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Home My WebLink About2804DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -2 -30 BOX 24 ' `''�9 11.hi , 1 No ,. T r , ' , ,' r = t� ., PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # wci 4a''a4 1 (0 `INC map I31ock Lo(s) Well Owner: Name: Address: ,Q eff Wa�e4 �� C'sC-C, WCi Use of Well: 1- primary 2- secondary esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment v, Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened vl' Open end casing Open hole in bedrock _ Other Casing Details Total length a j ft. Length below grade _11a4> ft. Diameter G in. Weight per foot �lb /ft. Materials: ✓ Steel Plastic _ Other Joints: —Welded ✓ Threaded _ Other Seal: _dement 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 I Well Yield Test _ Bailed _ Pumped VCompressed Air HoursZ Yield 6-- gpm Depth Data Measure from land surface- static (specify ft) 3 D During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available; please attach.. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 0 C> (.:� 5g 1. y. Lt i y7 If yield was tested at different depths during drilling, list: -Feet, Gallons Per Minute Pump /Storage Tank Information---. ; °. „.. Pump Type Sc,,d �yora; Capacity Depth L}910 Model 6-610 as Voltage aao HP / Hip Tank Type W1 x %}r /Volume 3 sa. Date Well C mplete Q i 6 /D Putnam County Certification No. aoq — /b Date of R port �3 �l -7/�!p Wel Driller (signatur NOTE: Exact location of well with ntstances to at least two permanent lanamarks to t)e provtaea on a separate sneevpian. Well Driller's Name 41-6 (hk Ct Vk (- t . ceg"r I 'c) Signature: "2 i_A"o, Address: _ /-6_oZ AST q µ! Sfi G t. a Date: 9 ! v White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF DEALT DIVISION OF ENVIRONMENTAL I4FALTH gEIPy_ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # SNI - 32- - 3 Located at nSc a wc.a% y L wke J?m *_J Town or Village Po +n Qa4 V4 11L-'( Owner /Applicant Name J a l W "t4S ..Tax-Map G L. Block 2 Lot 3 O Formerly Subdivision Name Subd. Lot # Mailing Address Zip Date Construction Permit Issued by PCHD 69 Separate Sewerage System built by Address Consisting of I Ste'° Gallon Septic Tank and 1, SU0 9a (/'m �„ � 6,44, xy Other Requirements: S A— 1 C- 04 +I- V C t t ke t c _Q Water Supply: Public Supply From Address or: Private Supply Drilled by Address Building Type S i ii q �_ fL4 4 (Y � Elas erosion: �r.fr�l '�e:'r, ccr;►.nlet d? �-� S Number of Bedrooms �..as garbage grin iisf ? C4 0 I certify that the system(s), as listed, serving the ab?yapref 's built plans (copies of which are attached), in ac I a th plans and the standards, rules and regulatio a utn Date: Certified by ` (D ign Profe siona Address 2 So LM Va 1S A B ( v al . P.e I s ki / l�. At we es' ntially as shown on the as- iss Cos ction Permit and approved P.E. X R.A. # 0 (0�- R $e 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 revocati9q, modification or change is necessary. Vitopy P Title: �� Date: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRUCE R. FOLEY • ... � . '�. - y YjrtiirG ii6piff7 �L►JI'8C10!': � - ' .. _ - „ . ;.• . I ..i r r i riviviAw rivief- r- i i L M4?11t- .%t?.:?t;'r: -�aiz ... ..rr Associote F011c Health Director Director of Patient $ervkee DEPAR'T'MENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278.6130 Fax(845)278-7921 Nursing Services (843)279-6553 WIC (44S)278-6678 Fax(843)27&-60&s Early InterventionlP► cbeal (945)278-6014 Tex(943)272-6649 E911 ADDRESS VERIFICATION FORM Jeffrey Waters OWNERS NAME: y TAX Mp DER, Section: 62. , Block: 2, Lot: 30 E911 ADDRESS: �496 Oscawana Lake Road TOWN: Putnam Valley _ AUTHC DATE: IQ1271Q9 The Putnam County Department of Health wit( 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. (E9I Ivtrfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Well Owner: Use of Well: 1- primary 2- secondary Drilling Equipment Street Address: age Tax Grid # - '�'% 10J�ccc tilci ma ltk A tQcP" ��h Map Block Lot(s) Name: Address: eft (,Ja �eQ 46 0,5CZ c,)e.,, esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby /Rotary Cable percussion Compressed air percussion Other (specify) Well Type Casing Details Screen Details Well Yield Test Screened .✓ Open end casing Total length aft. Length below grade ;A o_ft. Diameter 6 in. Weight per foot lb /ft. Diameter (in) Open hole in bedrock _ Other Materials: ✓ Steel _ Plastic _ Other Joints: _ Welded ✓ Threaded _ Other Seal: �Eement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes 1/ No Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Hours Z Yield V-" gpm Second _ Bailed _ Pumped Compressed Air 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 please attach. If yield was tested at different depths during drilling, list: Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface � S Feet Gallons Per Minute Pump /Storage Tank. Information Pump Type SL,� t,1s; Capacity S Depth L/ 9'4 Model 5&/Z' a,A Voltage Z90 HP Tank Type �Jdl x Th /Volume �6 3 Date Well C mplete a %b�� ///// Putnam County Certification No. 6p L? Date of 7port �jl -7 Cd,,�ca We] Driller (signatur d_t V" ctdttl;9� r4va r.: exact ►ocatton or wen wtm aistances to at Least two permanent ianamartcs tone proviaea on a separate sneevptan. Well Driller's Name /V d'(kk ct vk !q� c(&Irsa x Signature: �.t,,,„ti Cam►-; Address: j!a ACLA S 01 Sr G °V_6 as, Wcf'rl�y Date: -9 1 v White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES C _ ,•� 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.000083 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 01 /11 /10 10:55 152 BARGER ST DATE /TIME RECD: 01/11/10 11:00 ATTN: NORMAN, SARAH REPORT DATE: 03/04/10 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: OACAWANA LAKE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE -. ._ . -GOL .'-D BY :. - NORMAN AND- FrR,SON - - -. _~- - - -- " - TEMPERATURE < C" - __.. NOTES...: JEFFREY WATERS COLIFORM METH: MF ------------- ------------- - - - - -- ---------------------------------------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/11/10 MF T. COLIFORM 01/18/10 LEAD (IMS) 01/13/10 NITRATE NITROG 01/13/10 NITRITE NITROG 01/12/10 IRON (Fe) 01 /12 /10 MANGANESE (Mn) 01/13/10 SODIUM (Na) 01/11/10 pH 01/12/10 HARDNESS,TOTAL 01/12/10 ALKALINITY (AS 01/11/10 TURBIDITY (TUR ABSENT /100 ML ABSENT SM 18 -20 92221B <1 ppb 0 -15 ppb SM 18 -19 3113B <0.2.:MG /L 0 - 10 SM18- 20450ONO3 <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 <0.060 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 0.0`45 MG /L 0 -0.3 mg /1. SM 18 720 31118 2.86 MG /L N/A SM 18 -20 31.11B 7.1 UNITS 6.5 -8.5 SM18 -20 4500HB 102 MG /L N/A SM 18 -20 2340C 86.0. MG /L N/A SM 18 -20 2320B 0.5 NTU 0 -5 NTU SM 18 (2130B) COMMENTS.:- N[FTC - 'Coliform- _"T -his -r' esult indicates that (was) (was not) of a satisfactory sanitary ew York State and EPA federal drinking - -- th3- s- �a�.meter - -: 'I�iU- - comment app- l�e -s- to -t -he- only. the water quality according to water standard for matt ad- Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE'IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH -IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1,.000083 CLIENT #: 2500 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN, SARAH PUTNAM VALLEY, NY 10579 NON STAT PROC PAGE: 2 of 2 DATE /TIME TAKEN: 01 /11 /10 10:55 DATE /TIME REC D: 01 /11 /10 11:00 REPORT DATE: 03/04/10 PHONE: (845)- 528 -1491 SAMPLING SITE: OACAWANA LAKE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE - -� ,._ _ -- n - COL- .'-D -BY: i30R =MAN AIVDaRS�ON� -- -- - - - --` 1 EMPERATURE -.- .� : < NOTES...: JEFFREY WATERS COLIFORM METH: MF -- ------- - - - - -- --------------------------------- - - - - -- DATE' FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L;:• MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND.REL=ONLY ESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director m ELAP# 10323 RONIN ENGINEERING, PE,..P.0 - 1he rim4 t3uilcfi,; Suite 200, 2 Jolin Walsh l3oulevard, Peekskill, New York 10566 Tel.: 914 - 736 -3664 • Fax: 914 - 736 -3693 April 1, 2010 Mr. Joseph Paravati, P.E. Assistant Public Health Engineer Putnam County Health Department 1.Geneva Road Brewster, New York 10509 Re: Property of Waters Certificate of Construction Compliance 5 Bedroom Residence 496 Oscawana'Lake Road Town of Putnam Valley, New York 10579 Section: 62., Block. 2, Lot. 30 Dear Mr. Paravati, Based on our March 30, 2010 phone conversation, please find enclosed the following: 1. Four (4) Sets of "As- Built' Plans, revised through April 1, 2010, signed and sealed by Timothy L. Cronin III, the Design Professional. The enclosed plans were revised to show a dimension from the house to the property line and also to provide accurate dimensions from the.. house to the ends of the installed,septic trenches. The Construction Compliance can be granted. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, atrick M. Bell, P. E. Project Engineer cc: Jeffrey & Stephanie Waters -Owner File- Paravati-PCDH- Property of Waters- Oscawana Lake Road -SSTS As- Built- Trans -PMB- 20100401 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Patrick Bell, PE The Lindy Building, Ste 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Bell: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health March 31, 2010 Re: Construction Compliance - Waters 496 Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The surveyed house location with respect to the property_ lines :is..to be provided: _. _. fl? -a5- '1'.11 C1ICCI r:S1C 3. The dimensions for the beginning of the trench should be provided. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. JSP /kly truly yours, Joseph S. Paravati, Jr., PE Environmental Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 RONIN ENGINEERING PE, -PC !ne'C, dy BU'! ing,`Su fe�'!UU, 2`Joh'ii walsfi out rcd', Peekskill, New York"10566 Tel.: 914 - 736 -3664 • Fax: 914 - 736 -3693 March 22, 2010 Mr. Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Property of Waters Certificate of Construction Compliance 5 Bedroom Residence 496 Oscawana Lake Road Town of Putnam Valley, New York 10579 Section: 62., Block: 2, Lot: 30 Dear Mr. Budzinski, Enclosed for your review and approval please find the following item regarding the application for a Certificate. of Construction Compliance at the.above referenced project: 1. One (1) copy of the Well Completion Report The enclosed item shall be the only outstanding item that is needed for this project before a Construction. Compliance can be granted. Should you have any quest ons,or r.Pquire.additional .. G i.- t+' Gsitaie-n t, Ui -Iiai Respectfully Submitted, 4atrick M. Bell, P.E. Project Engineer cc: Jeffrey & Stephanie Waters -Owner File- Budzinski -PCDH- Property of Waters - Oscawana Lake Road -SSTS As- Built- Trans -PMB- 20100322 rf SHERLITA AMLER, MD, MS, FAAP Commissioner of Health _ ,t RE1TA MULINAR1; kN;1VISIV:. _..._.. Associate Commissioner of Health March 19, 2010 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Timothy Cronin, PE The Lindy Building Ste. 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Cronin: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 This Department is in receipt of your submission for construction compliance for the above referenced property. Please be advised that an open comment still exists from this Department's site inspection. (see attached) Upon compliance with the attached, this Department. will_consider "truction compilarice iurher. ' your`submission ror cons If you have any further questions, please contact me at (845) 278 -6130, ext. 43261. GDR:kly Enc. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 sr SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health November 20, 2009 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York I0509 Timothy Cronin, PE The Lindy Building Ste. 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Cronin: ROBERT J. BONDI County Executive Itui3>rftf ivtORRCS, 13E' - Director of Environmental Health Re: Field Inspection — Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 The above referenced separate sewage treatment system can be backfilled. The following comment needs to be addressed. ° .� -- Thy h;,use w ��ot oi�nsiruced in accordance wrth the plans approved by this Department. Please submit for review, two sets of revised house plans showing the actual existing layout. If you have any further questions, please contact me at (845) 278 -6130, ext. 4;261. GDR:kly Sincerely, , - e, -�- " -T -: �) , � � -, �; Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845)'-)78-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 BONIN ENGINE-ER ->P� The 0, 2 John Wa Lindy Building, Suite 20lsh Boulevard, Peekskill, New York 10566 Tel.: 914 - 736 -3664 9 Fax: 914- 736 -3693 March 15, 2010 Mr. Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Property of Waters Certificate of Construction Compliance S Bedroom Residence 496 Oscawana Lake Road Town of Putnam Valley, New York 10579 Section: 62., Block. 2, Lot: 30 Dear Mr. Budzinski, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: 1. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. 2. Three (3) Copies of a two (2) year guarantee signed by the Owner. 3. One. (1; Copv of Satisfact�gry.IR alts of a Water Ana: -! h� `!c .FVwn rvi6G'iCa Laboratories, a NYSDOH Approved Laboratory. 4.. One (1) E911 Address Verification Form verified by the Town of Putnam Valley. 5. Four (4) Certificates of Construction Compliance 6. Four (4) Sets of "As- Built" Plans signed and sealed by Timothy L. Cronin III, the Design Professional. 7, Two (2) Sets of Revised Floor Plans. We are currently waiting to receive the well completion reports form the well driller. I would kindly request that you review the above enclosed items at your earliest convenience and the required well completion reports will be forwarded to you when received by this office. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Res ectfully Submitted, Patrick M. Bell, P.E. Project Engineer cc: Jeffrey & Stephanie Waters -Owner File- Budzinski - PCDH - Property of Waters - Oscawana Lake Road -SSTS As- Built- Trans -PMB- 20100315 SHERLITAAMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health November 20, 2009 DEPARTMENT OF HEALTH I Geneva Road. Brewster, New York 10509 Timothy Cronin, PE The Lindy Building Ste. 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Cronin: ROBERT J. BOND[ .County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 The above referenced separate sewage treatment system can be backfilled. The following comment needs to be addressed. ThC- h ousir wQ nur consuucted'iri accordance with the plans approved by this Department. Please submit for review, two sets of revised house plans showing the actual existing layout. If you have any further questions, please contact me at (845) 278 -6130, ext..43261. GDR:kly Sincerely, 4;�� i-�>, T_,0_W Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 . Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: .lnmected-by: Street Location zvu&r = 1,Lir1t`s L uvlu "" WAIA vi "U c� y Permit # Stu - 3a2- ©'3 TM # 6)- , — - Subdivision Lot # -�--- 1. Sewage 'System Area AYIES1 AYE NO a. STS area located as per. approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.D.pth c. Natural soil not stripped .................... ............................... � d. Stone, brush, etc., - greater than 15' from STS :area.......... e. 100' from water course / wetlands ....... ............................... Il. Sewage System a. Septic :tank size .1,000 ...:. .1,250...:.....other..AS .D ©. b. Septicaank installed level ..... .. c. 10' minimum-from :foundation .......................................... d. 'Disteibution Box 1 All outlets at same elevation -water tested:. : .::.:.::.:.... 2. Protected below frost ...... ............................... 3..:'1Vfinimum 2 ft. Original soil between box & trenches. e.. Junction Box properly set ......... ............................... 6. Trenches, Length required .526o- Length installed 54o 2. Distance.to watercourse measured -t- too Ft.......... 3. Installed according to. plan . ............................... 4. 'Slope oftrench acceptable 1%16 - `1f32 "' /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 :1lk" diameter clean ...............'. 9. Depth ofgravel in'trench 12" minimum .......:........... 10. enTTds:,ca ed........ Y __ - -- _ �.;,.�feir °va�a.as"`. ..... _..... —,. .: Size of pump: chamber... 2. Overflow tank .............................. ............................... 3. >: Alarm, 6sual/audio .:.....::...... ::..... 4. 'Pump easily accessible, manhole to. grade ................. 5. :First 'box baffled ..... ................. ................. , ............ 6. Cycle witnessed by H.P.-estimated flow /cycle........... III. House(Buiildiiia a. `Houselocated pp er;a roY p ed plans ............. . IV. Well Well located. as per approved plans . ......:........................ b.. . Distance from STS.area measured L( o o - ft ........... c. Casing 18" above grade .................. . .......... :................. d. Surface drainage around well . acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush.with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall -protected & .dir.to exist watercourse g. .Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... : .......................... i. Erosion control provided ................. ............................... Rev. 12/02 COMMENTS KN F11 IVA I Street PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAT-LIT-SERVICE --FIEL ACTIVITY REPORT Town State W, PERSON IN CHARGE / k-, OR TNTF.RV MM-T) QA&U 9AJ44 Datt-, 2-'91-69 5a PUMP TEST'. [] DOSE TEST t . .4 3 It, O 4 03,s �o a o m .4 3 It, REQUIRED GALLONS � 7:5-- EL. START cot 7 Signature and Title REPORT RECEIYEI) BY.- I acknowledge receipt of this report: SIGNATURE: 02/96 Title: R.ev - STOP O REQUIRED GALLONS � 7:5-- EL. START cot 7 Signature and Title REPORT RECEIYEI) BY.- I acknowledge receipt of this report: SIGNATURE: 02/96 Title: R.ev - STOP '09-10 -M 13:41 FROM- BRUCE R. FOGEY T -586 P0001/0002 F -815 LORETTA MOLINARI R.N, M.S,N, . • - - -.. -L !:g;SO!'Snfp._Pk�51ic :.i(P.411h _l�t/•gct(7r r �9. Director of Pa&Wt DEPAR.T?VMNT OF BEAT,TH I Geneva Road W . w--24p- Brewster, New York 10504 RE EST FOR FIELD IESTO ATTENTION: ❑ ADAM STIEBELvING GEtNE REED All information below must be fdl-y completed prior to any scheduling. DATE: ENGINEER OR FIRiVI: "� o �'^. L. Cna iw 'T-r peon L: REASON: DEEPS: d PERCS: ❑ PUMP TEST; �( ROAD/STREET: �S a w� s� a. L a � C/ !� TO"., 744". w, SUBDIVISION: `"— - -- _ LOTH: -�� ' � � / P1cd� t k l t OWNER: ce t-u sle- taw 62.�bS -g2 YES NO ❑ 0"* Proposed SSTS within the drainage basin of West Branch or Eoyds Corner Reservoirs. sFC+•SS''S•.r�ithi_500: - ❑ Proposed SSTS within X00 feet of a watercourse or a �C wetland. © Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE;FTC -3 : 00 CO&1i4fPNTS: (FIHLDTEST) .1 . Idy -10 —Gb 13:41 FROM- BY THIS CERTIFICATE OF COMPLIANCE THE T -586 P0002/0002 F -815 NE'i1iT YORK ELECTRICAL INSPECTION SERVICES _ .:.. _ . . 5i1.INh9t� v ai��.,!��.t.�,.: �.�� ^•..:�,44sry��!'ytrrR; CERTIFIES THAT Upon the application of: Upon premises owned by: Richard J. DiGregorio Electric - Richard Di Jeff Waters - 15 Vic Pass 496 Oskawana lake Rd. Carmel, NY 10512 Putnam Valley, NY 10579 Located at: 496 Oskawana Lake Rd., Putnam Valley, NY 10579 Application Number: 10078672 Section: 62 Block:2 Lot: 30 Certificate Number: 10078672 BDC: 106 Permit Number; 1024.09 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: 496 Oskawana Lake Rd., Putnam Valley, NY 10579 Basement. was inspected in accordance with the NY$ and NFPA 70 -99 and the detail of the installation, as set forth below, was founded to be, in compliance therewith on the 15 Day- of October 2009. Name ]Date Quantity hating Circuit Type P•RES Septic Pump & Septio Alarm I Officer: Nick Morabito This certificate may not be altered In any way and is validated only by the presence of a raised Seal at the location Indicated. This certificate is valid for work preformed before date of inspection only. jeannis October 21. ie Page I of I J��p�M coG'y , SHERLITA AMLER, MD, MS, FAAP q --3 ROBERT J. BONDI Commissioner of Health. * * County Executive TVil1�C;iN`ARM,' ;ISSN' '�{i Y �� y _ ROBERT MORRIS, PE Associate Commissioner of Health Director of Environmental Health DEPARTMENT OF HEALTH I Geneva Road. Brewster, New York 10509 June 19, 2009 Cronin Engineering 2 John Walsh Blvd. Peekskill, NY 10566 Re: Field Inspection.- Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 r Dear Mr. Cronin: As requested, an.inspecdon of- the -.S"Tls-. �nches,oni,,y :l T �ie��cir -c n 06 bac % filled: Alf,ot&r components on the approved plan will need to be inspected upon completion. If you have any further questions, please contact me at .845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:kly Environmental Health (845) 278 -6130. Fax (845) 278 -7921 Water Supply Section. (845) 225 -5186 Fax ,(845) 225 -5418 Nursing Services. (45) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845)278-6085* WIC (845) 278 -6678 Early Intervention /Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITAAMLER, MD, MS, FAAP . Commissioner of Health • T�I," vir�;` i'`T"d'iVCVL'TiVAlil;121�,�MS1V •_,� Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 May 28, 2009 Cronin Engineering 2 John Walsh Blvd. Peekskill, NY 10.566 Re: Fill Pad Inspection for Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 Dear Mr. Cronin: An inspection of the fill pad at the above referenced project has been completed. The following comments need to he addressed. Trench permit and plans must be submitted to this Department for final approval of construction prior to the installation of the separate sewage treatr:�z- rrt 5}- terra: - a 1 Please note that field measurements by this Department in no way suggest the exact size, depth and location of the fill pad. It is the responsibility of the Design Professional to ensure the construction at the above referenced project is in compliance with the approved plans. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR:kly Sincerely, .7G Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 . Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 =6026 Nursing Home Care Fax (845) 278 -6085 _WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 v�r� 1-1a LL; 06 MUM- ATTENTION r u rNXR i;01d'JN d Y TiEPAR'Nh OF HEALTH DiVISTON OF ENVIRONMENTAL HEALTH SERVICES 0 ADAM MY. ,ST JEOP, FINAL INSPF.CTT0N All information most be fully completed prior to any inspections,beiag made. ENE For: Fill Treaches T -398 P002/002 F -116 PCHD Construction permit Located - U. Owner /Applicant Name: TM 6 Block - Lot 30 Formerly. Subdivision Name: - �--• Subdivision Lot Is system fill completed? le—s- Dater t `l Is system complete? Date: Is system constructed a per plans? Is well drilled? _ e 5 Date:`" _ Is well located as per plans? �5 Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been and verified their completion in accordaA approved plans anal the Standards, Rules Date: d Certified esgr Address:° � 15,14 v� e- S�c1ll Comments: Form FIR-99 9id00~ ve inspected n ermit and )am Win ep ment of 62980 a+ VU .LU 1 f ..1 f rrsut'j- T -450 P002/002 F -270 _ .. R .. ... ~ -U TINT:9 -x r—rTI �i .;``.; A iiritiE DMSYON OF ENVIRONIIYIENTAY, EMALTD SERVICES ATTENTION © ADAM GENE QUEST FOR FYNAL INSFFCTION For: pill All information must be fully completed prior to any Trenches . inspections being made. PCHD Co.ustruction permit #u Located: 05c", C/ 0w � Owner /Applicant Name: Formerly:' ormerly _ .Is system fill completed? �5 Is system complete? ecoa" Block _ .2-- Lot 3t� Subdivision Name: Subdivision Lot # T' Date: "7 M,0 (e-f ;r� Date: C/O? 2s P p k- 4- P r {w fiat, f o A Is system constructed per plans? G �f�c, 'fia � j�ut� Cti pau Is well dri1led? e—S- Date: Is well located as per plans? Are erosion control measures in place? 5 I certify that the system(s), as listed, at the above premises, has and verified their completion in accordance with the is: approved plans. and the Standards, Rules and Regulatio Health.. Date: (o l 6 167 Certified by: Address: 2 En �. i '-8 T2 ,e e ks1 -ic(, A) Y. i�Sb6 I have inspected Nn permit and pa ttuent of •7. 64,2 ?V Comments: F ere- -'G ��-� G►.� s Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Je-; W% s Owner or Purchaser of Building Co 1. Z Tax Map Block Lot W S -Pw mac. w Va t Building Constructed by TownNillage "i% �Scuwcti� ��•� �� Location - Street Subdivision Name 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 system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Nov. Day Z Year 2oo LJ\K G cral ntr t r (Owner) - Signature Corporation Name (if corporation) Address: 301) kLG-& kC-A— State k_v� Zip Signature: *� Title: ae-< Corporation Name (if corporation) Address: 3(�O State I( � W KI o 'F Zip e S l Form OS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C_ONSTR LJC'1°�:- '','"�L PERMIT # Located at ®5c a v, c., `.0 L-e. zo Tow or Village Subdivision name `-' Subd. Lot # Date Subdivision Approved Tax Map Block A Lot Renewal ✓ Revision rpm V--' Owner /Applicant Name Je- k-kcti + P�A V1 Date of Previous Approval Mailing Address RIcAc v C1 PA c e �- ` 413 Al Zip / OS-1 Amount of Fee Enclosed Building Type Si ✓, It F 0. Lot Area "`1.• 33 No. of Bedrooms S' Design Flow GPD + = 5 P Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1, 54�b gallon septic tank and _i j7l� u . C L r. VIA 6e--e- U-I 5-Go c r a y u e i ++ rc tic (,i ,o e Other Requirements: `!� cu �S 0 � A-0. UA are., To, be constructed by 7"g Cj ' �''" �` (--%^�`Qddress Water Supply: Public Supply From on ✓ Private Supply Drilled by Address 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 C tion Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a wr' c FF text be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place i etat '%di u: n any part of said sewage treatment system during the period of two (2) years immediately foll ng to of the the approval of the Certificate of Construction Compliance of the original system or Signed: - " R w P.E. R.A. Date Addresr 1 le sd' , `�, 1 vA , re e ks k r 11 . Ny /-S%(- License # APPROVED FOR C01- 53RV6TZ'DN: 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 d' harge of domestic sanitary sewage only. By Title: Date: O ite opy - HD File; Yellow copy - Buildi Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 2 John Walsh Boulevard The Lindy Building, Suite 200 Peekskill, NY 10566 914- 736 -3664 Fax 914- 736 -3693 June 5, 2009 TO: Joe Paravati FROM: Patrick Bell Per your request, find enclosed the septic application for Jeffrey Waters. Please call if you need additional information. Thank you. Pat SHERLITAAMLER, MD, MS, FAAP Commissioner of Health ROBERT J. BOND County Executive + . _T M - v w r� e...ra. • . q. ,.a .t .... a._r.... 11 - '.L.l?I3'4'° r�Li� „ 4 ROBERT MORRIS, PEL� Associate Commissioner of Health V Y `Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 June 2, 2009 Patrick Bell Cronin Engineering The Lindy.Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Trench Plan — Waters Oscawana Lake Road (T) Putnam Valley, TM # 62. -2 -30 Dear Mr. Bell: This office has received and reviewed the most recent set of plans for the above- mentioned project. We would like to offer the following comments for your review and consideration. 1. The SSTS profile is to be to scale. 2. The absorption trench detail should note the pipec.are. to -be id 1 ^' - - u��. __.._:� _ ...._... _ _..._ ? A :conef.r�f�aion Yei.�:i* 4ppicaton is Lo be- subini"tted for the trench plan. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Ve truly yours oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ?v a --,& -T 300 Richard PI., Owner Jeffrey & Stephanie Waters Address Yorktown Heights, NY Located at (Street) Oscawana Lk Rd & Tinker Hill Rd Tax Map 62. Block 2 Lot 30 (indicate nearest cross street) Municipality Putnam Valley Watershed Peekskill Hollow Brook SOIL PERCOLATION TEST DATA Date of Pre - soaking May 26, 2009 Date of Percolation Test May 27, 2009 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< 1 min for 1 -30 minhnch, <_ 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 Pg. 1 of 2 ^v y 46MAter Water Y 7+" i A �' � �- � xy) "? k. .. +'� b NY' � �,� h w; � �� ,i h "fit. n�FY' � �- � ��y��"`� a �ime�Inehe y.i/dp 2 � round t �Ikve �f � DropRa% Percolation t Hole "` Rnn No. Time��Sta Start Stop 7 n $to 3 Inches W 1VIin/Inch Rion yti s P3 1 1:30 -1:51 21 min. 15 in. 18 in. 3 in. 7 min /in. 2 1:53 -2:20 27 min. 15 in. 18 in. 3 in. 9 min /in. 3 2:23 -2:50 27 min. 16 in. 19 in. 3 in. 9 min /in. 4 5 P4 1 1:35 -2:02 27 min. 16 in. 19 in. 3 in. 9 min /in. 2 2:05 -2:35 30 min. 15 in. 18 in. 3 in. 10 min /i ..�...3. _.. ._i:3 3:06- rnin:.. -. i0. Iii._ =iy if sin.: -- TO-Mi iYi.. 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< 1 min for 1 -30 minhnch, <_ 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 Pg. 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH -- HOLE NO. HOLE NO. - - HOLE NO, ,.e.. ,,....vim. .e .. —,s >.... -.. _-a- ,_..y..•,+n+�+w•a arisr: c..r.- ue..�.•r�+^w� �..... v. w. an.. a ..w.s.KS.:.r...e�.a....��,ti -. �'n. —. -..ter .r. _..•v:.c'vc+�.> n.a +a . .s i_• -w. •..c..a- _:•...,... G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: 2 John Walsh Boulevard, Peekskill, NY 10566' Signature: L. Cronin III Address: Agfi4P feA %nal =s Seal 'J N y0`" TA 62 O ~KOFESS�O LETTER OF T W,, M ITTAL 'G P.,., `May 28, 2009 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: Proposed SSTS - Waters Property Oscawana Lake Road (T) Putnam Valley Tax Map #: Sec: 62. Block: 2 Lot: 30 PCDH Permit # (SW- 32 -03) THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT ❑ PLEASE REPLY Joe, Please find enclosed the following: �.rfa^3uQ::= :� T-re tIn T, .SystcarPi1iY� i�''tiYe'dUi)Vt` - referenced project, dated September 19, 2008, revised through May 27, 2009. 2.) One (1) copy of the percolation data sheet for the stabilized fill. . The required fill for the project has been installed and approved by your office as of the week of May 25, 2009. The trench plans are now being submitted to you as part of the requirements for approval of the project. Please review the enclosed information at your earliest convenience and contact me with any questions or comments. Thank you for your assistance in this matter. Res c fully submitted, Pa rick M. Bell Design Engineer CC: Jeffrey Waters, Property Owner File:Waters- Oscawana Lake Road - Paravati- 20090528 UTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVICES - C 9N M$JCTION P191WIT FOR SFW AGE.-TREATMENT SYSTEM PERMIT It J . _ 3r� —(0 Located at os c, %..., Kv, Lc4 Lv_ V, O "A Town or Village ,, \/4 t1:N Subdivision name Subd. Lot # Date Subdivision Approved Tax Map (® Block 7. Lot j O Renewal Revision f Owner /Applicant Named •� �� e �4 Date of Previous Approval Mailing Address 4'O C 0 , `-' 'L -A" A u e 1 S �M _ O'� Zip k ,0519 Amount of Fee Enclosed Building Type . d►r 6, F m i I Lot Area `8 • No. of Bedrooms 5– Design Flow GPDO 5 Fill Section Only N-**" Depth b rM 1;1. Volume ISO CO. IDS Separate Sewerage System to consist of f , S� gallon septic tank and 1. 5-6D I'm Other Requirements: To be constructed by - ED j L-tc -Al. "' �^ •c Water Supply: Public Supply From Address :. _g il➢'°� .V - �J -rev rr �i7iYr�J7 o�i I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s,, s� 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 Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a. a furnished the owner, his successors, heirs or assigns by the builder, that said builder will placed i iti any part of said sewage treatment system during the period of two (2) years immediately folio in isy e f the approval of the Certificate of Construction Compliance of the original system or any re r s Signed: Address Z- P.E. R.A. Date o Sl 04 License # 0 (o 2- '18 0 APPROVED FOR CONSTRUCTION: This approval expires two years fromte 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 ne essary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved f ischarge of domestic sanitary se age only. By: Title: Date: Z� White copy - HD File; ello co - Building Inspector; Pink copy - Own copy - Design Professional Form CP -97 NEW YORK STATE SPECIFIC WAIVER APPLICATION DEP tARTMENT OF HEALTH Request for Approval of Noncompliance with Bureau of Water Supply Protection . _ _ the Standards of 1ONYCRR Apperdix 75 -A - -• • —11-1- - - • ' " `- ' '�GLaJ C''wa`icY'ileauYiErit" ieiivard�= inciividuai Iiousetio7ti 5 steins GENERAL INFORMATION Name of Applicant past Waters First Jeffrey MI Address Street Cityfrown State Zip Contact Information Phone: 914 -629 -0592 FAX: email: Site Location street: Oscawana Lake Road ci rrow„ Putnam Valley county NY Zip 10579 The following information is being submitted in support of my application for a specific waiver from compliance with one or more standards pf IONYCRR Appendix 75 -A, "Wastewater Treatment Standards — Individual Household Systems' 1. The wastewater treatment system cannot meet the following standards of IONYCRR Appendix 75 -A: ❑ Separation distances cannot be achieved (75- A.4(b), Table 2, Separation Requirements) 0 Excessive Slope (75- A.4(1), Soil and Site Appraisal) ❑ Design is not addressed in Appendix 75 -A ❑ Technology is not addressed in Appendix 75 -A ❑ Other: Explain•Ayerage slope within SSTS area exceeds 15% maximum. 2. The following design is proposed to mitigate noncompliance with Appendix 75 -A (brief description): The proposed SSTS area will be graded with Run -of -Bank Material to provide a slope of less than or equal to the 15% maximum. 3. Supporting information provided: 6a Detailed Site Plan ® Detailed Design ❑ Soil and Site Evaluation ❑ Neighboring conditions of concern (e.g., wells, waterbodies, wetlands, etc.) ❑ Other: Explain: I, (applicant) Jeffrey Waters (type or print) acknowledge that this waiver request is necessary because it is.not practical for an onsite wastewater trea imnt system to meet t4q refcrenp b star ands of IONYCRR, Appendix 75-A on iliS'Yi Up i ty". Si tur NEW YpR Date I, (engineer) Timothy L. Cronin III (type or pri ac wle �P ywaiver t is ecessary because it is not practical for an onsite wastewater treatment system to meet the re d dar�li� A endix 75 -A on this property. In my professional opinion, the proposed design desc ' ed in v patio ,. �',�pivide a eg a of protection equivalent to the onsite wastewater treatment standard(s) will et oritt`hnd w' * . create an t... w, increased risk to public health or the environment. i,;;, �• '- t1 80 Signature /�' icense # *For Health Department use only Based upon the information provided in this application to waive the referenced standards of Appendix 75 -A and in Aacco dance with lONYCRR §§ 75.3 and 75.6 (b), the waiver requested is hereby: pproved as proposed. Approved, with following conditions: Not acted on, because additional information is required: Denied, because: Note: This waiver may be revoked should any 1 of - v "( health Department Representative before approving this waiver change after approval. if -<34 Date Instructions for Completing the Specific Waiver Application; Wastewater Treatment Standards — Individual Household Systems This Specific Waiver application form is intended for use by the applicant (property owner) or the applicant's representative (e.g., PE) to present information for consideration by the Health Department having jurisdiction to approve a new onsite wastewater treatment system (OWTS) on previously undeveloped property that does not comply with one or more standards of Appendix 75 -A, "Wastewater Treatment Standards — Individual Household Systems ". A specific waiver shall be obtained before construction of the onsite wastewater treatment system. Background: The responsible city, county, or district health office may grant a IONYCRR Part 75 Specific Waiver from a provision(s) of 1ONYCRR Part 75, Appendix 75 -A, only under the following circumstances: 1. Conditions at the particular site make it impractical to comply with these standards; 2. Appropriate protective measures to mitigate noncompliance are applied; 3. The design is not likely to pose a health hazard or create environmental contamination; and 4. Disapproval will result in a significant hardship. A Specific Waiver IS NOT intended as a device for routinely approving individual residential wastewater treatment systems that do not meet design standards. It is intended to provide administrative flexibility to resolve rare cases when hardships exist and/or other circumstances that make it impractical to meet Appendix 75 -A standards The Specific Waiver application shall provide information and background about the site conditions and detail the proposal so that the Health Department is able to determine whether to approve or deny the application. The Health Department representative may ask for additional information to be submitted to make that determination General Information Provide the applicant's current mailing address and contact information. Also provide the address of the property the specific waiver is being applied for, even if it is the same as the mailing address. Reasons for Noncompliance Check the applicable reason(s) for which the waiver is requested. If not already listed, include the specific standard(s) in the space provided and provide a brief explanation. More detailed information can be attached as needed or as appropriate. Proposed Mitigative Design Provide a brief description of the site characteristics and OWTS design in the space provided. Detailed information and plans can be attached to the application. ..tf::yNGi �iri� a ^_1fiilii ➢Sriuii _ .. __ - .. _ . Check any information provided. Any additional information can be listed after "other" in the space provided. Any or all of the information listed may be required by the Health Department representative depending on the complexity of the site ' conditions. To obtain a waiver, the applicant must demonstrate that the onsite wastewater treatment system design proposal is acceptable and is not likely to pose a health or environmental hazard. Detailed Site Plan contents may include some or all of the following: surveyed plat, accurate location of onsite and neighboring offsite (if applicable) drinking water sources or water courses, site topography, drainage features and any pertinent physical features. Appendix 75 -A, Table 2, lists required separation distances. Detailed Design shall be submitted by a NYS licensed P.E. and will clearly identify the OWTS components and locations. Soil and Site Evaluation shall incorporate the characterization of the existing soils through, at a minimum: percolation tests and test pit evaluation, which identifies soil types and geologic limiting conditions (e.g., groundwater, rock or clay). Neighboring conditions of concern (if applicable) shall include at a minimum, onsite or nearby: drinking water sources, watercourses and wetlands. Other identified possible areas of concern that could be impacted by the OWTS shall also be identified. Acknowledgement of Risks The applicant (property owner) is required to sign the Specific Waiver application and acknowledge the risks that may be associated with the OWTS serving their property. A NYS Professional Engineer (P.E.) is required to provide his or her name and license number on the form and submit the supporting information and stamped design plans on behalf of the applicant. Health Department Representative Response The Health Department representative will approve; approve with conditions; not act and request additional supporting documentation; or deny the Specific Waiver application. The determination will be sent to the applicant and a copy of the determination and all information submitted with the application will be retained. P:1Sections\Residential Sanitation \OWTS\GUIDANCE\Specific WaiverOWTS- Legal.doc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES •APPLICATION TO CONSTRUCT A WATER WELL please print or type Well Location Street Address: Town/Village: Tax Map # FCJ 1PV -6&1+14 V" ( Map (at. Block LLot(s) v Well Owner: Name: Address: Phone #: y�rk.�" W ' ') o Use of Well: f Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby ' Amount of Use Yield Sought_�gpm # People Served Est. of Daily usage J CVV gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling \/New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well T pe Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision �� Lot No. — Water Well Contractor: Address: — Is Public Water Supply available on site Yes _ No Name of Public Water Supply: Town/Village Distance to property from nearest water main: W Proposed well location & sources of contamination to be rovi d on separate sheet/plan. II , Date:. - 4_"'.._.,,:: .... 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 E ,rt -.'xi T4) ;The well,driller shall abide by,all�conditrons�of�the §permit+ 5) ; During alweil�dnlling�operations� (he�welt�driller�shall� r�, take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by PutnamlCounty. A Date of Issue ' Permit Iss ' g Offici I" Date of Expiration Title: Permit is Non -T ns erable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Ownery Orange copy - Well driller Form WP -97 Rev. 3106 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH . . -SPECIFIC WAIVER NAME: ADDRESS: SITE LOCATION: 0S ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DATE: STAFF PRESENT: Michael Budzinski P.E. Robert Morris P E Gene Reed Joe Paravati & Larry Weller SPECIFIC WAIVER REQUEST: DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES ❑ NO 14 WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO ❑ DISCUSSION RE UES APPROVAI, OR DENIED REASON FOR DENIAL APPROVED X DENIED ❑ DIRECTOR F ENVIRONM NTAL HEALTH COMMISSIONER OF HEALT - DATE DATE Environmental Health (845) 278 -6130 Fax (845) 278 -7921 (SPECWAIVER) 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 J�Jy3� J3 CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: Proposed SSTS - Waters Property Oscawana Lake Road (T) Putnam Valley Tax Map #: Sec: 62. Block: 2 Lot: 30 Previous PCDH Permit # (SW- 32 -03) THESE ARE TRANSMITTED as checked below: November ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT ❑ PLEASE REPLY Joe, Please find enclosed the following: IV► A�ii L 7 sl.) 'i[r (1) SOY Ji iIC ' l J-. T�4 Oclj Dl:nc9Lde3 ? Placement Plan & Subsurface Sewage Treatment System Plan dated September 19, 2008, revised through November 4, 2008 2.) Two (2) copies of the Fill Placement Plan, dated September 19, 2008, revised through November 4, 2008. The enclosed plan has been modified based on your October 16, 2008 review comment. Review the enclosed application at your earliest convenience and contact me with any questions or comments. Thank you for your assistance in this matter. Resp tfully submitted, elt" P rick M. Bell Design Engineer SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health November 5, 2008 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Patrick Bell Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re Dear Mr. Bell: Waiver Determination — Waters Oscawana Lake Road (T) Putnam Valley ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health The Putnam County Health Department reviewed the waiver request for the above regarded project on November 3, 2008. The following determination has been made: ❑ The Waiver request was approved. 0 The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. .. - ❑ ,. - � n,, �� "✓�(~.rPq ,'.PCi_':�., ..,ifs;,'.. yt� -,-. ... 'IJ+v� �� •.7 .;n::.n�i�,`� v.:ivu`d'"" - _._. __•° - - • The comments from this Department' letter dated October 16, 2008 are to be addressed. If there are any questions regarding this matter, please contact me at (845) 278 -6130 ext. 2157. JSP:kIy Very truly yours, f K../ Iseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health ROBERT J. BONDI County Executive �,. °-,.,.. '.., i' i' Olt3tr�lt 'iiviUitiKY�;•PE',.�... Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 16, 2008 Patrick Bell Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Proposed SSTS Renewal — Waters Oscawana Lake Road - (T) Putnam Valley, TM # 62. -2 -30 Dear Mr. Bell: This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The fill pad is to have dimensions (length and width). 2. Please provide a forcemain trench detail. - -- 4. The floor plans are for a 4 bedroom house. Is the owner submitting new plans for a 5 bedroom house? The average slope over the SSTS area is greater than 15 %. This application was approved by waiver. The waiver is now expired along with the permit. Please resubmit a waiver form (latest edition) for renewal. The application will be presented at the next waiver meeting. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 MEMORY TRANSMISSION REPORT R ` - TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 325 DATE NOV -04 10:25AM TO 919147363693 DOCUMENT PAGES 001 START TIME NOV -04 10:25AM END TIME NOV -04 10:26AM SENT PAGES 001 STATUS OK FILE NUMBER 325 * ** SUCCESSFUL TX NOT ICE * ** SHERLI7 -A AM LER., MU, MS, FAAP ROBERT J. 00ON01 Co)n.n lrrlo.,ar ofHaolth rt s Cea...y £xecv /i..a LQRETICA MOL.INARI. RN. MSN y ROBERT MORRIS. PE Assoolo /¢ Coln>» /ss /pi,ar ojHaalth Of ¢cror orEnrvlron�san /o/ Keo /rh 0EPARTMEiVT OF Fie^l --rH I Geneva Road, Brewster. New York 10509 October 16, 2008 Patrick Bell Cronin En gineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, LVY 10566 Re: Proposed SSTs 12enewal — Waters Oscawana Lskc Road (T) Putnam Valley, TM * 62. -2 -30 Dear Mr. Bell: -Phis office has received and reviewed the most recent set of plans for the above - mentioned project_ We would like to offer the following comments for your review and consideration. 1_ -'he- fill pad is to have dimensions (length and width). 2. Please provide a forcemain trench detail. 3. 'rho fill certification note (unsigned) is to be provided on the: [ranch plan. 4. The floor plans are for a 4 bedroom house- Is the Owner submitting now plans for a 5 bedroom house'? 5. -rho average slope over the SSTS area is 2;reater than ISIS. This application was approved by waiver. The waiver is now expired along with the permit. Please resubmit it waiver form (latest edition) for rcnowal. 'rho application will be presented at the next waiver meeting. -this office will continue its review upon consideration of the above - mentioned cornrnonts. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours Joseph S. Paravati, Jr. Assistant Public Health l✓ngineer JSP/kly En..iren meota/ Flealth (845) 278 -6130 Fax (845) 278 -7921 water Supply Sectlon (845) 225 -5186 Fax (845) 225 -5418 Nursing Servlcas (845) 278 -6558 Fa (845) 278 -6026 W1C (845) 278 -6678 r4-1n0 dome Cnre Fac (845) 278 -6085 Early [nter+.entlan /Preschool (845) 278 -6014 Fau (845) 278 -6648 LETTER OF TRANSMITTAL The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914436 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: Proposed SSTS - Waters Property Oscawana Lake Road (T) Putnam Valley Tax Map #: Sec: 62. Block: 2 Lot: 30 Previous PCDH Permit # (SW- 32 -03) THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT ❑PLEASE REPLY Joe, Please find enclosed the following: 1.) One (1) copy of the Specific Wavier Application The enclosed Wavier Application is being sent in supplement to the previously submitted SSTS application for this project. The previous SSTS application was submitted on September 19, 2008. The above referenced project requires a wavier because the existing slope within the SSTS is greater thank 15 %. As the project is currently proposed the SSTS area will be graded with Run - of -Bank Material to provide a slope of less than or equal to the 15% maximum. The Putnam County Department of Health in conjunction with permit SW -32 -03 has previously issued this property a wavier for slope within the SSTS. Please review the enclosed application at your earliest convenience and contact me with any questions or comments. Thank you for your assistance in this matter. Respe fullly/ssubm�jitttted,� Pa rick M. Bell Design Engineer PTTTNAM COUNTY DEPARTMENT OF HEALTH } DIVISION OF ENVIRONMENTAL &En T r g y • - . _ : .... Irv= U WA. L '& 5 v'is� uici''a C.Z SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: -rm S STREET LOCATION: 4a SGAWW,4 I-AK6 -i %t©A, REVIEWED.BY: RM, Cq jr3i SR.DATE: /g2/3/05, 1O/ 3/0 5, TAX MAN: (CONFIP.IM) 6 -2 i 2 - .'v Y(N DOCUMENTS N 2KD- UIREDDETAILS ONPLANS CONT'Dl - _�� . PERMIT APPLICATION °•' (_•.)HOUSE SEWER -1/7 FT. 4 "0'; TYPE PIPE. CAST IRON DWELL PERMIT OR PWS LETTER �UNO BENDS; MAX BENDS 45' W /CLEANOUT PC =97 t ' RENEWALS (ETTER OF AUTHORIZATION ( SITE NOTE (NO CHANGE) __)(ZDESIGN DATA SHEET (DDS)" � m,*rh ?4#ci FILL SYSTEMS =CORPORATE RESOLU'T'ION U . 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ^- (�SHORT E4F SPECS/ FILL NOTES 1 -5 �f�)/ PLANS -THREE SETS o� ly 3- )FILL PROFILE & D=NSIONS Zj LjHOUSE PLANS -TWO SETS - r�� r�Rs�y 4,0 "'j �U�L IN EXPANSION AREA �)�CE REQUEST • FILL GM TER THAN FEET SUBDIVISION U CLAY BARRIER LEGAL SUBDIVISION (�( �!)FILL'CERTIFICATION NOTE SUSDI) MION APPROVAL CHECKED }DEPTH GAUGES PERC RATE LZX )VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & MIPERVIOUS FILL REQUIRED• DEPTH 7(�(-_)SEPA.RATION DISTANCE FROM'TOE OF SLOPE CURTAIN DRAIN REQUIRED TRENCH* GENERAL �LF TRENCH PROVIDED- 60FT MAX �OCATED.IN NYC WATERSHED PARALLEL TO CONTOURS PLANS SUS5IITTED TO DEP j100% MANSION PROVIDED DELEGATED TO PCHD DETAILMUST FREE CRUSHED'STONE OR WASHED GRA.VEI EP APPROVAL; IF REQ'D (�(�GEOTEXTILE COVER. ; DL/ 'f TEST' HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROWSSTS �L!ERCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. EX- APPROVAL SSDS ADJ, LOTS �Zp' TO FOUNDATION WALLS (WETLANDS • OWNIDEC PERMIT REQ'D ?) -o, K , , , f {T � 100 TO WELL, Z00 IN DLOD,150 TO, ?ITS )DATA OODDS PLANS, &.PER_ T.SAME - t)es,ls r *Jj 1j0Q' TQ .STR e_?. °vT s�:C -T:J '. L I SO TO CATCH BASIN, 35 . STC +ItMDRATiK, PIPED WATER ETTER.BUZBA 10' TO WATERLINE (pits - 20') �0 Ylt FLOOD ELEVATION W/I 200" 50'-IN DRAINAGE COURSE, )SOIL•TESTING LOTSy10 YEARS OLD 200'i500' RESERVOIit, ETC. 150' GALLEY SYSTEMS REQUIRED •DETAILS ON PLANS : (10' MIN TO LEDGE QU TCROP �USEWAGE SYSTEM PLAN - (NORTH ARROW) / SEPTIC TANK BDS HYDRAULIC PROFILE U(_ -x)10' FROM FOUNDATION, 50' TO WELL )GRAVITY FLOW — &-l"A WELL CONSTRUCTION NOTES 1 -113 i / ,- DIMENSIONS TO PROPERTY LINES �DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION 2' CONTOURS EXISTING & PROPOSED UUMIN 15' TO'PROPERTY LINE RIVEWA3 SLOPES, CUT SLOPE �( JFOOTING/GUTTERICURTAIN DRAINS SLOPE IN SSTS AREA o 5 S20 %) 3) __)USDA SOIL TYPE BOUNDARIES 4LREGRADED TO IS %, IF REQUIRED �TiTI,E BbOCK; OWNERS NAME ADDRESS DOSE/PUMP SYSTEMS TM #, PE/RA; NAME, ADDRESS, PHONE# 4�DATE OF DRAW.INGMEVISION DATUM REFERENCE . j(--)LOCATION OF WATERCOURSES, PONDS lLAKES,WETtANDS WITHIN 200' OF P.L. (_--)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS X-JWELLS & SSDS'S WfIN 200' OF SSTS )k_)PROPERTY METES & BOUNDS •, )EROSION CONTROL FOXHOUSE, WELL & SSTS, EROSION CONTROL NOTE 14S ( oY )P.UMP NOTES . (rj(OSE' 75% OF PIPE VOLUNII'JDOSE VOLUME NOTED 2 a"70, 1 ETAIL FOR FORCKMAIN, (PIPE TYPE, ETC.) PTT AND D -BOX SHOWN & DETAILED ' (, U DAY STORAGE ABOVE ALARM - CURTAIN DRAIN STANDPIPES, T BOTH SIDES, DETAIL 15' MiN to CD5 =�5 %, 20' -4 %, Z5' -3 %,35'4"/., 100 % -<1% 0' MIN to CD DLSCHARGE/100' with 182 cons day discharge 0' MIN to NON- PERFORATED PIPE U4ENTS: AL-9 V/4 cogr 4 -tewch jil e. '08 -08 -06 12;58 FROM - � J i BRUCE R. FOLEY Public Health Director ATTENTION: T -064 P001/001 F -954 YV c- 3. -- it 7- 34- 34 7 3 LORETTA MOLIMARE R.N., M.S.N. Assoalate Public Health Director Director of Patient Services DEI'AR.TMENT OF BEAL'H 1 Geneva Road - •Brewster, Now York 10509 REQUEST FOR FIELD T JOSEPH PARAVATI n GENE RER'D All informations below must be &U completed prior to any scheduling. DATE: � h. p 0 g ENGINEER OR FE Mt PHONE #: C 4 REASON: DEEPS: PERCS: ❑ PUMP TEST: ROAD /STREET: 05 c C`% V-9- d TOWN: TAX WYO. G A -- a — 3 Ca SUBDIVISION: LOT #: OWNER: NVCDE, P CRITTRIA FOR JQ NT REVIEW AND WITNESSING. OF SOM TASTXNG: YES NO • �- ° -• u-- ��►-"` ��rroposeaSST3witninii�earsinagep�sinoi�vi% estnranchorisoynsiarnerFteservoirs: p Proposed SETS within 500 feet of a reservoir, reservoir stem or co'otrol lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o Proposed SSTS design flow greater thnn 1000 gallons /day or SPDES Permit required. o e� Proposed SSTS for a Commercial Project. It is the responsibility ofYhe design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ,des, to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE: I 3 i2omm ACTS: FOR COUNTY USE ONLY TIlVIE• �® �r �V TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO_Z�L HOLE NO HOLE NO L2 HOLE NO HOLE NO G.L. 1.0' �� %�t. ,►�`'. %!/ " rte. 2.0' ,, �., L-1 � W 2.5' r 3.0' 1' 3.5' 4.0' 5.0' �� L�, �_ 1 z l-,, 'x �^ 5.5' 6.0' 6.5 .. 7.0' 8.0' 6,5 .�._. Q•jl /a%i2_i�.t�'r�Y ��?,�_. _��i�a:`•nc�'' �__- il`'S- - ._. ._. ._..._ ._. ... .. � _. .. .. ---- - ..... _ _... .�_._ 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered —' Deep hole observations made by: 4�;, , Date 3 If le>S Design Professional Name: Address: Signature: Design Professional = Seal TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G.L. Fill Debris 0.5' 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.01 9.5' 10.01 4" Topsoil Redish Silty Loam Br. Sandy Loam w/Cobbles Fill Debris 6" Topsoil Redish Silty Loam Br. Sandy Loam w/Cobbles 40 4" Topsoil Redish Sandy Loam Brown San d & Gravel 1' Min. R-0-13 req. _L -:;- 2,1 Tin Th-a- T-i 1' Min. R-" recr Indicate level at which groundwater is encountered None Observed Indicate level at which mottling is observed None Observed Indicate level to which water level rises after being encountered NIA Deep hole observations made by: P. Bell (C.E.), Gene Reed (PCDH) —Date 8/1312008 Design Professional Name: Timothy L. Cronin III Address: 2 John Walsh Boulevard Peekskill, New York 10566 Signature: Design Professional=s Seal 617.20 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For.-.UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: 72,ROJECT NAME: Jeffrey & Stephanie Waters truction of Single Family Residence 3. PROJECT LOCATION: Municipality: Town of Putnam Valley County: Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) Oscawana Lake Road, 600 ft. southwest of intersection -of Tinker Hill Road 5. PROPOSED ACTION IS: ENew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a new single family residence, ssts and private water supply. 7. AMOUNT OF LAND AFFECTED: Initially 9.932 acres Ultimately 9.932 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Eyes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? EResidential ❑Industrial ❑Commercial ❑Agricultural ❑Park/Forest/Open space ❑Other Describe: Surrounding lands are zoned R -2 (Single Family Residential) °iU.'vui =5 H%TIOIV`fl�fvU�VE F1 FERMI I APPROVAL, OR HUNDINb, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? EYes ❑No If yes, list agency(s) name and permit/approvals Town of Putnam Valley — Site Development Approval Permit, Major Grading Permit, Wetlands Permit, Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E■ Yes ❑No If yes, list agency(s) name and permit/approval Town of Putnam Valley -Site Development Approval Permit, Major Grading Permit, Wetlands Permit, Building Permit 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes ENo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor e: Cronin Engineering P,E., P.C. /Patrick Bell Date: September 19, 2008 Signature: Lam— ✓`� If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPS ICATION.EOR.A_PPRQ�) �ALQ PLAN.a,�S ,F4R::.. ..,..,V , :.:� .�. A WASTEWATER TREATMENT SYSTEM 1. Name -and address of applicant: 2. Name of project: SS-VS s 3. Locationov: 4. Design Professional: -T- vwo' � Address: r 6. Drainage Basin: ` c� s U t t 1-6.0 0 "-) 'B ru'O k pe�� t < < t JU �► l o SZ, 6 7. Type of Project; Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................ ............................... Type I Exempt r ' Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... p 10. Has DEIS been completed and found acceptable b Lead Agency? A P Y g Y ................ 11. Name of Lead Agency A- 12. Is this project in an area under the control of local planning, zoning, or other �.__.... _. - officials Y ordir'a'_� 5' .5 ........:.... = r � .i1 y' 13. If so, have plans been submitted to such authorities? ........ .......... ...................... . -,it S 14. Has preliminary approval been granted by such authorities? *s Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water Zgroundwater 16. If surface water discharge, what is the stream class designation? .................... A 17. Waters index number (surface) ......... ............................... tA 18. Is project located near a public water supply system? ....... ............................... JVO 19. If yes, name of water supply 1,4 Distance to water supply 14 20. Is project site near anpublic'sewa.g9',collection or treatment system? ................ U 21. Name of sewage system �` Distance to sewage system 22. Date test holes observed,�"l 0 i, 23. .Name of Health Inspector 24. Project design flow'(galla� f 1� `X `play). T �' ........................... ............................... I � pd 25. Is State Pollutant Discharge„ Elimir.6h i System (SPDES) Permit required ?... (S#rm 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 27. Is any portion of this project located within a designate< ow or State wetland? y e5 28. Wetlands ID Number ............................................................. ..................... .........._ N 14 _ 29 Is Wetlands Permit required? .............. ....... ................. ..... ............:...............,.. f�S ,. . _.. ..... Has application been made to ow or Local DEC office? .................:............. �S 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 31. Is or was project site used for agricultural activity, involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, . landflling, sludge application or industrial activity? ................. .......... Yes o 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 potentiallyknown source of contamination? ............................... Yeso DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... es 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... o . . .a 35. Are any�4.sewage treatment areas in excess of 15% slope? . .......................:....... 36. Tax ;Map ID Number .......................... ............................... Map fo aL Block d Lot 3 37. Approved plans are to be returned to ..... Applicant _ Design Professional NOTE: All applications forreview_and anwo -val of a new SSTS to be located within the NYC Watersi_ed sh:al. _ oe sent to ;the 1)eparfinent,'and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwaterplans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. ri If the application is signed by a person other than the applicant shown in Item I .,the applicatiop mu CV-- rn be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this pr-&isi (*:-'r a PQ may be g rounds for the rejection of any submission. ;- Cn� 1 hereby affirm, under penalty of perjury, that information provided on this form is e a to the best of my knowledge and belief. False statements made herein are punishabl��s n a Class A misdemeanor pursuant to Section 210.45 of P� e4l�K �' r" SIGNATURES & OFFICIAL TITLES. ► 04� �' Mailing Address _e_ '\4 o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L�17YWOV'XU IhL16 i�1L�Ax11V1� :.....,. .. a.. - RE: Property of Located at (! SCC_11 U_Q^-e^ L (�- P-\ V cj &V to V\f\ Vu ci Tax Map # Cc Block _ a, Lot o Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize7-t o �-V \ L . (. vo 6, cn —r a duly licensed Professional Engineer X_ or to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the cle 145 and/or 147 of the Education Law, the Public Health Law, and- +_he. -Putna e. - -- * f I 1, Very truly yours, Countersigned: ' ' o `� h P. E., R. A., # OG _ , 0�, Mailing Address State .� Zip lc� 5% (o Signed: J.Mailin ArZ State Zip CS-5 Telephone: 3 6 Telephone: 14 - 6 Z-1 .-V51 m Form LA -97 New York State Department of Environmental Conservation Division of Water Bureau of.Water Permits, 4th FI_oor ... uz5- B�oauway;Fiibanq,New � � �z3J- 3'05.... Phone: (518) 402 -8111 Fax: (518) 402 -9029. Website: www.dec.state.ny.us Alexander B. Grannis Commissioner 4/12/2007 Jeffrey and Stephanie Waters Jeffrey Waters PO BOX 652 Putnam Valley NY 10579- Re: ACKNOWLEDGMENT of NOTICE of INTENT for Coverage Under SPDES General Permit for Storm Water Discharges from CONSTRUCTION ACTIVITY General Permit No. GP -02 -01 Dear Prospective Permittee: This is to acknowledge that the New York State Department of Environmental Conservation (Department) has received a complete Notice of'Intent (NOD for coverage under General Permit No. GP -02 -01 for the construction activities located at: Site Plan for Waters Oscawana Lake Road Putnam Valley NY 10579- County: Putnam Pursuant to Environmental Conservation Law (ECL) Article 17, Titles 7 and 8, ECL Article 70, discharges in 3C x! ?ZTCC:�3!1t11�? -� 2_Q -1.1 t � (?Ve �c�tlsTi ctYC risite.:�a�il1 re �r.1+ �1J1?�r 5 �� i eJrcSczE lvfi _. from 4/6/2007 which is the date we received your final NOI, unless notified differently by the Department. The permit identification number for this site is: NYR 1OM591. Be sure to include this permit identification number on any forms or correspondence you send. us. When coverage under the permit is no longer needed, you must submit a Notice of Termination to the Department. This authorization is conditioned upon the following: 1. The information submitted in the NOI received by the Department on 4/6/2007 is accurate and complete. 2. You have developed a Storm Water Pollution Prevention Plan (SWPPP) that complies with GP -02 -01 which must be implemented as the first element of construction at the above -noted construction site. 3. Activities related to the above construction site comply with all other requirements of GP- 02 -01,' PLANNING BOARD 265 Oscawana Lake Road Putnam Valley, NY 10579 -2004 (845)526 -3740; Fax: (845)526 -3307 E -mail planninsna,uutnamvalley.com January 22, 2007 WATERS, JEFFREY & STEPHANIE SITE DEVELOPMENT PLAN MAJOR GRADING PERMIT WETLANDS PERMIT NEGATIVE DECLARATION OF SIGNIFICANCE OSCAWANA LAKE ROAD TM: 62.-2-30 FILE: 62./0906/1101 WHEREAS, the applicant is proposing a single-family residence on 9.93 ( + /-) acres of land located on Oscawana Lake Road in the Low-Density Residence (R-3) Zoning District; and WHEREAS, the Planning Board granted Sketch Plan Approval on October 16, 2006; and WHEREAS, the Code Enforcement Officer has determined that a Major Grading Permit is required; and n.. WHEREAS,. the. subject site contains a wetland regulated by the Town of Putnam Valley u„ action. Specifically, the applicant is proposing approximately 160 sq. ft. of wetland disturbance and 6,000 sq. ft. of buffer disturbance; and WHEREAS, a Wetlands Permit is required from the Planning Board; and WHEREAS, the applicant submitted a report from the New York State Department of Environmental Conservation (NYSDEC) Natural Heritage Program dated January 5, 2007, indicating that the bog turtle (Clemmys mvhlenbergW had been documented within one mile of the subject property; and WHEREAS, an inspection of the property by the Town's Wetland Consultant revealed that the subject site does not contain what is considered to be critical components of bog turtle habitat and no evidence of the bog turtle was observed on-site; and WHEREAS, the Putnam County Department of Health granted approval for the proposed water supply and sanitary sewage treatment system; and Page 1 of 5 .d LOee -929 (9b6) pjeog 2u;uuetd dOS :iO LO 62 uer r WHEREAS, screening will be provided between the street and the residence to reduce the visibility of the structure from Oscawana Lake Road; and WHEREAS, the driveway location has been approved by the Putnam County Department of WHEREAS, the Planning Board has reviewed the proposed action in accordance with Chapter .144 "Freshwater Wetlands, Watercourses and Waterbodies," Chapter 155 "Soil Erosion and Sediment Control," and Chapter 165 "Zoning" of the Putnam Valley Town Code; and WHEREAS, on December 21, 2006, the application and Site Development Plan were submitted to the Putnam County Planning Department under §239-m of General Municipal Law; and WHEREAS, the applicant has submitted Parts 1, 2, and 3 of the Full Environmental Assessment Form (EAF), last revised January 4, 2007; and WHEREAS, the proposed action has been determined to be an Unlisted Action under the State Environmental Quality Review Act (SEQRA); and WHEREAS, the Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c) and determined that the proposed action will not have a significant adverse impact on the environment; and WHEREAS, the Planning Board has considered all reasonably related long-term, short - term, direct, .indirect, and cumulative environmental effects associated with the proposed action including other simultaneous or subsequent actions. NOW THEREFORE BE IT RESOLVED THAT, the public hearing for the Site '_......_.__ 11. .1 ev_ e Yop7nu'i .y - , . YT. Pl .. . ,._.. l r�„ c _ _ .,ri i losed; an&.. BE IT FURTHER RESOLVED THAT, the attached Negative Declaration of Significance is hereby issued; and BE IT FURTHER RESOLVED THAT, the Site Development Plan (Sheets SP-1.1, SP-1.2, and UD-2.1), titled "Site Development Plan for Jeffrey and Stephanie Waters," prepared by Cronin Engineering P.E., P.C., last revised January, 5, 2007 is hereby approved subject to the below-listed conditions; and BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid fora period of 18 months after the Site Development Plan has been signed by the Chairman and may be extended once, at the request of the applicant, by the Planning Board for a period not to exceed six months; and BE IT FURTHER RESOLVED THAT, the Wetlands .Permit is hereby approved subject to the below-listed conditions and the signing of the Site Development Plan and shall be valid Page 2 of 5 Z - d LOEE -92S (StB) pieog 2uiuueTd 409:TO LO E2 UeC for a period of three years from the signing of the Site Development Plan. All work associated with the Wetland Permit shall be conducted in strict compliance with the . _ appiovbd'Site l)eVeidpmenc`riall and s;ial U6`Cti: iii °d .:i�'�� -�; •,tt_s. `o?lo��C'.tl Ci Vii 4L1aL Jila LYL'.r initiation of construction; and BE IT FURTHER RESOLVED THAT, the Wetlands Permit shall automatically expire upon completion of work; and BE IT FURTHER RESOLVED THAT, a Major Grading Permit is hereby issued subject to the signing of the Site Development Plan by the Chairman; and BE IT FURTHER RESOLVED THAT, the Major Grading Permit shall expire six months after the signing of the Site Development Plan by the Chairman; and BE IT FURTHER RESOLVED THAT, the below-listed conditions must be completed within 6 months of the date of this resolution. Should the below listed conditions not be completed within the allotted time frame, this resolution shall become null and void unless an extension is requested by the applicant (in writing) within said 6 month period and granted by the Planning Board. Conditions to be satisfied prior to the signing of the Site Development Plan 1. Submission of all applicable fees and escrow. 2. Construction Monitoring Escrow in the amount of $2,500 shall be submitted to the Planning Board Clerk. 3. An Erosion and Sediment Control Bond, or other collateral acceptable to the Planning Board and in form acceptable to Planning Board Counsel, shall be submitted to the Planning Board Clerk. Said security shall be in the amount of $5,630. The applicant shall provide an action plan for the security indicating, to the satisfaction of Planning Yla_;tp take. -the T necessary corrective measures. 4. The Planning Board Chairman shall sign the Full EAF, last revised January 4, 2007. 5. Plans shall indicate that terminal catch basins (discharge to level-lip spreaders) shall have deep sumps and oil and grease separators. Maintenance requirements and a schedule shall appear on the Plans and annual written reports by a certified erosion control specialist (CPESC) or professional engineer, certifying satisfactory and timely compliance with said reports, shall be submitted to the Town. 6. Soils that are disturbed within the wetland buffer shall immediately seeded with a wetland seed mix approved by the Town Wetland Consultant and covered with erosion blankets. 7. A bond, or other collateral acceptable to the Planning Board and in form acceptable to Planning Board Counsel, in the amount of $1,000.00, guaranteeing the viability of at least 85% of the planted wetland buffer seed mix 3 years following the issuance of a certificate of occupancy for the single-family residence approved hereby. 3. The applicant shall provide $400 in escrow to provide for the following inspections by the Town Wetland Consultant: a. Preparation of the. site for planting. Page 3 of 5 E'd LOEE -929 (9116) pueog 2uiuuejd dog :10 LO 62 Uer b. Installation of plant material/Year 1 inspection. c. Inspections on Years 2, 3, (final inspection). .- 9.. _A.n inspection fee in the- rameonat of $331 (5° /) of erosion and wetland bond amounts) shall ^ be submitted to the Planning Board. 10. The applicant shall satisfactorily address any comments from the Town Engineer, Town Planner, and Town Wetlands Inspector. Prior to the signing of the Site Development Plan by the Chairman, final reports from the Town Engineer, Town Planner, and Town Wetlands Inspector addressing resolution compliance shall be submitted to the Planning Board. 11. Eight original copies of the Site Development Plan, signed by a Licensed Professional Engineer and the owner of the property, shall be submitted for the Chairman's signature. Conditions of the Wetlands Permit 12. The Applicant shall allow periodic inspections by the Town and its consultants before, during, and after construction. 13. The Town Wetland Inspector shall inspect the site at the end of construction but prior to the issuance of a certificate of occupancy to insure compliance with the Wetland Permit. 14-This Wetlands Permit shall be prominently displayed at the project site during construction. Additional Requirements to be Satisfied Subsequent to the Signing of the Site Development Plan: 15.At least two business days prior to the commencement of the work, the applicant shall apply to the Code Enforcement Officer for a permit to commence work, pursuant to Chapter 155, Soil Erosion and Sedimentation Control, of the Code of the Town of Putnam Valley. 10. Prior to the. issuance of ;q l uildir�; Permit,.. a_ site inspection shall be conducted with the. applicant, - contractor, Building Department, Town b;ngineer�, 'Town rlanrier, anti '1'owii Wetlands Inspector. 17. Prior ' to the issuance of a Certificate of Occupancy, a final site inspection shall be conducted with the applicant, contractor, Building Department, Town Engineer, Town Planner, and Town Wetlands Inspector. 18. Prior to the issuance of a Certificate of Occupancy, an as-built survey demonstrating compliance with the approved Site Development Plan shall be submitted to the Planning Board, Town Engineer, Town Planner, Town Wetlands Inspector, and Code Enforcement Officer. 19. Prior to the issuance of a Certificate of Occupancy, the Building Department shall confirm with the Planning Board Clerk that all consultant fees have been paid in full. Page 4 of 5 i+'d LOEE -929 (S +PB) pueog 2uiuue1d dog :10 LO 62 Uer Motion: Billy L. Crowder .. 8ec&ri&- � +:ukein6 -T. 'Yetter,_Jr: Yea Nay Abstention Absent Tom Carano X Eugene T. Yetter, Jr. X Richard Tully X John. Zarcone, Jr. X Billy L. Crowder X Michael Raimondi, Jr. X BY: air an Michael Raimondi, Jr. The Planning Board Clerk hereby confirms that conditions 1-11, identified above, have been satisfied and that the Site Development Plan has been signed by the Chairman of the Planning Board. Confirmed BY: Date: Page 5 of 5 s'd LOSE -929 (sips) pueog 2uiuueTd dTS :TO LO Ez Uer ,Jan 23 07 01:51p Planning Board (845) 526 -3307 p.6 State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination of Non - Significance Date: January 22, 2007 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Conservation Law. The Town of Putnam Valley Planning Board has determined that the proposed action described below will not have a significant environmental impact and a Draft Environmental Impact Statement will not be prepared. Name of Action: Proposed Single-Family Residence for Jeffrey and Stephanie Waters. SEQRA Status Type 1 X Unlisted Conditioned Negative Declaration: _ Yes X No Description of Action: The applicant is proposing to construct a single-- family ._ residence on 9.93 ( + /-) acres of land located on Oscawana Lake Road in the Low-Density Residence (R-3) Zoning District. In addition to Site Development Plan approval, the applicant requires a Major Grading Permit and a Wetlands Permit from the Planning Board. The site is located in the Wetlands and Watercourse (W) Overlay District, the Hillside Management (I-IM) Overlay District, and the Ground and Surface Water Protection (WP) Overlay District. Location: Oscawana Lake Road, Putnam Valley, Putnam County, New York Reasons Supporting This Determination' The Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c), specifically: 1. The proposed action will not result in a substantial adverse change in the existing air quality, ground or surface water quality or quantity, traffic or noise levels; a substantial increase in solid waste production. The subject Page 1 of 3 .Jan 23 07 01:51p Planning Board (845) 526 -3307 p.7 site contains a wetland regulated by the Town of Putnam Valley and disturbance to the wetland associated buffer area will result from the proposed action. Specifically, the applicant is proposing approximately 160 sq. ft. of wetland disturbance and 6,000 sq. ft. of buffer disturbance; all.of which is being properly mitigated. 2. The proposed action will not result in the removal or destruction of large quantities of vegetation or fauna; substantial interference with the movement of any resident or migratory fish or wildlife species; impact a significant habitat area; result in substantial adverse impacts on a threatened or endangered species of animal or plant, or the habitat of such species; and will not result in other significant adverse impacts to natural resources. The subject site contains a wetland regulated by the Town of Putnam Valley and disturbance to the wetland and associated buffer area will result from the proposed action. Specifically, the applicant is proposing approximately 160 s. ft. of wetland disturbance and 6,000 sq. ft. of buffer disturbance. The applicant submitted a report from NYSDEC Natural Heritage Program dated January 5, 2007, indicating that the bog turtle (Clemmys muhlenhergii) had been documented within one mile of the subject property; however, after an inspection of the property by the Town's Wetland Consultant, it was determined that the subject site does not contain what is considered to be critical components of bog turtle habitat and no evidence of bog turtles was observed on the site. 3. The proposed action will not result in the impairment of the environmental characteristics of a Critical Environmental Area as designated pursuant to 6 NYCRR Part 617.14(g). 4. The proposed action will not result in a material conflict with the Town's officially approved or adopted plans or goals. 5. The proposed action will not result in the impairment of the character or quality of important historical, archaeological, architectural, aesthetic resources, or the existing character of the community or neighborhood. The proposed structure will be visible from Oscawana Lake Road and substantial landscaping has been provided to limit its visability. 6. The proposed action will not result in a major change in the use of either the quantity or type of energy. 7. The proposed action will not create a hazard to human health. 8. The proposed action will not create a substantial change in the use, or Page 2 of 3 .Jan,23 07 01:51p Planning Board (845) 526 -3307 p.8 intensity of use, of land including agricultural, open space or recreational resources, or in its capacity to support existing uses. 9. The proposed action will not encourage or attract a large number of people to a place or place for more than a few days, compared to the number of people who would come to such place absent the action. 10. The proposed action will not create a material demand for other actions that would result in one of the above consequences. 11. The proposed action will not result in changes in two or more elements of the environment, no one of which has a significant impact on- the environment, but when considered together result in a substantial adverse impact on the environment. 12. When analyzed with two or more related actions, the proposed action will not have a significant impact on the environment and when considered cumulatively, will not meet one or more of the criteria under 6 NYCRR 617.7(c). 13.The Planning Board has considered reasonably related long-term, short - term, direct, indirect and cumulative impacts, including other simultaneous or subsequent actions. �r o`r further uiiorinaiion wutact= - - - r - Laura Lussier, Planning Board Clerk 265 Oscawana Lake Road Putnam Valley, New York 10579 This notice is being filed with: Putnam Valley Planning Board 265 Oscawana Lake Road Putnam Valley, New York 10579 Page 3 of 3 LETTER O CRONIN ENGINEERING P.E., P.C. September 19, 2008 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914-736-3664 Fax 914-736-3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: Proposed SSTS-Waters Property 0scawana Lake Road (T) Putnam Valley Tax Map#: Sec: 62. Block: 2 Lot: 30 Previous PCDH Permit # (SW-32-03) THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT 1:1 PLEASE REPLY Joe, Please rind enclosed the following: I-) One. (!)..copy of the.Preliminary Design far. Fill -Placement Only Plan, dated Septiffinber 19, 2008 ificiu&9 FifiTiaceme"Piku & Subgukface- SeWAge Y reatriielit' System Plan 2.) One (1) copy of the Resolution of Approval from the Town of Putnam Valley, dated January 22, 2007 3.) One (1) copy of Design Data Sheet-Subsurface Sewage Treatment System 4.) One (1) to the Putnam County Department of Health in the amount of $500.00 ��o 5.) One (1) copy of the SSTS Construction Permit Application 6.) One (1) copy of the Application for Approval 7.) One (1) copy of the Well Construction Permit Application 8.) One (1) copy of the Letter of Authorization 9.) One (1) copy of the Short EAF 10.) One (1) copy of the SPDES permit for Stormwater Discharge SSTS Plans have been previously submitted to your department in reference to this project. The last permit granted for this project was SW-32-03. The previous permit has lapsed and our client wants to renew the permit with modifications to the design size of the SSTS. The enclosed plans and applications are for a 5-bedroom SSTS an increase from the previous 4-bedroom approval for the property. Please use the previously submitted design data sheets to supplement the enclosed design data sheet for this project. Note on the enclosed design data sheet that the deep test holes are labeled as 18,19 & 20, these are holes 15,16& & 17 that were witnessed by Gene Reed on August J, ". . h LETTER OF TRANSMITTAL of the site's existing deep holes on file with the PCDH. Please also use the previously submitted house plans for your review. Review the enclosed application at your earliest convenience and contact me with any questions or comments. Thank you for your assistance in this matter. Res ctfu"y submitted' P trick M. Bell Design Engineer TOWN OF PUTNAM VALLEY...... . _.. CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: April 16, 2005 DATE PERMIT EXPIRES: April 16, 2006 APPLICANT /SSPONSOR: Jeff And Stephanie Waters 10 Elm Street Cortlandt Manor, New York 10567 PROPERTY LOCAfI')CON: Oscawana i,'ake Road' TAX MAP #: 62. -2 -30 SIZE OF PARCEL: 9.932 acres ZONING: R -3 _ PROPOSED ACTION: _Single Family_ Residence, driveway encroachment within ... .. »_. .___�. _. _.._..__ ._ a .._...,._. ._ ..- .- _.-- j'►'CtiiiYiU�UU�Ci• ." .. »_.r ...___ _........... ._. � ...___�. ___..... ,..__.,- ...�.. �.._.._.. __- MATERIALS REVIEWED: 1. Application Materials, file # WT- 12/05. 2. Site Plan as attached with application, as prepared by Putnam Engineering, PLLC., dated 08 -97. CONDITIONS OF PERMIT: 1. All construction'shall follow Site Plan as submitted with application. This project is a permit waiver renewal, originally granted to Martin Goldstein 03- 31 -98. Encroachment within buffer is necessary for access to lot # 1 previously approved as part of the Goldstein Subdivision. 2. The existing large Elm and Ash trees located at the edge of the wetlands should be preserved. Tree Wells should be constructed to preserve these trees from impacts caused by construction of the driveway. A detail should be added to site plan. Page 1 of 2 J .. .._..._ _. 3. A stone retaining wall should be constructed to serve`as the "limit ofdis Ur from' grading for the driveway edge that is closest to the wetland. 4. Erosion controls consisting of a row of silt fence and a double row of staked haybales shall be installed along perimeter of proposed driveway and along the edge of the wetland area. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 6. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 7. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 8. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 9. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon. satisfactory completion of the project. (this requirement waived, if additional deposit done at time of application) - Noncompliance with the conditions. above will:invalidate this Permit Waiver, and may result in a Notice of Violation and /or a to Work Q�rder:' Any questi6iis regardirig`this Perrnit`' Ayaiver— should be directed to the Town Wetlands Inspector (914) 494 -5544, or the office of the Building Inspector (914) 526 -2377. Site Inspection: 04 -02 -05 Date Permit Waiver Prepared: April 16, 2005 S*A_� W- 6694 Stephen W. Coleman Town Wetlands Inspector cc: Applicant Building Inspector Planning Board Page 2 of 2 AM COUNTY DEPARTMENT OF HEALTH TSION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTENJ PERMIT # Located at b�cAw 4 A Lm-c- Town or Village i o, ; ,,ice Subdivision name IJ�i4 Subd. Lot # Date Subdivision Approved rJ/A Owner /Applicant Name jg f:j=p i" Wtyr e? -S Mailing Address 10 Amount of Fee Enclosed 4740D Tax Map 6Z Block Z Lot a/o Renewal ✓ Revision Date of Previous Approval 44 i Zip os(+, Building Type 1 1= rl , g es. _ Lot Area q A lc. No. of Bedrooms + Design Flow GPD Ocr> Fill Section Only Depth °'S Volume 3Ao c'1( PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: 1 a i'1 i,.1 . 1? o a Ft L-%- t>Er-no J1 — U>Ec"tl V�►� r�S Our cX�St�,.lcz. `7`�P To be constructed by , 0e-r- Address Water Supply: Public Supply From on i'nva`te "Supply Address Driiiea by I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sy tem 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 ther to. , —� Signed: P.E. R.A. Date. O. Rpw�► y,7►L . P - Addres PLLG. License # 4) &114(Q APPROVED FOR CONSTRU&ION: 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 ermit. Approved for discharge of domestic sanitary sewage only. By: Title: " Date: White copy - HD ile; Ye o copy - Building Inspector; Pink copy - Owner- Or copy - Design Professional Form CP -97 t1� ,1 l(,� 5 �► -� f° vwtr�. pw� �B� s ti c,IUV�(ti f G � G� ei,/✓I . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f\/—.3-91 So - ,3z -03 Located at eSe -AeJ A-P 9 N LA&s- 1zc;,A n Subdivision name PJ //� Subd. Lot # Date Subdivision Approved rJ1A Owner /Applicant Name F 1Z -`( Q xrol -S Mailing Address k 0 n 6'j, Cof- l.f)rt� Amount of Fee Enclosed 44.E Town or Villages Tax Map &a Block Lot '30 Renewal _� Revision Date of Previous Approval 4/11 0-3 Zip jo 10-7 Building Type rj. �� Lot Areal ,. No. of Bedrooms--4--Design Flow GPD 00Q Fill Section Only Depth �° • Volume 0 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: I' lnojj� eio, t5ez %-00 —Mn--P-r" VAXi�les QJ6 3 45X15,T1jrs ''Bev To be constructed by `Q- '��°,�a -t`a 1,,jgf V Address Water Supply: Public Supply From Address or: , V Private Siippiy Dfilied Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sy tem 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 2 —IS License # C. &1 N. e.i 4s a r it- . o� `1! • 0 5"10` APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By� Title: Date: /0.5— Wh opy - HD File; Yellow copy - Building Inspector; Pink copy - ,Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ . _.. - . ... APPIjICA'TION'i O CONSTRUCT A WATE please print or type - r �PCHD Permit # Well Location: Street Address: o illage Tax Grid # O`xo�ti.r�r -►/! LACY -c- 4, fQ -r iAtn VhLLZ -`! Map CoZ Block ', Lot(s) '50 Well Owner: Name: Address: 4EPFfL£`/ WATE�Z-S 1 �J-ri 1, Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served i M,wijy Est. of Daily Usage Q3� gal. Reason for place Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason G-t„ t S„wi ar f" ►c c for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ...............:................................. ............................... Yes No ✓" Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No V/ Name of Public Water Supply: Town/Village Distance to property from nearest water main: ! r7IL.- Proposed well location & sources of contam' separ plan. - Apph=t S:b ^.�.t-tr:re. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. i A Date of Issue 1'-i `0< Permi Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy a, Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ . . please print or type 1. rCHD ?enact 9 F-%j a ` 9 Well Location: Street Address: To illage Tax Grid # L O-V< -- J41, &'riJ#<l VAt.L61� Map & 2 Block Z Lot(s) 3O Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought J5 gpm # People Served L&:niL-q Est. of Daily Usage p ) al. Reason for Rplace Existing Supply Test/Observation Additional Supply Drilling i ew Supply (new dwelling) Deepen Existing Well Detailed Reason ;e �J 5 '.iE';er=� rya%- 4;s' CSC for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision f-J ZA Lot No. Water Well Contractor: bC- `I��'Egtn l p�S &_r2 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: r, A `..c '- Proposed well location & sources of contamination to o eparhe t/plan. Date: �T —.`'� Applicant Signature: _. , q icw PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 'T A ®S— Permit Iss ng Official Date of Expiration © Title: d fir_ r Permit is Non- Transfe ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ••...• .• -n CERTIFIED MAIL,,., RECEIPT co I CERTIFIED MAIL,,., RECEIPT I'L.I (Domestic Mail I No Insurance Coverage • ••• I•l1 :1 (Domestic Mail I No Insurance Coverage r r For delivery information visit our website at www.usps.comjD For S ?' delivery ,Postage Postage C3 ' �a C3 C3 Certified Fee 3 C, �,O ' p Certified Fee O Poslrnailt O �� ark M Return Reolept Fee a Return Redept Fee (Endorsement Required) Here jy. (Endorsement Required) Restrlded Delivery Fee C3 R•afrkted Delivery Fee m(Endorsement Required) (( G\ ft 1 (Endorsement Required) Total Postage & Fees $ v� r=1 Total Postage & Fees $ Jr, - S O Sent To O n o O M �` 3Yreet, Ai a;treer: ilpt GLENDA ISAACS .__. or PO Bo BERNHARD BISCHOFF orPOBox' 114 EAST 90TH STREET - - -- sieie On1% � waary• t485 USCAWANA LAKE ROAD NEW YORK NY 10128 PUTNAM VALLEY NY 10579 N CERTIFIED MAIL,,, RECEIPT CERTIFIED P- RJ (Domestic Mail • No Insurance Coverage Provided) n-J I (Domestic Mail I No Insurance Coverage Provided S c3 I or delivery �•�I •IAL •E For r •FVCIAL U •E m m Postage $ , Postage $ C3 Certified Fee 3 0 w _ C3 Certified Fee C3 1 C3 Retum Redept Fee c� "°�tt�'� a k '.' O Return Redept Fee (Endorsement Required) i Ft•te rt• (Endorsement Required) Restricted DeINe Fee 'O Restricted Delvery Fee Y Ln ( Endorsement Required) i `' m (Endorsement Required) M ra rq Total Postage & Feos $ / Total Postage & Fees ? .r O ant o M ant o C3 a r` orpo i7pt. 0. TOWN OF PUTNAM VALLEY orP08o; STEVEN BRUNO °r��`Na TOWN HALL GN stale �a ary sran 2 RENEE GATE PUTNAM YALLEY NY _ _ N7 _ . _ } • Ai-y �il�A �hf� -: Postal Postal Service,,, c3 CERTIFIED MAIL,. RECEIPT n CERTIFIED MAIL,, RECEIPT iv (` (Domestic I No Insurance Coverage (Domestic Mail Only; No insurance Coverage Provided) r.. F ? For delivery information visit our website at www.uspsxomj) 04 F M.. "0 F 0 Postage $ 7 �� '` r.. Q Postage $ 1 y 7 Ln Certified Fee L i O Certified Fee 2-36 Postrti 0 1. r:.' C3 Return Redept Fee "`� "'l'�'1 ) �° M Return Reolept Fee re , (Endorsement Required) t erg ,�� )ti,_ (Endorsement Required) �. ,•I O Restricted Delivery Fee - Restricted Delivery Fee u7 (Endorsement Required) �,/` r m (Endorsement Required) r i OTotal Postage & Fees $ Total Postage & Fees $ O t o nt o O 0 3irear, i1pC nfo. APG ' LOUIS & LEESA HERNANDEZ orPOB -No. FRANK & DIANNE DENARDO orP0Boxl1 idW, siaie,ziP -483 0SCAWANA LAKE ROAD 7 BARGER HILL ROAD ciiy,- sieie, -; •- PUTNAM VALLEY NY 10579 PUTNAM VALLEY NY 10579 car= Fost`al'Ser`vlceERTIFIED MAIL,,, RECEIPT• ornestic Mail Only; No Insurance Coverage Provided) o l s Post ag a '$ t3 Certified Fee C3 �•3� O M Return Recept Fee (Endorsement Required) �r C3 Restricted Dellvery Fee Ln (Endorsement Required) M ServiceW L USE i f �HHe�\ro `I Total Postage & Fees ~ ', :t o sent To — — O or PO Bar I ��'SYate; LINDA POWER 463 OSCAWANA LAKE ROAD PUTNAM VALLEY NY 10579 0 Iv Iti rri Postage 0 O Certified Fee M Return Reclept Fee Ir M.. _. Postage '1i Certified Fee C3 ,� 4-1 O O O N M S O O N ru A,L USE I Return Reclept Fee (Endorsement Required) Restricted Delivery Pee US Postal ServiceW (Endorsement Required) �� r Total Postage as CERTIFIED MAILTNI RECEIPT ='I (Domestic Mail Only; No Insurance `Coverage Provided) Ir M.. _. Postage '1i Certified Fee C3 ,� 4-1 O O O N M S O O N ru A,L USE I Return Reclept Fee (Endorsement Required) Restricted Delivery Pee Here ^ � 0 } ` •,\ (Endorsement Required) �� r Total Postage as - PO&DONALD EMERY WStenPO BOX 630 MOHEGAN LAKE NY 10547 N 0 co rn Postage $ C3 D Certified Fee O L-j (Endorsement Required) Retum Rede Fee (EndorsementRequired) 'z �Restricted OelNery Fee ,,u1 f M Restricted C141ve Fee (EndorsementRequfred) �n ;'.;_' ry (} ul (Endorsement Required) rn m Total Postage & Fees J / ` / !, ; '� Total Postage & Fees $ s- O nt o O TeFro C3 .. p ►` s4i;iZ -A 1BRAD & DEBRA APPELL N �aeet Ari °r��466 OSCAWANA LAKE ROAD -. - -- or PO Box & LOUISE SAUER Clry,stere�,tfiT.AM VALLE_r NYJ� ,15?9 - _ !W.:Nja 473 OSCAWANA LAKE ROAD. _ -- . YV.`�lV ltiVr Y?jL •r° V 1 IUS�I`7. • -•• `• "'� "`" " " " "'"" Postal ru • , • • m (Domestic Only; lti 0 co rrt Postage $ 4ppy, QCertified Fee O P syrlg7l2 C3 'e'm Reclept Fee re (Endorsement Required) C3 (Endorsem Delivery e e m Total Postage & Fees C3 or POBox No. .0y5 d S«uv Fx.:rZGf ctty,'smpe, zr�a Q a :rr r _ ... _... 4. PUTNA M U0 UNTY" EPAK Y MEiv T OF HEALT1-11 DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at A L K -e d) V Vii_cti Tax Map # 6?? Block Subdivision of r•i //S. Subdivision Lot # Gentlemen: This letter is to authorize 7 2 C- Lot ---2) 0 _ 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 pi o ert it -a�c�rct.nce with th.P,stadrds rules or regulations. as romul ated ...___......._..._..�... -� .,...>?er yn. r.._�. _.._� _ g .p_ . • 24t by the Public Health Director of the Putnam County Heatli Lepar£men,`aiid ro "sign an necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity. '� �f Article 145 and /or 147 of the Education Law, the Public Health with theppovisa LaN.d�thl?'g *County Sanitary Code. ;ter A A- ',15 Cy P� _� !` Very truly yours, y Countersigns Signed: i44G (O ner of Pro ty) Mailing Address: tvrAxn a ic.,,JEE�z- �Pt- L4-.Mailing A ess: IT) 6-�'4=M ��• �asT�2 co v^ r� r State: Zip: 0 S-001 State: Zip: 1 1 Telephone: � 572,E —�� `� Telephone: 91 239 ' 3 -713 •,39_ 3 PUTNAk COUNTY DEPARTMENT OF HEALTH • 4t . ' DIVISION OF ENVIRONMENTAL ' _ .- - -- -• iN1?TVIDTJAI, WATER SUPPLY �s S[JIB -. ,V srL�'9V €:E >TR c 1 F�fFSYS Eii M •; : '• _ - REVIEW SHEET FOR CONSTRUCTION PERMIT . NAME OF OWNER �/ ''''Qir� STREET LOCATION: REVIEWED.BY: RM, O TSP SRDATE: �� T�+►X MAP#: (CONRIRDitED) �Or ' � ` Y N DOCUMENTS Y N LREO=M DETAILS ONPLANS CONT'D) PERNIIT APPLICATION HOUSE SEWER - %?' FT. 4 "0'; TYPE PIPE. CAST IRON WELL P'ERIMT OR PWS LETTER (—J(—)NO BENDS; MAX BENDS 45' W /CLEANOUT UUPC -97 ; LlS )LETTER OF. AUTHORIZATION ( SITE NOTE (NO CHANGE) ��- (- —)DESIGN DATA SHEET (DDS) /U(— jCORPORATE RESOLUTION Ue:JL10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE L�SHORT EAF . (,� :: FILL SPECS / FILL NOTES 1 -5 PLANS -'T WEE SETTS (�r��FILL PROFILE & DIMENSIONS O SE PLANS -TWO SETS U;Git_. JFE,L, IN 9XPANSION AREA ( )�lARTAN('A" RF e.. ��-- Y �i ��.NI' FILL GREATH$,TSAN3 FLET SUBDIVISION L_X2- LEGAL SUBDIVISION B _)L_)SUBDTVISION APPROVAL %' UUPERC RATE [ OL. ON PLAN FOR R.O.B. SIFTED & ZIPERVIOUS CUUL RQ DEPTH ' TION DISTANCE FROM TOE OF SLOPE (; TAIN l>KU N REQUIRED • . GE.�RAL TRENCH PROVIDED W Y;3 60FT MAX. U( -JLOCATED .IN NYC WATERSHED P PARALLEL'TO CONTOURS Li�DLANS SUB TO PCHD f vF' 100% EXPANSION PROVIDED ��BGEOTZXTILE DETAdXJDUST FREE CRUSHED'STONE OR WASHED GRAVEL EP APPROVAL, IF REQ'D COVER. ( L_-)DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN • F1tOM'SSTS_ C_UPERCS TO BE WITNESSED t 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. Ei�9,•YROVAL SSDS Z,p, TO FOUNDATION WALLS . FVETLANDS OWN/DEC PERMIT RE D? 100' TO WELL; 200' Il�i'DLOD;150' TQ PITS 1. DATA O SAME 100' TO STREAM WATERCOURSE, LAKE- lac. ez a 69 NEIGHBOR NOT1FiCATIO ' _ _ P _ , C �I!�.� = >: ...... ,` �• -. - "4�'^e �..� (__'} 30" TOCA�� '= 5f�'.,.I�i�'.P'�!•�'�TP;�v - •.- - -�:_- S10 YR: HOOD ELEVATIONW(I 200' OIL TESTING LOTS>10 YEARS OLD REQUIRED •DETAII.S ON PLANS )SEWAGE SYSTEM PLAN - (NORTH ARROW) )SSDS HYDRAULIC PROFILE )GRAVITY FLOW )CONSgRUCTIONNOTES 1 -15 " )DESIGN DATA: PERC & DEEP RESULTS 32' CONTOURS EXISTING & PROPOSED �(-_-)T1TLE BLOCK; OWNERS NAME ADDRESS TMf#, PFJRA; NAME, ADDRESS, PHONE# _,•,,/ DATE OF DRAWING/REVISION .: fA_ JDATUM REFERENCE . 0ULOCATION OF WATERCOURSES, PONDS LAIKZSXETLANDS WITHIK 200' OF P.L. � FLOOR AND :-_-j WELLS & SSDS'S WAN 200' OF SSTS ;JJ�ROPERTY METES & BOUNDS EROSI0N CONTROL FORIKOUSE, WELL & SSTS, EROSION CONTROL NOTE 10' TO WATER LDM (ptt4 .201 (;OC- -)50'• DnERMTTTENT DRAWAGE COURSE (� , 00'/500' RESERVOI�2, ETG 150' GALLEY SYSTEMS (�10' MIN'TO LEDGE Q1ITCROP y�E�$iC TANK (-'/(_)10' FROM FOUNDATION; 50' TO WELL WELL (fL_)DJMENSIONS TO PROPERTY lakfES (l/ (LOCATION OF SERVICE CONNECTION A_- ( MIN 15' SLOPE L_L<_JSLOPE IN SSTS AREA U(REGRADED TO 15 %, IF REQUIRED ' DOSE/PIMP SYSTEMS UUP.UMP NOTES . (__ L_ jDOSX 75% OF PIPE VO SE VOLUME NOTED U(__,)DETAII, FOR .MAIN, (PIPE TYPE, ETC.) U�AY- X SHOWN & DETAILED (� GE ABOVE ALARM . CURTAIN DRAIN elf UUSTANDPIPES, 5' BOTH SIDES MIN to CDS�S.! %,151-3%,35'4%, 100%- I% Mw to CE ARGE/100' with 182 cons day discharge MV 'to NON - PERFORATED PIPE )A` bIENTS: — -- IVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT -iS` - $TE-11 f-- : - PERMIT # i%"3 l 9 3 �jj Located at 0S'6*U,41\W4 6AIZ Town or Village Subdivision name A/4 Date Subdivision Approved Subd. Lot # Tax Map 6d- Block --2 Lot 30 Renewal Revision Owner /Applicant Name -)7-b /A3IS'4's4p/ �WOt'd� &W &,vf4 Date of Previous Approval 3 -/S gy Mailing Address 8 1o6X6tn' ®�st' I-c47"r -j 114-t u;:y ,N t j Zip 1057`1. Amount of Fee Enclosed feco Building Type Lot Area QG No. of Bedrooms 4' Design Flow GPD 806 Fill Section Only Depth ��` Volume �-F- PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: r #icyUif , &,6 rll.L 4E ?7O.J — D169W JJWMEr CJV6- 7b t /Si /�/C APO, To be constructed by '%d Address Water Supply: Public Supply From Address vate`aupply li'riied iiy- o .� -'7Z-r 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 5ystem 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. e R.A. P.E. : Date o Z/g- d Signed ' -� • � 1/ Address A//ynr? EW6tAJE�r2i,,-� , PL.Cx_ License # 062446 4-04V 6l"7N 6 kYZ- WS;-L--rL A, APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed �mid .inpegte b�yrthe PCHD and is revocable for cause or may be amended or modified when considered necessary by the Publicieahth irec,o .aWny revision or alteration of the approved plan requires a new Vermit. Approy9kfor discharge of domestic, sanitary sew4ge only. By: ad Title: ' is Date: White copy - HD 11e; ell w copy - Efuilding Inspector; Pink copy - Owner r ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . _ APPLICATION _ wplease Yprint or type . .. 15("RD''ermlt. #.. -/— Well Location: Street Address: /TowoNil lag�e� Tax Grid # 0441A LAkg - ;l j Map b,� Block a4 Lot(s) 30 Well Owner: Name:7*445156AAJ Address: Via W✓E6Paoi/k 1 8 to ,0ka&- A55 i0W.4A# 1/ a,6 gay Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought z5 gpm # People Served /120LV Est. of Daily Usage OC O gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling � New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: TO A6 D i 7rk'IWIA 460 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: / M.14AE f Proposed well location & sources of contamination to bemravided on eet/plan. 'ue- :-- �s�r /.�:%Or? 4ni.isfla�f_�itvh�ilrP,: _ PERMIT TO CONSTRUCT A WATER WELL ::; This permit to construct one water well as set forth above, is granted under provisions of Articl�0 of =the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code d provided that within thirty (30) days of the completion of water well construction, the applicant or their ignated; representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordant; with -the :. requirements of the Putnam County Health Department. 3) Submit a Well Completion Report 69 a form provided by the Putnam County Health Department. During all well drilling operations, the ap0cantand/br well driller shall take appropriate action to assure that any and all water and waste products fro®sucft w well drilling operations be contained on this property and in such a mariner as not to degrade onthei*ise�t 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 wate well driller certified by Putnam County. A Date of Issue 'r( 03 Permit Iss i g Offs ial: Date of Expiration '8 5 Title: Permit is Non - Transferrable / ) 1 -0 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owneri /Orange copy - Well driller Form WP -97 12/12/2002 13:57 FAX 845 2796769 LPUTNAN ENGINEERING a 002 /002 78,5'9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at 0 5C-A tlA ryA 409 ROMP k- ZWrALI 14 44W Tax Map # 6 Block X Lot '30 Subdivision of Subdivision Lot # Gentlemen: This letter is to authorize rT�40 a duly licensed Professional Engineer V" or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above noted property in accordance with the standards, rules or regulations as promulgated -by hg..P'uhlic Health Director of the Putnam Cou ty )Realth Department, and to sign all necessary papers on my behalf in connection with: this mhtter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education. Law, the Public Health Law, and the Putnam County Sanitary Code. P.E., R.A., Mailing A.dd4g� Very truly yours, Signed: (�6e 4dr of Property) ) Mailing ess: / G=. k VJ - ✓ State AJ Zip: 10- E09___ _. State: ' — Zip: Telephone: A�:5 , - �D % :6 � �? �I� hone: `'t1 A 1 ;, 14.111 -4 (9/95) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C _ . _ ...._.. _ ... Statt'.jrraxlccnm -i!•OcLaE R �i��s �_ .,.., .. ,�- ,_. • . 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 t141\106 --11( 06fNJk- sSmS 3. PROJECT LOCATION: Municipality �(/�► ✓LYL[� County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROP SED ACTION: New ❑ Expansion ❑ Modiftcatlonlalteratlon B. DESCRIBE PROJECT BRIEFLY: / a!�! �'i a ��32t.. �•.S' J S �dY' f %i✓�� `Arm► i � h �7:lJcfJ�� 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately %. acres S. WILL RROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Resldentlal ❑ Industrial 0 Commercial ❑ Agriculture . ❑ ParWForest/open space ❑ Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, ST LOCAL)? Yes ❑ No If list agency(s) and permittapprovals yes, / Ziff a'p/ -'5e"✓ 9` �.✓9�✓i- QrJiGO /r✓Lr O�j?J� — %�YJIJ E•��i� -/� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes Po If yes, list agency name and permiUapproval 12. AS A RESUL OPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes wo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE O� DICE~( �"r � �— Applicant/sponsor name: ��JJ " " Date• Signature: !�gu If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form• before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED` ACTIONS IN 6 NYCRR,, PART 617.6? If No. a negative declaration f may be superseded/,by another involved agency, ❑ Yes 6440 C. COULD ACTIONAESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Ar4wers may be handwritten, if legible) Cl. 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 ctiaracter? Explain briefly: /Lone- CJ. Vegetation or fauna. fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: /llo /tom C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly 1d N 2 r C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. - I C6. Long term, short term, cumulative, or other effects not Identified in Cl-057 Explain briefly. - C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. /V 02.11 / D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? E. IS THERE, OR IS TFjERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes o If Yes, explain briefly 'ART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of 'occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or_ reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box If you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Wl�t NEW YORK STATE DEPARTMENT OF HEALTH S p ecific Waiver Bur =U of Community Sanitation and Food Protection I from Requirements of Part 75 and Appendix 75-A. 1ONYCRB. f6f IridlVlduil ko'ds'etfdla Sewage Treatment Systems Name of Applicant eery ��sah No. Street 11 Qty/Town State Zip Address U No. Street cityrrown stale zip Site*Location 1. Reason why site does not meet IONYCRR.Appohdix 75-A (check appropriate box(es)): Separation distance cannot be achieved. Excessive. slope. High groundwateri Inadequate depth to bedrock or Impermeable layer. Soft unsuitable. Other(explain) ... ......... ...................... ....................................... ...................................................................................................... . ..................... ........................................ ....................................................... .................................................................... . I ........................................................... ................................................................................................................................... I ................................. ........................... Wroposed design or conditions of waiver.- 20 .... ...... ................................ ................. ....... r .................................. .................................................................... ........................................................................................................................................................................................................................................ .. 7.... ..................................................................... .......... ..... ................... ........ .................... . . ............ ...................................... .................. 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination.• Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) . .... ................................................................................................................. .......... ......................... .......... .............................. ; ................................................. r—' Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiver was granted. ORIGINAL - Local Health Agency COPY - Applicant/Design Professional ..... .. ................... : ......................................................... 6Xfff*—*- 7— BRUCE R. FOLRY.-, Associate Public. Health Director. Director of Patient Services DEPARTMENT OF HEALTH I - Geneva Road Brewster, New * York. 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 219 - 6558 WIC (845) 278 - 6678 Fax (845) 278 6085 Early Intervention (845) 278 - 6014 Preschool (945) 229 - 6108 Fax (945) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: de k ADDRESS: ko0'k_,,&4 P,-Lgs fil�now (41/o Afy 1057,79 SITE LOCATION:' 0S6A_c4�,00L /eke - I?olo DATE: . L5 /S/ o 3 1 Joe. r- STAFF PRESENT: Rob M., Mike B... Gene R., Shawn R., Bill H. SPECIFIC WAVIER. REQUEST: Ee4 raz& i&oyy 820- 7e 1, ,7o r HEALTH HAZARD OR st 00,3 I= rR.0-?0`ED V ARIP�N_CE.' ENVIRONMENTAL CONTAMINATION PROBLEM? + YES NO WILL,DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? + YES NO DISCUSSION' RE-QUEST APPROVAL OR DENIED -0 R -DENIED 6 REASON FOR DENIAL 10 6t�L4 -4 frl__� DATE: (SPECWAIVER) 4 -PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMI xE TREATMENT SYSTEM' PERNIIT # Located at 05C/sW&jQA� LAK—S 1200 -,] Town or Village? TN T Subdivision name Subd. Lot # Tax Map Block 2 Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name it-) G0UC3St`E t r,3 Date of Previous Approval Mailing Address [ I I 6,A Amount of Fee Enclosed G Building Type Sil• &LAr_- n l Lot Area No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume Zip I D 12'F Separate Sewerage System to consist of 25D gallon septic tank and _44,2> 4,2> Other Requirements: f Re's 340 To be constructed by `rz:> 15L Address Water Supply: Public Supply From Address � xpr -f-, Dril I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sew- age 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 thseretj. Signed.N Address 1I2TMes>Lr= P.E. �_ R.A. Date J31, License # n2044(� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: 3 i.s White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL c.. «. ,,. � _:..__.., .._.,,.�...._..._ ..•- `- .ajLdSa.�Fl:ilii��if �y�"ia >a_ . ; _ .. _ r. ._ ._ .. -_ _ -� .......... _..�'1�.I1D'1'��iY13T� t�f��.. - �..,;�_��r;.�.: :..� . Well Location: Street Address: �jown/Village Tax Grid # 05fAV4ANI& LA \�ds,� u-r-, �i� Map 2 Block 2 Lot(s)3° Well Owner: Name: Address: r1&-'tMN Ga`C..'-rm I II ► *cr 90, sT I q D Mao 0A4__ t4q o I'Vo Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought Mw 5 gpm # People Served L56-m Est. of Daily Usage Boo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No _(— Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: -ro SE'—_ Address: IsPublic Water Supply available to site. Yes No Name of Public Water Supply: TownNillage I Distance to property from nearest water main: 20 ®� Proposed well location & sources of contamination to be roy arat eet/plan. Die: 9 Applicant Signature PERMIT TO CONSTRUCT A WATER WELL Tiis permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Rtnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided th t 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 reluirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form pnvided by the Putnam County Health Department. During all well drilling operations, the applicant and/or will driller shall take appropriate action to assure that any and all water and waste products from such wll drilling operations be contained on this property and in such a manner as not to degrade or otherwise crntaminate surface or groundwater. AIPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless costruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be atended or modified when considered necessary by the Public Health Director. Any revision or alteration olthe approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Cunty. Die of Issue '3 is Permit Iss ing O cial: ]Eke of Expiration 0 Title: s; , c Prmit is Non-Transferrkbfet- NNite copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 X- U l n Ain w U 1N a Y DEPARTMENT. OF HEALTH DIVISION OF`NVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTE►''F- 'A'R1FATl� "I'.SVT*'..,::�. -..... . _ _ . s. 1. Name and address of applicant: rC�(1� GbI,�S� ►`� I I SST aoT�' ST, 9 Nt5w Yoe.K, tty !O)225 2. Name of project: 6ay5req tJ Sv6D%/t51ar,1 3. Location TN: PU1NDM 4. Design Professional: 5. Address: (02 GC.Et4E1r-A A,✓G- 6. Drainage Basin: 05<::�vJ44-JA. 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building X_ Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type H Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 1'4 4:::;' 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planningt. zqnjzag .or other ...::...... ............... ............................... ..................... 13. If so, have plans been submitted to such authorities? ........ ............................... Yr s 14. Has preliminary approval been granted by such authorities? x Date granted: 4/(,LM 5 cA R� �► 15. Type Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) .......................................... ............................... t� 18. Is project located near a public water supply system? 19: If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Distance to sewage syste .1 mwc- 22. Date test holes observed 7122 23. Name of Health Inspector 511-1— +-1L=-C6a S 24. Project design flow (galloI/10 y� � '"` sn - ................................. ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... IJ 0 26. Has SPDES Application been submitted to local DEC office? ......................... I`'� 15 any portion of this mroject located within a designated'r in or State wetland? 28. Wetlands ID Number........ ........................................ ..............................: !.. ....w� 29. Is Wetlands Permit required? ....................................... . .............. ........................ i __ 1�Ias_a;�r1 =s:c. s.:ii aaatG iG i own or Local DEC office? . .............................�1 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 }�d 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? ............. l'o .................. Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... l-J10 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? ................................ �F-s 36. Tax Map ID Number ........................:. ............................... Map � 2 Block 2 Lot 3 0 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located wi'iain he N `r',c : *Ya*P � "s is be gent . the. Deny ,.�. Ewa red , be sent m duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms"for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 21 0.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. 1 Ua WL,, I��r Mailing Address: ................................... l D 2 i l l t./ ,.N4,Z✓ � � fl 7t 1` r Y• :17• Y: � �]� DESZC-N M-M *r-. uB-S r c=- Star= MB O:A-C. SYSMY. F'�.: NO. IL O�,ri_.r Ltj�''(- j r�1 : • pf'^,ass la 2 ]-lap ses h v= N tLL Io�t at (St_�ec) �5�v�on1,� Lq� 5�. �02. Bloc: 2 I,,, 5 2 3 4 5 YX=: 1. Tests to be re_�t=a• are ebt'� i ^.� .at each for review. at sa depth a_ orc .3-mate? _rez=laticn test. hole. All data be I-Mae f=-Cm too of hale. . y em, , soil rates SoM nZA = MLA RECTJ--,=.- TO PM sM == w= J a,..e of - =Sca? c 27 �( D at- _ of Per=laticn Test 2&'12- 4 2 :4Z 2(0 1z 3 8 . �}EOLE Rl:.*: F' __ Se D �.I to Water Ex CTS. No . T ' G–Zcu .c Sa =ace L^ T c:es Sc'? qa a I►s? .. S`trt St= L`rclo T� M._r�r 5 2 3 4 5 YX=: 1. Tests to be re_�t=a• are ebt'� i ^.� .at each for review. at sa depth a_ orc .3-mate? _rez=laticn test. hole. All data be I-Mae f=-Cm too of hale. . y em, , soil rates 3'/2 - 3 2:1(,. 2:-4o 24 2&'12- 4 2 :4Z 2(0 1z 3 8 5 2 3 4 5 YX=: 1. Tests to be re_�t=a• are ebt'� i ^.� .at each for review. at sa depth a_ orc .3-mate? _rez=laticn test. hole. All data be I-Mae f=-Cm too of hale. . y em, , soil rates PUII i am= CIF IF= CE DES ' GN MM", r IYC r + SENA= -- Dj—IcpOS;Lr. 171 +�+ NO. at (St_e_t) OSrAVArJA sue. %'- Block 2 SOM A rte-- . ' �'�-� ZU—'=M M BE �.MTMT*r� W= p,P:_' ` ��IS L}ztr of P.. .c /(O! Data of F= *-=Ia`cn Test 5 0 FALc. gVr I:ec= to Water F °*' j o� ?;at= Lever No. VMS G_c-�d S =mace I- riches Soli Rate St= LT'ca T� ¢ 7.�I 1043 1048 2)0:50 10:58 g 22. . 2s 3 311:x. I I -'10 10 22 25 7 • c7 411 *11 W"21 Ifl 22 2s 3 3 3 5 G 0 . �\ _ IW®R.M.-MI � AMIN r JEC, mv . . . . . . . 1 �• 5 ' Tts is to bee r.efit ' at same dzptn unt a arprc xi ate y �.1 soil rates are cbt- ; ne4 at each pe=culation test role. All. data to* be suhr =t= for revi=-W. 2. rent: to be r as fret too of bale. . 3 10 2l :? !I • �o 23 23 3/4 2co 4 7 • c7 311 '-32 W02 ' 30 2.4 27 3 10 4 IV O3 ) 2:33 30 '24- 2-� 3 /C G 0 . �\ _ IW®R.M.-MI � AMIN r JEC, mv . . . . . . . 1 �• 5 ' Tts is to bee r.efit ' at same dzptn unt a arprc xi ate y �.1 soil rates are cbt- ; ne4 at each pe=culation test role. All. data to* be suhr =t= for revi=-W. 2. rent: to be r as fret too of bale. . . MCL CF II7' ' Ei'.'�.:ii'tVi�r7 DES_CLI w I"-k � - ��ua�urr� Sr�vt� DT�-T., Smmsm F=Z W. Owner `f1i I i:► _ • - . P.n.:res`s f 2 �-1�� Sf-f 1l l:L ,-�: . U.—tr at (5 = -.==t? DSCAvVArlA LaM 1 r) Sec. 4Q2 •Facec 2. '?,^ =r-N Tom/ M m BE c� �� I- �,,� .PMZ --"rrcNs cf Pra Sczk "c 5l (�8 Data of Fe_T 11 'ca Te!&,- �� % qS EO=- se De. za tz Wale F:" cm iic'_� LeV No. T Gr c s=.xaG° L} ^�.Lrc�:e= Ra == {.. ►C/ i� vl.r^ir L/ Y- Lm. S``a ` St= LL i.. r � MSc? y ^ i�T ��..i N'O(� S - l Is q ' 2-7 I �Z t�2 �� V2 3 Q W" it 2 24o, °o 3 to '(2 10:3& Zvi 23 4 � ` 5 1 2 3 4. 5 , NE �0FESSId�j NC J: 1. Tests to be re_peaLz-a at sa.-e de_rt;l until. a_ar=1mate y'e�I sail rats a_e cbtaire� at each oer =iation test hole. All &ta to• be szih^ =�= for review. 2. Depth to be T-M!-- frcr.: t---c of ho? e. . VEST PIT DATA a II Indicate level at which groundwater is encountered W,-A Indicate level at which mottling is observed N%'- Indicate level to which water level rises after being encountered NIA Deep hole observations made by: �' T N��, Date Design Professional Name: F- f, r�s X21 N� Address:1,nz Signatui Design Professional's Seal OF NEW J.A 1� 067744% q15 DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES DEPTH HOLE NO. HOLE NO. HOLE NO _ ,... . G.L. .. r 1.5' ` A71) _r)',jIJ b� 2.0' E5 N'G 2.5' 3.0' 3.5' 4.0' Csrz�1 4.51 Ilk. 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' ..:._... � � 10.0' Indicate level at which groundwater is encountered W,-A Indicate level at which mottling is observed N%'- Indicate level to which water level rises after being encountered NIA Deep hole observations made by: �' T N��, Date Design Professional Name: F- f, r�s X21 N� Address:1,nz Signatui Design Professional's Seal OF NEW J.A 1� 067744% q15 TEST FIT DATA ' DESCRIPTION OF SOILS EI,JCOUNTERED IN TEST HOLES DEPTH HOLE N0. _�. _!, e °:HOLE NO. HOLE NO. G.L. 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' ' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 1-- L,:SN7° i= r rsl= LeM rt'/n, T� T E LOAM r N G L,-OA-fA I-Veowri j Indicate level at which groundwater is encountered N/61 Indicate level at which mottling is observed N %A, Indicate Ievel to which water level rises after being encountered Deep hole observations made by: At*V-'-g-r gEt7—,714 nfG -- e,- Date c Design Professional Name: Address: (OF- Signal Design Professional's Seal .A y`rFp 087,94$ a P�ai,1' r1T DATA ' DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES 41 + ` �O DEPTH H HOLE NO. HOLE N0. HOLE NO. H G.L. 1.0' 1.5' 1-1 7;x,,,1 F(N LOA" 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' \ \ \ \ \\ \ \\ \ 5.5' 6.0' C?t 6.5'o 7.0'„►a env i 7.5' 8.0' 8.5' 9.0' =10.0 - --- -- -- --- - -. M. _ .. Indicate level at which groundwater is encountered �Jf A Indicate level at which mottling is observed N/14 Indicate level to which water level rises after being encountered N� Deep hole observations made by: A -i--) Date Design Professional Name: Address: Sip Design Professional's Seal / pF NEW A f �s� q0 67FP�� l zzor rrf DATA ` DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE INTO. HOLE NO. G.L. 1.0' 2.0' LoA Am 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' Indicate level at which groundwater is encountered Indicate level at which mottling is observed N /� Indicate level to which water level rises after being encountered NIA- Deep hole observations made by: rv(f=,, — R--H CQ Date I .% I °/-T Design Professional Name: L)-rp Ad\A Address: IO2 GL-MSI D/L Signa Design Professional's Seal OF NEW�o g� HAEC(y�' .A, . 1 os7 A 067,103 �AROFESSIONp�� - G.L. 21 A I St 71 DE-<CRI=,r=CN OF SOILS "I. ED IN TE5T bl ,r_� Emp No. ECZ NO. 5IM-N-V ijr, :rp L la4r Tarp I Flwa L.Z:;,At-f 8t io 'c !:I- c-L, T zc=- L:'-wirm To wr-:--Cz Wrm IZ 7M p-zs 27----7N - E� - 71 L-IC-AiT TA-rJ r-itAS Lox" GZAvlo-1, Mix D= ECLE CBSC v .j-=-CNS MADE BY: KeN HOU-6M / 131 LL HLe--Pctr- -S D - 4' Soil P.=-Le Used S.D. Uia:-.Ie Arm PMOVIdEd' No. of E =mss se* TarLk Camcit-7. Tyr-e NzscrPtion Are--- Provided BY 444 L.F. x247 width - t-rench Other Name siarp-ture 11 VLARM z.dr ass SML N4 1 0674 gOFESS T-ras SPA=- MR EiSrE BY Emm-LTH DZErLR—frXM-,T COY: Sca, Rate Arorcve"-- sq.ft/gall. - Chedlc •� by - Da+-= — r-irSS tlOA-M 8t io 'c !:I- c-L, T zc=- L:'-wirm To wr-:--Cz Wrm IZ 7M p-zs 27----7N - E� - 71 L-IC-AiT TA-rJ r-itAS Lox" GZAvlo-1, Mix D= ECLE CBSC v .j-=-CNS MADE BY: KeN HOU-6M / 131 LL HLe--Pctr- -S D - 4' Soil P.=-Le Used S.D. Uia:-.Ie Arm PMOVIdEd' No. of E =mss se* TarLk Camcit-7. Tyr-e NzscrPtion Are--- Provided BY 444 L.F. x247 width - t-rench Other Name siarp-ture 11 VLARM z.dr ass SML N4 1 0674 gOFESS T-ras SPA=- MR EiSrE BY Emm-LTH DZErLR—frXM-,T COY: Sca, Rate Arorcve"-- sq.ft/gall. - Chedlc •� by - Da+-= — �. I • ae I 1 2' 3` As 6' %t 1r.7 t ru F= F IM, -... L Imi-r ' Ta rJ Ft NS Lox" 6. (lst�' TAtJ r�N� I.oa M rte FINS Lopf`"1 �udNOy L�r-•I � - F= F IM, -... fiaLE N0. �o L-tdT Ti.�j Ft NS Lox" 6. (lst�' TAtJ r�N� I.oa M rte D K . F��oW N /�R•�` �udNOy L�r-•I � - fiaLE N0. �o 8' 9' 10, 12' I3t 14, i � trLlr:Yt'1��r• ? mozo= L - —r • • To Wr_� W? � I:c v Fes- P_�" . 'G M=m DE- EOLE CBS TA=, CbI.S PME FY: W4 SILL AsTres DES ICti Soil Rate Use. Mme/? " Drco: S-D. Us ^ e Arm P_;wid d No. of B�x�+5 Septic Tank Carzc ty -_ cm ? s. TY Absorption Are--- p_-ovi dea By L.F. x 24" width trecc*i Othe— - - Nc_+L' �L1- T•T•ji6•'h•�i �'1(`5�,11Li� . rL1—� S1gI'��:LI=E I F.ddress 102 SEALL l)g ID5)'L- ysFO 06746,6 p T: M SPA=- MR USE BY DEPP_�-f5:-LIT2 CN7.Y: Sail Rate ADDres; E s sq. f t/ga? . Cheer b� _ r, at L-tdT Ti.�j Ft NS Lox" D K . F��oW N /�R•�` �udNOy L�r-•I � - 8' 9' 10, 12' I3t 14, i � trLlr:Yt'1��r• ? mozo= L - —r • • To Wr_� W? � I:c v Fes- P_�" . 'G M=m DE- EOLE CBS TA=, CbI.S PME FY: W4 SILL AsTres DES ICti Soil Rate Use. Mme/? " Drco: S-D. Us ^ e Arm P_;wid d No. of B�x�+5 Septic Tank Carzc ty -_ cm ? s. TY Absorption Are--- p_-ovi dea By L.F. x 24" width trecc*i Othe— - - Nc_+L' �L1- T•T•ji6•'h•�i �'1(`5�,11Li� . rL1—� S1gI'��:LI=E I F.ddress 102 SEALL l)g ID5)'L- ysFO 06746,6 p T: M SPA=- MR USE BY DEPP_�-f5:-LIT2 CN7.Y: Sail Rate ADDres; E s sq. f t/ga? . Cheer b� _ r, at G.L. 2.1 31 At 5+ FINS �m b 71 V 9 10, 14' M. it ItAtz: J]Ztj�" ;=L. LCH TO WHICE ;G=11- =7EM P.Zs—zz A- =I- BEZ-1,1Z M= LIZ —7 DES EOLE MADE BY: Kej�4 ftLA L Z rg/,LL HGMas L 19 DESIGN Sail Pate Used Drcc: S.D. Usahle Area P----V;.r- No. Of EGO=S Seo4--,- TalLk Cacar-,,tv gam. TY_e Absorption Area Provided By L.F. x 247 width. t=e---&. Crit-her Nape Signature SEA iq 7aM Sp kCE FOR USE By E7---ajM MRA.R.—Ir". =-,T CNMY: Soa-, Rate Acaraved sa f t/gaal che=%aa by Date 14.16.4 (91'931 —Text 12 PROJECT I.O. NUMBER 81T.2O..' SEAR Appendix C Stater Environmental- Quality Review SHORT ENVIRONMENTAL ASSES.SM.ENT FORM PART I— PROJECT INFORMATION (To be completed by Applicant or Projetit sponsor) ' 1.-App fewr /SPONSOR 2. PROJECT NAME PUT-14w &IGINEER(N(p . GOG�7El`v ) SUC3n\11510N 9. PROJECT LOCATION: Municipality ONN 4F RfNAM VAW.S\\ County PVTNAAA 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, ate., or provide map) 05.CAVJAt4A LAY-P- j OND (5E L,04" U-1 M kr oN AWftD FLAN) 5. IS PROPOSED ACTION: ICI.New ❑ Expansion t_1 Modiflcallonlalleration 6. DESCRIBE PROJECT BRIEFLY: 2 LOT F T 51 PWT/AI.. C_,UWI Vlsl0N 7. AMOUNT OF LAND AFFECTED: Initially 9 32 acres Ultimately •� 32 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 9RYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ ParWForestlOpen space ❑ other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yea ❑ No If yes, list agency(s) and permltlapprovals PUTNAAi VI4{,l. y &AjNJIlJG D0tX0 - tWDV(Vl5(0N AT".0VAL- 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes (3 No If yes, list agency name and pentdtlapprMal 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERM117APPROVAL REQUIRE MODIFICATION? ❑ Yes. I.No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE aLApp"caasisponsor name: PUTNh�M F.,(JCaI►JEPi(L(h1G > -{'� � r'S( pate: `�/ Signature. If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment I OVER 1 FROM PUTNAM.ENGINEERING PLLC PHONE NO. 914 225 2955 Oct. 29 1998 04:35PM P2 law, Il O 1�`01r a .1171NI1' ALL PE..WAIVM CELUqER Freshwater Wetlands, Watercourses and Waterbodnq Ordinance of the Town of Putnam Yom, New YQTL The' Town' Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEORA, and will not have a significant environmental impact. Therefore, a ]PERMIT WAXIM is granted subject to the conditions noted below. DATE PERMIT ISSUED: March 31, 1999 DATE PERMT EXPMEffi: I PPLICANT /S NSQI March 31., 1999 M. Merin Goldstein Putnam Engineering, PLLC (agent) 102 Glenda Avenue Carmel, NY 10512 ®scawana lake Road/Barger HM Road Goldstein Subdivision TAX MAP #: 62. -2- 30 SIB OF PARCEL: 9.932 acres ZONING: It -3 PROPOSED ACIUQN: Construction of 2 IAt Subdivision wilt Road entrance to Lot I within Weftuds Control Area kAiERL4LS REVIEWED: 1. Goldstein Subdivision Plan, prepared by Putnam Engineering, dated 8-97, last revised 11/26/97. 2. Site Alteration Permit Application ibrms, file # WT -251, dated 02/23/98. CONDITIONS OF PERMIT- The existing large Elm and Ash trees located at the edge of the wetlands should be preserved- Tree wells should be constructed to preserve these trees from impacts caused by construction of the driveway. pow 1Q(2 FROM : PUTNAM.ENGINEERING PLLC PHONE NO. : 914 225 2955 I Oct. 29 1998 04:36PM P3 �. .A . s v�p 3 C ^�rq f; ^. '- ^.. ^V�'� • br.!1l1.€ Fa�l1R fQr e ty _.. ., „__C?3!w p£«34,3��-!'i2.��:$'�E?ti;..:1? r~�.v ?. r; a+r ,., ,,..,,,•rt.._.. .. ,. .. driveway edge closest to the wetlands area. The wall should consist of a free standing watt made out of existing stone on the site_ This will help to provide a barrier for encroachment into the wetlands. The wall should be placed as far from the edge of the wetlands area as possible. Due to the site constraints, it is understood that, some flexibility may be needed to properly place the stone wall of the driveway area to accomplish necessary driveway grades and slope percentages. Erosion Controls consisting of a silt fence and a double row of haybales shall be installed along perimeter of wetlands area. 4. The Building inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 6. The PlwvM Hoard, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from t?t- to time. 7. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shag be returned to the applicant upon satisfactory completion of the project. ._ _ -- .._. _.,.._.� .._ ,.._.�+10rt��rllFllAlIC �iti !`T'.t1trCQE�l�1G1�?�i�t7Cjv� vv�niiliiviirl�cdi� ''iiiiS °��iTiiii% :ir8evfcri, Div lrwfyr�,S'�i:`► ::, g_. � ..� _ ' ., . ._ .._ Notice of Violation and /or A Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) S26 -2377. Date Permit Waiver Prepared: March 31, 1998 Stephen W. Coleman Town Wetlands Inspector cc: ✓Applicant Building Inspector Planning Hoard Emrironmental Commission PaaW2of2 FROM PUTNAM.ENGINEERING PLLC PHONE NO. 914 225 2955 Oct. 29 1998 04:35PM P1 PLLr DATE: I O—L-q'q ' TO: I'� -t r-r �t N FAX NO.: 2-7 -79 2., 1 PAGES: 2, enduding this cover sheet. From the desk of— KEN HUFFY 102 GLEMEIDA AveNuE, CARREL, NEW YORK 10512 *PHONE (914)225 -3080- FAX (914)225.2955 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE_ SEWAGE TREATMENT SYSTEMS (�jS� it a n' 1. i . 3r.'i- Ali STREET LOCATION �S CA-V kt NAME OF OWNER ` �LO S.—Alf I" REVIEWED BY R-,I, GR, AS NIB, BH DAIE 2117/17 TAX NIAP # Y NZ' DOCUMENTS Y N_ Q PERMIT APPLICATION. PC -1 WELL PERMIT ""PWS LETTER LETTER OF AUTHORIZATION PESIGN DATA SHEET (DDS) 20RPORATE RESOLUTION SHORT EAF PLANS - THREE SETS E PLANS - TWO SETS VARIANCE REQUEST SUBDIVISION GAL SUBDIVISION BDIVISION APPROVAL CHECKED RC RATE w►��+LI wCit XREQUIRED DEPTH ;RTAIN DRAIN REQUIRED ANDPIPES GENERAL L CATED M NYC WATERSHED L S SUBMITTED TO DEP EGATED TO PCHD P APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED FRCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS ETLANDS (TOWN/DEC PERMIT REQ'D ?) ATA ON.DDS.PLAIVS,gc PERMIT SAME ,_.. .._. r- rRE- iy39-liZiGHE6U ivu lFIC;A'fI N ETTER BI/ZBA 0 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN- (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS roe 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS OIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# ATE OF DRAWING/REVISION ATUM REFERENCE LOCATION OF WATERCOURSES, PONDS PAKES AND WETLANDS WITHIN 200 FEET ROPOSED FINISH FLOOR AN�I) BASEMENT EL. 61(--- EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED OUSE - NO.OF BEDROOMS ELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS OUSE SETBACK NECESSARY (TIGHT LOT) USE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS LAY BARRIER r I L 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE EPTH GAUGES FILL PROFILE & DIMENSIONS ,VOLUME loe FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 44 B 60 FT MAX. .PARALLEL TO CONTOURS 19100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' _TO_P.L., D_RIVE;v4A .-L' iE i l S..- T_�7i: �E..ri1�i.,.- .._:.._....... _. ' TO FOUNDATION WALLS 15'WELL TO PL 00' TO WELL, 200' IN DLOD, 150' PITS 0' TO STREAM WATERCOURSE LAKE (inc. expan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 0' TO WATER LINE (pits -20') -50' INTERMITTENT DRAINAGE COURSE W/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS COMMENTS: PWflN to CDS= >5 0/o,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% 20'MIN to CD discharge /100'with 182 cons day discharge oe SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL )YELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION BIZ. .ru .t NAM COUNTY DEPARTMENT OF HEALTH 9 ,., z DIVISION OF ENVIRONMENTAL HEALTH SERVICES REALTY SUBDIVISION SITE INSPECTION FORM_ "Y1,�.- ...y.a...v -.•r Y .... Y.•. .I R .r ..CrA.e.t�.en. yt're �an i ^.� .C• .y_ :.�w..,�.��.s_ .... LAVERI�l INFORMATION Name of Subdivision (_�t -QS17EM( (TXV) County .± Site Location L y— 2 Distance to: Public water supply 7 fi" Public sewer system Building construction begun Extent Is property within NYC Watershed ? ................. 0 Yes No SECTION.B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly F-� Rolling Steep slope F--J Gentle slope a Flat 2. Evidence of swampland Low area subject to flooding a Bodies of water F7 Drainage ditches Rock outcrops 3. Do water courses exist on.or adjoin the property? . 4. �Vill these affect the design of the sewage treatment facilities ?...... 5. Do watershed regulations apply in this development ? .................... 6. Will extensive grading be necessary? F7 Yes 5?rNo Yes F;� Vo F7 Yes 12�0 Ces a No 7. Will extensive fill be necessary? ........................ ............................... E2rYes 0 No 8. Do filled areas exist in the tract? ............. ............................... ^Yes No n _ Ti la:-=is ccr,dirion`othe'fili'% SECTION C. SOIL OBSERVATIONS 9. Appearance of soil: ,/U Sand ravel <oam Silt F Clay Hardpan Imture 10. Observed from: 0� Borings F7 Bank cut ETBackhoe excavations 11. Soil borings /excavations observed by ��: ��scr �-' on 11 d /9"C7 12. Depth to groundwater on 13. Depth to mottling on 14. Soil percolation tests made by on 15. Soil percolation tests witnessed by on SECTION D. DRAINAGE 16. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes 10 17. Will groundwater or surface drainage require special consideration ? ....................... � Yes E io 18. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F-I Yes EKO Form RS -1 SECTION E. REMARKS s � � 19. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities?... ......................................... a Yes F-] No Inspection data 20. Have previous sections of this proposed If yes, describe subdivision been approved? ............. Yes 21. Will there be additional sections of this subdivision? .............. ... ............................. 0 Yes o 22. Is it probable that the total number of lots will exceed 49? ... ............................... 0 Yes 0 23. Additional comments 24. Site observer /inspector and title _ - Imo'" H16 25. Date(s) of observations) /inspection(s) 1 6 TEST PIT PROFILES Hole # Lot # Z Hole #_ Lot # Z Hole # (® Lot # �� Depth to water ' Depth to water Depth to water f VZO 2 Depth to mottling Depth to mottling Depth to mottling _... -.,.Depth -to r-ocmmp '�? Depth_... ro _rriu --- G.L. G. L. G.L. c J� 0.5 0.5 a_ 0.5 1.0 1.0 1.0 2.0 2.0 2.0 i 3.0 -D 3.0 9 "o �✓ 3.0 4.0 �' �oc 4.0 �U 'ice 4.0 u 5.0 �! l j LAC 5.0 f/ G,z,�c,&, 5.0 6.0 6.0 6.0 +� 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 1 Lzi i rt 1 FROFILES Hole # 19 Lot # Depth to water Depth to mottling Depth to rock/imp~ 7 -0" G.L. 0.5 1.0 2.0 3.0 4.( 5.( 6.( 7.( Hole # 1 ?. Lot #. Hole # 13 Lot # 1 Depth to water Depth to water Depth to mottling --�: W Depth-to Depth to rock/imp. % -o �f Depth to rock/imp. -O t G.L. G.L. 0.5 1.0 2.0 3.0 eL 4.0 5.0 6.0 7.0 8.0 -n 60 8.0 9.0 10.0 Hole # � Lot # � Depth to water Depth to mottling "Depth to.rocklimp� G.L. 0.5 1.0 2.0 3.0 4.0 5.0� 6.0 7.0 8.0 .1 will M 10.0 Hole # Lot # T Depth to water 0.5 1.0 2.0 3.0 .O 5.0 6.0 7.0 8.0 .l 10.0 Hole # -- --1� -- Lot # Depth to water Dgth_to mottling._ Depth-to rrio t T,.."..1- »Depth to rock/imp. Depth to rock/imp. C) �l I G.L. G.L. ,M 1.0 \v 2.0 _ L• 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 X 1.0 FAR 3.0 4.0 5.0 6.0 7.0 8.0 all 10.0 If i �.� i r11 rxUr1L�;5 Hole 4 sLot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to.mottlip 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 _ 12-OC, elti 2.0 2.0 3.0 // / /r C 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 4 Lot #- Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth jq- mottling Depth -to mottling- - - - -B tr.. tmott.L ng - __ _ _..__... - to �v� 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 10 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 LJTNAM r NGINEERING, PLLE. July 22, 2005 Joe Paravati Putnam County Health Department 1 Geneva Road s Brewster, NY 10509 Proposed SSTS Renewal — Jeffrey Waters Oscawana Lake Road Town of Putnam Valley TM # 62 -2 -30 Dear Mr. Paravati: -_ .. As per your request I am enclosing a basement/foundation floor plan for the above _ referenced project. Please include this drawing with the previously submitted 4 bedroom house plans. If you should require any additional information please contact me at this office. °yr PUTNAM ENGINEERING, PLLC I! Richard J. Z ., . (L05308) 4 OLD Roure 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAX (845) 279 -6769 - EMAIL: putnamengineering@suscom.net June 2, 2005 Joseph Paravati Jr. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Renewal — Jeffrey Waters Oscawana Lake Road Town of Putnam Valley TM# 62 -2 -30 Dear Mr. Paravati: In response to your March 10, 2005 letter regarding the above referenced project we have addressed your concerns as follows. 1. A copy of the Freshwater Wetlands Permit Waiver issued by the Town of Putnam Valley on April 16, 2005 is attached. np.ws n.f.th °.cFrt,fFn L1?oli, rFCetntc . nr w��, `��nr Noti _ep"ior T_,eii:ers mailed on March 16, 2005. 3. Roof leader and footing drain discharge lines and the drainage recharge pit have been labeled on the plans. 4. Attached are two sets of new floor plans for a 4 bedroom residence (garage floor elevation 776.0, finished floor elevation 784.6). 5. The dimensions from well to property line have been. revised to be perpendicular to the property lines. 6. The owner /applicant block has been revised to reflect the new owner's name and address. 7. The location of deep hole #11 has been shown on Sheet 3 of 3. 8. Depth gauge locations and a gauge detail have been added to the fill Section Plan, Sheet 3 of 3. (L05240) 4 OLD ROUTE 6, BREw8TER, NEw YORK 10509 0 (845) 279 -6789 a FAx (845) 279 -6769 o EmAx: putnamengineering @suscom.net 9. Volumes of R. O.B.,�unclass fied acid impervious fill.liave ieeri noted on`Sheet?2 - ....... of 3 and sheet 3 of 3. 10. All SSTS components have been removed from the SSDS profile on Sheet 3 of 3. 11. A fill certification note has been added on Sheet 2 of 3 (Trench Layout Plan). 12. The proposed grading around the dwelling as originally shown now corresponds with the revised floor elevations. 13. Two feet of solid pipe have been shown and noted in the enlarged plan on Sheet 2 of 3 (Trench Lay out Plan). 14. A note has been added to the junction box detail on Sheet 2 of 3 indicating the first 2' of 4" PVC laterals exiting each junction box is to be solid pipe. 15. Space for 2' feet of solid pipe on both sides of the junction boxes for the expansion area have been shown on Sheet 2 of 3. 16. - The words "Dust Free" have been added.to the crushed stone /washed gravel label in the absorption trench detail on Sheet 2 of 3. Enclosed are 4 copies of the revised plans for your review and approval along with The attachments noted above. Please call if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. Z p Enclosure RJZ /ea (►.05240) PUTNAM ENGINEERING. PLLE Englneers and Architects 4 OLD RouTE 6, BREwsTER, NEw YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EMAIL: putnamengineering @rcn.com SHERLITA AMLER, MD, MS, FAAP Commissioner of Health i'c_. r. I 1C��:i�i "L'1iC:at., .�i \, IV��i1V •• Associate Commissioner of Health March 10, 2005 Putnam Engineering Rick Zapp 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 d0 Re: Proposed SSTS Renewal — Waters Oscawana Lake Road (T) Putnam Valley, T.M. #62 -2 -30 ROBERT J. BONDI County Executive 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. �copy ofa valid wetlands permit needs to be provided: eighbor notification is required according to Bulletin ST -19, Section 4.A.11. PX Please show and label the roof leader and footing drain discharge point(s). 4. The approved floor plans show a full basement. Please provide abasement floor levation in the plan and profile view and show the basement floor in the profile. The dimensions from the well to the property line need to be perpendicular to the operty line. The owner /applicant block has the previous owner's name. ocation of deep hole #11 has not been provided on sheet 3 of 3. Depth gauges need to be provided along with a depth gauge detail. 9� lumes of fill need to be provided (ROB, unclassified and impervious). The fill profile on sheet 3 should only show the house, the fill and the existing ad e. SSTS components should be removed. The fill certification note (unsigned) needs to be provided on the trench plan. Z,Pfe-ase provide proposed contours for the house regrading. Please clearly show the 2 feet of solid pipe between the junction boxes and the start of each trench. 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 P � Please note in the junction box detail the. 2. feet of solid pipe between the Junction b es and the start of each trench. lease provide space for the junction boxes and the 2 feet of solid pipe on both si s of the box for the expansion area. lease add the words ".dust free" to the crushed stone /washed gravel label in the absorption trench detail. 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. JSP:cw Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer 6� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health '" ' m,LORETTA 1VIOLINARI, RN, MSN,~ Associate Commissioner of Health March 10, 2005 Putnam Engineering Rick Zapp 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Proposed SSTS Renewal — Waters Oscawana Lake Road (T) Putnam Valley, T.M. #62 -2 -30 ROBERT J. BONDI County Executive This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. A copy of a valid wetlands permit needs to be provided. 2. Neighbor notification is required according to Bulletin ST -19, Section 4.A.11. 3. Please show and label the roof leader and footing drain discharge point(s). 4. The approved floor plans show a full basement. Please provide abasement floor elevation in the plan and profile view and show the basement floor in the profile. 5. The dimensions from the well to the property line need to be perpendicular to the property line. 6. The owner /applicant block has the previous owner's name. 7. Location of deep hole #11 has not been provided on sheet 3 of 3. 8. Depth gauges need to be provided along with a depth gauge detail. 9. Volumes of fill need to be provided .(ROB, unclassified and impervious). 10. The fill profile on sheet 3 should only show the house, the fill and the existing grade. SSTS components should be removed. 11. The fill certification note (unsigned) needs to be provided on the trench plan. 12. Please provide proposed contours for the house regrading. 13. Please clearly show the 2 feet of solid pipe between the junction boxes and the start of each trench. 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 'b C1. 14. Please note-in the junction box tbe 2 feet..of solid pipe between theJunct on. . boxes and the start of each trench. ° 15. Please provide space for the junction boxes and the 2 feet of solid pipe on both sides of the box for the expansion area. 16. Please add the words "dust free" to the crushed stone /washed gravel label in the absorption trench detail. 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. JSP:cw J Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer LITl\l.�M NEINEERINE PLLE. E n 9 in eers an w.a. -d 4 .rchi„ -_; , tects SEPTIC SUBMISSION FORM TO: �05EPr1 i?aaAVnS-r e DATE:_T� ©S PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: J(FFf:,?FN L_jp�aejg -S T) Y�,u:g -1 aS�l��,•�A ��. 'T'I'l fv Z - 2 - 3c: A? ?moo.► � � QE z r-� T I�►"? �1- 3 --`i ai ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION f- M WELL PERMIT APPLICATION CR�r►�vlt�� HEALTH DEPARTMENT FEE ($400.00) ❑ SHORT EAF ❑ DESIGN DATA FORM LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: & QA,(VtR- WA&_ Fo(- 15iz-ko „ic- MR.-, iE;7,. e.J nA.-p- %k Cv, Zt v`3. jr- T,k 4S +,.J %%JSX r.►Qczr: 05 'Te BS 9L- �ItLEP"f T%i ►S pcS TI +� 2cWV �.S' i �o(� �'N�c I,Jp.I V�1� COPIES TO: SIGNED: FtGm,- (SepSubForm -2001) 4 OLD RouTE 6, BREwsTER, NEw YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: putnamengineering @rcn.com g TNAM NPLLC. ngineers and Architects D SEPTIC SUBMISSION FORM TO: DATE: ezo 21%0.3 PUTNAM COUNTY HEALTH DEPARTMENT U PROJECT: fG d�IJW" �fC�GuG�. -c C.� �0 ENCLOSED, PLEASE FIND: ❑ COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS Cl CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00) SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) Y• ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: 604,4, %/& SGW- 4 OLD ROUTE 6. BREWSTER. NEW YORK 10509 • (845) 279 -6789 - FAx (845) 279 -6769 - EMAIL: outenaabbestweb.net UTNAM NEII ®IEEf; INE, PLLE. t= rglreers arid Architects SEPTIC SUBMISSION FORM TO: -j-bSEpjj �S. A(eAVA Ti DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: �p�►�� OSCAvl�S}r!A �, ENCLOSED, PLEASE FIND: x4 COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION .a � o ❑ WELL PERMIT APPLICATION`%q- D ❑ HEALTH DEPARTMENT FEE ($300.00 ) ❑ . .SHORT EAF _ _ ..,.._ .... - .... - - -_.. _ .... ...... ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: ( &U I go) Pe 2 ydme- t`W,Ag Gj 6 Vx3 (.b'im� COPIES TO: SIGNED: • %6ISCA-- 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 o EMAIL: puteng @bestweb.net " L'iv=I v" AP1I= ARIR.ri.,M.S.iv. Acting Public Health Director Director of Patient Services ROBERT J. BONDI County Executive 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 March 6, 2003 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Paul Michael Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Waiver Determination - Vandeveerdonk Oscawana Lake Road, (T) Putnam Valley TM# 62 -2 -30 Dear Mr. Lynch: The Putnam County Health Department reviewed the waiver request for the above regarded project on March 5, 2003. The following determination has been made: ❑ The Waiver request was approved. ® The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. The Waiver request was dei:ied. An exoianation has been noted.below.. ❑ The Waiver request was not voted on. Explanation noted below. 1. Only one copy of the fill plan was provided. 2. The fill plan needs to contain the fill notes (PCHD Bulletin ST -19 Appendix C), 3. The absorption trench detail, the junction box detail, and the cleanout detail, need to be removed from the fill plan. 4. Since this lot is not in an approved subdivision, it is highly recommended that this system be built before the expiration of the forthcoming permit. There is no guarantee that a waiver will be granted again if the permit is allowed to expire. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj UTl!lAM 0. LZERINE PLLC Englneers and Archltects SEPTIC SUBMISSION FORM TO: _ J -0-24Ph S. 6'. PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: 7 _ DATE: f' t Uv� 2ca wa l a 6� 6a c( 7rm 62- 2 - 30 ENCLOSED, PLEASE FIND:II�;, COPIES OF THE SSDS PA�NNT( /Q/UI �l'2'i ❑ COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: �a&. b.1 Aee& MO jqS oe8qL, f-R- -,' _ ink 9Url. ��2cb3 cerlt,-2. COPIES TO: SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 (845) 279 -6789 • FAX (845) 279 -6769 • EMAiL: puteng @bestweb.net LORE 'M NIGLiivtii� Acting Public Health Director Director of Patient Services February 24, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 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 Paul Michael Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 f Re: Renewal of Approved SSTS - Vendeveerdonk Oscawana Lake Road, (T) Putnam Valley TM# 62 -2 -30, Permit # PV -3 -99 Dear Mr. Lynch: 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. �... _.. Your recent submission requesting a waiver to regrade to I Wo. hss:been acl ne.;yl ,dged and will -be formally submitted at the next waiver meeting. 2. Due to regrading to obtain a 15% slope, the fill is on average 2.5 to 3 feet with some areas at or above 4 feet. Therefore, a two sheet septic plan needs to be submitted (fill plan and trench plan). 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, A Y/ Josep S. Paravati, Jr. Assistant Public Health Engineer JSP:cj UTNAM IVCINEERING, PI-LC. Englneers and Architects SEPTIC SUBMISSION FORM TO: DATE: U COUNTY HEALTOEPARTMENT PR . OJECT: (7-)/291rA1414►�All-'c_X Os64 vIA 1,1A A A/,e- Ph.40 ENCLOSED, PLEASE FIND: "AS-BUILT" COPIES OF THE SSDS PLAN All ❑ CONSTRUCTION COMPLIANCE CERTIFICATE '70 ❑ WELL LOG ❑ HEALTH DEPARTMENT FEE ($200.00) ❑ WATER ANALYSIS to ❑ GUARANTEE 'FORMS - 3 ORIGINALS' ❑ E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION REMARKS: Ad 064, _,ua � 9 'y i KV, ,V .13 COPIES TO: SIGNEI 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279-6789 • FAx (845) 279-6769 • EMAIL: puteng@bestweb.net BR CE R. ' FOLEY " ... , Public Health Director DEPARTMENT OF HEALTH 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 7, 2003 Paul Michael Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Renewal of approved SSTS - Vendeveerdonk Oscawana Lake Road, .(T) Putnam Valley TM# 62 -2 -30, Permit # PV -3 -99 Dear Mr. Lynch: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. It appears that the existing slope over the SSTS. is o.n,average, greater. than 15 %. If this is - -- - - - the case, tl�� l,laiis caiiuorue approved as presented; "but a waiver: request can be made to - grade back to 15 %. 2. There appears to be more than 1 foot of fill over the system. Some areas are approaching close to 4 feet. 3. A datum reference needs to be provided. This office will continue its review upon consideration ofthe above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. ;Vve trul yyours, ph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj LITNAM NEII®lEERINE. PLLE. =a• .. �. - EfiLg' inL�li rh5 grid HrC/TItGL 5...,.. .. v SEPTIC SUBMISSION FORM TO: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: 7hD24V(5 DATE: ia• /9• aoOa W, 7-M) ba?ya- 30 ENCLOSED, PLEASE FIND: l� COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION U' WELL PERMIT APPLICATION wQS avZD5�r�Ial ,Pxo1ckae7-y) ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) 0 REMARKS: �K97af01Eel LETTER OF EXPLANATION SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • Fax (84,f) 279 -6769 • EMAIL: UTNAM NGINEERING,PLLC. EnglnLmrs and Planners March 10, 1999 Mr. Adam Stiebeling Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Goldstein Oscawana Heights Road Putnam Valley Dear Adam: This office is in receipt of you latest memorandum for the above project and we offer the following comments: 1. The proposed well has been relocated along side the proposed driveway for easier access. 2. The existing community water supply wells across the street have been labeled "ABANDONED ", as requested. At this time we would ask for your continued review and/or approval of the above project. Very truly yours, PUTNAM ENGINEERING, PLLC By: G Ken Hurley KH:rk (File 990229) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914)225 -2955 P FRWTNAM !' YER I PLLE Engineers and Planner s w February 2, 1999 Mr. Adam Stiebeling Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Goldstein Oscawana Lake Road Putnam Valley Dear Mr. Stiebeling: e� Due to the recent field testing, it has been determined that a subdivision of the above property might not be feasible. Enclosed, please find a submission for an individual septic approval for the referenced property. We would ask for the individual septic fee of $300.00 to be waived, due to the fact that our client has paid $450.00 for the Health Department Subdivision Review. `' ' �nould -you ha`ve'any questions or corriirients; please feel free fo contact this office. Very truly yours, PUTNAM ENGINEERING, PLLC KH:r Enclosure cc: Dr. Goldstein (File 990152) 102 GLENE IDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914) 225-2955 � Q BRUCE R. FOLEY March 2, 1999 Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Dear Mr. Hurley: _ - LORETTA,..MOLINARI R.N,,- :M;S:A1::_:.:. . Associate n 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re: Goldstein, TM# 62 -2 -30 Town of Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. As discussed, this office would recommend relocating the proposed location of the well to the front of the proposed residence. Please. also note community _w ter_1SU7r j 1�,ali ?pc±oi;; d;�i:.e x� dr oGntinu -to=��lamt�a�� ` W minimum 200 foot separation. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj s '1 BRUCE R. FOLEY February 23, 1999 Putnam Engineering Gary Tretsch 102 Gleneida Avenue Carmel, New York 10512 Dear Mr. Tretsch: LQ_RETTA MOLINARI_R N., .:M.S,N, -: -� Asiociate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 n�'© Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 ..Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re: Goldstein Subdivision Town of Putnam Valley This Department has reviewed the engineering plan for the above referenced subdivision project. Due to the constraints of the existing topography and ledgerock throughout the project site, it does not appear the site can support more than one subsurface sewage treatment system which. conforms to all applicable standards. _... Should you l ave. any tquestions. - please.contagt me aij i s:_�a Respectfully, In T �v L Michael J. B dzi Director of Engineering MJB:cj cc: AS c S T I BRUCE R FOLEY February 23, 1999 Putnam Engineering Gary Tretsch 102 Gleneida Avenue Carmel, New York 10512 Dear Mr. Tretsch: LORETTA MOLINARI R.N., M.S.N. _ .....� .,.. � . r. �. ;c`! Pfr7GF. ^.:g :.,._�ai.... %`�'= ^�a:T •.r', irKC:Ci' ... .. , -_. . 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re: Goldstein Subdivision Town of Putnam Valley This Department has reviewed the engineering plan for the above referenced subdivision project. Due to the constraints of the existing topography and ledgerock throughout the project site, it does not appear the site can support more than one subsurface sewage treatment system which conforms to all applicable standards. Should you have any questions, please contact me at this Department. Respectfully, A Michael J. B dzi Director of Engineering MJB:cj cc: AS r r V A !/ (I LC. Englneers and Planners February 11, 1999 Mr. Michael Budzinski, P.E. Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Goldstein Property Oscawana Lake Road Town of Putnam Valley Dear Mr. Budzinski: As you know, we have done extensive field testing and design on the above referenced site toward the owner's intention to create up to three (3) building lots on the approximate ten (10) acre parcel. However, as a result of the field testing, including seventeen (17) deep test holes, as well as the existing topography, conforming sewage disposal areas are limited. Therefore it is requested that you review the attached map and the previously submitted mars ;ird st:Yp�rtinb date, a�, lit us know u;le riealui iepartmeni s comments relative to subdivision of this property. Very truly yours, PUTNAM ENGINEERING, PLLC By: Gary A. Tretsch GAT:rk Attachment (File 990173) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 - PHONE (914)225 -3060- FAX (914) 225 -2955 PUTNAM COUNTY HEALTH DEPARTMENT New York State Department of Environmental Conservation APPLICATION FOR APPROVAL OF SANITARY FACILITIES FOR REALTY SUBDIVISION Note: Law requires that no subdivision or portion thereof shall be sold, leased or rented or any •permau?r_• - uildin . erry d ?hfir eo,� until. vans zre appc�: �Fci ?�;:�tev4 %o;nty ~Dcl;eriiiit nt'ciFriealtti "or uepaitment of Environmental Conservation. 'Application is hereby made for the approval of plans for realty subdivision as required by the provisions of Title II of Article I 1 of the Public Health Law, and Title 15 of Article 17 of the Environmental Conservation Law. GENERAL INFORMATION c n \ 1. Name of subdivision: �� IJ JQOD4 �I J`1�N Location T/C PL)TNM -1 Vim 2. Owner t� (namee of person, company, corporation or association owning the subdivisio ) 3. Business address: i�kS"r qon' Spa I tjavi �mv- N (O 12-S 4. If organized, give names of officers: G 5. Total area of entire property: I ,d. G Area of this section I /� Total number of lots -2- Total number of lots of this section �-- Have plans for previous sections been approved? Yes ) No Will plans for additional sections be submitted? Yes x No 6. Do you intend to build houses on this subdivision? Do you intend to sell lots only? X Do you intend to build on some lots and sell others without buildings? 7. Is this subdivision or any part thereof located in an area under the control of local Planning, Zoning or other officials? If so, have these plans been submitted to such authorities ?YE6 - Have these plans been approved or disapproved by such governing authority? 8. Nature of soil: (D� TZ�P��01 L �p -j�0 �'Tpr l A Wj: ww_ i 3 .Q (( 6f-eq uN 1::/All; GU Am (Describe to a dep�of 10 eet 20�et if seepage age pits are propose ti), giving thickness o�arious strata such as topsoil, ca—[ y, o , sand, gravel, rock, etc.) s� �7 By whom determined? �UTN6M �1(*fgO? I t46 How determined? � �� 140L-6-Date determined<_( 1 - (State whether ground is flat, rolling, steep or gentle slope, etc. r � 10. Grading: State depth of maximum cut �' Maximum fill �o 11. Depth to water table: Max. -71 4- Min. I By whom determined ?1 (Give maximum & i imum, if there is any variation) How determined? - DEED -P Tl51 D ate determined: ZZl WATER SERVICE21 12. Proposed method of supplying water (if public water supply, give name of municipality, water district or company Has municipality, district or company agreed to supply water? l 13. State approximate distance to nearest public water supply main of municipal system? 14. State approximate distances to nearest subsurface treatment systems: Zoo' 15. If a water supply application is re ut ed, has the approval from the Regional Permit Administrator, Department of Environmental Conservation been received? SEWERAGE SERVICE ' ��` -,,L -, 6. Proposed method of collection & disposal of sewage: ski T-�' A (Give name of municipality or sewer district if public sewers are to be used) Has municipality, district or company agreed to provide sewerage facilities? I�►�/i �; 17. State approximate distance to nearest public sewer main of municipal system 18. State approximate distances to nearest well water supplies: 2db DRAINAGE 19. Are there any low or wet areas that require drainage? Yes No Are there any watercourses, ditches, ravines which maybe filled in. -Yes No AIs there an existing local drainage plan? IQD Have these plans been approved by drainage officials? fJ Provisions for surface drainage should be shown on plans. GAS TRANSMISSION LINES 20. Does a high pressure gas transmission line pass through or within 300 feet of any lot in this subdivision? If so, has its location been shown accurately upon plans? ADDITIONAL INFORMIATION 21. Maximum number of bedrooms in completed house: Bedrooms in expansion attic: 22. Cellar drainage: Are cellar or footing drains to be installed? If so, show on plans how drainage will be disposed of. 23. Laundry wastes: Are laundry tubs to be located in basement? NX-0 If so, show on plans how waste will be disposed of. It is hereby agreed that if the attached plans, dated Igor any amendment or revision thereof, are approved by the State /County Department of Health or State Department of Environmental Conservation, installation of water supply and sewage treatment facilities will be made in accordance with the details thereof as own on such approved plans. If the subdivided lands shown on such plans are sold before such installations are made, it is agreed at purchases of lots will be furnished with a legible reproduction of the approved plans and the will be notified of the necessi of ak' su installations in accordance with such approved plans. Date: Signature Official Title 0 ultJ44 The statement must be- signcd 1'y t owner oiihe is :3 t,latted for s0divisioim)r illPyrecnnncil�l�.L��C- '.°.l -3f t ,,:.y3iy Or CCi�i3;a tai, ° -offecin'g°[fie�same for sale. TO BE FILLED IN BY PROFESSIONAL ENGINEER OR LAND SURVEYOR* The plans submitted with this application were prepared by me or under my supervision and direction Individual water and sewerage systems, if shown on the plans, were designed after careful and thorough study of local geological and existing sanitary conditions. Name (Give Firm, ifany) Address (02 6�L_6T4 es- t License and No. ��7(� Signature *Land surveyor only if granted exception under Section 7208n of the State Education Law. IMiPORTANT NOTES (1) The plans shall show all information required by the State Health Department Bulletin, Planning the Subdivision as part of the Total Environment. and such other information as may be required because of special local features or conditions. (2) Plans must be prepared so as to be completely legible and to permit satisfactory reproduction by microfilming processes. (3) One white print (either on paper or cloth) shall be submitted for filing with the Department, if approved, together with such other tracings or prints as may be required for filing with the County Clerk and the subdivision owner. m (4) A LOCATION DIAGRAM (scale about 1" = 2000') showing the situation of the subdivision with respect to main roads prominent ` streams, etc., shall be included on the plans. '(5) A KEY MAP (scale about 1" = 400') shall be shown on the plans if there are several Sections of the subdivision, outlining the relative location of the subject Section with respect to the rest of the subdivision. HD GEN 157 (7/97) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR _. : =: ....r.. .. ..... t <- ¢,'i i S1 7 1L'-R TREAl'l�ltNi S`YS�L l.l�.. _... 1. Name and address of applicant: h'I-1 1� Gb1�1�5� ►`� fHA 37 2. Name of project: cw-A 1tj 3. Location TN: PujN1W'n 4. Design Professional: pu- r��I�G�r 12,�,� 5. Address: (02 C9LEtJE1T-A 6. Drainage Basin: oSCd�v��r�,� I.� j•C� �czr -t , N �f 1012 -- 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building _ X Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt. Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... i- 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/ 11. Name of Lead Agency 12. I/s�� this rr��project .iinyan, area under the control of local planning, zoning, or other C .__.. ... ......_.. _. .,- �ill:.�1C'ici jy oYdinances? ...................... 13. If so, have plans been submitted to such authorities? .....:.. ............. ................... 14. Has preliminary approval been granted by such authorities? x Date granted: A&LM SKerc A FL"-1 A 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... ►J /A 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... �>~S 19. If yes, name of water supply Distance to water supplyi 20. Is project site near a public sewage collection or treatment system? ................� 21. Name of sewage system Distance to sewage systenmaPJ 1 c 22. Date test holes observed 23. Name of Health Inspector 51I-L... + 5e- S 24. Project design flow (gallons per day) .............. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ...................... ..................... ............................... ?.bvva 29. Is Wetlands Permit required? .. ............................. .. ..:.....,::...... :;. �f�_,,... Ias application been made to Town or Local DEC office? ............................... l�S 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 �-Jo 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? ......................... l`J'0 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... N� 35. Are any sewage treatment areas in excess of 15% slope? 36. Tax Map ID Number .......................... ............................... Map 2 Block 2 Lot '50 37. Approved plans are to be returned to ..... Applicant �_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located. within the NYC Watershed shall be sent to.the Department, and rtePC �r „�,,_; ��4 i;^ dc�rl eat to dre'irr; dithdagh the project may require DEP' �'- approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of v impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application 'is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES. PM4!�1 I^Wi rarl�2i rte RUM 6�y�u MC& Mailing Address: I 7� 2 G� l l C� GL_ r-s!� 10x`12.._. r DESIGN ne Own =T Ctn ,DG '1? I ►.1 Ac :Tess �� 2) c Cll (.L AM I`t l^�-- To= at (Stmt} DjCA1N�A (.�. 1� n 5�. �2 Bloc, 2- Let dt� (ar c ne_. es - - =CSS street) _ SAM == �� r=-CN �r�c•c_^ L'L_ rJ?.� M E° =L, _ Gr? APPr_; C-=CNS I>-t-- of Pr —Sca n, . Data of r_TC�! a t? Cn Test �oLG Tom*- i! =-- = =c 2 TZo 1"13 (� 22`2 2S`/2 3 3 �_`� �D:t�a )S 221/2 25'L J S a 5 2 947 In:(I 2•�- 23 2.C� 3 l D 12 (D :3& 2A' 23 9-4, 4 5 1 2 IrOT"�5: 1. Tests to be re_�t=a' at sari de_-,th until approximately -mil soil rates are obt- .puled -I .at each pecolaticn test hole. All data to' be suhraitte : for review. 2. Depth to be mz a f:-= too of hole. . - -•- a /rte C- -=rl tJ wa '�-ar Fr= = R -_pr Lever NO. .C..l'�f ace I inches Soil to }�� -•� Stec v�1'' Y-Ln. St =r` L LL1"CD ��Sirimzt TTS�..:D��+w Inches Y =es T (s T-27 9 22 `i2 25 `/2 3 2 TZo 1"13 (� 22`2 2S`/2 3 3 �_`� �D:t�a )S 221/2 25'L J S a 5 2 947 In:(I 2•�- 23 2.C� 3 l D 12 (D :3& 2A' 23 9-4, 4 5 1 2 IrOT"�5: 1. Tests to be re_�t=a' at sari de_-,th until approximately -mil soil rates are obt- .puled -I .at each pecolaticn test hole. All data to' be suhraitte : for review. 2. Depth to be mz a f:-= too of hole. . - -•- a /rte T= P= MM RMU= M BE SUEMI= W= APP=CXTTCN . DES S E=. NO It i j 21 4 Qt ST 71 91 io lit 121 L. rA.� F Lo,4. P.-I m ECI NO. EC= NO. — '3 GtZA vV--* L- MAX 13 T 14 LZ U, M DIC. ZVEL, iN-. -DT= JoiM To vr-. Z. LEVM-RZSES AE = '"-Em -, --\,-C- Eyca-Lam?= DF----3 Eo-iF VIADIE BY: KeN H04-04 611.(_. Rps p C,-t—em s DESTGN Sail Rate Used Drco: S.D. U�le Are Pr-Ov Lr-ea No. of BeFlrcams Septic Tarik C-=cac-;tv sals- Ty�:-e Absorption Area Provides BY L.F. x 247. width trance Ct.!,.e-- Naze FUMAM Signature , S�L A 06744b T=" SP_. USE BY F-E-ALTH DFURA.RM-C-ItT CN-.r-,Y: Soil Rate Arorcved sq. f t/ga-1 . Checked by Da+-= . - DESI C-v M '?' DISPOSeMT -._ Owner �tll�fY''T`F� 1 N Acaress � e2 N �t �v� y t LL, �6�Zn' 1 Lc,--tad at (Sl=eet) I)RAWA JA 1AIL6, Ste. (off Block 2- Icy 3U ` nea-- es t • cross, sus =.re.) ►ZJ� � ^' i.a�1C' 'v.lY- �1'-.� ��.4�.�.�.: • 1\.�l 1...` -.+ �I 1. w'��j i.' p,P=1 C:A I:r•:S Data OL Pr em-scalLnC �l Data OL Pe_TcolatlCi1 Wes 6-.- '2Co 2 2 311:x,• ll:lo l0 22 25 7.6,7 .. �}EOLZ l(:21 11) 22 ry�r /+� PERCOI =.—I CN Run ELapse BecL.Z to Frat =*- FYCm Watex- Level. 2�-- Ho. T. CrCLL ^.0 .S=face L^ L*:c =es Soil' Rat_ Spa-S Iii ^.. ":. wD Str =' t Stcu L�'CD to 2,• TnC�c_c TnC^a,�r- - .'L. ^.r..ieS W �l '2Co 2 2 311:x,• ll:lo l0 22 25 7.6,7 3 411.1 l(:21 11) 22 25 3 3 3 W 5 1 2 3 C tti0'I 1. Tests to be re_cc--tea* at same depth until approximately eacz1 soil rates are cbt- =i_ne-' .at each percolation test hole. Al.l.data to' be su]=itte for review. 2. Dept: ma—,=,re-nents- to be made from. too of hale. . 0 /;. �l '2Co 2 2 (: 30 2,3 -'7-33/4 3�4 3 7.6,7 3 3o 24 '2:7 3 10 4 IV 0 3 1 2:33 3o 2�-- 2-t 3 O 5 1 2 3 C tti0'I 1. Tests to be re_cc--tea* at same depth until approximately eacz1 soil rates are cbt- =i_ne-' .at each percolation test hole. Al.l.data to' be su]=itte for review. 2. Dept: ma—,=,re-nents- to be made from. too of hale. . 0 /;. TEST PIT r-a-m ID= Ea'p No. . 4 21 3' A' 7' 8' 91 i0l t 121 131 Licawr -na- r-J rlNIF-= V V UZI SIVO "&--I ECLE NO HOLE NO. F 14' -PAIQ TT7 'k F 14' TT7 7 L-7--qM, RISC S =E LNG Cyr I D=- EC)LF. CBS=,P--'aC6S MIAIDE BY:.et-�: JLV� j'r5iLLAev6 s LIA=:- -71-22417 DES 1C�i Soil Pate user. min/11" Drog: S.D. Usal le Area- P--Ovidea- No. of Bea-=-Oallz ark Cacacitv a-ls C. Ty�pe Absorption Area- Providers By L.F. x 247 width. trench Other Name -FLJ-r JAM K-r- Pty. Signature l QA SEAL j k a: ItAdress 102- �:56�1 ui 'rte is I D J5).L— ;pa" 0670- THM SP_ C-37 MR USE BY F=' TS DEPAIM-ENT COY: Soil Rat--a Acoraved -Cheakaa by Pzte Name Sigrzt:=e Q� ' T Azdress ScP.%, iq THIS SP -zkCE MR USE BY E--'A TH DEPA_ T .M', T COY: Soil Rate AoarcL c-d sq. f t /ga? . Che!ced bV Date TE5'T PIT nAM RMU= M BE SJEMI= W13M err: -LL-h lives 'J .a DESCc:=CN OF SO22S :rENCO Ni'ERED IN TEST EOLES DE.°'I'S EOL•E NO E= NO. E= NO. - -G L. .. 1T FA NC-E / TAnj 2' �iNE Lodh�. _ 3, A'GRy / 'i'�•IJ 6' V V 9' 10T 1?t 12' 13' 141 r TON, ��. !-.-D- , Pir C L� USES P_ '? E✓riG C�i' ►� /,� DE. Eolz CBSC� ,,T- a— rrICNS M-POE BY: KC-4 I U - IlGmas L'f Z ?�- DESIGN Soil Rate used M:r_/l" Drco: S. D. IIi�-bI.e Area Provided No. of $'droams S2DtiC Tar_k Ccm2Ci tv 5- TY - Absorption Area Provi dea BY L.F. X 24" widt-h trendrl Name Sigrzt:=e Q� ' T Azdress ScP.%, iq THIS SP -zkCE MR USE BY E--'A TH DEPA_ T .M', T COY: Soil Rate AoarcL c-d sq. f t /ga? . Che!ced bV Date rUi +MM CnJi71i i•ecPrsMlM CF EEALTE DIVISICN OF HE= CES SYST- owner*- Ad^ress jag - r t� at (St=e =_) 05CJA -N-& fJ 4 LAS A '0 5c_-. lU`�— IlZock 2 I,: t � (ir-dicate r em es t . =css street)- - l 2 3 a 5 2 - 3 Tests to be re_pc--t=a at depth until ararcximately ell soil rates axe obt_i.*: at each percolation test hole. All. data to' be su�rr�tt for review. 2. Deoth en t-- to by try fran too of hole. . - -- - n /� c %'_ r. T„��""'; SO=w.�G 1 �'.,lY DAM r• E •.,:fix:, =... Dml.T�.� iti E... PD��IC �'IC?45 I>-t -- of P_'- *:c Pat_ of Test 7. - ECIZ RUM EZa_ se r-e t_h to SVc =e_*' FiCQI ►hc�. �'" LeV� NO. Ti CLCI: *C S =face L^ Lic:es So i? Ra`a s� -jwD mLn S`�' St:D L`rCD L ^_ I�t.= ::��.� Li C? l 2 3 a 5 2 - 3 Tests to be re_pc--t=a at depth until ararcximately ell soil rates axe obt_i.*: at each percolation test hole. All. data to' be su�rr�tt for review. 2. Deoth en t-- to by try fran too of hole. . - -- - n /� c 14 -16.4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEQR Appendix C State Environmental Quality Review SHQRT _ENVIRQt�.I�1ENTAL- SSI_`S-!!ANT .FOfll!.?!_ ;.:;; - -- For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. - vhPPtIe*NT /SPONSOR PUT-NAM ENGINEEFR(N& 2. PROJECT NAME GoLav -CEt(J SUf3gVISIo)"I 3. PROJECT LOCATION: Municipality OWN Of R9NAM VAL.I e-( County FUTNAAA 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) oscA(NAtJA GAtKF j OA<D (%E L04gfrCN Mtkp oN ATACtieD PAN) 5. IS PROPOSED ACTION: iC{.New ❑ Expansion ❑ ModiflcatlaNaiteratlon S. DESCRIBE PROJECT BRIEFLY: 2 LOT Re5I Dr::;NT /AL, Sur�,r�rvlsrorl 7. AMOUNT OF LAND AFFECTED: Initially 32 acres Ultimately '� 3'Z acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ayes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? .Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Otiter -.Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No If yes, list agency(s) and permit/appwais PUTNAM VAi. Y RANWIM& &OA14D - tWDP(v15(0t. "I1ZdJAL- 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes ® No If yes, list agency name and permit/approval 12. AS A RESULT-OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? i C3 Yes. IG�.No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ,OppAeaaNsponsor name: FUTAJMVi CAIN eex 10 WA'4c . DES('r'Date. Signature: G/ If the action is In the Coastal Area, and you are a state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCAR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. 0 Yes a No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No. a negative declaration __.may be.superserfed by. another, involved agency..:.- _ __ L. Yes ��! No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Argwers 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 briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No I- IS THERE,. QR.IS THERE LIKELY TO BE,- CONTROVERSY RELATED TO POTENTV1 ADVERSE ENVIRONIM.FNTA!. IMPACTS? I L1 Yes lJ No If Yes, explain briefly' PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes; the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. - ❑ Check this box if you have identified one or more: potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature ol Responsible Officer in Lead Agency Signature of Preparer (it different from responsible officer) Date 2 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, NY 10512 GO Fax: 914- 225 -2955 LETTER OF TRANSMITTAL l/ Date: RE: TO: ( Fe We are sending you attached under separate cover, the following items: Shop drawings Prints Specifications Copy of letter Plans Other: No. of Copies Description These are transmitted: _ For approval — Approved -as submitted _ ... _ ;-d�. 0--r use — Approved as noted As requested _ Returned for corrections For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Copies to: SIGNED: )(—"'� Hu 2 If enclosures are not as noted, kindly notify this office. FROM : PUTNAM*ENGINEERING PLLC PHONE NO. : 914 225 2955 Jul. 16 1998 11:09AM P2 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Cam T-051 2- 914-225-3060 Fax. 914-225-2955 RE: DIVI-SL.Z7 4 Wc I a"^^k^A 12�Igv%r r.^qr,,nr-3+p � jftr, + a +t%110VVing i pme: A - are sending you LLQ%.1#4�W %0#4%4 4 "4U&V__ WOVE# the 1-1. ... ite.— Shop drawings Prints Specifications Copy of letter Plans, —.Other: No. of Copies DescripAion 7 These are transmitted: — For approval Approved as submitted — For your use Approved as noted e 'AS 2" (05t d- ftsu mit copies -TI-ts, 1:5 SyiKn^ flwq.) HerWU-n-4 k7=- t-ff SMINED: If endosum are not as noted, kindly notify this office. °"`� �-�-° �...e --moo � . _T41t"V� FROM PUTNAM ENGINEERING PLLC PHONE N0. : 914 225 2955 Jul. 16 1996 11:08AM P1 p UTNA 1mrs INE RAVE c . y n .. • s.P'. u _ •.' .r: 4; C✓ .. e_. ......r+ ., .- �err.i.._.� -....� ..:.... .. _ ..a � 3....r . w,. . � ... w • a s..'..� ...2 -..u. C> r.- aa. a a._U —�•Y .'+ _ + . DATE: TO: FAX NO.: PAGES: r/ ,-including this coves sheet. . ..... . ....:.� �- ::yam.....:'. . . From the desk of.... KEN BURLEY 102 GLENEIDA AVENUE, EARMEL. NEW YORK 10512 • PHONE (914)225 -3060• FAX (914)225 -2955 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue -Ca r -mR1 914-225-3060 Fax: 914-225-2955 TO: We are sending you - attached Shop drawings Specifications Plans No. 'of Copies LETTER OF TRANSMITTAL —77/ �- RE: Q-1..V-1SL"0T'Q under separate cover, the following items: Prints Copy of letter Other: Descrintion tl - I , D- I ') F LP-&LTH bePr . fee (1 qvo - wr-at-L-ts6^c- eer►a-J Fag-Y\-, P<---9-7 66-4,3 15-7 _These .are transmitted:. Ap.p rpvpd: a .svbmitted For your use — Approved as noted As requested — Returned for corrections For review/comment — Resubmit copies for approval Submit _ copies for distribution REMARKS: -rile 7bLi3ee -Tf,-S-r.5 LZSy,?g:' 0f:V(e-,r,- o� '7 / -z2-/ q -7, Copies to: SIGNED: Kfe��-1 If enclosures are not as noted, kindly notify this office. Vq8 L- VC OG . C-02 C--V C-rrf_ 1 pa 1. Two (2) copies of the Preliminary Realty Subdivision Plan signed and sealed by a Design Professional`showing: Z�"minimum scale of 1" = 50' for site plan. �/tad posed layout of lots. locations. pog-raphy; 5 foot minimum contours. Major physical features, i.e.. wetlands, watercourses. stone walls major J P Y � J or ,.;Ock outcrops, etc. -.00Jocations of sewage treatment area(s). ;�Odjacent property owners. ion ma at minimum scale 1" = 2 000' north arrow. P > Location of all existing and/or proposed wells and SSTS on and within 200 met of property line. P pem- boundary survey by a NYS Licensed Land Surveyor. Title box indicating name and address of property owner; property location, including street and municipality; name, address and phone number of Design Professional; date of drawing, including dates of any revisions; awing scale; and tax map designation. Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. 2, A preliminan• engineering report, if required. Following review of the above - mentioned documents, a detailed site investigation will be made by the Department. The Department requests a minimum of 48 -hours advance notice prior to on -site deep test hole inspection. If a member of the Department cannot be present at the time of the soil testing, a mutually agreeable date to inspect the site with the Design Professional will be scheduled and should be as close as possible to the date the soil is tested. _ C. Final Realty Subdivision Submission Requirements Upon finalization of the design and layout of the project, the Department will review final plans to assure that each lot complies with all appropriate Department codes and regulat' ns. The final realty subdivision submission includes: Realty Subdivision Application, GEN 157 (Appendix K). --�. : ZZI. Application for Approval of Plans For A Wastewater Treatment System, <ubmittal Appendix K). Fee (Appendix I). Z 5� . Design Data Sheets, signed and sealed by the Design Professional (Appendix �ffidavit Corporate Owner Application, if applicable (See Appendix K). Short Environmental Assessment Form (EAF) (Appendix K). 7. ngineering report describing the scope of the proposed project, type of water and sewage facilities, soil test results and any other information pertinent to the subdivision. Documentation for the formation of water and sewer districts, if applicable. 9. All applicable DEC and DOH Permits and Plan Approvals, if applicable. — 10. Proof that preliminary approval has been granted by the Planning Board of the municipality in which the project is located. 11. Proof is required to be provided showing that the requirements of SEQR.A have be - -..F7 1- Tie -.� .. niU _ y ........_.._ .. �„�.. , a.,,.., ...Jr rl j. ccs su Jcc< <G & co- re v iew. ohs pro& `l all c iii the form of negative declaration or a findings statement, if a positive declaration was issued. est well data in the form of well logs and water quality reports, if required. 11 Well driller's letter stating all of the proposed wells are located so that it is possible to get a well rig to each proposed well site within the property lines. (This item is required at the discretion of the Department's reviewing engineer.) )41114,', f the subdivision is to be served water and/or sewage by an extension of an existing water main or sewer line, the applicant must submit a letter and/or engineering report from the officials in charge of the water supply and/or sewage system indicating that there is sufficient water available at an adequate pressure and/or sewage capacity to service the proposed subdivision. 15. One (1) original and three (3) B/W copies of the subdivision plan signed and sealed by a Design Professional and Land Surveyor, licensed and registered to practic in New York State. showing: inimum scale of 1" = 50' for site plan. Lot layout with metes and bounds descriptions for each lot signed and aled by a Licensed Surveyor. Each lot must be numbered. Topography with 2 -foot contours; existing and proposed, and major physical features such as stone walls, ledge rock out croppings, drainage c annels, etc. Plan must include note disclosing the source and /or certification as to accuracy of the topographic contours. �oad and driveway locations. Location of any water courses, ponds, lakes or wetlands and protected controlled . areas surrounding wetlands on or within 100 feet of property cation map at minimum scale 1 2,000', north arrow. 6posed drainage system and easements. u1 rtain drains, if required. t m County Department of Health Realty Subdivision General Notes. p pendix F). . Location of all existing and proposed wells and SSTS within 200 feet of property lines or a note stating that none exist. proval legends. (Appendix G) SSTS SchPd„ie (Appendix H,:1 Posed house wi asement and finished floor elevations. roposed SSTS and well locations. T SSTS area shall be large enough to accommodate the primary and r �pserve systems and ROB fill, if required. A datum reference is to be provided (i.e., NGVD 1929 or assumed/other). Accurate location of all deep test holes and percolation test holes coordinated on plan with the soil data sheets. A minimum of two (2) deep holes and two (2) percolation tests are required on each lot unless additional deep test holes are required to define the extent of ledge rock or oundwater in the SSTS area. itle box -See Preliminary (Section 4.0 B. 1. ). ignature and seal of the Design Professional. onsent to file note signed by the subdivision applicant(s). Delineation of United States Dept. Of Agriculture Soil Conservation Service soil type boundaries. It should be noted that construction details for individual SSTS components, i.e., trenches, septic tank, etc., will not be required on subdivision plans, since these plans do not authorize actual construction of the sewage facilities. These details must , a Department document entitled, '`Procedures & Policies, Subsurface Sewage Treatment & Water Supply Facilities For Single- Family Residences." 16. The following are the specifications for the preparation and filing of an original map as required by the Putnam County Clerk's Office. y a. Size: Minimum 20" x 20" Maximum 36" x 48" b. Fee as per Putnam County Clerk. c. Sepia Mylar is not acceptable for filing. Attachments, glued or pasted to map and/or drafting applique film attached to map, will not be acceptable for filing. Real Property Law 334 All maps must be printed upon linen or canvas - backed paper or drawn with pen and Indian ink upon tracing cloth or printed on Mylar. The recording officer may reject or refuse to file any map that is unclear, crowded and not suitable for photocopying. d. All subdivision maps must be approved by the Planning Board where the property is located.* ORIGINAL SIGNATURE MUST BE AFFIXED. ,...M kas,. i clrl lltl.lrlg t'+Nc) 2 j ;ot,5 qr, more m11 3t le ai nrnved by tiiti r'�•tfn��p County Department of Health. ORIGINAL. SIGNATURE MUST BE AFFIXED. f. Survevor's Certification "Wel hereby cert o that this subdivision plat was prepared by us /me, and was made from actual survey completed by us /me on (date) ." SURVEYOR'S ORIGINAL SIGNATURE AND LICENSE NUMBER AFFIXED. g. Maps must have raised or stamped seal of surveyor affixed. h. Certification of Commissioner of Finance. ORIGINAL SIGNATURE MUST BE AFFIXED. i. Affidavit that a..copy has been served on the Board of Assessors in the township where` property is located - THIS IS NOT A LAW, BUT A COURTESY TO THE BOARD OF ASSESSORS /SOLE ASSESSOR IF AND WHEN THE PARCEL IS SUBDIVIDED. *Town of Philipstown, requirement varies. _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` REALTY SUBDIVISION PLAN REVIEW SHEET Reviewed by; _ C Date: T_'.le fir; rl� �b", :4zion °�' Vic.- F - - ,., �. mate ui Mia Street Location cS erbj ttel t d- Town Owner Address (P Tax Map Number 4 Z – Z –� P Date Map Rec'd — Design Professional Address Phone Number Y ` DOCU'UNTS Y N PLANS 2 L� r 54 GEN 157 i �� g LOCATION MAP PC -FORM ° r i VICINITY MAP 1-00 DESIGN DATA SHEETS �� NORTH ARROW CORPORATE RESOLUTION PLAN SCALE SHORT EAF 2 -FOOT CONTOURS,EXISTING & PROP. TTER OF AUTHORIZATIO SOURCE/DATE OF TOPO NGINEER'S REPORT DATUM REFERENCE ATIO TAX MAP NUMBER' PRELIM. APPROVAL AGREEMENT WITH TAX MAP FEE - AMOUNT $ 3DIVISION PLAT L TS FOR TEST WELLS TLANDS PERMIT (DEC/LOCAL) TER SUPPLY APPLICATION )TECTION OF WATERS �S CONNECTION LETTER CENTI Rn"'r: �i ` v_Er ". C�7...Nv.NE TION_ I 17.77 E OH PWS APPROVAL. LOGS rR QUALITY ANALYSIS 00-YEAR FLOOD ELEVATION /-GENERA CATED IN NYC WATERSHED ANS SUBMITTED TO DEP, tit DEP APPROVAL OBTAINED LOT LAYOUT W/METES & BOUNDS DESCRIP LOCATION WRT TO WATER/SEWER DIST. HOUSE LOCATION HOUSE FTG/LEADER DR FF ELEVATION SSTS LOCATION 100% RESERVE LOCATION WELL LOCATION DRIVEWAY LOCATION �../lI- A TTi PERC TEST LOCATION LABELED CURTAIN DRAIN LOCATION STONE WALL LOCATIONS WETLANDS LOCATION ROCK OUTCROP LOCATIONS WATER COURSE/BODY LOCATIONS EXIST. WELL /SSTS DRAINAGE SYSTEM/EASEMENTS SSTS SCHEDULE GENERAL NOTES APPROVAL STATEMENT OWNER'S SIGNATURE S/S OF DESIGN PROFESSIONAL S/S OF LAND SURVEYOR vc