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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -7.2 BOX 25 03120 T I, �Lif 03120 PUTNAM COUNTY: DEPARTMENT WHEALTH DMStON OF ENVI'ROr&MENTAL HEAL H SE4- -ICES % WELL COMPLETION REPORT ;Xcllk T r ax Ma 3 Blo"c'kTf Y Lot(s) 7. Well Owner: Na e: Address: Use of Well: 1-primary 2-secondary Residential Public Supply Air cond/heat pump jrrigdtion Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary — Cable percussion — CRn)pressed air percussion Other (specify) Well Type Screened _ Open end casing Ooen hole in bedrock Other Casing Details Total length �ft. ft. Length below grade Diameter in. Weight per foot 14 lb/ft. Materials: '>< Steel Plastic Other Joints: Welded __,4 Threaded Other Seal: ?e Cement grout Bentonite Other Drive shoe: ;,,-Yes _No ILiner : Yes V 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 Zcgprn Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet r Well Log If more detailed information descriptions or sieve a.nalvqe.s are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface - 2- e If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type _5_jAk- Capacity MAZ Depth alk Model I t-0,114 Voltage R20 HP Y2- Tank Type lea / (Volume -4pm Date W�l ed Putnam County Certification No. Date of Report Well iller (s• nature) NO Vact location of w with distances to at least two permane lapiamarks to be provided on a separate sheet/plan. Well Driller's Name Address: Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pinkcopy - Owner; Orange copy- Well driller Form WC-97 NIS- 1,� �• � it � �r� � fl �, , cCONSTRUC ITT FEIN N I V)%1Y Located at AVAO 7 Subdivision name AGI 1AE'AIM ENT SYSTEM""" Town or Village #J Tax Map Block_ Lot Date Subdivision Approved Owner /Applicant Name sell": Mailing Address Amount of Fee Enclosed f/ A� el- g Building Type eft L'r Renewal Revision Date of Previous Approval VJ 46L zip /0 l/ Lot Area �`— No. of Bedrooms -f— Design Flow GPD �� d Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage S, sy tem to consist of ld R-) gallon septic tank and 64 L. Ce 1 C2 -�r- %l/ew % v G Y' Other Requirements: '� U ` avle de P"y To be constructed by ��` /�� Address Wateur Su®n9v: Public Supply From Address - ana°_ - �u V cc l?t�ry 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. i Signed: P.E. �"" R.A. Date T Address X2--&— �, '. �' � 'i o /> �/ . License # /`jP*5P/ 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 permi A proved f ischarge of domestic sanitary sewage only. By: Title: �L� /% Date: Z(/V/4� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ra /.\7 ., t-: r+::` .:-n:...- ..a+fj•.:.•r,'r'�:�+a. �.•n�•re+:ww:�P+.ten.ra .,,. Daniel Donahue, PE 120 Breckenridge Road Mahopac NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road 13rewster, New York 10509 Tel. (914) 278-6130 Fax (914) M-7921 BRUCE R. FOLEY Public Health Director -e.a ,c.tr.la�:p:i'+'R7�•�' +i �vF .uwpiwa•ti.pi, rr.,, iC +'t October 26, 1998 Re: Proposed SSTS: Schongalla Albert Lane, Lot #2 (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. -- - :-F€ ercola ion- Tests; �jer ,riot_ �litnessed by r pF. q tiVF_ P - - ensa_ r s -Df Environmental on this lot, percolation tests must be witnessed by a representative of this Department. 1) Design Data Sheet has not been fully completed: a) Soil profile has not been provided for each hole. b) See subdivision plat is not an acceptable response. It is your responsible as the design engineer to provide the required information. 2) Construction permit notes the wrong street address. 3) PC -1 notes "see subdivision file" this is not acceptable. 4) Contour lines are notg discernable, however, all slopes between 15% and 20% must be reduced to 15% by the addition of R.O.B. fill. All slopes greater than 20% are unacceptable. 5) Design Data, i.e., percolation results and deep test hole soil profiles have not been provided on the plan. 6) Location map is to show lot location, map only shows subdivision location. 7) The 100 feet wetland buffer boundary is to be clearly delineated. X" v Letter to Daniel Donahue - October 26, 1998 - - Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. V 41y yours, Robert Morris, P.E. RM:tn Public Health Engineer enc. M! `6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES SI N— DA`I'A'SHE.ET = ;S6 'u- SAC `S EWZffi -EAT1V ElVT SYSTiM- Owner . �i�sG,y f�.�id��y�/ /ter Address 1V6)d,y Located at (Street) Tax Map i�—? Block Lot Z.. (indicate nearest cross street) Municipality "Illy Y Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time (pMin:) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 3 4 ^If' �' n t 5 f �. ;►� v� llc.. L 1 3 4 1 5 1 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. 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. Form DD -97 I UTNAM COUNTY DEPARTMENT OF HEALTH IIDMSIION OF IENWROIMIENTAL HEALTH S EIISWCIES AI?PLffCATIOR1 TO CONSTRUCT A WATER WELL P/! ,.:�� 1'Cff ili Yf 1 :a►a . . Wen Location: Str � e Town/Village Tax Grid # ' Map 4!�3 Block 'l Lot(s) ? �- Wen Owner: Name: Address: ,z G�`rh ti 1A AJ11dd S % F&r,!11.1 Use of WellIl: Residential Public Supply Air /Cond/Heat Pump Irrigation u°nnna�v Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply IIDAll➢ang _New Supply (new dwelling) Deepen Existing Well IfDetafled Reason for IIDr°irllkg Wen 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: ::7-2 1) Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /V /,I Town/Village Distance to property from nearest water main: A] // Proposed well location & sources of contamination to be rovided o ep e sheet/plan. Dated �, _ Applicant Signature: 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 CORISTRUCTRON: 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 watery l driller certified by Putnam County. Le J, A, Date of Issue / 4' Permit lmoc ffici Date of Expiration c Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH . INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TRY- ATNIENT SYSTE` IS, • STREET LOCATION � - S1`u'' �" NAME OF OWNE ` REVIEWED BY R, AS, MB, BH TAX NIAP # Y AOCUMENTS Y RILE'TTER MIT APPLICATION. EROSION CONTROL:HOUSE,WELL, SSDS 1 ERC & DEEP HOLES LOCATED LL PERMIT _ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION OF AUTHORIZATION LOCATION MAP SIGN DATA SHEET (DDS) EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE CORPORATE RESOLUTION IF PUMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF 15OUSE - NO.OF BEDROOMS LAN =PLANS WELLS & SSDS'S W/IN 200'.OF PROPOSED SYS. SSETS G t .� PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) E .� HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION NO BENDS; MAX.BENDS 45° W /CLEANOUT PfRLEGAL SUBDIVISION EIL SYSTEMS SUBDIVISION APPROVAL CHECRy CLAY BARRIER PERC RATE `� -10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH FILL SPECS FILL NOTES CURTAIN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS OCATED IN NYC WATERSHED VOLUME PLANS SUBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH PEP APPROVAL, IF REQ'D tF TRENCH PROVIDED 60 FT MAX. DEEP TEST HOLES OBSERVED ARALLEL TO CONTOURS RCS TO BE WITNESSED 100% EXPANSION PROVIDED X-APPROVAL SSDS ADJ. LOTS EPABUTION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) �..� ON PLA\ - FROM SSTS DATA ON DDS PLANS & PERMIT SAME ( Tn' iilVriViIl3UR NUI'IFICAI'lON 20' TO FOUNDATION WALLS _15'WELL TO PL ETTER BI/ZBA 100' TO WELL, 200' IN DLOD, 150' PITS 0 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20') S WAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE S S HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW COMMENTS: ONSTRUCTION NOTES 15'MIN to CDS= >5 %,10'- 4 %,25'- 3%,30'- 2 %,35' -1 %,100' - <I% DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /I00'with 182 cons day discharge CONTOURS EXISTING & PROPOSED SEPTIC TANRIVEWAY IDESIGN & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL OOTING /GUTTER/CURTAIN DRAINS WEL OIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE ITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: : -.- " PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Pe og '-'Coe uc AGLq Address wgao s,-j-,eee-7- Located at (Street) Tax Map 42 Block � Lot (indicate nearest ' cross street).. Municipality &7,�9,4i v�4z".0,='5e Watershed C-;,e6-7-4A1 Form DD-97 SOIL PERCOLATION TEST DATA t. Date of Pre-soaking Date of Percolation Test ................ .......... X X. ": depth 6:1.- a ef:�:-:-- a er.. .......... .. Hole Time :-Stop :... Ala se Time From roun .. . ... -Stolz . Percolahan " -m-N.. . ...... . ......... ........ ... . -..X..X .. ....... . ........... in , .... . .. Inches n V6 2 11'r 11rr a IX0 36 3 4 5 02 A 2 6 -PLO 3 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. s I 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 . TEST IPIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN 'TEST MOLES 2 DEP'T`H - _ _ �-1-CYLh-1`WO. I t�L C.L. 0.5' o Pf01 L 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 1 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 1-my, E 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered — t4-G VE - Indicate level at which mottling is observed 17— Indicate level to which water level rises after being encountered °® 146 v Deep hole observations made by: 7)g ar 1g,G. J, Vo w, t'�s'i,F Date Design Professional Name:�,�ti�.c Address: Signature: Design Professional's Seal v:c0, N ` PC -1 - PUTNAM COUNTY DEPARTMENT OF HEALTH A —PPL Ci4`rTO TUFF'APPKUJAi: "'OF: 'FLAKS'-FO-K RA``WASTEWAI'ER-Z!SPOSAL S fi*..._. 1. Name and Address of Applicant: 2414.10 ��� °•y G9G�'% GJoo � 5' 2. Name of Project: ,CJ73, -- S4 '�``''��'9 "� 3. Location /v /C: Pyi�l�ht dg r 4. Project Engineer: b &VI 64 d:.P d a�P_ 5. Address: ��' �� - ��'��G 'oo License Number: KW Phone: 9f 70 6. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home-Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted C/ 8. Is. A.Draft Environmental Impact Statement (DEIS) required? ............. 140 9. Has :DEIS been completed and found acceptable by Lead Agency? / 10.. Name of Lead Agency e hi's. pro jaL —f— i an, area !finder t %e Control Gt or other officials, ordinances? ........................................ t" 12. If so, have plans been submitted to such authorities? .................. �G ' 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 10f 16. Waters index number (surface) ........... ............................... N& 17. Is project located near a public water supply system? .................. IV6 18. If yes, name of water supply, Distance to water supply 19. Is project site near a public. sewage collection or disposal system ?..... Alt) 20. Name of sewage system,�IT %J Distance to sewage system lllr 21. Date test holes observed: 22. Name of Health Inspector: Af��A J7,ik;J 23. Project design flow (gallons per day) ........ ..............................� 11/93 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required?..--A/-47 25. Has SPDES Application been submitted to local DEC Office? ..........T..... �/fT 26. Is any portion of this project located within a designated Town or State ,c� wetland ? ...... ........................... ............................... I 21. Wetland ID Number ........................................................ N AIL. 28. Is Wetland Permit required? .............. ..e............................ AIQ Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... AI — 30. 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 or yP 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or-92. DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ylo r 33. Are community water, sewer facilities planned to be developed within 15 years? 34. 35. Are any sewage disposal areas in excess of 15% slope? ........................ TaxHap ID Number ......................... ............................... a- 36. Approved Plans are to be returned to: ................ Applicant QC Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. % 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 Lair. /7 ,/' SIGNATURES & OFFICIAL TITLES: !� s �"", — rze MAILING ADDRESS: PROJECT I D NUMBER 617.21 SEQ R Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ..::,::..- .::;::�'+��al f:. C?:�.E�C�,T;.1�'�'�i�a�; ��i.Qi`�i:�T��►a��:s �arp�:�d,.I:�j::A:�pj i c. �.; �t-..' a=: G? s�,'• �t;6:�P�si�r,$;�:.:.�.:,.;.:a:, :�:;:. »•.�::.::�'.:::�..•:. -.:, .�.�;;,�:; 1. APPLICANT /SPONSOR 2 PROJECT NAME S 1PPU SGlta:vG1rL1-4 _ �'i Es Ot�tiG'Fr ;f PROJECT LOCt•TION Municipah( _ CountyP&TIV a , ��L'7 J VA 1' 1" - --.. .. a. PRECISE LOCATION (Slr•el address and road intersections, prominent landmarks. etc -, or provide map) ,� L�r� -7 L ANA • I t!( "ew C Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: COA-14-1 Ilf V! 1%U i•y $' "V 7-6 sv-xar- 7. AMOUNT OF LAND AFFECTED' �✓ Initially /� r 1'� acres Ultimately Q� + acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 19Yes lJ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? W.esidential C3 Industrial ❑Commercial 0Agriculture DPatWorest /Open space ❑Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER 9.9.10 - MEYTAL A LEE[- .Y.LF -qpERti;�..... ; �Si"ATE L-yes ❑ No If yes, list agency(s) and permittapprovals P/ ,o G /� f�� ` fiAlfirt 11. DOES ANY ASPECT OF THE ACT'–.N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes a No If yes, list agency name and permit'lapproval 12. AS A RESULT �?O��yFF,�PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes INo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: A1*# /0- Date: Signature: 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 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617 1V it ves, r)oroin.lt•::'••: •: nf.,ness and use the FULL EAF. ❑ Yes O.K. B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. Ph PT 617 5" 11 No. a negative declaration may be superseded by another involved agcncv Yes ' l Ywo FSC�c)' t:;? �1i�3Fv":`._.+.. c' I�uf•# rr" i`: Y•. 1z. 1, f.: f.. �Tr�C;- L' 4.:+�.,SC.!.f.3.Ty- ?T'I� „ir -.,h .: {.. I L. •:' .}v...I.��.�� "�v=rr. <_,..�:.c^' ;;r���r!tlr�, ilgltllel;:c�i -:�.= . f Cl Existing air quality, surface or groundwater quality or quantity, noise levels, existing tfafhc Ca :i.'(ns. solid waste production or disposal,` Ipotential for erosion, drainage or flooding problems ?.Explain briefly: /% A% f„. C2 Aesthetic, agriCultural, 3rChar:0log..:3'• �-�5!nn,:, or other natural Or cultural rrSourCeS. Or COM.Mun:;. Or "•:1•;n.JrhoOd character? Explain bflB:iy %i C3. Vegetation or fauna, fish, shellfish -if wJJufe spec es, significant habitats. or rrlreatened or enclangered species? Explain briefly. n/- a AJ6 C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resourcesI Explain briefly /\ OR/ C5. Growth, subsequent development, or related activities likely.to be induced by the proposed action? Explain briefly. /Ya&e C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. /1,/ 0 iV 0. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes o If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one•or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible O ficer in lead Agency Signature of Responsible Officer in Lead Agency Name of add A1;enCy 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer! PUTNAM COUNTY DEPARTMENT OF HEALTH ,,..� ,:. �a z., ._, .P .:- «.:_..... o' c:�a :i.'��'•:TT -� 1 ^.;F*�.T r y.w4 a^ 3i;:�k;. Tn-%:i�TLr^� ss o..:_..r:::., �«::R:a.n ;c:.. -: ;•.�.. Re: Property of Date e 7 9 < III Located at (T) Section ��Block off Lot l 22Z= Subdivision of SC46(A14LII4 V Subdv. Lot # �. Filed Map # _Date 64 Gentlemen: This letter is to authorize 6 � �?f-kj �OAI *'0f 0c— a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in ,_.:.. C °(iIZ:2C3C : l.a ^,'tY i ±:� ti2 t�T•] S�Si1?�t�_e1�dIICt� i_v ^_.:Sl? i�'l�Vi.S.�? i I;! ° _c 6i, L r1.ic tL6n -' system or systems in conformity with.the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed & -'� J-- �' �� — Countersigned: Owner of roperty P.E. , R.A. , # / & p ' --�— Addr e s s Address Town �.� e, -w Telephone 2 -3 Telephone Fj T 'd d0 1N3WINW30 A1NnoD :WUN1nd :3WUN TZ6L- SLZ- SbB� -!31 TB-bb IIHl 50bd- b� -NIIl' jr e DMSION OF ENVIRONW14TAL HEALTH SERVICES ATTENTION J? JOUM °► ® GENE RRMIMST FOIE FINAII INSPEMM All informatiion must be fully completed prior to Bey inspections being made. PCHD Construction Pere Located: 16k Owner /Applicant dame: Fomnerly: Se, "J f' I # ._A((-ag -:�u For: Fill Trenches TM Subdivision Name: Subdivision Lot # _ Is system fill completed? Date: Is system complete? IWA 0 Date: is system constructed as per plans? Is well drilled? q.+. Date: Is well located as pet plans? -I- Are erosion control measures m la"? 'P&'1t**AI Block Lot P I certify that the system(s), as li abowe promises has been constructed and I have inspect d and verified their completion vWth the issued PCIiD Construction Permit and approved plans and the Standards: Rules and R%Wations of the Putnam County Department of Health. o CR _- _.,- e.+ "��.. .. _ ?•- ,i ""_.. �a •' ..• � . T)esign Professional -A ,1� . Form FIR-99 i a I TOA April 2, 2004 DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 'd Mahopac, N.Y. 10541 845-628-1576 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Robert Morris, P.E. RE: SSTS Permit & Well Permit Property Formerly of Schongalla Albert Lane Putnam Valley Dear Mr. Pavarotti: Enclosed please find: 1. Application for a permit to construct a SSTS 2. Application for a well permit 3. Letter of authorization 4. Three sets of plans Comments: This application is for a name change on the permit that is necessary in order to ohta-Ln-a-biffldinr -per in. 11N.Anarn. Valley,.: '7"' '7* m it By- D71 J. Donahue, P.E. Site • Sanitary • Environmental I F - G L IDIWSION OF ENVIRONMENTAL HEALTH SE VIf.S CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEl 6 PERMIT #_f 211�4 � Located at Town illage � �®� % % Ili Subdivision name Subd. Lot # ,- Tax Map Block Lot _ Date Subdivision Approved Owner /Applicant Name 6r e Mailing Address _ Amount of Fee Enclosed Building Type >ft/tea Lot Area No. Renewal Revision of Previous Approval Zips i of Bedrooms Design Flow GPDW Fill Section Only Depth Volume PCIIID NOTIFICA'T'ION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ej -r gallon septic tank and Other Requirements: 0 e, ,o-�7�f 2 Al P ,0e,4'.7 -r" To be constructed by ��� Address Water Sungly: Public Supply_ From ._ Address oar: _ Private Supply Dri lled by - Address w_ A I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem 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. ,rte R.A. Date Address �C. °��T 9� Ice 4 License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh n co sidered n essary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi proved ischarge of domestic sanitary sewage only. LGU By: Title: _ Date: 0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' - APPLICATION TO CONSTRUCT A WATER WELL //��/1� /� - :•;�,rm.5r c'!!a•;:i:��•JY„� •...,. .��;r.•�: f..�L:_�,.•. rlic3a$ r..p Well Location: Street Address: Town/Village Tax Grid # p2 0? 4a � /V l; P "I • /ed ap fp-3 Block Lot(s) Z! Well Owner: Name:/QP0< Address: 116 y��� /�•lt ��. J804, cdrL Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation Qrimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # +eap1e S tved+R- ewF�st. of Daily Usage 3 g1 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason S gj f v 4X of V FjALJ /p F /oge ^,! G/3 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes y No Is well located in a realty subdivision? ...................................... ............................... Yes_/ No Name of subdivision SG'C�t. q, i Lot No. .2, Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No l/ Name of Public Water Supply: Q111W Town/Village Distance to property from nearest water main: JG / Proposed well location &sources of contamination to be pr vided on sep a heet/plan. Date: /�� Applicant Signature -:_.-: - - _ i_....a _ _ -. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. MiT evision or alteration of the approved plan requires a new permit. Well to be constructed by a water ly, ller ce ified by Putnam County. Date of Issue f Permit Issuin - cial: 11 Date of Expiration vid,10 & Title: Permit is Non-Transfeiirible White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I; �}! � RE 'l X, 7 '{ DIVISION OF ENVIRONMENTAL HEALTH SERVICES r ...R r��...o.. w...sr... < -r.. r. •••nw. yrr�.i�.r -:.a. +tv f.m..sp.tr.r ••••• •. ••. •. . RE: Property of Located at LETTER OF AUTHORIZATION T/V ���Tax Map # p m ock Loth Subdivision of Subdivision Lot # Gentlemen: This letter is to authorize M Filed Map # Date Filed a duly licensed Professional Engineer t/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in confrmity:with the, s.of Article_ 145 and/or_147 -of the Education Law, the Public Health and ihe"Yufriam "County'Sanitary Lode:• Countersigned: P.E. R.A., # Very truly yours_, Signed: (Owner of Property) Mailing Address ��r�'� ailing Address: State lfld�l Zip A P71 f State 417 Zipl Telephone: ��` �-�. Telephone: ZeC d /6 /e) Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at AL Ja e:'T Z-. �I1J � own o Village J ► i'`p S'�.� dn- J�a-�fq / Subdivision name Subd. Lot #' Tax Map �� Block Lot Date Subdivision Approved �% /�.f�/ �� Renewal Revision Owner /Applicant Name & E4SE OA t Date of Previous Approval 11A Alv Mailing Address 14z e- U o r) M 4-�f0 � r 7 Zip Z 01 �� Amount of Fee Enclosed Y 4?6 D Building Type jai C y Lot Area/ G No. of Bedrooms __ -ftesign Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /J- .) gallon septic tank and Other Requirements: f/ D'o G VW T ew Z) 1eA e-1 To be constructed by ° ICJ p Address Water Supply: Public Supply From Address or:...' -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 Dqpartment, 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. L� R.A. Date /d Address /.L l Qir° G� a ✓T �S,c �d �4. /10� �- License # . '4-Ew APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified en nside4pecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new N it A prov r dischar of domestic sanitary sewage only. f By: Title: Date: ��� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IIDRISIION OF ENVIRONMENTAL IFIIIEAILTH SERVICES APPLI(CATffON TO CONSTRUCT A WATER WELL _ -1 _ �- �•4 cr .etv �� .� . au Fu.-- .1C.PV'.a�C.n d�.�;T..±TT\. �,.�_•• ♦i� �^:�'+♦;..�v '. �r. ��.G�a-vv.. ._r.. V.'4. e.� ...-rt.. >-. a..I.... tY.S•�:V'rvn n�.s.r.s+- �.siaa.. Vii: li.i.�r: ly F.Sc.'.- ... __.._ .. _ 'i /1 JJ�Jy �•'7l 'i. .i�`i:r e,•,., �'• Weill Location: Street Address: <JovVmkillage Tax Grid # Map /�7 Block Lot(s) WeRR Owner: Name: Xks O� Address: 5 ,4 Ile Akda rr 00-1,41 mg .41- Use of WeU: Y Res dential Public Supply Air /Cond/Heat Pump Irrigation >z unary 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 IIDrgllnng L'New Supply (new dwelling) Deepen Existing Well Detailed Reason M6119 lot for IIDrMinng Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Yes 4---'INo Is well located in a realty subdivision? ...................................... ............................... Name of subdivision WA. Lot No. � Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be rovided on se p ate sheet/plan. Applicant Signature: 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. Ay revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el driller ce ified by Putnam County. Date of Issue l Id 3 Permit Issuin cial: Date of Expiration Title: Permit As Non- Transffe>rr e White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 eONS-VE-TrN(;-- ENGINEERS *- ❑ Daniel J. Donahue, F.E. Mahopac, N.Y. 10541 914-628-7576 TO T9 ATTENT16" ~A4 seem 4 00-1 WE ARE SENDING YOU kAttached ❑ Under separate cover via the following Items: ❑ Shop drawings 0 Copy of letter ❑ Print$ ❑ Plans ❑ Samples ❑ specifications 0 Change order .0 tE- TRANSMIT—TED--as checked .. approval 0 Approved as submitted 0 Resubmit copies for approval 0 For your use 0 Approved as noted 0 Submit copies for distribution C As requested C Returned for corrections 0 Return—corm. print* ED For review and comment U, ❑ FOR BIDS DUE 19 0 PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: it aneOmawrts we not as ofted. hIndly AMOty us at Once. seem 4 tA M MEN' PW. ., . tE- TRANSMIT—TED--as checked .. approval 0 Approved as submitted 0 Resubmit copies for approval 0 For your use 0 Approved as noted 0 Submit copies for distribution C As requested C Returned for corrections 0 Return—corm. print* ED For review and comment U, ❑ FOR BIDS DUE 19 0 PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: it aneOmawrts we not as ofted. hIndly AMOty us at Once. D"'WISI ®N OF ENVIRONMENTAL HEALTH SERVICES ;> Q: i. C: ti'¢' ,w +:rce'.�r.- iaesnai:w:ee:ai.x ..... -;,.i: n..r .�r . ca- �r.`�a:T C; —. -:ras- sa..=.c ca..::u::.s �. "•iaiu:s�o-:e: LETTER OF AUTHGRIZA Y ffO RE: Property of jL-, Located at gAkl_?l K-7- �i/% 6✓ �,1/S, //,� /jam Tax Map # 1,2 Block_ Lot �--- Subdivision of L�k Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize D.47V �&---Z (J, d g( "l,a- a duly licensed Professional Engineer 4/or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education .lLaw�the_p>z�ic.Halth, _. � . - t1 - r, f;.. ty= Sanitary °Cuae: °� Countersigned - P.E., R.A., # ,F y Very truly yours, a Signed: (Owner of Property) Mailing Address A) R"-0� Z w, Mailing Address: l l / V ;%/ ' 07— State �'/� Zip Id f111 Telephone: ft/—,v/ y`f State Zip lD fi' Telephone: Form LA -97 %a 11 \n►.l /1 I1VMIN I VIA 11LAL Ili DIVISION .OF ENVIRONMENTAL HEALTH SERVICES Gad /-,y 76 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM c, Located at (Street) 164A.-t-- cm- . Tax Map Block Lot. %•2 (' scat nearest cross street) ' Municipality Drainage Basin kMA7AJ Date of Pre - soaking SOIL PERCOLATION TEST DATA. Hole No. Run No. Time Start - Stop Ela se Time �i1lin.) Depth to `Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate IVlin/Inch 1 2 02 z3 Z 32yO 7ry z2 Z S 2 23s 3 -3 3°7 30 . ZO z►' z l ' z Z� 4 5 Z 1 2a, 223 Z0 43 33 2 3 2'_ 30 Z.0 3 4 . 5 1 2 3 4 5 !VOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootamea at earn 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. Form DD -97 PUTNAM COUNTY DEPARTMENT OF.-HEALTH DIVISION OF ENVIRONMENTAL •HEALTH SERVICES 1)ESIN^DATA SHEET - SUBSURFACE SEWAGE. TREATMENT SYSTEM Owner.. Address!,%`i�f�l Located at (Street)�%rti� Tax Map Block Lot., dic to nearest cross street) ' Municipality • 1l � ¢ter �1� l Watershed LC SOIL PERCOLATION TEST DATA- . -. •,.. �.. Date of Pre - soaking . l� �� ° Date of Percolation TestQ , NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to b submitted for review. t 2. Depth measurements to•be made from top of hole. ; Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN -TEST HOLES �•Ur1T E Rj^,. unT A n. G.L. .. .. . 2.05' 2.5" 3.0' L 4.0' 5:0' 6 :0' 6.5' 7.0' 7.5' 8.0' 8.5' . 9.0' . 10.0' �e G ...? rr u,,, Indicate.level at which groundwater is. encountered D Indicate level at which, mottling is observed -' Indicate level. to which water level rises after being encountered Deep hole observations made by: Q 0�1c �,. �� �•�-, ii Date �a �a Design Professional. Name:. 1 . 01111..'A17i1�9_ Address: Signature: Design Professional's'Seal �oiessiofv ,Q , d. Dr?;�, F� Alt rtj 48431 -0 Nei PiTTNAM COUNTY DEPARTMENT OF HEALTH V DIVISION OF ENVIRONMENTAL HEALTH SER' VICES _ :w i.ra.:c• .. --... .<. A.:y:...- ...ti..�'i'ty.- WV: -:%.r ,:.. X.4]... .•.sr..."nT:. .... ... ...•'M. r..u• -� . INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATION , Name of Project CA oh l,l ` Is' . County Site Location!' Building construction begun Extent Is property within NYC Watershed ? ................. Yes F-1 No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. d_Iiilly- .F] Rolling O.Steep slope a Gentle slope Flat 2. Evidence of wetlands Low area subject to flooding Bodies of water ❑ Drainage ditches F� Rock outcrops 3. Property lines or corners evident........ .......:.... ............................... 4. 'Do water courses exist on or adjoin the - property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... Yes No O. Yes a No 7 Will extensive grading be necessary? ................. :...........................:.. 0 Yes No B.. Wa1Lex+e�s ve:filllbe. nec s ^-y f 9. Do Do filled areas exist within the S S T S area? ........ ..........................:.... 0 Yes . 4EJ. No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: 0 Sand Q Gravel Loam a Clay 0 Hardpan a]-Mixture 11. Observed from: =Borings a Bank cut Backhoe excavations 12. Soil borings /excavations observed by �; �`� �'�'' ""� on Ib o?A b , 13. Depth*to groundwater on ' 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ... ................ .................... Yes No 16. Soil percolation tests made by -= Gt on b I 17. Soil percolation tests witnessed by A0o14 17�I 1),hl on SECTION D (on back) Form ST -1 2 D.-DRAINAGE 18. Will proposed grading materially alt ' er the natural drainage in this or adjacent areas? F7Yes No 19. Will groundwater or surface drainage require special consideration? ...................... F—J. Yes V V---- N* o 20. Will gullies, ditches, etc.-, be filled and watercourses be relocated? ......................... Yes No* SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ............................................. Yes E:] No Inspection data 22. Do adjacent wells and/or sewage systems exist? ....................................................... MYes F7•No 23. Additional comments 24. • Site observer /inspector and title 25. Date(s)-of observation(s)inspec'tion(s) TEST PIT PROFILES Hole # Lot # Depth to water Depth to- m. ft' lino- Depth to rock/imp, Hole# 9 ' Lot # Depth to water in ottl no., Depth to rock/imp. G.L. - () .-- &,, 4 G.L. (r) — .0.5 1.0 1.0. 2.0- 20 Mr 3.0 4.0 5.0-1 4)� 5.0 .6.0 6.0 700 8.0 C-11 -Hole # • Lot # Depth to water Depth to rock/imp. . G.L. 0.5 1.0 2'.0 3.0 5.0 6.0 7.0 8.0 i-P, 75 9.0 9.0 9.0 10.0 10.0 10.0 *Wclg P.Mle MMO DSPARTMP.NT New OF W Yak Aju "-t few HEALTH low ATrUMN: a ADAM WRMLL*lrx AR ldonu&R below -Ifteet b@ bb Prior to arp k sMGWMc*VlxM-. pd#4001- REA 1. TQWM. SMIVISION. P jPgM3 0 P1101,41 0., nw MST-. 0 TAXNAPO', -q-ff --- 1A "71, f 1-1, I % i kj Ropasoi SM Mob ft &sisiep basin ofWest Dr" or C~ ftservoln. hop "W" wid ill mob" of o r 6rWair, ewrrflelr stem or s"ISIM. No *25 100 PON/day or IS ft mit roqWrot n= It is the few! y of the dedp pvhWorisl to provide dw Am bamt4 prior to son Tb6 Dopor0ma WH doWasise.dw NYCDZP P oar Udo w sdjpll ? budd on the MPOML It you *amend JIM to any of dw quesdon16 MYCVZIP wo wooM MW Ogg %ftF "b DW� um WO tWdftft a amMft s*mbh *a for &W 'w" W10 *g-'pMjj. tM p4Wp If Im bm dowmiad to be D01010ed bated ea do ab"s rssposft�aad Oft subs"got M dw P galm 6� M C,*V'.%Iv ru Ofty WATL 1.03, M&.Mblwwwww� rM. IL> OMWMT) A., , OCT-2-2003 THU 12:15 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. I Z 'd 30 1N3WIdUd30 AIN O WUNIJ Id: dWt 1N Public Mallth &- ,eatar 6dbL- tiLd -SVti % Ibl LL %i�{� 1CG LbYJG-bG-JI ID DEPARTMENT. OF HEALTH H 1 Geneva Road Brewster, 'New York 10509 Dbrew of P040 S"Vkw 5 ®N: DEEPS: ® PERCS41.O'Pl! MPTEST: 0 ROAD/STREET: r Jr TOWN: pp/. L irAx SUBD1ISiONt 1 e 669 A-) -"- /.o�,G.:0 LOTO: OWNEP.- C e a&0V e G s� � v ! a%� Proposed SSTS, within the drainage basin of West Branch or Boyds Corner Reservoirs. v ,9 -Proposed SETS within SW feet of a reserveir9 r rvoir, stern or control take. U -a -- �•-d = or���cs�'��:�►rdnm:4Q�f meE:~v� ®_v:�terc�a�� -�� o _ .._ ® gr Proposed SM design flow greater than 10 =tai® ildiiy �p �� r.S'� eo ; r ; r a ir Proposed SETS for a Commerical Project. It is the rapomibility of the design professional to provide the above information prior to Boil testing. Ibis Department wilt determine the NYG7}EP project states (Joint or Delegated) Used on the sespo tse. If you answered ja to any of the questions, NYCDEP mast wits the soil testing. This Department will coordinate a mutually suitable time for Meld testing with the PCDOH, the Damn Professional and NYCDEP. if m project has bees dettnaioed to be Delegated based on flit above: response and than subsequent information indicates NYCDEP is required to witoess the sod testing, it will be the sells rapomibiitty of the "pa profesosiohal,to schedule re-witnessing of the soil testing with 11 YCDBP. DATE. mm ST) FOR MUM USE ONLY PO4 PfiC-9,-WW : 10 P al ,, W DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS .. °_•`.C>;. C.. � .a�• /Zn.�az,:.R1b�. <1%'zTZ•e. r. r., ^.j.. r - _. �N, t[ 120 Breckenridge Road Mahopac, N.Y. 10541 October 6, 1998 914628 -7576 Putnam County Department of Health Geneva Road Brewster, N.Y. 10509 Att: Adam Stiebliug ,,5"c rttAJLAwig J'v�0�✓.' JY av Re: SSTS Lot #2 There�a� states Property ofSchongalla . Albert Lane Putnam Talley Dear Mr. Stiebling: Enclosed please find: L Application for a construction peimit.k 4-1 G! t 1�. <lh.X 2. Form PC -1 ` 3. Short EAF 4. Letter of Authorization i 5. Filing Fee $300.00 t 6. Four copies of plans for the ssts 7. Two copies of the hvuse,.nlans. n� atS'l�e'zt your prompt consideration of the above would be greatly appreciated sine y, Daniel J. Donahue, P.E. 1 Site - Sanitary • Environmental REf -ION, X)RD. 0-F-P-HON&CONNERSAT Time: Date- T,�r 4 Phone e7 Person calling: Reason Inspection- Deeps and/or Peres: Scheduled Field Meeting Time: Date: Y N Tentative/to be confirmed ( ) ( ) Town: P-12 -/I-,, va .1 2• y R_oad/S.treP.C,.. Tax Map 9: Comments: 4P i C4.- 41 ( C2 V7 i!5 Ad,-, W 'L 6 BRUCE R. FOLEY -- Public Health_ - Director..: DEPARTWNT,...OF -HEALTH , Division of 'Environmental Health Services 4 Geneva Road Brewster, New York • 10509 - Tel. (914) 278 - 6130 Fax (914) 278 - 7921 October 26, 1998 Daniel Donahue, PE. 120 Breckenridge Road Mahopac NY 10541 Re: Proposed SSTS: Schongalla Albert Lane, Lot #2 (T) Putnam Valley Dear Mr. Donahue: Review of plans and other `supporting' documents ''submitted, at-this time relative to the above- regarded project1as,been completed .'.,.,Comments are offered as follows: The construction ofthis sewage disposal. -system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. .if percolation _tests_ NJere_ r, Ji )v itpCssc( _i)y .�1., :Ted; PuP27X3t3ve:,.nf the 1\Te '�Yo =,1{ .(`, +y'- I?ep��►-tmsut -M• -- - Environmental on this lot, percolation tests must be witnessed by a representative of this Department. 1) Design Data Sheet has not been.fully completed: a) Soil profile has not been provided for each hole. b) See subdivision plat is not an acceptable response. It is your responsible as the design engineer to provide the required information. 2 Construction permit notes the wrong street address. PC -1 notes "see subdivision file" this is not acceptable. Contour lines are note discernable, however, all slopes between 15% and 20% must be reduced to 15% by the. addition of R.O.B. fill. All slopes greater .than 20•% amunacceptabl6. - ; <, : Design Data, i.e., percolation results and deep test hole soil profiles have not een' provided On the, plan., ,Lo-cation :map is to: show aot location;: map ,only shows subdivisionlocation. : ,, ; 7 The 100 feet wetland buffer boundary is to be clearly delineated. Lv� rt Letter to Daniel Donahue - Octob.er,2,6,,- 1998 Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. 3)ily yours, *P41 Robert Morris, P.E. RM:tn Public Health Engineer enc. SAM CpG BRUCE R. FOLEY - r s`' Public Ne -.liti '%,�oclrr � r DEPARTMENT :OF HEALTH Division . o :.Environmental Aealth' Services r: _ _ f Geneva - •'Road :..: _. • -. .- . •' -' - -. _.._ - Brewster, _New York 10509 Tel. (914) 278 6130 Fax (914) 278 - 7921 :. October 23, 1998 Daniel Donahue, P.E. ...120 Breckenridge Road Mahopac NY _ 10541 _. RE Schongalla Albert Lane, Lot #2 _. __.. (T)Putnam Valley Reservoir Basin Amawalk `Deaf Mr. -Donahue:. The Putnam County Department of Health . ty De r h a p _ , _ . _(Department) has determined that the above referenced application including fee, -and received by this Department on October 16, 1998 is complete. "The _Department. will notify you by November 12, 1998 of its determination. The Project has been delegated to the Putnam - County' Health Departreni for review pursuant to the guidelines set forth in the Watershed Agreement. -= Joint review with the NYCDEP will commence pursuant to the guidelines set forth . .. _. in the Watershed Agreement. if he DA artrmer ai s o- notify v'uu s `�e u ihe above eT , ;( d r, fi�lfF, :,; f >,P' t -P. _ .. __ . # _f, 1. t iL e; . e i:i. ,� . l _„ay t--- . . Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address.' This notice 'must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in Y PP , . accordance with .section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed..- - Rules and Regulations If the Department fails to notify you within 10 days of the receipt of the - .. : -- notice, your application will be deemed-complete, subject to standard terms and conditions as Set forth in the'regulations Please be advised that projects within the NYC Watershed may also require ,Dept. of Environmental r Protection review and approval of other aspects of a project, such as stormwatei plans or the creation o impervious _ n project applicant hould contactahe'Dept • of Envronmental , ' Protection regarding such activities to see if Dept of Environmental Protection review and approval t r _ ; 1s required } , w If you have any questions regarding this matter, please call me at (914)'278-6130 ext 166 h R W 4 1 t i D <>• •c �. ; s t Phi ut}>< "� iM : i.' •05 y H \f i J (,. It 4 y. y o �s V � �•�x�'�M t' �'"' T tit. \n n "s . � t t�l�..a�' �1� +�,��4�t e S r t 1 d .rstt:- ! -.t Yt{. •" _ } �i Fie 3.�. cZt_'�, ^Nl \A'� w '� , s� \ xt .l }w tT {r trl /ti:. } 11 . S i T V1 1 'r 4.} f .f�'f t%h!t.�.3�,ry,'j•lrC ✓4 1 �V 1 ,' 4 S 't C t Z} Cb t ti! �.. N'P 9a `kT � t '. v v f v obert Moms` PE Y 1 r. ! J .t4C w �t '� T 6r 0�4 i�.. tit'•' i 1 �• 3 f En t . •y �l Pp r t � „ � yi, J, tk 11 j 1 tLt�.ri j \�•ttS"r:i t y. .v 7.1, � 6 <. Pt ~�i 'p! r ti r � - .� J'tl�ll$f• . JL JL Liu.► ruv A I T JO l l 1 V l' ni. L-1L. I ri °~ ^ DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM _ - SF�CTI�`�.�,: r�.rt�',R.�Irx �.! �E�p�I I:IA'�'��1?�,,- :.::��•_,� -� - -...._ . , Y_.r:- �.:� -.. 4: �.-.:.; � ,� � :::a-:... ;;�: -�_,, Name of Project SG &A (T )(V) County PL,�-r Site Location Building construction begun V v 0 Extent r-- Is property within NYC Watershed? ................. e F--J No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. F--J Hilly f7 ,Rolling Step slope Gentle slope Flat 2. Evidence of wetlands Low area subject to flooding Bodies of water F7 Drainage ditches [7 Rock outcrops 3. Property lines or corners evident ....................... ............................... Yes o 4. Do water courses exist on.or adjoin the property? .......:...:....:..:.:...... Yes F No tmo S. Will these affect the design of the`sewage'.system facilities ?............ Yes No 59 f .,la w 0f4 6. Do watershed regulations apply in this development ? ...........:........... Yes No CM t,�i S 7 Will extensive grading be necessary? ry .... ............................... ............. Yes E J yNo 8. Will extensive fill be necessary for SSTS? ......... ............................... F-I Yes E0 5o 9. Do filled areas exist within the SSTS area? ........ ............................... Yes o SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: ❑ San d F--J Gravel F--J Loam [7 Clay F'� Hardpan F—] Mixture 11. Observed from: F--J Borings Bank cut Backhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reservt areas ...... ............................... F--J Yes No 16. Soil percolation tests made by 01 Vt2... M- on (oil 6 °l 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 t SECTION D. DRAINAGE - area; es -- gip. � .�1 =:�.� . e, - _ 1..�_ �. �... __ d��,�a,. •n -u� .,: : Y` :. N.0 19. Will groundwater or surface drainage require special consideration? ..................... F-] Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... 0 Yes o SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ........................... ............................... Yes � No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... 2fe s F No 23. Additional comments 24. Site observer /inspector and title �. 25. Date(s) of observation(s)inspection(s) I e c TEST PIT PROFILES Hole# Lot # Hole # Lot Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. ' Depth to rock/imp. Depth to rock/imp, -. _ ... .:........ .........,.:..:.: -- �G:'.__. 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 9.0 10.0 10.0 10.0 iL vun 1 Y LrrAK11VIENT OF HEALTH A -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Address Located at (Street) t3"t--- �M- . Tax Map Block Lot (indicate nearest cross street) Municipality y Drainage Basin / SOIL PERCOLATION TEST DATA NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 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 De th to Water Water from Ground Level Percolation Hole No. Run No. Time Start Stop Ela se Time Iin.) Surface (Inches) Start Stop Drop In Inches Rate llin/Inch - ki 1 2 oZ z3-L 3y0 W ZZ, Z ! S 2' 23,5 Cam. 3 3V7 -33 3� Z1� Z►�z l�z Z� 4 5 1 20f 223. ; 2 22 NZ.S _.._ �3 2s3 3 2 7� 3© 4 5 1 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. 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. Form DD -97 VISION OF ENVIRONMEl�TT'�E CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TIR PCI3IID CONSTRUCTION PERMIT # P V fali - r' Located at Village , z/ov Owner /Applicant Name 00,8460C 1�-At-e Tax Map Block Lot Formerly S 640"K I 'a Subdivision Name &6 o6 &t A ge /// P Subd. Lot # Mailing Address ivosg'& ®� Date Construction Permit Issued by PCHD f±AA Separate Sewerage System built by 19 kA /� �® A4 Address 210 0? ��- Consisting of Gallon Septic Tank and r.¢el e_1 41' Other Requirements: Water Spa]D&: Public Supply From Address r: Private Supply Drilled by C/O/' r 61 P9 Address P&, Building.Ty, - , c4 4'# F P.:jr, I as- cro..io icontrol been CcMv' eied? d Number of Bedrooms Has garbage grinder been installed? /10111 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of or Putnam Date: Certified by Address 42_� ell Department of Health. P.E .,ge-'-_ R.A. �� License # cr 5° Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: r 4-22 As - - &__/2LW copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN,-NISN .. ......... ROBERT J. BONDI Couno, Executive DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914)278-655i WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NATVEF-: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TO'VVN OF (Signature) 6 DATE: Dj I-- The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91 I VERFM PUTNAM CONTT�DEPARTME F NT O�� LT4 U H. D I' N N ORENVIRONMENTAL HEA�L- VIS -0 7H SZ,4, I " YVCE& . t�'kWELL COMPLETION REPORT W, M oc 0 ap�!" 'I§l'"*k L, tw,Ze Well Owner: N ajLne: Address:' Ak Use of Well: I-primary 2-secondary Residential Public Supply Air c'ond/he Iffigition" *o Business Farm Test/moni_ t r ifi Other(specify) Industrial- - Institutional Standby Drilling Equipment Rotary _ Cable percussion CRressed air per cussion Other (specify) ell Type Screened Open end casing en hold in bedrock Other Casing Details Total length jV0 ft. Length below grade 3U?__ft- Diameter in. Weight per foot lb/ft. Materials: � Steel Plastic Other Joints: Welded, / Threaded --Other Seal: >e Cement grout _ Bentonite Other Drive shoe: ;;,--Yes No ILiner: Yes V 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 F_ 1 Yield =?e,-gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are avai Yble,-- please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface e If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type !Qk-- Capacity 21.ao Depth 2 60 Model e-001JA Voltage R20 HP Y2. Tank Type olume 7 4 pt" Date Well Completed ?7' � 4d Putnam County Certification NO. I Bate of Report � Well. ill nature) . N® . act location of well with distances to at least two permane O 1 ap6marks to be provide on a separate sheet/plan. V e� Well Driller's Name GCS Address: Signature: _24 . Z�2 A Date: 2e�� C7 -77.. y f White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 ; y tin , , YML ENVIRONMENTAL SERVlCEE 321 Kear Street Yorktown Heights, N.Y. 10598 (914> 245"2 - ' ' ���� A]]�i�"�`H.' F��i".���';~D�Y���i��-' LAB #: 9.501681 CLIENT #: 57673 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RED BROOK BUILDERS 710 RT 6 MAHOPAC, NY 10541 DATE/TIME TAKEN: 07/27/05 09:01 DATE/TIME REC'D: 07/27/05 09:20 REPORT DATE: 08/03/05 PHONE: (914)-447-4677 SAMPLING SITE: 15 ALBERT LANE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : WATER TANK PRESERVATIVES: NONE COL'D BY: ROBERT MICELI _ TEMPERATURE..: < 4C NOTES"..: ----------- COLlFORM METH: -- --- --m MF -..--..-. DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/27/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/29/05 LEAD (IMS) 7.7 ppb 0-15 ppb 9003 08/01/05 NITRATE NITROG 1.93 MG/1- 0 - 10 9052 07/29/05 NITRITE NITROG N/A 9162 08/02/05 IRON (Fe) 0-0.3 mg/1 9002 08/03/05 MANGANESE (Mn) <0.010-MG/L 0-0.3 mg/1 9002 08/03/05 SODIUM (Na) 90.2 MG/1 N/A 9002 07/27/05 pH 6.3 UNITS 6.5-8.5 9043 07/29/05 HARDNESS,TOTAL 238 MG/L N/A O7/29/05 ALKALINITY (AS 44.0 MG /L N/A ` 9001 08/02/05 TURBIDITY (TUR 3.2 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE ;T;!WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD l E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, 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. ublic 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 guidislines 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 4.1 Albert H. Padovani, Director \ LAB #: 9.501681 CLlENT #: 57673 N0V STAT PROC PAGE: 2 RED BROOK BUILDERS DATE/TIME TAKEN: 07/27/05 09:01 710 RT 6 ' DATE/TIME REC'D: 67127/05 O9:20 _ MAHOPAC, NY 10541 REPORT DATE: 08/03/O5: PHONE: (914)-447-4677 ' � SAMPLING SITE- 15 ALBERT LANE, PUTNAM VALLEY, NY S4MPLE TYPE..: POTABLE : WATER TANK PRESERVATIVES: NONE COL'D BY: ROBERT MICELI TEMPERATURE..: < 4C NOTES...: COLlFORM METH: MF . ... ... ... . ... ... ... DATE FLAG PROCEDURE RESULT NOFdMAL _ RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATEIR CHEMISTRY. WATER WITH A LOW pH MlGHT BE CORROS}VE TO METAL PlPES 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 30O MG/L -T������������-'�� 140-300 MG/L (1 grain/gallon = 17.2 MG/L) | SU8011ITTED BY: ` Alber Direc M.T.(ASCP) C�) �~ vy/ ELAP# 10323 ^ YML E�UI NIAL SERVICES ��c�� Kear �treet Yorktown Heights, N.Y. 10598 (914) _2 5-f�800 ���'����'. H�`P��,�����' RED BROOK BUILDERS DATE/TIME TAKEN.-'08/12/05 ll.-30 710 RT 6 DATE/TIME REC'D: 08/12/05 11:50 MAHOPAC, NY 10541 REPORT DATE: 08/15/05 PHONE.- (914)-447-467'7 SAMPLING SITE: 15 ALBERT LANE SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COL'D BY: ROBERT TEMPERATURE..: NOTES...: KITCHEN TAP COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ` 08/15/05 IRON (Fe) <O.060 MG /L 0-0.3 mg/l 9002 LOKII COMMENTS: FAX TO 845-628-5989 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: n a4) �V) Director ELAP# 10323 PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . - GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM r Owner or Purchaser of Building Tax Map. Block Lot Building Constructed by Town/Village 4 Ldcation - Street Subdivision Name Building Ifype 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. Da ed: Month 9 Day .S ear S� General Contractor (Owner - ignature Signatur r Title: fret Corporation Name (if c rporation) Corporation Name (if corporation) Address: Ji6l P_ r- C � State . 1j � Zip A(a S'J/ Address: le R rt State �� `j' Zip IOS Form GS -97 qu;j1: Pgn&hue; P.E. Mahopac, N.Y. 10541 kS 914-628-7576 TO 169 -LIETTE03 (01Y — WE ARE SENDING YOU L—_ Attached 0 Under separate cover via,-, . ._._the following items-, * Shop drawings C-1 Prints ❑ Plans ❑ Samples ❑ Specifications * Copy of letter ❑ Change order ❑ COPIES DATE NO, ATTEN'rlom Per, ,,,of R C — WE ARE SENDING YOU L—_ Attached 0 Under separate cover via,-, . ._._the following items-, * Shop drawings C-1 Prints ❑ Plans ❑ Samples ❑ Specifications * Copy of letter ❑ Change order ❑ COPIES DATE NO, DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use CJ Approved as noted 0 As requested ❑ Returned for corrections ❑ For review and comment C; C FOR BIDS DUE REIVIAXS--- ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Retum-corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY 0- SIGNED: It enc;ocurst ore not as noted, kindly hatity us at once. SHERLITA ANTLER, MIT, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health August 15, 2005 .Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. 80NIDI County Executive L'�� Re: Construction compliance — Red Brook Builders 15 Albert Lane, (T) Putnam Valley TM# 63 -4 -7.2 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. Please provide the surveyed house location with respect to the property lines and make reference by note to the source of the survey. 2. The iron is above the maximum containment level of 0.3. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cj Sincerely, CJoseph 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 PJ6 DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS Mahopac, N.Y. 10541 845-628-7576 Auugust 10, 2005 Putnam County Department of Health Geneva Road Brewster, N.Y. 10509 At: J. Paravati RE: As Built SSTS Red Brook Builders Albert Lane Putnam Valley TM# 63-4-7.2 Dear Mr. Paravati: Enclosed please find: 1. Certification of Construction Compliance 2. Well Log and Bacti Results 3. Guarantee and two copies 4. F4 copies of the asbuilt plan 5. Filing fee of $300.00 6. E911 Verification Letter Gur pro uipt approviu would te• a�'r &&at6 Reg DIJ. Donahue, P.E. Site • Sanitary • Environmental SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Lt 7 MAR- Associate Commissioner of Health July 8, 2005 Dan Donahue P.E. 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Red Brook Builders Corp. Albert Lane (T) Putnam Valley, T.M. 63 -4 -7.2 A site inspection was made for the above referenced project on July 7, 2005. The following comments must be corrected in the field. he SSTS area appears to be greater than 15 %. he outlet cover on the septic tank is not fitting properly. A The first leg of the SDR35 pipe coming out of the tank is back pitched. mction boxes 1, 2 and 5 are installed backwards. f unction boxes 5 and 6 are not connected. A couple of trench ends appear to be back pitched and are sticking out of the gravel. All pipes shotild be pitched. -at d /16 — ..1/32 inch per foot and the pipes ., s,houid not be sticking up at the end of the trenches. All end caps need to be exposed. The trenches are not measuring to the lengths provided on the approved plan. /All large stones need to be removed from the SSTS area prior to backfilling.. I' "S- ®K ;YO. The curtain drain discharge location is not evident. The house inspection revealed a basement layout that was not in accordance with the approved floor plans. elf you have any further questions, please contact me at (845) 278 -6130 ext. 2157. S' cerely, CJoseph S. Paravati Jr. JSP:cw Assistant Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 - .. AL �.iu..< %_%jL) rN i x vivarAXIMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C , ( k ) FINAL SITE INSPECTION AJ/ C-, ?fP Date: Inspected by: gSp Street Location Owner.,_ �TQ�!!..�.�.:,�..a. = - =•': �.[�.`- .i:= Y,L�F+?.� �.v�(�.y:�,,�s... - : "::m:t`�._;:aw:.,'.: _ -r."` «'+•:-L"�'irnuty #�� �Vy.` :� y ALL �• TM #— -.3 ' Y- 7. o� 7 Subdivision Lot # I. Sewage System Area ' YE O COMMENTS --, a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth V c. Natural soil not stripped ................................................... C. . d. Stone, brush, etc., greater than 15' from STS area....:.:..: e. 100' from water course / wetlands .......................... II, Sewage System a. Septic tank size 000 . - ........... 1, 250 ...... ... other ...........:.... b. Septic tank installed level ..... : ................ ............................. c. 10' minimum from foundation .......... .......:....................... d. Distribution Box 1. All outlets at 95t: er tested.....:.....`:.:.. 2. Protected be 3. .. Minimum 2 ft.een box &trenches e. Junction Box - properly set .......... ............................... 6. cede . Length required Length installed 2. Dis urse measure ........ ( . 3. Installed according to plan. 4. Slope of trench acceptable 1/16 - 1/32" /foot............. ..� 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ...................... .... 8. Size of gravel 3/4 - I'A" diameter clean ................... rx ST G✓c.cic 1� G.�.t 9 epth -of av_e_1 in trench 12 minimum .:................. 0. Pipe ends �' .. g, ump or ose ys*^m� __ -_: � � ......:...._. _ .::.._ ::.• .. � : ��� -�'�, ��,; . m:....... _ .,. .._ .... _....i'. 'Sizes oi��ump cy� namb r. `� ......... .....................�......... . 2. Overflow t . . .......... ............................... .3. Alarm, visu audio .......... ............................... Pump access a anhole to • �P easil Y � grade ..::............. 5. First box baffied ............... ............................... :...... 6. Cycle witnessed by H.D.estimated flow /cycle........... M.:House/Buildina 'a. house located per approved plans "jo e'o�- b. Number of bedrooms . ..........................:.... �`- .. -... IV` Well Well located as per approved plans. .........................� -/' b. Distance from STS area measured ft" ft.... � r C. Casing. 18" above grade d. Surface drainage around well acceptable ................. , W. . V. Overall Workmanship . a. Boxes properly grouted .:.......:.... ..............................5 b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside-of box ... ............................... - d. Backfill material contains stones <4" diameter .............. I Twl 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 .... ....:..........:................ i. Erosion control rovided ..................... . ......................... . Rev, 12/02 Form z Sri It V I 0- 24 Iv -,E- ----------- si W it Sri It V I 99.03'40 "w .'.) -f ,I I si 99.03'40 "w .'.) -f ,I I