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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -12 BOX 24 rE ' IL i,yti TLS ti Ala �'J f- 02834 y TNAM COUNTY DEPARTMENT OF HEALTH d� ,;r�nra Tom, :rilT'3' T �E L "icy nr r, ar ° - . .': ' •.. -.,..: - . •3���3'1'V` �i .�i' i "1'j���lj'�ii1 \ Y a a�i ij � n 'iY"iL� "��i','Y' Apr O RTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT it Located at Town or Village'�`� Owner /Applicant Name J uAt4 Tax Map &Zm 10 Block Lot 1�- Formerly GE�A" Subdivision Name IN Subd. Lot # Mailing Address 35 A0tWq A\1 +E .) \40�&,F-Z5) t -i Zip 10,704 Date Construction Permit Issued by PCHD Zr( 16 - 0.75 2i- Separate Sewerage System built by 0 ,S C)EeWi)R Address � +JYaC��y � � ,�.ly jZ531 Consisting of � Gallon Septic Tank and Other Requirements: Water Supply: J462- L i= op Z4' uJI RF �� 7 Public Supply From, A)n10- JrS�AZ 4LAgAS Address or: X Private Supply Drilled by �C-&WW AJQ52 ( WC, Address QJD,M \ALt-� -`i �f' l`��5 N Building 1 ype -- Numberof Bedrooms Has erosion control been completed'! �¢ Has garbage grinder been installed? 0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the P�uutn County Department of Health. Date: 0 lZ Dq Certified by P.E. R.A. (Design Professional) ��5 �Z50S Address paw (O-� C 5N" "l � License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatmert system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. �Y \B Title: ' N 14 Date: c t7 White c(py - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 CpG J a - BRUCE R. FOLEY i..0PZFTT_A L IN A R i M $ NAT * MO R.N. . runitc rtealrn �irecior F Associate Public Heilih birector w Yo Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road - Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADbRESS: TOWN: AUTHORIZED TOWN OFFICIAL: DATE: John Narciso 62.10 -1 -12 West Shore Drive TOWN OF PUTNAM VALLEY i\ ) /1 i/ -. `' (Signature) The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Ede tion- )Free da""S's: 744'4 �1'1 1Map6LK)Block i ri de Lot(s) 1Z Well Owner: Na n :e: Address: k2 Use of Well: 1-primary 2-secondary Residential X Public Supply Air cond/heat pump .. jrr(gation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Z< Rotary _ Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing 2�Open hole in bedrock Other Casing Details Total length /./0 . ft. Length below grade + ✓ft- Diameter in. Weight per foot lb/ft. Materials= Steel Plastic — Other Joints: Welded _X Threaded Other Seal: /)-.'-'-Cement grout Bentonite Other Drive shoe: Yes No ILiner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes—No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours/ L4 /-I- Yield I � gpm Depth Data Measure from land surface-static (.�pecify ft) r , During yield test(ft) Depth of completed well in feet 11 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 3 7-0 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Typ _apacity le Depth 2-P Jode Voltage _5 Tank Typq 2U,0 (5� Volume Date Well Completed Putnam County Certification No. Date of Report >/ Well Driller (si re) NO ct l6cation of well with distances to at least two pennaneiltlandmarkS to be provided on a separate sneei/plan. W6711 Driller's Name Address -�7� G� - Signature: ::74 Date:- -7 Jr & 5_1 X / 7% White copy: HD File; Yellow copy- Building Inspector; Pinkcopy - Owner; Orange copy -Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH _. _._ DIVISION OF ENVIRONMENTAL HEALTH SERVICES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM John Narciso Owner or Purchaser of Building Capital Domes Building Constructed by 193 West Shore Drive Location- Street' Residential 62.10 1 12 Tax Map Block Lot (T) Putnam Valley Town/Village N/A Subdivision Name N/A Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: M er`al eontractot'(0 ner) - Signature Corpor tion Name (if corporation) Address: / 3 d 0 W YIZ,- Year 04 Signat State %yG/ A�` Zip Title: Corporation Name (if corporation) Address: ►W r-Akfe'vV fix State d y Zip Form GS -97 YML ENVIRONMENTAL SERVICES 32r Kear Street 1'orl::towr� I-ie'ct7Ptts.q i�l.l'. 1.t:�`.�98 _ W � .n,r,,�:�:.�� �<.,...--. -; �r .... �_..�.n,.:,c: -::: ;;.;.o,.,,:�•�.i,�� � ,.�_�e�s".�:�rjGt��'i7�� �.�..,..u,;.::..�,- _',..; ". = ..:- -...�� �:.,.,.o��::;-- .;;r,;; -:;. Albert H. Padovan:i., Director LAB #: 30404103 CLIENT #: 5'7591`' NON STAT F'ROC PAGE: 1 NARC I SO , JOHN F' DATE /TIME TAI EN N 0604/04 01 r, i')01 --*-- 193 WEST SHORE DR DATE /TIME REC ' D .; 06/14/04 01,50F, - NAM VALLEY, NY 10579 REPORT DATE": 06/21/04 PHONE% (914) -450 -9945 SAMPLING SITEg 193 WEST SHORE DR : PUTNAM VALLEY NY COL ' D BY: JOHN F' NARC I SO NOTES... : KITCHEN TAI =' N IV IVNIVNNIVNNIY IVMNNIVNNNNNNIV nINIV IVNNNIVNIV .v .VNN,VN DATE. FLAG PROCEDURE: SAMPLE. T`'1F'E .. ; POTABLE. PRESERVAT I VES r NONE TEMPERATURE. .m 4C - COI« I FORM METH:; MF RESULT NORMAL _ RANGE METHOD PUTiNIAM CNT`( PROFILE 06/J.4/04 MF T. COL I FORM ABSENT /100 ML ABSENT' 1 008 06/14/04 LEAD (.l'MS) <:1 ppb 0 -.:15 ppb 910). 06/14/04 NITRATE N I TROG 0.95 MG /L 0 - 10 9139 06/14/04 NITRITE N I TROD <0.01 MLA /L. N/A 9146 06/14/04 IRON (Fe) 0.071 MG /L c a 0.3 mg / 1 2037 06/14/04 MANGANESE. (Mn) <0.010 MG /L. 0 -0.3 mg/1 2037 06/14/04 SODIUM (Na) 6.43 MG /L NIA 06/14/04 pH 7.3 UNITS 6.5-8.5 ''!> {. 4ZI 06/14/04 HARDNESS , TOTAL 94.0 MG /L.. NIA 06/14/04 ALKALINITY (AS 60.0 MG /L. N/A ,.._--__ .... _.._..,_ .- 06 114 /04. _.. ,._ T'URS I D I TY (TUR COMMENTS: )FACT THESE RESULTS INDICATE THAT THE WATE ' ( S) _ ( WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD I i� WA THE NEW YORE : STATE: AND EPA FEDERAL_ DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED„ AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 10% of their than IS ppb and a treatment must be potential. -tb l i.c schools are set at 15 ppb e Rule for Public: Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /I._ of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-280o Albert H. Padovani, Director �/ ' LAB #: 32.404103 CLIENT #: 57591 '-'`` -NONSTAT PROC PAGE: 2 NARCISO, JOHN P DATE/TIME TAKEN: 06/14/04 01:00P 193 WEST SHORE DR ' - DATE/TIME REC'D: 06/14/04 01:50P PUTNAM VALLEY, NY 10579 REPORT DATE: 06/21/04 PHONE: (914)-450-9945 SAMPLING SITE: 193 WEST SHORE DR : PUTNAM VALLEY NY COL'D BY: JOHN P NARCISO NOTES...: KITCHEN TAP ' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD ` PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L L 70�14O'|iG/L GRAM ��������������� --'-_-__ --- _ -_-__---___--' - -_. SUBMITTED BY: �V41 1 6, — A��-o Director ELAP# 10323 BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 30 Jul 2004 File No. 95 -114 W. O. # 16029 RE: Certificate of Construction Compliance Narciso TO: West Sliore Drive Joseph S. Paravati, Jr. N/A Subd. Lot No. N/A Tax Map 62.10 -1-12 Assistant Public Health Engineer Permit/Title/PO # PV -1 -99 Putnam County Department of Health 1 Geneva Road Sent via: Brewster, NY 10509 US MAIL El UPS -NIGHT ❑ MESSENGER 11 UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY F� FAX E] UPS -GRND We are sending: UPS -COD El copies date description of document F-11 19- Jun -04 lAvolication Fee - $300.00 [_11 112-Jul-04� ICertificate of Construction Compliance for Sewer Treatment System ❑1 09- Jun -04 E911 Address Verification Form 3 12- Jul -04 Guarantee of Subsurface Sewage Treatment System ❑ 1 14- Jun -04 Well Water Test Results ❑ F-1] 23- Jan -04 lWell Com letion Re ort .. E� • 1 i2- Jul -v4 FS-STS 1=1J- l7Ullt .. . - - -• . _.. . ._. . ❑ —� REMARKS: For your review. Copies to: File Yours truly: Jason R. Snyder, Assistant Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey - watson.com 40 40-05 507980 631623 2475U PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • FINAL SITE INSPECTION `� ` •� Date: � ,t,Ln ln. - 'i � " •y .`_>- .i l . j7 63 t.h . ... _4 � . _,,,.. -+SL'*- ' e._ r -.a- w _ . ... —' . ... , ,- . ....... .. .. .•. •�Y.�— ".r :. .� \ �-,- _ n'ai n s .Y ..ic�+.tre , � . ti� St. etL_o r i•�� _ ;.r.c?4 u-• Owner 1.-�� :Le.., c�a,, 3 /aY� Town yy Permit # / TM # &Z. - 1 1 Z Subdivision Lot # 7r� �� 1. Seaage System Area a. STS area located as per approved plans ....................:...... b. ' Fill section - date of placement 3:1 barrier , Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. eptic tank size - 1,000 ......... 1, 250 ... .....other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box '.- ro erl set ........... ............ .................... f. renc es p p y T- l✓ ngth required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... _..._ . ..... .9: Depth_of- gravel in trench 12' -' mini*r►ur�..:.....,.,.::K;:::_< -. . . -ends cappeU.'.'.:. .::.:.:. ..... ................................ ` g. PjrumD or Dosed Systems ize 61 pump chamber ...... 2. Overflow tank ......................... .......................... N ..�. 3. Alarm, visual/ audio ...................................................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ : .......... * ....... . 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. house located per approved.plans...... ..... ............. ..... .. b. Number of bedrooms .......................... . ........................ IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured '� 900 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 pl f. Curtain drain outfall protected & dir.to exist watercb g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... .............. :................ i. Erosion control provided ................. ............................... Rev. 6/97 OR r- w � ionWE imm ION :a OR r- PUTNAM COUNTY DEPARTMENT OF -HEALTH DIVISION OT EIyVIRONMENTA.T, ITPA.TLTI SERVICES_ .. „ ..:.:n:_...:. , TXELD ACTIVITY REPORT cot 1�iAMF: j o►'J�t .:. kbn,gRS4: Drc .ve toy. Street Town State Zip PERSON IN CHARGE. /� OP TNTFR'(�WFT): . V " e,- t P M2UMP TEST 0 DOSE TEST -710?ID'I - to' REQUIRED GALLONS EL. START EL. STOP r SPF -rTnv. TRT Signature and Title REPORT IRIECETV -D BY.- I acknowledge receipt of this report: SIGNATURE: 02/96 Title; __ P, o3 0 _J EL. START EL. STOP r SPF -rTnv. TRT Signature and Title REPORT IRIECETV -D BY.- I acknowledge receipt of this report: SIGNATURE: 02/96 Title; __ . -- - - - ---_- • •. ur�r i , r-,u nu,•,co h'AUt bl a7/01/2884 90:15 74514'vV 3289 PAGE 82 •11 /al /2004 10:13 ?123e'S3740 NY Ecmrl PAGE 3; .... BY TW18 CEPMFICA GM OF C' C Mi WI,.CE TN8 NEW YORK SOARS OF FIRE UNDERWRITERS BUREAU OF MLECTRICITY AG FULTON BTREgr d NEW YORK, MK 10038 C10111ITIG10111m THAT Upon the application 04 upon 0rltrlltes oWMCI by P IL M ELECTIM. VOUGOVSKY JOHN WARCISCO ArTas FRONT STWT WEST OMORE CA1VE YOAICTOYNd HOTS., NY 103ft. P TNM VALLFY. NY 105?9 Located m AeST $MOR8 DR" PUTN M VALLIEW, NY 10579 Appikstion Number 1801022 CerMcals Number: 1201022 Section, Brock: Lot, Bulidine Farrrlit. 47441 80C. W1 In Described as a XMi4iAW oCCWWcy, wherein the prernim electrical system consisting of e,aetneal devices and w:rir*, eascribed below, limewd itvar the ommiaes at. Hasane K NIL* A visual IFSWt'On at !tat PMMI Rt► electrical splam, lit7i14ed to electrical dsvrcfs 8nd wlrh,s to this extant droned herein, wee conducted In accordatice with the requiremerts of t w applicable- coda endVar stendard promulgated by the State of New Volk, Jspartment of $fate Coda Lnforcemtnt ane Adms nistrabcn, or other au herby having iurlsdicaor, and found to be in corrp m cs thWowlth on the may of 1, Ippq illlf 7 UC FX MP AND ALARM. taitisW► Servliss t . 1� 30 1 Tba1e sw aetrioe�,fity„t0011�rMave >i.mee nuo°aa"t: 20o C3 Mean: 1 CT: so seal 1 of I TI' cVrllficate may net tie eitcred in eny wy wW If wtlldsted only by the presence Of* WHO se l MOO (Mat.-On Oditakd, � eG�cr L� SAS g ,�,� y JUL -13 -2004 09:53 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES ATTENTION ® JOSEPH j 'GENE REQUEST FOR FINAL - INSPECTION For: Fill Date: 7/13J2004 Trenches P.01/01 PCHD Construction Permit :# PV-1-99 Located: West Shone` Crave (T) (V) (Tj Putnam Valley Owner /Applicant Name: John Narciso TM 62.10 Block 1 Lot f2 Formerly:.- . -..... Gerarda Was"' t Subdivision Name: WA Subdivision Lot # ' . . N/A Is system fill- completed? Yea _ _ _ Date: 41612004.__._..... Is system coplete? NIA ` _ Date: WA Is system constnicted as per plans? WA Is well drilled?' NIA: Date: WA_ _ Is well located as per plans? NIA ,mm Are erosion control measures in. place?.. Yos I certify that the system(s), as listed, at-the above premises:has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. /70 Date: _... Certa y: PE X RA Design Pfofessional Address: Badey & Watson, P.C. ;S063 Route 9, Cold Spring, NY tic. # 062505 TfITQI P (Al JUL -13 -2004 TUE 09:35 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 MAY-14-2004 16:07 BPJ)EY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OFXNVIRONMENTAL HEALTH -SERVICES ATTENTION X JOSEPH' F_j GENE CCL F:�AJIL clx�kk(,N3 REQUEST FOR FINAL -INSPECTION, For: Fill Date; 5114,2004 Trenches PCHD Construction Permit # PV-1-99 Located: (T) (V) West Shore Drive (T) Putnam Valley Owner/Applicant Name: John Narclso _TM 62.10 Block Lot 12 Formerly:' Gerarda DeClement Subdivision Name: WA W Subdivision Lot # _'A Is system fill completed? yes Is system complete? WA,__ Is system constructed as per plans? NIA Is well drilled? WA Is well located as per plans? N/A.. Are erosion control measures in place? yes Date: Date: 4N2OO4 NIA D4te: N/A P. 01/01 I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion.in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations" of the Putnam County Department of Health. - --------- Date: Certified by-, PE RA Design Professional Address: Badoy & Watson, P.C. 3063 Rotitb 9, Cold Spring, NY Lic. # Comments: 2" force main his been inspected, Permission to backfill has been granted Form FIR-99 TOTAL P.01 k InM=. 01 1-rkInM •r'11 WTV nCDn0TM1=K1T np P 1 APR-06-2004 16:42 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH ❑ GENE REQUEST FOR FINAL -INSPECTION For: Fill. Date., 4/8/2004 Trenches PCHD Construction Permit # PV-1-N Located: West Shore Oivie (T)(V) .... .. .... __MPUtnarn Valley Owner/Applicant Name. John Nardso TM 62-10 Block._._! Lot 12 Formerly: Gerarda DeClement Subdivision Name: --- NIA Subdivision Lot # WA Is system fill completed? Yes Date: 416/2004 Is system complete? WA Date: WA Is system constructed as per plans? WA Is well drilled? NIA ...__ WA Date: Is well located as per plans? WAS Are erosion control measures in place? Yes I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations ations . of the Putnam County Department of Health. 001 Date: 4W004 Certified RA_ DesignProfessional Address: Sedgy & Watson, P.C. 3063 Route 9, Cold Spring, NY Lie. # Comments: Fill for !!anslon area is ready for inspection. 06=5 Form FIR-99 P.01/01 APR-A-PPIPW THE 16:27 TF1._:R45-2713-7921 NAMF:PUTNAM COUNTY DEPARTMENT OF P. 1 SENDING CONFIRMATION DATE : MAR -29 -2004 MON 17:42 NAME : PUTNAM COUNTY DEPARTMENT"OF-HEALTH TEL 845 -278 -7921 PHONE : 92654428 PAGES : 0/2 START TIME : MAR- 29.17 :41 ELAPSED TIME : 00'00" MODE :. ECM RESULTS NO ANSWER FIRST PAGE OF' RECENT DOCUMENT FAILED TO SEND FULLY... �!mm @uFldm m hnpagp�jp vojvm�svlp �o. P� Pv9Rnv �a ase me ym�4pa[P�V�Fq aqi 7vc n a8asram �jVS 7o�P0?T�n •' �Pvo �4pmm[v" P!'�a4+3oaynaP>oi�WP�FP,c�SalP� . 1VLI N8�IO�III�-"�o�lf��fi6n!Paa!>guoa �P^�3o[a4J. �7.NffiA81VZ6 ASTjVId..N9�Ai0� djdag azPeTa. j7 , , Namtuo� 9seala ❑. �°a�� w9a�n i 0 7 C' •ejBQ .mom I `1ma / C/v or .01 .8/99-BLZ (59B)1*d 0109 .9GL(S98)Ivegap,i�tlerynveowj .Ipve j 5809•W( tO-A 8499.86[(518) D7M Bi89'fl(i (S69) oaLUO3 Bvrynp ) e6L• ele (6+8)+Ad ocl9•la(m) R;T n m�wadl•na 606o()(foA ,nojVsgshaaa 'PnoyueaWp j . �HIIM AO strWUUVglaa +�rm�ua Aunop .awnv YnmH an9nd jaxoe r imsou •HS•vy 'a-u rnvrunow v.>.I.axo•) c � i. -'a o LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 FACSIMILE TRANSMITTAL ROBERT J. BONDI County Executive r To: _�Gi $a�"� Fax: T - From: �- /•'v.,2w� T► . Date: Re: ��GL�� SL Pages: CC: ❑ Urgent �or Review ❑ Please Comment ❑ Please Reply - - .�. --- - - -. ✓� C CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845 -278 -6130) and destroy all documents associated with this facsimile. b Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH _ �.. :� '. �Z--r t- •r. �.,.. w Y.iT Vf iy /\Y�Y\ _. _ .a3':e.:v.- _ - """"- ` - ;-Tu1 v °ISlt7ir`'r.31'�v'riiiidlrii�i i °H:;.. iitrr�i'iuY'vLx'C il-'�,�:� " -. .`.`�`. •. , G," FIELD ACTIVITY REPORT Sd AnDRESS: 1ba, Street PERSON IN CHARGE OR TNTFRVTFWF.T): Name and Title TYPE OF FACILITY : mil, FINDINGS: Town .&J J ._. State Zip �0_� Ay Aze (y Lr9 �rti c� fY n 6 r l� r/ ���vti y jZ��C "� YVc% 5�L✓� rc.C'�i. S N2 ,Alf ���/I � � ��L - mil�c•2�/A 41:t—T44� 13 v I H.1 o Sign t re and Title RFA()RT R'E,CETVRT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: D. Zip - 02!%96 `Title, MAR- 24 -20Q4 12:12 BADEY & WATSON, PC P.01i01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION X JOSEPH 0 (GENE REQUEST FOR FINAL - INSPECTION Date: 3!23/2004 _ For: Fill Trenches PCHD Construction Permit #� . PV -1 -99^ Located: West Shore Drvie (T)(V) (Y) Putnam .Vailey. Owner /Applicant Name: John Narcieo TM 62.10 Block 1 _Lot 12 Formerly: , Gemrda DeCiement Subdivision Name: Is system fill completed? Yes Is system complete? -- NIA Is system constructed as per plans? Is well drilled? �.. WA Is well located as per plans? Are erosion control measures in place'? Subdivision Lot # Date: Date: NIA NIA —..M NIA Date: N/A N/A 3/2312004 N/A N/A r I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Date: 3!24/2004 Certified PE X RA _ Design Professional Address: Radey & Watson, P.C. 3063 Route 9, Cold Spring, NY Lie. # 062505 Comments: Fill for expansiory area is ready for inspection. Form FIR -99 MAR- P4 -AAR4 wFn 1 P! Sr, TPI • Qdr - -J70 -7004 &1nmC. -ru ITA i^K4 w rr.i nrr �r Twwr. it .. MAR -23 -2004 10:59 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES fc .:. mr w . Yi... c a..t.n. ti .. •4^ _ .. ATTENTION X JOSEPH ❑ GENE REQUEST _FOR FINAL - INSPECTION Date: 31=004 PCHD Construction Permit # PV -1 -99 For: Fill ... Trenches _.._ P. 01/01 Located: West Shore Drvie (T) (V) { Putnam Val" Owner /Applicant Name: John Narciso TM 62 -tom Block 1 . Lot 12 Formerly: Gerarda wlenwt Subdivision Name: WA Subdivision Lot # NIA Is system fill completed? Yes Is system complete'.? _NIA Is system constructed as per plans? WA. Is well drilled? _, , NIA Is well located as per plans? _ NIA Are erosion control measures in place? NIA Date: 312312004 Date: `NIA _.. Date: NIA I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. _ Date: — _ Certified by: PE _ RA_ Design Prdfessional Address: Badey & Watson, P.C. 3003 Route 9, Cold Spring, NY Lic. # Fill for expansion area is ready for Form FIR -99 nPPAPTMFTIT nr P 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV-1- % Located at WiF-sT silogE bP,%vE TownorVillage PUTtjAM VALl &- Subdivision name iJ /p Subd. Lot # _44& Tax Map 62, 1 Block -�— Lot 1,2- Date Subdivision Approved 1 /� Renewal Revision_ Owner /Applicant Name ;[c) g W WA,(, i 5 e:) Date of Previous Approval 09 h -71 p � Mailing Address �3CL uplz&i . vF. Y©nJki= 9,5 jklt Zip o 14 Amount of Fee Enclosed Building Type R E6 i Di�NTIAd_ Lot Area ).,7-_ No. of Bedrooms 14 Design Flow GPD_&0_0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage-System to consist of @ , 26-0 gallon septic tank and LAQZ. LE (ExisT JX2 Zli it Wif)3E A &kEl ioO :TR NC1+F5 6PACZD AT iO 1 O.C. Other Requirements: q jTn(ao Crg, PUMP PIT pu,PT 41 AQ M To be constructed by CASS SE E `id N5 Address �5 ggL) e4iC A/ Y i b5f g Water Sunuly: Public.Supply_From _ Address or: _!_ Private Supply Drilled by t j 0 o .A o p tj f E a5ol ji t1(. Address 'P 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 thereto. Signed: Address R.A. Date OZ /Z Lb3 License # 06 Z ;�C6 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. n By: Title: Ile. lA 69;^6w Date: o� Whitt//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 . , -. �. .�, ....,....._..,,.. � . •�poa'se�nnf'orrype.�.� .. �.. L.. ... ,... _ .�.•r ril'� °1=erniYi �•.. �N�._ � �:4f.� -.. _.� .. Well Location: Street Address: . Town/Village Tax Grid # QJ EST SHO RF— % vt PUTOAm VALLFY Map62,1 Block I Lot(s) 12 Well Owner: Name: Address: o P Q,5 o �- M v viJ S Y 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 5- gpm # People Served 6 Est. of Daily Usage L�Q gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason PROUIDL Q L U n NCB 5 r Dt L 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 N Fib Lot No. $j fA Water Well Contractor: bZo aR ,,w An1,prg- o , i �i c• Address: P UT O W VALLEY rUY 165`79 Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: 0 gyp, Town/Village 12 /A Distance to property from nearest water main: 7 1 A4 it-5 Proposed well location & sources of contamination to be provided on separate sheet/plan. Do te:.. ....h ... _� .:... Applicant Si nature: ... . y1 p _ 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. /J Date of Issue Id I /.c>31 Permit Issuing Official: Date of Expiration 9 Title: / 5s-, s, Wk ,r ff-Cel v Permit is Non - Transfe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER ®F AUM0PJ ZAU0N RE: Property of Located at T/V Putnam Valley.. Tax Map # Subdivision of John Nardso West Shore Drive 62.10 Block 1 N/A Subdivision Lot # N/A Filed Map # N/A Date Filed Gentlemen: Lot 12 N/A This letteris to authorize John P. Delano, P.E. a duly licensed Professional Engineer X or Registered Architect — to apply for the required . wastewater treatment, and/or water - supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as .promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary paper's on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health .Law,:and h,- _Putnam CounfV Sanita.ry Code. - -- - - _ - Very truly yours, - Countersigned: a &'ed: . P.E.,, # 062505 wnerofProperty) Mailing Address. Badey & Watson, P.C. 3063 Route 9 Cold.Spring . State New York Zip Telephone: 10516 845- 265 -9217 Mailing Address: 35 Murray Avenue Yonkers State NY Zip 10704 Telephone: (914) 966 -0177 Form LA -97 ,f O15 -I14 p Ss (Gcz-+.A) Fume Rtra- . (C-2NP) ��.+ tj GV - C�) 1.0 -- 1. H9 d Mon. PLASTIC-PIPE:' FRICTION LOSS PER 100-FT.-- GPM GPH 3/a" 3/4C; I Y4 wj) Ft. ; Lbs. 01. Lbs. Ff. Lbs. FL Lbs.' R. Lbs. 'Ft. " Lbs. 1 60 4.25 1.85 1.38 .60 .356 .155 .11. -.048 2 ..120 15.13. 6.58- 4.83 2.16 1.21 - .526 38 .164 .10 .04 3 180 31.97 13.9 - 9.96 4.337 2.51 1.09 -336. .21 .090 .10-.1 .043 4 �240- 54.97, 23.9 17.07 7 .42 4.21, J,83 .565 .85 150 16 .071 5 300 84.41 36.7 25.76 11.2 6.33 2.75 1.92 .835 .51 .223 .24 .104 6 360 .36.34 15.8.." 8.83- 3.84 2.69 .71 .3109. .33 .145 8 480 63.71 27.7 15.4 - A.60 4.518.. 1.99 1.19 .518" .55 ..941. 10 600 97.52 42.4 25.98 11i7 6.88 :2'.' 9 9 1.78 ".774, .83 .361 15 900 --49.68 t; 21.6 -14.63 6.36 175 '1.63 1.74 .755 20 1,200 86.94 -'37.8' 25.107: 10.9 6.39 2.78 294 1.28 25 .1,500 38.41 16.7�- 9.71 4.22:... 4.44 1.93 30 .19800. 13.62 5.k 6.26 2.72'' 35 2,100 18.17 -1.90 8.37 3.64 720 00 - i55 10 24 10-70- 46 45 2,700 29.44 12.80 1 . 3.46 '5.85 50 3,000 16.45 7. 1 5 60 3,600 7 777 7 23.48 10.21 1 I \f/,7, EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS Size of Fittings, Inches Friction r-' 1�. � �/ . a¢,,uA•fr wµ!'s.aa � x _i. - _ .- -..b .. w . e5 n. ..a'tx.. . - t- ... � .._ � rre.������llWW - ia.- .r fix . - J_ e _ w w a 11/4" rtes 2" 2� /z" I \f/,7, EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS Size of Fittings, Inches 1 /z" 3/4" 1" 11/4" 1� /z" 2" 2� /z" 3" 4" 5" 6" 8" 10" 900 Ell 450 Ell 1.5 0.8 2.0 2.7 3.5 4.3 5.5 6.5 8.0 10.0 14.0 15 20 25 1.0 1.3 1.7 2.0 2.5 3.0 3.8 5.0 6.3 7.1 9.4 12 Long Sweep Ell 1.0 1.4 1.7 2.3 2.7 3.5 . 4.2 5.2 7.0 9.0 1 1. 0 14.0 Close Return Bend 3.6 5.0 6.0 8.3 10.0 13.0 15.0. 18.0 24.0 31.0 37.0 39.0 Tee - Straight Run 1 2 2 3 3 4 5 Tee -Side Inlet or Outlet Globe Valve Open 3.3 4.5 5.7 7.6 9.0 12.0 14.0.. 17.0 22.0 27.0 31.0 40.0 17.0 22.0 27.0 36.0 43.0 55.0 67.0 82.0 11.0.0 140.0 160.0 220.0 Angle Valve Open Gate .Valve -Fully Open Check Valve (Swing) 8.4 12.0 1,5.0 18.0. 22.0 .28.0. 33.0 42.0 58.0 70.0 . -83.0 110.0. 0.4. ` 0.5 0.6 0.8 1.0 . 1.2 1.4 1.7 2.3 2.9 ± 3.5 4.5 4 '5 7. 9 11 13 16 20. 26 33 39 52 65 Check Valve (Spring) ,- 4. 6 8 12 14 19 23 32 43 58 -. Example: (A) 100 ft. of 2" plastic pipe with one (1) 900 elbow 0!10-0_)_svvi :,a 90°' -elbow - Equivalent to - 5.5 ft. of straight. pipe - -- Swing Check - Equivalent to 13.0 ft. of straight pipe 100 ft, of pipe = Equivalent to 100.0 ft. of straight pipe 118.5 ft. = Total equivalent Pipe Figure friction loss for 118.5 ft. of pipe. (B) Assume flow to be 80 GPM through 2" plastic pipe c , rl 1. Friction loss table shows 11.43 ft. loss per 100 ft. of pipe. 2, In step (A) above we have determined total feet of G% pipe to be 118.5 ft. U 3: Convert 118.5 ft.'to percentage. 118.5: 100 = 1.185-. 4. Multiply 11.43 x 1.185 c,A 13.54455 or 13.5 ft. = Total friction loss in this system. J G'00 1.1 .......... 4 6L o f 20 " 30 50:`ia"'60;'(' '"70 ;,80 0 1100�.-i 13 GPM 110 1)20.- 130 G F�40,; 0 L, 20 30 W/h. CAPACITY':�/'� CANADIAN STANPARD A�IDCIATION SP P fiz. ;`,%N APPLICATIONS Three phase:'' /2 HP— FEATURES Motor. Fully submerged in. Specifically designed for the 1' /2-HP 200/230/460V 60 Hz, 3500 RPM. Cla s-B Impeller: Cast1ron, semi -.... high.-gradeturbin6 oil.for.,..-.:. lubdicatioffand efficient heat: following -uses: - Homes . insulation, overload open,*fion-clog *th pump-, outvanes fo(mlichanical seal transfe'r. • Farms protection must be prot6 tion.balan6ed for Designed for.Continuo.us • Trailer courts provided in starter unit. smooth Operation. Silicon ''Operation: Pump ratings are • Motels. Shaft: threaded, 400 series bromi'Impellervailable as - Withilrit.he motor manufacturee-s • Schools stainless steel. an Optjdn..�F.. recommended working limits,' • Hospitals Bearings: ball bearings •`be upper and-lower. Cast Iron volute ca . i ini ::C n operate t . uously can,. d'dbri.i without damage.� Industry f Power. cord: 20 Dot. 6;r maximum efficiency. typ 6r • Effluent Systems standard length (optional % )table 2 1 RT atge adal fof. ei -rail -systems. U p0and :Bearings, p, lo'we'r.heaVy'duty ball.bearing. SPECIFICATIONS available). Single phase: ,1/3-and 1/2 HP witkiRWIiiii tikf. silicon construction. - Pump: 16/3 SJTO with three - 6'*Olde . ; d ...,Power* Cable: Severe, dui tly • Solids handling capabilities: maximum. prong plug. %-11/2 HP —.14/3 STO with We leads. �A. sea 1pq. faces Stainless steel.. rated, oil and water resistant. Epoxy sdal:o.n�motdr end • 2' NPT; Thre'd-phase, 110,*" V2-1 ! 2 ..e provides secondary Discharge size: Capacities: up to 128 GPM. 14/4 STO. with bare Shaft' barrier, In case of outer jacket t darbageandlo.preven oil: -.Total heads: up. to 123-' feet leads. On CSA listed stainless : — wicking. TDH. models — 20 foot length - d' fi L k t - three p. oc nu o design S Sk J;- STI W-1m. PI awl, yump V standard. 'Sealing against contaminants darbi,d6.--,r'otary:seat/silicon apin-tt.component.damage. carbil:16"81ationary seat, 300 on ac'Ibidehtal • reverse rotation. leakage. . .. series stainless steel metal parts, .BUNA-N. elaStomerS.* Temp.... emperatur: METERS. FEET 104 °F (40•C) continuous 90 _4 140 °F (60-C) intermittent. i. SERIES: -3885 SIZE:./' SOLIDS • Fasteners: 300 series stainless steel:. 25 eo M El 5GPM — .7. 7 RPM: VARIOUS • Capable of running dry 70 *7 SFr' El ZZ without damage to 20 - components. = 60 Ec Motor: 15 t& .7" • Single phase: Y3HP, 115. 7• or 230 V 60 Hz, 1750 RPM; 40 1/2HP, 115 V, 60 Hzt J 1`1 3500 RPM; '/2 HP =1 Y2 HP, 10 10. 30 230 V. 60 Hz,- 3500 FPM. EO' r Built-in overload with 5- 20 automatic reset. Class B insulation. 10 6L o f 20 " 30 50:`ia"'60;'(' '"70 ;,80 0 1100�.-i 13 GPM 110 1)20.- 130 G F�40,; 0 L, 20 30 W/h. CAPACITY':�/'� q. V: S ®1994 Goulds Pumps, Inc. Effective May, 19 TS Item No. Description 7 -�+ � .. Submersi ble 1 Impeller r. 2 Casing.- ,_...m _ Effluent Pump � �, -Mechanical seal- .,_ _ ..:,, -.. :t ..r•i.....+._ �.... 4: ••.,- a.resz:.. x, ...'1'�`I 4 Shah 6': 5 Motor l ; 4 I 6 Bearings- upper and 8 ' 3 ° lower I ; 7 Power cable .. tom' 8 0 -ring MODELS'. PERFORMANCE RATINGS (galli ns per minute) Order No. HP Volts Phase Max. Amp. RPM Solids Wt. (Ibs.) 1 WE0511H WE0511HN WE0311 L 115: 9.4 Order WE0512H WE0 12H WE 1012H WE1512N WE0512HN WE1512HH rde _ . WE0535N WE0735H WE 1035H WE1533H WED535HH WE1539NN WEQ312L' '� 230 `.: 4.7 (. .� � WE0311L WE031 /M WE0532H WE0732H WE1032H WE1532H WE0332HR WE15UHN /S 1750. 56. WE0312L WE0312M WE0534H WE0734H WE1034H WE1534H WE0534HH WE1534HH ' WE0311 M . 115 9.4 1 NP 'h' 'h. 1/i 1 1'h '� 1 I WE0311H 230: 3. ^' 'RPM 1750 1750 .3500 3500 3500 3500 3500 3500 WE0511H •' .115..' 13.0 WE0512H 230 6.5 5•; - - - - - 60 - 10 °x,3.80 r65 56 84 WE0538H 200 3.9. 15 . 60 '''° 57 69 90 -104- 128. 53 82 WE0534H 230 3' 3.4. 20 36 '45 60 83 98 122 48 77 WE0534H 1/_ 460. 3. 60 25. 25 50 76 92 116 45 75 WE0511 HH 115 13.0 ... il- WE0512HH • 230 1 ". 6.5 '30 38 .67 85 109 40 72 WE0538HH 200 33 3.:35 26 58 78 102 35 70 40:; -15 70 94 30 67 ... .. WE0532HH 230 3 3.3 -.. . _ WE0534HH 460 :1,65 45 ti7 "' 86 25 li4 r' WE0712H 230 1 10.0 'S0 2 57 77 18 60 3� d..:55;: ... 42. _.67 1258 WE0738H % 200 6.2 _ WE0732H . 208 -230. 3. 5.4s o '': 8 .:32 . 56 3 54 WE07341f 460 2.7• . 3500 r, 65 '' 21'' 46 51 7LI :..70..... 1.1.. 35 47 WE1012H_:. .. 230 1 � '12:5" WE1038Fr . 1 200 8.1 75: 25 43 WE1032H 208 -230 3 7,0 80. 15 40 ' WE1034H_ 460 3 ..- WE 15112H.: - 250 •i " i5 u - r a_. • , _ : ; 9A _ � _. _ .�.:.. WE1538H ` 200:_ . 10.6 1 t0 :.:. 15: WE1532H T68-230 3 9.2 120. 5 WE1534H 460 4.6 WE1512HH .1� 230 ' 1 15.0 . so DIMEI�ISIONS WE1538HH 200 10.6 (All dimensions are in inches. Do not use for construction purposes.) WE1532HH .. 208208 2 3 . . 9.2. D' h, rt,.Y4 aftd 1 HP 05' WE1534HH .60 4:6 except for model WE0712H and WE1012H - 18';1 %HP =18' METERS PEST 120 MODE*: 3885 SIZE: 3'i SOLIDS 35 -WJEI ROTATION ?1, ss •.I�Y1% - • 15 so '... KICK -BACK _ J EFFLUENT EJECTOR SYSTEM Effluerit ejector system ( Package Includes: 5 otters ease Of ordering Submersible Effluent Pump WE0311 L, 10 and installation, A Single 12L or WE0311M,12M, WE0511HH,12HH 0 0 ordering number specifies Mercury Level Control Switch o . 10 zo 30 4o ao so 70.. so 00 100 arm A2.5 (115V) A2.8 (23OV) a complete system designed Basin A1.1601S, Basin Covet A8 -1822 for most residential and - -;.� ° _•�,,.,; Check Valve A9.21) x l• .. r , , , ..;.... ......'•.t ..r .;; CAP�crv. . SWE0311L. SW E0312L, commercial sump. Order pump applications. 1M,SWE0312M, SWE0511HH, SWE0512HH. WATER TECHNOLOGIES GROUP SBrECA FADS NEWT= 3148 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. 12 BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 15 Apr 2003 File No. 95-114 W. O. # 15291 RE: Narciso TO: 0scawana Lake West Mr. Joseph S. Paravati, Jr. N/A Subd. Lot No. N/A Tax Map 62.10-1-12 Putnam County Department of Health Permit/Title/P0 # I Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT ❑ MESSENGER. W UPS-2 DAY El PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ UPS-GRND ❑ UPS-COD ❑ We are sending copies date description of document ❑2 ISets of 16 sheets - Plans F-1 I ❑ 1 __j E-1 I REMARKS: Copies to: File Yours.truly: John Narciso Desirce Narciso 40 40-05 507980 631623 21231 BADEY & WATSON LETTER of TRANSMITTAL 3.063 Route 9, Cold Spring, New York 10516 Date: 02 Apr 2003 File No. 95 -114 W. O. # 15291 RE: Permit Revision Narciso TO: Oscawana Lake West Mr. Joseph S. Paravati, Jr. N/A . Subd. Lot No. N/A Tax Map 62.10 -1 -12 Putnam County Department of Health Permit /fitle/PO # PV -1 -99 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GRND 9 We are sending: ,'/� U UPS -COD ❑ copies date description of document 174 01 -A r -03 JSevarate Sewajqe Treatment System Sheet 1 of 1 El ❑ —� El ❑ —� REMARKS: Revised as per your comment letter of 03/28/03 Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey- watson.com John Narciso Desiree Narciso 40 40-05 507980 631623 21137 LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 27.8 - 6648 March 28, 2003 John Delano, PE Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Dear Mr. Delano: ROBERT J. BONDI County Executive S Re: Proposed SSTS Revision — Narciso West Shore Drive (T) Putnam Valley TM# 62.1 -1 -12, Permit # PV -1 -99 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 t h� F rY hsi.�n ti an�hac -sho v be shown., /. The existing contours that have been changed due to the placement of fill needs to be shown in the plan view, /3. Has the ROB fill been placed in the expansion area? If so, see comment # 2. If not, � proposed fill should be shown in the plan view. V4. Please provide 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. truly yours, ee o Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj BADEY & WATSON. LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 25 Feb 2003 File No. 95-114 W. O. # 15291 RE: Permit Revision Narciso TO: 0scawana Lake West Mr. Joseph S. Paravati, Jr. N/A Subd. Lot No. N/A Tax Map 62.10-1-12 Putnam County Department of Health Permit/Title/PO # PV-1-99 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT RJ MESSENGER ❑ UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ UPS-GRND El We are sending: UPS-COD F1 copies date description of document F�i 121-Feb-03 [Construction Permit for Sewage Treatment System El I ILetter of Authorization F-41 114-Feb-03 ISevarate Sewage Treatment System Sheet 1 of I 71 121-Feb-03 IP=p data & info F-11 121-Feb-03 lApplication to Construct a Water Well 71 120-Feb-03 JApplication Fee 71 1 ❑ 1 F-1 I F-1 I L REMARKS: Z". Copies to: File Yours truly: John P Delano, PE Tel: (845) 265-9217 ext 12 Fax: (845) 265-4428 Email: jpdelano@badey-watson.com John Nardso Deshu Nardso 40 40-05 507980 631623 � 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT F'- TREATMENT _TREAT TENT SYSTEM PERMIT # ice... Located at W � s � `)� Z� ��I� Town or Village � bz-, om qALLf-:--i Subdivision name K JA Subd. Lot # Tax Map GZ. i Block 1 Lot ( Z Date Subdivision Approved `U JAN Renewal iC Revision Owner /Applicant Name G et�QDA 0 E P-97 Date of Previous Approval 0110d19 1`l Mailing Address 1–�i 2S 1,- 4�J \-�j Ty-AAA\ \AL.i.iN til Zip - - Amount of Fee Enclosed;�C Building Type 12iSi7Z4–FIAL Lot Area 1g" No. of Bedrooms 'I Design Flow GPD v(DO Fill Section Only Depth Volume Separate Sewerage stem to consist of 5C' an 6 ) Z F F Other Requirements: ),CJ-X3, Gyiu-c—�i OLWV , P i i , PyA,-p ° .4� R✓v, To be constructed by C..ASS JE�5E � 5 off, Address �v a c ►� t Ill q 1 I-S v Water Supply: Public Supply From Address .. �!. ._�':r..4o.1;. 1:' :°1 `ii _...1 is Y�F„p,,. _ j_ J� '_.�.: '- <.,�t.P. vA ...r.. '6-- `:..��.. Ui-- iy DrillC:a1 by y V�y�V'yi� %` V51 tc�i:r,.A --We I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date Mhila,7 License # 06Z5Gc�l APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharger of domestic sanitary se age only. /PP By: Title: Date: White copy - HD Fill; Y low opy - Building Inspector; Pink copy -Own Orang opy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ ..... APP>r JCATION TO CONSTRUCT-A WATER. WELL •. _ .. j, . - � • - ... ...... .� . -please print or type ._., . _.... _ .. -..�_ - . - . ...... _.��....... -- •-° PCHD Permit # ..,' . .q`i Well Location: Street Address: Town/Village Tax Grid # WiF�5-1 J- -1 l . U,V,L.i+ -4 Map Block Lot(s) I Z Well Owner: Name: Address: CTEAQ)A =CLiF-Mg -Af S LctEes — R, \J F Dom- -- Use of Well: a 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 V gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason 90040Z 9u T&GIZ L , ►0 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 Y Name of subdivision P/A Lot No. X EA Water Well Contractor: &pgelol WC. Address: 1Arh ��,ri -� L�y� N�% /U� I Is Public Water Supply available to site? .................................. ............................... Yes No �C Name of Public Water Supply: m JA Town/Village JA Distance to property from nearest water main: '> l 11A, LE Proposed well location & sources of contamination to be provided on separate sheet/plan. Date-:. � r 17 -1.61 e � T%J; Ca ...C•'_bnattir _ A � - _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _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 Ovate well driller certified by Putnam County. r Date of Issue 7 1 Permit Iss g Offici : Date of Expiration -0 Title: Permit is Non- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owneri/ Orange copy - Well driller Form WP -97 @S T BRUCE 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 September 6, 2002 John Delano, PE Badey & Watson Engineering 3 063 Route 9 Cold spring, New York 10516 Re: Proposed SSTS - Renewal (PV -1 -99) DeClement, West Shore Drive, (T) Putnam Valley TM# 62.1 -1 -12 Dear Mr. Delano: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The-above refereneed:_SSTS renewal.is.c,lbj?c± to -tb con itions fthe.letter `� tom Adam Stiebeliiig of this Department (copy enclosed). - Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, /aaltt — - Shawn Rogan Public Health Technician SR:cj •' o BRUCE R. FOLEY Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing services (845)278-6558 WIC (845)278-6678. Fax(845)279-6085 June 1, 2001 Early Intervention (845)'278 - 6014 Preschool (845)228-6108 Fax(845)279-664i John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: DeClement, West Shore Drive TM# 62.1 -1 -12, Town of Putnam Valley Dear Mr. Delano: This office has conducted a second "final site inspection" on Wednesday, May, 30-, 2001 for the above referenced project as requested. I offer the following for your consideration. A. ROB fill is required in expansion area. B. femainder of system components required, i.e. tank, pump chamber;, force main, pump,. u eseetc. .._ C. Reinsvection(sl are required. --. - - - -- Please also note applications to construct the separate sewage treatment, system and well have expired, renewal is'required. 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 y urs, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Public Health Director DEPARTMENT OF 1 Geneva Road Brewster, New York e REIM i 10509. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678. Fax (845) 278 - 6085 Early Intervention (845)278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June 1, 2001 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: DeClement, West Shore Drive TM# 62.1 -1 -12, Town of Putnam Valley Dear Mr. Delano: DOE This office has conducted a second "final site inspection" on Wednesday, May 30, 2001 for the above referenced project as requested. I offer the following for your consideration. A. ROB fill is required in expansion area. B. Remainder of system components required, i.e. tank, pump chamber, force main, pump, house etc. _.- -R- cbmpeWorl(s )- are ie- gaiieCl .�._. . _> ....�.�_ T - •- - ... �. z.:, _ Please also note applications to construct the separate sewage treatment system and well have expired, renewal is required. 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 y urs, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj ,"i. -1'aUWV a -4-"U nrnual o, w"Imurvr rk F. 01/01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAI�INSagnQI3 ~ _.:. - . _ .. -. - For- pin Trenches X PCHD Construction Permit # F \% - Located U1i lEi� ��)4741!::' lib Nz g— RsTrj "'t �, y Owner/Applicant Name 64. C Lr-M g r' TM Z . I Block _j 1Z Formerly Subdivision Name ht r/A Subdivision Lot.# J Is synem fin completed? Yuf - Due csJ- —y lo, Is system complete? r-n Ems Date art: !vCIL Is system constructed as per plans? e,16BA t-t-Y Is well drilled? 00 Date Is well located as per plans? 0 /A- Are erosion control measures in place? Y t; S I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit ns and approved pla and the Standards, Rules and Regulations of the Puttmam County Department of Health. Date: Cert�ed by: S P. ��r.�o, P. f; AQaY { PE RA i Address Lic. # Comnments:. - 1 -SSyEs Q► "QJnCC,=A7 ,W ,(oo1?-- GvMw*sn,-T— LjOrlpe_ Or o ©z I+AVF— ftz~u .bar ss Q j Si rte' t slsPVc'r'ro� o1= FOR # DAM 13 GENE Form FIR•99 TOTAL P.01 BAILEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 12 Aug 2002 File No. 95 -114 W. O. # 14035 RE: Permit Renewal DeClement TO: West Shore Drive Shawn Rogan Oscawana Lake Park Estates Subd. Lot No. M &B Putnam County Department of Health Tax Map 62.10 -1 -12 & 38 1 Geneva Road PermivTitle/PO # PV -1 -99 Brewster, NY 10509 Sent via: US MAIL El UPS -NIGHT El MESSENGER ED UPS -2 DAY El PICK -UP El UPS -3 DAY El FAX UPS -GRND We are sending: UPS -COD copies date description of document 112-Aug-02 Construction Permit for Sewage Treatment System ® 112-Aug-02 ISeparate Sewage Treatment System Sheet 1 of 1 2 26- Oct -01-7 IFloor Plans ❑ ❑1 12- Aug -02 I [Application to Construct a Water Well ❑1 109-Aug-02 ::] JApplication Fee - $300.00 money order ❑ - -7 ❑ REMARKS: Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey - watson.com 40 40-05 507978 631625 13224 BRJCE R. FOLEY LORETTA MOLIN �eaYh . Director ARI RN., M.S.N.. - .. v Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, . New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845)278-6085 Early Intervention (845) 278 - 6014 Preschool_ (845) 278 -6082 Fax (845) 278 - 6648. January 2, 2001 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: DeClement, West Shore Drive TM# 62.1 -1 -12, Town of Putnam Valley Dear Mr. Delano: This office has conducted. a "final site. inspection" for the above referenced project as requested. I offer tWe following for your consideration.-. System is not installed according to approved plan. Equal distribution is required. B. ROB fill is required in expantion area. C. Remainder of system components required, i.e. tank, pump chamber, force main, pump, D. Reinspection is required. 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 yo rs, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj a�� c i - cr�cK� 1 1• c0 tiHLtY & WATSON, PC P'UTNAM COUNTY DEPARTMENT OF HEALTH P.01 /01 DMSION OF ENVMONXENTAL HEALTH SERVICES t'lidl: Trenches_ -_ FCHD Comstruation Permit # - 1- 91 Located _ W S7 S kUi E i�Q.1VF (Y) (v) .)T'N� Rl L1=4 Ovvmcr /Applicaat Name C tZ:E DA 192LAZ rUl,, E R1 i T1M1��Block F.ot , Formerly Subdivision Name_ N k Subdivision Lot N. fV l i'`I Is System fill completed? S`bS- E� b�L� bete Z -7 00 Is synom complete? 'i? N�= Lw Aare ! Z Z� . � Is system constructed as per piaas? NO Is well drilled? N3 p Date R1 Is well located as per plans ?_ ri I A Are erosion control measures in place? j i=ce I Oct* that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Comtruction permit and approved plans and the Stain rds, Rules and Regulations of the Putnam Cottaty Department of Health. Date: Certified by: PE RA Deciga Profestiaw! address Lic. # al / Form FIR-99 TOTAL P.01 �✓ PUTNAM 0JU:7PY DEPARTMEN JF HALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI E TREATMENT SY EM PE # ��- 1. 99 rn � j Located at W E5 T` er-1 `L -A V F--- Town or Village RATW H Subdivision name Al ia Subd. Lot # Tax Map (a2 I Block i Lot Date Subdivision Approved W/A Renewal Revision Owner /Applicant Name Date of Previous Approval Mailing Address 34 W M5 Lk-NF , 1UTNAdA VW W r VV k�C(Z+—' Zip i0siq Amount of Fee Enclosed 4 ' , 00 Building Type TIC Lot Area "1 "�.-- No. of Bedrooms A Design Flow GPD e-)00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System to consist of I�2`t) gallon septic tank and 402- Ll' 2.4" Vii1toE- NP60 fa V70: j 'T C+l S;PAe-F-p pif - toi 0 -C1. Other Requirements: _iZl� -� . fit? (P,, i � ,C 00 `Ek PUPA P pc 7l ,'Pi�t►''►'lQ � To be constructed by e VAS- i ugl--. Address* R1iThld � V Water Supply: Public Supply From Address �lr• . -��` ,P,-,- »w 'l .�r�lc,- �i.:ily 1+�- a q p� m. S rr.; ....,, U r.l��p�i�"iryi�3° �vur z .,v i v Address 1 viii/ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment 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 thereto. Signed: Address R.A. Date F'r --B,ip oAb License # Z- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Ap roved for kcharge of domestic sanitary sewpepjonly. �f rtle: Date: It copy - HD Fi , Yell co - Building Inspector; Pink copy - Aer; Oran opy - Design Professional Fonn CP -97 PUTT M P UNTY DEPARTMENT, -E 11 1 LT DIVISION 00 r NVIROI EIS TA L HEA.L H'H SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type . P . -D Permlt # Well Location: Street Address: Town/Village Tax Grid # `� I (VNA 1 VAUj Pe Map 6?-,1 Block Lot(s) ( . WellOwmer: Name: Address: Pum'i V ti, 109 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 5 gpm # People Served (-- Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling "X.` New Supply (new dwelling) Deepen Existing Well Detailed Reasomtl I. i1VA- i'1v- �iPPtr 1— . -iS�l; for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No V Is well located in a realty subdivision? ...................................... ............................... Yes No X Name of subdivision Q/A Lot No. 1 Water Well Contractor: WV.MPAJ M©P v:► tt t- Address: u o- hzPA J Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: vj A Town/Village Distance to property from nearest water main: `? ; M I LE Proposed well location & sources of contamination to be provided on separate sheet/plan. l/ . bSyr.. +... Date: 2- l0 tt�, - orlicantSig- iatture 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. APPROVEID_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 Perini Date of Expiration — ^- Title: Permit is Non- Transferrable White copy - lD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �r J DEPARTMENT OF HEALTH Division of Environmental Health Services A Geneva Road Brewster, New York 10509 . Tel.. (914) 278 - 6130 Far (914) 278 - 7921 TO: All Design Engineers and Architects FROM: Bruce Foley, R.S., Public Health Director RE: Revocation of NYSDOH General Slope Waiver BRUCE R. FOLEY Public Health Director DATE: August 13, 1998 On ugust e ew York State Department of Health has revoked the general waiver,. granted in 1995, allowing the installation of residential septic system absorption trenches in in -situ soil with a slope greater than 15% but not in excess of 20 %. The revocation applies to all applications for construction permits for individual septic systems, and approval of residential subdivisions, with the following exceptions: (1) construction permits for subsurface sewage treatment systems on lots in residential subdivisions approved.prior to this date;(2)s a pror°tgthisda .and (3) applications for approval of residential subdivisions for which, prior to this date, (a) the county department of health has received a complete application; (b) the applicant has _ received preliminary subdivision apFro . f augl Cati z_prc' kc ^v?, �.departhlen' completed its field inspection report; and (d) the county department of health has provided field evaluation comments thereon to the applicant. This Department will continue to approve residential absorption trench designs proposed on slopes greater than 15 percent but not exceeding 20 percent, that have been regraded to 15 percent by the addition of R.O.B. fill. Furthermore , all references to installation of absorption trenches on steep slopes, without regrading to 15 percent, in the Putnam CountyDepartment of.Health "Procedures and Policies Subsurface Sewage Treatment and Water Supply Facilities Program for Single Family Residences ", Section (3), Paragraph (H), are invalid until further notice. BRF:cj .tt. ' 6 c ust r _ln..�..... .. - . � ate. �. . �!!a .._� s..zv ....i. �. ti. w P .K'i+: ' = 'wlei+•.� -ow9 '•:f .f:...��.�•l��r. ?.: r DEPARTMENT OF .HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 BRUCE R..,FOLEY, R.S. Acting Public Health Director 1 of 2 MEMO T0. Professional Engineers, Registered Architects and Land Surveyors submitting plans to Putnam County Health Department FROM: Michael J. Budzinski, P. E. (�- Sr. Public Health Engineer RE: 1. Slope waiver issuance from NYS Dept. of Health 2. Galley systems DATE: January 22, 1996 1. The NYS Dept. of Health has issued this Department a general waiver fro:i Section. 75= A.4(a)(1) of 10 NYCRR Appendix 75 -A entitled, "Wastewater Treatment Standards - Individual Household Systems" to address subsurface absorption system construction on sites with natural slopes of- greater than 15 percent and less than or equal to 20 percent. Absorption trenches may be placed in insitu soil for the above specified slopes provided: 1) they are placed a minimum of 10 feet center to center (i.e. eight feet separation .hetwpen- -si dewal--i s -c,-'r- Q- moral s_��' dusor �c �= �� °�:�t �: encfjes. :.: ) Vertical separation distance of four (4) feet to high groundwater and the bottom of the absorption trench is maintained, and 3) a minimum vertical separation distance of five (5) feet to bedrock or impermeable soil and the bottom of the absorption trench is maintained. 2. The NYS Dept. of Health and NYS Dept. of Environmental Conservation have provided this Department with design criteria for the design and installation of galley type subsurface sewage treatment systems. All galley systems (flow diffusers, tri galleys, and 4 x 4s) are to be considered as seepage pits and the following design criteria shall apply. T Effective Depth of Center To Effective Sidewall Area Percolati Center Gravel Sidewell Credit for Tests (in Galley Type Spacing (ft) Requirement Area Credit End Sections below_ -gr Flow 12" sides & 4 SF /LF 12 SF 24 & 36 diffusers 24 bottom Tri Galleys.. 24 12" sides & 5.2 SF /LF 15.5 SF 28 & 44 bottom 44 Galleys 24 12" sides & 8.67 SF /LF 26 SF 36 & 6C bottom A minimum of 18 feet of undisturbed soil shall be provided between parallel trench sidewal1s. The effective si'dewall area credit for end sections shall apply to the exterior ends of rows only (i.e. sidewalI ends within the interior of the sewage sys- do not receive credit). Down gradient venting of galley systems is strongly recommer to enhance the flow of air into absorption facilities. All galley type systems shal- installed a minimum of 150 feet from wells upgradient or not in a direct line of drainage. 2 of 2 A minimum of 18 feet of undisturbed soil shall be provided between parallel trench sidewal1s. The effective si'dewall area credit for end sections shall apply to the exterior ends of rows only (i.e. sidewalI ends within the interior of the sewage sys- do not receive credit). Down gradient venting of galley systems is strongly recommer to enhance the flow of air into absorption facilities. All galley type systems shal- installed a minimum of 150 feet from wells upgradient or not in a direct line of drainage. _ AUG-11 -1958 1E =19 PlYSDOH LyyEGF,L AFFRI F,S p P • ©8/013 01WERM 4RIM 1 �LVM _ DEPARTMENT HEALTH l ;s Cefte of Put is He It lhinr®rlity Piece Albarri. N" York 12M.33g9 sib A: CeE3ucna, tW" ii,� 149:�.k�, Karen Stllimke Gonrmi3sr�ner EXdet Sepuly Comrrissrr.�r� ..December 14, 1995 . Mr. Bruce A. Foley, R.S, Acting public Heatth Director Putnam County Health Department Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Re: General Waiver Request - f0NYCRR Part 75 and Appendix 75-A Dear Mir, Fo This is to respond to your December 5, 1985 letter requesting a general waiver from Section 75- A.4(a)(1) of IONYCRR Appendix 75-A titled "Nlasie'.+aater Treatment Standards - Individual Household Systems" to address subsurface absorption systemtonstruction at sites with natural slopes of > 1S to S 20 percent. The final draft of the Department's Design Handbook reflects detatis for construction of absorption trenches in "in -situ" sail with slopes of > f5 to 20 percent in- lieu -of site modification (i.e.. 5 20 percent slope changed to 5 .I& pRNAs. i lop e),.. The rtalation hip.:be'�'eai "rrs; it Jr:� >1of3, an* 1 an, die �06b- � various vertical separation distance's from ft bottom of any absorption trench to High ground Mater, bedrock, or impermeable soil" for slopes of > 15 percent to !S 20 percent is recognized in the handbook, A minimum horizontal separation distance between parallel absorption trenches of 10', 9', 8', or 7' can be maintained when the minimum vertical separation distance from the bottom of any absorption trenctr to high ground water, bedrock. or impermeable soil is 2', X. 4' or 5', respectiveiy. The Putnam County Department of Health proposal requiring (a) "absorption trench systems will be installed with a minimum horizontal separation distance of aight (8) feet between parallel absorption trenchei,' (b) "a minimum vertical separation distance of four (4) feet will be provided between high ground water and the bottom of the absorption trench,' and (c) a minimum veriicat separation distance of five (5) feet will be provided between bedrock or impermeable soil and the bottom of the absorption trench" is acceptable provided that thesis systems will be installed in in situ soil with a percolation rate of 1 to 80 minutes per inch. Absorption trench spacing means sidewali 110 sidewell of parallel trenches not center to center of absorption trench distributors. Hub- 11 -199H 16 =20 NYSDQH I EGPL AFFAIRS P.09/09 A General Waiver for the Putnam County Health Depdrtrrtent proposal far design of absorption trenches in in -situ sail with a slope of > 15 percent to .20 percent subject to the aforementioned conditions is' granted and will remain In affect until the proposed changes to Appendix 75•A and the Design Handbook are . compteteti and csnder the-General W4iive � . ax � :-.r - .. , ., .. - •- + -. ..r.. Sincerely, Richard W. Svenson; P.E., M.P.A. Director Bureau of Community Sanitation and Food Protection lat01 /9&WPR00254 cc: Mr. Tramontano Mr. Croswell ,, TOTAL P.09 s -o a .i0 Goulds Submersible Effluent Pump 3885.. CANADIAN STANDARD ASSOCIATION SP APPLICATIONS. • Three phase: %z HP — "FEATURES Motor: Fully submerged in Specifically designed for the 1 %2 H P 200/230/460 V, 60 Hz, 3500 RPM. Class B Impeller: Cast iron, semi- high -grade turbine oil for lubrication and efficient heat following uses: insulation, overload open non -clog with pump - transfer. • Homes. •farms protection must be out vanes for mechanical seal protection. Balanced for Designed for Continuous 9 • Trailer courts provided in starter unit. ° Shaft: threaded, 400 series smooth operation. Silicon 0 Operation: Pump ratings are P P 9 within the motor manufacturer's •Motels • Schools stainless steel. bronze impeller available as an option. recommended working limits, g • Hospitals Bearings: ball bearings upper and lower. Casio Cast iron volute g can be operated continuous) P y •Industry • Power cord: 20 foot type for maximum efficiency. without damage. • Effluent systems standard length (optional 2 "NPT discharge adaptable Bearings: Upper and lengths available). for slide rail systems. . lower heavy duty, ball bearing SPECIFICATIONS Single phase: 1/3 and' /2 HP Mechanical Seal: Silicon construction. Pump: —16/3 SJTO with three carbide vs. silicon carbide Power Cable: Severe duty • Solids handling capabilities: prong plug.' /4 -1 %2 HP sealing faces. Stainless steel rated, oil and water resistant. 3/4' maximum. —14/3 STO with bare leads. metal parts, BUNA -N Epoxy seal on motor end secondary moisture • Discharge size: 2" NPT. Three phase: %2 -1'/2 HP elastomers. provides • Capacities: up to 128 GPM. —14/4 STO with bare Shaft: Corrosion - resistant barrier in case of outer jacket damage and to prevent oil • Total heads: up to 123 feet leads. On CSA listed stainless steel. Threaded wicking. TDH. models — 20 foot length design. Locknut on three • Mechanical seal: silicon SJTW and STW are Phase models to guard 0 -ring: Assures positive _.3P! :f1P �fjfaf� jF?t /Cl�i� _._standard;_ ~ carbide- stationary seat, 300 on accidental reverse rotation. and oil leakage. series stainless steel metal parts, BUNA -N elastomers. • Temperature: 104 °F 40 °C contin ous METERS FEET ( ) u .s 140 °F (60 °C) intermittent. • Fasteners: 300 series 25 e stainless steel. • Capable of running dry without damage to 20 components. W s Motor: 15 s0 • Single phase: %3 H P, 115 Z . . or 230 V 60 Hz, 1750 RPM; `'1 a0 ' /2HP,115V,60Hz, J 10 3500 RPM; %z HP —1 %z HP, ° 30 230 V, 60 Hz, 3500 RPM. Built -in overload with s 20 automatic reset. Class B insulation. 10 0 0 '/N )GPM 10 20 30 m3/h CAPACITY ©1994 Goulds Pumps, Inc. Effective May, 1994 11 83885 gill N mill PH a MnQi .N.M.— IN 11111111mm 1. Emil I IN IN Emil oil �ii 40 50 60 70 80 90 100 110 120 13 '/N )GPM 10 20 30 m3/h CAPACITY ©1994 Goulds Pumps, Inc. Effective May, 1994 11 83885 FARTS Item No. Description 1 Impeller 2 Casing 3 Mechanical seal 4' Shaft 5 Motor 6 Bearings - upper and lower 7 Power cable 8 0 -ring MODELS Goulds �, 7 - Submersible �- -- Eff Went Pimp 4 8 ? 3 3885 2 - i- -1 Order No. HP Volts Phase Max. Amp. RPM Solids Wt. (lbs.) WE0311L Mercury Level Control Switch 115 A2.5 (115V), A2 -6 (230V) Basin A7.1801S, Basin Cover A8 -1822 9.4 Check Valve A9-2P WE101211 WE1512H WED512HH WE1512HH WE0312L No. 230 4.7 WE0738H WE1038H WE1538H WE053SHH WE1538HH WE0311M 1 /' 115 WE0532H 9,4 1750 56 WEC312M WE0312M 230 1 4.7 HP % WE0511H %2 115 13.0 1750 1750 WE0512H 3500 3500 3500 3500 3500 230 5 6.5 - - WE0538H 200 80 3.9 - - - - 56 84 WE0532H 15 230 3 3.4 90 104 128 53 82 WE0534H sesame 460 60 1.7 ®��� WE0511 HH Y2 115 1 13.0 30 60 WE0512HH 38 230 �--mmmm 6.5 WE0538HH 58 78 102 35 70 200 40 3.8 15 WE0532HH 230 3 3.3 6 62 86 25 64 WE0534HH 50 460 1.65 125 52 77 18 60 WE0712H 230 1 10.0 60 WE0738H 200 8 32 56 3 54 6.2 1/4, memeesCDCmmmss WE0732H 208 -230 3 5.4 WE0734H 11 35 47 460 .75 2.7 3500 WE1012H 230 1 12.5 70 WE1038H 1 200 8.1 33 WE1032H 208 -230 3 7.0 11`1 WE1034H 460 ,1y 3.5 WE1512H 230 1 15.0 meme:B� WE1532H 208-230 3 9.2 WE1534H 112 460 4.6 80 WE15121-114 230 1 15.0 WE1538HH 200 10.6 ammm� WE1532HH 208 -230 3 9.2 WE1534HH 460 4.6 METERS FE I, �I sm 351- 30 11 u 25 E J 20 r F O 0 10 20 30 40 50 so 70 e0 90 100 GPM 0 10 20 m3/h CAPACITY. WATER TECHNOLOGIES GROUP SENECA FALLS NEW YORK 8148 PERFORMANCE RATINGS (galidns per minute) Package Includes: offers ease of ordering and installation. A single Submersible Effluent Pump WE031IL, 12L or WE0311M.12M, WE051 1 HH, 12HH WtuI WLU311HH WE051211 WEN 1211 Mercury Level Control Switch Order A2.5 (115V), A2 -6 (230V) Basin A7.1801S, Basin Cover A8 -1822 for most residential and Check Valve A9-2P WE101211 WE1512H WED512HH WE1512HH Order No.: SWE031IL, SWE0312L, No. SWE0311M, SWE0312M, WE0538H WE0738H WE1038H WE1538H WE053SHH WE1538HH WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WE053211H WE1532HH ;Ceeeeesmsessssme WE0312L WE0312M WE053 4H WE073 4H WE103 4H WE153 411 WE053 411H WE1534HH HP % % %2 1/1 1 1' i '/2 1 %7 RPM 1750 1750 3500 3500 3500 3500 3500 3500 5 - - - - - - 60 - 10 80 65 - - - - 56 84 IN 15 60 57 69 90 104 128 53 82 20 sesame 45 60 83 98 122 48 77 ®��� 25 50 IN 2 30 I 38 67 85 109 40 72 �--mmmm 35 26 58 78 102 35 70 40 15 47 70 94 30 67 45 6 62 86 25 64 U. 50 125 52 77 18 60 _ 55 17 42 67 12 58 60 8 32 56 3 54 65 memeesCDCmmmss 21 46 51 70 11 35 47 .75 ssm 25 43 ��e� 15 40 m 90 mm eameee 33 100 ®® 24 11`1 ,1y meme:B� eem�aeeem ammm� oommom���mm� �I sm mimes mmI msmms miss CCms�ms 0 10 20 30 40 50 so 70 e0 90 100 GPM 0 10 20 m3/h CAPACITY. WATER TECHNOLOGIES GROUP SENECA FALLS NEW YORK 8148 PERFORMANCE RATINGS (galidns per minute) DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) D'' /3, %2,'/, and 1 HP =15' except for model WE0712H and WE1012H =18';1'1 HP =18' EFFLUENT EJECTOR SYSTEM Effluent elector system Package Includes: offers ease of ordering and installation. A single Submersible Effluent Pump WE031IL, 12L or WE0311M.12M, WE051 1 HH, 12HH WtuI WLU311HH WE051211 WEN 1211 Mercury Level Control Switch Order A2.5 (115V), A2 -6 (230V) Basin A7.1801S, Basin Cover A8 -1822 for most residential and Check Valve A9-2P WE101211 WE1512H WED512HH WE1512HH Order No.: SWE031IL, SWE0312L, No. SWE0311M, SWE0312M, WE0538H WE0738H WE1038H WE1538H WE053SHH WE1538HH WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WE053211H WE1532HH WE0312L WE0312M WE053 4H WE073 4H WE103 4H WE153 411 WE053 411H WE1534HH HP % % %2 1/1 1 1' i '/2 1 %7 RPM 1750 1750 3500 3500 3500 3500 3500 3500 5 - - - - - - 60 - 10 80 65 - - - - 56 84 15 60 57 69 90 104 128 53 82 20 36 45 60 83 98 122 48 77 _25 25 50 76 92 116 45 75 2 30 38 67 85 109 40 72 3 35 26 58 78 102 35 70 40 15 47 70 94 30 67 45 6 62 86 25 64 U. 50 125 52 77 18 60 _ 55 17 42 67 12 58 60 8 32 56 3 54 65 21 46 51 70 11 35 47 .75 25 43 80 15 40 90 33 100 24 11`1 ,1y DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) D'' /3, %2,'/, and 1 HP =15' except for model WE0712H and WE1012H =18';1'1 HP =18' EFFLUENT EJECTOR SYSTEM Effluent elector system Package Includes: offers ease of ordering and installation. A single Submersible Effluent Pump WE031IL, 12L or WE0311M.12M, WE051 1 HH, 12HH ordering number specifies Mercury Level Control Switch a complete system designed A2.5 (115V), A2 -6 (230V) Basin A7.1801S, Basin Cover A8 -1822 for most residential and Check Valve A9-2P commercial sump and Order No.: SWE031IL, SWE0312L, effluent pump applications. SWE0311M, SWE0312M, SWE0511 HH, SWE0512HH. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. 12 .I v2" i • � i �• 2n>< -Q 185 (G2►.A) 301 C � l�'S puvtiP PtTE 1--2c1 (G(ZNP) (f/o i(P I% 4 I Friction ..g TECHNICAL DATA I gg � EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS Size of Fittings, Inches 1 /z" 3 /e" 1" 11/4 11/2" 2" 21/z" 3" 4" 5" 6" 8" 10" 900 Ell 1.5 2.0 2.7 3.5 4.3 5.5. 6.5 8.0 10.0 14.0 15 20 25 450 Ell 0.8 1.0 1.3 1.7 2.0 2.5 3.0 3.8 5.0 6.3 7.1 9.4 12 Long Sweep Ell 1.0 1.4 1.7 2.3 2:7 3.5 4.2 5.2 7.0 9.0 11.0 14.0 Close Return Bend 3.6 5.0 6.0 8.3 10.0 13.0 15.0 18.0 24.0 31.0 37.0 39.0 Tee - Straight Run 1 2 2 3 3 4 5 Tee -Side Inlet or Outlet , 3.3 4.5 5.7 7.6 9.0 12.0 14.0 17.0 22.0 27.0 31.0 40.0 Globe Valve Open 17.0 22.0 27.0 36.0 43.0 55.0 67.0 82.0 110.0 140.0 160.0 220.0 Angle Valve Open Gate Valve -Fully Open 8.4 12.0 15.0 18.0 22.0 28.0 33.0 42.0 58.0 70.0 83.0 110.0 0.4 0.5 0.6 0.8 1.0 1.2 1.4 1.7 2.3 2.9 3.5 4.5 Check Valve (Swing) 4 5 7 9 11 13 16 20 26 33 39 52 65 Check Valve (Spring) 4 6 8 12 14 19 23 32 43 58 Example: (A) 100 ft. of 2" plastic pipe with one (1} 900 elbow and one (1) swing check valve. fr., n. �:ri+:ght -pipo. Swing Check - Equivalent to 13.0 ft. of straight pipe 100 ft. of pipe - Equivalent to 100.0 ft. of straight pipe 118.5 ft. = Total equivalent pipe Figure friction loss fo`r'1.18.5 ft. of pipe. (B) Assume flow to be 8.0 GPM through 2" plastic - pipe. C?7 1. Friction loss table shows `ft. loss per 100 ft. of pipe. _ 2. In step (A) above we have determined total feet of pipe to bee ft.Ze >,_f _ . C 118.5 ft. to percentage. 118.5 4. Multiply 11.43 x 1.185 r 13.54455 or 13.5 fti= Total friction loss in this system. 1 6, 07 0 1 Do 3/8 Y2 3/4 n 1 n 11/4 ff GPM GPH Ft. Lbs. Ft. Lbs. Ff. , Lbs. Ft. Lbs. Ft. Lbs. Ft. Abs. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 2 120 15.13 6.58 4.83 2.10 1.21 :.526 .38 .164 .10 .044 3 180 31.97 13.9 9.96 4.33 2.51 1.09 .77 .336 .21 .090 .10. .043 4 1240 54.97 23.9 17.0.7 7.42 4.21 1.83 1.30 .565 .35 .16 .071 5 300 84.41 36.7 25.76 11.2 6.33 2.75 1.92 .835 .51 .223 .24 .1 .104 6 360 36.34 15.8 8.83 3.84 2.69 1.17 .71 .309 .33 .145 8 480 63.71 27.7 15.18 6.60 4.58 1 1.99 1.19 .518 .55 .241 10 600 97.52 42.4 25.98 11.27 6.88 2.99 1.78 .774 .83 .361 15 900 49.68 21.6 14.63 6.36 3.75 1.63 1.7.4 .755 20 1,200 86.94 37.8 25.07 10.9 6.39 2.78 2.94 1.28 25 1,500 38.41 16.7 9.71 4.22 4.44 1.93 30 1,800 13.62 5.92 6.26 2.72 35 2,100 18.17 7.90 8.37 3.64 40 2.40.0 23.55 10.24 10.70 4.65 50 3,000 16.45 7.15 60 3,600 23.48 10.21 1 Do IA•; i_ I• � t��re:,`;�iq a `*'�,1.. }.. ^; } � 1��a �1i�` 1 - �• vt' ` ' d � • a �y (,. SOL, .ti- f:'.f• �1, din ` .. y. i, [LLD IL 4 • C = =' JL "Pe caching 21 feu from floor to ceiling, the octagonal living room in this Prairie -style plan combines the z'. lofty feel of a tree house with the warmth and welcome of traditional style. Moreover, it's the heart of an imurvative floor plan designed for relaxed living. 'The space is almost wee -trunk -like in its setting;' says architect John Allegretti. -Other rooms spin off the central room like limbs. The overall organization of the plan breaks bpace down into smaller spaces, creating zones for living." Those nines include the main -level master bedroom and. on the other side of the house, a casual living/dining/kitchen complex. Two mom bedrooms and a full bath fill the upper level of the home. A balcony between the upstairs rooms offers a breathtaking view of the living room and the yard, as do shuttered windows that open to the living room from one of the bedrooms. The foundation was designed for an unfinished bastment. Overtones of Arts and Crafn and Prairie architectural styles are apparent on the home's exterior. Wide, gddhke trim and [road overhangs create a welcoming, low- to- the-cartb look. 62 8 19N 16 , ,4/ ntcl 1.08 AC. $ 20 O A kt� I e K0.61 8. 15 8' 1 21 (� I AC. v $: U c i - 22 14 .1 i AC. 24 y1. 8 771.61 25 ' 13 n / 1.33 AC.� 8 26 7- ' rs 12Y �k 27 • rr 0 1.26 OP I � JOZ69 s is 1 30 _ 4.10 AC. 1 aF a 31 6 2.00 AC. CAL. 10 QD 32 o' 8 X66 9 1 S0 8 ao 0 / Pqc_ 33 8 8 8 I 'rJ e g 34 7 35 ri IT 36 3' ItND o ``+� 37 N 1 4 �r 38 . /J 40 39 4? 2 $ 1 42 41 43 • JJ- - Q 'Q /1I 44 'G;. �S� �� a.n y1 /r Yt• ,p 45 46 , '6 /J V • \ f1 50 \ /i �c9 25 VOtea( C;-7 Dc&u-)Oo9 CoLkf7 Dear Date - fEj34ZUM?4 101 101 015 RE: Department of Health Review of Proposed .SewageTreatment System for Property Name: &h-2AJZDN VeCLF--MZ-Y-J-► � Address: WF—c-,T SH09-tt r->w VS Town: FUTNJA� \/A-(-L� Tax Map #: 6S. Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. --.F-ealth r -Lq. fg. m q Lr(� L74.fti c -k - aC - , the. Department's review of this application, you may call the Health Department at 278-6130. Received By: Address: Tax Map #: Very truly yours, BY: A9AM 5-r1 eeeLi� Title: AI*5T-- ?UP--,Uc-Hf-?ALT'++ August 1997 0 APPENDIX E' FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER VOtea( C;-7 Dc&u-)Oo9 CoLkf7 Dear Date - fEj34ZUM?4 101 101 015 RE: Department of Health Review of Proposed .SewageTreatment System for Property Name: &h-2AJZDN VeCLF--MZ-Y-J-► � Address: WF—c-,T SH09-tt r->w VS Town: FUTNJA� \/A-(-L� Tax Map #: 6S. Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. --.F-ealth r -Lq. fg. m q Lr(� L74.fti c -k - aC - , the. Department's review of this application, you may call the Health Department at 278-6130. Received By: Address: Tax Map #: Very truly yours, BY: A9AM 5-r1 eeeLi� Title: AI*5T-- ?UP--,Uc-Hf-?ALT'++ August 1997 0 0 V APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date fw"U' 10) flag '-Reo M r.(,l. OI' Y C!r' 111v WEST stW.5 DRAME TUTW y) \Jm,r-4rN'� RE: Department of Health Review of Proposed SewageTreatment System for Property Name: CC-�� AEC.I_�Mlu i Address: wF-sr`5 v va vF- Town: FixtNAM VAu.f;q Tax Map #: G2, I C-) 1— c2 Dear Cow —t j &u=5 M" oki-kirre Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If. you have .arty _n�ies:tins _ co.ncerr►5- or,.information _.which . may . bear.- entheHea ?tl Department s review of this application, you may call the Healti Department at 278 -6130. By: Address: Tax Map #: 62-,)0 )0 — 1- 11 Very truly yours, By: A4)W Title: A9,T_ I?c.l&(c- E}fAt_-(:K "(WW- Received August 1997 d 0 25 APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER • i i U *,*':) 4Aizg. t'R7 )J i2v 't3A<t_1 -XM 0'2° t Mil 2 t v o Dear CaN71&uouS t%o .�y wjl Date ffZf'._- -kA9.Jj to/ 1OACJ7 RE: Department of Health Review of Proposed SewageTreatment System for Property Name: GE9M- 7A DECLOMF+-rr- Address: \&(t \ s j:Dp —i\1i Town: Pa,-Wftf14 J,kt.LVAe Tax Map #: G7, ID —I —I? Please be advised that an application for a Construction Permit relative to the construction - of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have_ any gti.estio- ^-s –.ro- .ire ' �j< f icy. 1 p `J+'�: '°. ' s" . Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map #: G?-.10 —I — I?j Very truly yours, By: AyR- 4 Sice,5UN(j Title: A55`>; RA?u_ Hfgkc ► "I W%f_ August 1997 1, r.l. ..Y -,,t •�.�- 1. ��:... z., rr;r � /. � r 1 r+ n. A r, S S ,� iSA' 0 `r \J St Z / ` •' % 101 "1., O N v ~ N N d ofo N . � a Z N . 01 % • i ° a a° p� Q Cot got 000°/ s 4 _ Q o x n to W/ • 0000, 030-, w/ - 00 r3 oc fz fz a Go w ' 001. 00f3 bra00 Oct cw Q �o N C9N . 1•• 1.60'Z9 0/d 21 C _ N 136000_ P/0 51 12 P/0 51 -1 - r �-a / I iJ / 5 3ie ; o c a.a�6 6.91 AC. Z3, x `7 9 , n 2.73A CAL. 1.42: Ac.CA 3.47 AC. 1.52 6C 10 Al. 7.34 AC. m 11 " s 10.02 AC. CAL. loo.e 12 y*e '? zs 6.57 AC. 8 iejA _ 13 15.44 AC. ie(1 361 /;P,/0,- _ P/0 51- -1.2e �rs 6 -- �•.. , . 4 s 35.53 AC. CAL. / 1�T.11 3. 1 +>:g 62.06 �.. O,SC.4ff',4N,4 108.18 AC. CAL. 0 i 32.09 62.09 , //62.13)1 .' e WHEAT /`.. I SLAND \ z i 62.13 �� �� ,' � � 62.63 62.64 � 6 2.71 �rs 6 -- �•.. , . r T' Town of PUTNAM VALLEY 96197 ,TAX MA:P NEW r -'. 62 1.18 Property Owner of Record TAX "MAP OLD. 45 5 -1.1 a '?HISSLINGER ROBERT & � IRIS KAPLAN : ��' , NAD'86 ft. NYSEZ'29 ft. • - ida�s6•it: ' it tsc< <y ii. � DOGWOOD COURT N- COORD: 933540 508320 GOLDENS BRIDGE NY E- COORD: 668540 630586 10526 ACERAGE: 108 LIBER: 716 PAGE: 768 ROAD or STREET: OSCAWANA LAKE WEST FRONTAGE: 200 FRONTAGE: 200 DEPTH: DEPTH: ASSM"I': $262,700.00 ASSMT: $49,800.00 Town of PUTNAM VALLEY STAR MA IYEWEW 1 62J0441 TAX MAP OLD: 47 -3-6 NAD'86 ft. NYSEZ'29 ft. N- COORD: 933070 507849 E- COORD: 669510 631555 ACERAGE: 1 LIBER: 1042 PAGE: 130 ROAD or STREET: OSC LK WEST FRONTAGE: 150 DEPTH: 350 ASSMT: $48,400.00 96197 Property Owner of Record 190 WEST SHORE DR PUTNAM VALLEY NY 10579 Town of PUTNAM VALLEY 96197 TAX MAP,IEW62101 13 ^ Property Owner of Record TAX MAP OLD: 45-5-1.3 MEZ-EY:DR PSTtBAN °& AiVNE *I % ; , NAD'86 ft. NYSEZ'29 ft. 1103 HARRITON RD N- COORD: 933370 508148 BALTIMORE MD E- COORD: 669660 631706 21210 ACERAGE: 1 LIBER: 764 PAGE: 1081 ROAD or STREET: WEST SHORE DRIVE FRONTAGE: 200 DEPTH: ASSMT: $49,800.00 0 5' vvtl Z 287 711 828 US Postal Service Receint for Certified Mail Dr. .Esteban Mezey ¢ 1103 Harrington Road ( Baltimore, MD 21210 i . lt.. - i i. 2;287 711 827 US Postal Service RPI -Pint- fnr rartifiori Moil Robert Kisslinger PO Bob ;67 Dogwon'd Court Golden" Bridge, NY 10526 in rn rn Cr Cr 00 M E ti Cn a a, a. `c a C C C a G U U 0 Z 287 711 826 US Postal Service Receint for CPr#ifiad Mail Fred MelHon 190 West Shore Drive Putnam Valley, NY 10579 Postage Postage t 0 I p5 Certified Fee 3S Restricted Delivery Fee Special Delivery Fee . Return Receipt Sho • to Whom & DatsZp Restricted Delivery Fee 7 in Postm J USQ� Return Receipt Showing to Whom & Date DeWwe n Retum Receipt U < Date, & Addr ess TOTAL P & tz - $ L EPostmark e O `C �V LL -03 J �� CL i . lt.. - i i. 2;287 711 827 US Postal Service RPI -Pint- fnr rartifiori Moil Robert Kisslinger PO Bob ;67 Dogwon'd Court Golden" Bridge, NY 10526 in rn rn Cr Cr 00 M E ti Cn a a, a. `c a C C C a G U U 0 Z 287 711 826 US Postal Service Receint for CPr#ifiad Mail Fred MelHon 190 West Shore Drive Putnam Valley, NY 10579 Postage $ d Certified Fee p5 Special Delivery Fee Restricted Delivery Fee Return Receipt Sho • to Whom & DatsZp Return R Date, & 7 TOTA ge & F Postm J USQ� 0 1. 1 e a, BADEY & WATSON Surveying and Engineering, P. C. 4QUte- 9 Cold Spring, NY 10516 (914) 265 -9217 739 -3577 628 -1800 FAX (914) 2654428 To: Adam Steibling Putnam Co, Dept. of Health 4 Geneva Road, Route 312 Brewster, NY 10509 LETTER OF TRANSMITTAL 1. _.. ",.. ..- tf:- :.:.F"- ",aai)• "1- '11i Vim". Job No: 95 -114 Re: Copies Date No. Description Sent By: ❑ x US Mail ❑ UPS ❑ UPS Overnight ❑ Fed Ex ❑ Messenger ❑ Pick -Up 1 02/10/98 Vmfruction Permit For Sewage Treatment System 1 ett r Of Authorization 1 p °cation of Approval of Plans For A Wastewaater Treatment Systems 1 02/10/98 Enviromental Assessment Form 1 12/12/97 e 'gn Data Sheet 3 02/10/98 lof 1 TS Plan 1 02/10/98 plication to Construct A Water Well 1 02/10/98 (set) eighbor Notification Data 1 02/11/98 Money Order in the Amount of $300.00 Remarks: Signed: John P. Delano, P.E. Copy to: FILE PUTNAM U €` I'Y DEPARTMEN " ) F EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner GE -AJZV 'DEGLip,7�f*j Address N WVF::P1 LAQ'- ,FL(INJ W � 1 Located at (Street) W r=ST5j- op F_PP i.VF, Tax Map. C-2-1 Block I Lot 12 (indicate nearest cross street) Municipality P,,i-njAM L,c�W_A_;� Drainage Basin ti_. �t>uZ- \AJ NZoytK SOIL PERCOLATION TEST DATA Date of Pre-soaking DGE. - i� , taa� Date of Percolation Test 9C--C• 11 IC19-7 Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Dro In Incles Percolation Rate Min/Inch A 2 1'4 &-- Tuu iq i O1 22 3 � A 3 Z W(a ° -7_,Z0 14 19 2Z _a 4 2t 22 -2� i3 1�i 22 A 5 2: ��, �- 52, 14 t o 22 '__-5 ' l _ 11 _ ! W 13 2 21.6 °- 2: 3 3 2' -40 2' 6:3 �'� i�l 22 3 4 4 2= --3:t1 i5 I�l 22 3 C3 5 '5'.14 - 3°• 0 1 1 22 ?) 1 2 3 4 NOTES: ,1. '`Tests,to berep'eated at same depth until approximately equal percolation rates are ontamea at each ;',percolation test }role. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be suliii`ited for:'revew. Deptl i ieasurem6nts to be made from top of hole. ti Form DD -97 P. t TEST PIT DATA DESCRIPTION -OF SOILS ENCOUNTERED IN -TEST HOLES ...., . ... - _a •..',.m :.- . r,..:-- ..o. - -•:, e....., _...: _:. a. •.; v..... ..._ „ , .. M .. -�- .c ..r ,..,_, . .. ,.. .a ...m .v.•... s .rxf�- ,......a:• =:. :. - .a�u.. � F .. .. - -.. <r= DEPTH HOLE NO. G.L. 0.5' 1.0' i=>5r- 13 5A�-Yp' i,o�vy 2.0' inf5t�� 2.5' 3.0' LO05F- .T 3.5' rnc���CtAuJ 4.0' Co�nPfit,T 4.5' Memw - coptv-s> HOLE NO. HOLE NO. W050 7 LOW lie TD Wl�D1UW1 •- L'yA� 5.0' 5A W'P SPtty� 5.5' 6.0' 6.5' 7.0' 7.5' iU M CvfleSL� \N trH MMMAM - OoAf -55 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered t,.3oT �t•Kc�cart; Indicate level at which mottling is observed Nn- Oe Indicate level to which water level rises after being encountered tJ11A- Deep hole observations made by: V-. GC p LLPnr-Orar—a ZA 4 v./ ,�?G Date i 7 4 9-7 Design Professional Name: Address: -b Vim'so'i P =C �q�Uti +u��i�erlr�, 0 OF Signature: is Design Professional's Seal a f 14 -16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617M SEAR ' Appendix C SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only, PART I— PROJECT INFORMATION (To be completed by Applicent:or Project sponsor) . 1. APPLICANT /SPONSOR 2. PROJECT NAME, GE Z/Ai% 3. PROJECT LOCATION: Municipality p(;Ttj:00 --, V County R'k –rNpe.-f (CiU- 4. PRECISE LOCATION (Street address And road Intersections, prominent landmarks, etc., or provide map) . 1N ES'�: � OG �i�T ''� �-� v�� Af�'�c�� �l>A�•l..`�I � iM (l.� t.:'icX���- t✓e 1N'�1z�Tiv� �l t� r?a�.� t} -it,i� �3f�•. S. IS PROP SED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: ��s.�s-in..uc- �v;•� �� �Ii✓� S•rLlc�ti.�;I+�t(� �:t�e�vt'.�•,�� ��� �i�i,L 7. AMOUNT OF LAND AFFECTED: Initially 4 1 1?— acres Ultimately i ' `Z acres 8. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 9No If No, describe briefly 9. WHHq{T IS PRESENT LAND USE IN VICINITY OF PROJECT? Ksldential ❑ Industrial Commercial ❑ Agriculture ❑ Park/For 3t /Open space ❑ Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER. GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? OYes ❑ No If yes, list agency(s) and permlVapprova13 TO,A.'Q 'Z-e�A PKW-A :rF104A0c*_ 11. DOES ANY ASPgCT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes J&No If yes, list agency name and permil/approval 12. AS A RESULT O_ F PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY. KNOWLEDGE Appllcant/sponsor name: (� '�E7 Dater' Signature: If the action is in the Coastal Area, and you are a state agency, completethe Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSME(To be completed by Agency) t A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No . AGT;. ^.`. niErF_.v r^C ?i, ^f;: ;'E �. Flc ✓:'}V _A^' .^-!z V!_n_ (_Ll FOf;4 "hl,iSTED'. ".f3TtON- :H. 6 RYC Ft, PART 1317.£? A10. •es_73i1v9 deC!arat!nn may be superseded by another Involved agency. ❑ Yes ❑ No - C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. 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 C5. Growth, subsequent development, or related activities likely to be Inducedby 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. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ 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 detall to show that all relevant adverse Impacts have been Identified and adequately,addressed. ❑ 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 oFResponsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date t 2 PUTNAM " U- T DEPARTMENT ?F EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ r Art'k AY'r c i Vrv'F 'i�`v : l)F— OF FUR .._. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Gar- APt-)A- Dec-Ligme.--ti r LQJ�� LAS 2. Name of project: GEf{AP VEr- �F- Me-Q 3. Location TN:. Rmt -JAsA �P 4. Design Professional: JbrqJ f, ��c,��. �.0. 5. Address: �"G-44 O/A'r>o!J i>-C_ - 6. Drainage Basin: zl—�J Cdto^i�..sc`i�, ?. 7. Tyne of Project: _X 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 Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 90 10. Has DEIS been completed and found acceptable by Lead Agency? ............... OJ A 11. Name of Lead Agency DEPAft - m51v`- v1F HeAAL:R( ...1.2: Js- this.nroject in an are�. ���n4Pr the control of local elan i ig _ c n na. o- i ther_ officials, ordinances ?S 13. If so, have plans been submitted to such authorities? ........ ............................... Ko 14. Has preliminary approval been granted by such authorities? ko Date granted: L4/A 15. Type of Sewage Treatment System Discharge ................. surface waters _groundwater 16. If surface water discharge, what is the stream class designation? .................... A 17. Waters index number (surface) ........................................... ............................... tS 18. Is project located near a public water supply system? ....... ............................... t )() 19. If yes, name of water supply 14 JA Distance to water supply A 20. Is project site near a public sewage collection or treatment system? ................ tsy 21. Name of sewage system N% Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... > 25. Is State Pollutant Discharge Bimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... No 27. Is any portion of this project located within a designated Town or State weddrnd? NO �.. c T.1 ! . .. .... .... .............................. ............................... 29. Is Wetlands Permit required? .......................:...................... ............................... NO Has application been made to Town or Local DEC office? ............................... N A 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, landfilling, sludge application,or industrial activity? .............................. Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: v . No 33. Is there a local master plan on file with the Town or Village? ......................... qRS 34. Are community water and/or sewer facilities planned to be developed within _15 years in or adjacent to project site ? .................... ......... ............................... �vo 35.. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map !;`Z, i Block i Lot 12 37.. Approved plans are to be returned to ..... Applicant )e Design Professional NOTE All apr I ai�oiis ^- review anu approvai o r a newSS T 'to oe located wittun the i� Y % watersiiea shad "'" " "l' "' be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 & OFFICIAL TITLES:) Qom. TOP, APP L_iCA4J—� Mailing Address:. .. ............................... tzq-. 9 Cc,Lo spv. J6. tj 105i6 PUTNAM C;OLATY DEPARTMEN'Y 01, HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Gem —Aeo A 'Dect_E mEt t Located at T/V ?QTtv",4<w{ V � 'ax Map # X2.1 Block 1 Lot i2 Subdivision of tJIA- Subdivision Lot # t LA Filed Map # " ,- Date Filed i�1� Gentlemen: This letter is to authorize J 04t1j ?, a duly licensed Professional Engineer _X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations -as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions- of.Articl- e,14S. and/or.1_4-.7 of the-Education-Law, the Publ�ic:F?ealt - -- ...` _ .. � I;aw,� arid�tlie luiriam "County Sanifary Code: _ - -�..e _ ---- .___.b_�....... -. Countersigned: P.E.,I. # 25D5 Mailing Address 16k)6�-tllt' iLT_ 1 . COLD SP149-i c State W5,yJ Cx'. -iL Zip WSi E, Telephone: Ui 14 - 2C-S` -12 (-1 Very truly Signed (Owner of Property) ` 1041 X957 ` 1V , Mailing Address: " --' State WEW 14OR K I Zip ipSi- Telephone: (_k) Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS 1..._ _RE!!IEl�SH,EF•T. T'(1R rf3 `a " "TITr�TLYA.. Lfi`.0 -1:�, .. ><....- - _ .. .:•, .:. , .. ,,.- -. ,.,t.. ......� _ STREET LOCATION �Oc" ��L . NAME OF OWNER L9 � � L 401 REVIEWED BY DATE Z 1241 q S TAX MAP # Y /N j ]DOCUMENTS Y `� i APPLICATION , PERMIT _ PWS LETTER E"R OF AUTHORIZATION W DATA SHEET (DDS) ORATE RESOLUTION T EAF z HOUSE 4A >'S - TWO SETS FEE ANC REQUES ,�4F 'I SUBDIVISION L AL SUBDIVISION tt•� (Z SUBDIVISION APPROVAL CHECKED wo PE RATE I QUIRED DEPTH URTAIN DRAIN REQUIRED STANDPIPES ,GENERAL 0 ATED IN NYC WATERSHED L #NS SUBMITTED TO DEP 15E GATED TO PCHD •• EP AP 'YROVAL, IF REQ'D DE TEST HOLES OBSERVED •- - - - �`rn "5' W 1 i Nt,551D; IF REQ'D • N, � - - APPROVAL SSDS ADJ. LOTS TLANDS (TOWN/DEC PERMIT REQ'D ?) ATA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION �)&TTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) eREQUIRED DETAILS ON PLANS E AGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE_ GRAVITY FLOW STRUCTION NOTES E IGN DATA: PERC &DEEP RESULTS 0 OURS EXISTING & PROPOSED RIVEWAY &SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: EROSION CONTROL:HOUSE,WELL, SSDS P51 �C & DEEP HOLES LOCATED ICEPRESENTATIVE OF PRIMARY & EXPANSION L'9CATION MAP XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE F UMPED, PIT & D BOX SHOWN & DETAILED USE - NO.OF BEDROOMS �LLS & SSDS'S W/1N 200' OF PROPOSED SYS. P PERTY METES & BOUNDS SE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONT ;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES TION NOTE L PROFILE & DIMM SI9bt5. VOLUME FI M EXPANSION AREA TRENCH I.TRENC_ri PRMD ' fir_ "... 64,:�'._M��Y:. 0100% PARALLEL TO CONTOURS EXPANSION PROVIDED k oON PLAN - FROM SSTS: . P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 200 FOUNDATION WALLS �15'WELL TO PL 10 ' 0 WELL, 200' IN DLOD, 150' PITS 0 TO STREAM WATERCOURSE LAKE (inc. expan) 0" CATCH BASIN, 35' STORMDRAIN, PIPED WATER 1 ' 0 WATER LINE (pits -20') 5 RMITTENT DRAINAGE COURSE 2 500' , SERVOIR, ETC. _150' GALLEY SYSTEMS 15'mi o CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% 2 ' into CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL FORM ST -2 4.0 CONSTRUCTION PERMITS Prior to anv construction of a SSTS, plans for such system must first be approved by the Department. - There are generally two types of construction permits reviewed by the Department: those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots Re uir< Q No fill or Fill Two -Feet Deep or Less onstruction Permit Application. (Appendix K) F( er of Authorization for Design Professional. (Appendix K) Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) C orate Resolution (if corporate ownership). (Appendix K) ort Environmental Assessment Form (EAF).(Appendix K) Design Data S.Noel..JApoendix.K):.- �_�._..:. (� NOTE: All submitted Department application forms shall contain original 4 ' signa s (no photo copies). Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice in New York State: These plans shall be to scale (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall ' elude, as a minimum, the' following: Propertv survey with metes and bounds descriptions and major physical features. The plan shall make reference, by note, of the survey source and in the case of lots not subject to a filed map, a certified copy of a survey shall be provided. A datum reference is to be P rovided (i.e., National Geodetic Vertical Datum 1929, or assumed/other). i r vcr House location with proposed finished floor and basement elevations s cifed. Plan and profile of the SSTS, to include 100 percent reserve area, construction details of absorption system and components including septic t , distribution or junction boxes, pump pit, dosing siphon, etc. L cation of driveways. L cation of well or public water main and house service connection. Two -foot contours of the property. If ground is to be cut or filled, both e 'sting and proposed contours must be shown. Location of any watercourses, ponds, lakes or wetlands on, or within 200 feet of property. Accurate location of all deep test holes and percolation test holes. Omission of soil testing on lots in recently approved subdivisions will be at the di 'etion of the Department. Location of all existing wells and SSTS within 200 feet of proposed SSTS arjwells. or a. note stating that none exist within.200_feet:__ Title box indicating name and address of property owner; parcel tax map identification number; property location, including street and municipayity; name, address and phone number of Design Professional; date of drawing, /cludina dates of any revisions; and scale. .L ion and discharge points for gutter, footing, storm and curtain drains. . Desi criteria on plans to include number of bedrooms, soil percolation ra and deep test hole soil information, and sizes of SSTS components. C struction notes pursuant to Appendix C. Space for Putnam County Health Department approval stamp (minimum 3" x 5" preferably at the lower right hand portion of the design plan. Location map (minimum scale of 1 " = 2,000'). t � . Erosion control measures for house. well and SSTS. r When a pump pit is proposed due to insufficient elevation for gravity flow or for dosing purposes, the pump pit design/detail shall include, as a mini m, the following: Make and model of pump to be used and operational characteristics. / One -day's storage past the high -level alarm within the pump chamber. �c�9 Check valve. Cam: Gate valve. Unions - Operating and alarm levels for pump. - Means for pump removal for maintenance. - Pump curve should be supplied with the engineering report. - The pump operating range should be indicated on the pump curve. - Pump dose volume to be equal to 75 percent of the volume available in the SSTS pipe network. - Minimum velocity of 2 feet per second to be provided in force main. - Baffled distribution box to be. utilized for SSTS. - Trench detail for force main, specify pipe type and rating, bedding and cover. Note stating, "All electrical work and. matQralc purzp1��r�ta lla'?on snail comply "tivith the National Electrical Code. " - Note stating, "All pump power and control wiring shall be made directly to the control panel without any outside splices. " - Note stating, "The pump control panel, disconnects and alarms shall be located inside the hoarse. " 8. (2) sets of house plans with title block as specified in 7.. k. above, one of h' h must accompany copy of approved Construction Permit to the Building I pector of the local municipality. Upon approval of the Construction Permit, the house plans will -be signed and stamped: "Approved For Bedroom Count Only).). I . 9. If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. ::..4 .....e -{ ,v: ^... .+f�_�"Vtiv. �sL {C!.re..orvrW a—':�<:l� c*�• _.e. .,�.�.r � ... - ».. < <Tr:�� r. -ell Permit Application, if required. (Appendix K) 1�1 Applications for Construction Permits for lots created prior to 1969 will not be / reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. - T?nsmlttuif t .�ti €aun. lets? r>aec��nfi rF,h -by the Design Professional. i)tt 12. Fee - See Appendix I. B. Construction Permit Submission Requirements For Lots Requiring Fill Greater Than Two Feet in Depth 1 -6. Same as Section 4.0 A. 7. Same as Section 4.0 A.; except for d. d. Two separate plans will be required; the title box for both plans must contain the statement, "Prelimina�Design For Fill Placement Only' Fill Placement Only . I Plan and Profile of Fill Section - Three (3) copies of this plan will be required showing the dimensions of the fill pad (i.e., length, width and depth. top and bottom slopes of periphery of the fill ) depth gauge locations. well, septic tank. house and driveway locations. This plan shall not show the design of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. All horizontal separation distances involving fill greater than 2 feet in depth are measured from the toe of the slope of the fill. The estimated volume of fill in cubic yards must be specified on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e., one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1) -copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. This plan. will be retained . for the Department's —ftil s -fb reference:.:...... After a "Construction Permit" for the placement of fill is issued by the Department, a copy of the "Construction Permit', one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building Inspector in the respective municipality in order that a `Building Permit' may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that- -he' SSTS is constructed in accordance with the approved plans. If any significant departures from the approved plans are proposed because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Same as Section 4.0 A. 13. Fill must be stabilized in accordance with fill note #1, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: a. Results of a minimum of two (2) soil percolation tests in the stabilized fill. b. Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on Lktd and does hereby certify that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is considered suitable for use in a subsurface sewage treatment system. The soil percolation rate in the settled fill based on percolation tests after stabilization is min /inch. " SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) years old, regardless of whether the same or a new owner is involved. "� �_.... 5.0 CONSTRUCTION PERMIT RENEWALS hyLs The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization 2. Construction Permit Application !s v' Ih 0 z :z S Tz� o O ' t� �3 bsin o o i Tulip _N5858 00 W_ _ 33.00' sef m AS -BUILT RELOCATION- DIMENSIONS OF SSTS 1A 44.7' DISTRIBUTION BOX 1B 71.8' DISTRIBUTION BOX 2A 46.8' BEGIN LATERAL 2B 73.3' BEGIN LATERAL 3A 55.6' BEGIN LATERAL 3B 73.2' BEGIN LATERAL 4A 64.0' BEGIN LATERAL 4B 74.7' BEGIN LATERAL 5A 126.7' END LATERAL 5B 48.1' END LATERAL 6A 120.1' END LATERAL 6B 38.4' END LATERAL 7A 113.1' END LATERAL 7B 28.3.' END LATERAL 8A 45.2' BEGIN LATERAL 8B-- 75.2' BEGIN LATERAL 9A 52.5' BEGIN LATERAL 9B 76.2' BEGIN LATERAL 10A 63.4' BEGIN LATERAL 108 75.6' BEGIN LATERAL !!A 11B . -35:4' 135.3' i END LATERAL END LATERAL 12A 31.5' END LATERAL 12B 139.0' END LATERAL 13A 28.0' END LATERAL 1,313 140.4' END LATERAL 14C 13.3' SEPTIC TANK 14D 26.8' SEPTIC TANK 15C 18.2' SEPTIC TANK 15D 21.3' SEPTIC TANK 16C 20.0' CLEAN -OUT 16D 21.1' CLEAN -OUT 17C 22.5' PUMP TANK 17D 26.0' PUMP TANK 18C 19.7' PUMP TANK 18D 29.8' PUMP TANK WD 78.8' WELL WE 101.4' WELL 5583800 E rist/ng D/str/but /on Existing 402 LF of Absorption trench 22 '0.* 6^/ Now P/n h cap $e V225. cop , found 0.2 set /n found 01 cut ' t Formerly or �tP 1 I , I ' I f I i F---- - - - - -- AJ .P, is 1 r; Sibenman former /y (L. 754 cp 1081) Pin & cap set- -, 4' Mezey f ' P + Crass � 350. —1,000 GAL PUMP TANK T op /e 4' PVC CLEAN —OUT I \-1,250 GAL SEPTIC TANK Pin B cap set N ij Cot i` 1 35P ( P/n & t Pow OF BEG, 1 1•