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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -54 BOX 24 ro 7 IL ,. 16 Jr. i F L� - �T J JL 02917 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: n . ``;�J1"^(.�C���n.�e,tyGtLr1� T, w illa e _ f Tax Grid # lvfap��b� lilbck '`" 1✓of(s�j" Well Owner: Name* ddress: . Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length - ft. Length below grade , "left. Diameter G` r in. Weight per foot � Materials: � Steel Plastic _ Other Joints: _ Welded ? Threaded _ Other Seal: /_ Cement grout _ Bentonite Other Drive shoe: dyes No Liner: Liner Yes �C 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 HoursZ Yield /6 gpm Depth Data Measure from land surface- static (specify ft) � During yield test(ft) Depth of completed well in feet t 30 0 Well Log If more detailed information descriptions or sieve analyses are available, please attach.z Depth From Surface Water Bearing Well Diameter(in) ..', Formation . Description ft. ft. Land Surface so p?.�► ~' _ 1 ._ _ �- .. -._:. -� .._ m M tV -Yi C:7 ri If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Infontration Pump Type3_,�,.✓I�,e.Capaci' Depth rO ( Mode 'Z Voltage 2_S49 HP f Tank Type L�d Volu Date Well Completed { Putnam County Certification No. Date of Report Well Driller (signature) j o? �3 T 670TE: Exact location of Well with distances to at least 1perm2menraniarks to be provtaea on a separate sneevptan. Well Driller's Name ran- . Address: /S Y �J Signature: -� �; . _ Date: n `c S' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy-- Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH -1,ON. F ENV, TR.ONMENTAL VEA TR SERVU CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV_ 0 Located at �5Q % % SCw�`}t `f} Town or Village �U)`A//9�! t3L Owner /Applicant Name �j�� �F� Ae/A�(jd///Tax Map k-Z - /5' Block Lot Formerly /9(,-, _ Subdivision Name Mailing Address Subd. Lot # `� Date Construction Permit Issued by PCHD Separate Sewerage System built by 'V > 0Zw� . Consisting of /V<3 Gallon Septic Tank and ��/ �r C - / C�� 2V ff Other Requirements: t! iUX� IllL ( Water Supply: Public Supply From Address or: Private Supply Drilled by Jve ) IAC Address N7 ypc. ' / yep, "G."';:.z =. V /4!(iLi�- rP. titsS �ra75ivii Cvi'iu"vY v:•: i..: aii� avw° 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 dance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulati ns the Pia County Department of Health. Date: ; /5. ft ;- Certified by Address IF "o v6e�k P.E. r� R.A. 77,1o, License # _07b:75 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: Title: 4-POiC Date: /.?j Lo > copy - HD File; Yellow copy - Building nspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street - Address: Tgwn/Villa e: Tax Grid # Mip I3Tock Well Owner: Name: ddress: '77� Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length �ft. Length below grade �' . Diameter G` in. Weight per foot �lb/ft. Materials: -/--Steel Plastic Other Joints: Welded K Threaded -----= _—Other. Seal: !`' Cement grout _ Bentonite Other Drive shoe: --Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped Compressed Air Hours Yield _/O gpm Depth Data Measure from land surface- static (specify ft) �a During yield test(ft) Depth of completed well in feet r 3GU 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 so r If yield was tested at different depths during dril ling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type,_� Capoe Depth -ZrO Mod35Z'. Voltage 2-90 HP Tank Type �D Vol.� Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) i'T O(OTE: Exact location of vlell with distances to at least tw permaWentpndmarks to be provided on a separate sheevplan. f Well Driller's Name ten- Address: J 1� Signature: - 1 %,� 1. Date: n %S� White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: DATE: a e) 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 Certificatc of Construction Compliance. (E9I 1 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building �r r4A C 01j,)P INC. Building Constructed by Location - Street Z_ K s Tax Map Block Lot ���A�t V,4t�tiy Towh/Village Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of C3onstruction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated; Month I Day /,/ Year 0 General Co tractor (0w "' Owner) - Signature Corporation Name (if corporation) —� Address: 1 U i s /2 s// 2 !/ i `f u 1,4 t, Signature: Title: Corporation Name (if corporation) Address: State "Tot- Pl- /9 /L. S Zip Zo 4 o 7 State Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (.91.4)- 245 - -2800 -. -, - aaovani, Director LAB #: 1.600476 CLIENT #: 2500 NON STAT PROC PAGE: 1 ANDERSON WELL DRILLING DATE /TIME TAKEN: 01/24/06 03:00 1.52'BARGER ST DATE /TIME RECD: 01/24/06 03:30 ATTN: NORMAN, SARAH REPORT DATE: 02/10/06 PUTNAM VALLEY, NY 10579 PHONE: (914)- 528 -1491 SAMPLING SITE: 507 OSCAWANNA LAKE ROAD SAMPLE TYPE..: POTABLE TANK PRESERVATIVES: NONE COLD BY: SARA ANDERSON TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY 01/24/06 01/31/06 01/27/06 01/27/06 01/26/06 01/26/06 01/26/06 .01/25/06 01/26/06 01/25/06 01/31/06 PROFILE MF T. COLIFORM LEAD (IMS) NITRATE NITROG NITRITE NITROG IRON (Fe) MANGANESE (Mn) SODIUM (Na) pH HARDNESS,TOTAL ALKALINITY (AS TURBIDITY (TUR ABSENT /100 ML 1.6 ppb 1.78 MG /L <0.01 MG /L% <0.060 MG /L <0.010 MG /L 63.6 MG /L 6.5 ..UNITS 238 MG /L 84.0 MG /L <1 NTU ABSENT 1008 0 -15 ppb 9003 0 - 10 9052 N/A 9162 0 -0.3 mg /1 9002 0 -0.3 mg /l 9002 N/A 9002 6.5 -8.5 9043 N/A N/A 90.01 0 -5 NTU R COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE 4(WAS)�AWAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDMG-,TC''THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p� EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 72800 Direc:.itUr. ... _ . _. LAB #:.1.600476 CLIENT #: 2500 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN, SARAH PUTNAM VALLEY, NY 10579 NON STAT PROC PAGE: 2 DATE /TIME TAKEN: 01/24/06 03:00 DATE /TIME REC'D: 01/24/06 03:30 REPORT DATE: 02/10/06 PHONE: (914)- 528 -1491 SAMPLING SITE: 507 OSCAWANNA LAKE ROAD SAMPLE TYPE..: POTABLE : TANK PRESERVATIVES: NONE COLD BY: SARA ANDERSON TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE is suggested. 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-: .1n 0 0- f7C /L ' l yrdin/ gaiio'n --17 *. 2'- MG /L) SUBMITTED BY: Director ELAP# 10323 v v v l A A. x "x x 1%,x\11 i lmlr 1 Uk' tiLA. l.d. DIVISION OF ENVIRONMENTAL HEALTH SERVICES f ZrL! /a FINAL SITE INSPECTION �� L%t�� �� Date: ® C yY 5,1,.,,;;1 I;= ,„5� Inspected by: Street Location rs �� (� � e Gk, Tow- Permit # pv - -i TM # I / Subdivision Lot # e I. Sewage System Area a. STS area located as per approved plans ..........:................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. .. ............................... d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course / wetlands ...................................... II, Sewage System a. Septic tank size - 1,000 ...:. . O .........other ................ b. ' Septic'tank installed level .....:1111 .............. ....................... c. 10' minimum from foundation .......... .1111 ..:....................... 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 - properly set .......... ............................... 6. renc es 1 Length required Length installed _ 1 Y 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 - V/ 2" diameter clean ........ . ........... : 9. Depth of gravel in trench 12" minimum.......:........... 10. Pipe ends capped .......................................................... g. Pump or Dosed Svstems 1. Size of pump chamber ........ ..............................\ 2. Overflow tank .......................... ....................... ....... 3. Alarm, visual/ audio ........:........... ...........................1111 4. Pump easily accessible, manhole to grade ............. 5. First box baffled ................................................... :...... 6. Cycle witnessed by H.D.estimated flow /cycle........... III..HouseBuildirig A. house located per approved plans ...................:. : "... ...... b. Number of bedrooms ............. I....•....................(51 1... IV:` Well Well located as per approved plans.......:............. mil) .......... b. Distance from STS area measured ���° . ft.... ..... c. Casing- 18" above grade ... • ....:......... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ...... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... .......... ...................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. .Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................................................ Rev. 12102 u M106 A m e MM Man ME __ - - - EUM MEN MWE ESM MEE ME WOM vEE MM No I No 1. E ICI GpiO�= rirl� C� OWN Me u M106 _ .:....._ . PUTNA?YI- COTTNTY DEPARTMENT OF -1 EA�,TH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES -' - - ATTENTION JOSEPH GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches k inspections being made. PCHD Construction Permit # n Located: QSC#- %g9r-A LWkit /2:,a (T) M /TNII--. V14-6 ` Owner /Applicant Name: TM Z�Z•/f Block �_ Lot Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? `/ 5 Is system complete? y� S Is system constructed as per plans? Y�-s Is well drilled? 4( 3 Is well located as per plans ?'�S Are erosion control measures in place? Date:, Date: Date: 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:.... j Z 1 a L05— Certified by: _ . PE ... X - .RA 7 I pO Design Professional Address: NAco- tkA(L(- j" CTS P11'd Lic. # 07(M3 NM ii =0 Form FIR -99 [SION OF ENVIRONMENTAL HEALTH SERVI �;(Iri S 1 idL1(.1 l�lv >l Ei8lvitr FOR SE WkiA ]& `1`R&kriVIEN ` S Y"S i'EN PERMIT # PV-&-O/ Located at 0SrA,—A -7v l LAAye-, 49-M Subdivision name +j 1.4 Subd. Lot # Date Subdivision Approved Owner /Applicant Name /y12- VAl151 94-4& If Town or Village VU,-A1A7`k KA-aK,1z Tax Map �Z j Sr Block / Lot Renewal Revision Date of Previous Approval 02. z Mailing Address IL�i �S'eA4 il9 6�'IZfkl(4 A Zip /V S" Amount of Fee Enclosed -N �y Building Type 11 , > Lot Area No. of Bedrooms 4- Design Flow GPD PCV Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: 2 / � ` t Iv </- iN i z?cy To be constructed by Water Supply: Public Supply From gallon septic tank and _"/ & Z. Address Address Private .Supply Drilled by �A As, 250,1/ _ 1VAe 114V&I . . Address r' I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment 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 repair thereto. Signed: P.E. R.A. Date 7 (� Address 1 Z 3 WASs I[ AZ'io0�1 A*4 F /1a License # w AA O6 77/ 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 peppit. Approv for harge of domestic sanitary sewage only. By. Title: p� Date: Ait7copy - HD File; Yellow copy - Building nspector; Pink copy - Owner; Orange copy - Design Prof siona Form CP -97 PUT HAM YAW IRV SEVELOWIT? _ Code Enforcement Officer 4 101tN ALLEN OWN OF PUTNAM VALLEY uty Zoning Inspector BUILDING, ZONING, AND SANITARY DEPARTMENT September 23, 2005 The FEA Development Group 51 Westchester View Lane White Plains, N.Y. 10607 Re: TM# 62.15 -1 -24 507 Oscawana Lake Road Dear Property Owner: TOWN HALL PUTNAM VA1,1_,EY, N -Y - � (845) 526 -2377 Fax(845)526 -8806 DOREEN PIACENTE Bldg. Dept. Clan: This office is in receipt of an Official Request for Stop Work Order from the Putnam County Department of Health dated September 15, 2005, stating that after a site inspection of the above property the SSTS installed within 200 feet of the public water supply wells (Glenmar Gardens). (see attached) Please be advised that no further inspections by this office will be made until Notification from the Putnam County Health Department is received_in_this office that the .,.,,.ul .,,r. u,, 3cut. ,..l, t..c :,o.. espan t,once -has vetli cai i ecicc,. If you have any questions, please contact this office. Cc: Joseph S. Paravati, Jr. r/ Mr. & Mrs. Beck 1 Very truly yours, r IRV SEVELOWITZ Code Enforcement Officer SHERLITA AMLER, MD, MS, FAAP - . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Stephen J. Ferreira, P.E. 103 Perry Dr. New Milford, CT 06776 Dear Mr. Ferreira: . . T J. ,BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 15, 2005 Re: Field Inspection —Beck Oscawana Lake Road (T) Putnam Valley, TM # 62.15 -1 -54 A site inspection was made for the above referenced project on September 14, 2005. The following comments must be corrected in the field: 1. Based on field measurements, the wells for the Glenmar Garden public water supply are still within 200' of the existing SSTS. Before anymore inspections are made, please have a licensed land surveyor locate the wells, the ends of the existing and newly installed .. SS'T's- :trench. es, the strea mr -_a.i the House. r rovide- a-signpd a.Id_sealed plari_frc rn t'r_t4 surveyor. 2. Please check with the Town of Putnam Valley and provide a letter concerning the stream and if any wetland area is associated with the stream. If it is not considered a stream, the septic area can be shifted. 3. The revision submitted needs to be further revised showing all the actual surveyed information, the actual house footprint, and the actual layout of the SSTS as installed. 4. A stop work order will be requested from the Town of Putnam Valley until the SSTS issues are resolved. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI.:. _ OFFICIAL REQUEST FOR STOP -WORK ORDER September 15, 2005 Town of Putnam Valley Town Hall 265 Oscawana Lake Rd. Putnam Valley, NY 10579 Iry Sevelowitz Re: Stop -Work Order Request: Beck Oscawana Lake Road (T) Putnam Valley, TM # 62.15 -1 -54 Dear Mr. Sevelowitz: A site inspection for the above referenced. n_ ro' egt,.was.made.on.:September:14, 2005 and the -- -�- _ L SSTS installed within 200 feet of a public water supply wells (Glenmar Gardens). It is respectfully requested that a Stop -Work Order be issued until these items.have been satisfactorily resolved. Thank you, in advance, for your cooperation in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278- 6130 ext. 2157. V truly yours oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:km cc: Mr. 8r- Mrs. - Be'filiviromnental Health (845) 278 -6130 Fax (845) 278 -7921 StephenrJvjF r4cB.84s) 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 08/25/2005 15:24 1026 T (9(f) Z -10 -7g1-1 _.._ PUTNAM COUNTY 112+EP"TMMT OF HEALTH D ISION OF ENVIRONMMNTAL HEALTH SERVICES ATTENTION �JOSF'Fjff C] GENE All information must be fully completed prior to any Trenches . . inspections being made. PC14D Construction Permit Located: I-4k.-.--- .. (T) (V) vr;'VA0-+ Qw:ner /Apphcaut Name 6W44 TM i7 !� Block _�: Lot Formerly: — Subdivision Name: —� Subdivision Lot # Is system W1 completed? Y Is system complete? _T e Is system constructcd as pox plains? Is well drilled? Is hell located as per plans? Are erosion control measures in place? Date: Date. VK46rr- Date:. ��i' wr" PAGE 01/02 I certify tliai 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 PCID Construction Permit and approved plans and the Standards, Rules and RCgulations of the Putmm County Department of Health.. Date. Certifiod by: r PE RA Design Pr fessional Address: l�� J'ic/ iQ � i� Lic. # l Comments: _ Force FIR -99 AUG -25 -2005 THU 15:28 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT nF P LORETTA MOLINARI Public Health Director June 23, 2004 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 Mr. & Mrs. Jeff Beck 428 Smith Road Peekskill, New York 10566 Dear Mr. Beck: ROBERT J. BONDI County Executive Re: Proposed SSTS —Beck Oscawana Lake Road, (T) Putnam Valley TM# 62.15 -1 -54 The following letter is in response to your request for an update on the above referenced project. The application for a revision to the approved SSTS, as submitted by Stephen Ferriera, PE, was approved by this Department on June 22, 2004. This approval allows the approved revision to be _ _ - c�nstnzctea.. rtes bee corstT'..'cted and. representative from this Department will make an inspection. Final compliance will be granted once all construction pertaining to the SSTS and well are completed, and inspected by this Department. This includes the construction of the house, a walk- through to verify bedroom count, all piping, tanks, all components of the system, and any outstanding comments that have yet to be addressed. Please also be advised that the new area proposed for expansion requires fill and the fill must be placed before compliance is granted. If you have any further questions, please kindly contact he writer at ext. 2157. Ve truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY DEPARTMENT OF HEALTH � : Y DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMEN PERMIT # ' Located at z2Zfc4 -ry4wd 446c � Town or Village ✓l/L /� Subdivision name Subd. Lot # Tax Mapk Z./-f Bl ck Lot Date Subdivision Approved Renewal Revision L Owner /Applicant Name W Date of Previous Approval Mailing Address z 57 /;W le.6 Gl�� Zip IOT66 Amount of Fee Enclosed Building Type x4.. Lot Area _ No. of Bedrooms Design Flow GPD bo ,V� C- A -.-, ,7,. -e -f- Pill Section Only Depth Volume Separate Sewerage Systenn to consist of S�C7 gallon septic tank and t/—�. Ve � Other eauire'm To be constructed by Address Water Supply: Public Supply From Address or: _Private Supply 1)ritlea ny /7ri��f�ti- �G/s�` �•l._Au�ess ..__,� �..; .:W. - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the senarate 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. --f Signed: .-- P.E. R.A. Date S 66' 0 Address 14f (J�7W 77,6 License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: (� WhiZ opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL -a- please print or type - Y1,11D Perinli tt - s- % Well Location: Street Address: Town/Villa�g/e Tax Grid # 0SCAia/r�w6. [ nVTAW;�.1 Map �� Block Lot(s) Well Owner: Name: T� -� Address: slccC 5ZZ Use of Well: ResidentiC 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 4L Est. of Daily Usage _*00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 0 L �y gjL - for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: sa4) Address: oz, 41W, 64- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village - Distance to property from nearest water main: Proposed well location & sources of contamination be provided n separate sheet/plan. ,D; ►te:!d (� Applicant Signature: r ' r 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 Permit Issuing Official: 1CJ Date of Expiration a Title: Permit is Non- Transf rable White copy - HD file; Yellow copy - Building Inspector; Pink copy � Owner; Orange copy - Well driller Form WP -97 N SJF Engineering Services 103 Perry Drive New Milford, Connecticut 06776 (860) 350 -2499 Joe Paravati Putnam County Dept. of Health Brewster, NY RE: Zosc W Dear Mr. Pararvati: iAay 24, 2n, .� . Savo VrSoz-0 0NS���4 O Diu GLU0�D 11UFoP.4T76 A) . A ly Yours, � PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION,,OF_ENVIRONMENTAL HEALTH SERV?'CES._ DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner,e�,G�%,�S Address o 56 Located at (Street) aC4V*WA 41-14e A" Tax Map Z IS Block Lot (indicate nearest cross street) Municipality ,—: ,., j � Drainage Basin ��fC�CL Glavv a le SOIL PERCOLATION TEST DATA Date of Pre - soaking 6116 /©e% Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time 61in.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate NEWInch 2 �"' 3y — �o' �� 2? 0, y " 27 I2 3 �� 3 / -�OJ - �' ld7 r/ Z 7 ,� 3 �/ O 5 2 3 4 5 1 2 3 4 5 PIVTES: 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 min/inch, 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. Forth DD -97 ., DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. HOLE NO. D HOLE NO. G.L. 0.5' 1.0' g,�o vv,yd 2.0' 2.5' 3.0' w 3.5' �. 4.0' 4.5' 5.0' 5.5 pr 6.0' 6.5' 7.0' 7.5' 8.0' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed — Indicate level to which water level rises after being encountered Deep hole observations made by: Date , A, Design Professional Name: Address: w3 1prz-, gje-3 1� p, E'Vi Ptl c.,ta� cam— a l� X16 Signature: Design Professional's Seal 2 a °l:vY'��:'YLI'ii'" Public Health Director June 15, 2004 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 Steve Auth 227 Canopus Hollo"oad Putnam Valley, New York 10579 Re: Dear Mr. Auth: County Executive ` Proposed SSTS Renewal —Beek Oscawana Lake Road, (T) Putnam Valley TM# 62.15 -1 -54 The following letter is in response to your request for an update on the above referenced project. The lot was originally approved to construct an individual subsurface sewage treatment system (SSTS) and well on June 19, 2001. The system was installed sometime in the spring of 2002 and was inspected by a representative of this Department on May 10, 2002. At the time of the inspection, the house was not constructed and the well was not drilled. Since the connection from the house to the septic tank was not made and inspected within the two -year time limit, the permit expired and needed to be renewed. During the renewal.process, it was brought to our attention that the SSTs might be within 200 feet of the + - four community wells for - Glenmar Gardens. A sife- inspection was conducted by this Department with the design engineer, Stephen Ferriera on June 2, 2004, and after taking measurements, it was confirmed that the SSTS was within 200 feet of three of the existing community wells for Glenmar Gardens. Two of the three wells were already existing when the SSTS was constructed. Therefore, the SSTS needs to be moved and reconstructed a minimum of 200 feet from all four wells. Revised plans need to be submitted, reviewed and approved by this Department before reconstruction can begin. It does appear based on the site inspection that the system can be moved and meet all .separation . distances. r If you have any further questions, kindly contact the writer at extension 2157. Very truly yours, �C J ` oseph S. Paravati Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property ofd Located at afci4rjf1-4)6 T/V aj- 11A Tax Map # Subdivision of Subdivision Lot # Gentlemen: Filed Map # Block / Lot Date Filed This letter is to authorize a duly licensed Professional Engineer Y_ 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- .1.47.of the. Education Law, the - Public HPalt�'� Law; ai d fhe Puinarn Wit Sahitary Code _ .....____ _ Countersigned: P.E., R.A., # 076 773 Mailing Address %? 3 f l/.,€tiv �l C�ifGr� State Zip Telephone:D Very truly yours, Signed: (Owner of Property) Mailing Address: State Zip elephone: Form LA -97 AA COUNTY DEPARTMENT 3 HEALTH y, a "c �4 'T 5/7 5�f 8 }! fir S DIVISION OF ENVIRONMENTAL HEALTH SERVICES s .,...... -.o . . " %�'1`u�tL "I�11'1T..� IATl�I]EIVT SYSTEM ... PERNUT # 1 V — Located at N)q LAkn' / /1- Subdivision name Date Subdivision Approved Owner /Applicant Name Ml�' - V" Subd. Lot # Mailing Address cS�liT%i = l Amount of Fee Enclosed Town or Village Tax Map .G Z'fs Block Lot S Renewal Revision Date of Previous Approval G4- A/ Zip leSi�G Building Type S�✓ 1 +. &0 Lot Area No. of Bedrooms _ Design Flow GPD 2o o C� f- Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /750 gallon septic tank and Other Requirements: To be constructed by Water Supply: Public Supply From Address Address .or• Private'Su l..Dr�l�Ld b _.:fir' as�lp _�; eiGG :X;2 ,. r ie 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: P.E. R.A. Date o Address A0 3 &W9 -ioA V1 cl7- License # 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 anew pe App ved d chEfte of domestic sanitary sew a only. T By: Title. ESP Date: 611q 10, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fess' pal Form CP -97 PUTNAIII COUNTY DEPARTINIENT-OF, HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES k - FINAL SITE INSPECTION Date: Street Location 0- Q� � o�k-e ' ��Q� Owner j7gG (< Town Permit # `'' V — (c — 0 (_ TM € l_2, /,S— — / — Subdivision Lot # - 1. Sewaae Svstein 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. SeMic tank size - other--:.-.;:: -• - - -r•-- ............................... 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 - properly set ........... ............................... f. Trenches 1. engt required Length installed 2. Distance to watercourse measured. -f /OCFt.......... J. 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 314 -1 %:" diameter clean .................... cif 4ravel. it tTPrtci� - 10. Pipe ends capped .................................. :.................... g. PumD or Dosed Systems Size ot pump c am er ................ ............................... 2. Overflow tank ......:...................... ............................... 3. Alarm, visual / audio ..................... ............................... .. 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ :.................... 6.• Cycle witnessed by H.D.estimated flow /cycle...... _ a:- °nvus b. -N.Uffi IV. Will' -- A ra-a .:: 0.- ........................... / .......... ...........................�._. °Distance frdii STS area measured ' ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ........................ V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & di to extst�watercour r COMMENTS I � _ I Imam A . . Ia Z t" Ivy v al�� Public Health Director May 13, 2002 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LMETTA '- MOUNAki K.N., - M*S:N'." Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Stephen Ferreira, PE 103 Perry Drive New Milford, Ct. 06776 Re: Field Inspection - Beck Oscawana Lake Road, (T) Putnam Valley TM# 62.15 -1 -54 Dear Mr. Ferreira: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. • A reinspection needs to be made for the well, cast iron pipe, footing drain and house be roo��L ce��nt -u - on-ccrnpletion - -.. . - _..._- -- -. - If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide 05/10/2002 07:06 9147341029 TOWN OF CORTLANDT PAGE 01 Mr'K`C'�-Cl�R7C IOJ 1 b f hh0.J1'I: F'U I PO 8'I #- UN I Y LJP--V !F{ I I fs -� fC- f 1 I U y171Y r �Y1r�C7 +' • <' e c 1 PUTNAM COUNTY DEP,ARTM" OF HEALTH DM810N OF ENVMONNDCh'TAY, gEALTH SERVICES ATTENITO�� 0 ADAM GENE RFD= Rog FrnLAL 1a= For. PIA All information must be fully completed prior to any 7regchcs �__ X _ inapecn'oas b ft made. Pm ear s memnpermit #_.,r„v .— � —.0 l OwnodApplmat Name:. CA, 440. AR-4k .1 TM Block Lot s Pormcdy: _ - Svbdiv�sianName: • SubdivWo4 Lot f Is 1vste� / f mN �1 i kpleted? _ ^� 1 4 - -- - -- jDyata: Is system 4vamcted w par place? „ c![ d h well drMGd? A10 Date: .. ...Is wd! locawd ns•per• pleas?----- -•- .-_-- �”- •- ....... . _ ....... .. _... _ .. . Are ec Wan comtrd measures i m place? Ica tify ttat the syst *51 ac red, ,al fie; *w. lii�emises has bear comttuttcd and I have Impoctad and verified ih4 completion in accordance with the issued PCHD Construction Pemit aad approved .Vb= and the Stond`ards, Rules and ftulatim of the Put= County Depaameat of Stealth. - Date' 5 0 L—:` Ca iSed by. A _M ' D Professiaeal Address, ...D 3 Form FIIL•99 � MDY- 4 -PSV1? T1411 18:13 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL � , - please print or type PCHD l eei111ii # Well Location: Street Address: Town/Village Tax Grid # f ✓nv9-^ ✓ MapW Block % Lot(s) SY Well Owner: Name: ���/fic% Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply DrillinW - New Supply (new dwelling) Deepen Existing Well Detailed Reason Ae �LfC S� z •c�L for Drilling Well Type �_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Y Is well located in a realty subdivision? .................. Yes No Name of subdivision Lot No. --�" Water Well Contractor: ANAW -Sev G,/�. LG , /lute- «f Address: Grp- �S / — Is Public Water Supply available to site? .................................. ............................... Yes No A Name of Public Water Supply: Town/Village Distance to property from nearest water main: sou /G/�r ,/��t �✓-T� �� Proposed well location & sources of contamination to be provide on separate sheet/plan. Da ±°: / d! Applicant Signature: -. •�L.�" . - .. — - 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 Putnam County. Date of Issue 19 v 1 Permit Issuing O cial: Date of Expiration I b� Title: Permit is Non- Transferrabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 \� PUTN_ AM COUNTY DEP. DIVISION OF..ENVIRONM /•• A�TC�TTTT /'ITTA1TyTTT1•ft�i"�'i��• ILocated.at wa.vit Town or Village. vlfw Subdivision name `:'Subd;'" of # Taz lvlap 2.15 Block � Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name /l>%let . ' Date of.Previous Approval Mailing Address f%8 �CA41 _ rZeF .T �i,Fli t,�/GG Ny Zip /d 430'4. s6 G Amount of Fee Enclosed aO Building Type S,N /,t,,. �s�o Dr t Area l No. of Bedrooms Design Flow GPD 2° ° (,P 94 N Fill Sep ion Only. Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of._ /moo gallon septic tank and !I/cr, 4, c- 2 E Z.4 4",4. Gl/S 1,.(, �prii— w.l•s./_.. 4it0 i �mdiJf4 T. eZleAl /iitns,4 Other Requirements: To be constructed by ;'` Address Water SuRRN: Public Supply From 'Address or: ,� Private Supply Drilled by o�. «, lt/,tGG [x,c�,,, Address dg(." 47wo,, Ja i I represent that I am wholly and completely responsible for the design and location of the proposed-system(s) and that the separate sewage treatment 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, anal 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 daring the period of two (2) years immedia;eiy foilo_'wing dic:date of tht. issuance of'-he approval of the Certificate „f Constr uction Co::,pliance of the ^rio'raC - _ _ system or any repairs thereto. Signed: P.E. -OZ:13__ R.A. Date Address /0 3��� fetC,/y /CFo•�/J 4-��G` License # APPROVED FOR CONSTRUCTION: This approval expires two year§ 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 anew pemf4. Appr ved td cha a of domestic sanitary Lsewa a only. By: - �IiiIrs". Date: White copy - HD File; Yellow copy - Building Inspector, Pink copy - Owner; Orange copy - Design Pr fess' nal Form CP -97 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 To: Fax: From: j 'g2 /�(� Date: (�Sc�� L�� �wr� Pages: Re: rM sti CC: ❑ Urgent C4 For Review ❑ Please Comment ❑ Please Reply ROBERT J. BONDI County Executive 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. LORElTA -MuLiNARI R:N.; M.S.N: 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) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Stephen Ferreira, PE 103 Perry Drive New Milford, Ct. 06776 Re: Field Inspection - Beck Oscawana Lake Road, (T) Putnam Valley TM# 62.15 -1 -54 Dear Mr. Ferreira: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. • A reinspection needs to be made for the well, cast iron pipe, footing drain and house bedroom count upon completion. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, - M � � /M I I Gene D. Reed GDR:cj Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4P PT j s T���QN.: FOR APPROY 4L nF PLANS F0 - A WASTEWATER TREATMENT SYSTEM _. .... _ . 1. Name and address of applicant: 1 . ` 1t*zs- 2. Name of project: - 3. Location TN: 1 X_/, -iu 4. Design Professional: 5re, p,1,4/ j /AA 0 W 5. Address: A &�„ Ael i/� 6. Drainage Basin: l ,(ALL 11,14,w -t) A4e4 e7- Ge77(' 7. Tvl2e o ro'ect: 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 9. Is' a Draft Environmental Impact Statement (DEIS) required? ......................... /,o 10. Has DEIS been completed and found acc ble by Lead Agency? ............... D 11. Name of Lead Agency c V 12. Is this :project in an area under the control of local planning, zoning, or other naiccs' .............. .......................................... ...:...:............. 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? _ Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water � groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water 19. If yes, name of water supply 20. Is project site near a public sewage system? ............. N I A. Distance to water supply or treatment system? ................ 21. ' Name of sewage system Distance to sewage system 22. Date test holes observed Z4 01 23. Name of Health Inspector AMA. WBEE#11# 24. Project design flow (gallons per day) 'Boo 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... JU o 26. Has SPDES Application been submitted to. local DEC office? ......................... /-"o Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE;Popertjtal Martin S. Goldstein and Glenda Isaacs ko�ted7-at� Oscawana Lake Road, Putnam Valley, NY 62.15 -1 -54 T/V �7it/ Tax Map # Block Lot 5 Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize 15Tr,,,0N,0_;Ad J- fj� A+ a duly licensed Professional Engineer _! or Registered Architect to apply for the required wastewater treatment and/or water supply - permit(s) to serve the above -noted property. in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater 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, andwtl e.Pu- iaxn.County S:anitary.:Co.de Countersigned: P.E., R.A., # 076M Mailing Address 1D3 %i,QRY D State 7- Zip 06-774s: Telephone: $tO ,31570 :,Very truly your , L (Owner of Property) Martin S. Goldstein d 114 E. 90th Street -. Apt. 9D New York, New York 10128 SUM e1 ore 1.- 212 - T 72 - Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH- DIVISION OF ENVIRONMENTAL HEALTH SERVICES T STEM ONNmer AW, ?/AX *- 1,316-ed— -Address Located at (Street) LS c,,o-wAWA-2.4,69 4 W Tax Map 6ZW-j— Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Form DD-97 .... ... . . ..... ............ . ... en "W D thl-o -_- a . Japse Tirn e No Awn.) Fro m `G f"p""u- n d '.= Surface (IA*cbes )..,".i::....-..--.,..�D to ta: r . Mli in -A . . . . . . . . . . . . X, ar z 70 3 2 Z3 Z,�'/ �- z7'% `' 3'1'`'` ",�Ic 3 11 sy ff, Y61 -zv- I's z7j/ I jq M401 4 1,9 y 5 - - Z-7 It 2 ff Z61z, 3'1 0. P7 A .3 4 1,Y 11,6 5 .2 3 4 L 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtain ' ed at each percolation test hole. -i.e. :s I min for 1-30 min/inch, s 2 min f6r 31-%minfinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1,5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 9.0' 9.5' 10.0' 2 T19ST PTT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after-being encountered Deep hole observations made by: A-Ma Date G' Design Professional Name: Ee T &=49Cj�fj Address: A3 f y 044-7 NEw tillcF -e��� �'� 6(e77( Signature: Xjlfl,-A� Design Professional's Seal :. PROJECLI.D..NUMSER - NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONS ERVATI0 DIVISION OF REGULATORY AFFAIRS + State.En+!If_;gmecY!- �!'a:siy ricm i ttVVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I Project Information (To be completed by Applicant or Project sponsor) 1. Applicants or ' 2. ProjecCName 3. Project location: �+ V �L �i' Municipality l U /V /�l<'t' County A. Is pr ed action: New ❑ Expansion ❑ Modilicationfalteration S. Describe project briefly. 9 Tj% /� /�'G /C.�r Gr✓ /s/�'.�xs T� t!r✓r�ST�'L�c T M tM& 7741 6. Precise location (road intersections, prominent landmarks, etc. or provide maf ) 76a/ 6't4T sT Qr-- ;P-1.l1tcs4 2 ' SS' 7. Amount of (and affected: Sy '' ZS Initially acres Ultimately acres a. Will proposed action comply with existing zoning or other existing land use restrictions? Yes ❑ No If No, describe briefly 9, Wb4 is present land use in vicinity of projectt Residential ❑ Industrial ❑ Commercial ❑ Agriculture Parkland/open space ❑ Other 10. Does ction involve a permit/approval, or funding, now or ultimately, from any other governmental agency (Federal, state or local)? Yes , ❑ No It yes, list agency(s) and permit/approvals 11- Does any aspecpq( the action have a currently valid permit or approval? ❑ Yes No If yes, list agency name and permit/approval type 12. As result of pro s ed action will existing permitiapproval iequire modification? ❑Ye s No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: ✓G,���ritf !/ ��`' Lt's % /Fi! � N � 9/ Date. Signature. — - It the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 06/25/2001 12:01 7377666 - — ... Stephen J. FerreiM, P.E. .. . . 103 Perry Drive New Milford, Connecticut 06776 (860) 350 -2499 Adam Stiebeling Putnam County Health Department Devision of Environmental Services 4 Geneva Road Brewster, New Yorke 10509 Re: Neighbor Notification June 6, 2001 The following is a list of neighboring properties and the corresponding tax identification numbers that have been notified of the proposed application: 1. Martin Goldstien d 62,00 -2 -30 2. Carmine Colangelo/ 62.00 -2 -29.2 3. Frank Denardo d 62.00 -2 -29.3 4. Gary Burris,! 62.00 -2 -23 5. Town of Putnam Valley ✓ 62.15 -1 -55 6. Peter Mendola s1 62.15 -1 -56 7. Steven Bruno V 62.15 -1 -78.5 PAGE 02 The return tecexpts w7ii be fog. rclew to you as soon as thev Come tome. Please.contact me if there are any further questions. Sincerely Yours, /s4tepent Ferreira �-- o•� , .sttr.w 3. * At tT a ~°d • j • 3 / # 17 .7i x. CAL • f { 1 f t� •t4 X11 1 412 A A 47 2.15 '• ) 1738 Ac. 4i r 3a.os x. / = y 11.41 AC. ti \ 13t A In a sumo --- = � 43 N .6 t AC. 0.01 At. "1.07• fo z . \ ,.,,, At 1 j IQ is Ac. ti b Wo " • .I _ I ?� tl N •SAC. CAL �r f� 35 2' 26 s 20 s'_e s ` . % 9 ; r t A ' "r✓ 4.21 pC. = 8.0 At CAL. . ; .29 n • 10.06 At. 1 2.06 Ac & b . o C.• f At C63 AC. 14. .95 AC. CAL. 54 9." Ac.. CAL ;\ 53 a .. 40.52 AC. .0 16 , 4 9s 32 7.108 At 7.35 AC. 4! 1.11 ' f 12.54 AC. > At �a i . 40 40.31 36,10 AC. AREA IN DISPUTE ar Nttx �+ $ +' a ` • t .� v. ` • IS • ,� • �+ ,,Q� 5.46 At.� ` X2.53 ` r a • s,.x .yo � d, � GAL { s♦,4 i2 Z. AC. �` it �• sl �` �•'r. 20.86 AC. 31.0 ♦''„ 5.1 a — _ 73.1.95 4 P/0 .� I. —° °- - �----- ._. °_.�__ �• .yam' •1.1 I, • 1 � 7 L t; I� , �f D m w d 0 0 06/25/2001 12:01 7377666 f6 I i , ti , Y to1 PAGE 04 vii ° O to1 PAGE 04 Complete Items 1. 2. and 3. Also oompiete Berri 4 if Flesbk -.W Odil ry is desired Print your name and addm= on the reverae so then we can resin the card to you. Mtsch this card to the track of the ma ili iecce x on -the font N space pwff fs. 44icie Addressed m: '1A.A�it �� r. A Rewived by F*M pi*1 6MOV 8. ode of Owb" { ! Complete items 1, 2, and 3. Also oomPiete Rem 4 if Restricted Oelaary is ditmd. a Print your nems and address an fie reverse C. 9iowure 1} so tehat we can return the card to you. O ent Ag ! • Attach Oft card to the Dark of the meUpisce, p Addeseee or on the front if space permits. Q, ww ham 11 9,vh 1. Addressed to: `t If YES. MW' as lufow: No I r? •- 1 l 3. &er Type lr (`! � n j1jq` (F Al �GeOW Met 0 FX� M@% Mai • 4 %r G (qtr 0 Regseed O Reno n Rcp b Mee o t,a��i 0 CAp. rr�r 1 Lt5�19 ,. RaatrkeM oeirryr t��� O Yye Form 3811, July 1999 Domestic Rearm Receipt t479sS-0GM reS2 PS Form 3811, July 1989 e Complete items 1, 2, Wed 3. Also complete A Received by (Pie n Cfrhem B. see D�alniwy. Item 4 N Rest �y is desred. _ V I P4M your naffs 9rd address an the reverse C. S' so that we can return fro card to you. e Attadt this card to the back of the mallpiece„ O A@" or an the front if specs permits, i O AdOnsaae Mine Aadras W IM o. b delivery hen Awn 1? O)les �/V!I rES.Oda csal adM�ssa briar. f�No 3. WICa"ed MM t� i � Fxprass IAai '3�Alc l 1p ]� �%� �l %i ( �reCryyfisd a PAgw std o amum Reanotor MekC wale 1' � Q O lnaknd tAsB 0 c.O.D. s. Raeot t.d ner+rer» t&air FOO O Yea O�r� Arflcte Number raw rfom wrWas Mg" 170 ass � S Fonn 3811. July 1988 Domeaffc ft tun FbaetA neaaasb0�s-0eBs C. X f&MOvery addie" dlttererd nosh It Rr It YES, enter daily" address!hetow: r !h 3. a Type f(,eebtted Mail O FAPMM Mitt O Registered O Room AoveiO for Merehandias o O ImwW Mee ❑ C.O.O, °a 4. iiestrfated (haven? MX&O fee) Cl Yet Domeafc Retum Receipt • Complete Items 1, 2, and 3. Also complete item 4 M Resbicted Delivery is desired. • Print your name and address on the reverse so test we can mk,rrn the card to you. • Attach this card to Ow bock of the mailpiece, or on the front it space pemlits. cozsssm►rc.:sa 11 A Received by ^m P*f cxa rryj a. C Slgna & O Agent diliererki e'.m sea+ 11 +.t�elow: No 13 ale ey addhas Mcw6w Mail 13 figwn Mae 13 A90"sd a Re urm. Receipt for Mardkmdh ❑ enured moo O c.oz. ' 4. weavhcred oeaverV7 tFA<a Feisl O Yes D ' .�3A / r P9 Fam 3811, Duty im oomease Ranrn Receipt ta2ieaothaaces:cmrt Complete itams"J, 2. and 3. Also compWs Kern 4 If IRWtdcW Delivery is dedred. Print yaw rame wid address an the revairse so that we can iiWm the cod to you. Attach this cwd'to the back of to mailpkM EL at an the bwd 1114spme PwmitL MICJS lmo- 7 IV Y' lo,579 2S Form LD Lo LO C14 C14 1 LI) CD C14 CD July 1m A. ReomAnd tpj Plassa PW CMwW 18. C. Sbriors Addresses 0. Is aiawy adtfDan kdit eiq Imm ilea l? If YES. ~d*my add mm below: 3. =rwd DEXPmasmail 0 pwoebw a Ravm Pam for mucits; adieo a lrmgw mwl 4. ReWded Osliv"? (Earn Fm) 0 yea 1025064114141962 e Complete Items 1. 2, and 3. Also complete tam 4 it Flasaicted Delivery is desired. 8 Print your ram and address on the reveres so that we can return to card to you. 10 AttKh Vft Cwd to ft be* of Ow madipiece, or all to bwd if spas PWMft 1. MW AddMMW to: VA IV- 2. pr 0 Carnosto items. 1',2. and 3. Also complete A. IF IT&tWpL _� Ar 0 Item 4 If ResVoctlix't. Delivery is deeke& Print I your name ,,p�d address an the reverse an Ihd we can rWm the card to you. C. Sig ur — Aftch this card foft back of the mailpiece, X. E3 AgeM or on rive troM if illp'aw pwrnks. D AddW., — 1. AoWft AddmmsW to: D debArl, A 0 N YES, OMO delivery address bela - q qo 3. :ppe* c IX mail 0 Exvm ma 0 Registered 13 Return ReoW for Marchand 1 13 Insured Mail DO.O.D. 4. ReWeled Del*"? Wx" F" 13 y" N4 0— Farm 3811, Domestic Return Receipt P. Asceimed by'#,Ysm Print OsaM B. Data of Qelivery �DAg-ft C. S" Q. K*wNwv mapa awim ap;m ftm i? 12C /V YES. ante; delivery address Waw:' = Mae SOW kW MaChmillas Z; El In Mail C.O.O. C3 yes it 10259MMmw 9.0 ..... ... -9.0- 10.0 10.0 Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water .I��rt�: to r.,,ttlg _- - Depth to inott7iiig Depth to mottling - Depth to rock/imp. Depth to rock/imp. G.L. G.L. 0.5 0.5 -- -1:0 -- - 1.0- 2.0 2.0 '3.0: 4.0 4.0 5.0 50 6.0 7.0 8.0 9.0 10.0 . Depth to rock/imp. 0.5- 1.0 2.0 3.0 4.0 5.0 6.0 6.0 7.0 8.0 9.0 10.0 fro, TEST PIT PROFILES`�� Hole # - L� Lot # H Hole # _ Lot # H l Depth to water !v D Depth to water. 1J[ D Depth to water �Deliti to °mocling °° U ` - Depth to mottling Depth to mottling Depth to rock/imp. D Depth to rock%imp.. D Depth to rock/imp: . G.L. _ .r. C� (� G G.L. I G G.L. _ 0.5 0 0.5 0 0.5 1.0 1 1.0 1 1.0 2.0- 2 2.0. <G -..3� D 2 2.0 3.0' w 3 3.0u 3.0 4.0 r dr r- 4 4.0 4 4.0 5.0 5 5.0© ". -too 6 �(D 6 6.0 S� 8.0 8 8.0 8 8.0 -9.0- 10.0 10.0 Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water .I��rt�: to r.,,ttlg _- - Depth to inott7iiig Depth to mottling - Depth to rock/imp. Depth to rock/imp. G.L. G.L. 0.5 0.5 -- -1:0 -- - 1.0- 2.0 2.0 '3.0: 4.0 4.0 5.0 50 6.0 7.0 8.0 9.0 10.0 . Depth to rock/imp. 0.5- 1.0 2.0 3.0 4.0 5.0 6.0 6.0 7.0 8.0 9.0 10.0 fro, 9.0 10.0 . Depth to rock/imp. 0.5- 1.0 2.0 3.0 4.0 5.0 6.0 6.0 7.0 8.0 9.0 10.0 fro, TEST PIT PROFILES Hole # Lot #, Hole # Lot #, Hole # Lot # Depth to water _ Depth to water -_ J�epth- .to;ater Depth .io mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 . 3.0 4.0 - 4.0 - 4.0 . 5.0 5.0 5.0 6.0 6.0 . 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0-- 10.0 10.0 10.0 Hole # Lot # Hole* Lot # Hole # Lot # Depth to water _ Depth t� waler--- - - -- .D�pt_h tQ wtei::;v; - Depth to mottling - - T Depth-to-mottling"- - -= Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. _ . - -- .. G.L. -- G.L. 1.0 -.... _... ; 1.0 1.0 2.0 2.0 2.0 3.0..... __..:.._ 3.0 -. -- 3.0 -... 4.0 4.0 4.0 5.0 5.0 5.0 6:0 6.0 6.0 7.0 7.0.. 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0