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Home My WebLink About3177DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.—l-24.16 BOX 26 03177 I m6 ism r m Isom t;-6N II hiz s '� r. - , r , - 03177 �D PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF_EN-.VIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD,SONSTRUCTION PERMIT # / p ar— ?00 C_ �_g �3 Located at #?&T a A/ Village 6 ff:A �I Owner /Applicant Name Tax Map Block _� LotJ Kf,4 Formerly Subdivision Name ff if'17 of T Subd. Lot # 6 Mailing Address O f G f% &Ati11 L�%k /QG/%%J /°tea � � %' Zip Date Construction Permit Issued by PCHD - -� Zlf Separate Sewerage System built by�G��r� �� Address Consisting of /f?JL• Gallon Septic Tank and .rbe' Other Requirements: e Water Supply: Public Supply From Address or: Private Supply Drilled by I% A AP' F0,01 G,h Address Iiac i' ElW-rticcrtrol. been comb _letcd? Number of Bedrooms ,� Has garbage grinder been installed? 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 P tram C t artment of Health. Date: `% l Certified by P.E. R.A. nn � ign ofession Ae --f � � License # Address � /( G� rr 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 revocatio , modi cati or ch g is necessary. By: Title: 4 l-1og— Date: dlEl�cl White copy - 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 5.3 WELL COMPLETION REPORT `• aii, .: C: kvoi- .:. & &t cct ..t"- c -s: - - , t _ �_ ..... r_ = = :;a` v v iiiagc T Tax "d V% %J I �: cxaL L 1U6,auv11 vi wcn w►u► uismnuus to at Least two permanent ianamarxs to De proviaea on a separate sneevplan. — Well Driller'sT Alo Y 1K ,j, r S oh 114 1 Address: �� s f 17f /rAr, af�,�f Signature: Date: � /v qq '��/ " White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Addjejs:, jTown/Village; - Tax.Grid,#-7-q-..6q9. J, 4,- Lot(s) Well Owner: I Name: Address. I je 13 rAu &,r 53 Ila v, 1 0 o 4A 4" V Use of Well: 1-primary 2-secondary VResidential Public Supply Air cond/heat pump _ Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby 4 Drilling Equipment Rotary _ Cable percussion Compressed air percussion _ Other (specify) Well Type Screened Open end casing __L/Open hole in bedrock Other Casing Details Total length _,Z_L_ft. Length below grade .,s -ft. Diameter (► in. Weight per foot 11, lb/ft. Materials: i.- Steel — Plastic Other Joints: Welded _ &-Threaded Other Seal: &,--Cement grout Bentonite — Other Drive shoe: _It-Yes . _ No ILiner: Yes -L.. No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes -7- No Hours Second Well Yield Test est Bailed Pumped L-Compressed Air Hours Yield _L_ c, gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses -yailable. please attach. Depth From Surface I Water Bearing Well Diameter(in) Formation Description ft.. ft. Land Surface )r b i le If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type Capacity Depth A Fro Model /0 6.,l Voltage -130 IV Tank Type JL,X ?,, /Volume Date Well Completed Putnam County Certification No. -Date of Report Well Driller (signature) Nuiz: txact location or well Wan aistances to at least two permanent ianumarKs to oe proviaea on a separate sneettpian. Well Drillees>kme, Alo it %% a U — A,,je I & 0 h Signature: Address: r 4 *, St 4 7y a1. U:1 IA Date: dIVA6 4// White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 �/- .' ° , YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N�Y. 10598 Albert H. Padovani, Director ^ LAB #: 32.906004 CLIENT 0-10163. NON STAT PROC PAGE 1 ��-------------------- -------- ---------- BAUER, JEFF AND LIZ 53 HORTON HOLLOW RD. PUTNAM VALLEY, NY 10579 SAMPLING SITE: 53 HORTON HOLLOW : PUTNAM VALLEY, NY COL'D BY: LIZ BAUER NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 09/22/99 08:30A DATE/TIME REC'D: 09/22/99 01:30P REPORT DATE: 10/05/99 PHONE: (914)-528-1405 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/22/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 09/22/99 LEAD (IMS) <1 ppb 0-15 ppb 9101 09/22/99 NITRATE NITROG 0.57 MG/L 0 - 10 9139 09/22/99 NITRITE NITROG <0.01 MG/L N/A 9146 09/22/99 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 09/22/99 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 09/22/99 SODIUM (Na) 2.59 MG/L N/A 09/22/99 pH 6.9 UNITS 6.5-8.5 9043 09/22/99 HARDNESS,TOTAL 154 MG/L N/A 09/22/99 ALKALINITY (AS 136 MG/L N/A 09/22/99 _TURBIDITY(TUR ^' <1 NTU 0-5NTLl_'-_�_-�_,._ _'-'�-MENTS�- .'_�-�--_'~�__ -M* E6 BACT THESE RESULTS INDICATE THAT THE WAT S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDAR OR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested 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 is suggested. � � YML ENVIRONMENTAL SERVICES 321 Kear Street .Yorktown Heights, N.Y. 10598 '- ~ ��s�c~��. ^ ~�`'=�`^�=�~~_--- Albert H. Padovani, Director LAB #: 32.906004 CLIENT #: 10983 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BAUER, JEFF AND LIZ 53 HORTON HOLLOW RD. PUTNAM VALLEY, NY 10579 SAMPLING SITE: 53 HORTON HOLLOW : PUTNAM VALLEY, NY COL'D BY: LIZ BAUER NOTES...: KIT TAP . ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 09/22/99 08:30A DATE/TIME REC'D: 09/22/99 01:30P REPORT DATE: 10/05/99 PHONE: (914)-528-1405 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 SUBJEClED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGR PER _ k A MR - SUBMITTED BY: Director ELAP# 10323 ID: 01 9142145'l 70 LAE-.' Pi"AGE 01 Y. o r k- to wn Heights, N Y' 1 C)590 ( 9 14 ) E� 5- EG(")i) A I b er t H. Pad o v an i D i v- ec to r LAE, Sc 05, f': 1 (-.) t CL 7 }'NT # , 1 C*.983 - - -- - - - - -- - - - - - - - - - - - - - - -- BAUER. JEFJ AND LIZ 53 HORTON HC; .LOW RD. PUTNAM f'ALL.F-V... NV I t" 5`7 NON --':)'TAT PR'LIC F'AGL 1 ------------------ DATE /TIME TA�� .EN: DATE /TIME RI C' 08/17/99 01,45P REFT-IR"I DATE 8 /31 PHONE. (914 )--528-14C)5 SAMPLING SITE., SAME SAMPLE TYPE..-. POTABLE PRESP.-4:1 VAT IVES: NONE COLD BY: LIZ DAUER TEMOERATURE... !:" 4C NOTES ... : P'", IT 1,iF - COL.1, ;,.)RN METH; MF - - - - - - - - - - --- -- -ti-- DATE FL.Ar.), F,R0CJ-:'DLJRE RE51ULT NORMAL RANGE METHOD /179 MP T. COL IFORM ABSENT ML ABSENT (3 C -C-'N T S WAE- RACT THESE R'ES,U',',`S INDICA)F." THAT THE, WAIE, WAS NOT) OF' A SATISFACTORY SANITARY DUALITY ACCORD INr," �- -HE NEW YC01:.' STATE AND ERA F'EOERAL DF%`.11*,41,-.'l'Nll3, WATER' HE F,ARAME,lER!-.`, TESTED, AT THE TIME OFF COLLECTION. SUBMITTED BY: e* r" -','v an M T b -s p Director ELAF-o S P- 3r 99 AT. 23 A14 PUiNIAM Ci' KIV HEAL'N FAX ND, 1914 .1757921 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Gymcr or Purchaser of Building Tax Map Block Lot EX�Q l t`^2 P 'j G M V I Building Constructed by TownNillage 53 -i-iv r .6,w 1-16 1 b Q t2t, C- �,, 1--k%,\ to -,) t s Location - Street Subdivision Name t �p _ Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system sewing 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 goad 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 wilIM or negligent act of the occupant of the building utilizing the system. i--t- urination. of-tht ublic Health Director of the Putnam County Department of Health as to whether or not the failure of the s stem -- -� to operate was caused by the willful or negligent act of the occupant of the building ut oxZ9 the t — system. Date : Month Day i Year Genet ontractor (Owner) - re Corporation 14me (if corporation) Address: State Zip Title: Gwk -� Corporation Name (if corporation) Address: State ZiV6 Form GS -97 T PJ6DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS .: r_tild.reckenricge Foal Mahopac, N.Y. 10541 914- 628 -7576 September 19, '1999 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Adam Steibling RE: ASBUiLT SSTS Horton Hollow Estates Lot#6 Horton Hollow Road Property of Bauer Putnam Valley Dear Mr. Steibling: Enclosed herewith please find the following: 1. Certification of Construction Compliance 2. Well Log and Bacti Results _ 4. Three copies of the asbuilt plan 5. Filing fee of $200.00 Continents: The Putnam County water analysis will be submitted shortly. The owner was unaware of this requirement. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C;0NS1'RUCTI N PERMIT PR SEWAGE TREATMENT SYSTEM PERMIT # A, q q l Located at .4_"41 Subdivision namel��/{�1 %d�rY�J Subd. Lot # Date Subdivision Approved Owner /Applicant Name J_ 21.1 dj -e'r V 'Town or Village Tax Map '94 Block / Lot,,,?, Renewal Revision Date of Previous Approval Mailing Address�C�91.�1l� Amount of Fee Enclosed 3L% �,► Building Type;-,v2,-t,! i�� Lot Area n, ANo. of Bedrooms -__ Design Flow GPD d C & Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of If 7 a gallon septic tank and Other Requirements: eq// To be constructed by __T_/? J Address Water Supply: Public Supply From Address p'Y1�iaiF \INi 4j Y.. Yµ .�.�h. .� _ .♦ e- ... ....+. -.. ... - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date License #y,�l 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 nm' . Approved for discharge of domestic sanitary sewage only. �} By: Tides �c l L - ( _V .k' INC Date: 101 White copy - HD Vile; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL P'C141f Permit Well Location: Street Address: Town/Village Tax Grid # ,y,,1 `P 4.4v w pro L�L-4j GWv0 Map V Block/ Lot(s)"-) ,% ° Well Owner: Name: J , ?/14 ''r Address: Q4 /- 11,4r le-,Ola c,-/ ?Yi !.50-'e'-G% lax- Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation Ipprimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institution Standby Amount of Use Yield Sought gpm a Est. of Daily Usage 4, -� al. 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 v Is well located in a realty subdivision? ...................................... ............................... Yes L-::- No - Name of subdivision #79-:7V 1v z, FJ .!' Lot No. Water Well Contractor: -rlp p Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /1f / Town/Village Distance to property from nearest water main: %V /, - Proposed well location & sources of contamination to b vided on se heet/plan. Date: Applicant Signatme: 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 wat�well driller certified by Putnam County. Date of Issue L 1 I n I cl� Permit Issuing i Date of Expiration , ov Title: Permit is Non- Transfei"rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 � u n A1v1 C O U 1N T Y DEPAK"1 T ° E NT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT. SYSTEM ..: .... .. .. M 1. Name and address of applicant: 2. Name of project: SIN,4 f_ rw"/z, Y r? F r 3. Locati�&: C010A, Re, 4. Design Professional: hfIN IEG 4. Z)o'/.t 'yur-- 5. Address: /a10 EV49e..-- oc � e 6. Drainage Basin: 4q A741tdlo9z- y 7. Type of Project: _ Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ........................ 10. Has DEIS been completed and found acceptable by Lead Agency? ............. Exempt Unlisted y All*- 11. Name -of Lead Agency / Z.± 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ............................................. ........................................... -r' 13. If so, have plans been submitted to such authorities? .. ............................... rN o ` a_ 14. Has preliminary approval been granted by such authorities? Date gri rated: Al 15. Type of Sewage Treatment System Discharge ................. surface water Ygroundwater 16. If surface water discharge, what is the stream class designation? .................... N/r & 17. Waters index number (surface) ........................................... ............................... -- tL 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ A10 21. Name of sewage system Distance to sewa�e system sle'' r44WVrs/a'y 41' hl -qZ7 22. Date test holes observed F14, r-- 23. Name of Health Inspector rric.,E 24. Project design flow (gallons per day) o0 0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N6 26. Has SPDES Application been submitted to local DEC office? ......................... /V/& Form PC -97 2 27. Is any portion. of this project located within a designated, Town or State wetland? A/d 28. Wetlands ID Number ............................................................ ..............................� required? ................................ ° /V y __ ... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... ij(U 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? ............................ Yesap 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? ............................... Yesw- DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .......:................. 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... A U 35. Are any sewage treatment areas in excess of 15% slope? . ............................... All, 36. Tax Map ID Number .......................... ............................... Map'% oL Block_L Lot��jl. 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new S_STS to be located within the NYC Waterslted, shall.._. �._ _� s.a�i'„yt_lt °4G1 -tfi'° �°.na,+ »+� � +,.... «.7 ^ ..yy ...., .` � rn; n .' -: 'e:.. -'.• :.: _ ..�-. r++..: � f4. •� . .. .. ' ' _�._.. _ _.. _;:m: _ s- t,:.a La.vF:_,`w::aii�vts iio• i G:. Ja.11t l�l`di1p11�Q��UTG�LC,r, aiciin'ugn lI1C �ro�eci•riiay require i�tr'Y . 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& OFFICUL TITLES: Z) 4uieL J. c)6.vgr1i4° Mailing Address: ................................... pl,q e y, .6rj';� - )?UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1JR— ACY SFNV CE -THE ATMENT -'> Addr ess Located at (Street)®"_'u1? /176i';. m,_ Pa., Tax Map Block / L00 (indicate nearest cross street) Municipality _ dyTlVtfv� Drainage Basin ef j/�,f4,g2 SOIL PERCOLATION TEST DATA Date of Pre-soaking P /� /!7,,0 - Date of Percolation Test Hole No. Run No. Time Start - Stop Elax Time n.) D?th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Nn/Inch I Z>T- f .217 3 2 0 a le Qz 2 3 z rl! y a- 1 9 q /s- 5 A 7. 3 -77 Irz Ar C2 i 4 2 3 4 NOTES: 1. Tle9ts to be-rep"d.ted'at same depth until approximately equal percolation rates are obtained at each percolation I test ho le-.',,. (i.e.. s I min for 1 -30 min/inch, :5 2 min for 31-60 min/inch) All data to be 'submitted fbr`review.:` ' 2. ep!th measurements to be made from top of hole. Form DD-97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed A1,4 /V Indicate level to which water level rises after being encountered Deep hole observations made by: Date. v Design Professional Name: 2�N1f34, �, !7ej v!f _ �� N� Address: Q J. QO,'V `� �', did (` .y '•.e A i Signature: Design Professional's Seal DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5' 7r,6 Pro Z Tv ?,role- 1.01 1.5' 2.0' 2.5' 3.0' . 3.5' 4.0 LU d ky At,# f AO 4.5' p 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' u..... 8.5'. 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed A1,4 /V Indicate level to which water level rises after being encountered Deep hole observations made by: Date. v Design Professional Name: 2�N1f34, �, !7ej v!f _ �� N� Address: Q J. QO,'V `� �', did (` .y '•.e A i Signature: Design Professional's Seal PROJECT I D NUMBER 617.21 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM -.For UNLISTED ACTIONS :Only DART I DD(1 IF(`T INFOPMAT1(1N rTn ho rmmnlpfpri by Annlionnf nr Prnipnt snonsorl 1. APP CANT rSPONSO I 2 PROJECT NAME ! � ff -I - -- -'1�- -t-0= -- - - - -- - - - -- - - -- - -- - - - - - -- 3 PR JECT LOCI. i!ON /j/'J / / yyy ' Municipality -�•— �� — 4/I County 19!/ / A eA - -- -- -- - - t i 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5 IS PROPOSED ACTION 041ew El Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: CJA41Q V 6 f'/vA---' ' /� �► sl.T ,.y �" (,r/�C� 7e s,� 7. AMOUNT OF LAND AFFECTED: Initially r acres Ultimately 0. acres 8'. WILL PROPOSED ACTION CDMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? iYes I--! No If No, describe briefly 9- WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? M J esidenlial ❑ Industrial ❑ Commercial ❑ Agriculture Park/Forest/Open space ❑ Other Describe: 1l): ILGES C'r, 1 INVOLVE A P RA tT AP,P, Fur VA .{�R.FUbI «tr "I^,•MC6 "l Of!.!!' ?i111t.T�L fr7^, " Ff"' -'T4c^ Cv:'Et F:i.Tt iJi::L hjC1 V'PrFEBra:.- STATE OR LOCAL)? L-yes 0 No If yes, list agency($) and permittapprovals %�/ G /� f�� ✓Z 11, DOES ANY ASPECT OF THE ACT'-.N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permit /approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? E-1 Yes P-No I CERTIFY THAT THE INFORMATION PROVIOED.Ar,B�OV�EIS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: 1's" / 64 0 X17 F Date: P _ Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form befo-}: proceeding with this assessment OVER 1 --t%1 ,I — L". 'I h V,vl.l L. Ir.i_ •Y .,J LZ .J.,:1: A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617 12' II ves. q,lydin.hl• c ^ ::, -Cess and use the FULL EAF. ❑ Yes O.K. B WILL ACTION RECEIVE COORDINATED REVIEVI AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRP. Pt. RT 61767 11 No, a negative declaration may be superseded by another involved agency I J Yns n-Kb C ..COt1LG ACTON RESULT-1 W, ARY. A0V1 R,- EZFr:ECrS.4SSOCJA.TEaW.I.T.H' d {iNG 1Arw.• -:s _ •!writt_n, 1f_tegIW0) - :I irk. E_Vt.L� : ^ : ,. _ _.._. .r..: .:�....:,....- .•;.r ^4 r: -... .�, •o t.x >e•.^.......:_,..J =w _.- e::�- ._�.... x:.. s:�": : .... .� .:e -r ._. CI Existin air _ ti..__. t Existing qualify, surf acc or grou ndv.•alrr quality or quantity, noise level S, Czi51ii1Q fr atflt��e l.ifis"sOr,O"wa$Pe °prQduCtrtiri �3tYdispOSa1' -•'- potential for erosion• drainage or flooding problems? Explain briefly: I^ ' /V R% 1�, C2 AestheUC, agriCUltural, archaeologti.;a_: ^IS!nrn•...Jr other natural of cultural rnSJuiCc5, of Com.mur;; .;r iti,nb.�rhOOd cnardeter? Explain brrrefll C3. Vegetation or fauna. fish, shellfish of v.•III }rile species, significant habitats or thr°_alened Or endangered species? Explain briefly' /-/-o tie 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 /V OA-- FF C5. Growth, subsequent development, of related activities likely to be induced by the proposed action? Explain briefly. /Y cnr. C6. Long term, short term, cumulative. or other effects not identified in CI-05? Explain briefly. /Vf ,Y �. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. AL/ aiVrte:. D. IS THERE, OR IS �-771�TH�'ERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes Lwvo If Yes, explain briefly ,..°'__._ -a ._. "La-- •-o%,o ».- _- ,....► .o_ . o.....-.. �....., �r-::' �..: a.:.::: �.. 4,..> �.. se- a-. e�...'.:; �y. ,:e- _.__'o^...= .a-= ,_�-- -^+=�' a- m -'..., .. --- ,.•m- wo.�r:. -.o-.•: Y.r. ..: __ ...�:.�a_ PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any .supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: ame Print or Type Name of Responsible Officer in Le ad Agency Signature of Responsible Officer in Lead Age7hcy to • L Agency Title'of Responsible Officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SE V CE SS, LETTER OF AUTHORIZATION Located at yfl2 lu T/V 4a%!/� Tax Map # �%/ Block �_ Lot i 2z Subdivision of oe j / _ f' Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize IM /V a duly licensed Professional Engineer _� or Registered Architect to apply for the required wastewater treatment and/or water supply permits) 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 in conformity with the provisions of Article 145 and/or, 147 of the Education . T:t Law, and the P�n ��Co Very truly yours, Countersigned: Signed: P.E., R.A., # (-y r of operty) Mailing Address /•�-Ll Mailing Address: C-OitiAACA LV� 4 State Zip Telephone: ZLp ---g o � State N Y Zip IaS7 7 Telephone: ' ` NOS S Form LA -97 DANIEL J. D/®lpe�1'AHL�E, P.E. T 120 Breckenridge Road Mahopac, N.Y. 10541 914 -628 -7576 November 10, 1998 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Adam Steibling Dear Mr. Steibling: RE: SSTS Permit & Well Permit Horton Hollow Estates Lot #6 Horton Hollow Road Propert y of Bauer Putnam Valley Reference is made to your telephone message of November 9, 1998. I have signed a sealed the drawing; however, because of the relocation of the SSTS, it was necessary to relocate the well in the location shown on the plan. I have shown the locations of both SSTS and wells on the 100 scale map. I hope the above meets with your approval. .. .. se..a. ... _.,. �,..._ _ .... _-_.. .. Sir jv�e�.,e -� Daniel J. Donahue, P.E. Site ° Sanitary - Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _.. - REVIEW _ S �1N,FviI3 +u STREET LOCATION �`� ZTa+L[ �+ �C c�Ylr"fL� NAME OF OWN R REVIEWED BY RAI, GR AS MB, BH I.� ! q �g TAX r lAP # 72 _, — Z f• (� Y DK DOCUMENTS YY� ERMIT APPLICATION. I /I IEROS S PC -1 PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLA S - THREE SETS USE PLANS - TWO SETS VARIANCE REQUEST FEE _ SUBDIVISIONVISION �r�l kfGAL SUBDIVISION SUBDIVISION APPROVAL CHECKEO_' °"`°`) PfRC RATE P?L.L REQUIRED DEPTH RTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP L LEGATED TO PCHD DEP APPROVAL, IF REQ'D TEST HOLES OBSERVED P FRCS TO BE WITNESSED WE - APPROVAL SSDS ADJ. LOTS ETLANDS (TOWN/DEC PERMIT REQ'D ?) ITA ON DDS PLANS & PERMIT SAME (� 1? SG:,C L> fr iRr=v tTllTi�f`'. f{1Tt. -- LR BI/ZBA '[O4R. FLOOD ELEVATION OTHER REQ'D PERMITS) � REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE , G VITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS i ' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT C )+OOT NG /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS i ,TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: & DEEP HOLES LOCATED OF PRIMARY & EXPANSION OC N MAP lar REA; SHOWN; GRAVITY FLOW, SUFF.SIZE UMPED, PIT & D BOX SHOWN & DETAILED SE - NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45o W /CLEANOUT . FILL SYSTENISSYSTENIS CLAY BARRIER k0 FT. HORIZONTAL PE 3:1 TO GRADE Flbib SPECS ! FILL NOTES TION NOTE L FILL IN EXPANSION AREA TRENCH hARAtEL CH PROVIDED l� 60 FT MAX. TO CONTOURS 100% EXPANSION PROVIDED ME ON PLAN - FROM SSTS TO P.L., DRIVEWAY, i.AROF TRF,ES, TOP OF Fill. :. aijG�i�un' T';• v1- i' n ''r;L`L'S-_._.iSwELi= iui�C.__ _ PTO WELL, 200' IN DLOD, 150' PITS WTO STREAM WATERCOURSE LAKE (inc. expan) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits -20') INTERMITTENT DRAINAGE COURSE x'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' - <I% WMIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10, FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION 7 �tily CONSULTING ENGINEERS ,(X_Danicl J. Donahue, P.E. - e 209 Breckenridge Road Mahopac, N. t. 00541" 914- 628 -7576 TO�✓ WE ARE SENDING YOU C ❑ Shop drawings ❑ Copy of letter LcETTIEN ors TURS0NOVUL DATE S /< L) JOB No. ATTEN TI' N RE i X X U nder separate cover via the following items: Print ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ��For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted BAs requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS Oklyesubmit =copies for approval • Submit copies for diEtribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: September 22, 1998 DANIEL J. DONAHUEq P.E. CONSULTING ENGINEERS. - 120 Breckenridge Road Mahopac, N.Y. 10541 914628-7576 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Adam Steibling RE SSTS Permit & Well Permit Horton Hollow Estates Lot#6 Horton Hollow Road Property of Bauer Putnam Valley Dear W Steibling: Enclosed herewith please find the following: 1. Form PC -1 2. SSTS application 3. Well permit application 4. Design data sheet 5. Letter of authorizati m 7. Short EAF 8. Four copies of construction plans 9. Two sets of house plans. Comments: Your prompt attention would be appreciated. By: Daniel J. Donahue, P.E. Site- Sanitary,, Environmental - Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 MEMO To: Dan Donahue, PE From: Adam Stiebeling Subject: Bruer SSTS - PV -25 -98 Date: August 5, 1999 Ci'^- m'•(�.T vC i ^.�.. K= T._ -u'f. 4' •rte Associate Public Health Director Director of Patient Services � rt 99 A final inspection for the above referenced property was conducted on 8/3/99. The following items require attention: Uncover septic tank for size inspection. Clean out "concrete spillage" at tank baffles. /Install cast iron pipe - house to tank. �-Ur , '1vex ofiti- t—1 �n« v�nr+.� �:^_4- - �b ii.sp., -c iou: :i1jpC 10x1 ot.. . v bend is required. /5. Remove all trees within 10' of system, specifically tree at the northeast side. Y Well not drilled in approved location on plan. --- \ ,0 c j0gJr-,0 �/ Erosion controls measures not installed. Please schedule an appointment to conduct a reinspection. You may contact this office should you have any questions. ABS:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES FINAL SITE IISPECTION % l Rafe :_ inspected by: - ry w �� Owner % ;r4_ Town Permit ;z T V' — 2.5 TikI rr ? 2— i' Z .1 b Subdivision Lot T 1. Seiyaae 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 / etlands ...... ............................... II. Sewage System a. optic tan. size -1,000 . ........1,250.........other.... b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. ivlinimum 2 ft.Original soil between box & trench -Is Junction Box properly set.................................................... , engtFi required ' Lengt instll 6 2. Distance to watercourse measured Ft.......... J. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %z" diameter clean .................... 9. Depth of gravel in c........................................ ._..,..i g. Pump or Dosed Systems Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans ................... Number of bedrooms ....................... ............................... IV. Well a. —Well Iocated as per approved plans . ............................... b. Distance from STS area measured ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ...................:........... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... FA C0NYNi TENTS _1114 (MSPa'zT- rt-i=i r t4 v Tie ins Measured by Tape UNIT A B SEPTIC TANK 13 76 DIST. BOX 45 44 83 End of Trench 197 30 2 98 37 3 100 42 4 103 49 5 105 54 6 50 100 i 7 44 98 8 39 97 i 9 33 95 10 28 94 ASBUILT PLAN SEWAGE TREATMENT SYSTEM HORTON HOLLOW ROAD HORTON HOLLOW ESTATES LOT PUTNAM VALLEY (T) TM# 72 -1 -24.16 DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 628-7576 MAHOPAC, N.Y. 10541 DATE: September 19,1999 SCALE 1 " =30' SURVEY BY: BADEY AND WATSON. 35C S BUFFER n.�N� J6C 84 85 a 37C 1' ��nth Set tyP M i i. F i • I i c; r Set Loth /Ch Itn i I I i i u Set Loth r I i r � t . Lott, se f t ,_r' Lath S`_ ''•^ILoth set Set Lo Lath box. e y Electric it PWe StePS 0 > ere V'17- .0 t � � . 3 i 1 1 1 1 1 I r r r i i 1 t T r I lr i N �O ai �l. i� t M1. E m t Sete' pt ,� Se Pin , 1 r. h Sep 3 S STS A-S RL41, AE - 1- ..:'. t THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTBL_M AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE R WAS COVERED OVETt THE SYSTEM WAS CCMSTRULTEp IN ACCORDANCE WITH A STANDARD RULES AND REGULATTONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THR NR {U vnno )i a, xi 5-7-Ou 70-21 1 _9R" 1-500 0 000' 18.' L 83.07 O O O Q; :P lQ XUttl" +!VVili Ia1a1.�� fl- 71n0VI 1TdM xI t t � i , - - - - O - -f (low 57 7 to sus \1� 00� M' slQ— '��IU an�nS '9S 1 p alb -� i o ; W 'ST .:4 iJV130�9s7'c's�rd t r C -. -' 5 OM -� Cl ell �o�Pea 68 ;s ova •n :r��..— �� /_ -z 1 � _� � , >.. � ,nPus - [< —'� ✓� __ ,l yudj _-� /DUG�fa�� ID007 .LL ft . dde .,g£ a e 5 D \ y ao o t ., >y,Jo .� o `� ` \ •ice \ \C� i ."' a4111 or • - of the r wr _ �SR�'v 4P, p ®j .pp.o. • 1?. This pl �asti i - - area I '�- Qr ` \O N e 1 /ond `Gona1, _� -- Edo ?� U. �d i, 14. TDee 5 QLO \ ` -129 - 6: { r i 6 �. �' The \ z S,�.CsFEDeTt <t, P� - i �. s T arlO - / / - / / [rem VC.- __ DrsY,BAria a 'r7ccrs 3� �1 � -. P � i - \ 3, Conti° /- 11. S- - -�— T c ,�\ \ U2 y- 0 s /i <i ✓ / <<i <lfii —_�` �So 1' f�1/ \`1 00 Ci 6 AD n1 J 7 P� x O OII �- r! :/' 32•� °'P' _ - -- WAJ � � ;�� .. -c "-a -. � ( •�i _,�,. .� :_ /�_,...� vim. t s a . ? fNICT'RIRIITION :ROX ®ET ..i �.I �i