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HomeMy WebLinkAbout2939DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -78.4 BOX 25 02939 PUTNAM COUNTY DEPARTMENT OF HEALTH 'TH- SERVICE:S ...«.. �..:.,:::.: CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV -- t5 —W Located at l!?� SAW I L L R Q A'6 Town or Village � UT IV A M \1 A UZ I/ Owner /Applicant Name_S�W N BQ-O y n Tax Map �2 i) � Block Lot 79 Formerly Subdivision Name eK U �� Subd. Lot # 'A Mailing Address _ %W M111 (ZOAb I P O T NA M V A L) —" -1 %U Y Zip 5 -79 Date Construction Permit Issued by PCHD `7 / I V00 � ��'� '- -7 0nlF1pA AUK Separate Sewerage System built by SAN A`Sn ,) , KTA' IA(Address (� 2 oT 0 N� /1/ y 10; 2ci Consisting of \'2-13Q Gallon Septic Tank and A60 j- , F . US T2E N C, N Other Requirements: -I 1 DEF—P Cu �-Tf \1 N �kN\N Water Supply: Public Supply From Address or: , Private Supply Drilled by NOKMAN AAA -(� %N 1NCLAddress P � B ANGER. ST/ -Bailding-Type . Has- etasion °control:beencoiyipleted- ---•.•1'. S °. Number of Bedrooms Has garbage grinder been installed? G 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 regulatiow of the Putnam County Department of Health. Date: -1 '-s ° ©1 Certified by P.E. X R.A. �Les� n roiess► nail Address 5q CLT 22 P�CZEW STF � N D; License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage 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 revocaticqn modif cati o ch a s� necessary. By: Title: Date: J10 d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 DEPARTMENT PUTNAM COUNTY OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Wit Lodi ua Stree dress: �D T wnNilla 1/ �_ Tax Grid # 70 Map(�Z SBlock Lot(s) •1 Well Owner: Name: �Aj7ddress: v 66 Use of Well: primary 2- secondary :K Residential Public Supply Air cond/heat Omp Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment X 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 eft. Diameter G`' in. Weight per foot . M lb /ft. Materials: Steel _ Plastic _ Other Joints: _Welded Threaded _ Other Seal: 7( Cement grout _ Bentonite Other Drive shoe: )e Yes —No Liner _ Yes X 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 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in fetet �5_0 v Well ]Log If more detailed information descriptions or are available, please attach. Depth From Surface Water ]Searing Well Diameter(in) Formation Description ft. ft. Land Surface 3 " / Sd d '' • �" If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3/�t ,v Capacity Depth d f ModelS'07- /$ Voltage 230 I_P 31c,! ff Tank Type 30Y Volume 7 Date Well Completed y dl Putnam County Certification No. Date of Report t3 �0 6 1 Well Driller (signature) imu vm;: exact location of wen with distances to at least two permanoht landmarks to be provided on a separate sheet/plan, Well Driller's Name � i- nLa.,— G � C Address: Signature: Vii= Date: ---9!1 2).71 White copy: HID File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 L.- '1~00" gn�n ; :7.- '.�,�`�`�. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 _ Albert H. Padovani, Director | LAB #: 87.100027 CLIENT #; 13489 NONSTAT PROC PAGE ' 1 BRUNO, STEVEN DATE/TIME TAKE.: 06/14/01 12:00P 60 SAW MILL RD. ' DATE/TIME REC'D: 06/14/01 12:37P PUTNAM VALLEY, NY 10579 REPORT DATE: 07/05/01 PHONE: (845)-528-1318 SAMPLING SITE: 60 SAW MILL RD. : PUTNAM VALLEY, NY, 10579 COL'D BY: SHARON ROBBINS NOTES...: HOSE OFF WELL TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METHP MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE ' 06/14/01 LEAD (IMS) 3"8 ppb 0-15 ppb 9101 06/14/01 NITRATE NITROG 1.01 MG/L 0 - 10 9139 06/14/01 NITRITE NITROG <0.01 MG/L N/A 9146 06/14/01 IRON (Fe) 2.70 MG/L 0-0.3 mg/l 2037 06/14/01 MANGANESE (Mn) 0.167 MG/L 0-0"3 mg/1 2037 06/14/01 SODIUM (Na). 11.0 MG/L N/A 06/14/01 pH 6.5 UNITS 6.5-8.5 9043 06/14/01 HARDNESS,TOTAL 76.0 MG/L N/A 06/14/01 ALKALINITY (AS 42.0 MG/L N/A - ` . COMMENTS: - ~ � xn,^�r-,ur' ��u���li ����������w^s��t�5'� l�P � . EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. | Fe/Mn If both iron and manganese are preientv.their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a / moderately restricted diet, a maximum of 270 mg/L of Sodium ' is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH I060 TO-S.S. ` .�' I // // it YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y, 10599 Albert H. Padovani, Director LAB #: 87.100027 CLIENT #: 13489 NON STAT PROC PAGE 2 BRUNO, STEVEN DATE/TIME TAKEN: 06/14/01 12:00P 60 SAW MILL RD. DATE/TIME REC'D: 06/14/01 12:371::' PUTNAM VALLEY, NY 10579 REPORT DATE: 07/05/01 PHONE: (845)-528-1318 SAMPLING SITE: 60 SAW MILL RD. ;: PUTNAM VALLEY, NY, 10579 COL'D BY: SHARON ROBBINS NOTES...: HOSE OFF WELL TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE SAMPLE TYPE".: POTA8LE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM MEM Ml::' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Albert H. PaAfani, M.T.(ASCP) Director ELAP# 10323 o i -",A I w W ,/ " ".-`�. _ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y.�0598 � Albert H. Padovahi, Director | LAB #: 32.104949 CLIENT #: 54697 NON STAT PROC PAGE- ROBBINS DATE/TIME TAKEN: 07/12/01 04:00 152 BARGER ST DATE/TIME REC'D: 07/12/01 04:50 PUTNAM VALLEY, NY 10579 REPORT DATE: 07/20/01 � SAMPLING SITE: SAW MILL RD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: SARAH ANDERSON TEMPERATURE..: NOTES...: KIT TAP COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 07/12/01 NF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/12/01 IRON (Fe) 0.861 MG/1... 0-0.3 mg/l 2037 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: -- -- Albert H. Padovani, Director .~ .T.(ASCP) B-AP# 10323 SERVICES YML ENVIRONMENTAL, SER 321 KeAr Street ... ... Y.orktown _Hex ghtt, N.. Y.. -. 10598 qf 4) i��615 Albert H. PadovaQi, Director LAB #: 32.105308 CLIENT #: 13489 . NON STAT PROC PAGE I BRUNO, STEVEN DATE/TIME TAKEN% 07/26/01 IR:OOP 60 SAW MILL RD. DATE/TIME. RECID: 07/26/01 01--.15P PUTNAM VALLEY, NY 10579 REPORT DATE: 0*7/30/01 PHONE,.- (845 -) -528-131 R SAMPLING SITE: 60 SAW MILL RD. c PUTNAM VALLEY, NY COLT BY: SHERRY ROBBINS NOTES...: KIT TAP --- w --- I ---------- — ------ SAMPLE TYPE.6: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 07/26/01 IRON (Fe) 0.076 MG/L- 0•0.3 ing/l 2037 07/26/01 TURBIDITY (TUR .<I NTU 0-5 NTU COMMENTS: Fe/Mn If both irc combined sh SUBMITTED BY: I Albe Dire l acv s- 60 Savo Mill U., Putnam Valley, NY 10579 ♦ Tel: (845) 528 -7575 [ax: (845) 526 -0864 m Public Health Director F... °LORETTA` MOLINARI RN., M.S.N. y Associate Public. Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 I ''' ! I _ �, I!� !1� !' ! � ��•� A 1 ?'' ' ! � _�, � I iii �� r 4� I" �1 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: do �5 T, The Putnam County Department of Health will not issue. a Certificate of Construction Compliance unless the above forge is completed, i.e., a legal E911 address is assigned.by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) 7 9 4567 P. 05 1H'f —ki 1 —•�l�l, 1 01 :56 Pr-1 HARRY W M I CHOLS 1 4 '.mss ..._. PUTNAM COUNTY DEPARTMENT OF HEALTH ^Y,MIS ION .OF- ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ,�; fZuNO Owner or Purchaser of Building Building Constructed by Co o 5Aw M t Lu �-f) Location - Street 3uilding Type Tax Map Block Lot TownlVillage ot2.. S-1 F-444 tS d Subdivision Name 4 Subdivision Lot # I represent that 1 am wholly and completely responsible : jr the location, workmanship, material, eonstructior and drainage of the sewage treatment system serving the above - described property, and that is has L ' ,n 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 herebv 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 t-vo years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, .except where the failure to operate..properly is caused by the willful or negligent act of.the occiipartt of the-building utilizing the- system, The undersigned further agrees to accept as conclusive the determination of the Public- Health Director of the Putn ?m County Department of Health as to whether or not the* failure of the system to operate was causeu by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month 5 1 Dpy / Year GeV4al Contractor (Owner) - Signature Corporation Name (if corporation) Address: 7 �% C1Ct P State ��tV Zip /D5-cd 0 Signature: Title: Corporation Dame (if corporation) Address: State Zip Form GS-97 July 25, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance Bruno Subdivision - Lot # 4 60 Saw Mill Road Putnam Valley, New York 10579 T.M. # 62.15-1-78.4 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS-4, "As Built SETS" dated 6/28/01. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 7/3/01. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment," dated 5/1/01. 4. Laboratory Report, dated 7/20/01. — 5 - --;Application -Fee in the.amount.of $200.00 payable to Putnam -County Health Department. "T-91 1 Address Verification Form," dated 6/13/01. "7". "Well Completion Report," dated 5/30/01. If the are questions any que ions concerning the enclosed, please call. �rHanry,W. Zichols Jr., P.E. HWN:JM:jmm 00- 1 0 1 4 10 A AI J r! v i; CI I-) r J PUTNA 1 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES S Y5 FINAL SITE INSPECTION Z - Date:: Street Locat' Town TM# 6Z - 1-5-- — 70 4 Inspecte y: Owner J Permit # \l — ► S Subdivision Lot 1. Sewage Systeth 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. Sei4aQe System ...... ,1,250 other ................ a. Septic � size - 1 ... b. Septic tank installed leve ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box . 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. T re n_cT es length required Length installed 2 Distance to watercourse measured Ft.......... \4nstal led according to plan ......... ............................... ? e of trench acceptable 1/16 -1/32" /foot ............. . fr om property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .....:............ 7. Room allowed for expansion, 100% ......................... e of gravel. 3/4 -_ 1 %" diameter:cle °9 dp "gravel inirench 12" mi - 10. P e ds ped.... ....... .......... .... g. u mp or D sed stem _ � r . Size of m e .. .......................... .. 2.Overflo .........: .............................. 1�1.... 3. Alarm, vis a dio ............. ............................... 4. Pump easil cessible, manhole to gra ............ 5. First box baffled ...................... ......................... ....... 6. Cycle witnessed by H.D.estimated flow/ ........... / III. ouseBuildirig a. house located per approved plans .............................. b. Number of bedrooms ................ ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured-' 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .................. :................ NO COMMENTS Aft ul d DEC -18 -2000 11:18 AM HARRY W NICHOLS 914 279 4567 P_01 %a wd lamed w W Plus? I 61 es cre do elm Fay l base 6o cBc ! H have l�ected and va" didt Wm k , e erl* to bsued PO Conaugdon ft nit od appe®ve6 paw Stmduk Male$ and UV94oas of The Pub Pouay Doyafteot of Meal& Dw. OmWA b '44 A aD l Addim: - PUTNAM COUNTY DEPARTMENT OF HEALTH �- DIVISION OF ENVIRONMENTAL HEALTH SERVICES u i. CONSTRUCTION PERNIIT'F® GE TREATMENT SYSTEM PERMIT # �' I '� ' O Located at Town or Village Subdivision name 59"V kD Subd. Lot # 4 Date Subdivision Approved 101 `y5! %0i Tax Map G*Z'1'r2 Block 1 Lot -713 A Renewal Revision Owner /Applicant Name IST'EN1 =H bp-0 H�) Date of Previous Approval Mailing Address 5 ND ? U11J Ni�\ Pi k, � i Zip Amount of Fee Enclosed I Q ;-) f Building Type VLE� 1 pl✓�A 6e Lot Area '� ,I* No. of Bedrooms 4 Design Flow GPD bM, Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of M_; o Other Requirements: 11 Peg tiU Pct`'► i i� To be constructed by T6. .6rP, gallon septic tank and Address 460 LF A65 Water Supply: Public Supply From Address or: Pn��ate Supp1X Drilled b ' Address .. ... I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of 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 Cty v, 'rte "Q bQ P.E. >� R.A. Date 611-© 100 �►3W�iZ 1�`� License # 5�1` 4- 1 b Scpt APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or, modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. App ved Vsi of domestic sanitary se ge only. _ ._.__.._ 7 I co By: Title: t I� Date: White copy - HD File; Yellow copy - 'ldi g Inspector; Pink co - Owner; Orange copy - Design Pr fessi nal Form CP -97 P TJ NAM COUNTY DEPARTMENT OF HEALTH lID1IVffSff(DN OF IENVIIR®NMIENTAIL HEALTH S1ERW C1ES _ ... _ .:.. AIEDIPILIIC DTI N 'Il'®_C ®N 'IC'IlBUC')I'..A WA�'lEllB WIE]L]L please print or type PCHD Permit Well Location: Street Address: Town/Village Grid # , , JTax 15/A'VJ H11� 4� V11AW QN�,� TMap 47-J6 Block i Lot(s) -18'4 Well owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought i- gpm # People Served S "4? Est. of Daily Usage _ �,�gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling A New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Tylne_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 7t Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision 5�-V l Ao Lot No. 4 Water Well Contractor: i � p Address: i Is Public Water Supply available to site? .................................. ............................... Yes No A Name of Public Water Supply: °-- Town/Village Distance to property from nearest water main: --- Proposed well location & sources of contamination to be provided on sepapte sheet/plan. Date:_- l °=�? Applicant Signature. _ - . V V ]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 7 19 epa I f Permit Issuin Official: Date of Expirationi 1 711 ¢ oZ. Title: Permit is Non- Trannsffe>r>ral Ile White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Harry W. Nichols Jr., P.E. 311 Clock Tower Commons — ..Aoute2Z wiier, - NY - 10569 Telephone (914) 279-4003 Fax (914) 279-4567 June 20, 2000 Mr. Adam Steibeling Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Steven Bruno Bruno Subdivision - Lot #4 Saw Mill Road Putnam Valley, NY TM #62.15-1-78.4 Dear Robert: Enclosed are the following: 1. Five (5) prints of drawing SS-4, "Proposed SSDS," dated 6-20-00. 2. "Short EAF," dated 6-20-00. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4.- "Construdion Permit for Sewage Disposal System'," dated 6-20-00. 5. "Application to Construct a Water Well," dated 6-20-00. 6. "DesiZn 114tq Sheet." . . - . . . -.:.. .. . .:. ..— .. 7. "Letter of Authorization," dated 6-20-00. 8. Two (2) copies of Residence Floor Plan(s), or Bedroom Count Only. 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, ir Harry W. ichols Jr., P.E. HVYrN:hi 00-106. 0 l?"UTNAM COUNTY DEPARTMENT OF HEAL'T'H DWISION OF ENVIRONMENTAL HIEAIC,7['H SERVffCES. ; LETTER OF AUTHORIZATION RE: Property of Located at '6141W T/V &_14h yh 1. � Subdivision of Subdivision Lot # Gentlemen: OUL. - �-OA0 Tax Map # G2-- 115 Block I 01LU Ldp 0 Filed Map # �A %l _ Date Filed This letter is to authorize I ��W W. j i% R- Lot -16 .4 a duly licensed Professional Engineer 5� 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 confoxmity_w ish-the provt�ioms..of:Article .I4.5.:and/6f_.147 off: the,Education.Law,..the.Publbc - Health ; : =_ Law, and the Putnam. itary Code. Countersigned: Y.E., R.A., ii Mailing Address s N 1 CI,rC<..''` State N1 Zip � 06dl Telephone: blAl� } �-i C w tA Oo a. Very truly yours, 11 Signed: (Owner of Property) Mailing Address: 2— f?e,A. _ 610- e, 06 o- Vk State Zip 0 Telephon S 2-9-- (3 j Vq f �� Form LA -97 e- _..- 'V Ic . ..n �.r %.: . -`t=' �i�. •. s . � �. r .a. r . - ...� ®��}�� .L ��1 \ �� ~ ♦ �� /L y v • n.• e n . .w r •. C' • - P .M � .. .w .. .... s • I CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmentaG impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: July 08, 2000 -- -Ili w DATE PERMIT EXPIRES: July 08, 2001 APPLICANT /SPONSOR: Steven Bruno 2 Renee Gate Putnam Valley, NY 10579 PROPERTY LOCATION: 10 Saw Mill Road TAX MAP #: 62 -15 -1 -78.4 SIZE OF PARCEL: 3.78 acres ZONING: R -3 PROPOSED ACTION: Single Family Residence, SSDS, Driveway and Well within wetland buffer . MATERIALS REVIEWED: 1. Application Materials, file # WT -347. 2. Proposed SSTS, Lot # 4, as prepared by H. Nichols Jr., P.E., dated 06- 21 -00. 3. Survey of Property prepared for Steven Bruno, by Taconic Surveying & Engineering, P.C., dated 03- 05 -99, last revised 07- 05 -00. DATE OF SITE INSPECTION: June 03, 2000 CONDITIONS OF PERMIT: 1. All work to be constructed as shown on the proposed SSTS plan as prepared by H. Nichols Jr., P.E., dated 07- 05 -00. 2. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. Page ❑ PAGE ❑ 1 ❑ of ❑ NUWAGES 020 a .. b -3 .; ..::. When- EFosion controls - ar@ •required, -they anust -be �maintained4properl� throughout; ,. . <. ...: s , the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 4. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 5. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and/or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: July 08, 2000 cc: Applicant Building Inspector Planning Board Environmental Commission Page ❑ PAGE 020 of ❑ NLWAGES 02❑ Stephen W. Coleman _�_ -T-u Wetlaiids- )oi- --- `_-° , BRUCE R. FOLEY .- Public. ffeakh; Director 'a _r• - LORETTA MOLINARI R.N., M.S.N. -Associate. - Public::: Health ; nirector.,. Director of Patient Services - - DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Fogg July 13, 2000 @K) Harry Nichols, PE 311 Clocktower Commons Brewster, New York 10509 Re: Bruno, Saw Mill Road TM# 62.15 -1 -78.4, Town of Putnam Valley Dear Mr. Nichols: 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. Proposed 100% expansion area is within 100'.0" buffer of wetlands. * Current regulation (Sanitary Health) require a minimum 100.0' buffer. * All trenches must be outside buffer area. 2. Plans as submitted are approvable, with exception to comment #1. _.. This officemi.11 continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj 14.164 (9/95) —Text 12 PROJECT I.D. NUMBER 617.20 S EGA R Appendix C - _ - State'EtivironmentattQdellty SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR ! j V�\JF_H HO 2. PROJECT NAME . LoT W01JiDtlP�l� T� 3. PROJECT LOCATION: p �T�9" Municipality 1Pc County f 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modlflcatlon/alteratlon 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED:'�a 3 "-*)% �3 Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR -OTHER EXISTING LAND USE RESTRICTIONS? AYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? &9sidenllal ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other pgscrlbe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? NYes ❑ No If yes, list agency(s) and permil/approvals P1:p11ir \n1AtdkR_- ToNH WESI.PrHD� IN�$F Op- 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? KYes ❑ No If yes, list agency name and permlUapprovai J o t' VNA d L< 4ft-C'J�� --raNr of, Qw 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes RNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name:" Date: O Signature: . i/ V If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 IFn >.d,. PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? • If yes, coordinate, the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another. Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or. threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, ors 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. 66. Long term, §hort term, cumulative, or other effects not Identified In CI-05? Ezplaln briefly. C7. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATEb TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART.111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude: If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if. you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of lead Agency ° PriRt or= ype Name o " esponsi rcer n'Ceb Agency - - -w Signature of Responsible Officer in Lead Agency Signature of Preparer (ITUITFere—nt-Triom responsible officer) Date 2 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES .DEPTH HOLENO. r�' ._ I(�Ll✓ NO.J ..:_ : ..,`MOLE G.L. so 1.5' 2.0' - 2.5' 3.0' 3.5' 0P- 6iL g ^L ®D- WL 4.0' 5V- 4` .�� 4.5' aoct- 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered 11` o,) Indicate level at which mottling is observed Nom Indicate level to which water level rises after being encountered Deep hole observations made by: Jff*�- mood (WWA) AQKA 611QEU Date 5 -15 - t)o Design Professional Name: W-p-Y W D Address: Wt.- C.4-o TAyo- C,0 M&W( Signature Design Professional's Seal �pF NEW �. NICW C- iii 13 > W No. 56124 �A9QEESS�aNP/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIWSION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _'5Ta,4 aN R>P-Q H"Z) Address 5 -W MILL NN K%14W V4LL_t1; 1"y Located at ($ 1 treet) 5pw Tax MaPO-15 Block Lot (indicate nearest cross street) Municipality TH#11_1 . .X)A�A._Ef Watershed, 1406Q0 P-4\) 0- SOIL PERCOLATION TEST DATA ro (1-k� zf.� cm Is) 00 Date of Pre-soaking Date of Percolation Test ............ :::::::: : ' : ... . ... .... ...... . . . . .. ................... ...... ............ .... .................... ...... ...... .... " ' .. ........ ................. ........... _­_ ............... ..................... ....... xx: .. .. ............ .... . . . . . . . . .. . . . . .......... ... .......... .... . . . . ....... .......... ................ . . . . . . .. ... ... . . . . . .... . : : : : . : :: : ................... ........ . . . . . . .... . ......... .. X. .... . - ....... ... . . ............. I I . . . . . . . . '. . . ......... . ....... .. ............. W­- e0t 46. t ........ D er.— ........ :G'""*" d rom: -roun . ...; ..... .. .... ........... ... .. .......... I .......... I ..... * ..... :*��-:-:-X-::;:: .... X.W . r. . . X...:%-.-:-:-.-� :.. . . .... X . ..... : .......... . Perco a on ..... . . 0 el.. 0....::.. ........... ...... i::.: ... .. ..... ... ...... ........... .... . .. .......... ;X: .... ....... . ... ... ............ .. ....... ....... .... XS t ...... .... ..... ............. .... ..................... pe::Time . . ....... .... .. Jr ace::: n tart fines es ja h rD 2 3 4 G4 5 % 2 3 Si 4 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 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. Form DD-97 .z 27. Is any portion of this project located within a designated Town or State wetland? YE-5 28. Wetlands I_D Number. _ _ ...> ,.........�... .........:.:.- :.....:.�i� a.a,►,►,�(^.. ,..�.,� 29.Y Is Wetlands Permit required?: ................................................ ............................�,� Has application been made to Town or Local DEC office? ............................... t 30. Does project require a DEC Stream Disturbance Permit? .. ............................... N 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 4 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 0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... YE5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ...................:. NQ 35. Are any sewage treatment areas in excess of 15% slope? . .......................:....... N4 36. Tax Map ID Number .......................... ............................... Mal)6t S Block Lot 37. Approved plans are to be returned to ..... Applicant A Design Professional _. NOT_E:.AII applications. fox_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 l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Lqw. A SIGNATURES & OFFICIAL TITLES. '47 jo'. m Mailing Address: X11 C LbL4- �To�OL- .... ............................... ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FORRO�Ag. 01F PLANS'IH'0R A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: PU i -vk1A V Nth 2. Name of project: Q' IkDNOUO�, 66-M 3. Location TN: 4. Design Professional: "P� -► W,5. Address: X11 C- U4 -'Mv4- C4('tMO� 6. Drainage Basin: �y��� �RUS�( `4•�0� 7. Tyne of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted ')t 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... �4N 11. Name of Lead Agency H :1.� . Is.;this project i an area,under the control- of-1 :ocal;planning -,. n ri ing, or;other.. . officials, ordinances? ......... ............................... ............. ............................... Ti 13. If so, have plans been submitted to such authorities? ........ ............................... Na 14. Has preliminary approval been granted by such authorities? Ma Date granted: R 4 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... MA 17. Waters index number (surface) H A 18. Is project located near a public water supply system? NQ 19. If yes, name of water supply Distance to water supply dN 20. Is project site near a public sewage collection or treatment system? ................ 40 21. Name of sewage system r4 N Distance to sewage system QJh 22. Date test holes observed ll br5 j O 23. Name of Health InspectordPW 6" 1--& 24. Project design flow (gallons per day) ................................. ............................... $0CS 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... I 14 D 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 a 41 r r r r , �• ,b�, pro ' . �/, � ', � !'� ..�. i, `'��,. ���) � � �'t! • . ru n , 0 •, ,. "} G .pv � , r u. `: .,tee �� �% o)l CI G' .! i. ! .. : I r 11 1. y._ •.-' ;mom? F TIC F`fi� ' Nib •,� � . 4r .. • h� xV Q7 �,��• :. yeti '• � _ : ; I/ 1, % 1 , � ; Ih �; �.p " � !3 i :: rr -r � /� /i r i � �1I' p � •Ii�l, 1 � � A ' F ��� iu t` �—� I� � / j / i' J. Y' I�`�'ar sr ,/• "(loo)£S:'955 'nNt '. ;� `� `i � , , f - - _% '' : •,'l l � i .;� / �/ � ,, I �h , � CNI) OL „'95S shNl •9�C `• ` i � i . i i I . ''1 r � E ” i, a \• ¢� , � (iro)EB OL5 `nNt / / 1 t t. 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