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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -33.1 BOX 25 I Ile, a I I 17-2 111 to I Ir r him 1 � 61111 1!1 m I , ,� l o . w L 03141 ° 41 C1 .D] PUTNAM COUNTY DEPARTMENT OF HEAL I ` 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT Located at S 44 vloop Town or Village _ E nY ,J m V q/ &/ Owner /Applicant Name Formerly C3 Tax Map 433. 0 Block 4 Lot 3�3, i Subdivision Name 09-1— (� J IJ D16'4 Subd. Lot # I Mailing Address �9 d>LL <,i 1-Dt 4jfA C- �1� loo C2i Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by Address �b 13vK, 362-4 y�-q, ,v , Consisting of Gallon Septic Tank and 460 Of 2 Fr IJ 1 og. Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by TO Address A-(> ✓,o' A, j� Building Type /ew`) m4 L Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? 1 r� 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 regulationso the Putnam County Department of Health. 6, Date: -7 -9-0 /�a Certified by E Address - P6 130:V q5-0 %llc=� P.E. t/R.A. License # �C76&� 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 Director /Commissioner, such revocation, modification or change is necessary. ?15• Title: % Date: !o Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street iA,d�dress: Qp yr Town/Village: M a-� Tax Map # Map 3 Block Lot(s) 33,11 Well Owner: Name: Address: gh"'tS M ar's 1 Cd 7.<a v �aC,�- esTefr Avt 7urv, � A,l� N, . p2-Seconda'r'y We: Residential _Public Supply Air cond /heat pump _Irrigat' n Business Farm Testimonitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussioA"�Compressed air percussion Other(specify) Well Type _Screened _Open end casin�\1 Open hole in bedrock _Other Casing Details Total Length 2Lft. Length below gradg7�j ft. Diameter (bin. Weight per foot /alb /ft Materials:----1 Steel Plastic Other , Joints: Weldec�-1 Threaded Other Seal_'"�'� Cement grout.. Bentonite Other Drive shoe.----4 Yes _ No Liner: _Yes _No Screen Details Diameter in Slot Size Length ft Dept to Screen ft Develo ped? First I I _Yes No Hours Second I I Well Yield Test _Bailed Pumpe Compressed Air Hours (D Yield $ gpm Depth Date Measure from land surfac e- static spec] ) During yiel test ( ept o compete we m Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface /}AJ & 9 lc mal d Q5 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5'-44 Capacity Depth gUO Model GSOi Voltage o2 0 HP 3 Tank Type 41(�ML Volume __7_ date,, ell completed p s Well Driller ,y'�tia X. H Pump Irist'aller, j C Certificate "# ac?' NY x § 3✓ _. x 'l .: q x ¢AS. ". d ,+,'; 4e:ra #�,`Vn r e ate t* PC Certificate, #�,D'�(? k, .b 1 NYYState # rd,r%?,," 17A .i.��� t1 .. 1 girl T� 4h 4 4. �e Well �Driller!Name °B�Address x GEr ��G, We" iller(s nature A �'3 r,?� � mgr; t "ki a `Q }7 'tlfi�h� LEIq, 1 Pum Installer Name & Address x, xx a� , , t x uVt Installer sl atue RP! 10 k8�x`x i.�t.. 1 ! ad;3'' �e'� +fix'° ,n`' FL�1° B �. 8, �,. f .. NOTE: Exact Location of well with distances to at least two phrmanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM CAP oruo Owner or Purchaser of Building CA PU)tL, O Building Constructed by 34!� 4000. Sr Location - Street Z&,4 mL Building Type Tax Map Block Lot Town/Village Subdivision Name 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: Month Day 0 Year 0/� VSignature:L _ Title: 0 General Co or er) - Signature Corporation Name i oration) Corporation Name (if corporation) Address: g 141 5�el _ f State M G < L Zip D L� Address: State Form GS -97 ALLEN BEALS, M.D. MARYELLEN ODELL Commissioner of Health 1 County Executive ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF. HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 E911 ADDRESS VERIFICATION FORM OWNER'S NAME:— Wood Streot-Deyeldpment Carp- TAX MAP NUMBER: " 63.-4-33.1 E911 ADDRESS: 344 Wood Street TOWN: Putnam Valley AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 7/20/16 d 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. i KLY 7/13 YML ENVIRONMENTAL.SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.602303 CLIENT #: 114 NON STAT PROC PAGE: l.of 1 TORLISH AND SONS PO BOX 271 ,'-.7TENTION: DUANE TORLISH A,RMONK, NY 10504 DATE /TIME TAKEN: 08/12/16 09:55A DATE /TIME RECD: 08/12/16 10:30A REPORT DATE: 08/23/16 PHONE: (914)- 273 -3448 SAMPLING SITE: 344 WOOD ST, MAHOPAC SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: D. TORLISH TEMP RECEIVED: 8C ON ICE •NOTES...: COLIFORM METH: MF -------------------------------------------..-_--_--_-_-__--_-_---- _-- __-- _-- _- _--_-_---- __ - - -- START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD r A ; ~ 08/22/16 IRON (Fe) 0.26 MG /L 0 -0.3 mg /l SM 18 -20 3111B ,rc, r� COMMENTS: ,Te /Mn If both iron and manganese are present, their total value 'r combined shall not exceed 0.5 mg /L. IMS•= IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) S, 4� �a THE ABOVE TEST r AND RELATE ONL 1 SUBMITTED BY: ALL REQUIREMENTS OF NELAC, S 7ZECEIVED BY THE LAB Albert dovani ,vbl�lf' .SCP) Director ELAP# 10323 Rug 03 2016 12:17PM HP LASERJET FAX p,1 YML ENVIRONWICN' AI; :3 1'RIVICES 321 Kear .. -.. °t Yorktown Height;,. 'R.Y. 10598 (914) 24' '2Bevil Albert H. Padov.w --d, Director *� PEST REPO]:'P B ##: 1.601980 CLIENT #: 114 STAT PROC PAGE: 1 of 2 %RLISE AND SONS DATE /TIME TAKEN: 07/25/16 03:OOP BOX 271 DATE /TIME RECD: 07/25/16 03:30P �A'TENTION: DUANE TORLISH REPORT DATE: 08/02/16 Z:2MONK, NY 10504 PHONE: (914)- 273 -3448 SAMPLING SITE: WOOD ST, MAHOPAC SAMPLE TYPE..: POTABLE : TANK PRESERVATIVES: EN03 COLD BY: D. TORLISH TEM? RECEIVED: 7C ON ICE Np TES yM. COLIFORM METH: MF ------------------------------------------ ..........----------- --- ,. ------------------ ft�,TART DATE /TIME END DATE /TIME FLAG PROCI3DUR3 RESULT NORMAL - RANGE METHOD Pb /Cu -LEAD limits for public schools are set. at 13 ppb. EPA Lead & Copper Rule. for Public Systems n-,gaires that no more �t than 10W of their distribution points have: .q URAD value of more than 15 ppb and a COPPER value of 1.3 mg /l: elsie water treatment must be undertaken to reduce try waters corrosive ya potential. 'a /Mn If both iron and manganese are present, tb Lotal value S combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRET.AT10.1; WATER SAMPLED AFTER $F SITTING UNDISTURBED A MINIMUM OF 6 H!;:i)'RS OR OVERNIGHT) 1`•: NMS m NORMAL METAL SAMPLE. (INTERPRETATioti- 'RATM SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIKIM) tAr iFiii PUTNAM CNTY PROFILE 07/25/16 0430 07/26/16 0330 MF T. C'OLIFOR D.OSPNT /100 ML ABSENT SM 18 -20 9222B a• 07/29/16 0230 07/29/16 0233 LEAD (IMS) 6.7 ppb 0 -15 ppb SM 18 -19 3113B 07/27/16 0300 07/27/16 0400 NITRATE NITRO 0.91 MG /L 0 - 10 HACH 10206 0.7/27/16 0230 07/27/16 0300 NITRITE. NITRO X0.01 MG /L 1.0 MG /L SMIS- 204BOONO2 08101116 IRON (Fe) 0.04 MG /L 0 -0.3 mg /l SM 18 -20 31118 07/29/16 MANGANESE (Mn 0. 1.0 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/29116 SODIUM (Na) 46.62 MG /L N/A SM 18 -20 3111$ 1( 07/29/16 0230 07/29/16 0233 * OH (i.7 UNITS 6.5 -8.5 SMIS -20 450ORB , 07/29/16 HARDNESS,TOTA 510 MG /L N/A SM 18 -20 2340C k:r 07/29/16 ALKALINITY (A 100 MG /L N/A SM 18 -20 2320B 07/25/16 0355.07/25/16 0400 TURBIDITY,(TU :3.52 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: Y ?TC T oliform - This result indicates tha�. "ae water y (was) , (was not) of a satisfactory sar.l.ta" t� cpiality according to ?a. ew York State and EPA federal drinkirxr °: ,pater standard for this parameter. This comment applies to tlba ao:s.l Coliform test only. Pb /Cu -LEAD limits for public schools are set. at 13 ppb. EPA Lead & Copper Rule. for Public Systems n-,gaires that no more �t than 10W of their distribution points have: .q URAD value of more than 15 ppb and a COPPER value of 1.3 mg /l: elsie water treatment must be undertaken to reduce try waters corrosive ya potential. 'a /Mn If both iron and manganese are present, tb Lotal value S combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRET.AT10.1; WATER SAMPLED AFTER $F SITTING UNDISTURBED A MINIMUM OF 6 H!;:i)'RS OR OVERNIGHT) 1`•: NMS m NORMAL METAL SAMPLE. (INTERPRETATioti- 'RATM SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIKIM) tAr iFiii Aug 03 2016 12:17PM HP LASERJET FAX p.2 YML EVVIRONMEN'LU. YE VICES 321 Kear Yorktown.. Heia-ht. % N.Y. 10598 ( 914) 245-26 Albert H. Padovand.,. Director AB #: 1.601980 CLIENT #: 114 N-)N !3,'. tT PROC PAGE: 2 of 2 ?!'ORLISH AND SONS DATE /TIME TAKEN: 07/25/16 03:OOP .:0 BOX 271 DATE /TIME RECD: 07/25/16 03:30P ATTENTION: DUANE TORLISH REPORT DATE: 08/02/16 ARMONK, NY 10504 PHONE: (914) -:273 -3448 SAMPLING SITE: WOOD ST, MAHOPAC SAMPLE TYPE..: POTABLE TANK PRFSE:RVATIVES: HNO3 ;T,'D BY: D. TORLISH TEMP :RECEIVED: 7C ON ICE ` "E;S...: COL:[F'�3RM METH: MF 'PART DATE /TIME END DATE /TIME FLAG PROC IEDURE', RESULT :NORMAL - RANGE METHOD w,i No limits for Sodium a d. are proscribe. S::,cjge. ; r ;;,uidelines state that for people on a sodium restricted cL.ec. th water should contain no more than 20 mg /.L of Sod.ium. F ox: on a moderately restricted diet, a maximum of 276 . r3 'L of Sodium is suggested. H *� P F. 0FMK Vol �1 r PH SCALE IN WATER RANGES FROM 1 -14. KU%SLrb: �C�JENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED 'PESTS IY'' !:' ATE:R CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO N T. -,. ' AI.• PIPES AND FIXTURES. THE NORMAL RANGE OF PH IS 6.:3 'IT:> 3.5. pH IS A FIELD MEASUREMENT AND IS TESTED OUT ,'r'DF;. THE HOLDII4G TIME. pH REPORTED FOR REFERENCE ONLY. TOTAL HARDNESS IS DEFINED AS THE S: Michael J. Nesheiwat, M.D. Interim Commissioner of Health Robert Morris, P.E., M.P.H. Director of Environmental Health August 1, 2016 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: Department of Health 1 Geneva Road, Brewster, New York 10509 (845) 808 -1390 Re: Field Inspection — Cardillo Wood Street (T) Putnam Valley, T.M. 63.4-33.1 An re- inspection at the above referenced property has been completed. MaryEllen Odell County Executive There are no further comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. S incerely, Gene D. Reed Principal Engineering Aide GDR: cml Michael J. Nesheiwat, M.D. Interim Commissioner of Health Robert Morris, P.E., MPH Director of Environmental Health June 3, 2016 Department of Health . 1 Geneva Road, Brewster, New York 10509 (845) 808 -1390 MaryEllen Odell County Executive Roy Fredriksen, P.E. Re: Field Inspection — Cardillo PO Box 950 Wood Street Mahopac, NY 10541 (T) Putnam Valley, TM 63. -4 -33.1 Dear Mr. Fredriksen: An inspection at the above referenced lot has been completed. The following comments need to be addressed: ® Baffles need to be installed in the septic tank. 0 The curtain drain velocity dissipater needs to be installed. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, Gene D. Reed Principal Engineering Aide GDR: cml a PUTNAM COUNTY DEPARTIVIENT OF HPALTT3 DIVISION OF ENVIRO NTAL LTR SFRVICES '7,,'P- 7 %6 - o FINAL SM INSPECTION V /< D.ate:: 6 I Inspected by: Street Location Owner Ca Town :P }- yxa_ffi k;Z P.crmit # '7> 1I - o ;z- - / s` TM # �D t - 3 r l Subdivision Lot # S 3 , 1. -Sew System Area a. ST'S area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................:.. ............................... d. Stowe, brush, .etc., greater than 15' from STS area.......... e. 100' from water course/wetlands ............ .......................... II. S a I . Septic. size.- 1,000_.'.. ,25 .other. b. Septic malt ii stalled level ............. �V).: a - c. 10' .from foundation ............................. d. Dist baron Bo 1. All ©utlets at same elevation- water.tested ................. 2. Protected below frost .................. .......................... :... 3. -. 2 ft. Original soil between box & trenches e. JuA B - properly set ......................... :................. 6. .:... 1. Idfigth required (/ 5-:0 Length installed ( o 2. Distance to watercourse measured 4 /6) v Ft.......... 3. Installed according • to 4. Slope of trench acceptable 1116 -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, 10.0 % ................ ..... 8.. Size. of gravel 3/4 1lh" diameter clean ...............:... 9. Depth of gravel in trench 12" minim ......::........... 10. Pipe emds•.ca ed ...... ......... ...... I........................ .... g. Pum : oa�.Do 8 iteffis 1. Siii bf pump. chamber ................................................... 2. Ovve&ow tank .....:........:.......... ............................... . 3. Alarm, vial/ audio ........:........... ............................... 4. Pump Wily acces.0----,...1 ible, manhole to grade ................. 5. First bb baZed... .......................................... I.............. . 6. C, cle witnessed by H.D.estimated flow /cycle........... a. mouse located per approved plans... b. Number of bedrooms ...................... r�.. . �......... 1V. Well located as per approved plans . ......:........................ b. Distance from STS area measured 4162,9 ' • ft ........... .c. Casing• 1S" above grade ................ ............................... d. Surface drainage around well .acceptable .....:........... V. ' Overall WorlananshiD . a. Boxes properly grouted ........................ 0......................... b. All pipes partially bac Eed ........... ............................... 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 watercou6 g. Footing drains discharge away from STS area ............... h_ Surface water protection adequate....._ .............. . ...... i. Erosion contro provided ................. .......0....................... Rev. f2ro2 N®1 COUNTS fs Z>/ 05/31/2016 13:12 FAX 518 566 0903 PLAT STORM RM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL BEALT13 SERVICES ATTENTION 11 JOSEPH REQUEST FOR F1NA1 1NSPECISON All information must be fully completed prior to any inspections being made. PCHD Construction Permit # <EIWE For: bill Trenches Located: d.)e0 5 t Tee• ' (T) (V) � �� Py/ l %1 /.,e Owner/Applicant Name: c1f x TM � • O Bc: i rC Lot Formerly: Subdivision Name: 4.. Subdivision Lot # % Is system fill completed? Is system complete?� Is system constructed as per plans? c?'S Is well drilled? ' Is well located as per plans? Sirs Are erosion control measures in place? e [a 001 /001 .Date: _ Date: 26 i(o Date: _ �2� �/a I certify that the system(s), as listcd, at the abovepremises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. P•� Date :' ! Certified b (2 Vi_ PE De ' - Professional Address: �� 670 X �SA�� %y) i:94C % 105-41 Lic. Comments: Form MR-99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 010012 e;,TjZE6— T Subdivision name Pra Lr C 1 1 DI G Subd. Lot # 33,1 Date Subdivision Approved (0111 q 5- Owner /Applicant Name C..14QYD I LL6 Town or Village ouvv% t e Tax Map Cc . a Block I Lot 313• Renewal RRevision,0 Date of Previous Approval Mailing Address Ig gj L(, egpg `T! 4,4161P& 4- Zip La_�Kw Amount of Fee Enclosed 2 Building Type CoLoM I A L Lot Area Z AC-No. of Bedrooms 47 Design Flow GPD lv a Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and S�0 L - F OF ..2 f t iNi,'Do T2 gfj"e S Other Requirements: _ _. T FT Cc.IQ'TA<! 4, jyme6 11%i To be constructed by -T Fyn Address Water Sup&: Public Supply From Address or-. _L,-, Private Supply Drilled by _ T (3 p Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sQuate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: � P. E. R.A. Date Address Q o -.x< %,�—O , /'l 4 4oa-ar_ f4 ,,.° / 0S <4/ License # 150S0 APPROVED FOR CONSTRUCTION:. This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew permit. App for ischarg� of domestic sanitary sewage only. B �� P'�- Title: Date: ite py - HD File; Yellow copy - Bui ing Inspector; Pink copy - Owner; Orange copy -Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH` DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Loa CAe.t� I L L b Located at W p 0 P TN CPU -WAA USAt.C�_ Tax Map Subdivision ofVFL 6 1yol ac Subdivision Lot # 33. 1 Filed Map Date Filed L ! 1 �1J To whom it may concern: This letter is to authorize A duly licensed Professional Engineer 'der °-Registered Architect to apply for the required wastewater treatment and/or water supply permits(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of Health of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: ( Oes4n professional) Ra Y A 6 so Etlac. /4 (Print ame) P.E., R.A., #yS� Mailing Address: F(3 Br) - ?5-0 6&44 c State Zip Telephone: Date:[ Email: i?A %rQ (l IIGS/r- .,l ( rz Q C{ p94 i.% Signed: (Owner of property) Lo Q l 5 e' -X'171 LL d ( Print name) Mailing Address: 18 'TeO?4z /4A M84C. N State /l/ / Zip Telephone: 9) q— 1j04— #q7 5 Revised July 2013 kly Michael J. Nesheiwat, M.D. Interim Commissioner of Health Robert Morris, P.E., MPH Director of Environmental Health Department of Health 1 Geneva Road, Brewster, New York 10509 (845)`808 =1390 MaryEllen Odell County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN:u�`�(���.1� FROM: 62 , p tl7 l DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application ❑ Renewal ❑ PROJECT: ;#C LOCATION: Wood S� TOWN: i,nr,U,�;,��(�.L; DATE SUB'D APPROVAL TM # NOTICE OF COMPLETE APPLICATION DATE: J j DELEGATED Michael J. Nesheiwat, M.D. Interim Commissioner of Health Robert Morris, P.E., MPH Director of Environmental Health March 7, 2016 Department of Health Geneva Road, Brewster, New York 10509 . - (845) 808 -1390 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Re: Dear Mr. Fredriksen: MaryEllen Odell County Executive Complete Application Determination for Cardillo Wood Street (T) Putnam Valley, TM Amawalk Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on March 3, 2016 is complete. The Department will notify you by March 29, 2016 of its determination. Z The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the 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 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 .ext. 43157. Respectfully, J seph S. Parave Jr., P.E. / sistant Public Health Engineer JSP:cml ✓ ✓ 0 PUTNAM COUNTY DEPARTMENT OF HEAL '' Z DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 00 D e I Town or Village P(j- r1g4,y . V4 y Subdivision name D4 L C4 I W f cI- Subd. Lot # Tax Map l0 3.0 Block 4 Lot 33 Date Subdivision Approved (%/ ys' Renewal — Revision Owner /Applicant Name C fib! U-0 Date of Previous Approval Mailing Address /cg f / LL•Sl,o ' f,e e#c4 , Jj. /4o pp Corti(• Zip / 0,54 Amount of Fee Enclosed 0, 00 Building Type C 01,o,4/ A L_ Lot Area No. of Bedrooms 4- Design Flow GPD 6 O O Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate SevveraFee System to consist of gallon septic tank and 4S o L.J:r d f 2 Fr Other Requirements: '7 r-r Cu9T l&l b"/ N To be constructed by j n Address Water Supply: Public Supply From o Private Supply Drilled by 7 S D Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. R.A. Date 416 ! S License # ©S APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for dais-charge of domestic sanitary sewage only. By aZ7 9M �..3� ite c y - HD File; Yellow copy - Buil ing Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type F-CM70 `ryt'11 4 R° Well Location Streeet Address: Town/Village: Tax Map # V 7 b0 �D � Pv 1q►� �9 Map 63 Block 4 Lot(s) -3 ° Well Owner: Name: Address: Phone #: C�i�Dl[.[rD Vie ,[Ls�Q4 Te11' , 1,4 oP 4c, 14 Y �- 49 5 Use of Well: ✓ ttIesidential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/Monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Existing Supply Test/Observation Additional Supply Reason for Drilling /Replace _Z New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No ✓ Is well located in a realty subdivision? ........................................... ............................... Yes �_/No Name, of subdivision Q9L 4111010 Lot No. Water Well Contractor: IrB.D Address: " Is Public Water Supply available on site? ....................................... ............................... Yes _ No ✓ Name of Public Water Supply: — TownNillage Distance to property from nearest water main: —' Proposed well location & sources of contamination to be provided on sheet/plan. separate ate: �-t �s 8 Applicant Signature: A 4 �•' Date:-4113//5- 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. 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 7// Permit Iss4-9-O Date •of Expiration Title: <S; Permit is Non- Transf6rabfe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health June 29, 2015 Roy Fredriksen, P.E. PO Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Proposed SSTS - Cardillo Wood Street (T) Putnam Valley, TM 63 -4 -33.1 This Department 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. Two sets of floor plans are to be provided. 2. The tax map number is to be provided on the plan. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. Sincerely, J seph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP: cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 13, 2015 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Roy Fredriksen, P.E. PO Box 450 Mahopac, NY 10541 Dear Mr. Fredriksen: MARYELLEN ODELL County Executive Re: Complete Application Determination for Cardillo Wood Street (T) Putnam Valley, TM 634-33.1 Amawalk Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on April 23, 2015 is complete. The Department will notify you by June 3, 2015 of its determination. O The Project has been delegated to the Putnam County Health Department 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 the Department fails to notify you within the above referenced time frame, you may notify the 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 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans. or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43157. Respectfully, aosep�h S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road; Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW Ai FROM:'.' DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application ,,*t,fUK' Renewal ❑ PROJECT: -1crz 4l? f f e LOCATION:' TOWN: Pt4?6,ot �'j DATE SUB'D APPROVAL"" e. NOTICE OF COMPLETE APPLICATION DATE: DELEGATED PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: &(DU c4/20111 d Address: /6 1 +1 usl lots %rr. r Located at (street): woo D -�Tr� � TM # 63.0 —4- 33. 1 Municipality: -- l =-I-'J /s'I � � Watershed: An ,9 ,,),gL11, SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: & 6 !(=_ Date of Percolation Test: Hole No. Hole depth (Inches) Run No. Time Start — Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop water level drop in inches Percolation Rate min/inch 0 1 `22 2 i 0: 40 I 10 30 Iq 24h VZ 2 3 1 1.'/V 11:40 30 j 2 IZ 2- Z 4 5 2 iv• 4¢ il:/4 30 3 / : 14 f 4f 30 .v /02 Z Zv 4 5 3 25 1 0.. /U 4k,: 3o /I 24h Z 12 2 jo4& i° ib 90 Iq 21 2 5" 3 11'41 go 1 2 2 15^ 4 5 1 10, 1 jo.-41 30 2v ZZ 2 l 2 u: ,!Nv Zo o 20 2/' /"2 2© 3 i P 2 v 30 20 2A 1 ' Z Z� 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., < 1 min for 1 -30 min/inch, < 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, pg 1 of 2 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Z'0L) . ChP'pxLc--7 2. Name of Project: 5N5 C'eSI4N l24*4 hl 3. Location: TN: I�J'j'l�l'IN7 V11 Ltd y 4. Design Professional: ROV A. ' t2I� AJ 5. Address: Pb Q 6X. 7S ; 64 /aUrhe; N y 6. Drainage Basin: APB nkJX LJ< 7. T e of Project: rivate/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No t-40 Type Status (check one) ...................................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No N D 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No lam[ 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, / /�, e ordinances? ............................................................. ............................... Yes/No � s 13. If so, have plans been submitted to such authorities? $ 14. Has preliminary approval been granted by such authorities? ` Date granted: 95- 15. Type of sewage treatment system discharge ........................ surface water groundwater 16. If surface water discharge, what is the stream class designation? .......................... 17. Waters index number (surface) ............................................. ............................... 18. Is project located near a public water supply system? . ............................... Yes/No l� o 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .......... Yes/No �c? 21. Name of sewage system Distance to sewage system — 22. Date test holes observed 46 '% 23. Name of Health Inspector 24. Project design flow (gallons per day) ............................. ............................... X00 O 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No (mod 26. Has SPDES Application been submitted to local DEC office. Yes/No Rev. 11/02 Form PC -97 Pg. 1 of 2 RE: PUTNAM COUNTY DEPARTMENT OF IIEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER Or AUTHORIZATION Property of (f A2 D l � L Located at T/V PUj- V�Ue Tax Map # 3• Block.— Lot 3 S. f Subdivision of 0 j d 1) IGC Subdivision Lot # 33. f ' Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer L,-fir Registered Architect ' to apply for the required wastewater treatment and/or water supply pen-nit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned P.E., R.A., # _ .f °Sc�sc�s Mailing Address F0 t?--IJX 9-<d State 0:54 1 Telephone: " POO ` 02 -& Very truly yours, Signed: (Owner of Property (/ Imo-. Mailing Address: 15 pjj,�tc(< ,�rtAoo_ State E 0! Zip Telephone: TO '1 I �50" Form LA-97 Sw ' 817.20 f _ Appendix C. u l I�`l7 r t •5 y ?,.wr <<sBW State Environmental Quality Review ` t, .FSHORT ENVIRONMENTAL ASSESSMENT'. FORM For UNLISTED ACTIONS Only C S l PART I PROJECT INFORMATION To be ccompleted b A ucant or Project Sponsor) 1J; APPLICANT /SPONSOR . • 2. PROJECT NAME. 1 r S f , all � Lov. r -,� 3 PRaIECT LOCATION Mrinlcl lily ,..'�� CountyU. 4,t PRECISE LOCATION (Street address end road Intersections, prominenClandmerks, etc.; or Oovide map) `r j4 jt; q }sal,' 0. a tA) O f9k /fM. /`J•'� `" /. _t ,1 't�'_ `i'a�il�•t�, kl,l PROPOSED ACTION Is: Expansion Modigcatlon /alteration dt+tll DESCRIBE PROJECT BRIEFLY: a sdw„ rpjSr�lle,fb✓) C� f /f OV�C' 104, v° /��. -'r'ry� yS', /�=.hj ►`,?;t�'r`�` i, -4 )• 7i AMOUNT OF LAND AFFECTED: ' I . : InNialy acres Ukirriately Z acres tier i57l17 WILL PRO WACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? t? }i es No If No, describe briefly ' j 8 i WHAT I3,13 ENT LAND USE IN VICINITY OF PROJECT? esidential a Industrial Commercia El l ParklForesUbpen Spa ce Other s 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR- ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDE , STATE OR LOCAL)? r l•f)ti?n ' r (�j es ` No' If Yes, list agency(s) nerve and permWapprovals y pew ��Ann►ny. Q� (d arL01n' pPTI + i I r 4 , Y 11 �'• DOES,AW ASPECT OF ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVALS s� es LVN0 . If Yes, list agency(s) name and permil/approvals Nsn,+ 12:) 1A AS A RESULT OF.PROP D ACTION WILL EXISTING PERMIT /APPROVAL, REQUIRE MODIFICATIONS �• .I Yes • o +, °( "I �t I CERTIFY THAT IN R 10 PROVIDED ABOVE IS TRUE TO 7HE BEST OF MY KNOWLEDGE : ApQllaainthponeor nert>os ' ' Date: dd I( 1 E-11111 i 'I�, i ti. � '11,tihrj 1(�f ?�T [`,Al- it ail Moltf - 17 1!�. .�� w A17� iy� M s1t� M'Iff ptO1'1'1 ��Ttb t:�, ,jdi�j j`><�i'I,h� 071n + a p Q fr +DV�1� .• , ..h ''' ',•.'P'I hl � y_y11i,�ily1,1 ! , ,Li ' . ,�.. , -,' .•iwi ��� . {'h' 1-.I,SI'f��Ii,i3 . to }�,�L�rP;,l }P ah�ii I I h�;l� r, i ., vi �V iil I,i�l�il ijSll �l 14�rI� 7I�y,+1,I J l►a oq►, U II = IMPACT ASSESSMENT To be com leted b Lead A enc 't`,1��Irrr YCRR PART 817 47 If yes coordinate the review process and use the FULL EAF.`f ? A31DOES ACTION EXCEED ANYTYPE I THRESHOLD IN e N El 0 No r, B',WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS INS NYCRR, PART. 617.0- If No, a negative' 4 ', iy e, declaration may be superseded by another Involved agency C COULD-ACTION RESULT IN ANY.ADVERSE EFFECTS ASSOCIATED. WITH THE FOLLOWING: (Answers may be handwritten, N legible) " >,C9,' Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern; solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 'i C2 Aesthete, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood charegtefT• Explain briefly ,. r , ,. C3 . Vegetatton or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 1 f f r T ^ N ,;C4 A community's existing plena or goals as officially adopted, or a change In use or intensity of use of land or other natural resources? Explain briefly ,.a CS.' Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: ' { , . ! CO. Long term, short term, cumulative, or other effects not Identified In C1 CS? .Explain briefly:. { '; NC7 Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly: >' D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS,THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CFA)? Yes • No If Yes, explain briefly: ; E., IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ No 11 Yes, explain briefly:. Yes PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) ' g p g INSTRUCTIONS: For each adverse.elfect identified above; determine whether it is substantial large, important or otherwise sl nificant Each I. ' effect should be assessed in connection with its (a) selling (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversiboon (e) ;_.geographic scope; and (Q magnitude. if necessary, add_attachments or reference supporting materials. Ensure that explanations contain 1 sufficient detail to show that all relevant adverse irripacts have "beer identified and adequately addressed. If question D of Part II was checked `. yea, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics ofthe CFA 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 FAF and/or prepare a positive decaraton. 3r F Cheekthisboxifyouhavedetermined, basedontheInformationandanelysise6oveandanysupportingdocumentatlon ,thettheproposedectlonWlL � , NOT result In any significant adverse environments Impads'AND provide, on attachments as necessary, the reasons supporting this determineUon Date ; ame o gently t: j0 1 1 1 �, Roost 1 JT.N•9 OV Nq, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: /— 01/ Latd L 1O Located at (street): Municipality: ?Wwa-m Halle .$/ Address: 3-94/ a.)ooel S- ft e---4 TM# 63, 4( — 33,i Watershed: 44 n -O —Wo-fik SOIL PERCOLATION TEST DATA Witnessed by: < , E Date of Pre - soaking: V4 �� Date of Percolation Test: Hole No. Hole depth (Inches) Run No. Time Start— Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop water level drop in inches Percolation Rate min /inch 1 w -- tor o 3 /0 2 3 1glo - jj, 5/O 3o I C1 - .1 i %i jj- 4 5 �. �. 1 1p,,j _ 3 z .4.0 3 4 5 3 16r 1 1011b 10;16 30 -mil % Yi 2 30 - 3 ! 30- z. 4 5 1 -- 30 .1-0- ;L2- .1 .- 2 .- _ 30 z0- 2- ZO 3 3ro a-0- z 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., < 1 min for 1 -30 min/inch, <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, pg 1 of 2 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 INQUEST FOR FIELD TESTING ROBERT J. BOND[ County Executive All information below must be full}, completed prior to any sclieduliug. DATE: ENGINEERING FIRM: /?o PHONE #: PERSON TO CONTACT: EW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: PERCS: 0,-11)UMP TEST: ❑ ROAD /STREET: 3 O 4 JA) 00P TOWN: Pu n Grn V& le TAX MAP #: s SUBDIVISION:: LOT #: OWNER: Z-0 () <�q1Z0i loo (CQAP:4 1Je•t� ee� NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ Proposed SSTS within the drainage basin of Nest Branch or Boyds Corner & / Croton Falls Reservoirs.. 11 DO Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. • DO Proposed SSTS within 200 feet of a watercourse or a DEC wetland. • g' Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ W Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. . If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- wituessing of the soil testing with NYCDEP. troll C6VNgv Van ONLY DA'C1Li 79 M M Mop FOR r1ftIP It"TINCIALr 6`i�1VlPerii „aiitgl:tlaalth (s45) 278.6160 14x 440 ) 916•.701 1 wotar stir �► PDX S) 221.9419 r� Notighij 04 v $) 270 -s4sa Pax (04a) 378.4026 wtc (949) 270.6070 Nuraluqq 1yt+uia nr4 Rnk (806) 279.6Atia manly 11Harviiisdo /i�raralloid (845) 218.6614 Mix (940) 299=4046 I �19. s i i 2.24 / I / AC. / / / 20 / da ' 1 ry. 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" � 37 A . 1.57 AC.p AC. �- 216.55.00 _ - 390_00- - 8 ' 38 8D7'02 g . 2.75 AC. i 3.17 AC. tee. _ a54.s4 -_ -_ �' 382.01_- /�a.00 804.55 1 g N O y AN m .L . 5 24.88 AC. 41 40 N 16.25 AC. 9.18 0 AC. � n 1 1. 1 1 1 TytAs 1 I ,4 $• : 3 � I 230.04 418.82 ..... 1 29 1 1 y . _i P/074 -1-46 -� P/074 -1.47 74 -71/0" -1 W U 51 52 53 . PRELIMINARY 62 SCALE ••••••••••: �-•� V*TL4kNOS LINE BSYMBOL 1 DEVELOPERS LOT NUMBER 5 62 '- - DEED DIMENSION DIMENSION ) SCALED D ENSION 100(S) ) TOWN OF PUTNAM VALLEY f - -6F1I- CALCULATED AREA 234AC. GAL VISUAL CENTROID a, oeacFi ui,uaon x PUTNAM COUNTY NEW YORK DATE AERIAL PNOTOCRAPNY NY STATE PLANE COORD. 73 74 ��,G. ��� � ��� �wMf �• rte,,.•. �! ®� �o; A f, N a C /may \ \ ti 4�A E ,4��.. .. M i to �• MP t 18 M � ��tt'►PU � ��IIt�p�1filmuuu ►Ittud' oa g PROISOSED S�rdA J �e 9 - (10,000 r.,..., ":• $Flf •.1 "4 �''. � PT2 a P'� PAS E D Q F EXR � ` r... .: s. ..•P Y:•, � 10 l eZf. wHh9a= t00'.r{Ipstgp�tie3nXS�L'3YR�➢�t ,�� � • �tf, �I�i53+b`b� loci j �`�: 0 F.• 0 0 1n df�4�ilra 91 dtij�age [bYpU is trblo :r I • lei ioa, g'�yj sIR }'' fan tlre1! it�k4�p a��{ w 20 e• •M .moo. VJilfi R: h. K-A a R,i DTI ,,�tQtt,•I .. .PT3 r. �.,OPTI �♦ all t11tltltttl'1)l� - * ' t r •' , TING • C PROPOSED 7' DEEP 'CURTAIN , PROPOSED' . DRAIN L =120 '. •1�:' �• ' •� •';',; c. 4:Ot D#ELG t FE =103.0 — , tag' Ykr r g6 O 20 M Z r z'qa` irk AUCr •. •7f 2AyM PR ' * "" OPOSED DRL'V �` s 00 y 1 a : x ERO�ION:'GON7R0L x • e !rs o aA !I +`M EX.- .DRILLED,. tir ; WELL i t PROP W,EIac., Y' seem •zo'N o'V:'i:• Wee {59 ge : � •IBM IBM ///,,,�•., 28"m 14"M c • laillam Re .n0 AS BUILT SEPTIC LAYOUT SCALE 1' =30' NOTES: 1. THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM WAS CONSTRUC THIS PLAN. AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVE SYSTEM WAS CONSTRUCTED IN- ACCORDANCE WITH ALL STANDARD RULES AND PUTNAM COUNTY DEPARTMENT OF HEALTH AND.THE NEW YORK STATE DEPART 2. THIS LAYOUT IS BASED -ON A COPY OF SURVEY OF PROPERTY PREPARED BY F SURVEY IS DATED JANUARY, 12, 2016 AND.COMPLETED JULY 16, 2016. INDICATED ON �ER;;';THE 4TIONS OF THE F HEALTH. BAXTER, PLS. 1 2 3 4 5 6 7 8: 9 1011 12 . 13 14 15 16 17 18 A 21 5'k.. 48.5' 55.3' 61.6' 67..5.' 72.8' 79 5' 63 $'. 64.1'. 68 5'; 7 ;79 T 65.1' 69.6' 82.0' 87.4' B 38,#j, 55.6' 61.0' 66.4' 71`5! 76:2' 82 3' ': 31.6' . 38.5' . • 92.4' 98.T 89.3' 91.3' ' 106.0' . 110.0' 113 -A' 11 R 7 Y 4 � fT i rr �¢ _ ; � . • _y x a'� E'=,,- "fir b-h � { ..Nw' - 10M ,Y �- °� ..�'ax^ .:,..� �.� ..fYy.f d..+�s" }��!s�.�s �- 1-"^{'r•