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Home My WebLink About3147DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -1.2 BOX 26 E-Xi�llrl - fig ; -' � i. - IN r f -,T IN 03147 a NAM COUNTY DEPARTMENT OF HEALTH S ON.OF -ENVIRONMENTAL.HEALT -H H,- J( CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # RK 3i - 6,1 -5'h/,9 J 4 y Located at Town or Village ,7whlaryrn Owner /Applicant Name /Y c /�_J l'ivr's� ; Tax Map '72 Block Lot'/, 2 Formerly '? /"r Mailing Address ZZ 4!2ei91e) Subdivision Name Subd. Lot # Date Construction Permit Issued by PCHD /, d —O *- A/ V 2, -// Zip /10-/ Separate Sewerage Sxstem built by _ iii l ��,�� Address �c%� ////o��i/ir� Chn- d6IS'9 Consisting of Gallon Septic Tank and 3 6 U of 2�" �✓/ `�� ,-,�� /� Other Requirements: Water Sunnly: Public Supply From. Address or: di" Private Supply Drilled byi,�r7�r� %�,��i/�an Address /�,c%•n /��-M /V� ..__- �iiil�..1'�'la:.`S�J:�r' _ : �.!3'.�.�1`ti /_ __ ��- F'--'--' O�?; �iY .��:rnwrnl..�PPn_rnsririi�jF.�S i� ..._.__)��*�. _ -- - - - -• -_.�. Number of Bedrooms Has garbage grinder been installed ? /V 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 regulaCifflrof the Putnam County Department of Health. Date: 2 d P.E. k" R.A. �. pNCls S (Design Professional) Address License # Z Any perso occup d 2 b e systems) shall promptly take such action as may be necessary to secure the correc f ditions resulting from such usage. Approval of the separate sewage treatment system s mg �, as soon as a public sanitary sewer becomes available and the approval of the private water su a null and void when a public water supply becomes available. Such approvals are subject to mo ion or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By �- �� Title: /4P 4,c Date: .3/6-1-7/v-7 'hi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 � yML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 1.700381 CLIENT #: 59940 NON STAT PROC PAGE: 1 MINERVINI, NICHOLAS DATE/TIME TAKEN: 01/22/07 02:00 66 DENTON AVENUE DATE/TIME REC'D: 01/22/07 02:35 EAST ROCKAWAY, NY 11518 REPORT DATE: 01/29/07 PHONE: (646)-33t-7722 SAMPLING SITE: 49 INDIAN LAKE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : WELL PRESERVATIVES: NONE COL'D BY: NICHOLAS MINERVINI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/22/07 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01/23/07 LEAD (IMS) <1 ppb 0-15 ppb 9003 01/24/07 NITRATE NITROG <0.01 MG/L 0 - 10 9052 01/25/07 NITRITE NITROG <0.2 MG/L N/A 9162 01/24/07 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 9002 01/25/07 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 9002 01/25/07 SODIUM (Na) 6.03 MG/L N/A 9002 01/22/07 pH 7.5 UNITS 6.5-8.5 9043 01/26/07 HARDNESS,TOTAL 88.0 MG/L N/A 01/26/07 ALKALINITY (AS 72.0 MG/L N/A 9001 01/23/07 TURBIDITY (TUR <1 NTU 0-5 NTU ` COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIIG)HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 -----�T LAB #: 1.700381 CLIENT #: 59940 NON STAT PROC PAGE: 2 MINERVINI, NICHOLAS DATE/TIME TAKEN: 01/22/07 02:00 66 DENTON AVENUE DATE/TIME REC'D: 01/22/07 02:35 EAST ROCKAWAY, NY 11518 REPORT DATE: 01/29/07 PHONE: (646)-335-7722 SAMPLING SITE: 49 INDIAN LAKE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : WELL PRESERVATIVES: NONE COL'D BY: NICHOLAS MINERVINI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - 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 WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L GRAM-�E��LITER_-- �== _ SUBMITTED BY: Albert Direct -- -� *- ~ ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ;Well Permit #, 3 �,I L Gil - oL/ WELL COMPLETION REPORT Well Location Street Address: 7 Town /Village: Tax Map # ��o x J GPS ` Depth ,J-yl 4 q,. ' V4 Ile- Map Block Lot(s) Well Owner: Name: / Address: ' j % �✓ r J // �f 4 C /� (� r' � /:rte d Use of Well: esidential Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring `Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion _Compressed air percussion Other(specify) Well Type _Screened /Open end casing _ Open hole in bedrock _Other Total Length ft. Materials: ,Steel Plastic Other Casing Details t Length below gradeN'ft. Joints: Welded ✓Threaded Other Diameter in. Seal: Cement grout Bentonite Other Weight per foot LILIb /ft Drive shoe: Yes ✓No Liner: _Yes "o Diameter (in) I Slot Size I Length (ft) I Dept to Screen (ft) Developed? Screen Details (First Well Yield Test _Bailed Depth Date Measure from ; Well Log If more detailed a nformatiun descriptions or sieve analyses are available, please attach. Depth ft. Land-Surface t yleia was testea 3t different depths luring drilling ist: A-1 _Yes _No Hours Pumped 1//Compressed Air Hours lYield gpm irface-static (specify ft) During yield test (ft) Depth of completed well . ,3,;, pr, V J J 7o o m Surface I I Well Diameter ft. Water Bearing (in) Formation Description - cf 0-0 alions ver minute rumpibtorage i anK intormation Pump Type t, t,&-6kCapacity__,r- Depth lz 0 ModeLC,* IS-33 Voltage aid P /,,o TankTvpe K06-10 Z olume `S-" NOTE: Exact Location. of well with distances to at lebst two permanent landmarks to bq 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 HEY'Lfit ':.i "1'a�iti ?l~tVt _ `r, I_, ,� JhGT�a� PUTNAM COUNTY DEPARTMENT OF HEALTH �� ) Tt-R ^� DIVISION OF ENVIRONMENTAL HEALTH SERVICES Zap V, / N Weli �ermif#�, � � �►�i , >av W�_zy _.. WELL COMPLETION REPORT Well Location Street Address: ,J;d "Qs+ 401/� !�� Town/Village: ryt .f�, /jp Tax Map # �Zo I Z Map Block Lot(s) GPS . Well Owner: Name: � / L/� Address�a ' � /� �� 4� `,u�� / 1 eti ✓,h / d / �e e V 14'S " Use of Well: 1- Primary 2- Secondary __Lkesidential Public Supply Air cond /heat pump `Irrigation Business Farm Test /monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment ,Rotary _C able percussion Compressed air percussion Other(specify) Well Type / _Screened ✓ Open end casing _ Open hole in bedrock _Other Casing Details Total Length ft. Length below gradeNvAt. Diameter in. Weight per foot lb/ft Materials: teel Plastic Other Joints: Welded ✓Threaded Other Seal: Cement grout Bentonite Other Drive shoe: Yes _S,�14o Liner: _Yes "o Screen Details Diameter (in) Slot Size Length ft De t to Screen ft Developed? First Al _Yes No Hours Second Well Duller Name & Atldressv '' Welk Oriltler (slgna e) a ,rw. ,,r'a� 8 A U Well Yield Test _Bailed _Pumped (/Compressed Air Hours Yield 6 gpm Depth Date Measure from land surface - static (specify ft) During yield test (ft) I Depth of completed well ft. Well Log If more detailed information '��Sr"!pl(OnS ^r" --!�. sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface e p O•$.•✓ h rd e a-- _� �-, •.._. L_ _ . `�rYf,..j'! .. �� . i ' y f .r __ _ __ . If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths V114 Pump Type �3r6 /,Capacity,I during drilling Depth 4 '74D ModeC9 bs--3 3 list: Voltage a30 P Tank Type w � o Z i olume Date Well Completed Well Duller PC Cert(ficaten# o% NY State # C V / Date of Re ort P Pump Installer PC.Ceftif(cate# l: NY Well Duller Name & Atldressv '' Welk Oriltler (slgna e) a ,rw. ,,r'a� 8 A U /rI P m :Installer Name &'Address dM:: ��:� .� Y .,,t >. /�> *V?�,,/�= P� pins tall er ( nature) OTE: Exact Location of well with distances to at lebst two permanent landmarks to bed 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. -,_ -. ' '_p- Olf i f�hIfG73 642 t,','- '�2 7> . - / - 1.2- Owner or Purchaser ffBBuilding Section Block Lot Building Constructed by Location - Street Subdivision Name Municipality IF Subdivision Lot # Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 "Cent;; f cate. of Constr"uct'• rm ...Cnmp .iance" "ii) . ]C _S,C-1VdUe _:HST)'1s'i.�. rjl. .. _ r - 1 repairs riiade-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 Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the caused by the willful or negligent act of the occupant of th e the system. Dated this day of Signature Title l General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk system to operate was building utilizing Co�oration Name (if Corp 2 CGS/ / en -X-i G� Address 6xO7e SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L(9itla;`t lA 1111)fLiNXiG; iUV,'7� Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 E911 ADDRESS VERIFICATION FORM OWNER'S NAME: MINERVI TAX MAP NUMBER: 72.7.1-1.2 E911 ADDRESS: 49 Indian Lake Road TOWN: Putnam Valley AUTHORIZED TOWN OFFICIAL: (Signature) _...:_..�.: _.: DATE:— ...1 / 1.2 /07. The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legaPE911 address is assigned by an authorized town official. This form is. to be submitted with the application for a Certificate of Construction Compliance. E911 addressverification 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health -►bkif i w til ii4Aki, }tlri, NIS—N Associate Commissioner of Health March 14, 2007 Frank Sullivan DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 2972 Ferricrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: ROBERT J. BONDI County Executive ROBERT MORRIS, PE T Director of Environmental Health Re: Field Inspection — 49 Indian Lake Road (T) Putnam Valley, TM # 72- 1 -1.2, Lot Upon a final inspection today at the above mentioned property there are no further concerns at this time. If you have any further questions, please contact me at (845) 278 -6130, ext. 2155. JD:kly Sincerel , J e Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 fC' p CA-,/ r S: ed C.O. • /ado. .2 --oto 17 40 Yk 4 i . -P 32 ij k' so ax v. 01 2 47 9.7 Ale e0 III\ 1t 1, 440' �4ref II-C, . 01 P)'rl7 ) AM COUNTY DEPARTMENT OF HEALTH f7 1�7d'*a* ON QF ENVIR0,111I HEALTH SERVICES. E� AS TOTED FOR CONFORMANCE WITH 7 2 CABLE RULES AND REGULAT;ONS OF THE AM COUNTY HEALTH DEPARTMENT. ' 1- -7 /101 A/ y JURE & TITLE UATE el,4 //0 P.- rp Aei .4/j,4r�y. PUTNAM COUNTY DEPARTMENT OF HEALTH .0644A IV DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: Ts Street Location Owner _ _`►rY+i -T �° .. -;.�;2 TM #— :2 ,�q - 1 - Subdivision Lot # loy (I b w t i Go f * 3 1. Sewage System Area YES 1,NO a. STS area located as per approved plans .......... :................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................. .. ............................... d. Stone, brush, etc., greater than 15' from STS area......:... . e. 100' from water course /wetl ds ..... ............................... II. Sewage System ;k; a. Septic tank size - 1,000 ......... 1,250......... her..... ... C/ b. Septic'tank installed level .............................. . ... . c. 10' minimum from foundation .......................... ........ d. Distribution Bog 1. All outlets at same elevation -water tested ................... 2. Protected below frost .................. .................:............. 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box -properly set .......... ............................... 6. rTr enclies 1. Length required n Length installed 3o(. . 2. Distance to watercourse measured Ft... . 3 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. ✓ 5. 10 ft. from property line - 20 ft.- foundations.......... c� 6. Depth of trench <30 inches from surface .................. ✓ 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... ✓ 10. Pipe ends capped. ....... �.. .............................. _9. PMR or Doss . 3t s �_ r - ..._ . i Size�of pump h .... ..` ..................... 2. Overflow t ................ !..... ................ 3. Alarm, siiaUaudio ............ .....:..............:.......... ..... I Pyy�n easily accessible, manhole to grade ................. 5!First box baffled .......................... ............................... ./_"�6. Cycle' witnessed by H.D.estimated flow /cycle........... M. House/Buildhig a. house located per approved plans..... ..... ...��''`. b. Number of bedrooms .... ....................:.,....:: =- ...�... IV. Well a Well located as per approved plan.......:.. ;n :..J.0 Lt b. Distance from STS area measured e � ` f .... .... � C. Casing 18" above grade ................ .............:................. d. Surface drainage around well acceptable ....................... V. Overall Workmanshin . a. Boxes properly grouted .................................................. b. All pipes partially backfilled ........... ............................... f c. All pipes flush with inside of box ... ............................... v d. B ackfill material. contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. . f. Curtain drain outfall protected & dir.to exist watercoW g. Footing drains discharge away from STS area.......;....... h. Surface water protection adequate .... ....:.........:................ i. Erosion control provided ....r , �: ............ �........ Rev. 12/02 M r COMMENTS l 1 N, Ll .tom%, ajM�. Gk�tiy Orm 61 - Date: Inspected by: If Fill pad located per the approved plan Fill Pad Length Required Lengtk' Fill Pad Width 0 Required Width Fill Pad Depth Required Depth � 4t Run-of-Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if, applicable) ei//j�j' Additional Comments: Tf-eo w,< fi=f n Reserved for Field Sketch if Applicable SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . "- ..- L`�it�['�'A" Nit- ii•'INA�1;'"it1�; `�f5'�i:•�. � .: � -"'. ° Associate Commissioner of Health March 6, 2007 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Dear Mr. Sullivan: ROBERT 1 BONDI County Executive Director of Environmental Health Construction. Compliance — Minervini 49 Indian Lake Road, (T) Putnam Valley TM # 72 -1 -1.2 This Department has received the application for the above referenced project. Before proceeding with the review, the following outstanding comments need to be addressed: ✓ X2. X" /3. A cleanout for the 45° bend on the effluent line was not added. An inspection of the h for bedroom count needs to be performed by a representative of this Department. 3 The well needs to be inspected, including a measurement from the well to the SSTS. It may be necessary to expose part of the septic system if the well appears less than 100 feet F_ 4he-SST, c Please contact this Department when the above items are ready for re- inspection. JSP:kly Sincerely, 6' lloa-e� oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 MRS D.XW OU .TTENTION 13 AD t3cwn .4 . al ii for floa rat be Uly "Q*sd per to MY T aspections bed made. 'CM C=,"Cdcm Pla mit # _ � i4/ (Tv My clnrtairly: "'` u ,� 3 system fi1 compwed? S oywa oust ucted as p4r mss? �4 Ara ._.... :s weg drilisd? ..�.....r....... ........,�... .. :.;....... .s ��?� Iocsl+md as _ter ;nl? km orosion corstrd tmassurom ia pleics? ;iM,agin j�afY,ro;ra„ra,nm.. =•...a W certify tbat the sy l : .d, At. std vedled Owlt..ccgpbjfti Ig ao t�tfs r MA�PA+i 1 �maueaMp • i ?orm r IRag9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . n.--. t- ::l- v..i/d.eF::= w.a��.rt'..�w -4 ^.+..•h4v�M'•.: •�G..0 vRa .t l.._l3 Y ..w c�.c.n .- n •.... • -. a�".�•: a.-.. rb`W4.'WU: ...-. ✓..s nFS -nw P�r...+1��c�.S nV �e ^v .. is.: a.R CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEMn PERMIT # -'( &JCf4 Located at '10/�e- /%0 �i DL Subdivision name le, ;Y G/4!,4 ,4/. Subd. Lot # Date Subdivision Approved Owner /Applicant Name /r" G&lr r^ Mailing Address G4� Pzel7 k1Z Amount of Fee Enclosed Town or Village Z e9 G l/vIle Tax Map %- Block Lot /s Renewal Revision Date of Previous Approval Zip .�jZ�7 Building Type�1 /�-� Lot Area No. of Bedrooms Design Flow GPD L/.- ap Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and ,L Other Requirements: To be constructed by Address Water Supply: Public Supply From Address or: 1�' Private Supply •Drilled-by � � Address ' A4/yi'�!�/�� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage, treatment s, sy tem described above will be constructed as shown on the approved amendment thereto and in . accordance with the standards, rules and regulations 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: r-01�4�-- P.E. R.A. Address `7 i/ -j Li APPROVED R CO RUCTION: two year s from the e s struction of the sewage treatment system has been completed and inspected PCHD and is revo a be amended or modified when considered necessary by the Public Health Director. Any revision or al ed plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By: Title: /i Date: WhL copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH N 'F :4 Q DIVISION OF. EN MRON, -1..-TA--;_ T_ ERVIUE DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 'V/'v21 114%1'Ale-t"YIJ-7 Address a A-e7cjf Located at (Stt&dt)-7 -M Lot "14 Tax ap Block (indicate nearest cross street) Z2. Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test ... ........... . ... ...... . . ... ev o . rom rW, ou-d .......... .. rc . o1i ow, .. . ...... ... ..... .. - S IYLn) ()inches) Start Stop r ..o .. ... x . I Rate , H .... top ........ : ne es 12- 7- ry 2 Lel 3 -3 2 4 5 OF A IF NW.' 0 _A- 2 3 4 5 .2,0 2 23 -3 2 2,7 '3 1� .0 C2 3 -3 J 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at, each percolation test hole. (i.e. _.< 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 r f1 t4 F T LORETTA MOLINARI Public Health Director April 7, 2004 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 ROBERT J. BONDI County Executive Re: Field Inspection — Minervini Indian Lake Road, (T) Putnam Valley TM# 72 -1 -1.2 Dear Mr_ Sullivan: A site inspection was made for the above referenced project on April 5, 2004. The following comments must be corrected in the field. 1. All trees in the impervious side slope need to be removed and voids filled in with impervious If you have any further questions, please.contact me at (845) 278 -6130 ext. 2157. JSP:cj Sincerely, Joseph S. Paravati, Jr. l/ Assistant Public Health Engineer 03/27/2004 16:47 9149624248 JOSEPH SULLIVAN PAGE 01 .rt.� Y.u:._wi.aa�.�.eNa.r -s .�..1' .r.Va..ti ...r awry �' .'' Y J.r .�.a.r. •�.vu.. wvali.Y^..I�`.:'. b'^/ —.eP r.r.'.....T..I..r. .a. /. f. '-r »^ - ♦ .- w✓.�..a_• ,ATTENTION .c PUTNAM COUNTY.DEPARTbMNT OF HEALTH DIVISION OF ENVIRONNENTAL HEALTH SERVICES 4 GENE For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # t2ll Located: - CO M, Owner /Applicwt Name: I ) o) TM _ 7 � Block J Formerly: Subdivision Name:6' y cl•�� - Subdivision Lot # Is system fill completed? _ V Date- .0 ¢ - - - -- Is system complete? ` Date: Is system constructed as per plans? . Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? I certify that the systems), as listed, at the above premises has been constructed and I have inspected and verified their completion iu accordance with the issued PCM Construction Permit and �ppxeved- vlar_s rid-the Stsnap�ds u iPS and a ala:iors:.o€ the �a,Covgty D pa eut of - .._.;,_ ..... Ieahh... __. ��.. .. .._. �_...._ Certified by: _ +'" Date: � � PE RA. esign Professional MAR -27 -2004 SAT 18:19 TEL:e4S- 278 -7921 NAME:PUTNAM 000NTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . au f ..4 ^.p...0. ..x - .r n - -. Ki'+tsv: ♦ rr -. • ., w. T ..q'.:m...w . -. _.im .. r .- -.r•v - -c. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # p N 3 Located at -:. � z&n / Ale /jj e o, O/u'fj Subdivision name /U Y We-51-4 Subd. Lot # 3 Date Subdivision Approved Owner /Applicant Name /1/, C/f, Aly y Mailing Address Town or Village o/ Tax Map % Block l Lot Renewal !l**� Revision Date of Previous Approval y ,y e- /cos 7��i /t�� o t�s�a y Al Zip „ l7 Amount of Fee Enclosed 3 U y Building Type jrd � c (" Lot Area No. of Bedrooms -3 Design Flow GPD 6"-ell Fill Section Only Depth . Volume Separate Sewerage System to consist of /d, o o gallon septic tank and Other Requirements: 1e- iar� To be constructed by Address Water Supply: Public Supply From 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 tLereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. F Ne* Signed: ze / `�� s �S R.A. Date �o,3 Address 2- Grp License # 1 & /� vv� ° 2 APPRO OR CONSTRUCTION: ' o years from the date issued unless construction of the sewage treatment system has been completed an PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public ector. Any revision or alteration of the approved plan requires a new enmit. Approve 44r discharge of domestic sanitary se a only. By: Lt Title: ZP� Date: � ( White copy - HD Fill ; Y o copy - Building Inspector; Pink copy - Owner r Uec p y - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A, .WATER WELL �..c- .�..Ci a'+.a.:✓a�- r�ra,�,ms` ar., .. .-a+-.a.c.:.r.iy._-•;c .4,.. �C_:.yy',w;;1'�.c piint'airype I�'C�I� PermitV-J Well Location: Street Address: TownNillage Tax Grid # Map 7A Block / Lot(s) 1-.2 Well Owner: Name: Address: Use of Well: r Residential Public. Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _,"_ gpm # People Served Est. of Daily Usage 1e gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _�/' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes �' No Name of subdivision / y ez4_ 4 we_ 7_A_ Lot No. .� Water Well Contractor: JV�. f �., n�rid�� Address: r Is Public Water Supply available to site? .................................. ............................... Yes No e°° Name of Public Water Supply: TownNillage Distance to property from nearest water main: /x%l-s:::� Proposed well location & sources of contamination to be provided on separate sheet/plan. Date.:. �o�/ � _Ap?i1_i.�nt 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. APPROVEID.FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. I j A Date of Issue -0 4 Date of Expiration Permit is Non -Trans errable Permi Title: White copy- HD file; Yellow copy -Building Inspector; Form WP -97 u- ve��ra+ t,e<irr iry 61vv /ate 12/16/03 06s19pm P. 007 CHRISTINA GRIFFIN _91447EKNM 12/16/03 06t19gi,+ P. 003 v•, as t ,• j ?t �f1 tr -r tx• -w W -w x• -:o• Lei dvr� 1 ,i 3I ® F — _ u' a• as vGRl % 11 •e OO X-4 b zti. ILJ 11 11 kt i a n' -a' l S- 4 a Lax Z ,.. 3 rfJ NAD'l: C0ljNTY DI:FA iTM t PP OF B ALT11 f :1*4�11 E PLANS APPROVED T�Oi. 111'.U'r:L %O +C COUNT ONTL -_..- ._---- —_ �•, P,li;'it{00;1•i:� 'f 1�: %� - /- �- a YJv�tiw y /�y ALL gi.TP T I ;T 1 ST ,iir 17 it P ^T t "a; TO THESE i OU.E A ; f, PC. 1.'i:i 15 ^u3J' Cl it "i1.L it '1`71 . 1•:.Lu�l'1 Jd -i APPROVAL Fl t SCi_;1;A_'LTIRE av t11`I" : -' DATU } � uY R1 ;. i PROJECT ID NUMBER 617.20 S EQ R APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only.'. I !n !n� ..5�._ r. T. J. (. ;he.,:.)r.?:�::- °- Ati'.fa^:;� ^rt 1. APPLIC NT/ SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: �� / g // Municipality /dh7 County 4.-PRECISE LOCATION: Street Addesss and Road Intersections. Prominent landmarks etc -or provide map ,1 ` // 5. IS PROPOSED ACTION: New Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: ' ` Initially acres Ultimately acres :` `r" ::.: 8. WILL P OPOSED ACTION OMPLY WITH EXISTING ZONING OR OTHER RESTRICZI6N: S7- ` Yes No If no, describe briefly:. p 7 -�: 9. WH T IS PRESENT LAND USE IN VICINITY OF PROJECT? •(Choope as many. as apply.) Residential Industrial Commercial []Agriculture Park / Foiest / Open`Space a Other (describe) .. . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY.OTHER .GOVERNMENTAL, AGENCY. (Federal, State or Local) Yes No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY. VALID :PFtMIT OR ,•APPRbVFL ?.....,. Yes No -If yes, list agency name and permit / approvak 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? QYes No. I CERTIFY THAT THE, INFORMATION PROVIDED ABOVE IS TRUE TO THE BAST OF MY KNOWLEDGE Applicant / Sponsor Name ,' . Date: Signal re__1C If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before'proceeding with this assessment PART.II - IMPACT—ASSESSMENT—(To be-completed by Lead AgendA _- A. DOES ACTIO� XCEED ANY TYPE -I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. Yes o B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6? .'If No, a negative declaration may be. superseded by another involved agency. Yes 4SPO C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. 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: C2. Aesthetic,, a gricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: ic/ / " /�aI�G C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endarigered species? Explain briefly: 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 resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed ect'ion? Explain briefly: 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 _ < ' D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL..AREA.(CEA)? Of -yes, explain briefly_: E. IS THERE, ORRIS/THERE El Yes 1h,2 t1fl LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex lain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important orothervise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration-, (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action'on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse irnpacis which MAY occur. Then proceed directly to the F EAF and /or prepare a positive declaration. be—IGheck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed ai WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting determinati 'G- 1� - � �1.2-ID 3 Name of Lead Agency Date or Type N amebr Responsible Officer—•h Lead Agency Title of Responsible t ClIfficer Signature pon ib Officer in Lead Agency Signa ure of Preparer (If different from responsible officer) l ~Oy RK STATE DEPARTMENT OF HEALTH `_ ;_ . - , . _, .- .< ... •- - - = . �+: sf ^C•"f fi:_'s,' =.:;�•; a;t; :; rrotection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems of Applicant -Location r_ 4 Reason why site does. not meet tONYCRR.Appendix 75 -A (check appropriate box(es)): Separation distance cannot be`achieved. r- xcessive.slope. High groundwater: Inadequate depth to bedrock or Impermeable layer. Soil unsuitable. Other (ex lain) w P......................................................... ............................... ................................... ............................... , ._..................... 2. Proposed design or conditions of waiver: � � �_�� . �...}�..... .. � . ....................r.. ...._.... ........ � :................ -............................................ __..............__._ __._...._...__. _.__......._... ........ _ .... _ ........ .... ..... � 3. The proposed design may have the followig limitations (check appropriate box(es)): J increased risk of well or spring contamination. 1,7 Increased risk of surface water contamination.• Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) �.... ... _ _ _.._. ................................................ ............................... _ ...................................... .. . . . . . . . . . .. .. . . .. .. . . . . . . . . .. . . . . . . . . . . .. .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................... : ........................ . .............................. . . . . . . Additional information attached onstruction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with Vew York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver nay be revoked by theissuing official fora change in conditions for which this waiver was granted. A ORIGINAL - Local Health Agency COPY = Applicant/Design Professional 1..'1 ...................... ........ ............................... GATE ., BRUCE R FOLEY Public Health Director MMAVAI ADDRESS: LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 - Geneva Road Brewster, New, York. 10509 Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 27$ - 6558 WIC (845) 278 - 6678 Fax (845) 278 -'6085 Early Intervention (845) 278.6014 Preschool (845)228-6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER SITE LOCATION: 7",—. i„ ls- & ,Oj DATE: . ��- /-> 3 STAFF PRESENT: ., Rob M., Mike B.. Aft=- Gene R., Shawn R., Bill H. SPECIFIC WAVIER. REQUEST: z> 0�0 -. -_ -- .... r _ _. .. DOES. THE PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION. REQUEST APPROVAL OR.DENIED APPROVED .DENIED REASOR FOR DENIAL • DATE DI TOR (SPECWAIVER) LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 FACSIMILE TRANSMITTAL. ROBERT J. BON DI County Executive To: /1._ � ,-�,<:iv�`� Fax: q7 -Of � From: e �>� Re: & ".vti Pages: CC: ❑ Urgent 162-For Review ❑ Please Comment ❑ Please Reply vlwc�t? a� hz rem �. r'l Civt �' rti ,I'-:f-��hy CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845- 278 -6130} and destroy all documents associated with this facsimile. 12/17/2003 13:07 FAX 8456476908 1��glq V14 #jAl/ Alr z7Y- 79z 0001 12/17/2003 13: 12/17/2003 13:08 FAX 8456476908 0 002 11• -01 6 ° 64 0. k 0 0 e e I e eo fa 1 z 4 a C a R R 0 s• —o• s• -a• i � p le -10i p 4 —Ili U.7 . LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 -6648 December 5, 2003 Frank Sullivan, PE 2972 Femcrest Drive. Yorktown Heights, New York 10598 ROBERT J. BONDI County Executive Re: Proposed SSTS Revision — Minervini Indian Lake Road, (T) Putnam Valley TM# 72 -1 -1.2 Dear Mr. Sullivan: 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. Since fill is greater than 2 feet, a 2 sheet septic plan is .required. 2. One cleanout is required on the sewer line. _ tb^:?4 (' ii: cu'i: 9bdv'''I11S-: i lii' 4$�.``tc tank should be brought closer to the house and place on a gentler grade. 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. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj i LORETTA MOLINA Public Health Directc * _`+ r..1 ,.a :K= an.�vac�a�ir.�• +RHe r`a::- ..a.�w:•,'�.. ._.� s1. -•wa. ..,. ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 5, 2003 Frank Sullivan, PE 2972 Ferncrest Drive. Yorktown Heights, New York 10598 Re: Proposed SSTS Revision — Minervini Indian Lake Road, (T) Putnam Valley TM# 72 -1 -1.2 Dear Mr. Sullivan: 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. Since fill is greater than 2 feet, a 2 sheet septic plan is required. 2. One cleanout is required on the sewer line. 3:::_ --�_:['he -1xiI -sj;, on is on y ry st_r � , __� e, which wia? .cause p«oblems_in se—gIng:-tlie.xank, T he tank should be brought closer to the house and place on a gentler grade. 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. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj i j , LORETTA MOLINARI ROBERT J. BONDI Public Health Director �' 04 County Executive DEPARTMENT OF HEALTH. 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 2, 2003 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Waiver Determination — Minervini Indian Lake Road, (T) Putnam Valley TM# 72 -1 -1:2 Dear Mr. Sullivan: The Putnam County Health Department reviewed the waiver request for the.above regarded . . project on- December l.. 2003. The - following determination has been made: ❑ The Waiver request was approved: X The Waiver request was conditionally approved. However, the revision(s) noted below . ....___..4a�.:- ....._- __ —_ ^-_ rn „et IMP ��ri�nq?tf �rinS��G t ,�. tg::7��I'i�c::�? nf'�lli...._. _..._ ._.�.__._ _..�__-•� - --._ - _ - -•- - -• _... -._= .� ❑ The Waiver request was denied. An explanation has been noted below. ❑ The Waiver request was not voted on. Explanation noted below. 1. Previous comments need to be addressed before approval is granted. Please be advised' that no work can commence until approval for latest revision is granted. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP :cj PUTNAM COUNTY DEPARTMENT OF HEALTH - -01 I TONM- T±,,IN N ENTAL HEAT :;THSER- CES___. - LETTER OF AUTHORIZATION � RE: Property of 1 fl �' � J l".2 e` ✓" Located at _.WZ_'e d i a e7 /��, � -�e d, G T/V/ � a t°- Tax Map # 7 Block / Lot Subdivision of Subdivision Lot # 3 Filed Map. # �� Date Filed Gentlemen: This letter is to authorize 44�1 5 td� a duly licensed Professional Engineer V 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 /!��^ -:/� .of -the. E.d 1r�.ni'lfiii S ,;_W 'f1Ct -R fDl C 1Jw- DTI vV1YlVirilY� ♦ILYa�Y tliv�'ia J � v"1� aJ'V a �a � 1 _Y:i °ar�L: iIl � T � -. _: _ .�. 1�.... �� — t . ,..__. ._.._._ . -�_,. .rte a _l�` 11.x_- .� ".�A.._.._ Law, and the Putnam County Sanitary Code. Countersigned: P.E., , # Mailing < yY State Zip Telephone: �� % Z y Very truly yours, Signed: (Owner of Property) Mailing Address: 3 5y 6-J �r_ CMG / A -v✓A-- State /V, `i Zip �� rq Telephone: Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATME PERMIT # Located at Subdivision name Date Subdivision Approved Owner /Applicant Name Mailing Address Amount of Fee Enclosed Building Type - Subd. Lot # Town or Village Tax Map Renewal Date of Previous Lot Area No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by Address ?vtgr SunQly: _ Public Supply From or: Private Supply Drilled by Address I represent that 1 am w oily and completely responst le ror the desi gn -a nd 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: l <, s P.E. R.A. Date Address a ,5� <' License # APPROVED FOR CONSTRUCTIO s a es two years from the date issued unless construction of the sewage treatment system has been compl ati( J ` y the PCHD and is revocable for cause or may be amended or modified when considered necessary by the irector. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of dourest c sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at - J" Subdivision name Sul)& Lot # Date Subdivision Approved Owner /Applicant Name Mailing Address Amount of Fee Enclosed Building Type Town or Village Tax Map - Block Lot Renewal Revision Date of Previous Approval Lot Area No. of Bedrooms Design Flow GPD Zip - Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by " *I,- V- P blic Sunnly From or: Private Supply Drilled by — gallon septic tank and Address . _ 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. of NSW Signed: �� pNCI s R.A. Date Address * w�.G� * License # APPROVED FOR CONSTRUCTION: This o 2 years from the date issued unless construction of the sewage treatment system has been completed an , CHD and is revocable for cause or may be amended or modified when considered necessary by the Public ' " or. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 /I - - LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 21, 2003 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York Dear Mr. Sullivan: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal Indian Lake Road, (T) Putnam Valley TM# _ 72 -I -12 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. The following item does not meet current coder propps —on natural grade —7- Vol Due to the above, the current application is denied. However, you can request a waiver. 2. Since last submission of application, a lot line adjustment between lots 2 and 3 has been filed with the County clerk's office. The current proposed plans do not show this adjustment in lot line and area. Please provide the new lot configuration and appropriate area. 3. There are no deep holes in the proposed primary area. 4. The proposed regrading is not at 15 %. A--" 5. Regrading at 1:3 side slopes is being shown before the required 10' horizontal t separation from the last trench. 6. The perc rate on the plans is 6 min/inch and on the design data sheet it is 5 minhnch. ,�,,' Please clarify what the perc rate actually 7. Please show any driveway regrading., 8. Please provide a datum reference. 9. A cleanout is required every 50 fVie on both the sewer line and the effluent line. I/ 10. Provide fill pad dimensions. �/ 11. Please show water line and location of service connection. 12. Please provide short EAF form (both sides). 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. Ve truly y ours, Joseph S. Paravat i, Jr. Assistant Public Health Engineer JSP:cj d LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 21, 2003 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York Dear Mr. Sullivan: ROBERT J. BONDI County Executive r Re: Proposed SSTS Renewal Indian Lake Road, (T) Putnam Valley TM #`72 -1 -1,2 14— 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. The following item does not meet current code:. a =. SST_vr000sed On 111�'Ur�i ,t'�7i1t` �i'. ?11�/n' �L ,/n ��:,,✓ ra�irU to ?_io.�•- •___. -_ . _ _«:.. ; ✓2. 11. •siF i �i, a .i,,.N Due to the above, the current application is denied. However, you can request a waiver. Since last submission of application, a lot line adjustment between lots 2 and 3 has been filed with the County clerk's office. The current proposed plans do not show this adjustment in lot line and area. Please provide the new lot configuration and appropriate area. There are no deep holes in the proposed primary area. The proposed regrading is not at 15 %. Regrading at 1:3 side slopes is being shown before the required 10' horizontal separation from the last trench. The perc rate on the plans is 6 min/inch and on the design data sheet it is 5 min/inch. Please clarify what the perc rate actually is. Please show any driveway regrading. Please provide a datum reference. A cleanout is required every 50 feet on both the sewer line and the effluent line. Provide fill pad dimensions. Please show water line and location of service connection. 4,� Please Provide short EAF form (both sides). 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. Ve truly y ours, Joseph, S. Paravat i, Jr. Assistant Public Health Engineer JSP:Cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH ilSX3IY.mLTAL iWTF�?t?SLTl?p =Y& SU sST. TZPACE6 `ti�,`J[i�.NTu'3`iJCri.^y` "�` -� " "' "."' r`"° ` `• REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION, / TAXIAP #: (CONFIRN1ED) REVIEWED.BY: RM, GR, )lie, SRDATE: `� 3 YEN DOCUMENTS PERMIT APPLICATION tJ (WELL PERMIT OR PWS LETTER ER OF AUTHORIZATION :N DATA SHEET (DDS) 1 RESOLUTION 1S TT S -THREE SETS E PLANS O SETS ONCE REQUEST - Pis bf a SUBDIVISION RATE to _ . ¢, c nom, I-c u i., .TAIN DRAIN REQUIRED GENERAL ATED.IN NYC WATERSHED NS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED ►PPROVAL SSDS ADJ, LOTS TA ON DDS PLANS & Y N (REQUIRED DETAILS ON PLANS CONT'Dl• �(--)HOUSE SEWER - V," FT. 4 "01; TYPE PIPE. CAST IRON NO BENDS; MAXB CLEANOUT ►tee RENEWALS---- `t;i&m 5 2 �TTE NOTE (NO CHANGE) 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE & DIMENSI J nrri v�¢- ( "�J/ UFILL IN EXPANSION AREA FILL GREATER T ET UU CLAY BARRIER N IA- C--)C-JFlLL'CERTIFICAn0lq NOTE UL-)DEPTH G �k-JLJV N PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM'TOE OF SLOPE LF TRENCH PROVIDED 60FT MAX. ..�.� -�---- PARALLEL TO CONTOURS 3�•'��"nj O' U 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL. (:!�)(_JGEOTEXTILE COVER SEPARATION•DISTANCES ON PLAN - FROM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 0,-100'TO 20' TO FOUNDATION WALLS WELL, 200' IN DLOD150' TQ PiTS L__)100' TO STREAM, WATERCOURSE, LAKE (Inc. ezpan). ..L T- SY.i+�C��i!57 iJ1TC3•. -- �•....� _ -•- _.. -., -• -e _ . - C�10' TO WATERLINE (pits - 20') U 1 O YR. FLOOD ELEVATION WfI 200' Q: .150'. ��NT DRAINAGE COURSE (� ✓ SUIL TESTING LOTS>10 YEARS OLD Ti(_ & _'-'200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS. / REQUIRED DETAILS ON PLANS ?(�� L,10' MIN TO LEDGE OUTCROP (�✓ SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK ( �SSDS HYDRAULIC PROFILE ZC-.Jlo" FROM FOUNDATION, 50' TO WELL L�- GRAVITY FLOW WELL (`CONSTRUCTION NOTES 1 -15 ONS TO PROPERTY LINES DESIGN DATA: PERC & DEEP RESULTS OCATI6N OF SERVICE CONNECTI ' EXIS PROPOSED s 111 D SLOPES, CUT k x 7 '-'el MIN I SLOPE /GI �i VIC/ U FOOTIN G AINDRAINS TS AREA 20° / USDA SOIL TYPE BOUNDARIES UREGRADED TO 15 %, IF REQ UUTITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME , ADDRESS, PHONE# SYS �D- CR VISION UUPUMP NOTES . N (_j(_)DOSE 75% OF PIP UME/DOSE VOLUME NOTED CATION OF WATERCOURSES, PONDS -J. _JDETAIL F RCE'.MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. UUP D -BOX SHOWN & DETAILED L(�PROPOSED FINISH FLOOR AND 1 DAY STORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN D ,/ T ��. USTANDPIPES, 5' BOTH gm. ETAIL is fo �� 15' MIN to CD 0'-4 %, 25' 3 %, 35' -1 %,100 % - <1% P R METES &BOUNDS .- (_)20' MIN DISCHARGE/100' with 182 cons day discharge ()EROSION CONTROL FOR.HOUSE, SSTS, EROSION CONTROL NOTE (--) to NON PERFORATED PIPE :OWZMNTS: PUTNAM COUNTY DEPARTMENT OF HEALTH TSION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # p►' -31 =Located at .. d l °g rl Town or Village Subdivision name ��' `/ G %� 1j7 Subd. Lot # Tax Map �72 Block / Lot a- Date Subdivision Approved 5��z�C/i Renewal Revision Owner /Applicant Name �l, clf' ✓� /��'v �' °� �' Date of Previous Approval Mailing Address Amount of Fee Enclosed 6 Pw e7 I-d'd? zip. // 5-/ dr ) Alf Building Type ��iG��riG'�c' Lot Area /.d.4G No. of Bedrooms 9 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S sti tem to consist of / e e a gallon septic tank and Other Requirements: To be constructed by /L -1110 Id ly- x'12 A;'7 % • & Address .Public Supply From _ Address ~ or: '' Private Supply Drilled by �/1�3 f,� <'%� �` itYtess io 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 sy tem 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 fSS builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years kb . Wxl . immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original .+ system or any repairs thereto. tv y Si d: cis .o�,� P.E. R.A. Date Address % 1000 r b .i` License # APPROVEID'FOR CONSTRUCT i, _ >� empires two years from the date issued unless construction of the sewage treatment system has been comol ..., ted by the PCHD and is revocable for cause or may be amended or modifiep when considered necessary by the Ftulilic Health Director. Any revision or alteration of the approved plan requires a new dknnit. Approved r discharge of domestic sanitary sewa a only. By: �'`� I Title: Date: , TCL_ White copy - HD Fil Yel copy - Building Inspector; Pink copy - er; O e copy - Design Professional Form CP -97 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: /Zi G /�i h �✓ y' %r� � /�%�y� �o'n 1.,� ✓'Grp i1 r 2. Name of project: 3. Location TN: 4. Design Professional: °� 65 ol`I d ,00 5. Address: Ve 6. Type of Project: Private/Residential Food Service .Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Me Type Status (check one) ....................... ............................... Type I Type II 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10 Vamp of Lead Agency 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... -Ekempt Unlisted "PVo 12. If so, have plans been submitted to such authorities? ..............� ................... 13. Has preliminary approval been granted by such authorities ?, Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water ✓` groundwater 15. If surface water discharge, what is the stream class designation? .................... -- 16. Waters index number ( surface) .......................................... ............................... 17. Is project located near a public water supply system? ....... ............................... Ale 18. If yes, name of water supply _, Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ N'a 20. Name of sewage system —* Distance to sewage system � 21. Date test holes observed // 9% 22. Name of Health Inspector Form PC -97 .i' 2 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination. Yes/NoO DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... /ylp 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ...................... ....................... .......... ......... Ale 34. Are any sewage treatment areas in excess of 15% slope? ......................... olio 35. Tax Map ID Number .......................... ............................... Map �� Block o° Lot 2 36. Approved plans are to be returned to ..... Applicant Ao' Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNAUl , A 91 ff L TITLES: SJ 4 , , t,., �, i ��E t, ! 55 1{ � � it l�.,t MaiIgs, vE,. i ...................... t . Project design. flow (gallons per day) .................................. ..._......,.................... ...231 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /Ve 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? Afd 27. Wetlands ID Number —' ........................................................... ............................... 28. Is Wetlands Permit required? ............:................................. ............................... Ma Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? .. ............................... AA° 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/NoO 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination. Yes/NoO DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... /ylp 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ...................... ....................... .......... ......... Ale 34. Are any sewage treatment areas in excess of 15% slope? ......................... olio 35. Tax Map ID Number .......................... ............................... Map �� Block o° Lot 2 36. Approved plans are to be returned to ..... Applicant Ao' Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNAUl , A 91 ff L TITLES: SJ 4 , , t,., �, i ��E t, ! 55 1{ � � it l�.,t MaiIgs, vE,. i ...................... t . .6)4 PurrNA,M, COUNTY DEPARTMENT OF HEALTH IjIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIG NDATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -,- V, Address ZJ Ve,,t7�0 g5; Located at (Street) ,? e� a a' Tax Map Block Lot (indicate nearest cross street) Municipality 12 Vv'atershed SOIL PERCOLATION TEST DATA Date of Pre-soaking 3 —,;V— g Date of Percolation Test 7- Depth to Water. W. atcy No* Rtn, Hue a Se El Time oun From Gr d Sul-face (Inche#) Stop'..:*.: 'Level Drop In. 0 0 p Start e 361 2 3 4 5 2 3 4 5 2 3 4 — 5 NOTES: 1. 'rests to be repeated at same depth until approximately equal percolation rates are obtained at car. 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 n TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 Design Professional Name: Address: Signature Design Professional's Seal i 4 M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of Located at T/V� �h� a ax Map # _7Z Block / Lot A Subdivision of Subdivision Lot # 3 Gentlemen: Filed Map # Z841 Date Filed • 51 a zf C" j This letter is to authorize t --,?/..-1 /ZYi a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam - County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health :.:.... _ _�l✓ a }vy,�. �th �?utr� C t .��- nitary:,our._ Countersigned: P.E., R.A.,-# Mailing Address 24895 State A1190Z, C/ Telephone: 2 ti y Very truly yours, Signed: (Owner of Property) Mailing Address: - e 6 J .T J 4f, A L/ L. State _ 1C�0 c is A,, Ire Zip Telephone: Form LA -97 BRUCE K FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 November 15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Minervini, Indian Lake Road (T) Putnam Valley, TM# 72 -1 -1.2 Dear Mr. Sullivan: 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. V 1' Please clarify topography on 1" = 20' plan. 2. Maximum length of gravity flow trench shall be 60' -0 ". (Expansion area states 4 - 80' trenches). �j. Ciaiiiy uehtiro1 1111 kcjth : 1 b.. �. I/ 4. Title block to state proposed sewage treatment system. 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. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj \�\O`PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` `" - "'" M .. `'%(I�1J`�'�lTl;'1 �(�►1� 1'E1tM)<T FC�R S :, TREATMENT SYSTEM PERNIIT # ✓ 3 - �! lD U 0 U Located.at Town or Village ,1-A4e,y4f w ya ,O�le—y Subdivision name 160N W 51 Subd. Lot # 3 Tax Map 72 Block / Lot /. 2 Date Subdivision Approved ��a /6' ! Renewal Revision Owner /Applicant Name i /% per ✓. n Date of Previous Approval Mailing Address Amount of Fee Enclosed 3 Od Building Type ,&_,fia4w ec c Lot Area No. of Bedrooms 3 kla Design Flow GPD Jd o Fill Section Only Depth Volume Separate Sewerage System to consist of / /00'0 gallon septic tank and Other Requirements: /� // �® maims i'n a re y" To be constructed by Address Water Supply: Public Supply From Address • _.��': _ ✓� Pndv4te. o�np: j�ri�ipr�},v 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: ��AnNCio9 R.A. Date /V -./o/ Address License # 2 s // vY.✓ APPROVED FOIKONSTRUCTION: ap a years from the date issued unless construction of the sewage treatment system has been comple d and insp CHD and is revocable for cause or may be amended or modified w en considered jqecessaryhy e blic Health Director. Any revision or alteration of the approved plan requires a new PAM App ved i ch e o d mestic sanitary sew ag only.: By: Title: Date: G( Z 7 C'7 White copy - HD File; Yellow copy - Building Inspector; Pink cop - Owner; Orange copy - Design Prolssiork I Form CP -97 APPLICATION TO CONSTRUCT A WATER WELL a t? �...._a. -- �y� ^� 4� _ -_• please pant or type g j ��u'"'i Well Location: Street Address: Town/Village Tax Grid Grid # �hd.%a.7 /a Se- /-c a % /1re X Map ; P2 Block / Lot(s) -° Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm . Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __,3' gpm # People Served Est. of Daily Usage 6ogal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling a/New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes A'4 No Name of subdivision (i /P A 1,01 h12: Lot No. _ Water Well Contractor: Al Address: %3drT Is Public Water Supply available to site? .................................. ............................... Yes No &-° Name of Public Water Supply: -- Town/Village -- Distance to property from nearest water main: /P/. /z'Zo Proposed well location & sources of contamination to be provided on separate sheet/plan. ic&nt PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell dril er ce ti ed b Putnam County. Date of Issue Z? loh Permit Issuing Official: Date of Expiration Z6 0 Title: t Permit is Non -Trap ferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 'r..e�i -..� DRV�� ` `}:''`may, _3 �� "'. -t..�.:io`..- .r�..•.Q . ..-. N:.e -..• Public Health lDirector (::r) DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 January 9, 2002 Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Minervini Indian Lake Road, Lot #3 (T) Putnam Valley, TM# 72 -1 -1.2 Dear Mr. Sullivan: Enclosed, please fmd the three sets of revised plans and the check for $150.00 for the above SSTS because it is an incomplete application. Theresa Nemeth Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LOS 1 111 Associate Public Health Director Director of Patient Services Environmental Health (845).278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 November 15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Minervini, Indian Lake Road (T) Putnam Valley, TM# 72 -1 -1.2 Dear Mr. Sullivan: 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 clarify topography on 1" = 20' plan. 2. Maximum length of gravity flow trench shall be 60' -0 '. (Expansion area states 4 - 80' trenches). 3. Clarify de�Qth_ of fill..(dtl er. l'..- 0 ". or 2' - 0") both are noted. 4. 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. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj