Carbon Ceramic Single Row Ball Single Row Ball Polyester Coated Steel Engineered Thermoplastic 3/4 Inch Dielectric SE40 Single Phase 70 Fluid Ounces Three Phase 63 Fluid Ounces. Three Phase 16/4 .424 ±.005 Power Power Ground Power Power Power Ground PAINT Painted after assembly before testing. Dark green, water reducible alkyd enamel, one coat, air dried. MYMOM M' IwFKM%A PUMP Pumps 'or A VNII. or GCNcgt^.. �—aa..S TECHNICAL DATA SHEF50 Single Phase 14/3 16/3 .375 * A 1 .388:t.005 WTW ni STW -A Power Power Ground Power Power Power Ground PAINT Painted after assembly before testing. Dark green, water reducible alkyd enamel, one coat, air dried. MYMOM M' IwFKM%A PUMP Pumps 'or A VNII. or GCNcgt^.. �—aa..S TECHNICAL DATA SHEF50 SAY Ajo ,n 4 ilk Lo ��a• QQ p.. f 6 c�aw t n� no I , i. R TAX MAP—DESIGNATION: SEC. 62., BLK. 1, LOT 20 CROSS CUT FND. s ON LINE �i r •3 tn tn 1a N i2 m W W 0 = 0 0 0 Z o k Z 'k N/F MAUS S 82'30'30" E 365.49' LOT i, &FILED MAP No . 2 7 5 4 I FILED MAP No. 2 7 5 BLOCK "P" LOT 2 O AREA 86,755 S.F. 9 9 1 ACRES PU 9 9 - 12 1 L= 19.79' ' i R= 25.00' .y A 1 50x`6 LIC. 49087 . 5,10N PIN L =68.35' ? JAMES A. DILLIN, PLS ryoUND R= 167.00 PROFESSIONAL LAND SURVEYOR N 8444'00" W 82.04' GOSHEN, NEW YORK UP REFERENCE:,. BEING LOT 14 & 15 IN BLOCK P, AS SHOWN ON A MAP ENTITLED CERTIFIED TO: MICHAEL TI — ;OMAS DOEBBLER "MAP OF BLOCKS 'M' TO 'S' INCL. & A PART OF 'I' WILDWOOD KNOLLS, AND KENNETH PREGO Tllt= COMPANY LOCATED AT LAKE OSCAWANA," FILED IN THE PUTNAM COUNTY CLERK'S TITLE NUMBER c' OFFICE ON =TOBER 18, 1943 AS MAP NUMBER 275. } COPIES OF, THIS SURVEY NOT BEARING THE EMBOSSED t SEAL OF T1;JE LAND SURVEYOR SHALL NOT BE VALID. UNAUTHORIZED ALTERATION OF THIS' DOCUMENT, IN ANY GUARANTEES OF CERTIFICATIONS ARE NOT TRANSFERABLE WAY, CONSTITUTES A VIOLATION OF `THE STATE OF NEW TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. YORK EDUCATION LAW SECTION 7209 (2). — SURVEY OF PROPERTY PREPARED FOR MICHAEL THOMAS . SITUATE I TOWN OF PUTNAM VALLEY PUTNAM COUNTY, N.Y. JANUARY 3, 2002 SCALE, 1 " = 5 O' j• .r�..lh. w... M?OD N!�D614GlI3Sl! �rw rim r roe-o a]�s VIroCK yS bli! av Cy ].bw lal�. ow.•r ar✓ Cull! alti .vaNP % Y IOma n.ege. Omi - AYOa.T GOIM1Cl flR b %!?nJ � bQ m M/.11r�• yyp.CnT1pM nCR?mTf. MJ VATION as nm% nr.e uaiva (1r �K� V. L. 5EAM.DETAIL no �uF lava. C DROP FLOOR DETAIL ro Sc++t �mee n]aio ^OMOfw�e.^O%isl�' � tau I w f �E f g f F f f a p 3 i L -�.. u u a.e PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED TOR BEDROOM COUNT ONLY, FOWLA rION PLAN _BEDROOMS 1/ Q . ° ALL SUBSEQUENT REl °ISIONIALTERA7 ONS TO THERE H�(Z -fOSE� F,VECS) BEOR° NC�I)5 _ P NS MUST BE S fiMiTTED TO THE PCDOH FOR APPR�C F-L �e66Lef� 1211 ��• P1 11AM \/ALLer Z_7-U Z NATURE TIT i e: DAM- 1 O 8 iy V2. 0 'K TILE FLOO R DETAIL (THIN SET) NO SCALE I OF vHEALTH HOUSE PLANS APPROVED FOR BEDRO0,11 FIRST FLOOR PLAN &;UNT 0!4. V4,. r B17DROOLIS ALL SUBSEQUENT, REVISTONIALTERATTONS T,) THESE HOUSE PLANS MUST BE SUBMITTED 1-0 TUE PCDOI�- FOR APPROVAL S G NAFURE & �TITLE PROPOs 11 Os FivE:(' 5) 91c.44AEL DOEeftEp- P-c%--"ILL RD Rur4 r4VALLE-( tSfY - S :f 117=6; usa.�m� mw; rrrss �1` dJ.rwrr w�� Vy'iwrr LE6@m. xr��gs wr. O w,rr m. G �rr�ia� 6 i�ygsa m � tY. faY m N7yo IEAOBt C RAM Illiall� ID!4 Q1]z• NY 1lm +b GI]abMY to M9 QI]a b1Y• IOIF 8 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED {'011 BEDROOM COUNT ONLY, C�CONP FLOOR PLAN BEDROOMS .i ecN.e . vs• - P - v c' i` \Jp, ALL SUBSEQUENT REVISION, ALTERATIONS TO THESE HOUSE Pp-oposEo FIV E (S) �E,:> Hmme PLANS MUST BE SUBMITTA'TO -TILE PCDOR FOR APPROVAL DMII�' I >rL E,55LE- 4, SIONATUIiE & TITLE DATE P-(>-- '� ILL ROAD, Pu-r tl' \/ J- 1=Y ii s, A` i ' ?_ FORMAT CONSTRUCTION ;►AIM NEIGHBOR 1 1 / H E R MAt Ex >0=- MA4 Dear% EDITH LocroF&A Date TAdUAR'( 3, 2002- RE: Department of Health Review of Proposed SewageTreatment System for Property . Name: M IC. AE IL [, Address: RpckH I LL Pc>x. D Town: PuTt�AM NAALLEY, f Y Tax Map #:r2. --1-2D Please be advised that an application for a Construction Permit relative to the construction Of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of-Health. Attached please find a copy of the latest site plan. If you have any questions, concerns . or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: r 'off N 1-7 i LL R oA> Address: RMJA M u,E--(,t4 Y ID579 Tax Map #: (o 2.1 Very truly yours, lip � r r August 1997 Dear MR4 Mp.,5 m F Date TAdUART 3, Z(002- RE: Department of Health Review of Proposed SewageTreatment System for Property Name: M lc_ - AEL DOE- 156 LE�- Address: ROr-- V-d I LL RC>A C> Town: PuTt4AM \/ALLEY, �y Tax Map 4: r2.--l-2D Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made* to the _PixtW County Department of Health. Attached Tease copy ..Ipa e.find.a c­ Dv of the latest site plan.._ If you have any questions, concerns or information which ' may bear on the Health Department's review of this application, you may call the Health Department at 278-6130. "Very truly yours, Title: 0 W Received By: EF I P E -7 * -P-CC y. � I Lj— RC >:41> Address: P-oTI AMNAUEYN.Y. 105-7 Tax Map 4: CO August 1997 Lc ■, / , / ' ' Date TA f UARi 3, Z002_ RE: Department of Health Review of Proposed SewageTreatment System for Property Name: M lc_ AEL DE gESLE�_ Address: Town: PUTP lAW/ALLEYI DIY Tax Map 4: 62. -1-20 Dear MP+HF -5 PAUL 1 IAus Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan . If you have. any questions, concerns or information .which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, Title: O W d E fZ Received By: M A U e2 Address: 5 79 OscA A r A LA IC E RoA D POT M VALLEY, t I -Y- OSIq Tax Map #: t) Z August 1997 , Dear A4a MAC IE L?bC-j3L3wqZ Date TA I VARY 3, Z002- RE: Department of Health Review of Proposed SewageTreatment System for Property . Name: M IC_dAE:L �r= V>5LEP_ Address: ROC--KA I LL ROA D Town: PU-r�JAK.\/ALLEY,�Y. Tax Map 4: 6 2.-1- 2 0 Please be advised that an application for a Construction Permit relative to ,the construction of a sewage system and/or well proposed for the captioned property has been made to the -Putnam-County. Department of Health. Attached please find-4 copy. of the latest site. plan._. . If you have any questions, concerns or information which ' may bear on the Health Departments review of this application, you may call the Health Department at 278-6130.. Received By: MbeSSLEP, 1(0 RPC41- •IWI 0 ' Address: AMVA _LFE�6 •Oe 10575 Ta'xMapg: - Very truly yours, PW%L%VIqW7'"%W-'_7 01,61,6ANO, � I Title: 0 W d E- p - August 1997 SENDING CONFPSTION DATE : JAN -3 -2002 THU 11 :47 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919142712820 PAGES : 1/1 START TIME : JAN -03 11 :46 ELAPSED TIME : 00127' MODE : ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED- BRUCE R. y01@Y LORMA MOLn"M RN.. hUN. Nub h'"M A/eres .ra*dit P.*M¢ H.*h DOvum Ohrb q/ PoeeM SYrwrn ' DEPARTMENT OF HEALTH I Oeneva Reed Brewster. New York 10509 e..t�.w.aur swat ms)rn•suo ramr)rn.tsu P-d-gaeidmm3)An•a5sr WM(Nr)27A•s6n rkr(t1t)rn•60lS Fehr ra—r— w!*sn.wu xatms)rts -ma wwwt mt)Au.su in(04r)m•Uts Decemba 28.2001 Ralph Mastromonwo, P.E. 13 Dove Court Croton- on-Hudaon,NY 10520 Rodchill Road, Lota14 & 15 (1) Putnam valley. YM# 62 -1 -20 Dear W. Mavhomomoo: This office has received and reviewed the most reeont set ofplaas for the above mentioned project. We would like to offer the following comments for your review and consideration. A. Well Permit Application (WP.n requited. 13. Proof of Neighbor Noffmation Documentation required • Lots created prior to 1969, rsquires to complete Neighbor Noti6cation p G Certified copy of ormy required. 77rie 045ce will condauo its maiew, upon masidemtion of the above motioned commonts. Please feel foe to contact me at ext. 2157 if any questions arise. very truly yurs, C Zo v � Adam B. Stiebelicg Assistant Public Health Engineer ABS:tn r -�7;- �' BRUCE R: TOLE`I ,: , .- :. . .. . Public Health Director DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 Fax(845)278-6648 Preschool (845)228-5912 Fax(845)228-6113 December 28, 2001 Ralph Mastromonaco, P.E. 13 Dove Court Croton -on- Hudson, NY 10520 Re: Doebbler Rockhill Road, Lot#14 & 15 (T) Putnam Valley, TM# 62 -1 -20 Dear Mr. Mastromonaco: 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. Documents: Well Permit Application. (WP -97) reqWzed. - - B. `y PrcuL i3cigliuur ivoiilica�ion %ocuineritation required. ` * Lots created prior to 1969, requires to complete Neighbor Notification procedure. C. Certified copy of survey required. 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, Adam B. Stiebeling Assistant Public Health Engineer R! DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT i WELL LOCATION Stree Address K Town Village ity Tax o Pv l A Y .-f. 6Z. - Grid Number 1-7-0 WELL OWNER Name c►�AEL OF Mailing Address LE to (Zcz. F� LL P- 0. P. dY I OS rivate O Public USE OF WELL - rimar 2 - secondary RESIDENTIAL 0 BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION. 0 INSTITUTIONAL O STAND -BY ❑ ABANDONED ❑ OTHER (specify: ❑ AMOUNT OF USE YIELD SOUGHT 5+ gpm /4i PEOPLE SERVED_ /EST. OF DAILY USAGEIGOO gal REASON FOR DRILLING EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING D o WELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: W1 LOW,U�DD rNOL.US _ w bL6_1r. P D El 1-90 HA [?It- 705 Lot No. WATER WELL CONTRACTOR: Name r,I ptoh DR.IL.LI 16 Address: BA AEV, . pV IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES . X NO NAME OF PUBLIC WATER SUPPLY: {� �� TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: A �i;•. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED S.e E S1T'E PIA•J OF NEW y DON REAR OF THIS APPLICATION 0 P E S E Pp4G� ( ate) (signature)• ±'s Ic "Sa•'i.Jy t;r.•s•t4 -p , d. . PERMIT 'a, TO CONSTRUCT A WATER WELL �° pRaF�ss►'3�i This permit .to construct one water well as set forth above is granted une 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.hal.l : 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 provided by the Putnam County Health Department. Date of Issue: Date of Expiration: Permit is Non - Transferrable 2/87 19 19 Permit Issuing Official White copy: H.D. File Yellow copy: Building Inspector• Pink Copy: Owner Orancre conv: Wpl 1 nri 11 or PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Lv �oGIG F-tI LL �DA l� Pur�AM VA LL- t:Y, N .Y. 10579 2. Name of project: M " EL [--)oebbLa p- 3. Location TN: BJT�AM V,A LLEY 4. Design Professional: RALD� MASTrZoj -ig co5. Address: 13 1�OfE >12T GQ Pr '14yIo5zo 6. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)9 Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Ao 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name'of Lead Agency ^ d/A 11. If this project is an area under the control of local planning, zoning, or other .officials, ordinances? ......................................................... ............................... 12. If so, have plans been .submitted to such authorities? ... OJA ............................ d1A 13. Has preliminary approval been granted by such authorities? Date granted: N 14. Type of Sewage Treatment System Discharge ................... surface water X groundwater I 15. If surface water discharge, what is the stream class designation? .................... 1� 16. Waters index number (surface) ........................................... ............................... 01A 17. Is project located near a public water supply system? ....... ............................... N O 18. If yes, name of water supply �Q Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ O 20. Name of sewage system ��Q Distance to sewage system 21. Date test holes observed O C) 22. Name of Health Inspector PAM i! -1 Form PC -97 2 3. Project design flow (gallons per day) ... _ .. ........................................................... - �4. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? 1J 0 27. Wetlands ID Number ............................................................ ............................... 28. Is Wetlands Permit required? .............................................. ............................... p Has application been made to Town of Local DEC office? ............................... t'J 0 29. Does project require a DEC Stream Disturbance Permit? .............. 30. Is or was project site used for agricultural activity involving application of -,pesticides to orchards or'other crops, solid or hazardous waste disposal, II landfilling, sludge application or industrial activity? ............................ Yes/No 110 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any II other potential known source of contamination? ... :.............................. Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... �LA 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................. ............................... 34. Are any sewage treatment areas in excess of 15% slope? . ............................... p 35. Tax Map ID Number .......................... ............................... Map!�Z. Block Lot ZO 36. Approved plans are to be returned to ..... Applicant Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 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 to to . SICNA7 URES & OFFICIAL T'IT'LES. I' Mailing Address: ....... ............................ ®�/ �. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner M1cdA[:LE)09E%* -ep- —Address J(P Rc>--dJLL. P-Q P\/ t Y. 1057Cj Located at (Street') �H I LL .1 O .4P Tax Map 6 Z.':Bloclk Lot 20 (in icate nest cross street) Municipality Watershed H U p5niJ SOIL PERCOLATION TEST'DATA Dated Pre-soaking C>CT 1, Z-001 Date of Percolation Test SGT 2, Zoo] cn . . .... ... A 7 - 3:47 2 3 4( -4.1(o 3o '20 2 Z/4- 4 3 4:ZZ'4:E;zl 30 20 2Z% 2 Y4 4. 5 ..3 1 3-- 15:3:45 30 20 Z Z'I-z- 2112- 2 3:48 4'18 C5 Z Z 2- 3 4.24-4:54 - Z.O.: 2-2-- Z- 4 ROTES: 1.. Tests to be repeated at same equal percolation rates are obtained at percolation test hole, (i.e. -< I min for 1-30 min/inch, --, 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES .....DEP,g: _.. u. BOLE 140 v G.L. TopSol To Ps® I L- 0.5' 1.0' 5ILTY LOAM MEDIUM LOAM 1.5' 2.0' 2.5' SILT LOAN' V41 3.0' MOIDC WELY c OHP TP-AcE -5M D 3.5' 51 LT LoA cif 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' -r 9.01 10.0' HOLE NO. C) T 3- - To So I l_ S I LT LOAN) FItJE 5At4 05 At40 s.I.LT w /COM L E5 Indicate level at which groundwater is encountered i Oo E Indicate level at which mottling is observed t1l o 1� E Indicate level to which water level rises after being encountered iJol�iE Deep hole observations made by: I. Date O 1-1 D Design Professional Name: Address: Signature �n l � . Design Professional's Seal -F NEW Y ?,GE MASp9p��i- a F?OF � °• 05149 ��G "ROFESSIO�P� PA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at T/V F_QIAHVAI.LEY Tax Map # .6P2. Block I Lot Z,O Subdivision of It Subdivision Lot # 14+115 Filed Map # 275 Date Filed 011 a Gentlemen: This letter is to authorize P.A t- PF G. MA,5Tpo MONA60 a duly licensed Professional Engineer < or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County. Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law; &d_tne Puu P.E., R.A., # Mailing Address G2oTo� -o�- UI�� State . `i% Zip 10570 Telephone(9 14) 271 -47�Z Very truly yours., Signed: (Owner of Property) Mailing Address: l(,p R.C��� --� ILL P4A[::> PUT4 M' \/ALLPY State N CAN G0 Zip p Telephone: 4j� c5?- B-0a09 Form LA -97 RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271-4762___J914) 271 -2820 Fax _ .. .. —.... .... _.. -.._ .. ... �i. . v♦ � ! ♦ r. � v -w...0. ..- ... �' c_ v .. .. .. ♦ rz.v.. ...s... -� r — C .��T..KS -♦ •r C' a �n Mr. Adam Steibling November 15, 2001 Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Proposed SSTS (62 -1 -20) for Doebbler Oscawana Lake Road, Putnam Valley Dear Adam: Please find enclosed the following materials: 1. Four (4) signed and sealed copies of the SSTS Plan Lot 20, Map of Blocks 'M' to 'S' & A Part of '1', of Wildwood Knolls, Rockhill Road, Town of Putnam Valley, Putnam County, New York,. Prepared for Michael Doebbler, dated November 12, 2001. 2. One (1) signed and sealed copy of the Construction Permit, dated October 25, 2001. 3. One (1) signed and sealed copy of the Letter of Authorization, signed on November 15, 4. 2001. 5. One (1) signed and sealed copy of the Application Approval Of Plans for Wastewater Treatment System. 6. One (1) copy of the Short Environmental Assessment Form. 7. One (1) signed and sealed copy of the Design Data Sheet, dated October 17, 2001. 9. One (1) copy of the Pump Curve Performance Report. 10. One (1) copy of the Adjacent Site Plan for Tax Lot 62. -1 -21. 11. One (1) check payable to the Putnam County Department of Health in the amount of $300.00 for application fees. We are requesting your review and approval of the above - submitted materials. Please call me if you have any questions. rely, Iph G. Mastromonaco RGM /pf Enclosures C-., ,[ RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914) 271-2820 Fax Mr. Sean Grogan January 4, 2002 Putnam County Dept. of Health 1 Geneva Rd. Brewster, N.Y. 10509 Re: Proposed SSTS (62 -1 -20) for Doebbler Oscawana Lake Road, Putnam Valley Dear Sean, Please find enclosed the following materials: 1. One (1) signed copy of the Application to Construct a well dated January 3, 2002; 2. One (1) copy of the certified Property Survey dated January 3, 2002 3. One (1) copy of each of four (4) neighbor notification letter certificates of mailing. This addresses the information requested in your review letter dated December 28, 2001. At this time we are requesting your continued review and approval of the referenced project. Please call me if you have any questions. Ralph G. Mastromonaco RGM /soc Enclosures i OLD f• . PiTTNAM COUNTY DEPARTMENT OF 'REALTY _ _ D USIO N 0E E NVIRONMINTA)L HEALTH SERVICES. INITIAL INDIVIDUAL /COMMERCL42L SITE INSPECTION FORM SECTION A,,,GENERAL INFORMATION' C Name of Project o pL Ge (T) County Site Location �. . i +, c,r_ R-An t QS C Aw A w A- Building construction begun tea Extent 161 c +ET Is�prorrty within NYC Watershed ? ................. ❑ Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly _ Rolling_. :Steep.slope �_Gentle,slope—E Flat - -- -- – 2. Evidence of wetlands Low area subject to flooding Bodies of water Drainage-ditches %Rock outcrops 3. Property lines or corners evident ....................... ............................... Yes No –_. –J.t pprtY• -4: ` Do watercourses exist on or ad'oin the roe ? ............................ (� Yes No - 5. Will these affect the design of the sewage system facilities ?............ 6. -Do watershed regulations apply in this development ? ...:::::::..... 7 ^ 1111 dxteusive gradi be ..:.:...................° ............... . 8. Will extensive fill be necessary for SSTS? ......... ............................... 9. Do filled areas exist within the SSTS area? ........ ............................... ❑ Yes –� Yes Yes ❑ Yes Yes No No _. . No If yes, what is the condition of the fill? - - - -� - - -- - SECTION C. SOIL OBSERVATIONS 10. , Appearance of soil: Sand– Gravel - Loam Clay. Hardpan Mixture 11. Observed from: ❑Borings ut B ckhoe excavations 12. Soil borings /excavations observed by S o 6 on La 6 a 13. Depth to groundwater is on - - - 14. Depth to mottling `' on 15. Are test holes representative of primary & reserve areas ..................................... E] Yes E] No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by 1Vi o on SECTION D (on back) 4 � V 2 SECTION D. DP AINA E: 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes 0 No 19. Will groundwater or surface drainage require special consideration? ......:.............. ❑ Yes L 1 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... ❑Yes l`v 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 L2 o Inspection data - -- - _ 22. Do adj acent. wells and/or sewage systems exist ?... ::. - - - - - - 23. Additional comments S(4ow1 .. Z� �r f ��l �•-� cy i f ZAo -C2 (f.. 24. Site observer /inspector and title 25. Dates) of observafion(s)inspection(s) TEST PIT PROFILES Hole # Lot # _Hole # -- - = - toI'ICT6 r -E] No -- mmlmv -Lot # ._. _ ......._ - -Hole # Depth to water Depth to water Depth to water ---- = "- Depth to mottling � V 2 SECTION D. DP AINA E: 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes 0 No 19. Will groundwater or surface drainage require special consideration? ......:.............. ❑ Yes L 1 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... ❑Yes l`v 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 L2 o Inspection data - -- - _ 22. Do adj acent. wells and/or sewage systems exist ?... ::. - - - - - - 23. Additional comments S(4ow1 .. Z� �r f ��l �•-� cy i f ZAo -C2 (f.. 24. Site observer /inspector and title 25. Dates) of observafion(s)inspection(s) TEST PIT PROFILES Hole # Lot # _Hole # -- - = - toI'ICT6 r -E] No -- mmlmv -Lot # ._. _ ......._ - -Hole # Depth to water Depth to water Depth to water ---- = "- Depth to mottling Depth to mottling _ Depth to .Ley tc vivekii np: *. -- - Depth to rocklimp. Depth to rocklimp. G.L. G.L. G.L. - - - -- -.0.5 .... , . 0.5 _ _ _.._.. 0.5 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 10.0 10.0 M 10.0 1 r.� i rt 1 YxUl+'1L�;5 Hole # Lot # "Z Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth mottling. - Depth t?.r}l l n:�_., _ - .. M . �y _ ^to Depth to rock/imp. 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 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling__ __ Depth ~to ~rock/imp. Depth to rock/imp.� Depth 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 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 Pen *h M.mott?ir_ . -.. _..._ Dcpih to •mottling ...: ...... Depth 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 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water . Depth to water Dc ;o. 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 9.0 9.0 9.0 10.0 10.0 10.0 tep- 1'2 -01 10:51A Ralph G. Mastromonaco PE 914 r . a � BRUCE R. FOLEY DEPART OF HEALTH 1 Geneva Road Bmwm, Now York 10509 AT?' NMONr XADAMSMBELING o GENE REED All information below most be IWIX completed prior to any scheduling. 271 4762 P.01 278 --nZl LORErr'A MOUNARI R.N.. M.S.N. Aueelatt Publk 14dltk D(+s W 211- ?,S?, o7 =k9l,1of REASON: DE PS: PEM..)( PUMP TES?: o ROAD/A' RIZIr &,r_ ALL RaAy * 'Qa6mAbLA LAKE ROAD TOWNt PUJ 1 AM VALLK-Y TAX MAP#: 6 Z•~ I- 20 MDIYISION: WILPWOofl k�oLt6-'B(�ocK P **'275 LOT#: 1f= CL=A EM JOINT AM ==SINAI TL i YES NO C3 �( Proposed SSTS within the drainage basin of West Branch or Boyde Corner Reservoirs. o �( Proposed 8STS whin W feet of a reservoir, resa voir stem or control.la im. o �( Proposed SETS within 204 feet of a watercoum or a DEC wetland. : . o $'T3aipt fly 1+ than 1000 gaaDons/day or 5PDE8 Permit required o fors Conlinn- si Froiet a .. _. It is the responst6Dky of the dafan professional to provide the above information prior to soil testing. This Department will doerafte the NYCbEP project status (Joint or Delegated) based on the response. If you answered ja to any of the questions, NYCDEP mast witness the soil testing. This Department vn'R coordinate a mutually soluble time for field testing with the PCDOH, the Design PrelsHonal and NYCDBP. If ai project Eau been deterv$md to be Weyated based on the above response and then subsequent information InfAcates NYCDEP is required to witness the soil testing, it will be the sale ruponsibility of the design professional to schedide re-witnessing of the soil testing with NYCDBP. 7 t a_OUNW U M ONLY RATS1 00 U�1 ff. c J cT� _ ClIliv V (0&4k.� V, (lV \( c 4 C. I C qr 0 SEP -12 -2001 WED 11:06 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P Sep-12-01 10:51A Ralph G. Mastr-omonaco PE 914 271 4762 V1 w CD • 0- p 0 0 C IN) 0 Tor �r 4i rt II it 0 OCUA 0 pJ 0 t4 0 o0 Ln ' ri 0 Z OD 4A 0 0) OD !o cti 0 0) co 4- LA o LTI 00 7' 0. P.02 ? -4 �j0 j z < SEP-12-2001 WED 11:06 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 U) OD Ln 0 .0 a M 0 LA IQ .0 rn 0 O rP OD ? -4 �j0 j z < SEP-12-2001 WED 11:06 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 Oct-24-01 11:47A Ralph G. Mastr-omonaco PE 914 271 4762 A, 1r) �o 1-11 Y_ -4. oiw or I,q ' i I ' i s I� 101 �Md 1 101 OZ —I — * Z9 .09- - . i talvos ".JUNnoo tNvN.Lncd .)19-nVA V4VN.Lr-ld dO NMOI � OV021 -nlH>Ooa Z 0 101 Nvid SIAS nrT-;3,d-PrArA1 1•1cn 1z)-rAr- TC71 -QdcZ-O7O-7C3:)1 . . —4,OL-- gee a .0c.ates P.02 TMU amodowd ,wt MOMC- DIMIAM rrIIIkITV nCOADTMCKIT nC 0 !D a Oct-24-01 11:47A Ralph G,. Mastroemonaco PE 914 277E 4762 P.01 FAX -' L .. N 0'V ITTAL W0rHEET,er: 1 RALPH G. MASTROMONACO, P.E., P.C. Consumng Engineers 13 Dove Court, Croton -on- Hudson, New York 1 0620 (914) 271 -4762 (914) 271 -2820 Fm TO:ADAM 5TEiBLW,:;, P— oc-Y-4, Imo. VIC4P M \/AL L,� Fax Phone: 1- 845- 278 ° 79 2I ?A- Date: C;�=Tobe -ICI, 2001 Plumber of pages (including cover sheet) From: V-& DE55LE Ree Fax Phone: (914) 271 -2820 Voice Phone: (914) 271-4762 Remarks: ❑ Urgent W For your review 4 Please comment ❑ Reply ASAP Message: A ®A v) PIEASE REVIEW pcoo- ®WAPx:;) Yap 16 � 'A I-b ®a-5 Ie,- 1 PAIR -54,- . OCT-24 -2001 WED 12:06 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Oct-23-01 02:16P Ralph G. Mastranionaco PE 914 271 4762 P.01 FAX %AF TRANSMITITAL SHEET RALPH, G. MAS7ROMONACO, P.E., P.C. I ConsuftV Engineers 13 Dove Court, Croton-on-Hudson, New York 10520 (914) 271-4762 (914) 271-2820 Fax TO: A DA l4i u- r-> M V.A i-Lef Fax Phone; I - 845.278-79,Zl Z31 Date: 19, 2601 Number of pages (induding cover sheet) From. K kE. De;e-135LE P- Re: Fax Phone: Voice Phone: Remarks: ❑ Urgent R For your review X Please comment Messa0e: A c>A vj PleA'5E P (Lo P OSA L 1-5 A F WE P��- �-ATF I � 12 15 � �l� ��1. (914) 271-2820 (914) 271-4762 ❑ Reply ASAP -5sDIS VES-16A �ooe.7E . F A 55o P��E r°(ZWAP-1r—> FI 6c' NOTES P P,'5 DATA 51- i� Ti- b�Je.�'� M� OCT-23-2001 TUE 14:35 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. I I to 4762 pct7�,?6-01 03:22P Ralph G. Mastramonaco PE 914 271 RALPH G. MASTROMONACO, P.E., P,C. Cornufflng Er 4re .w 13 Dove Court, Croton -an- Hudson, New York 10520 (914) 271-4762 (914) 271-2820 Fax 'j. 21 (r�7 Date: 4:fA=Tonep� IUD, Zc)o I Number of pages (including cover sheet) From., M i Y-e Dor=55 E P- Re: Fax Phone: (914) 271-2820 Voice Phone: (914) 271-4762 P.01 Remarks: ❑ Urgent W For your review X Please comment ❑ Reply ASAP Message: PleA5E GALL TO i OP Pr / F -rr,> Acv-- F AAA v) PLEASE RE-V1r-,vV Ppofoseo -5-sps QEYS-IcAl�. T�EPF-Clf>OSAL F WE Ike Opmom PAT- e 9 Z d 2 1� I� il. KO H P X25 L-- F A 55o Fyrml Fs��os. PIEAS� ��wap� Yo�� F°i�Lo r�°T� '4 t-b P e.5 la, �I P.ATA �rl4�k�'w M� OCT-26-2001 FRI 15:40 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 c G JU 114=Wl0v0=U A.U41 IUJ Wvrvll ICI; -IWVN 6dbL- tiLd-�Wti ; Ill W;`34 la-I Nwwd- Jd -l'JU INI SST$ PLAN LOT 2 O ROCK"LL ROAD TOWN OF PUTNAM VALLEY PUTNAM COUNTY , N.Y. PREPARED FOR _ :...... 5CALE, 1' - 30' 62. -I -2a LOT 14E15 I res 86 .755 a. . 6- Z15"L-v ell 17M1 \ I I I I I 101 1 1 "I'aa"re1 w I M. 7717 to P77oPO71m ro M 3 N I I 3q I I 1 I I I 1 a _. / /-//7 // / /tea •/ / as Aa » / / / /on / J Oi RvEd, i� A� O 9-1 R 114 ZO' d Z9LV iLZ V16 3d 0:3RuOwOalsEW • O ydLeb dZZ: CO IO- 9i - -400 .108"Pt =19 -01 04:16P Ralph G. Mast eromonaco PE 914 277E 4762 P-02 L _ OCT -19 -2001 FRI 16:34 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 d O&t-19 -01 04:16P Ralph G. Mastromonaco PE 914 271 4762 P.01 FAX TRAN�S.�IAlTTAL.. SHEET RALPH G. MASTROMONACO, 0. E., P.C. ConsuftV Engineers 13 Dove Court, Croton -on- Hudson. New York 10520 (914) 271 -4762 (914) 271 -2820 Fox TO: A DAM STEni�Li�G �E o=we -4ii u- o Fax Phone: 1-845. Z7 S - 79 2 I Date: cn=Tose-R.19, ZcDo Number of pages (including cover sheet) From: M 1 kE De;,F- 55L E P- Re: Fax Phone: (914) 271 -2820 Voice Phone: (914) 271 -4762 Remarks: ❑ Urgent W For your review X Please comment ❑ Reply ASAP Message: A DA MJ PIB4SE REV,EW asED ppo Sst�� AE I P � T-�E PROPOSAL 15 A ICE Ee v � o F �- M � u5e . 2,12 115 Mid PL (a 2,5 L.F oFa55o� -,o,J Fi�ws. A rb DES 16, N, pA'rA -SFi,E(S . Tikdr'r�q MT:) OCT -19 -2001 FRI 16:34 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 ®ct -23 -01 O2:17P Ralph G. Mastromonaco PE 914 271 4762 P.O2 P .., t OCT -23 -2001 TUE 14:35 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 � � «s :�� � - �� -�� - � 1 ....: , Lam.; �. /�: F � l ��� 9 0�. , `4i. .., �O•�: (�'b; f !-�w� r,�:if _ Vt IL � �� 1S I`_ s �w�f�1 ��. � �QS . � 1 ���• 4 )as I L-T- qD0q Ty-r_- 5 L DEFAOTMIE-T A,41D v, �iES -j a4 pe, 10, ,6" ,�, - -0� HT f 124 Q zl�• , 4--. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENSONMIPTALPEALTH SERVICES. APP NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE PUMAM COUNTY HEALTH DEPARTMENT. 3 yo rlGNATURE & TITLE f-ojoA Ff--< E D R I K-5 E rJ, e E-, W,5 L) L� i t-1 G C-D-J 6 11-4 r-- C--4-- Fc> ao>( 5 0 A6 6il U -T -L Aftoj3'. Of NEW i LL (104i�