Loading...
HomeMy WebLinkAbout2784DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -56 BOX 23 02784 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 Caroline Danford 77 Bell Hollow Road Putnam Valley, New York 10579 Dear Ms. Danford: ROBERT J. BONDI County Executive ROBERT MORRIS, PEA Director of Environmental Health May 18, 2006 Re: Addition Approval, Danford, A- 153 -06 No Increase in Number of Bedrooms 77 Bell Hollow Road (T) Putnam Valley, TM# 62. -1 -56 I have received and reviewed the plans for the proposed addition to the above- mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated May 17, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush .,tom P C t nye nr_c.ti. i. ri .3. f.,,,ho,,k t scuds «r� .7 auczts; etc:. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Mike Luke Public Health Sanitarian ML:cj cc: B.I. (T) Putnam Valley 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health -L,0" i rA 1vi0 L'INARI, RN, MSN Associate Commissioner of Health ROBERT I BONDI County Executive (� U DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 - o ADDITION APPLICATION RESIDENTIAL ONLY STREET '17 177CU &CC604V, V TOOT ����° qNIMAX MAP# Coz,"1 -� NAME CACO(jwC C, d� irW PHONE t6 �9 45f7_ 1PCHD# ' S -06 MAILING ADDRESS �'7etl- §oc1v� �� �v�r�► �'A��� rv-� `oSi1 (DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS_.) PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of,the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health. Dept.;. Geneva d,.. -_ 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area ,including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non- professional sketches are acceptable, 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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).27.8-6014 Fax (845) 278 -6648 r Harry. W: Nichols ki P.E. FU_ Patterson Park,•Suite 106 AV I 2050 Route 22 Brewster, NY 10509 rle.rar, rr a Fax 84 5) 2794567 To: C t+0 Attention: Date: Job No.: Project PL/fwzi.&-% Vd r-41 IO 5 Gentlemen: We enclose . / (I) copies of � v B/W Prints Reproducibles Reports Specifications Memorandum Copy of letter Description: C_ Tracings Revision/Date No. C4 J S-tc,,'V c_ ru Sent ia: Our Messenger Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to . Very, ruly yours, e. W. Ni ols Jr., P.E. SHERLITA AMLER, MD, MS, fl+AAP LORE'I"I'A MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count County Executive Re: (Owner's Name) Tax Map #: Address: `� % I�S�I --� - IA0 l: L o W Town: j,t r IJ AM V ALL-E !j Year Built: Accord in to records maintained by the Town, the above noted dwelling, is in compliance with Town Code. is not in compliance with Town Code. ... TheLegal Bedroom Count is: 3 This information has been obtained fr m: Certificate of Occupancy: Other: 2 `7 0� Building nspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 a a UP 33'4 -------------- ---- ' { . I 1 DECK < b ' GARAGE I `2 l ---- ---- - - - - -- 1 ' -� 15,0 ,g'g { i ! I y 7 t J Nook .. ' 1 1: t PR --! j �)� b 153 2S7 s'g Kitchen �. 40' o T y. IN a rn P 37 1'2t-- 3'8 —1 Y i GARAGE °-- -'- ------ Wasfher/0ryer ° CL --------- - - - --- a 2 LMM Room `V JR ' Library j Down i • . 158 r H 9',0 --�i� 75 'F� —,3'3 Y • + Dintnp --------------------- I �., Entrance N 10 i +D ,D 22'8 � 710 i., t • } � I f'I i 30.4 s,. i 75 13'8 PUTNAM COUNTY DEPARTMENT OF HEALTH 1f t, HOUSE PLANTS APPi"OVED FOR First Floor SCALE:,�e^ =,'o t., BED13OCP:'1 COUNT ONL7. 3 BEDROOMS Sheet Title y D P KLYBAS LLC Project Location: DANFORD/ KLYBAS RESIDENCE o �``"'� PROPOSED OFFICE '�f Architects r 77 Bell Hollow Rd .SftJflBtUfE 8h Title Date ` / /j —^ Putnam valley. NY 10579 �" ^°1°^ "e°0r• "''10� Date: March 30, 2006 Fiat Fbor 3W-W42 teas! Scale: ,sr _ V- a i; i'• i• f pi f {: t. , _ �.o | �."^," DFNEAk�N �U\mp�/�uup"""~._.� ~ RN « __—.",a"" Second Floor om�,�^°� .� ^ ~ . ___- .� � Date Sheet Sheet Me PROPOSED OFFICE FPOS�D OFFICE kchdacts 77 Bell Hollow Rd Ptdnam Valley, NY 10679 Second Floor '(S Date: March30.2006 30"U2 ® 01pulNAM COUNTY DEPARTMENT OF HEALT w -.._Iff T:u ' K,-N MENTAL,HEA.LTH DERV CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # pV _ I �o ` Located at 11 BEW, RoW W k-af) Town or Village p�NAM \4 A I Owner /Applicant Name CAP4U i-AF 5' AW-O K Tax Map 62-0 Formerly Subdivision Name Subd. Lot # Block I Lot 5(o WW- 1 Mailing Address 00) 1-4'0 WAWA � 0 �9 P l VNUt& ► 9014 Zip Date Construction Permit Issued by PCHD 01011M Separate Sewerage System built by PM ce tj Address %� 6ELL {+604 RA . P+NAM _ A j0SI Consisting of i o Ao Gallon Septic Tank and ��S VF- 165 . 'lam l-t t h Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by $(YD APTK("\ej � Address f 6'�q K % ( -"Q.t�'K(ti -aildi::g' YPC - -- �:. _ �!�I r? _ _..� .... , osj :: c :trvl ; �en`�or3Yleied� Number of Bedrooms �b Has garbage grinder been installed? N4 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 regulatiggs of the Putnam Count Department of Health. Date: ©7 � 1 0A- Certified by C tv � r �D �� �D si Jn P�ofession�l), +A� Address f^� I�-f; 'E'1� -„ 1'�1'� P.E. X R.A. License # 6664 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. By: Title: Date: 7 Whi opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Jul 08 04 12:19p BRUCE R. FOLFRY Public Health Director Planning Board (914) 526-3307 p.1 LORMA MOLIMAR1 R-\'., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH - 1 Geneva Road Brewster, New York 10509 Eoytr6amental-licittk(914)279-6130 Fax (9-14)278-7921 r&rjiu&5crvkw(9l4)278-6"8 WIC(914)278-6678 Fax (914)278-6US FArly1ntcneadoa(9l4)278-60L4 Preschool (914)278-6082 Fox(914)279-6648 I OWfqFM NAME: TAX MAP MJNEBER: E911 ADDRESS: TOWN: t A) G AUTHORUED TOWN OFFICIAL: (Signature) DATE: J'u1_1 &:2-004----T f I The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, Le., 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. (S911VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT We!!^ oc2taon.- . ... :. '+5. ,,�W -m.. A ' Tax.F,.r..i .• ♦ i'.AC . �I.1 C.A. -• ll,It• Map Cv2 , Block Lot(s)Cjf�, Well Owner: Name: A dress: Use of Well: 1- primary 2- secondary ( Residential Public Supply Ai cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing >e Open hole in bedrock. _ Other Casing Details Total length V ft. Length below grade Rig ft. Diameter go/e in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: 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 J4� gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve _analyses avaiianl�,'._ please attach. Depth From Surface Water Bearing Well' Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _ft V Ih Depth god Model '7L l4o 7.412 Voltage 2"3 0 HP Tank Type to­_ "09– Volume 9 11 Ae-101 pl,,F44 _ /, Date Well Completed ;1—,� q Putnam County Certification No. M-2 epo Well rille (sign ure) NOTE: Exact location of well with distances to at least two permanent laridmarks to be proV "n a separateAheet/plan. Well Drillees Name f Address: yrr�� Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - fw&ner;l R"rarngge copy /Well driller Form WC -97 Public Health Director April 1, 2002 DEPAR'T'MENT 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 (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Proposed SSTS - D , Bell Hollow Road (T) Putnam Valley, TM# 62. -1 -56, Lot # 3 Dear Mr. Nichols: 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: il! Provide 100% of the required primary and expansion trenches. ._ Nouse_P]arls_subxmltted,arP considered to-be ..a four (4). bedroom residences = >revise - - _ accordingly. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, r Shawn Rogan Public Health Technician SR:cj r] PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICE , S DESIGN DATA SHEET - SUBSURFACE, SEWAGE TREATMENT SYSTEM Owner Ott< HFOR Address. 10 45 4AR 2C FOWW4 t� Located at (Street), MV,Tax Map G"L,' Block Lot 6(o (indicate nearest cross street) Municipality P L) VH 1�fJj V A q, r—,y Watershed..' P0600 �LNE� SOIL PERCOLATION TEST-DATA Date of Pre-soaking Date of Percolation Test 'bi ul I NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each .,percolation test hole. - (i.e. s I min for.1-30 mih/inch,':5 2'm'in for 31-6.0. min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 - Depth o:- � - WM' et From Goun d W a er Lever ke, rco :H Tune ..... ... Amp. Time s(Min.) Stirface. (Inches] - Staft: St OP::: .0' In Prq P n: es, . e Min/Inch X1112 �JJA 2 V 3 to 11 3 . ..... �- 4 5 t 2 9A C3 4 5 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. s I min for.1-30 mih/inch,':5 2'm'in for 31-6.0. min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 - Indicate level at which groundwater is encountered H oral Indicate level..at which. mottling is observed NQ Indicate level to which water level rises after being encountered WA Deep hole observations made by: �WALVA 5T01a AH(A NO) Of' M 'Owbate AVM Design Professional Name: HM4f W, MA6VWL5 J'�- NE- Address: tad: sz �dW �0 Signature:. S , } ` �� .. ; A t, 'IN Ind Design Professional's Seal JEST PIT DATA 2 , TDESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES li�PTrI . G.L. 0.5' T� 1.5' 2.0' 2.5' �� SA�9 1;�`� �• 3.0' 3.5.' L 4.0' 4.5' 5.0' 5.5' 6.0':j 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered H oral Indicate level..at which. mottling is observed NQ Indicate level to which water level rises after being encountered WA Deep hole observations made by: �WALVA 5T01a AH(A NO) Of' M 'Owbate AVM Design Professional Name: HM4f W, MA6VWL5 J'�- NE- Address: tad: sz �dW �0 Signature:. S , } ` �� .. ; A t, 'IN Ind Design Professional's Seal • PUTNAM COUNTY DEPARTMENT OF" HEALTH DIVISION • OF ENVIRONMENTAL•` HEALTH - SERVICES � } ' • . .'APP_ LIGATION FOR APPROVAL OF PLANS FOR —" - A. WASTEWATER TREATMkNT'SYSTEM • k •' L'::' 1. Name and address of applicant: Gil.- ;IJ-a!✓�R"D ; "'' :'' .......... ...• .. � llo:= -,�-�. �"�.L,� P- Qom. :�.. .. • ._:; ;r:•�. .���. 2. Name of project:.... Imo ` 3. 5S `�` 3. 4:- 'Design Professional: I4AP-R.Y ►nJr NVVL/_2; )W5. 6. Drainage Basin: R(2 6,J' - 7. Tvne�„ of Project; Location TN: PuTNPrM Address: _ �?-o 2�0 Z2 TE X• " Private/Residential Food Service Commercial Apartments.... Institutional Mobile Home`Park Office Building Realty Subdivision Other (specify) �J.. 8. Is this project subject to State Environmental Quality Review (SEQR)? T ype " t, atus . ( check. one) ................... .... .,.............. ... :........ .:. .'Type I . Type II;,. - - Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ........,...... i NR 11:- Name of Lead Agency NA 12.` Is this project in an area under the control of local planning, zoning, or ffi 43 -If so,.have =plans been submitted to such authorities? .:::..'. .... 14.':" Has preliminary approval been granted ,by such authorities? � Date granted: . '..... ,'...• l -. '. 15. Type of Sewage Treatment System Discharge ................., surface water k groundwater 16.: If surface water discharge; what is the stream class designation? :....... :. Iy;q =17: Waters index number (surface) .. ....................... :....... 18. Is project located near a public water supply system? ....... ............................... No ; 19. If yes, _name of,, ater supply": N A Distance to water supply,,oL14 20. Is project site near.a public sewage collection or treatment system? 21. Name of sewage system ' g y I� Distance to sewage system' W 22. Date test holes observed 23. Name of Health Inspector A '0Affi . STTA . 24. Project design flow (gallons per day) .............................. ............................... ;.:;; ; 6 p.�4 w; .25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N 0 26. Has SPDES Application been submitted to local DEC office? ......................... f� Q Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? 28: Wetlands ID Number ....... ................................... ......:...._........._......... _ NQ 2i. - s �V dtlands Permit required ............................................. ............................... N Has application been made to Town or Local DEC--office? ............................... N; o 30. Does project require a DEC Stream Disturbance Permit? 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 �fl 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................... ............ Yes/No; -= -- DESCRIBE: 33. Is there a.local master plan on file with the Town or Village? ...:..:.; ................ . 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............................. ................................ 35. Are any sewage treatment areas in excess of 15% slope? ................................ N b 36...Tax Map ID Number .................. : ................... ..................... Map 6`�-� Block- I Lot 6 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE:. All applications for rev1ew and- approval of anew SSTS to be io ated v ithl:1_ w':e :`I 'C ` - 'etshcd shall - _ be sent to title llepartment, 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"Ihe 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 a ctivities,fro•m DEP and submit those forms to DEP for review and approval. If the application is signed by a person .other than the applicant shown in Item' l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 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 Pen# Llrw.,, SIGNAT'1rIIdES & OFFICIAL TITTLES. i+AW WU N+ Mailing Address: .................................... 060 R-T 2q_ : PUTNAM COUNTY• DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES LETTER OF AUTHORIZATION RE: Property of _ CAP-4w HC 5, pAN F-D" Located at ALL T/V ptl'�NP�M �NL- Tax Map # Block Lot ';P(a Y Subdivision of WI�Be P- Subdivirsion -Lot # Filed Map # Date Filed Gentlemen: This letter.-is to authorize a duly licensed Professional Engineer < or Registered Architect to app y foi the required wastewater treatment and/of water supplypermit(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 C.O. nry 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/pr.water supply.sy5lerns in - tonfCoril W,1411 tac PrOWSiuns of-Artit;ie 145-wnd/or'147 of -the Education Law, °the Public Heali: - I aw, and the Putnam Cotin Sanitary Code. Countersi P.E., R. A. 'Mailing A State Zip... Q� ©� Telephone: (W ) Very truly yours, Signed: (Owncr of Prgperty) Mailing Address: 11045 State N y �.lp.... �y.. Telephone: �� 1 �� �� 0 (o Forn. LA-9' Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 - — - - Route Telephone (845) 2794003 Fax (845) 2794567 _ March 19, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Weber Subdivision, Lot #3 Bell Hollow Road (T) Putnam Valley, T.M.# 62. 4 -56 Dear Robert : Enclosed are the foll owing: 1. Three (3) prints of Drawing SF -3, "Preliminary Design for Fill Placement Only," dated 3/19/02. 2. One (1) prints of Drawing SS -3, "Proposed SSTS," dated 3/19/02. 3. Shart. EAF. 4. "Application for Approval of Plans for a Wastewater Disposal System," dated ._ ..._ 3/19/02. reiiriit fot'Sewage iffsposal= aystertl, _dated 3ii9iU2` 6. "Application to Construct. a Water Well ," dated 3/19/02. 7. `design Data Sheet:" S. `2,etter..of Authorization." 9. Two -(2). copies of residence floor- Plan(s), -far bedroom count only. 10: Review Fee in the amount of $300.00. If there are any questions concerning the enclosed, please call . Very truly yours, Harry W. Ni ols Jr., P.E. HWN:JM:jmm 02 -0 17.03 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET . J S STAMFORD, CONNECTICUT o69o5 NELAC, CT and NY State Certified Environmental Laboratory •Z' •- - v .•- s> t, v> . -:"XY. rd. a.n. . ntr a-+ n c a =. •R W >v n. .c r•':. .. .• •.• Mailing Information: Collector's Information: Name: Boyd Artesian Well Co. Client: Name: John N. Address: 1054 Rte 52 Address of site: 77 Bell Bollow Road City: Carmel City: Putnam Valley State: NY Zip: 10512' State: NY Zip: Telephone: 845-225-3196 Fax: 845-225-8420 Telephone: Sample's Information: Site: kitchen tap Date Collected: 6/25/04 Date Received: 6/25/04 Preservative: HNO3 Time Collected: 7:00am Time Received: 3:00pm Temperature: <4C Lab No.: J046687 Date Analyzed Test Name Result MCL Method 6/25/04 16:00 Total Coliform Absent Absent SMWW 9222B 6/25/2004 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 6/25/2004 Color ND 15 Units SMWW 2120 B 6/25/2004 Odor ND 3 TONs SMWW 2150 B 6/28/2004 Iron <0.050 mg /L 0.3 mg /L SMWW 3111 B 6/28/2004 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111 B 6/28/2004 Sodium 11.3 mg /L N/A SMWW 3111 B 6/28/2004 Chloride 21.0 mg /L 250 mg /L SMWW 4500 Cl C 6/28/2004 Hardness 76.0 mg /L N/A SMWW 2340 C 6/28/2004 Nitrate 1.21 mg /L 10 mg /L SMWW 4500 NO3E 6/28/2004 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 6/25/2004 pH _ .. 5,63._S.U. 6.5 -8.5 S. U. Stv'NVA.N 4500..Fi� . — ..... ---:: "::. _SMWW _ _ - .� 4500 SO4F 6/25/2004 Turbidity 0.57 NTU 5 NTUs SMWW 2130 B 6/28/2004 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable S.U.= Standard Unit MCL- Max. Contaminant Level ug /L- micrograms per Liter Signature: Michael Lapman President mg /L- milligrams per Liter ND- None Detected NTU- Nephelometric Turbidity Unit TON- Threshold Odor Number Reviewed b r Sharon Houlahan, Director State #: PH -0218 ELAP #: 11715 Tel 203 961 9911 Toll Free 1 866 567 5097 Fox 203 961 9919 irnsenvironmental.com July 9, 2004 Mr. Joseph Paravati Putnam County Health Department One Geneva Road Brewster, New York 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 - - - Brewster. NY 10509 - . Fax: (845) 279 -4567 Email: hnengineer@aol.com Re: Individual SSTS Compliance - Danford 77 Bell Hollow Road Town of Putnam Valley T.M. # 62. -1 -56 Dear Joseph: Enclosed are the following: 1. Five (5) prints of Drawing S -3, "As -Built SSTS ", dated 07/07/04. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 07/09/04. 3. Three copies of "Guarantee of Subsurface Sewage Disposal System ", .dated 07/09/04. _. .� ... .: ~ 4. Laboratory Report, dated 06/28/04. 5. Application Fee in the amount of $300.00 payable to Putnam County Health Department. 6. "E -911 Address Verification Form ", dated 07/08/04. 7. "Well Completion Report", dated 07/07/04. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. N ols Jr., P.E. HWN:gav 02- 018.03 LORETTA MOLINARI Public Health Director June 4, 2004 r.,�..r. •.e':...,�� r-.:mvK .�-. • �.. �c . ... _. - v .. - .r... .v+ <>� - e- nu.c.+i up,. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509. Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection — Danford Bell Hollow Road, (T) Putnam Valley TM# 62 -1 -56 Dear Mr. Nichols: ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on June 2, 2004. The following commet must be corrected in the field. - Encl_-:caps need to be eA�,os?': £ ^_ _r _ _ trench length.; - . -- -�-;,/ ,..__ _... ._.. ....... -�.... _.......,_.v . M.....a..3r 112 e„tion c_ id -.to= -determine._ ._ _ d .._.... � .. _ _.� .. .._... _ _..._.. �L The pipe coming into boxes 6 and 7 needs to be trimmed. Box 10 needs to be replaced. tyl / . The sleeve for the PVC SDR -35 pipe that runs through the rock wall needs to be exposed. 0 If the last bend before the first junction box is 45 °, a clean out needs to be provided. V� Please provide location of footing drain/roof leader discharge. The catch basins provided at the end of the driveway are within 50 feet of the SSTS V" a area. tyyvtTnave any MRer qu JSP:cj please contac me at (845) 278 -6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES l� y�d FINAL SITE INSPECTION � �V" Dater 1 �k In .3 1- specie y. Town Permit # joy - « - TM # 5-(, Subdivision Lot # Weh� Lpf • - 3 1. Sewage System Area Y 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/wetl s ...... ............................... II. Sewage System a. Septic tank size - 1,000 ........1, 250 .........other ................ b. ' Septic'tank installed level ................ ............................... c. 10' minimum from foundation ............................ I............ d. Distribution Box 1. All outlets at same elevation -water tested....... ........... 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between bo trenches e. Junction Box - properly set ............ .................... ...: -6. Trenches 1. Length required Lengt 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 he - 20 ft, foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 %..........1 ...........:.. 8. Size of gravel 3/4 - 11/2" diameter clean ................ 9. Depth of el in trench 12" - ::......... - g,4�mo or Dosed{ �. 1. Size of pump chamber...... . .... .......Ik .................. 2. Overflow tank ........... ............ .... ................... 3. Alarm, visual/au ' ........:...... ............................ 4. Pump easil cessible, manhole to grade ................. 5. First b affled .......................... ............................... 6. C�� yyc witnessed by H.D.estimated flow /cycle........... III. HouseBuilding a. douse located per approved plans.... :::....:...:.......... b. Number of bedrooms ...................... ............................... IV. Well Well located as per approved plans.......:. I ...................... b. Distance from STS area measured d'co -d ft........... c. Casing 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ... ............................... . b. All pipes partially backfilled .................... .........4....... 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 waterco g. Footing drains discharge away from STS area ............... C h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev: 12/02 M= M= M= M =� MM II/ COMAIENTS 7 C - = 7, uci Or (( o�c SITE INSPECTION FOR FILL ?AD Date: �f Inspected by: Fill pad located per the approved plan's Fill Pad Length hgo q�, Required Length_ �. Fill Pad Width 69 Required Width Fill Pad Depth 0 �J� U Required Depth Run -of -Bank Fill Quality (Oo p,� Slope from Top to Toe G �cw• j 3 Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) .... .... .: . 6' . • riudluuuai �.Oii117ic1ItJ: Reserved for Field Sketch if Applicable JUN -01 -2004 08:00 AM HARRY W NICHOLS 914 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OV HEALTH DIVISION OF ENMIRONMENTAL HEALTH SERVICES For: Fill ; • . Date: Ca `'� . Trenches PCPID Construction Pertait # t6 —OZ-0— ; Located: Owner /ApplicautName: C_ Dckk CJ TM_ .it2,• 1310c I Lot Formerly: Subdivision Name: �c- Subdivision Lot # Is 'systerii'fill Coazpleted? Yeli Date: Is system complete? ;^ Date: --CJ Is system constructed as per plans? f Is well drilled? Dater -j —a' : r .Is well located as per'plans? Are erosion control measures in place? -- 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 PdHD Construction 'Permit. and approved plans and the Standards, Rules and Kegulations of the Putnam County Department of Health. .'Daw:, ..'•'- "'� , r`s►.ii�e . Desi rofessi4a., Address: Cotxmeam. • ';`` .FOR: C7 ADAM p GENE t'1 Pwira ti'a . • • :�.': . Form FIR-99 JUN -1 -2004 TUE 06 :17 TEL :845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUT'NAM COUNTY DEPARTMENT OF HEALTH REVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ?V tC -off Located at bo-t_ Houjota Q_*Ajs Town or Vill Subdivision name OtZh g Subd. Lot #_ Tax Map 62. Block Lot 56 Date Subdivision Approved 0-7A# &® Renewal Revision Owner /Applicant Name CA9ZQU L5Q 3 /ApAlPhro-b Date of Previous Approval Mailing Address Q 1 Q -A s'I 9 p S �,cI.Q�� �B c rz y Zip 1 l� Amount of Fee Enclosed Building Type Qsso bffac & Lot Area 3.0a ACNO. of Bedrooms 3 Design Flow GPD 60 Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewea•age s�ffi to consist of tom gallon septic tank and 3`15 aF A ®S �a.qc�(e Other Requirements: To be constructed by 1731> Address Wak Sunnly: Public Supply From Address ®F: X— Private Supply Drilled I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date oS_09 -o4 License # SC 124 APPROVED FDIC CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. -�5_L By: Title: ,�'iJ Date: Whi opy - HD File; Yellow copy - uilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Harry W. Nichols Jr., P.E. Patterson Paris, Suite 106 2050 Route 22 Brewster, 11Y. 10509 1, " - �_� fieiephone'(945) 2.79 3•' - ' Fax (845) 279 -4567 t L)_CIVxv!IzrI% 4CIJ are- s (i��- A) "I - Att'ent'ion: ;/A , t/o•e, Ars'cvf l Gentlemen: We enclose (13Tcopies of: 7LB/W Prints Reproducibles Specifications Memorandum Date: 5719 O t Job No.: -Project /IV,, e T J) - Sv 4 ►- Reports Tracings Copy of letter Description: Revision/Date No. r !rylc l �..C✓i►ts:y c _1vrc..- �c�'�- :5�.�7`j .... ..:.::: .._... Sent Via: )Wur Messenger Blueprinter First Class Mail Special Delivery Your Messenger. Hand Delivery Copy to Very trP yours. - Harry fit' :(JI`tich Jr., P. . - APR -28 -2004 01:44,PM HARRY W NICHOLS 914 279 4567 pUTNA q CotTNTY.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES For Fill </ P.01 Date: Trenches PCHD Construction Per6tt #6 P V %i!� 702- Located: 6 �a� (T) Owner /Applicant Name. C4 —PaLs e a�►�� TN1 8io6k Lot,, . Formerly: Subdivision Nave: At Subdivision Lot # 3 Is 'systerd -fdl completed? • ��-S Date: Is system complete? Date: Is system constructed as per plans? —� Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? YGf — �- I certify that the syste6(s), as listed, at the above premises has been constructed and I have inspected and .verified their c6mpletion in accordance with the issued PCBD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health_. Date; Certified by: � .E .�RA-- _ ..._._ ..�..., r.. Des! Professional . Address:' �- i,ic. # S 6 12-4 Comments:. FOR: ® ADAM. ® GENE 0 4L Form FIR-99 APR-28-2004 WED 14:01 _TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMFNT nF P_ 1 T. .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ....... _.._.... _ ....... ,_ ....ry _... , ._... _ � ....;... �..._.....�.. ,.. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT IT PERMIT it f V / 6- d Located at 5a�— NQLLDW k n D own or Village Subdivision name W 21�" Subd. Lot # Date Subdivision Approved -7 I'm 100 Owner /Applicant Name C—AP -0 L ' 1�- Mailing Address M "46 �0 Amount of Fee Enclosed P urlim V pruzl Tax Map Gl-` Block r Lot 5 (-o Renewal Revision P44 Date of Previous Approval 00 Zip I jt-j5 Building Type DES 105HCF, Lot Area 00 �*o. of Bedrooms Design Flow GPD 600 Fill Section Only Depth a-15 Volume o t-Y Separate Sewerage System to consist of IQ o o gallon septic tank and Other Requirements:. To be constructed by r6D Address Water 'guooly: Public Supply From Address ur: rtwate �uppiy Driliea by A - ess 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 acpordance 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. A /JIB %��� . -- Address f)-060 l ti� BPL� N y 10 X4°1 License # 5(.17_4 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 yhen considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe it. Ap roved f ischarge of domestic sanitary sew only. By: Title: Date: 3� Z White copy - HD File; ello c py - Building Inspector; Pink copy - er; ge copy - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT OF HEALTH ➢DUWSgON OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL pease print iir type Well Location: Street Address: Town/Village Tax Grid # emu- �ol.L0� ?- 0 POV14 NM \ L t�Y Map Cot - Block I Lot(s) 5(0 Well Owner: Name: Address: IIr5 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- p>rimany Business Farm Test/Monitoring Other (specify) 2- secondlairy Industrial Institutional Standby Amount of Use Yield Sought V54- gpm # People Served Est. of Daily Usage 600 gal. Reason for Replace Existing Supply Test/Observation Additional Supply IIDrfllnng New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type `iL Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No >< Is well located in a realty subdivision? ...................................... ............................... Yes - No Name of subdivision \J4 6 Lot No. # Water Well Contractor: 1$D Address: " Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: _ Town/Village - Distance to property from nearest water main: Proposed well location &sources of contamination to be provided on sepaz ' sheet/plan. Date 'w.�.�•..:, d "1-. �. Applicant Signattu�e: _ A _ . •,��. - . 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 .]F'OR 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. /% „ A Date of Issue -02 Date of Expiration — ---0 Permit is Non-Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 • fr ., ,, 11 Y'1 ii'it• 'trl�l!`'�4! �'?, J._ PROJECT IACAk ` ' PRWWT 1.0. NUYBFA e�rzo -. . S. LS PR0P0W A0TM'•: • ��'�1+!'y' V.��y 4 -'�•v� J.••+4'a:.T' a:J .F 1•�°•^}�. .• . i � `,4� (1 (� i.4'�.J}l�ll ��e�• "`'_' 7. AMOUNT OF LAND AFFEOTEOS Q Q�.�Y•r�_� fl State YImnRlental Qwuty,1i1ewil,�rlk.,l,rdl.lir0 .4 8. WILL PROPOW ACM COMPLY WRN EXIBTINO ZONING NOW tOW�TINO LAND USE Rt PMOTOW. ; {tit'; «�' �r P. WHAT 18 PF1W, LINO W9 M VitEfM OF; PRWtbOTT SHORT ENVIRONMENTAL ASSESSMENT :­` 4: ♦• � • r .FQBM; , • � �� �r O�-'�r � f � i141: i i 1 {U 1 i x:11 'J J� .� '' ! �I � � � , .. : .:..•r,.al,.�y.�..••. r � �. \_�0�� .,, f •., .,r•. :, �.. �.. �.+� •. , , '_ {Ji. 1 :jtli'1,'7�rr;1x I.Z•. •�6.v; be ooMletod by Appllmt or Pm) eot apotrlasor� � L:r.f •fi. ,a uu�l� w , ' <. ;. PART I- -PROJECT INFORMATION (ro .. •.' ..wvucANr rsFONSOR g _o [A 1-4� DAB � PaaEOT NAME— � .. � �: �....._... J._ PROJECT IACAk . PRE=9 LOCATION WjW oddmu and road InWam U9(%% Prom WI landnu"sto. a PMYWO map) -. . S. LS PR0P0W A0TM'•: • • �,� N.� ..._o � o ModllloaLloNallaratlon .:.... .._.__.: . S. OESCAIBE PRWECT BRIUM . . _ .. .....,.. . -_. ,.., ..,;•.J • .:i:! •iii•:. y.�r•; 7. AMOUNT OF LAND AFFEOTEOS INWI �� 00� 8. WILL PROPOW ACM COMPLY WRN EXIBTINO ZONING NOW tOW�TINO LAND USE Rt PMOTOW. �Yq Dino -u Nor aworlf� ertaty ,. P. WHAT 18 PF1W, LINO W9 M VitEfM OF; PRWtbOTT �4 OApnouflure ®Pwww"UOpon ❑ Waa OtMr, Ij 10. GOES AOT10?l 1kWLVE A FERMI` AF'PROVAI. OR FUNDWO, NOW OR ULTIMATELY FROM ANY OTHER OOVERNMWMJ!k WENCY pt CRAA. STATE OR LOCAW ... _ �❑ YN :'....:. ®NO . �.. � iS1r � �"^'7MI � pa11111�a�pl011i1� � ... , t t � .. ;'> i ,' ti , _ —i:, ..... • � 1. , 1 i { f {'. i ( G , 11. 00 ANYABPEtfiQf.•TNi WWRA.WN{ENTLY.VALID a Pt;�IWT OR APPROVALt . f. No Ai t I Yr t' ft 1l.;dr ..... ... • V ... � -...t ' , .� ... • •� - - -- • ..... .. ... • .., :,., , .,.4 �','.,.,/ • Pfi OP ; 12. AS A RE8ULT.0�Fy W..AM WU E�UMI PEAMRN1PWAL AWN moW. ATp" NI ; O YN ,. L�Nc 1.1l. ..x.1..4• y. • 1 CEA W THAT TNEINFOWTION PROV10110 ABOVE 13 TAUS To THE BEST OF Jjy,* OWA.E00E ' 1" ! AvptluAtlaPonior nanwc � � � �) *" ac« 411*11 Slynatur� :...__. . if the a coon is fi tho.Coastal Amax and you am a et4te aaettay; aompiste.'the ;A'�'` Coastal•Assessmnt Form" before pmosedinq with 'this assessment Miffs 5 1•. PART II—'ENVIRONM9NTAL'AS3E33MEAIT'(T0 bo'CoMpleted by Agenoy) A. DOES ACTION ANY yypg I THRWOW IN HYGM PART. 4117.0- 11Y66,900 Ly!?s tm roview PrqQM -600'96 —�— I — B. WILL ACTION T 90FJV9 O0OR01NAT90.F4VV M may to "per SMAW lhvgkw $11,05 ❑ Yoe C- COV0 A IN ANN ADVE"g gFfWT# ASSMAT90 WITH THE FOLLOWING.- (An#WM MY 00 Cl. U14IIA9. all quality, iW4i* orw4w quality or quenuty, polooi levels, 99OWT 9olont,81 lot o(coon. drakuw Or floofte 00614MV 9*16A br(iefly! ..... ..... C2. A0 . 81hotic, 8911culturol, afGhwol"Ical, hlotoflo, or olhor rQtu(gl or cultural roeourcea; Of community of nolghWtOOd chafttO &4161A bdolij: C3. Vogotallon or launa,-Iloh, shallileh of W)WIIIg opgoleo, olgnlllwl habitelo, or lWoolonod or ondongo(04 UP001601' U918111 IXIOIIY: -C4. A CoMmynity'o 09181" PION Of PAIG U9111014111yadopted, of achange In use 4f 1111®10117 Of UN /47 C5. olottolh. OV000quont developa"k W (018100 aellyll1w likely to 00 Induced by the pfopom 00tion4 9AP101A Melly. A C6. Long term, Wwrl W(m, CUMAW% wow offecto nal weiawled In 0140 Explain Molly. . . ..... C7. Other Impact& (including changes In use of either quantity Of type vi onorgy)? Explain Molly. 0. _Hk UIRACT =TASUNswaff -qF- &-mv- WILL T y L 15 THEAF- OR it D--q-MUKUY TO 6 OONT8OV9NY- R9LAT9b TO. POTENTIAL A0V9N9 ENVIRONMENTAL. IMPACTS? Yob It yeso'expla briefly %RT III — DETERMINATION OF SIGNIFICANCE (To be completed by''Agency) INSTRUCTION& For offew Identified above, determine whothier It Is oubatantlal, larq%limponant.orotherwiff - !!qnIfic Each effect ahould b#-�l*Sg in COU"On With 116 0) "jUnp. p.9, , UMN or rW4k#kpMbW %#�:. lily -90�:qm " �411* - , .. -- owl reference POO 4 erleli�,e We'. lhbl and (1) macinfluds;-� It pff0i &W attachments or fors #up 16i n I oxplanallons contain oufficlent detail to ftV "I all relevant advor" hapools be" been "tilled.and wo. usilely ad it pUt 11 q .4104"a I Question D of W" choolto y", the delorml"lleft VA sIgnifloance MU91 QV0114110 OW POWntlill'IMP401 Of the PMPQ$W ICIIon on the en%fIronMqntW Gh&r&Qjjd&UC4 of the CEO. ID Check thla box It y o-u have Identilled one or MO(OV0101`11116111Y 1111r9i of Significant adverso IMPBOW Which MAY ccur, Then PtOC40d directly to the FULL EAF an or prepare a politive'declaration; ,,JgT hock thlo box It You,.,havi, deist-mIned, hamfl on the InformatJoh 4hd.&nWy$j@ above and .any supporting documentation,. that the .proposed action WILL NOT revull'In any 419nIfloant adverse environmental Impacts AND provide on gttagh m9frijo &l.f.140egsitryo the re q ppVepl"k tqrMIn I a Ion: .. .. -.. - �'�� � � , ,i -ri��4 via 18'u �aa ........,00„��' = -..... MUM P wvujfadj $rii� iR r!"" N aglow WE RW= Rikely -4% PUTNADI COUNTY DEPARTKENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH WDIVEDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONMUqI4'S NAME OF OhNER. STREET LOCATION: ��� REVIE«EDBY: R.L OR, AS, ATE: —TAX 1vIAP ',:(CONFIRUED) Z' IN DOCL"`IE \TS . (_JPERtiIIT APPLICATION (•-JWELL PERMIT ORPWS LETTER CZLJPC -97 L,/)L )LETTER OF AUTHORIZATION LQLJDESIGN DATA SHEET (DDS) LJL6CORPORA,TE RESOLUTION (Z( -)SHORT ExF (UL JPLA`iS -TEREE SETS (,eJ-LJHOUSE Pw"?s -TW'0 SETS Lj(/)VARL4NCEREQUEST SUBDIVISION 4JLEGkL SUBDIVISION )L }SUBDIVISION APPROVAL CHECKED UUPERC RATE /J- (Q(_,)FML REQUIRE DEPTH UL OCURTAP; DRAIN REQUIRED gEnPkL (� CATED ri NYC W D U ()( )PLA: D TO DEP UUDEL ' DT- , P APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED (/; C_JPPRCS TO BE WITH -ESSED (:: L EZAPPROVAL SSDS ADJ, LOTS —)E CVETLANTS (IOWN/DEC PERbIlT REQ'D ?)'- ' (%�UDATA ON DDS PLANS & MUM SAME L-,(,::JRE 1969 NEIGHBORNOTIFICATION �L LETTER BUZBA -• -_ �� ;-.�� j •'3T^.•�;:: ;i:vvli t:iJATivNi�//Iiub` -` - . Lice50-IL TESTING LOTS>10 YEARS OLD REOUiRED DETAILS ON PLANS LUSEWAGE SYSTEM PLAN - (NORTH ARROW) (:::�L,SSDS HYDRAULIC PROFILE GRAVITY FLOW • - L CONSTRUCTION NOTES 1 -15 _ LDESIGN DATA: PERC & DEEP RESULTS (,f:)r�T CONTOURS.EXISTING & PROPOSED C,,Jr DRIVEWAY &SLOPES, CUT FOOTIa`iG /GUTTER/CURTAIN DRAINS ( ( USDASOILTYPEBOUNDARIES (TITLE BLOCK; OWNERS NAME ADDRESS � � Tb1,:, PEIRA; NAME, ADDRESS, PHONE- }!J� DATE OF DRAWIi`iG/REVISION ( DATUMREFERENCE _ 'LOCATION OF WATERCOURSES, PONDS ' �LAKES,WETLANDS WITHIN 200' OF P.L. �J`�PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (,WELLS & SSDS'S WAIN 200' OF SSTS (:::: _)PROPERTY METES 4 BOUNDS v COMMENTS: /40 x (REvsHErn i _ (REQUIRED DETAILS ON PLANS CONT'D) UUHOUSE SEWER -'/:' FT. 4 "0'; TYPE PIPE CAST IRON (:fj�LJNO BENDS; NIAX BENDS 45° W /CLEANOUT 1 RENEWALS E NOTE (NO CHANGE) / FILL SYSTEMS U�(• )10' HORIZONiaL; PAST TRENCH SLOPES 3:1 TO GRADE U�- -)FILL SPECS/ FILL NOTES �S' ffiF ILL PROFILE & DI�i'SI'6�S FILL Di EXPANSION AREA FILL GREA TER TA.4 —,V- 2 FEET (�} CLAY BARRIER NJa p I' (/FILL CERTIFICATION NOTE �� o—On4i 01-v (DEPTH GAUGES C/fLJVOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (,eCJSEPARATIO ISTANCE FROM TOE OF SLOPE _:PRCQVIDED 3 60FT MAX. (, e- -JpAR. LE L CONTOURS (,,-::5LJDET UST FREE CRUSHED STONE OR WASHED GRAVEL (GEOTEXTME COVER SEPARATION DISTANCES ON PLAN - FROM SSTS ( )10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL L�20' TO FOUNDATION WALLS _ __)100' TO WELL, 200'V DLOD,1-50' TO PITS (,-jr- 100' TO STREAM, WATERCOURSE, LAKE (mc. e=pan) (.2C-)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (��1T1'-Ti�1y'i�iLrVR. -f^its INTERMITTENT DRAINAGE COURSE (f (-,200' /500' RESERVOIR, ETC. 150' GALLEY SYSTENIS (,t:5L_)10' ZNMN TO LEDGE OUTCROP SEPTIC TANK L)10' FROM FOUNDATION; 50' TO WELL _ (� LJDI1MENSIONS TO PROPERTY LINES'-- - --- -! �' "' �.�J LOCATION OF SERVICE CONNECTION — - �GR___1M 15' TO PROPERTY LINE SLOPE L�LjSLOPE IY SSTS AREA (S20 %) (_JL jR•EGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS UUDOS 75% F IPE VOLUMEMOSE VOLUME NOTED L�L�DET R ORCE MAIN, (PIPE TYPE, ETC.) UUPTT - OX SHOWN & DETAILED L�L�1 DA STORAGE ABOVE ALARM CURTAIN DRAIN UUSTA IP , 5' BOTH SIDES, DETAIL L�L�15' b S✓ >5 %, 20' -4 %, 25' -3%, 35' -1 %,100 % -Q% (__)( _)20' I41 to CD DISCHARGE/100' with 182 cons day discharge b to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAIL. HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village:. -._ ._..._... Tax . Map (A, Block �..1: Lot(s) % Well Owner: Name: 'Address- 1° l A of - Residential Public supply Ad con pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Use of Well: D- primary 2- secondary )Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter min. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: ;K Cement grout _ Bentonite Other Drive shoe: 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 L%J— gpm )[Depth Data Measure from land surface - static (specify ft) 8 During yield test(ft) fa/ Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 91 ZS-' ev If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity 9._!3p `" Depth Zais Model 76407412 Voltage 2*0 HP Tank Volume _ Date Well Completed Putnam County Certification No. Date of po Well ill e (sign ) NOTE: Exact location of well with distances to at least two permanent landmarks to be pro v a on a separateheet/plan. Well Driller's Name jDate: dress: Signature: �grangie o White co PY : HD File� Yellow co PY - Buildin Ins ector� Pink co PY - er� copy- - Well driller Mo� Form WC -97 S EXISTING 3 BEDROOM RESIDENCE A IS 4''d So LID SD& 35 1000 GAL. $eerie TANIL 2 e.O Pvc-1111 3 q C.0 ExI6r. ;e 4 0.0 . O 5 35V AB5 M1,IC 24 ' 6 35' 2.5 ~— Imo% 114- 36' . ti xPI 31_ ao3PROJECT PROPOSED SSTS WEBERSUBDMSION LOTN7 3 16 O PJe 41 BELL HOLLOW ROAD _ s PUTNAM VALLEY NEW Y( a -- �, CLIENT: CAROLINE S. DAN-FORD z 110 -45 71 ROAD 2 C 2 201.26' 5° 20'56 "E FOREST HILLS NEW YO Harry K Nichols Jr.; BELL HOLLOW ROAD Suite 106, Patterson 1 2050 Route 22 Brewster, NY 10509 (845) 279 -4003, Fax 279• CONSULTING SITE ENGIt DRAWING. TITLE AS - BUILT. ..SSTS .. N tz: MI, ra _ ..... W J 4 y v SITE LOCATION PLAT SCALE: I"= 2000 PROPERTY SHOWN ON TOWN OF PUTNA M VALLI TAX MAP: 6Z.-I-56 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSIJjN OFWNVIRONM�EONiAL HEALTH SERVICES. APPROVED AS NOTED FORS CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE P COUNTY HEALTH DEPARTMENT. ��[^^ 7 !a oy GNATUREIME R,y5c -vmci for PGHO Approved Stamp LOT. # 3 SCALE : I °= 30� DATE : 07 -01 -04 DRAWN BY': MC CHECKED DY : HWN JOB No.: 02-018-, ORAWING No DIMENSION CHART (in feet) Number A B 15 43 2 61 I 40 3 101 1 82 4 139 120 5 190 172 6 195 178 7 200 1 84 8 205 190 9 211 196 10 217 202 II 223 208 12 228 213 13 233 219 14 239 225 15 257 216 16 252 230 17. 247 225 18 242 219 19 236 213 20 230 207 21 225 201 22 .220 196 23 214 190 24 209 184 NOTES THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE THE DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. SURVEY INFORMATION FROM SURVEY PREPARED BY CHARLES Boo LuK05,L.5. m N d o� r 0