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HomeMy WebLinkAbout2874DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.13 -1 -53 & 62.13 -1 -63 BOX 24 �� e"IE PU'T'NAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NUTS: EXact location o°f well witn aistances to at least two permanent lanamarxs to De proviaea on a separate sneevpian. Well Driller's Nam I D a L j s `� S (�!(.�� Address: /-Km / "V g 9/p Signature: Date: i 2.1 ' � O t? White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -47 /L SiTee�`i ciurGs�: - - M1 � -T' `l'o W— village L �� y l'ix Grt0•J#." . r. MapOZ- lock Lot(s) Well Owner: Name: Address: g os-6 ) A-LA-'Vl 4 57- t o i t/, ti Use ell: f -prim 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casing_ Open hole in bedrock _ Other Casing Details Total length / 4 '2- ft. Length below grade /00 ft. Diameter in. Weight per foot ,+ lb /ft. Materials: g_ Steel _ Plastic _ Other Joints: Welded __ Threaded _ Other Seal: X Cement grout Bentonite Other Drive shoe: K' Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped X Compressed Air Hours Yield S gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyst s _ are available, please attach. ., Depth From Surface Water Bearing Well Diameter(ln) Formation Description ft. ft. Land Surface Jib f it j)plf 1V r" 0 /V o ✓ )eh- � C l+ WJ7 r !f ?.i i,o, ' ._�_ ... -:. _,: r,�i•' /.�- - - - - If yield was tested at different depths duririg,drilliiig; Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 56-5 Capacity 5- Depth 3-LC Model tD S/u Voltage 1.3 HP I Tank Type ►a.�zjbvf ') Volume Date Well Completed Putnam Co . rtification No. .� Date of Report rll310 Well Driller (signature) - NUTS: EXact location o°f well witn aistances to at least two permanent lanamarxs to De proviaea on a separate sneevpian. Well Driller's Nam I D a L j s `� S (�!(.�� Address: /-Km / "V g 9/p Signature: Date: i 2.1 ' � O t? White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -47 /L N CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # Located a S D PA VE- Town or Village Owner /Applicant Named -( 6& L' y) Tax Map & 2' 13 Block i Lot 5- -3 Formerly 10 G 5CO 12-5 U t /E Subdivision Name 02�4 � z4 Subd. Lot # nV S 13C.UGs� Mailing Address ?j T C�iV11c®S D}'d b� i PV T Nf f l�i -b` j % Zip 10S-7q Date Construction Permit Issued by PCHD 3 Separate Sewerage System built by Address 9h1�LG19% 'b , L /U 1W d Consisting of 4 0Q 0 Gallon Septic Tank and 3 (,�� Z� T T72�h�11 Ch' Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by- -Ti) jLL, (s Address iLm o tj I� ld;,r....,...Y.�t.,d: Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam C unty Department of Health. Date:) 7/ 1 0 Certified by P.E. 4 R.A. Address/ 24 Qf / &M ,, dSS�"', )1 Z. S -63 License # S 3z-% 7 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the. judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT iNux ';: bxact location of well wim atstances to at least two permanent tanamarKs to oe proviaea on a separate sneevptan. Well Drillees Nam TO 2 t% S14 +- s Cys Address: /1-9 ClAl X Signature: Date: J2_13 1 Q q White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 S� .- A- f �� s T� GAS r�t� Map . / lock / Lot(s) S� Well Owner: Name: Address: 100, k i�ly $ A! l-�. Use ell: - -pri 2- secondary -)-- Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing _)!�_ Open hole in bedrock _ Other Casing Details Total length / a 2 ft. Length below grade j U ft. Diameter Lin. Weight per foot fl_lb /ft. Materials: x— Steel Plastic Other Joints: _ Welded � Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: -,< Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped j Compressed Air Hours Yield S gpm Depth Data Measure from land surface- static (specify ft) 29i During yield test(ft) 3S,4) . Depth of completed well in feet i/O. , Well Log If more detailed information descriptions or sieve.3nal�,,ses...., _ are available, .... please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface f. ?/ H/l®p. 0 / if 31y /0 ,V(7 '�. -... V jTe_ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 57i.,b Capacity Depth _32.0 Mode15� /v Voltage 2 3 � HP f Tank Type W fro I Volume Ll Lt Date Well Completed 41Itiitq Putnam County Certification No. 003 Date of Report 12-1310Y Well er (signature) -- iNux ';: bxact location of well wim atstances to at least two permanent tanamarKs to oe proviaea on a separate sneevptan. Well Drillees Nam TO 2 t% S14 +- s Cys Address: /1-9 ClAl X Signature: Date: J2_13 1 Q q White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 S� SHERLITA AMLER, MD, MS, FAAP (_- 'nmmicsznnerofHealth -..... -- _ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 E911 ADDRESS VERIFICATION FORM OWNER'S NAME: BELLAMY TAX MAP NUMBER: .6 2.13 -1- 5 3 E911 ADDRESS: 1 Tamp c 17ri ve Putnam Vall AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 10 / 2 0 / 0 9 ROBERT J. BONDI County Executive. 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 addressverification Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 V-1— eoA r% 'f74.4n 1 A L'.,.. /4A r% 774 44Cd Q PIT TNAM COUNTY DEPARTMENT OF JEA.LTH . D STOW Off' EN�ONMENTAL REALTH SER VICES GUARANTEE ®p suEs DACE SEWAGE TR,?ATMZNT SVSTIEM Owner or Purchaser of Building Z-k")-e— �1� 0c'" Ck Building Constructed 31 gNa vevtj j 4 Location a Street 4jL,13-- --r2 .Taxmap Block Lot Tow Village � z v)c ti ���y _OScc'waby i-{ L1ToQ f1 rl �, 0 ubdivision Name Building Type Sub vision 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 ofthe Putnam County Department ofHealth, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition P'°ay_ part oB sM'd d by me..Which .fails to opeme for s perm of: �vo. years .._:. immediately followirsg the date of approval of the "Certificate of Construction Compliance" for the sewage treatment systems, or any repairs made by me to such syst M except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undef'signed 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 systems. Tested: month / Day 30 Year a c� Gene ontractor (Owner) - Signature Corporation Name (if corporation) Address: 311'�rL-v r Dr I —IV, C�'ku State tv Zip —ASP Signature: Title: z PCs.z Corporation Name (if corporation) Address: -13 Y C _I �ro�h►`ll / �J� LT h State Zip Yo Fam GS-97 Lama Fraae services, onc. 335 Clapp Hall Road LaGrangeville, NY 1 2540 (845) 656-1960 or (845) 494-1904 Nz r.`.m CU�a��N � EEC ENE INS i/a�_L�,1 -I��N ���F Tf -iE S�E'1 IC S`r'�1 EM FOR 2 YEARS AT 31 JAMES STREET, �N PUTNAM COUNTY, NY EXACT CD° LOCATE ON OF STAKE OUT AND ACC OURDWG TO --- -- --- ----- Louis A. Panarello, President .L -2? _ Date F ,.. ....... _ . c o _2004. i?.: .......,... _ _ . L_ _ P. YML ENVSROMMENTAL SERVICES 321 hear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 . Albert H. Padovani, Director LAB il: 1.904943 CLIENT #: 114 NON STAT PROC PAGE: 1 of 2 r {-- r r- r r-- -- - r r _. - -I- -r ---- r r- «-- - «- b --------- TORLISH & SONS DATE /TIME TAKEN: 11/24/09 10:15 BOX 271, 45 MAPLS AVE. DATE /TIME RECD: 11/24/09 10:50 ATTENTION: nVANE 'IVRLISH REPORT DATE: 12/02/09 ARMONK, NY 10504 PHONE: (914)- 273 -3448 SAMPLING SITE: 31 JAMES DRIVE, PUTNAM VALLEY, NY SAMPLE TYPE..= POTABLE : TANK PRESERVATIVES: NONE •COL' D. BY. D.. TORLISH.. ......... _. ....._ .. ^._.._ .__ ...... . TE9IPE1�11CI't�RE:::' c &C' - .NOTES ... : COLIFORM METH: MF r rry. y- r---------- .- r- rr-- --- ~---------- --«. V». YM« »---- r---- r-- �- r-- «---- r- -- ---- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/24/09 MP T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 11/24/09 LEAD (INS) cl ppb 0 -15 ppb SM 18 -19 3113B 11/25/09 NITRATE NITR.OG 1.35 MG /L 0 - 10 SMIS- 204504NO3 11/25/09 NITRITE•NITROG <0.01 MG /L 1.0 MG /L SM18- 204500NO2 11/25/09 IRON (Pe) <0.060 MO /L 0 -0.3 mg /1 SM 18 -20 3111B - 11 /25 /09 MANGANESE (Mn) .00.010 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 12 /01/09 SODIUM (Na) 24.8 MG /L N/A SM 18 -20 3111E 11/24/09 pH 6.9 UNITS 6.5 -8.5 SM18 -20 4500HB 12/02/.09 . HA4DNHSS,TOTAL 236 MG /L N/A SM 18 -20 2340C �rx .Y.nas ! e oc n .:ujr,. /r. . _ .....t��tn '_ • '.',:. ..SM. 19- 20.. 2 +20R.. 11/24/09 TMIBIDITY (TUR 1.0 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: FAX MFTC a Coliform G This result indicates that the water (wag) (was not) of a satisfactory sanitary quality according to ew Yc rk State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Fe/Mn If both iron and manganese are present, their total value combined ahall not exceed o.5 mg /L. Na No limits for Sodium are proscribed_ Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. Pox those on a moderately restricted'diet, a maximum of 270 mg /L of Sodium is suggested. ST F;".:;d• ym MWIROMMUL SERVICES 321 AeAr street 'Yorktown Heights, N.Y. 10595 (914) 245 -2800 mart N. Pradavani, Director g,Ag 1.904943 CL'LXMT #Ba 1.14 STAT PROC PAGES 2 of 2 - �errr ♦- -- r— V4V --M b- ---- -- t— O.Vtl - ----- - -- --- --- yam... --- q-ft.... a.V b--- ---- - -ymAr `1'ORLI9N & SONS DATE/TYM$ TAM.- 11/24/09 10:15 BOX 271, 45 MAPLE Avg. DATE /TINB RECD: 12/24/09 10;50 ATTMITI ON: DWS TORLISH REPORT DATE : 12/02/09 A om, sy 10SO4 PIK=: (914)- 273 -3448 SAMPLING SltN: 31 CANES DRIVS, PUTNAA VKUAY, NY SAMPLE TYPE-- POTABLE : TANX PRESMtVATIVES : NONE COLD BY: X. T'ORUISN -1 PERATURE:'. = NOTES...: COLIFORI+Q Ngii: My rV---- o.V- ---- VMb--- --- ----- --- - - -4.. Mb�.V VVw.b- ----------- - ---- -- -- v-W-- ---- -- e. DATE FLAG PROCEDURE RESULT NORVAL - RANGE METHOD PFD PH SCALE Ili. WATE t RMES ?RON 1 -14. MASUR.E NUT OF pR IS ONE OF THE INPORTALIT MW F=UMLY DSED TESTS IN WATER CHEMISTRY. WATIM WITH :' -. LOW PH NIGHT $L CORROSra TO MBTAL PIPES AND F HE NORMa RAN OF PR 19 6.5 TO B,5. BEd TOTAL HARDNrSS IS DEFINED AS TUB SXDM OF TIDE CA mum & mAwwrum COMCMRATION, BOW UPIMSSED AS CALC:EXM CAnONA'TE, Iiq MG /L. nM EIF►RI M-SS My Yt.ANGE FROM 0 TO HUNDREDS OF MA, DEPODS ON THE S=CE AND TRFATPMT TO VWCH THE WATER HU BEEN SUBJECTED. SOFT STATER: 0 -70 XG /L VRRY BMW VATM: ADOVS— 300, MODERATELY- NERD- WATER :„ 70 -1� 6 MG /� . , Md /b °� XI'"l .Pig33 . L %TER -.D4/L (1 grain/" gallon - 17.2 KG /L) THE ABOVE TEST PRMDUM MEET ALL UQUIREDMTS OP NEIAC, AM RELATE ONLY Tn THESE MPLES R SCRIM BY Tm L" Ad SUBMITTED BY'° •riWd i.V aUI YR. . AS P Director WAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 1.904943 CLIENT #: 114 NON STAT PROC PAGE: 2 of 2 TORLISH & SONS BOX 271, 45 MAPLE AVE. ATTENTION: DUANE TORLISH ARMONK, NY 10504 DATE /TIME TAKEN: 11/24/09 10:15 DATE /TIME RECD: 11/24/09 10:50 REPORT DATE: 12/02/09 PHONE: (914)- 273 -3448 SAMPLING SITE: 31 JAMES DRIVE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE TANK PRESERVATIVES: NONE COLD BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE 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 MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 Grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONLY T THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 G ._. Albert H. Padovani, Director LAB #:-1.904943 CLIENT #: 114 TORLISH & SONS BOX 271, 45 MAPLE AVE. ATTENTION: DUANE TORLISH ARMONK, NY 10504 NON STAT PROC PAGE: 1 of 2 DATE /TIME TAKEN: 11/24/09 10:15 DATE /TIME RECD: 11/24/09 10:50 REPORT DATE: 12/02/09 PHONE: (914)- 273 -3448 SAMPLING SITE: 31 JAMES DRIVE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE TANK PRESERVATIVES: NONE, COLD BY:.D. TORLISH TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE PUTNAM 11/24/09 11/24/09 11/25/09 11/25/09 11/25/09 11/25/09 12/01/09 11/24/09 12/02/09 12/02/09 .11/24/09 FLAG PROCEDURE RESULT NORMAL - RANGE METHOD CNTY PROFILE MF T. COLIFORM ABSENT /100 ML ABSENT LEAD (IMS) <1 ppb 0 -15 ppb NITRATE NITROG 1.35 MG /L 0 - 10 NITRITE NITROG <0.01 MG /L 1.0 MG /L IRON (Fe) <0.060 MG /L 0 -0.3 mg /l MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SODIUM (Na) 24.8 MG /L N/A pH 6.9 UNITS 6.5 -8.5 HARDNESS,TOTAL 236 MG /L N/A ALKALINITY (AS 86.0 MG /L N/A TURBIDITY (TUR 1.0 NTU 0 -5 NTU COMMENTS: FAX SM 18 -20 9222B SM 18 -19 3113B SM18- 2045.0ONO3 SM18- 20450ONO2 SM 18 -20 3111B SM 18 -20 3111B SM 18 -20 3111B SM18 -20 4500HB SM 18 -20 2340C SM 18 -20 2320B SM-1.8- (213..08.)_......_.._ COMMENTS: MFTC a Coliform = This result indicates that the water (was) (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Fe /Mn If both iron-and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. SHERLITA AMLER, MD, MS, FAAP _.Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 9, 2009 Jack Karell, Jr., PE 12 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Scorsone James Drive (T)Putnam Valley, TM #62.13 -1 -53 The above referenced separate sewage treatment system can be backfilled. There are no further comments to be addressed at this time in reference to the open work inspection. If you have any further questions, please contact me at (845) 278 -6130 ext. 43261. ,._ ......,.. GDR:lm Sincprel. Gene D. Reed Sr. Environ. Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 jr w -LY9A4T4L a,rVULN T X jutWAKEM"T OF EMALM IDIVIRON OF FXVMONMMAL MALTH SMVICES -ATTENMN —' GUEST FOR F�AT �SP Fbr: All informationpust be fully oompleted prior to any Trenches. S inspections being made. PCHD Construction Permit 0 Located: W-4 Ownex/Aj Formerly: Is system fill completed? Is SYSWM COMPI&W-7 Is system quoted as per plats? T—'S I -s<On - t drill 7 Is �Well'T'aciteias per plans? Are erosion coP 4m ms in PLwe7 Date: Date: Date I certify that d, at the above premises has beenconstwted andl bgve inspected and varif*d. aid n accordwee with the issued PCHD Construction Permit and approved 01W, Rules. and Regulations of the Putnam County Department of, TJL-, Certified by: I�A im Prof Desiga Profes io rezi 63. Comments:. /-Ou- - 4 ;4 i '& F VS--4 lr(p - 1 ?66 FY.T.W.11FIrpm H5 TNAM COUNTY DEPARTMENT OF HEALTH VISION OF ENVIRONMENTAL HEALTH SERVICE CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV — C ( Located at T�%G S Q�� �� Town or Village fl✓r/i�%}'�% Subdivision name �1 �� i¢�S Subd. Lot # z L2-1 � Tax Map &24 3 Block Lot 5- 3 Date Subdivision Approved _ 7"(1 z5 Renewal Revision Owner /Applicant Name SG6TS�j1� Date of Previous Approval Mailing Address 737ye X S g, tea,.hAaQ C N zip S'i�/ � Amount of Fee Enclosed !# Soo, a O / Building Type tU 6V,0 ?rAbN4 Lot Area. 4 ArN ✓of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 00 D gallon septic tank and 33 ( LF Other Requirements: To be constructed by —j0 �� ,� &7E72411A4WAddress Water Supply: Public Supply From Address ...o . Supply ` _ _le _y ... _ ....._... _ ._ _.. �... r. Private �lliilled b ,(� Ci+� 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 .E. ZX1 R.A. fdA/, Al % License # Date ///"/,17- S'3L7 7 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 p rmit. Approved for discharge of domestic sanitary sewage only. Title: bW Date: 3 i copy - HD File; Yellow copy.,:- Buildi Inspector; Pink copy - Owner; Orange copy - Design Pro ks sional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES � 6' rr T 4 j •m v � s' nnv. Q°.l:�i' ° 'I please print or type PCHD Permit # V —® Well Location: Street Address: Town/Village Tax Grid # I � �".� J P��-I c/ LIVif Map f B I o c k Lot(s)S7 Well Owner: Name:,9_�S'ene Address: t,c.,(-�i'� I POO 6X s _� if I A44 aC /V Use of Well: Residential Public Supply Air /Cond/Hea Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served Est. of Daily Usage ! 6 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well 'Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ..... ............................... Yes___ ,K No. Name of subdivision G Lot No. 3 Z 2y Water Well Contractor: r Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Propose well location & sources of contamina 'on t be pro 'ded on separate sheet/plan. `A I� AA -D' t%'. Q QLU1G;.�..... 0 . __ I PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 3 F Permit Issuing Offic' I: Date of Expiration Title: 5� a &Z'_ Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fnrm WP -Q7 M W4 , , c 4 4''i 2 ta rr, ?. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVIS1.ON OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at VG1!(e Tax Ma # %• j Block Lot J TN � p 3 Subdivision of SCQ(tJp/lGt �� <(4]J- Subdivision Lot # Z� 3Y ` t z 3 Filed Map # 11S" G Date Filed 912,(11 S Gentlemen: This letter is to authorize -76, ✓% a duly licensed Professional Engineer T or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and /or water supply systems in conformity with the provisions of Article 145 and/or 147 of the. Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersiane; P.E., R.A., # Mailing Adddrress . 1 K i� �U 01aX . State zip Zj �0 State` Zip Telephone: Q l T F7f-7H� Telephone: q4q ZO Z 30-7 C1 PUTNAM COUNTY DEPARTMENT OF HEALTH Di ISiON OF EN VfROlo MElNIAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM Name and address of applicanf.Z705"�G/o/4 �0�2S6N�' Z' c L ��• 0e c S3 2. Name of Project: �Cp�Sa1V�,� A�! 3. Location: T /V: (/J�'.�/ CT� 4. Design Professional: %P -- L4� ` 9V - 5. Address: /L/ C(J - Al 6. Drainage Basin: �(j�(/r�-7Z h4�/y j // �/6ri'L /��%% �O/� �r /Z` 7-V 7. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No Type Status (check one) ................ :........ ............................................ Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............. Yes/No 11. Name of Lead Agency 12. Is this pr sect it an area under the control of local planning, zoning, or other offici -ls, ordinances? .................:........................................... ............................... Yes/No A10 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No --• 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of sewage treatment system discharge ........................ surface water x groundwater 16. If surface water discharge, what is the stream class designation? .............. I........... 17. Waters index number (surface) ............................................. ............................... 18. Is project located near a public water supply system? . ............................... Yes/No AJ 0 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .......... Yes/No /1J 0 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ............................. ............................... &00 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No 26. Has SPDES Application been submitted to local DEC office? ......................... Yes /No Rev. 1 1/02 Form PC -97 Pg. I of 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No /V 2`8. Wetlands ID number .................................................................. ............................... — 29. Is Wetlands Permit required? ...................................... ............................... Yes/No A)O Has application been made to Town or Local DEC ........................... Yes/No 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No fJo 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: N� N4 33. Is there a local master plan on file with the Town or Village? .........................Yes/No 34. Are community water and /or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............ ............................... ..Yes/No N D 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No ND 36. Tax Map ID Number .............. ............................... Map &Z• 13 Block / Lot S3 P43 `7 ,. - ' Apprpy, d plank A eL_.f,e_ __ oyne. -- _ .Apn;icant J: seen P►_Qf��si;�ilul - _ to ret d to ...� ............. . NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of pei jury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. _ SIGNATURES & OFFICIAL TITLES Mailing Address: ................... Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH V.C..71.�.�81 ..;.:TT� 7.�r =i -R T.�V•1 W�.T Tt..� 1[ F.gTH �. r �.i'� ♦ - _. L- "'I S� i , 1 E �i ,r::I�R` — P4TMvi W DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner C_ C0A)5T4VQ:fQ Address P0136Y �C l Located at Street �j•%n ES y Tax Ma (oZ. , —� Wry/ (Street) p 13 Block 1 Lot S (indicate nearest cross street) Municipality PV r Watershed "W oz b�a;-,f / I4 Gg2- SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test ole No. Run No. Time Start -Stop ElainTime (M.) pse Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 2 150 ct0 S- 3 v Z31 2� 4 5 2 3 2,& 31Y 4 5 ®3 1 n (� 33/� 2 1357 22 -L 3 3 , 4 5 f% NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. S 1 min for 1 -30 minhnch, S 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 11g. I of 2 0` 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered h'e Deep hole observations made by: ��-�e_� �`� «� R 4 14, Date. y If Ise Design Professional Name: AA &_44- /jx� Design Professional =s Seal \kA R Q< ... `. Np 5321rf TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. �/ HOLE NO. D 7-- HOLE NO. D3 G.L. 0.5' �r 1.0' so/dif loam ,_��� _� Sa _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered h'e Deep hole observations made by: ��-�e_� �`� «� R 4 14, Date. y If Ise Design Professional Name: AA &_44- /jx� Design Professional =s Seal \kA R Q< ... `. Np 5321rf 617.20 SEQR Appendix C a State Environmental Quality Review SHORT..EWRON!► ENTAL ASSESSMENT FQRrvi. For UNLISTED ACTIONS Only Part 1 PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: ` -r 2. PROJECT NAME: 3. PROJECT LOCATION: Municipality i(r�` `` { County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) 5. PROPOSED ACTION IS: flew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Ca� ST�VL -:';��i P.�A � �" � S � iLP�� Ff}-d� l �.•}' � 1��� ,fl�'A �°�`7�d1� � 1!t/.��,.C- c�' � ��'�. / 7. AMOUNT OF LAND AFFECTED: Initially 9? . --*� acres Ultimately ®x'? acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 'kes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? rrrpe�r.61 . �lAn[�r �ltural. . )P,+rklFo °FSt,C1ne�� , _.. / Describe: ,� /l� L. J�j k��� �p� ' t WAA1 � 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? *es ❑No If yes, list agency(s) name and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes fiMo If yes, list agency(s) name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes o 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY K� LE rdEE r Applicant/Sponsor L CfI /�-�2 - "fl✓G f�L2C�� Date: name: Signature: If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER of PART It— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 817.12? If yes, coordlfTale the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE, COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration C1 Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2 Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly. C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4: A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In 01.C5? Explain briefly. Cl. Other Impacts pncluding changes In use of either quantity. or type of energy)? Explain briefly. 0. IS THERE, Of I5:THt if%' LinEL`r TC, syz; � O:' PSY P. i.1 EL- ?CF:I?fti3 N7JAt i_1OV RSE�ENVIRGNMENTAL i-MPAa?8? ❑ 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 (Le. urban or rural); (b) probability of occurring; (c) duration; (d) Irreverelbility; (e) geographic scope; and (Q 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: Print or Type Name of esponsi a Officer In Lead Agency Signature of esponsl a Officer in Lead Agency ame of ea Agency Date 2 Title of esponsi a Officer Signature of Prtparef III different rom responsible officeo iii.�wctt'J�0.`�..i�sa,?s'�.i�r i� lt�" �1r. u:. `I'S•.t._. }.�YY:tc.`,vSSsdh,..c as, .. - � , -.. - fl t��� +vt6� 1( 4 {�1s¢(�4(µa'�yVr41 +iW {YltlS +il� J q °ti :if 1 l ry£1 hfs FFFFY�' Ir� ,t5� Y tl C l:k" „�st� iF ���ltn'n�,I4+ ttJtY -"'j iNp,{5�•ii+tatl "'> 7 r� vl a I �1i +'k+ lllrl` yl•T•+•v t �}4 5 r� malt >++ - ,� 1 ] �ti t E ' ni`31 �f..+. >r• is ���i � v�'t1 F'¢�y +'1$! v Y��j� YU Ih�• li t�(ti�vl hJr i i f -.. i�f ,iy ��jt p`i tlx'kt4A.tYf }Gtr aa4.. ! f +ty� at dlt ia.a'�!K + y i s. .trw e E ��r�lir }9G- .s 3tY nnf vn r +.,�•.. s •j,.t�t ' .t $ 6 •+ > J,. .�. ` .-+-.: ... .. r zz5 r� �. iin s l: •f t 9 ,� @ {ll'yl ��jr u Sy . ��'`Si l5v a. �� � �i'}� f.J*'io + +� .s,itGlt tf•�s �r e A j,� v''' l+w \ 0 y . 1 +� -`^ 1.. ��• 1. 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Is delivery address different from Item 17 ❑ Yes & If YES, enter delivery address below: ❑ No 3. a Ice Type Certified Mail 0 Express Mall ❑ Registered 0 Retum Receipt for Merchandise - ❑ Insured Mail O C.O.D. — ❑ Yes m Complete items 1, 2, and 3. Also complete Item 4 If Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. _ 1. Article Addressed to: QQ ,{ V HLAJ-a, V eu✓ lD• . I(Jocj,,, VgHey, ))y / 05 7�/ A. Signature ❑ Agent D. Is delivery addrels different from Item 54 0 W If YES, enter dei;,'my address below: ❑ No Nj 3.,S.e/ry,ICe Type W �.enitled Mall t O Express Mall /❑ Registered +, ❑ Return Receipt for Merchandis ❑ Insured Mae L t ❑ C.O.D. ❑ Yes 2. AM _(Ire 102595m-M -1540 PS Fo.... Complete Items 1, 2, and 3. Also complete item 4 if Restricted Deliwery Is desired. Print your name and address on the reverse so that we can return the card to you. p Attach this card to the Back of the mail lece, or on the front If space Xnnits. A. Sign 0 Agent X ❑ Addressee M Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. G Print your name and address on the reverse so that we can return the card to you. o Attach this card to the back of the mallpiece, or on the front Ifs ace permits. - „RG ved by (Printed Name) �_ihJ 1�'V� f v iv to of livery 1. Article Addressed to: MA'Scam Michael Pa��eE� 1'Ylciur22t'1 3 � I� log (i 5f�n V � e l,o �� . I -�. Fa" Va I l eY (,� D. lad elivery address different hors Item 7 C3 Yes if YES, enter delivery address below: ❑ No Article Addressed to: r �551ey �� P '.yr�nfl2.l� Ve�:`t.rgZ' ,5 14t c a y) p `Vi e(_.l] Dr, 1 / hj'i, /1� ',L4K�VV1 V� I lC A /'I / I 1 3. Serve lope ,.>I�Certmed Mao Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mall ❑ C.O.D. 0 Y 2. Ad B. 102586-02.M.15 ❑ Agent D. Is delivery address different from Item 17 ' ❑ Yes If YES, enter di' ery address below: ❑ No 3.ce 7yp0 Certified M }:1 ❑ Express Mae Registered? ' ❑ Retum Receipt for Memhand ❑ Insured Ma.1� ❑ C.O.D. �__..,..... „ -f._ �c.,.... c..� ❑ Yes At • 1 R i rt R' ' PS Fc,.,, loes9soz -M- 1 i -------- � _ 102595-02- M'1540 f` :omplete Items 1, 2, aid Also complete i SI re r• /� a Complete Items 1, 2, and 3. Also complete A. :em 4 If Restricted , a id Is desired. I , / ❑ Agent item 4 If Restricted Delivery Is desired. X , ❑ Agenl 'riot your name end e�idrrss on the reverse L a Print your dame and address on the reverse 0 Ada, ❑ Addressee o that we can return. to card to you. N by ( Printed Named C. to of alive that we can return the card to you. B. bynted Name) . D to of ,ttach this card to the k of the mailpiece, .� I ry 0 Attach this card to the back of the mallpiece, -r on the front if spac:7 permits. T/ / or on the front if space permits. �• IN dress different from Item 7 Y D. Is delivery advmv different from hem 17 ❑ Yes rticle Addressed to: 1 ^Anlcle Adtlressetl to: -- If YES, ante delivery address below: ❑ No It YES, livery address below: ❑ No i T; i. a T r Feb 25 08 04:01 p ,ASSESSOWS OFFICE_ .�_...._ _ TOWN OF PUTNAM VALLEY SHERYL KEATING Assessor February 25, 2008 Re: 62.13 -1 -53 and 62.13 -1 -63 Town of Putnam Valley To Whom It May Concern: PA A request was submitted to me to combine parcels 62.13 -1 -53 and 62.13 -1 -63. 1, in turn, submitted the merge to the County Director, County of Putnam. When I spoke to the County Director today he stated to me that this merger would be done prior to March 1, 2008 and a new tax map would be issued to me. Since both parcels are vacant land either tax map number would have been appropriate to use, however, I picked tax map number 62.13 -1 -53 and I can only assume that the County will do the same. If you should require any additional information, please do not hesitate to contact me. Very truly yours, SIM RY TING Assessor 265 Oscawana Lake Road Putnam Valley, NY 10579 845 -526 -2517 Office 845 -526 -1077 Fax EE3.29'2008 09:08 8 02284030 REAL PROM,Y _ 02531 P.001 45 -' N 19A o) co Q/ QQpp 55 208 -- - - -�. { 100 M C 7A clq 100 6 V6 V6 �q 2 co 1 B co �jp ■� 1 P 21.A 6A I 0 c 100 �_�_ ado 22B 5B 00 22A °� 5A 1100 � 1 23B 4B 23A 4A 248 3B 5� 22 r 24A 3A C) 100 25A CAN 10Q 6 2613 1 B < 100 4 "� ca Nt C6 M .,.__ _.__..., „....,,,..,,... r} iY`J Putnam vaney G6A "{ A � 62.13.1. 53+'63 -53 100 asaessc�r �.. 100 A - 2/21M SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA- MOLiNARI..RN.. MSN Assoc ate�C'ommiss'iorrer of Hie fi_ii John Karell Jr., PE 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 26, 2008 ROBERT I BONDI County Executive Director of Environmental Health Re: Proposed SSTS — Zeal Construction James Drive (T)PV TM #62.13- 1 -53 &63 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The tax lots are to merged prior to the issuance of a construction permit. This office will continue its review upon consideration of the above- mentioned comments. __ _..... P1' _ _sz feel free to n n..t .ems,7 c'7 •r n tn ;t '. c 5 , " --auy- qusstioiiJ a113e. - ..- ._.. .. _._ ..: _..__....... JSP: lm V y truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health t _ C • .• i..�i [4 a: °'i '1 '/Qi '1fi.: Llih'���s ^t; -RN ?- +9SN" • - .ec ,. . . Associate Commissioner of Health January 11, 2008 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed SSTS Joseph Scorsone James Drive, (T) Putnam Valley TM # 62.13 -1 -53 & 63 ROBERT J. BONDI County Executive R OBERT MORRIS, PE Director of Environmental Health 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: Presentation of mailing receipts of the neighbor notifications need to be submitted to this ' . _Department. prior to final The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Respectfully, Gene D. Reed-,--' Senior Environmental Healt4"Engineering Aide GDR:kIy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 JK JOHN KARELL, JR., P.E. 121 CUSHMAN ROAD 8 ��- 878-7894 January 4, 2008 Gene Reed Putnam County Department of Health Geneva Road Brewster, New York, 10506 Re: Proposed SSTS: Scorsone, Zeal Constrution James Drive, Putnam Valley (T); TM # 62.13 -1 -53 & 63 Dear Mr. Reed: Attached herewith please find one set of plans for the captioned property revised to reflect the comments in your December 24, 2007 letter as follows: /The EAF is attached. Neighbor notification is in progress. All existing and proposed contours are shown. Existing SSTS's on neighboring properties are shown. There are no SSTS's within 100 feet of the proposed well or 200 feet if in direct line of drainage to the proposed well. - The absorption trench detail has been clarified. mom'"- ^�+ ' p�'�� h` hi1J `b-e'-lire' �lteU't0 /IG`Vlde Jrfe-i -e uii-ed•- 1' iii "1 iv V i V 1- �il� 0.11J1 Vll trC�`illli 100 foot separation distance. Grading has been provided to raise the elevation of the septic tank in (' order that gravity feed may be provided to the first trench. It is noted that the grade at the first trench is 103, therefore the invert of the pipe in the first trench can be 30 inches deep or 100.5. Gravity flow is easily possible from the septic tank. Driveway and house grading is shown. t/ The differences in the house plans and the house site plan have been rectified. It is noted that this property is not in the NYC watershed nor are wetlands an issue. It is requested that you review the plans to assure that all of your comments have been satisfactorily addressed. Final approval can then be granted upon my presentation -of the mailing receipts. ry trul yours, John ar��J��� r SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .:, . .._1:GR::.••T��.- r..�iul'�.��ni a"�;-iYiSi'+i' ° .._ .,� ..: _. . Associate Commissioner of Health December 24, 2007 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: ROBERT J. BONDI County Executive ....,:. _ ROBERT MORRIS, PE~ Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed SSTS Joseph Scorsone James Drive, (T) Putnam Valley TM # 62.13 -1 -53 & 63 Review of plans and other supporting documents submitted at this time relative to the above regarded project has beeircompleted. Comments are offered as follows: J�, This Department short EAF form needs to be submitted for review. , Neighbor notificat o2z tt_ rewe �! Existing and proposed contours need to be shown in the proposed SSTS area. 4. Locations of adjoining septics need to be shown or indicated on the plan. The typical absorption trench detail is not legible. It appears a portion of the proposed SSTS is within 100 feet of an existing well. 7 It appears a portion of the proposed SSTS can not be gravity fed. Proposed grading for the driveway & house site is to be provided on the plan 1/9. The garage opening on the submitted floor plans does not match the location shown on . the site plan. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Upon receipt of a submission, revised to reflect the above comments, this application will be Respectfully, GDR:kly Gene D. Reed Senior Environmental Health Engineering Aide PUTNA1vI COUNTY DEPARTMENT OF HEALTH UUCURTAIN DRAIN REQUIRED / GENERAL ( JL // OCATED.IN NYC WATERSHED (,_}�LA.NS SUBMITTED TO DEP �L ELEGATED TO PCHD N' /)DEP APPROVAL, IF REQ'D �/ EP TEST HOLES OBSERVED PERCS TO BE WITNESSED U EX- APPROVAL SSDS ADJ, LOTS _WETLANDS (TOWN[DEC PERMIT REQ'D ?) ��)DATA ON DDS- PLANS & PERMIT SAME UU ,P7M7 96 NEIGHBOR (100 YR: FLOOD ELEVATION WII 200'' N/x SOIL TESTING LOTS >IO YEARS OLD REOUDRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFIIfE _)GRAVITY FLOW ;UCTION NOTES 1 -I5 DATA: PERC & -DEEP RESULTS QURS-',EXCSTiI!CG & PROPOSED 'AY & SLOPES, CUT ►FOOTING /GUTTERICURTAIN DRAINS (USDA SOIL TYPE BOUNDARIES ITTTLE BLOCK; OWNERS NAME ADDRESS TM, PURA; NAME, ADDRESS, PHONE# IRATE OF DRAWING/REVMION ATUM REFERENCE . ►LOCATION OF WATERCOURSES, PONDS N% LAEms,WETLANDS WITHIN 204' OF P.L. ►PROPOSED FRMH FLOOR AND BASEMENT ELEVATIONS (WELLS &ARD SS SS /lN 200 - OF=:8 MWEW ►PROPERTY METES & BOUNDS - ►EROSION CONTROL FOXHOUSE, WELL & SSTS, EROSION CONTROL NOTE GULF TRENCH PROVIDED '3 60FT MAX ( ARAELEL TO CON TOLTIi�. 00100°/ AN ION PROVIDED. L_)UDF,TAE:,DUST= FREE -C RUSHED= STONE>OR= WiiSHED= GRAVEL U(,�GEOTEXT -I'I:E COVERt -- ckP.�k �.. +rcv, pl:n SEPARATION DISTANCES ON PLAN : FRCFO I -SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TQ MS 100' TO STREA1�y4VA? ??atC�E;_i�As�:•.��t�- e�pnr;.. . , .. -- . "S 10"A. CATUR BASIN, 351.STORMDRA0, PIPED WATER Lj 10' TO WATERLINE (pits - 20� SO'. DMRNIITTENIT DRAINAGE COURSE 200'9500' RE5ERVOD2, ETC. 150' GALLEY SYSTEMS U 10' Mil's TO LEDGE OUTCROP SEPTIC TANK (r,10' FROM FOUNDATION; 50' TO WELL WELL ( L�DIlYIENSIONS TO PROPERTY LINES )LOCATION OF SERVICE COZiNECTION L/-J(,�MIN 15' TO'PROPERTY LINE SLOPE Li ROPE IN SSTS AREA ry otS20 %) EGRADED TO 15 %, IF REQUIRED • . DOSE/PUMP SYSTEMS PUMP NOTES . TWZ)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCKMAIN, (PIPE TYPE, ETC.) ePIT AND D -BOX SHOWN & DETAILED jNl DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS =>'S %, 20' -4 %, 151-3%,35'41/6, 100%-<1% 2NO'MIN 0' MIN to CD DISCS ARGE/100' with 182 cons day discharge to NON- PERFORATED PIPE DIVISION OF ENMONMENTAL.HEALTEE II4DIVII3UAL WATER.S.T,?PPLY & SLL v`LrrLAi`sl:T1iEA'rMENT SYSTEMS SHEET FOR CONSTRUCTION PERMIT NAMEOFOWNER: STREETLOCATION: ZA E6 RBVIEWED.BY: RM, ( Jar', SRDATE: /l 0 y 0? TAX MAP#: (CONFlRI M) 6.&L 4 / 3 --L Y/ N DOCUMENTS ' Y (REOUMED DETAILS ON PLANS CONT'Dl ' .. PERMIT APPLICATION , - HOUSE SEWER -'A" Fr. 4 "0'; TYPE PIPE, CAST IRON �a/ WELL PEF,IYIIT OR PR'S LETTER CL.�UNO BENDS; MAX BENDS 45' W /CLEANOUT )PG97 (l }LETTER OF AUTHORIZATION RENEWALS UL�,STI'E NOTE (NO CHANGE) (r L_)DESIGN DATA SHEET (DDS) FILL SYSTEMS ( , )CORPORA.TE RESOLUTION 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( -I SHORT- =FARO FILL SPECS / FMi, NOTES 1 -5 ( Z PLANS -THREE SETS ( OUSE PLANS -Tiro SETS FILL PROFILE &DIMENSIONS f FILL IN EXPANSION AREA (VARIANCE REQUEST FILL GREATER THAN FEET SUBDIVISION CN CLAY BARRIER -)L GAL SUBDIV ((__)LESUB DIVISION . FILL 'CERTIFICATION NOTE (_)L_)SUBD'IVISION APPROVAL CHECKED j DEPTH GAUGES UUPERC RATE 1 a-EPARATION'DISTANCE OL. ON PLAN FOR R.O.B., tJNCLASSIFIED & EM?ERVIOUS LUUU� L REQUIRED DEPTH FROM'TOE OF SLOPE UUCURTAIN DRAIN REQUIRED / GENERAL ( JL // OCATED.IN NYC WATERSHED (,_}�LA.NS SUBMITTED TO DEP �L ELEGATED TO PCHD N' /)DEP APPROVAL, IF REQ'D �/ EP TEST HOLES OBSERVED PERCS TO BE WITNESSED U EX- APPROVAL SSDS ADJ, LOTS _WETLANDS (TOWN[DEC PERMIT REQ'D ?) ��)DATA ON DDS- PLANS & PERMIT SAME UU ,P7M7 96 NEIGHBOR (100 YR: FLOOD ELEVATION WII 200'' N/x SOIL TESTING LOTS >IO YEARS OLD REOUDRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFIIfE _)GRAVITY FLOW ;UCTION NOTES 1 -I5 DATA: PERC & -DEEP RESULTS QURS-',EXCSTiI!CG & PROPOSED 'AY & SLOPES, CUT ►FOOTING /GUTTERICURTAIN DRAINS (USDA SOIL TYPE BOUNDARIES ITTTLE BLOCK; OWNERS NAME ADDRESS TM, PURA; NAME, ADDRESS, PHONE# IRATE OF DRAWING/REVMION ATUM REFERENCE . ►LOCATION OF WATERCOURSES, PONDS N% LAEms,WETLANDS WITHIN 204' OF P.L. ►PROPOSED FRMH FLOOR AND BASEMENT ELEVATIONS (WELLS &ARD SS SS /lN 200 - OF=:8 MWEW ►PROPERTY METES & BOUNDS - ►EROSION CONTROL FOXHOUSE, WELL & SSTS, EROSION CONTROL NOTE GULF TRENCH PROVIDED '3 60FT MAX ( ARAELEL TO CON TOLTIi�. 00100°/ AN ION PROVIDED. L_)UDF,TAE:,DUST= FREE -C RUSHED= STONE>OR= WiiSHED= GRAVEL U(,�GEOTEXT -I'I:E COVERt -- ckP.�k �.. +rcv, pl:n SEPARATION DISTANCES ON PLAN : FRCFO I -SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TQ MS 100' TO STREA1�y4VA? ??atC�E;_i�As�:•.��t�- e�pnr;.. . , .. -- . "S 10"A. CATUR BASIN, 351.STORMDRA0, PIPED WATER Lj 10' TO WATERLINE (pits - 20� SO'. DMRNIITTENIT DRAINAGE COURSE 200'9500' RE5ERVOD2, ETC. 150' GALLEY SYSTEMS U 10' Mil's TO LEDGE OUTCROP SEPTIC TANK (r,10' FROM FOUNDATION; 50' TO WELL WELL ( L�DIlYIENSIONS TO PROPERTY LINES )LOCATION OF SERVICE COZiNECTION L/-J(,�MIN 15' TO'PROPERTY LINE SLOPE Li ROPE IN SSTS AREA ry otS20 %) EGRADED TO 15 %, IF REQUIRED • . DOSE/PUMP SYSTEMS PUMP NOTES . TWZ)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCKMAIN, (PIPE TYPE, ETC.) ePIT AND D -BOX SHOWN & DETAILED jNl DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS =>'S %, 20' -4 %, 151-3%,35'41/6, 100%-<1% 2NO'MIN 0' MIN to CD DISCS ARGE/100' with 182 cons day discharge to NON- PERFORATED PIPE FUTNAM COUNTY DEPARTMTNT OF HEALTH DIVISION OF ENVIRONMENTAL ]HEALTH- SERVICES v .._ b MTIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project (bx)STffirT1614 (T)X County �t►!'0 Site Location- Building construction begun Extent Is property within NYC Watershed ? ................. Yes 25No SECTION B. TOPOGRAPHY (Please check all appropriate oozes) 1. a -Hilly. -E� Rolling a Steep slope Gentle slope Flat ' 2. Evidence of wetlands a Low area sub }ect to flooding Bodies of water Drainage ditches Rock outcrops 3.. Property lines or comers evident ........................................................ s 0 ...... ............................... Ye No 4. - 'Do water courses exist on or adjoin the-property ?. .......................... .. ' = .Yes �N'o 5: Will these affect the design of the sewage system facilities ?............ 0 Yes EE'-No 6. Do watershed regulations apply in this development? ...... Yes ;No 7 will extensive grading be necessary? ............................... .. ............ :.. Yes No :. ..will e -tens re u11 be Necessary for SST ? :....... ...::..:...::.................. Yes 9. Do -filled areas ex within the SSTS area? ........ ........................:.:.... Yes S. No If yes, what is the condition of the fill? J SEC'T'ION C. SOIL OBSERVATIONS 10. Appearance of soil: land 7 Gravel �oam Clay Hardpan Mixture 11. Observed -from: o Borings B cut Backhoe excavations 12. Soil borings /excavations observed by on Q 13. Depth *to groundwater on ' 'Zc� .14. Depth to mottling on. Dr% 15. Are test holes representative of primary & reserve areas ..... ............:::................ Yes No 15...Soil percolation tests made by` on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 2 SECTION D. DRAINkGE M Will proposed grading materially alter the natural drainage in this or adjacent areas?= Yes �No 19. Will groundwater or surface drainage require special consideiation? ........................ =,Yes =L,- 0 20. Will gullies, ditches, etc.-) be filled and watercourses be relocated? .......................... = yes No SECTION E. REMARKS, 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................................................. Y I Inspection data 22. Do adjacent wells aiid/or sewage systems exist? .................................................... =... Yes No 23. Additional comments 24. Site observer /inspector and title 25. Date(s)-of observation(s)inspection(s) TEST PIT PROFILES -Hole 4. --/-Lot Holt r, 'Lot -u Depth to water Depth to mottling Depth to rocklimp. VO Depth to water 1 tj 46 Depth to rook/imp. G.L. , ?- /0 "' G.L. Z 2-: /0 " 0 6 2.0 tv/6t4t6 Z,- 3.0 - 4 . 0 : 4.0' Cevnv;�eV 0 6 5.0 .0.5 10'11- q I i.o rAA1 -1 6.0 7.0 8.0 � e z# J7 9.0 2.0 3.0 4. 0 5.0 AI fl /,DAN 6.0.E OMMMOLMOMMI 9.0 (�r2tp4C7e4D r,' 0064 Holt U Lot -Tur Depth to water Wk 'Depth to. mottling Depth to rock/imp. G.L.- 0.5 1.0 (,21 6YU v, 1 Olt, 3.0' Rlf) A.4 4.0 5.0 6.0 7.0 0 . 78.0 - e! -JqffMf4 9.0 10.0 10.0 BAUM, -1 - 0 y-.. Public BaaJtb Dinctm ATTENTION: DEPARTMENT OF IEALTH 1 Geneva Road ,]Brewster, New York 10509 )I JOSEPH PARAVATY a GENIE RRED LOREl CA MOLINARi 1LN., M. x. Xssoctate Public XsalrA Director Dtrectw of Patent $O"fces Allinformation below must be fuU completed prior to any scheduling. DATE: � ENGMER 0R lam: iGA-�G LJ-' PHONE #: K REASON: DXEPS: 4 • PFRCS: a PUW TEST: ❑ ROAD/STREET: z e'-- 5 D p- ) TOWN: FV �(�l 1 i� V %j'(.,.E�C-- TAX mAP #: (y 7-, °^-1 -- 5 Jk (v --_ . SUBDiVIS10N: 05QWA& 1;t(,G 720 LST�fT DOT #: 2 z y z,�- U C ( �% t��p e,�- OWNER: � G� C J 5W T D ( 01 Qe-T N�CCDE1' CRi'Y'EYtiA FCl�t JQk1�TT tEVIEW A.ND W1TNESSRiG OF SOLL TESTZ7W'G J YES NO f a ML. Propose! SSTS �vithi al:� da alnage h gla 'pit F wncb a. o ►is Curaer l�ceservoics. - - c- - � -4--- -- -Yrd ' osed SSTS within 50U feet of a reservoir, reservoir stem or control lake, a §L Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Q K Proposed SSTS design flow greater than 1000 galloaslday or SPDES Permit required. ❑ J-L Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing, This Department will determine the NYCDEP project status (Joint or Delegated) bused on the response. It you answered Yf. to any of the questions, NYCDEP mast witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NSICDEP. If a project has been determined to be Delegated based ou the above response and then subsequent information indicates NY'CDEP Is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re-witnessing of the soil testing with NYCDEP. Folt COUNTY USE ONLY nkr& TOM 4r (FIELDTEST) 1 1P s N>.I2 01 s 2r�w s sv Im.n I I I r= AVENUE -�_ Im r in vw t I N I't y led PP I * IN UNCA5 WA y 112 uj s o CANOPUS AVENUE IDD IDD a J of ID91 I pu I& 20D } ? _ x 35 ° x 39 1m �v :5L 49 rer 4 l a 13 rrW r d e10, Ion rx Iap r dr b 40_ QB -5 ts 53 " rs+l rr� Ir rre _ w 26 � k 33 !a tr s L ` rii u �a l2 er+r • 190 100 1/ ".' y, I' _ Im mu zoo zzauz — _ r+ R s I r M Z0V 109 ^IDD . YI 4i I - - - - - -- p7— — 5i 54 rs0 r - • I = A , I j 1 10o J 90 n ' Iloo �, — — — — — — - Y 6 �� I = y 2e I q ' Li .� 45 9 /3 30 I 11 � 41� - j Igo 7 10o Ian rz.sz 3v) I - I , 3 Z " Inl lr 1 44 57 . I +c �" _ +91,5 1 a • 56 - 1 ^m - - b d6 190 ARTO 1 1 119 AVfNI l lot I r r / y I 'Amp I't y led PP I * IN UNCA5 WA y 112 uj s o CANOPUS AVENUE IDD IDD a J of ID91 I pu I& 20D } ? _ x 35 ° x 39 1m �v :5L 49 rer 4 l a 13 rrW r d e10, Ion rx Iap r dr b 40_ QB -5 ts 53 " rs+l rr� Ir rre _ w 26 � k 33 !a tr s L ` rii u �a l2 er+r • 190 100 1/ ".' y, I' _ Im mu zoo zzauz — _ r+ R s I r M Z0V 109 ^IDD . YI 4i I - - - - - -- p7— — 5i 54 rs0 r - • I = A , I j 1 10o J 90 n ' Iloo �, — — — — — — - Y 6 �� I = y 2e I q ' Li .� 45 9 /3 30 I 11 � 41� - j Igo 7 10o Ian rz.sz 3v) I - I , 3 Z " Inl lr 1 44 57 . I +c �" _ +91,5 1 a • 56 - 1 ^m -