The URL can be used to link to this page

Home My WebLink About3058DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.26 -1 -6 BOX 25 03058 r F ` . ' li-ilr' T. IL '��r, 7 ' , '� ■ 4.%- it f - I IL I jw TL 03058 .1 J \b` PUTNAM COUNTY DEPARTMENT OF HEALTH - IVSOT- _OF_ENVIOI�TMElT�,L- A LTH.. SERVICES_ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV-39-00 Located at 24 Wenonah Road �o Town or Villag a ley Owner /Applicant Name Mark Pawera Tax Map62.2 6 Block 1 Lot 6 Formerly John Pawera Subdivision Name John Pawera Subd. Lot # 2 Mailing Address 24 Wenonah Road, Putnam Valley, NY Zip10579 Date Construction Permit Issued by PCHD 10 / 31 / 0 0 Separate Sewerage System built by Mark Pawera 24 Wenonah Road Address Putnam Valley, NY1 ()579 Consisting of 1250 Gallon Septic Tank and 420 LF of Leaching Trenches Other Requirements: 0 -2 ft. Bank Run Fill to make grades parallel Water Supply: Public Supply From Address, 152 Barger St. or: X Private Supply Drilled by Norman Anderson AddressPutnam Valley, NY 10574 a g�.7I►A.�.;_,. 3c Fi�nsirn Control been connplieted'._ Number of Bedrooms Has garbage grinder been installed? no I certify that the system(s), as listed, serving the above guilt plans (copies of which are attached), in accordanc plans and the standards, rules and reg on of thgPi Date: 4/4/02 Certified by Address 2 Muscoot Road Nor ses wer co tructed essentially as shown on the as- the iss ed P HD Construction Permit and approved Coun& De a tment of Health. P.E. R.A. X NY 10541 1 License # 1 1 0 5 6 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 revocat' n, modification or change is necessary. Af_ - 2,, By: �° Title: �-- Date: White copy - IRj File; VJllow copy - Building Inspector; Pink copy - �Gvner; Ofange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Weii Location Street . Adore' s: - - n /v� ag �. , Tax Grid # Mao).)6 Block Lot(s) (O Well Owner: e: Address: Use of Well: 1- primary 2- secondary Residential Public Supply it c- nd/hent pump rrigation 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 2� Open hole in bedrock Other Casing Details Total length ;:9-'7 ft. Length below grade AS" �1 ✓ft. Diameter in. Weight per foot _Z6 _Ib /ft. Materials: 2!!'L Steel— Plastic _ Other Joints: _ Welded . Threaded _ Other Seal: X. Cement grout _ Bentonite Other Drive shoe: iGYes _ No I Liner: Yes _Z 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 -J-0 gpm Depth Data Measure from land surface- static (specify ft) -5v During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve . znalvses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface S ro If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capaci Depth Y60 Mode /af Voltage 2-3o HP I Tank Type k)X 30 -K Volume / yO Date Well Complet d /b-o, o )", 1 Putnam County Certification No. Date of Report Well Driller (signature) NOT $,: Ex ct location of well with distances to at least two perman ht la dmarks to be provided on a separate sheet/plan. } Well Driller's Name L7�,,,� Address: l l/ Signature: Date: ?, /o� 7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 9ML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown h y '10598 - = | Albert H. Padovani, Director | PAWERA, MARK DATE/TIME TAKEN: 03/20/02 09:00A 44 WENONAH ROAD DATE/TIME REC'D: 03/20/02 10:00A PUTNAM VALLEY, NY 10579 REPORT DATE: 09/28/02 PHONE: (845)-526-3859 SAMPLING SITE: 24 WENONAH ROAD,PUT VALLEY,NY SAMPLE TYPE..: POTABLE : PRESSURE TANK VALVE PRESERVATIVES: NONE COL'D BY: JOHN PAWERA TEMPERATURE-- < 4C NOTES...: COLlFDRM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 03/20/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 03/20/02 LEAD (IMS) <1 ppb 0-15 ppb 9101 03/20/02 NITRATE NITROG 3.23 MG/L O - 10 9139 03/20/02 NITRITE NITROG <0.01 MG/L N/A 9146 03/20/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 03/20/02 MANGANESE (Mn) 0.056 MG/L 0-0.3 mg/l 2037 03/20/02 SODIUM (Na) 8.13 MG/L N/A 03/20/02 pH 6.8 UNITS 6.5-8.5 9043 03/20/02 HARDNESS,TOTAL 152 MG/L N/A 03/20/02 ALKALINITY (AS 66.0 MG/L N/A - 03/2Y0/02.�''.TURBIIlITY`(TUR_` '--~--~ -- �--~--'-`--~` �''~- --'— -` ---------~--'~---'r-'---_----_---~'- �-'-- COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING~ DHE 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 pph 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 26 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 ma/L. of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 ` Albert H. Padovani, Director | LAB #: 32.202001 CLIENT #: 55286 NON STAT PROC PAGE 2 PAWERA, MARK DATE/TIME TAKEN: 03/20/02 09:00A 44 WENONAH ROAD DATE/TIME REC'D: 03/20/02 10:00A PUTNAM VALLEY, NY 10579 REPORT DATE: 0 3/28/02 PHONE: (845)-526-3859 SAMPLING SITE: 24 WENONAH ROAD,PUT VALLEY,NY SAMPLE TYPE..: POTABLE : PRESSURE TANK VALVE PRESERVATIVES: NONE COL'D BY: JOHN PAWERA TEMPERATURE..: < 4C NOTES ...: COLIFORM METH: HF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. TOF pH[SONE 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 O 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 `MO�ERATELy�HARD WATFR:.7O-140 MG/L �-`MILLIBRAM.P�3F(�LITER' 00 MG /L (I arain/cia SUBMITTED 8Y: - Albec�,77-1. Padovani.� I.T. 4msc Director PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Mark Pawera Owner or Purchaser of Building Mark Pawera Building Constructed by 24 Wenonah Road Location - Street One Family Residence Building Type 62.26 -1 -6 Tax Map Block Lot Putnam Valley TownNillage John Pawera Subdivision Name 2 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: M nth 04 Day 0 4 Year 0 2 I General Contractor (Owner) - Signature Corporation Name (if corporation) Address: 24 Wenonah Road., Putnam Val ley State NY Zip 105 7 9 .1 Signature: Title: Owner Corporation Name (if corporation) Address: 74 Wpnnnah Rnad, p_ ,�,+ �nam vgllz� State NY Zip1 o 5 7 9 Form GS -97 DIVISION OIL'_ E -NVIR(JN E�I� HIS �L-'a �$- VITCE-P- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Mark Pawera Owner or Purchaser of Building Mark Pawera Building Constructed by 24 Wenonah Road Location - Street One Family Residence Building Type 62.26 -1 -6 Tax Map Block Lot Putnam Valley TownNillage John Pawera Subdivision Name 2 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the_occtlpant pf the= building —ut. izi The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: M nth 0-4 Day o 4 Year o 2 General Contractor (Owner) - Signature Corporation Name (if corporation) Address: 24 Wenonah Road, Putnam Va.11ey State NY Zip 10579 Signature: Title: Owner Corporation Name (if corporation) Address: ,4 wennnah Rnaaf _P_: nam State NY Zip10 579 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Mark Pawera Owner or Purchaser of Building Mark Pawera Building Constructed by 24 Wenonah Road Location - Street 62.26 -1 -6 Tax Map Block Lot Putnam Valley TownNillage . John Pawera Subdivision Name One Family Residence 2 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system:. The. undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: M nth 04. Day 0 4 Year 0 2 General Contractor (Owner) - Signature Corporation Name (if corporation) State NY Zip 10579 Signature: 14611��_ Title: Owner Corporation Name (if corporation) Address: ?4 WAnnnah Road, A „}„am State. NY Z1p1 o.579 Form GS -97 Jun 10 02 03:51p Planning Board (914) 526 -3307 P.1 BRUCE R- FOLEY Public Health Director LORETTA MOLWARI RN., M.S.N. 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 Fox(914)278-6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: .:.!1;7 J �� c -Ju It /L'' ! o a-�8 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above forum 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) D 69 N Q Z e / - - cwt on .. �•.., /cl 11 11, 13 14 15 /y°/ 8 7 6 5 4 3 g Nlj, & 4'�Pe "IFS � R-a1MS • - OWF�fr:1N0 e t2 atery) / 40.72 O�PyB C apilc tonk I 45o GAL eons, alp• BO.00' � \S14.42'0O "W r >rod Znd. W 0 6 N N 0 0 0 N AS BUILT L0e-&TI Oki A F5 I I'teM 81 3S 7h N L- 2 �s 41 N W Z -7 3 1 �9 4 36 7 5'L 33 8 4e 35 104 8$ p J Ill tl p � D Z w 10 107 $0) II Ilz °JI 12 Irio °73 13 /20 °1 io rQ• !25 � S rs 128 ioo G D 1"rEM % 1 IOFj \Vt:LL d� • ¢ilgr(34'' //dr{Ve to �-. ✓ (O SURVEY REFERENCE i vreN AS BUILT PREPARED BY RobE2T BERGENDORF, P.L.S., N.Y. STATE LICENSE 1(o pea LAND SURVEYOR NO. 40507 DATED FEBRUARY 19, 2002. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM HAS BEEN \ _ CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT I INSPECTED THE �OT,g4' W SYSTEM BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE ��.. �• exl$ ?I PUTNAM COUNTY DEPARTMENT OF HEALTH. O (v rutnam Country Department or ii aitl � I" 01vieion of Environmental Health Services E� ►pproved a's noted for conformance with rnop.cet applicable Rules and Regulations of the EREO -4 nam County Health Departtmment/ vhP`�nENCEG,eo-Q'� \3�.°J S' Ft�0S3.00 ^ /- - S \4 °00'00 "W i_�66.OS' � 0 i . J601 Pete s14- oo•oo °w 11aLaa• R.4 ;aa.00 L °45s.oa• -1•—� puY 2' en Prop. 1, `N9 E l*! O w A H Im O A C� p h AREA - \.3456 ACRES RItxM ARO N. OORR. 1ho m —yor w.he Tad. t1\10 mqp by om rl lty that tho ur y ehaU.an horoon wpm, eom.- imtfid byfna en 6 /1m /2000 pnd It1mt -Ih1e meP w° mplatmdby fnm mn /22/00 end the! thlm s voye e boon preperod In •abet done• with tho axletlnp Gedo I Praelleo ter Land SWrvmym edepl.d by the New Yorh t eto Ammeelmilen et Protmemle Len 1 d myero. mrwx eeama°y /IS /z�182S . M�.PREVISED 6/22/2001 G /J /J /J Ju" TO DA-re w,'10 /02 \GH ARO M. 60RR,P.L.S- OUTC 6. P.C. ®CX 916, MAMOP AG, N.Y. 10041 JGATION OF MOU36.WtSLL.86PT \G TANK APPROX �.00. OP ®® O O1RT DRIVE„ 11ERT M. ®GR®6NOORFF. PA—S. N.Y.0.11e.no. 4O®OT, eOMM. %te 4 r _ ne � fod eof set n 1 \no IL a m_ 1 - . 0 \ (� ?REP AREO P OR ® / ® ZW N 10 - apoppr; N %u°onerel SITUATE \N THE / a, / /PIb o. ` - TOWdV Ot PUTNA,M VALLEY `, ooptla tanh U PUTNAM COUNT Y mew:L.a. N J NEW YORK of � atQx.wle. so.00• \ � P ERA N ` t e.W : c2 slaty) •I S\4- 42�oo••w 1 . Q i•ed Incl. 1 tl 40.'72 Pw °lo n 't—d eoI / \. A1\ port \t \eatlonm or. —%W for thlo Tap and ooploo thoroot �) {'. °r "d• , on\y 1t sold map and aoplom boor tho Impr0000d o001 of the /� t7l'tya_ ` ® , oU—av r whom. o\gnotur. appoaro horoon O ' ~ " �.. :/ •'� 2, A \torat\on eT tnlo dcaumont and oopioa IhorooT \o \11oge1 O •.� / l exoopt by o Iieonoed land ouryoyor) and 1n vlolat \on at m ' wall - Sootlon 7209.SubtlWblen 2 of th. Now York Slot. Eduaot\c O ^ O '• pets N /F •'BORr,�, ;S. L000tbn .t undorground \mprov.monto and /er onar. —t- • z h—ftb . T any ox\mt,aro net oortlt\od. •\ \ f 4. TMo InaP and eoplom thorooT aro oortltlod to th. co—. nom _3 -� X07,84' W ewnorm,t \tlo aempany and londing lnaM.tlenCm) ohown horoon 0 • e . �, ; �, ` to those' part \om o nly, Y 0 S. OC COPYR \OMT R\CHARO H. 60RR,P �S. 800 nuu nlwrro tl ^o dflye O O O _ .'t (` 1 G. LOT 2 1m shown on map eMltlod '•2 LOT SUBDIVISION for i 10 JOHN C. PANNMRA•• 111od In thho Putnam County C\orWe oil \ Septemb.r 12.E000.as. map no. 2841 . J601 Pete s14- oo•oo °w 11aLaa• R.4 ;aa.00 L °45s.oa• -1•—� puY 2' en Prop. 1, `N9 E l*! O w A H Im O A C� p h AREA - \.3456 ACRES RItxM ARO N. OORR. 1ho m —yor w.he Tad. t1\10 mqp by om rl lty that tho ur y ehaU.an horoon wpm, eom.- imtfid byfna en 6 /1m /2000 pnd It1mt -Ih1e meP w° mplatmdby fnm mn /22/00 end the! thlm s voye e boon preperod In •abet done• with tho axletlnp Gedo I Praelleo ter Land SWrvmym edepl.d by the New Yorh t eto Ammeelmilen et Protmemle Len 1 d myero. mrwx eeama°y /IS /z�182S . M�.PREVISED 6/22/2001 G /J /J /J Ju" TO DA-re w,'10 /02 \GH ARO M. 60RR,P.L.S- OUTC 6. P.C. ®CX 916, MAMOP AG, N.Y. 10041 JGATION OF MOU36.WtSLL.86PT \G TANK APPROX �.00. OP ®® O O1RT DRIVE„ 11ERT M. ®GR®6NOORFF. PA—S. N.Y.0.11e.no. 4O®OT, eOMM. %te 4 F. ..__----- r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # I' (- 3 q - 3_3 Located at aL4 WENONAH ROAD Town or Village PUTNAM VALLEY Subdivision name JOHN PAWERA Subd. Lot # 2 Tax Map 6 2.2 6 Block 1 Lot --49p*- 6 Date Subdivision Approved4 / 5 / 2 0 0 0 Renewal N/A Revision Owner /Applicant Name JOHN PAWERA Date of Previous Approval N/A Mailing Address 44 WENONAH ROAD, PUTNAM VALLEY, N.Y. 10579 Zip 10579 Amount of Fee Enclosed $ 3 0 0 Building Type ONE FAMILY Lot Area 1 .3 7 A& of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 420 OF 2 FT. WIDE TRENCHES Other Requirements: 0 -2 FT. BANK RUN FILL TO MAKE GRADES PARALLEL To be constructed by NOT SELECTED Address Water Supply: Public Supply From Address °Private Suppiy'Driiied by NUT SELECTED __...A..... -. -= 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 s, sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Complianc ' sati factory to the Public Health Director will be submitted to the Department, and a written guarantee will be furn' ed the owner, his successors, heirs or assigns by the builder, that said builder will place in good opera ' g condition part of aid sewage treatment system during the period of two (2) years immediately following the date f e issuance the appr val of the Certificate of Construction Compliance of the original system or any repaAthereto. Signed: Address2 MU P.E. R.A. X Date 1 0/ 31 /2000 H, I.AMPAq , N.Y. 10541 License # 1 1 0 5 6 APPROVED CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment systein'.has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessaryby tke Public Health Director. Any revision or alteration of the approved plan requires a new p t. A ov4bisc ge domestic sanitary Asewae l y. By: Title: Date: White copy - HD File; Yellow copy - Building Spector; Pink copy - Owner; Orange copy - Design Pro essio al Form CP -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH IlDHVISION OF ENVIRONMENTAL HEALTH SERVICES AP-PLICATMN TO CONSTRUCT A WATER WELL r - a • , - please piinf or`rype :RC HD `Permit � Well Location: Street Address: Town/Village Tax Grid # 44 WENONAH ROAD PUTNAM VALLEY Map 62<2Q31ock 1 Lot(slf= 6 Well Owner: Name: Address: JOHN PAWERA 44 WENONAH ROAD, PUTNAM VALLEY, N.Y. 10571. Use of Well: X 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 5 gpm # People Served 4 Est. of Daily Usage _LO 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply (Drilling X New Supply (new dwelling) Deepen Existing Well (Detailed Reason NEW HOUSE for (Drilling Well Type Drilled X Driven ('travel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision JOHN PAWERA Lot No. 2 Water Well Contractor: NOT SELECTED Address: Is Public Water Supply available to site? ................................. ............................... s No .X Name of Public Water Supply: N/A own/Vil ge Distance to property from nearest water ma' Proposed well location & sources of contami ion to a provi ed n sep a e sheet/lilan. Date'. 6 2 2 9 9 Applicant a S.� ^.at',zr?: PERMIT T ONS U A WATER W IL J This permit to construct one water well as set abo , 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 dri ler ce 'fie by tnam County. Date of Issue l 00 Permit Issuing pfficial: QL Date of Expiration to CQ-. Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 r u l*1N A.1VI U V U N T Y DEYARTM +' N T OF HEALTH f DIVISfON OF ENVIRONMENTAL HEALTH SERVICES. APPLICATION FOR APPROVAL OF PLANS FOR �. �TF- W_ATE+ B.".!i'R.F:.A'- 1'MR.tNT SYc; 1... 1. Name and address of applicant: JOHN PAWERA 44 WENONAH ROAD PUTNAM.VALLEY,.N.Y. 10579 2. Name of project: JOHN PAWERA 3. Location TN: TOWN OF PUTNAM VALLEY 4. Design Professional: JOEL GREENBERG, R.A. 5. Address: 2 MUSCOOT ROAD NORTH 6. Drainage Basin: HUDSON RIVER MAHOPAC, N.Y. 10541 7. Type of Project: X Private/Residential. Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) . 8. Is this project subject to State Environmental Quality Review (SEQR)? . , `- Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted x . 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been. completed and found acceptable by Lead Agency? ............... N/A 11. Name! of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, or other _.. _ YES,-- _fD 411 .S - 0- kdi0an.ce5 :....:..:,,'.:.::.:• :..::.:::..:.:.:::: :::.. :....::.:::.........: ;..:: ......::::.:.v _.._.._ ._...d..._._ 13. 'If so, have plans been submitted to such authorities? . ............................... 14: Has preliminary. approval been granted by such authorities? Date granted: N/A 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? ...... :.............. N/A 17. Waters index number (surface) ........................................... ......6........................ N/A 18. Is project located near a public.water supply system? . No . . ............................... 19. If yes, name of water supply . N/A Distance to water supply 20. Is project site near a public sewage collection .or treatment system? ................. NO 21. Name of sewage system N/A Distance to sewage system 22. ' Date test holes observed 1/4/99 23. Name of Health Inspector ADAM STEIBELING 24. Project design flow (gallons per day) ................................. ............................... 800 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N /A' Form Pr._o7 - 1 27. Is any portion of this project located within a designated 'town or State wetlandl'. No v 28. Wetlands ID Number .......: ..... :..................................................................... . ...... . N/A 29. Is Wetlands Permit required? ...... .... ........... ...:.:.....:,.,,.... �::,:.,.�: ;....,...0...a ..,.,:._ -. NO- Hts application been made to Town or Focal DEC office? ............................... Nom_ 30. Does project require a DEC Stream Disturbance Permit? ... . ................. . ........ ...' NO 3 L Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfalling, sludge application or industrial activity? ................ ............ Yes/No NO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal.site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... YES 34. Are community water and/or sewer facilities planned to be developed within 15.years in or adjacent to project site? ................................ ............................... _ NO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36.. Tax Map ID Number .......................... .....I.......................... Map6 2 a 2 6 Block 1 Lot. 5 & 6 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and app_ roval of anew SSTS to be located within the NYC Watershed_shall. __. w„ ` eed -� d be s;. �� i;�,duplica a io the-OE�, -aitmtigzh the project may require 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 fortes 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 afrm, underpenalty ofperjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Chas A misdemeanor pursuant to Section 21A45 of the Per: am a In SIGNA TUBES & ®.F'p'ICUL T'IT'LES. Mailing Address: ................................... 4 AM VALLEY, N.Y. 10579 Nd V W. 1V A aJ, k X'A T J JJ'1 \ A V A' . LA.Cj' t'%JU A AA DIVISION OF ENVIRONMENTAL HE AL'1 H SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM _ Y 44 WENV NAH ROAD.- .. biO FiZT;E 'N' �': '1•� .�: ..�;_ Located .at (Street) '4 4 WENONAH ROAD TaX Map 6 2.2 6. Bock 1 Lot 5 & 6 (indicate nearest cross street) Municipality TOWN OF PUTNAM VALLEY Drainage Basin HUDSON . RIVER SOIL PERCOLATION TEST DATA Date of Pre - soaking 2/4/99 Date of Percolation Test 215/99 Hole No. Run No. - -Time Start - Stop Elapse Time tMin.) De th to Water Vrom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 1 0:02 ,10 *i'20 18 22 -25 3 18/3 ='6 2 0:21 10:39 18 22 -25 3 18/3 =6 3 0:40 10:58 18 22 -25 3 18/3 =6• 4 5 2 1 0:04 10:23 19 22.5 -25.5 3 19/3 =6'.3 _- -. r.-°- 0z�4° � t3 : 4 �1 "9° : x=.2.5 :-� -3"" - 3 0:44 11:03 19 22.5 -25.5 3 19/3 =6.3 4 .5 - 2 3. 4 VOTES: I. . Tests to be reheated at`saine depth until ahnroximately eaual percolation rates are obtained at each percolation test hole:- ([e'. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. Depth measurements to be.inade from top of hole. Form DD -97 Indicate level at which groundwater is encountered NONE Indicate level at which mottling is observed NONE Indicate level to which water level rises after being encountered N/A Deep hole observations made by: JOEL GREENBERG, R . A . Date 1/4/99. Design Professional Name:. -JOEL GREENBERG, R. A." Address: TWO MUSCOOT ROAD NORTH R�R�� RQtdCE MAHO PAC , N.Y. 1 0 5 41 n A o�' = `p ��A ., �t1R` 9 Signature; DR TEST PIT DATA DESCRIPTION OF SOILS ENCOUN I'EItEll AN TEST HOLES DEPTH HOLE NO. 1 _ _HOLE N ®. _?.._ ----- v.. - - --LP- �y,g,, u -t3 TOPS CSIL *" TOPSOIL 0.5' 8" BROWN ,.. BROWN 1.0 SANDY LOAM SANDY LOAM 1.5 WITH GRAVEL WITH GRAVEL 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' ..` 5.0' 5.5' 6.0' 7.0' 7.5' 8.0' 8.5' _ 9.0' 10.0' Indicate level at which groundwater is encountered NONE Indicate level at which mottling is observed NONE Indicate level to which water level rises after being encountered N/A Deep hole observations made by: JOEL GREENBERG, R . A . Date 1/4/99. Design Professional Name:. -JOEL GREENBERG, R. A." Address: TWO MUSCOOT ROAD NORTH R�R�� RQtdCE MAHO PAC , N.Y. 1 0 5 41 n A o�' = `p ��A ., �t1R` 9 Signature; DR - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL`HEALTH SERVICES :� :._.:...a:.:. m�.-- .._.:. r. �.,: r.... -•,� �� = :.e•.::•r...::o a .v...a...•- ,•....r. :- e,:•v,. ww:T.>•..o ..-. -- v:�:..:e. -.a`r. - s....: � .. ... :� ..... w.:w �. ... .�.. •.: v.w,•w,.a....:fn.•a ,...n .�. LETTER OF AUTHORIZATIONy RE: Property of JOHN PAWERA Located at 44 WENONAH ROAD T/V P[+' mA_M VALLEY Tax Map # Subdivision of N/A Q 62.26 Block 1 1ot5 & 6 Subdivision Lot # 2 Filed Map # 284f- Gentlemen: Date Filed --. 9/12/2000 This letter is to authorize JOEL GREENBERG , R.A. a duly licensed Professional Engineer or Registered Architect X 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 Ark. /or :1.47 of the Education Law, the Public Health Law, and the Putna �anttary'�ode. r-� �: T � P. Mail State N.Y. Telephone: •• Zip 10541 628 -6613 .fir..; . Very truly yours. Signed tv la.0444 (Owner roperty) Mailing Address: 44 WENONAH ROAD PUTNAM VALLEY State N.Y. Zip 10 Telephone: 526 -3857 Form LA -97 ".1 AA AA " '"kA AA- -AA�0%A^A,AAi0%WAA,AArA04 AA' AMiAAtRAlAA!AA-AA;R04,'AA,AA,AA,AMIAA AM AAAA ^A PRO PUTNAM COUNTY HEALTH DEPT. t 0 2 0 5:4 8 4 Geneva Road (914) 278-6130 Brewster, NY 10509 Date): d. 4r The Surn Of- Dollars $ g For eg VfS es io 7z Z-- El Cash E% Check VM.O. F-I Crddit Card By IL -a -im COVER SHEET PROJECT (Owners Name, STREET: SUBDIVISION LOT# MUNICIPALITY: T MAP NUMBER: DESIGN PROFESSIONAL: A DATE: REVISION U REQUESTED ADDITIONAL INFORMATION OTHER Public Health Director V DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10.509 iviiil.iNkRII'k.NV ` M S.Nt __.... Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 October 10, 2000 Joel Greenberg, RA 2 Muscoot North Mahopac, New York 10541 Re: Pawera, Wenonah Road (T) Putnam Valley Dear Mr. Greenberg: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 2, 2000 is complete. The Department will notify you by October 23, 2000 of its determination. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2157. ABS:cj Very truly yours, &ej� t— - Adam B. Stiebeling Assistant Public Health Engineer BRUCE R. FOLEY Public Health Director. - . DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETfA MOLINARI R.N., M.S.N. ssgciatg fpub, rJffc 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 October 26, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Mr. Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Re: Pawera, Wenonah Road, Lot #2 Town of Putnam Valley, TM# 62.26 -1 -6 Dear Mr. Greenberg: E2 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. Documentation 1. The correct Tax Map # for the parcel #2 is 62.26 -1 -6. Please correct on all applicable documents. Plana 1. Contours are unreadable on the plan. Please clarify. 2. Plan shows 7 deep test holes, notes and design sheet provide soil profiles for only two holes. 3. Perc test holes are not shown on the plan, perc's required. 4. Plan shows grading in SSTS area. (CC -97) permit does not indicate grading required. Please verify. 5. Provide dimensions from property lines to locate well. . r ntvpc . . Oi.T. ' ..°' 6 (:� :!— so, dir. . .. ._• • ".... and plan to be submitted for an individual SSTS only. 7. Please label length of laterals on plan. 8. Show location(s) of required erosion control measures on plan. Specifically at well and SSTS. Detail Sheet. Notes and Title Block 1. Remove all details that are "X "ed out. These details are not required. 2. Please specify which septic tank (size) is required, detail H - septic tank shows 3. 3. Fill notes required to be completed. 4. Complete item "# 2" soil under Design Criteria. 5. PCHD notes, bulletin ST -19, Appendix C - Rev. 12/99, notes 1 -15 required. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj _ 1 110E .. R. _ FOL.EY - Public Health Director LORETTA MOLINARI -R.N., M.S.N.., _ Associate Public Health Director Director of Patient Services DEPARTMENT OF BEAT H 1 Geneva Road Brewster, New York 10509 - t :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 R Date: To: � 00it f� Fax #: � 2 y ` No. Pig (Including cover sheet) ]From: AA Adam B. Stiebeling Public Heaith- Engineer -,.•: :. ..,,;.: - -- -- _ .: . ZFOorr our information ]Please respond our review Attached as requested As discussed IPlease call Notes/Messages A- Z In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2157. s .. BRUCE R. FOLEY ��I'uGii �r`Gaiii•=siij•ecPc ;� ;�°'. V LORETTA MOLINARI R.N., M.S.N. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 FILE Nursing Services (845) 278 - 6558 WIC (84 5) 278 - 6678 Fax (845) 278 - 6085 be Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 October 10, 2000 Joel Greenberg, RA 2 Muscoot North Mahopac, New York 10541 Re: Pawera, Wenonah Road (T) Putnam Valley Dear Mr. Greenberg: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 2, 2000 is complete. The Department will notify you by October 23, 2000 of its determination. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2157. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUT\ 01 COUNTY DEPARTME \T OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FILIAL SITE DiSPECTION am Date: Inspecte Street Location 2`�_ . k�-f Ji``'4.. - � Qr`.sat:ti, Pr�: -�:; �"Tro�vri.v Permit # 3 —00 TM r C�2 Z� — l - Subdivision Lot 2 j C4 1. Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. 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. Swage System a. eptic tan.; size -1,000 ...... .1,250. other ................ J b. Septic tan'.< installed level ................ ............................... c. 10' minimurn from foundation .......... ............................... C d. Distribution Box 17 A out ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... .....................:......... f. I renc es �,^ T gth required Length installed (� 2. Distance to watercourse measured Ft.......... �1 3. Installed according to plan .... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 0.:iF- _ends °caupu:;: _::...:::,...; .:.:. ...::...::.::...:......::. ::..: g. Pumo or Dosed Svstems . ize ot pump chamber .......................... ..................... � I 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........... III. HousefBuildin a. house located per approved plans......................... \ b Number of bedrooms ............. ............................... IV. Well z. Jell 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 backfill ed ........... ............................... 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 watercours g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate ... ............................... i. Erosion control provided ........... :..................................... P. v 6!97 12/27/2001 17:05 8456282807 JOEL GREENBERG PAGE 02 �..�.. -..: —... vim- -- '•:cr, . -a --t'•. •n�-�. -.:.r. a «..w.m..� -an.. r.�•. --.as �s- ,varc•: -•a- a-� :�'- :sc.:..a.. �....uc�r -:...� . PUTMN COUNTY DEPARTMENT OF MALTH DIVISION OF ENVIRONI MEN M HEALTH SERVICES ATTENTION ADAM • j-. • MIU411f w All information must be fully completed prior to any inspections being made. PCHD Construction Permit # 13 GENE For: Fill Trenches * * * ** Located- 24 WENQN:AH ROAD (.T) M PUTNAM VALLEY Owner /Applicant Name: JOHN C. P,AWBRA -rm6 2.2 6 Block 1 Lot 6 Form_er1y. Subdivision Name: _JOHN C. PAWSRA Subdivision Lot . Is system fill completed? Date: Is system complete? YES Date: 12 [ 21 / 01 Is system constricted as per plans? YES Is well drilled? ' YES Date- 11 / 01 Is well located as per plans? YES _....... Are erosion control measures in place? YES I certify that the g9em(s), as listed, at the above premises bos been 'constructed and I have inspected and verified their completion.in accordance with the issued PCHdD C coon Permit and approved plans and the Standards, Rules and Regulations ktthie Pu C ty Department of _Health - �--�, A. Date: 12/27/2001 Certified by ::. I AddM$- 2 MUSCOOT ROAD NORTR, Comments: PT - RA 1 1NLic. # 11056 Form FM-99 DEC -27 -2001 THU 17 :05 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. P h, 7 0 Clarenc Fahnestock Memorial State Park Camping K AJ* J) 7 x 0 0 Oslo AY R 14 0 0 T F. 0, elDL R'S TA N ;y JD OAAr RO 0 LITHE NORTH CC ARTHUR > GAY 0 9 AV 0 " 4A /Y/( 4 S WA So", RO Q 1. % HUDSON VIEW CT MM rry o PL SLIT jpN PL SrAR VIEW NOR CEDA 0 2 0 x 0 HI TYLEP cour Y I J . I r 12/27/2001 17:05 8456282807 JOEL GREENBERG JOEL GRE�INBERG, R.Ay N�im .2 Mill-IC-00 l' ROD NORTH �L " NIAHOPAC, NEW YORK 10541 -628 -6613 FAX 845. 628 B�NIAIL• .�. DATE: T0: RE: P.r ATTENTION: FAX NUMBER: FROM: COMMENTS: PAGE 01 TOTAL NUMBER OF PAGES INCLUDING THIS TRANSMITTAL SHEET. IF YOU DON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSIBLE. DEC -27 -2001 THU 17:05 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1