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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -13 BOX 26 03157 I grow Is Low � :. I T. j . I . . log . r � go r gob - b 03157 If yield was tested 'U M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES rub WELL COMPLETION REPORT _Qqllons Per Minute Well Location Street Address: Town/Village: Tax Map # qP Pump Type _Lf,10 MI X lWell frz �j 'Ice Map 72 Block Lot(s) Depth q?O Model4EL � !'O Owner: Name: Address: NC4".e- S�r&k,2 Use of Well: L–IZ6sidential Public Supply Air cond/heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) Tank Type Volume $tom iV. 2-Secondary Industrial Institutional _Standby PC Certificate # .�d -t3 NY State # /�, j ' Drilling Equipment LIRroiary _Cable percussion Compressed air percussion _Other(specify) t' :10 0 u M. - ., .s a I I F: I p WS Well Type Screened Azdpen end casing Open hole in bedrock Other Total Length 13 ft. Materials: _1�Steel' Plastic Other Joints: Welded t--"Threaded Other Casing Details Length below grad4LI, "ft. Diameter in. Seal:' Ll--C'ement grout Bentonite Other 771 Weight per foot /3 lb/ft Drive shoe: —Yes _Zljo Liner: Yes_LAo Diameter (in) Slot Size Length (ft) Dept to Screen (ft) IDeveloped? Screen Details first _Yes No Hours Second Well Yield Test —Bailed _Pumped 9ACompressed Air Hours 7 r Yield y gpm Depth Date Measure from land surface-static (specify ft) During y7e d —h 7 test (ft) 7 f d gll- t o complete we n �3 6 zcm Well Log Depth From Surface- Well Diameter If more detailed ft. ft. Water Bearing in Formation Description information Land Surface d z - - ILI Lj -n sieve analyses are available, please attach. If yield was tested Feet _Qqllons Per Minute Pump/Storage Tank Information at different depths Pump Type _Lf,10 MI X Capacity during drilling Depth q?O Model4EL � !'O list: Voltage ZJQ HP i, a Tank Type Volume $tom iV. Date Well Completed 1Nel[ °Drl er PC Certificate # .�d -t3 NY State # /�, j ' Date of Report t' :10 0 u M. - ., .s a I I F: I p WS R NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided olla separate sifeet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Rev. 3/06 NAM COUNTY DEPARTMENT OF HE - OF ENVIRON TAIa T C> E OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENTS STEM PCHD CONSTRUCTION PERMIT # Located at ..� ���� n Town or Village VL^o L/ 11" Owner/Applicant Name— Map '79L, Block d Lot d Formerly , Subdivision Name Subd. Lot # 4- Mailing Address t lj a. -''' -y �� „'' sad, ��i A. / Y zip . Date Construction Permit Issued by PCHD vz e7 Co vi� it Separate Sewerage System built by e: •Address Consisting of f, Gallon Septic Tank and " Z t`- iL Other Requirements: Water Supply: Public Supply From Address or: V""' Private Supply Drilled by °'.5',pPiAddress Pwf, b,CC AJ- ,5�?1 -.. __ -M-1- - - - .._.: a.. �. -�= - —s e�nciDdLCi4Ylt2�l - Number of Bedrooms 4 Has garbage grinder been installed? .T `� i��1Se:: t:�.�.��- i✓€:/�.:1 t�r..a %/ e� �1%�uanj : ,� 1�<:druv.r, S Can h� s.:1:.Yrc.:! rn fha: fvi�vF'�. .% ��7 /�-Pff� I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: *7,- V °" 10 7 Certifie -. c ��s1 �' =— � �-a-� �-� P.E. t'""' R.A. Address ela jo'e r k5 8141j, J -Y License #- Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. dcopy- Title: Dater el 410-)0-7 HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ........,. ; _ .....,.._� :. ,.. _ ... e... .., .. _,. .....y: r >...:. ...., ... r. f . - �..,,,.. ,.yo, :.. �.r .- ...�.. 'fJ& ,......_.n� .a. Well Permit # "��� WELL COMPLETION REPORT Well Location Street Address: � ! Q Oa 'TP% 41 llgke Town/Village: pt,,A1,tj U6 116. Tax Map # Map 712 Block Lot(s) GPS ` Well Owner: Name: Address: /j n Mic-44 AW-7(1� la r,#—j 5 Jw, Use of Well: 1- Primary 2- Secondary (if£esidential _Public Su ply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment otary _Cable percussion Compressed air percussion Other(specify) Well Type Screened pen end casing _ Open hole in bedrock Other Casing Details Total Length 13 ft Length below gradejl ft. Diameter 4—'Jin. Weight per foot /0 lb/ft Materials: Steel Plastic Other Joints: Welded t, Threaded Other Seal: Cement grout Bentonite Other Drive shoe: ' Yes I/No Liner: _Yes o Diameter (in) Slot Size Length (ft) JDeptto Screen (ft) Developed? Screen Details I First Second Well Yield Test I Bailed Pu Depth Date Well Log If more detailed inforrnaflon ' = -descrip'tions or sieve analyses are available, please attach. If yield was tested at different depths during drilling list: Air (Hours -7 -t— Mel ,3a Depth From Surface Well Diamefi ft. ft. Water Bearing in surface Feet Gallons Per Minute Purr Pump Type Depth W10 Voltage Z3 Tank Twe I?" _Yes _No Hours Sao Formation Description ry anK Intormai Capacity_j ModeT6 3 HP fL ,Q Volume & NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided olfa separate stfeet/plan, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 %a L- S ULKI Public Health Director LOREITA MOLINAfti 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 144 WAX-RITURSULIA OWNERS NAME: Af ic--kae C 4 Ate -" 541—a ov, TAX MAP NUMBER: -7Z-1 — 1-3 E911 ADDRESS: 82— G 4,dLeL q TOWN: ttq AUTHORIZED TOWN OFFICIAL: (Signature) DATE: O I O 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. (E911 VEREW YML ENVIRONMENTAL SERVICES 321 Kear Street � Yorktown Heights, N.Y. 10598 (914) 245-2800 . Albert H. Padovani, Director LAB #: 1.704o37 .-CLIENT #: 60253 NON STAT PROC PAGE: I of 2 STRANG, ALETHEA DATE/TIME TAKEN: 07/16/07 09:25A 82 INDIAN LAKE RD DATE/TIME REC'D: 07/16/07 10:25A PUTNAM VALLEY, NY 10579 REPORT DATE: 07/23/07 PHONE: (845)-424-6032 SAMPLING SITE: LAUNDRY SINK SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: ALETHEA STRANG TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 07/16/07 MF T. COLIFORM 07/20/07 LEAD (IMS) 07/23/07 NITRATE NITROG 07/18/07 NITRITE NITROG 07/19/07 IRON (Fe) 07/23/07 MANGANESE (Mn) 07/18/07 SODIUM (Na) 07/16/07 pH 07/19/07 HARDNESS,TOTAL 07/17/07 ALKALINITY (AS 07/17/07 TURBIDITY (TUR RESULT ABSENT /100 ML 2.6 ppb 0.48 MG/L <0.01 MG/L <0.060 MG/L 0.021 MG/L 7.26 MG/L 6.7 UNITS 98.0 MG/L 74.0 MG/L <1 NTU NORMAL - RANGE ABSENT 0-15 ppb O - 10 N/A 0-0.3 mg/l 0-0.3 mg/l N/A 6.5-8.5 N/A N/A 0-5 NTU METHOD SM 18-20 9222B SM 18-19 3113B SM18-204500NO3 SM18-204500NO2 SM 18-20 3111B SM 18-20 3111B SM 18-20 3111B SM18-20 4500HB SM 18-20 2340C SM 18-20 2320B SM 18 (2130B) ' MFTC THESE RESULTS INDICATE THAT THE WATER A SATISFACTORY SANITARY QUALITY ACCORDI��~�6��HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limit!s for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. mblic 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 (914).245-2800 Albert H. Padovani, Director LAB #: 1.704037 CLIENT #: 60253 NON STAT PROC PAGE: 2 of 2 STRANG, ALETHEA DATE/TIME TAKEN: 07/16/07 09:25A 82 INDIAN LAKE RD DATE/TIME REC'D: 07/16/07 10:25A PUTNAM VALLEY, NY 10579 REPORT DATE: 07/23/07 PHONE: (845)-424-6032 SAMPLING SITE: LAUNDRY SINK SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: ALETHEA STRANG 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. CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by 8 ,�- 1P1,4L6LPq L-k - F Location - Street Building Type Tax Map Block Lot Town/Village Subdivision Name q 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 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 J j Day LO Year 07 Signature [!G itle:r. General Contractor (Ownefr- ignature Corporation Name (if corporation) Address: F State Zip :r' ' , (-,A "P0� 5 6 - �r-.C. , Corporation Name (if corporation) S� Address: Z7- 30X✓,aP0.S Aodo_y L State N% Y Zip 10 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. _ .._ _ . s.. _. _ , . -.= >"":>c -�. �•.. - «. ..... .. , . .�... tea. x,. ,-. - .r � .- ._._ .. � ;! � - a _. -:� .a . ':s,.= ..:y.,.�,.q.`•.5'.. :: ". -...� , ...�.._ :....... `- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building ° Building Constructed by Location - Street ;57.r-,P. Building Type Tax Map Block Lot TownNillage Subdivision Name Iq 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 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 dct of the occupant of the building utilizing the system. Dated: Month J �- Day, LO Year Q7 Signature: % (D-4 ; itle: General Contractor (Ovine 4ignature Corporation Name (if corporation) Address:�"�a. State Zip Co 0,1-Zq' 'I/ ; 1 Corporation Name (if corporation) Address: 2_7-3a-0,0P0 5 State I Zip 10 1. Form GS -97 1 .�r�.. Q11 / •� .\ \ l 563.W' T R'DT Hench\ztzr /c Y'u•: 12.4 XI 53 UTNAM COUNTY DEPARTMENT OF HEALTH IVISIONQF ,VIRONMENTALHEALTHSER VICfS. ual- tv -[l -off 36 %PPROVED AS NOTED FOR CONFORMANCE WITH y ! PPLICABLE RULES AND REGULATIONS OF THE c; „ `P�°� , 1 1 0 / / 81 L`TNAM COUNTY HEALTH DEPARTMENT. se d 3!i®(y i ! t��TY r �� =�F-i= c2 - >: t CO— 534 . ry l Qj' Cp ,T \__/ J //6 DT _ z f- r `�'� �;" o 'rIJT -ZC! "DT-- 4fr'�-- „DT 8 TITLE /4 p �; a t1 >: :�� 0, T \ 18,TT \ „D DT 6 „D .• ( ;:..1 F3 o� ��� -y�4 2(. \ 6„ CT'ki DT jr -'�dM PO*iE't:TTS CO' =O'RDi r.l L�,"T"1:5 p,� +rb Bev 4 2 - Lat. B.✓d5 SLN _..___$Z.V.... 116, 3 — z 40-6 1 1'; constructed a�iridicated '. 3 457r-0 It —tea— on this plan and that the system was inspected by me before it was covered' 9T { FoFNEN Bu+cO�ft:_ CAifQs _ -- -___ -_ + 87`-3 r7 =0 -- regulations of the Putnam Dept. of Health'and the zo'-B -- PEKc`5 6�vD. Go�0- "SP'Ri*►G lQ+!5; 16 of Health. P.E. No 490 02 > gµ7. ZGS- 9`342• - - 8 4G'-i v8'-6 a d t'1 _6J 1VT6_- - — r� 7BL6 641-0 .:- O Q` `� \. ! ! Sty Q / C' DT o : ^ e, 6„ DT 6” r (�;\ ! W edl I4 ti 536 - ce 1 1 ' 52.01' x{ 536 4„ CT a en a, n urk ST_ ev. SI; Xa TD) A5 -13 UIL_T PLAN -2a- w.owd ,J,:Ki ltilw\1re �-LLS t B ov3k+ to aie oec to, 2406 s a. o . Steal E 4 °_.30 vkwnk S%- -- �.�.. - This is to certify that the'sewage disposal system was 1 1'; constructed a�iridicated '. `g F tia }oe PEa GATE :.% r2: ,0i —tea— on this plan and that the system was inspected by me before it was covered' 9T { FoFNEN Bu+cO�ft:_ CAifQs _ -- -___ -_ over.. The system was constructed in accordance with Co. all standard rul gs and ,- - - - ------- regulations of the Putnam Dept. of Health'and the New York State )7ept. LArR6!1GE BE�LUSGa PEKc`5 6�vD. Go�0- "SP'Ri*►G lQ+!5; 16 of Health. P.E. No 490 02 > gµ7. ZGS- 9`342• - - i - F, a d t'1 I. xt , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM t a.� t f c+kek 5 4, Owner or Purchaser of Building ° okt-�-W— ,C: Building Constructed by Location - Street if, K)• Building Type 7a t Tax Map Block Lot PPt'lG� TownNillage Subdivision Name q 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 JjLj Day LO Year 67 Signature:"_,_ '� itle:r� General Contractor (Owne - ignature Corporation Name (if corporation) Address: �� ._f 6wri-ex,;�11 State y Zip le 6-2-`4 Corporation Name (if corporation) Address: Z713 (lvie p ✓5 AcLv.; State 11 Zip 1. Form GS -97 FROM Putnam Co. #ealth /dept. Cn' L&onmental #ealth . LAWRENCE BELLUSCIO, P.E. / Geneva 2d. 92 Perks Blvd. �6!!P_tl�l1 >f.Q.!?..,. -N_ , /Q509 �. Cqld Spring, NY - Y 10516 1qttn: 9'0ae h % anavat L, Ya. 2e: St&ang cent L. - of compliance SUBJECT . P. l e xm a# PV//'0/ FOLD HERE DATE n riu 20, 200% Dea& Aa. l a&avat L: Cncloaed pleaae �ind the n.eviaed aarbuilt dwg. 0& the above ae�en.en.ced. Z,� Z can be of any fua.the& a*&-& 1tcnce duin.ing cyoua &eview, pleaae call on size. Velty tn.uly cyoun.a, 6nc: (3)- ,4& 7built dwga. cc: Mt' -chael & AJ- ethea Stang, {pplicanta Law&ence Qellu&cio SIGNED FORM 6125, RAPIDFORMS, INC.: TO REORDER CALL 800 - 257.8354; FAX 800. 451 -6113 P E MEM SHERLITA AMLER; MD, MS, FAAP Commissioner of Health LOR. TTA MOLINARI; kN9 MSN Associate Commissioner of Health Lawrence Belluscio, P.E. 92 Perks Blvd. Cold Spring, NY 10516 Dear Mr. Belluscio: :y — - DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Construction Compliance — Strang 82 Indian Lake Road (T) Putnam Valley, T.M. # 72 -1 -13 ROBERT J. BONDI County Executive `It0HERT MORRIS; Director of Environmental Health August 15, 2007 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 beginning of the trenches are to be provided as part of the as -built dimensions. 2. Please provide unique numbering, i.e., do not repeat numbers for as -built locations. This office will continue its review upon consideration of the above - mentioned comments. please feel. free to contact me at est. 2157 if any questions arise. JSP: ens Very truly yours, Joseph 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 Putnam Co. flea.Cth Dept. CnvL&onmenta.b flea.Lth / Geneva 2d. B&ew&ten, NY . -/0509 f ttn: go&e/ h l a/cavati., Yn:. 2e: SUBJECT�— FOLD HERE DATE Yu J—y 30, 2007 Dean Ma. l a&avatL FROM LAWRENCE BELLUSCl ®9 P.E. 92 Perks Blvd. Cold Spring, NY 90596 FiVFd rs'' t v) suo -404 i` tip re c St tany. 7 Cent L. . o� comp L ance TO 72.-1-13 ( l l - l u t nam V a.b.Ce cy Cnc.CoAed, p.Leaae �Lnd the documentat Lon 0& a cent L. . o� com -. pJ -Lance �ok the above n.e�en.enced. S.hvu.Ld addLtLonaL Ln�on.matLon be necea&a&y, pLea&e contact me at cyou& ecaaLLeit convenLence. Verccy tn.u.Ly you/z,&., � r r Lawn.ence QeIJ-u&CLO CC97 3% �,,-bult WC 97 (/ l wt k ana.bc�.�.I& 00.00 A- 0. (/ E911 VC2fA �rr (3J Gs Su&vey leap }� cc: l'1 i chae flZe La Stn.an A ppl Lcant& �� FORM 6125, RAPIDFORMS, INC.: TO REORDER CALL 800 - 257-8354: FAX 600451 -6113 �a �°/� �7 �7 p /J SP L.D— AfE/Nl FROM Putnam Co. Health dept. CnvL&on.mentaL #eaLthp LAWRENCE BELLUSCIO, P.E. / Geneva ?d. 92 Perks Blvd. B &ew.&t ea, NY 10509 Cold Spring NY 10516 _ - - - _?�ir+ Ph/FaX (> 45)� d7 +r+1 err. far_ s_ ,;.ate :..... -. '—:... •.o vv ,. ,...:.:iC.::.t <.: ,: 'm -.ry ,: :. .r.:.2 :.. w .. ......s.,. :,.m= .�_......... )-P dttn: goaeph %aaavatL, Ya. 2e: S_f&ang - Ce&tL�. o� compLLance SUBJECT . P. . . / O 72-1-13 % / )-Putnam V aLL e y R" HERE DAM 9uLcY 30, 2007 bean. lea. % an.avat L: Cnclo.&ed, plea..e tLnd the documentatLon �on_ a ce&fL�. o� com- pLLance �o& the above 14etenced. Should add!tLonal LnPn.matLon be nece- .&aay, plea&e contact me at cyoua ean.LLe&t convenLence. r Lawn.ence BeUuacLo Cnc&: NJ CC97 i3% 4&,bult dwg&- (/� WC 97 wta anal &L& ll $500.00 M-0. (/l 6911 MOM J3% GS 97 Sun.vety /flap cc: Michael & fllethea St/tang, 4pp.LLcant.& SIGNED -- i FORM 6125. RAPIDFORM% INC.:70 REORDER CALL 800.257-0354: FAX 800.451.8113 SPEED -MEMO Iri 7T3n SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .. "�Y�11v � � T.i_•�r:. PAL., '.,.. R�'.��31�...� � .P. � r-._1 a !'A ii'[vui.�n2ia a�t� Associate Commissioner of Health July 27, 2007. Lawrence Belluscio, P.E. 92 Perks Blvd. Cold Spring, NY 10516 Dear Mr. Belluscio: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 1 BONDI County Executive Director of Environmental Health Re: Field Inspection — Strang Indian Lake Road (T) Putnam Valley, TM # 72 -1 -13, lot 4 All items from our letter of July 10, 2007 have been satisfactorily completed. There are no further concerns at this time. Upon receipt of your construction compliance it will be reviewed. If. y!.)u,, aso.ve..,an.y fil:rthPr_questio>Zs, please contact -me. at ($a5) 27R 61.30. e-xt..21.55 ....:........ JD:kly Sincerely, J eph 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 r - SHEiRLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN� Associate Commissioner of Health July 10, 2007 Lawrence Belluscio, P.E. 92 Perks Blvd. Cold Spring, NY 10516 Dear Mr. Belluscio: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Field Inspection — Strang Indian Lake Road (T) Putnam Valley, TM # 72 -1 -13, Lot 4 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. Drainage area around well needs grading. �2. Bedroom count needs to be performed. ..P ariy'iiist1P. (li, st ns p�e c�..,.� Tlt �.t me' JD:kly SincereI , seph 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . FINAL SITE INSPECTION am Town ,5yrpl,4171 V,4 4-LO TM # 1— /3 1. Sewaze System Area a. STS area located as per approved plans .......................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................ ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ..... ............................... IL Sewage System a. Septic tank size - 1,000 ....... ..1,25 ..:......other .............. b. ' Septic tank installed level ............................ ......... 1111 1111 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 Bog - properly set ........ ............................... 6. T'�renc ides F Length required Len gth installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ............... 4. Slope of trench acceptable 1/16 - 1/32" /foot............ 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ........................ 8. Size of gravel 3/4 - 1112" diameter clean ................... 9. Depth of gravel in trench 12" minimum .......:........... ?.0. Pipe ends XPd :...:.._...._._..Y.- ,........_. g: Pump or Dosed byAern§ _ 1. Size of pump chamber ............... ............................... 2. Overflow tank..... ..................... ................1111........... 3. Alarm, visual/ audio .......... ......... ........:..:.............. ..... 4. Pump easily accessible, manhole to grade ................ 5. First box baffled ....................... ............................... acle,wjtness'ed by H.D.estimated flow /cycle.......... IIwilding =I-Iouse located per approved plans .......................:....... b. Number of bedrooms .................... ............................... IV. Well Well located'as per approved plans....... :........ f.... b. Distance from STS area measured 2 ft.......... c. Casing 18" above grade .... .. .................. d. Surface drainage around well acceptable ...................... V. Overall Worlunanship . a. Boxes properly grouted ................ ............................... b. All pipes partially backfilled .......... ............................... c. All pipes flush with inside of box .. ............................... d. Backfll material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dinto exist watercou g. Footing drains discharge away from STS area ............. h. Surface water protection adequate ........ .. ...................... i. Erosion control provided ............. ............................... Rev. 12/02 Permit 44 pV`•- Subdivision Lot # �a .5 Date: 0 ected by: ,. PUTNAM COUNTY DEPARTMENT OF HEALTH ( DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # PV `` —® / Located at rrJIQ&A Subdivision name tew "k) 951'• Subd. Lot # Town or Village ?VJL144-"A Ljall ev Tax Map 72, Block f Lot 13 Date Subdivision Approved 1?f Renewal Revision 1� Owner /Applicant Name 9tkC<'-4 ALC' eg 641"a LAI Date of Previous Approval 12- �4 Mailing Address ! ¢ Ai1 rxr"r1�6,v-o i AJ V Zip Boo 6Z4 Amount of Fee Enclosed $ Building Type fz,y Lot Area 3j 2`f No. of Bedrooms d- Design Flow GPD� A.0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1, gallon septic tank and ¢QpL -)=?< Other Requirements: To be constructed by Address Water Sup /ply: Public Supply From .. �.._- �i. n�, s,,.....-- Mf'..;`: p�l ��. t���tTS '•fri�,1'�.�.,.:�:�.�,v., :'�L'"��Cl� 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. Sign ee , P.E. ✓ R.A. Address `l2 Re-r4�5 81a (_c��al ,�Y" «tai, /����41�, License # Date e--Z� 4WC, 2-- 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 �ermit. Approve or discharge of domestic sanitary se ge only. ..�.� By: �% � 4 �_. Title: 6,'ate: White copy - HD ile; ello copy -Building Inspector; Pink copy - OwneOr copy -Design Professional Form CP -97 PUTNAI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL r-,... _. -:_:.Z s...+i.Tact....�- :.ir :�mt;.._ .: Coen: L{: CO:rr. +.�- '..a- v�:i,•,.'ai =.:.. -- ,c.c.s` ';t.as',w�.$$����i��r_77 _.1R -. i1 y....:.s Well Location: Stre t Address: T wn ge Tax Grid # e✓ '•tea '762, Map Block Lot(s) 1.3 Well Owner: Name- 5 Address: ll �/ :0-" AA 'd,S��d A T (es-2iq 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 gpm # People Served q Est. of Daily Usage ZE gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling blew Supply (new dwelling) Deepen Existing Well - Detailed Reason Wit i 'w ye--r ve- s4 e- ,,,,,p re5tJ — 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 Lot No 44 . Water Well Contractor: X.�2r � e��S ®d�►. Address: Is Public Water Supply available to site? .................................. ............................... Yes No G-� Name of Public Water Supply: IUZA Town/Village Distance to property from nearest water main: N Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signa -. 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 wa r well driller certified by Putnam County. ' 1 Date of Issue Permit Issue Office Date of Expiration r Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I FROM Putnam Co. #ea.Lth Dept. CnvL&onmenta.L health LAWRENCE BELLUSCIO, P.E. / Geneva 2d. 92 Perks Blvd. Q n.ew &ten., NY 10509 _ Cold Spring, NY 10516 11- 4ttn: ()&e h l aaavatL Yn.. Ze: 2_/)''j.(v&n to Cvn &tn.. l e&mLt# PV // -0/ SUBJECT • / • • . lI',7i 72• -1-13 (l )-P hC J-Lp&town FOLD HERE DATE 74ula 23, 2006 Dears M&. l aaavvt L: Cnc.Co &ed, pLea&e �Lnd the aevL&ed SSDS p.Can, �on. the above &e�en.enced, &howLng a new houac a'ad we..L.0 tocat Lon. 41&o note that the appJ- Lcant'& name ha& been changed �&om loaoh to Stn.ang. Cnc &: (3) SSDS l.Can, (1 J Cr 97 (1i WP 97 (/J $250.00 chh Ven.y tau.CY cyoun. &, Lawn.ence Qe.C.Lu &cLo rc'v&d 8 -20 -06 cc: Mike/ 4 Lee St xana, 74 p pL Lcant& FORM 8125, RAPIDFORMS, INC.: TO REORDER CALL 800.257-8354; FAX 800451.8113 �+ p q SPEED -MEMO ' IVISION OF ENVIRONMENTAL HEALTH SERVI .� x.....�..:,�. . -- .e +. -. .r -. ...o .�- .r+.-- .��'......s .... ..._....- ...- .....E..... ..a. .-..- �. ..w- � �... ... �.. .. a .�. ..nom .. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 0 f 6l Ll °-01 Located at 14441 all tk. Z- Town or Village Ptfr1,,St,-t Llalj Subdiv � ision name � °'4 9-k- Subd. Lot # Tax Map '72 • Block I Lot Date Subdivision Approved '.r Renewal U/ Revision Owner /Applicant Name All cL. 4 7'e-Orli V 40 Date of Previous Approval 4 0 .10 1 Mailing Address 12- �e- i eLt,. 4C7- Zip 'd 419,30 Amount of Fee Enclosed -0 400 e&'© 44 -0d Building Type Lot Area S-?-4 No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Seuarate Sewerage System to consist of 1 L',6 gallon septic tank and 4440 L- Other Requirements: To be constructed by X43. a Address Water Supply: Public Supply From Address or:�� private" supply "15rii�e'by �°�•�a . = �w� -_ - ?'.: °°adress c Y ` 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 amendmentthereto 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. Si � �°`° - P.E. ✓ R.A. Date 47-Z-7 �- Address 42— per` &udaf 6 f'c kf License #-4q,002— 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 permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: ! p2 ao v q Wh' e py - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL plba a prini or type i i.YYL f t.lfiTili rr b Well Location: Street Address: Town/Village Tax Grid # Lk- - Q. F44 1,4► iltlq Map -72-= Block U Lot(s) 13 Well Owner: Name: Address: i Z � _ Use of Well: VResidential 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 Ll Est. of Daily Usage_ -00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling e/New Supply (new dwelling) Deepen Existing Well Detailed Reason ¢«x v p e-5 l8 s for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ................:..................... ............................... Yes Al" No Name of subdivision' L4 1�. ., Lot No. L�� Water Well Contractor: j4g.de—c5 ®11 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /�-f 1A Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date :_ i0 - -ZS -04 - Applicant Signatiffe.: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue o y Permit Issuing Official: Date of Expiration Title: '� Permit is Non-Trajisfefrabfb White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Ir Putnam Co. #ea.Cth Dept. -6&iv� °L&06- nineni aL # ea.Lt h / Geneva IM. fittn: Yoe ; I a&avattL SUBJECT FOLD HERE. DATE Oct 26, 2004 /L. .2e: FROM LAWRENCE BELLUSCI®, P.E. 92. Perks Blvd. Colas Spring, NY 10516 - �OUe'�ri �t7 J) L1aJ��3�d *Jd P'�iio o'ax Y?enewa.L pexmi & PV T o,toh, Ti4# 72.-1-1-3, rut. V) Dea/L 14/c. l arcavattL: Cnc.Loaed plea &e �Lnd the &ev.bied SSDS p.Lan �olt the above enced &enewa.L appJ-Lcat Lon. 1 .1 can be o� any a& &i. -ance du&Lng you& n.evLew, pLeaie call on ,tee. Ve&y -btu. y cyou&A, Lawa.ence BeUu &cLo Cnc&: ( /) (UP -%% (3) SSVS l.Ln, &'vlid 10 -26 -04 cc: {, i.c�a & T e&,ty l on.oh, 4pp Li.can -L& FORM 8125, RAPIDFORMS, ING: TO REORDER CALL 804257$354; FAX S00451 -8113 ��0o 22 ((����J22��]]�� a� PEED °0l1UEMO 1N 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 October 20, 2004 Lawrence Belluscio, PE Perks Blvd. Cold Spring, New York 10516 Re: Proposed SSTS Renewal - Torok Indian Lake Road, (T) Putnam Valley TM# 72. -1 -13 Dear Mr. Belluscio: ROBERT J. BONDI County Executive 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. A A new well permit is required when submitting a renewal. ... .. - _�Te_3ee:ste_plarrne�tlst free to contact me at ext. 2157 if any questions arise. Sincerely, foseph S. Paravati, Jr. Assistant Public Health Engineer JSP:Cj PUTNA W COUNTY AEpARTMENT OF HEALTH • ` V 1 ! `� C DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATME_ NT SYSTEMS.' ONS- - . ^ RE�?IEW S�]E'T�.F�O1t: C. ZpL,'°Tl.'t3 ,,P, ,- NAME OF OWNER: N I' `` STREET LOCATION: r' • � �5/DN lam` REVIEWED.BY: RM, OR, SP, SRDATE 22, C - l Y N DOCUMENTS �Y ,N EEOUIRED DETAILS ON PLANS CONT'D) PLICATION C� " ' • IPE, CAST IRON WELL YERMTT OR FWS LETTER 0 BE S; MAX BENDS 45' W /CLEANO Pc-97 DETTER OF AUTHORIZATION (GSM NOTE (NO CHANGE) ESIGN DATA SHEET (DDS) FlLL SYST (c6(, JCORPORATE RESOLUTION (,-J(�10' HORIZONTAL; PAST CH SLOPES 3:1 TO GRADE SHORT EAF . (___)LPL SPECS/ TES 1 -5 L %PLANS -THREE SETS (U(� (,L p & DIIaNSIONS (�CC.__J,�•H�OUSE PLANS - TWO SETS (!} IN EXPANSION AREA (_ �(i/jVARIANCE REQUEST . Flu GREATER i;T /v C SUBDIVISION (__^)(_,) CLAY BARRIER, (�ULEGAL SUBDIVISION (�(�FHy'CERTIItI N NOTE , SUBDIVISION APPROVAL CHECKED U(,�DEPTH U PERC RATE _ U N PLAN FOR R.O.B., tJNCLASSIFIED & IMPERVIOUS _JLQML REQUIRED' DEPTH SEPARATION DISTANCE FROM'TOE OF SLOPE U�CURTAIN DRAIN REQUIRED / TREN ' GENERAL t EIL jLF TRENCH PROVIDED o o 60FT k4,X LeOO nrlull -e � (__)4CATED.IN NYC WATERSHED (___) PARALLEL TO CONTOURS ' (�UPLANS SUB984rrM TO DEP 0100% EXPANSIONPROVIDED DELEGATED TO PCHD � )DET UST F VSHED'STONE OR WASHED GRAVEL (_j(,_ )DEP APPROVAL, IF REQ'D • . ' • ' (Z DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - #AOM'SSTS (_) ERCS TO BE WItNESSED + EX- APPROVAL SSDS ADJ, LOTS �1 10f TO Y L. DRIVEWAY, LARGE TREES, TOP OF FILL . U �ZO TO FOUNDATION WALLS . �S (TOWNIDEC PERMIT REQ'D ?) U 100' TO WELL, Z00' INDLOD,'150' TQ PITS �f )DATA ON DDS- PLANS & PER Mr SAME • 0100' TO STREAM, WATERCOURSE, LAKE- (me. ezpaM), �_JU/PRE 1969 NZGHBOR NOTIFICATION )50' TO CATCH .DASIN, 35'. STQR3?DRAINi PIPED ;__-) TIER BLZBA :T �1A 13 ihi too 0'. YRa .F3;f10mnei= x'41N V dri =209 = - 50 +. DRAINAGE COURSE F �SOM- TESTING LOTS>10 YEARS OLD 200'J500' RESERVOi i, ETC. 150` GALLEY SYSTEMS 'iREOUIRED- �DETAILS ON PLANS : (�( —)10' mw TO DOGE QUTCROP (- SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK VUSSDS HYDRAULIC PROFILE (46L -J- 10' FROM FOUNDATION; 50' TO WELL -)GRAVTTY FLOW ONSTRUCUON NOTES 1 -15 ' DIMENSIONS TO PROPERTY LINES , DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION J D ONTOURS EILISTING & PROPOSED � (^, 15' TO'PROPERTY LINE PFOQTING(GUTTFMCURTAIN DRAINS A^ (�r ��,OPL IN SSfiS AREA I USDA SOIL TYPE BOUNDAMS ��`� ;� `-JAL TITLE BLOCK; OWNERS NAME ADDRESS (�(f,REGRADED TO 15 %, IV REQUIRED ff . , DO G'~ TM#, PE/RA; NAML, ADDRESS, PHONE# P DATE OF DRAWING/REVLSION UU UMP NOTES %DATUM REFERENCE , UUDOSE 75% O OLUMEIDOSE VOLiTN1F NOTED " _)ULOCATION OF WATERCOURSES, PONDS UL --)DE R P'ORCE:MAIl�i, (PIPE TYPE, ETC.) _ S WITS Z00' OF P.L. �D DD SHOWN & DETAILED PROPOSED FINISH FL . C-j1 DAY STORAGE ABOVE ALARM BASEII�NT ELEVATIONS �c�✓ Ali n� D FVELL3 w )STANDPIPES, S' BOTH WS W/W 200' OF SYTSM XA UA , ERTY 1�TE5 & BOUND5 • • et 20'4%,1S1-3%,35'-I%, 100%-:<I% CONTROL FOAZOUSE OUZO` o CD DLSCHARGE/100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE O' MIN NON- PERFORATED PIPE A AYL11 { �,rovn�Cr S.S773 vsn�rrrs: � S Jew (..kG • ACC a'Z�J7•. � .r'�a% 1 �'t MET)09/01100 • �� Z °'' LGj S v J tz. ib� - `l� l z� f>. n , r� , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION ._OF ENVIRO LETTER OF AUTHORIZATION RE: Property of '� �' a � ��a. '°� -® a',a Located at TN ire-ism Tax Map # I Z. Block t Lot 13 ..Subdivision of Subdivision Lot # 4 Filed Map # Date Filed -i Gentlemen: This letter is to authorize Lawrence Belluscio a duly licensed Professional Engineer _ _ 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 treatment and/or water supply systems i3_ conformity _w_iththe_�Rrovisions::of A�cle -l4 a_ fld/ort47,of t?�e_ductisn I;aw;:e:Pulilic _Htfr I,aw, and the Putnam+County Sanitary Code. e Very truly yours, Countersigni'-� '� i ed: X -- P.E., ., # 49002 (Owner of Property) . Mailing Address -792 Perks Blvd. Cold Spring Mailing Address: t-,? 6 15>c �,,, State NY Zip 10516 State ° Zip O &S Telephone: 845/265 -9342 Telephone: Form LA -97 — -- – --- – – – – – FROM Putnam Co. #e'a0th Dept. LAWRENCE BELLUSCIO, P.E. 6nvL&o'nmentaJ- #eaJ-i-h 02 Perks Blvd. Geneva -,col[c�ppring, NY 10516 - &45fZ65Z9342 51 Fdeiii 4ttn: &ie A PaxavatL, 91L. YZe: J"?enewa.0 peItmLt# PV / / -0 /, - SUBJECT 7q. Y.. ff. To /z, o A, TA # 72. 3., ( T) - P u t. VUy MLD HERE DATE Sent 27. 20041. Dears Pa&avatL: 6-ncj-o,a:ed p. eaae. find the documentation fon the itenewal of the a6ov,?-'-/Lefe/tencecl peltmLt. .Site condLtLonA have not changed wince the time of the laat appILo,vaJ-. Ve.&y tauL.y youlLa, Lawaence Be.UuacLo Enc,&:, �04 4/ 400.00 lm Z�-97 SSDS-Pj-n, xlv&d 9 -27-04 cc: 4LLcia & Teltli-y Toxok, applLcanta 7- FORM 6125, RAPIDFORMS. INC.: TO REORDER CALL 800257-8354; FAX BOD-451-811 rY DIVISION Of ENVI-RONMENTAL -HEALT.H-SERVICES CONSTRUCTION PERMIT o EWAG�,'�'U ENT SYSTEM PERMIT # P Located at jf K46Lt t. Town or Village Subdivision name Ro -,-� I xtw Z5-8ubd. Lot # Sf Date Subdivision Approved o i5-- 28 g( Owner /Applicant Name A l l ClG'L f Tax Map ZZ= Block % Lot 13 Renewal Revision Date of Previous Approval Mailing Address t 2 9 i�;X t! A . +�"�?e.vl W t C-X, G- L Zip DG 83' Amount of Fee Enclosed Building Type Lot Area No. of Bedrooms Design Flow GPD A�0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETE Separate Sewerage System to consist of i, 2-5;Z> gallon septic tank and L4®6 L. Y. Other Requirements: To be constructed by %// iq_ C? Address Water SuDDIv Public Supply From _ Address �. or: Private Supply Drilled by %°ler i �'aM Address — Rp� ` " 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Si G y� -"'-� P.E. 1,- -ice -- Date D 1-3i "01 Address I z- Ayt 5 g1 ✓44-• 0 Li4, /LJ i� License # 4-q Z)0Z--- /47576 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 co sidere necessam by the Public Health Director. Any revision or alteration of the approved Ian requires anew a 't. Ap oved Ch ge of domestic sanitary sewag only. By: Title: Ov Date: ol White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fe ional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES P -!F— TIQN l!O.Cf,) dSTRLIC.T A:.WATER: -WELD :..:..<. - please print or type PCHD Permit # Well Location: Street Address: TownPOffl%m Tax Grid # 14JL4_K- t✓k- ;Q R*141" l/ ll�f Map 7Z= Block [ Lot(s) 13 Well Owner: Name:. Address: ` �, $ F;9-e- L,, . 10 1-0 k areeK W Lc'k' o6ego - Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 6- gpm # People Served __a_ Est. of Daily Usage 6 OCR gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling t-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 W LA Z5"ti+e-5 Lot No. `f lk e� Water Well Contractor: a K ed'5001 Address: `e Is Public Water Supply available to site? .................................. ............................... Yes No t/ Name of Public Water Supply: L -- � - Town/Village Distance to property from nearest water main: A) A , Proposed well location & sources of contamination to be provided on separate sheet/plan. Da_e:•Ci -.. -Ypl cant Sigia� 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 dri er ce ' d b Putnam County. Date of Issue ' f Permit Issuin Official: Date of Expiration ® Title: Permit is Non- Transferr 1 White copy - HD file•, Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH RE: Property of LETTER OF AUTHORIZATION 'A lien Tl e—rry To r-okl a VVIO Va 4jp o t Ie� Located at 46 LA✓l �A k-e— d� T/V 'P"4AaVn t4i Tax Map # '79 . Block l Lot I.; Sub division of Romi k -6kv,. Subdivision Lot # Al Filed Map # 1 '7?9,4 Date Filed ` R 74,"( Gentlemen: This letter is to authorize Lawrence Belluscio a duly licensed Professional Engineer x_ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this mater, and to supery se the onstru_ct or of said wastewater.. treatment and/or - water- :s�xgpl systems inconformity with me provisions of Article t145 and/or 147 of the, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, ' Y A Countersignln lb igned: P.E.,., # 49002 Owner f Property) Mailing Address -_ 92 Perks Blvd. Mailing Address: 86 Cold Spring State NY Zip 10516 Telephone: 1265 -9342 State fts Y Zip �41 579 Telephone: � q Form LA -97 ; ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 APPLICATION FOR APPROVAL OF PLANS FOR - -- ._ ...... _ .. _ _ fir- ..- <....... ,. WAS'T'EWATERTRIEATMFNT�S'BTkM-. 1. Name and address of applicant: it-, La- e__r-r / �a ✓'ee+� ,ter c.c� � �� c� C� � �o 2. Name of project: 7e re 1L 5S 3. Location TN: Pa zt -wl 4 11ezy 4. Design Professional: eia, i ?E 5. Address: qZ Ped'k -S 6. Drainage Basin: //ad 510M. 7. Type of Project: v""Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A)o ° 10. Has DEIS been completed and found acceptable by Lead Agency? ............... /00 ° 11. Name of Lead Agency AJIA 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ... 13. If so, have plans been submitted to such authorities? ........ ............................... AJo 14. Has preliminary approval been granted by such authorities? Date granted: o 15. Type of Sewage Treatment System Discharge.. ................ surface water kL""groundwater 16. If surface water discharge, what is the stream class designation? .................... /v - 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... /1).0 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 4)0 21. Name of sewage system &ZA - Distance to sewage system 22. Date test holes observedbl -03 01 23. Name of Health Inspector 4. 5 -I e_b el < "1 24. Project design flow (gallons per day) ........... ................:.............. en 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A10 - 26. Has SPDES Application been submitted to local DEC office? ......................... A),O Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? /1Jo . 28. Wetlands ID Number ... ............................... .... ............................................... larids Pe'rit regtiir "ed ?` Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... AfO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous: waste disposal, landfilling, sludge application or industrial activity? .... Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination. Yes/No AJ,0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? �5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ........................ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Boo ' 36. Tax Map ID Number .......................... ............................... Map 72• Block l Lot IS 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of anew SSTS to be located within the NYC Watershed shall..:-. :. b._senfA6a iiU4 sent in'duplidafeto tTie b�f� `although�e approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLE .� .................... Mailing Address: ............... A_)y 16676. ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ ...:�... .,. ,..:E= �.S�'ACE SV�' DOE*I'RiA`'I°iN'T``SYS"i'Eli.._ .r ......_.�_, Owner Y'/ U ,mod /G t 2 g� Address te�.y! w �C-k GT D GS3a Lczn LIL t8. Located at (Street) 1,.4 ,m . vJ Tax Map ?Z• Block r Lot 3 (indicate nearest cross street) Municipality �-T) �1�vt.� -+ wz iJ1 Iy -Drainage Basin 14ud66m SOIL PERCOLATION TEST DATA Date dPre- soaking j Z -zo -oa Date of Percolation Test " Hole No. Ran No. Time - Start - Stop Ela se Time �11Iin.) Dep th to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 3 4 5 + T' 3 ' 32'"o; 46 15':7' . �1 .74- 3,D 25 .4 1 2 3 4 NOTES: . 1. Tests to be repeated at same depth until approximately equdl percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES r _ DEPTH HOLE NO. ( HOLE NO. 2- HOLE NO. G.L. 7"42 0.5' 1.0' 1.5' 2.0' '2.5' 3.0' 4.0' 4.5'. 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Al )ZA Deep hole observations made by: Date y 1-63-61 Design Professional Name: Lawrence Belluscio Address: ` .92 Perks Blvd . Cold Spring, t-dY 10516 Signature. Design Professional's Seal 1* aG J.8FL`..yc n Off' r �0 PE 04") -OF N - 14.16.4 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 SEOR k Appendix C State Environmental Ouality Review - S T. -•.:s -' . - a- .•<•z•�i :.n: -,.? : +ice +..i.:sr SftA `'"ENVRcyNWki`AL`ASSESSMENT FORM. For UNLISTED ACTIONS Only' PART I— PROJECT INFORMATION (To be completed by Applicant-or Project sponsor 1. APPLICANT /SPONSOFj7 /l Ci le � d-O rI rr 1` 2. PROJECT NAME. dG ci td� 3. PROJECT LOCATION:: 7:— KCI.✓� Municipality /' v 1�� County v't-P1 i.VI-1 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) c'Zd . C cY 4- VVI L � �s t OL,&o p us - ct Ow S. IS PROP99ED ACTION: ew ❑ Expansion ❑ Modificationlaiteration 6. DESCRIBE BRIEFLY: /PROJECT / 7. AMOUNT OF LAND AFFECTED: VAL VA= Initially acres Ultimately acres S. WILL P OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 0911yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: �- - w. .s- ,...r.,- .�.....we� .c...a•s.. -. �.....r.�, w >.�....p -�r..r .. M.... ..i - +vz. vv .� ...�.u�,nti.arsv -... rr.u.ic... r...- .,n,...... 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(s) and permlVapprovals 11. DOES ANY kSPE 7 OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? + ❑ Yes No it yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING'PERMIT/APPROVAL REQUIRE MODIFICATION? f� ❑ Yes ❑ No I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AMAeafWsponsor name: + - �` Ci$ G l O C: Date: Sign�� • ���� s If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? It yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B., WILL ACTION RECEIVE-COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration nay:tis s'up$rs@Ced 6arsoti;ar�lrtirai�a���oiscyr. _, . t ::, ..:. :'�: -.. ,: .r: rr.. _.. W _ _ �•' . ❑ Yes ❑ No 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 patterns, solid. waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 'C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: Cd. 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 CS. Growth, subsequent development, or related activities likely to be Induced.by the proposed action? Explain briefly. VT r ... - i`i% C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly.' J } D C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. Q, =GS:�NF33E S)f3[ tHEAE1ItSfLt TA.:BIc, CONTROVERSY FiELATtEf"TO•POTENTIAI RDVEFlSE tJV)t'GAIHl,ENTAL IM °AC761> ».> ❑ Yes ❑ No If Yes, explain briefly , PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each-effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) j irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that ' explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have, Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare.a'positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 9 ON, M, c LA 04 1110 AVS,4f7' _11BOR141 AM- 116 , t, TM CO. I MO LC. -0" am*," olwt < 2•� CD + -- ---- H L - L Trip To LOS rosT -43'X41 20 13t R L 0%. lo-v2* MIN 2� W BED om 41 I:I ^A27* m L213 LIN r ON L - - - -1 V 11 M(W ,\`,, I ILI jw iAY K-LL LEAJ`G 5- Mo. ovr w oE6FtZMS m I > r O -7 + PUTINAIll COUNTY WW 01 DE*K OVV• UNE o ftaoE olwt STRLZ I BY Wma SIZES AXp DETAILS rI HOUSE PL T All.1,ROVFD FO`fi DED11 Erfi, orris 1,400VEN, PECK ALL. S AM JLTA' LA S MU 1R BE U' TO THE OUNT ONLY, TP ums,E Flotigg fi,r . oy ATROVAL /DATE 2 sa nu -7 257" .1• Is LIM Or ROOT ovl!K )plt)1,4N ;4AIrt- V 11 M(W ,\`,, I ILI jw iAY K-LL LEAJ`G 5- Mo. ovr w oE6FtZMS m I > r O -7 + PUTINAIll COUNTY WW 01 DE*K OVV• UNE o ftaoE olwt STRLZ I BY Wma SIZES AXp DETAILS rI HOUSE PL T All.1,ROVFD FO`fi DED11 Erfi, orris 1,400VEN, PECK ALL. S AM JLTA' LA S MU 1R BE U' TO THE OUNT ONLY, TP ums,E Flotigg fi,r . oy ATROVAL /DATE 2 sa FROM #".Putnam Co. Health Dept. Dv of Envrnm!,tl 1111th Sv's LAWRENCE BELLUSCIO, P.E. 1 Geneva Rd. 92 Pdrks Blvd. Brewster, NY 10509 Cold Spring, NY 10516 Attn: Adam Stiebeling, Re: Torok, SUBJECT T. P.H. - -E. . . TM# 72.-1 -13, (T)-Putnam Vlly DATE March 27, 2001 Dear Mr. Stiebeling: E�� Enclosed please find the revised SSDS plan for the above referenced lot. As requested, a copy of the survey showing the lot line change be- tween lots 4 & 5 is enclosed for your records. I believe all other points as presented in your March 19th letter of review have been addressed,*. If I can be of any assitance or provide clarification, please call on me. Very truly yours, Lawrence Belluscio Incls: (1)- Survey map (3)-SSDS plus, rlvsd 03-27-01 SIGNED FORM 11292 RAPIDFORMS INC TO REORDER CALL 800.257.8354- FAX R00.451-8113 00296 SPEED-MEMO Public Health Director 1:6kB' TA` M0UNARI 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 March 19, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Larry Belluscio, PE UZ Perks Blvd. Cold Spring, New York 10516 Re: Torok, Indian Lake Road- Powhatan Estates, Lot 4 TM# 72.4-13, Town of Putnam Valley Dear Mr. Belluscio: This office has received and reviewed the most recent set of plans for the above mentioned project. We would li to offer the following comments for your review and consideration. D uments Please provide a copy of survey by Anthony T. Rowan, PE/LS, revised March 21, 1983. The submitted separate sewage treatment system plan differs from the "amended" subdivision map "Lands of Powhatan Estates, Henry P. Mauro, filed May 28, 1981. Please clarify. In 1. Dimension required to locate well from property lines. Please: provide.tlie =loe'ation of well corrieciiont e vi e line.,j- Please provide direct line of drainage as detailed in Appendix B, Putnam County Health Department Bulletin ST -19, for the well. Please identify notation (direct line of drainage keyhole) as drawn on plan (copy attached). Please reference Bulletin ST -19 for direct line of drainage determination. Please provide grading of Lot #5 on plan to be used for direct line of drainage determination. Please provide a 4' o PVC outlet pipe out of the distribution box to area of expansion (beyond primary trenches). 4' m pipe to be capped at both ends for use as future expansion. Please provide the following note on plan "there are no other septic /wells. within 200'0" unless shown: 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, K Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUTNANNI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONN EN'TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS e. S7 �^ REVIEW SHEET FOR CONSTRUCTION PERMIT _ -S1 T LOCATION: VIEWED BY: R��I, GR<AS,/SRDATE: T.�X (C ) ' Y DOCU`LENTS �� (R RED DETAILS ON PLANS CONT'D) . (� PERMIT APPLICATION . HO'I:•SE SEWER -' /," FT. 4 "0'; TYPE PIPE CAST IRON 'ELL PERMIT OR PWS LETTER NO BENDS; (LAX BENDS 45° W /CLEANOUT C -97 RENEWALS VHORTEAF ER OF AUTHORIZATION (___)SITE NOTE (NO CHANGE) GN DATA SHEET (DDS) FILL SYSTEMS ORATE RESOLUTION (� 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE �' � C FILL SPECS' FILL NOTES 1 -5 S -THREE SETS FILL PROFILE & DIMENSIONS SE PLANS - TWO SETS �i`(- U FILL IN EXPANSION AREA (_ VARIANCE REQUEST FILL GREATER 7AAN2 FEET SUBDNISION U CLAY BARRIER (� LEGAL SUBDIVISION (__)( FILL CERTIFICATION NOTE SUBDIVISION APPRQ34AL CHECKED DEPTH GAUGES (� CRATE VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (�L REQUIRED DEPTH U SEPARATION DISTANCE FROM TOE of SLOPE U nCURTAIN DRAIN REQUIRED THE NCH GENERAL F TREN CH PROVIDED 60FT MAX. LJZW ATED IN NYC WATERSHED ARAN LEL TO CONTOUR (�( NS SUBNRTTED TO DEP ( 00% EXPANSION PROVIDED (j�EGATED TO PCHD Alp DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL U EP APPROVAL, IF REQ'D ! GEOTEXTILE COVER D> TEST HOLES OBSERVED SEP ON DISTANCE&6N N - O SSTS U ERCS TO BE WITNESSED M ( 10' TO P.L. DRIVEWAY, L GE TREES, TOP OF FILL V(—J,1969 PPROVAL SSDS ADJ, LOTS 20' TO FOUNDATIO "L LANDS (TOWN/DEC PERMIT REQ'D ?) 100' TO WE 0 LOD,150' TO PITS ON DDS PLANS & PERMIT SAbIE - 100' TO S - Span) NEIGHBOR NOTIFICATION 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (_) TTER BUZBA 0 WATER LINE (pits - 20') L__.) 100 YR. FLOOD ELEVATION WA 200' ( '0' INTERMITTENT DRAINAGE COURSE SOILTESTING -LOTS> 0YEARSOLD I .. ,s. `- 00'/; -09' RESr4'00W,-E T �L:. "T50' GALLEY SYSTEMS _. _ R i .E . __Tf L _ -_ _.. ��0' KILN TO LEDGE 0� OP LS SEWAGE SYSTEM PLAN - (NORTH ARROW) —' 'EF�'IC TANK SSDS HYDRAULIC PROFILE F0 1TVAw -l—s urm —� ( a{ - )GRAVrrY FLOW `' - , ONSTRUCTION NOTES 1 -15 )ESIGN DATA: PERC & DEEP RESULTS t' CONTOURS EXISTING & PROPOSED )RIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTALN DRAINS USDA SOIL TYPE BOUNDARIES WLE BLOCK; OWNERS NAME ADDRESS FM9, PE(RA; NAME, ADDRESS, PHONE/; DATE OF DRAWLNG(REVLSION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (WELLS & SSDS'S W/IN 200' OF SSTS (PROPERTY METES & BOUNDS,/' n COMMENTS: (REVSHEET) 0 PROPERTY SLOPE �( SLOPE IN SSTS AREA (520°/6) r (jREGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS U( PLTNIP NOTES ( _J( DOSE 75% OF PIPE VOLUNv1E/DOSE VOLUME NOTED (___) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (__)( PIT AND D -BOX SHOWN & DETAILED .U( I DAY STORAGE ABOVE ALARM CURTAIN DRAIN (_j( STANDPIPES, 5' BOTH SIDES, DETAIL U 15' Nn to CDS= >5 %,20'4%,25'- 3 %,35' -1 %,100 % -Q% (___) 20' 1ILN to CD DISCHARGE /100' with 182 cons day discharge (-J( 10' NILN to NON - PERFORATED PIPE REGISTERED MAIL RETURN RECEIPT REQUESTED 0. Q Date _ Jan 31 2001 .Q.60�..002.8�_.9 ,.744... _ _ 3 Building Inspector Iry -Sevelowitz ---------------- - - - - -- 265 Oscawana Lk. Rd. ----------------- - - - - -- Putnam Valley,,NY 10579 ---------------- - - - - -- Re: Construct residence Applicant Street Town TM# Dear NIs_�SY�.L43d1.Z s ___ Lon Permit for single family Terry & Alicia_Tooli___ Indian Lk. -- Rd. ------------------------- Putnam Valley 72e -1 -13 --------------------- - - - - -- (I am) submitting an application to construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval req Yes No B) Is any portion of the parcel control area, and if so is a Yes_ _ No C) Is any other local permit or aired for any variances? located within a regulated wetland or its vetland permit required? approval necessary? If the answer to any of the questions above is yes, please contact the Health - Department in vriting or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Name -Adam _Stiebeling, A.P.H.E. Health Department Inspector JK /jp wetland bh Very truly yours, Lawrence Belluscio, P.E. Engineer, 1 1 — ' -- - .2 h Duey P'Pad We►�' ft �/ p . R &Std �h 4 60 K M n p t sic, i or oh C�so dettc J. �d4' To p . :674t? Jt n ahe besigndte`'Tac Mapl7t' Area .�.4' acres ^.✓ jESIdWOF'•SYSTEM T ' "Percolai oii' rate` = G' to min/ in; App a O GPD %SF ... ; 2. Design flov - �0�?;, GPD °(► ;;, rms) i - tis� jgial �P.'C.r. septic tank:, `- Y ' gal %1:00, GPD %SF. -' ?r %2 -0 wide:;t•.ZF. :.•:. �^ Use t = SO I;F ateral R a �.. 5, . i �' l A0 %� , expansion area . provide0. All :9 ",: dia Pvr - :';' � � "tionba, -f PIP48 A Oy le P-" c) ti 00. PIPso Ovjy _7 4 10 Are All- 4� YY A 'oDDVS LQ-t it,uat within the Designated ..Tax'Map7, Area x.2.4 acres" :81GNOF SYSTEM, Percolation rate to iiin/111; Ap"jigia,.ra t e... p GPD/SF. Design flow = J?00 GPD (.4 Bdrms); gal P.C. use I septic tank: SW gal /1.00 GPD/SF = gob.. -0 Wide trench = LF. .Use 50 LF laterals. 10.0% expansion area provided. All nines VOIA I I he :4 min of 4" dia PvP i"Prf. BRUCE R. FOLEY .. Public-- 14-cifik- ,D;r�ctor.- LORETTA MOLINARI. RN., M.S.N. '- Hedlt3s Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509, REQUEST FOR FIELD TESTING ATTENTION: 04DAM STIEBELING ❑ GENE REED All information below must be u Qyl completed prior toa?any scheduling. DATE• OG -63-61 ENGINEER OR FIRM: �- ,S�C1 USGtl7 `l; • PHONE #: �G � g 3 4o'L 1-111 DYMIM DEEPS: ' &-' PERCS: ❑ PUMP TEST: ❑ ROAD /STREET: f3 d14-tl1. TOWN: Rai- M a w► I)a C-L-1 TAX NSA SUBDIVISION: po 1,U v .` E-5- & '� OWNER: 5'--yep t4 eLn �j C� C r cf vK�� LOT #: `- Str�� YES NO ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. y ❑. Ya'roposee :SSTS within OO.feet of a.reservo:r, reservoir stem or��o�rtr�ilakY,: ❑ ti Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. 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 testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE: COMMENTS: (F =TEST) FOR COUNTY USE ONLY ' 62 ( -o3 -1--7f FROM Putnam Co. Health Dept. Div. of Enwrnmltl H11th Sv's LAWRENCE BELLU . SCIO, P.E. I Geneva Rd. 92 Perks BrewstQr,-,.XY__M-509 _j Ph/Fax (845) 265-9342 *51 For Fax Attn: Adam Stiebeling, Re: Torok, Constr. Permit SUBJECT A. P. H. E. TM# 7 2. 1 . = 13 '(T)-1 -Putnam Valley FOLD HERE DATE Jan 31, 2.001 Dear Mr. Stiebeling: Inclosed please find the support documentation for a SSDS-,a pproval, for the above referenced. Should you have any questions or need.clarification,.pleasb- contact me at the above tel. no.. Thank-you. very truly yours, Lawrence Belluscio Incls: (1) LA-97 (1) CP-97 (1) $300.00 M.O. (1) Shrt EAF (1) DD-97 (1) PC-97 (1) Notify Ltr. to B.I. (3) SSDS Plns (1) WP-97 (2) Hse Flr Plns cc: Stephen Seligman, owner -ap I SPEED-MEMO r� V ! r Q Ti } (. f. J [:- � .41, tom• Y :Yl. } r , a 1 i � � • til i.� N �, r j (� � ^ t • f'•;i•2" � r a r s ^•i � a e._ � " .yl - T.: � Z { as y _ _ X;4' •.. , ai 1R � e Q 4F 1 0.