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Home My WebLink About3178DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72.-l-24.17 BOX 26 03178 I. 7 } 03178 r , t 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # �'Y 3 5 L o Located at Town or Village,, /77a r-7 J� y Subdivision name 14/2 �j�/r�a,i Subd. Lot # 7 Tax Map 7-2 Block f Lot z 4. j 7 Date Subdivision Approved IW4 Renewal P-1' Revision Owner /Applicant Name Alcr r y /3%i LJ / Date of Previous Approval Mailing Address 3 7--�- �iy i,J ✓�% � %�o d � .�H�a rr � ��/ 1�� ZipJ�'.5 -"7i Amount of Fee Enclosed 3 ev1", Building Type /'��i��r�GG Lot A=5 -AAA No. of Bedrooms -4 Design Flow GPD is e)r' Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 - :5 gallon septic tank and 4 Other Requirements: To be constructed by 4 G1/ » ef, Address Water Supply: Public Supply From Address a.._ - -- Ul.' ` %I,vatC Su�'plyLla11G 'Uy 1V �'7 -•;, Gs- �.�- tom,,.+ �.:.L55 I 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: zf Address APPROVED FOR CONSTRUCTION: Tl sewage treatment system has been completed modifi when considered necessary by the F a new &rmit. .Approval for discharge of do By: — White copy - HD R.A. Date eyr� License # -P 4i J'2 -� ,?V P o years rom the date issued unless construction of the CHD and is revocable for cause or may be amended or Any revision or alteration of the approved plan requires ae onlv. , t Title: copy - Building Inspector; Pink copy - Date: 9 Z�, copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER W_ELI.%- _ please print or type V _ PCHD Permit # V Well Location: Street Address: pp �'Xv�"' g11e�� Tax Grid # �/��d� /f✓Ci� Map 72 Block / . Lot(s)2.4.)7 Well Owner: Name: Address: / 9'�Sr' -r 1�u,�y /'!?J( /'/-" a%�'I Use of Well: esidential 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 4 Est. of Daily UsageFogal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling e-"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 ai Is well located in a realty subdivision? ..................................... ............................... Yes A-, No Name of subdivision � Lot No. 7 Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village —° Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. *A:. ��'�a3� Rp� ?i �� Sikriaturi;: ,Da __. 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 war well driller certified by Putnam County. ® le Date of Issue Z Permit Issuing i�al: Date of Expiration . ^ Title: �� If tl Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property. of ��h r� ` dL le d d Located at TN of Tax Map # %—' Block / Lot > y 7 Subdivision of AV /47 � � /vim Subdivision Lot # Gentlemen: Filed Map # 26 5 ,5� Date Filed iifi ?_�Z 37 4- This letter is to authorize � ti �/ i ✓�� a duly licensed Professional Engine r /1� or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health utIlulir ;3ui,cj� .,U WALy..�.;3.'1c : , 7� Countersigned. P.E., R.A., # _ a�� Z Sssa, P� Mailing State s .� ZIP Telephone: — Telephone: Mailing Address: State Zip Telephone: '6-2- �% %✓ Form LA -97 ,PUTNAM,COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P f'f - 3 Located at Subdivision name P57 ,�v % %rw5ubd. Lot #__2 Date Subdivision Approved Owner /Applicant Name Mailing Address .3 TS C 1 -/0 j") Town or V illage P )mow rr, Tax Map 9 z. Block 1 Lot 4-,17 Renewal Revision /yQ 1.J /" y Date of Previous Approval Amount of Fee Enclosed 3 Uu Zip 10 -s'71 Building Type �5�'4 �n G L. Lot Area No. of Bedrooms 4 Design Flow GPD Aav Fill Section -Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /? 5,v/ gallon septic tank and �� -4� ,J Other Requirements: To be constructed by r, r- / Address Water Supply: Public Supply From .. :_...._.....:_.__ ... -, Address or �,, ,Private Supply Drilled by ~ /�' �- n c�-s �� y - Address /�� rg er 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 treat rr ent system during, the period of two (2) years immediately following the date of the issuance of the approval of the Certifjzate of Construction Compliance of the original system or any repairs thereto. !� �.,� %(� ✓, �..'P.E. of c�w e 3 amv6i Signed:y A Address '� 9 i-7 APPROVED FOR CONSTRUCTION: This approval pires two years fro a We ss construction. of the sewage treatment system has been completed and inspected by the PCHD and is r r may be amended or modified when considered necessary by the Public Health Director. Any revision or a proved plan requires anew per,it. App kvfed l isc rga� f domestic sanitary sew e only. By: '`: —1 � Title: L t_ Date: White copy - HD File; Yellow copy - Building inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -91 PUTNAM' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEM _.... _ . . ,,..y.... ..... - .:..... - -a:. � - »- ..-. -. '. i�2f�F""':: �;." i'' 4Ji: Ji \TtiY'rii"iiY�rirYL��Cl�'L�jr.:• -. _...- � .. .. .....w._.._ '.. ..0 r - NAME OF OWNER: 1404A4 16 STREET LOCATION: REVIEWED BY: RM, GR; AS, PATE: TAX MAP #: (CONFIRMED) Y N DOCUMENTS (.e!5C_)PERMTT APPLICATION ()(_)WELL PERMIT OR PWS LETTER UUPC -97 % . (Q( _)LETTER OF AUTHORIZATION C—)(-_)DESIGN DATA SHEET (DDS) ()(_)CORPORATE RESOLUTION C_JUSHORT EAF ( -JL,)PLANS -THREE SETS C_)UHOUSE PLANS - TWO SETS U(--_)VARIANCE REQUEST SUBDIVISION U( )LEGAL SUBDIVISION U(___)SUBDIVISION APPROVAL CHECKED C--)C-_)PERC RATE U(_JFILL REQUIRED DEPTH ()(_)CURTAIN DRAIN REQUIRED GENERAL (�( JLOCATED IN ATERSHED UUPLANS TTED TO DEP (� GATED TO PCHD DEP APPROVAL, IF REQ'D C.Li UDEEP TEST HOLES OBSERVED (—)C--)PERCS TO BE WITNESSED (c! )(_)EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) (_)( _)DATA ON DDS PLANS & PERMIT SAME C_J(4:::jPRE 1969 NEIGHBOR NOTIFICATION (__)C: jJLETTER BI/ZBA (� ESTING LOTS >10 YEARS OLD REOUIIIED DETAILS ON PLANS (` 1(�- -)SEWAGE SYSTEM PLAN - (NORTH ARROW) ((� SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 0-12'CONTOURS DESIGN DATA: PERC & DEEP RESULTS EXISTING & PROPOSED .WAY & SLOPES, CUT ING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES (Q TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# OF DRAWING/REVISION Zc.�DATE (M DAT REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U(_JPROPOSED FINISH FLOOR AND _,� BASEMENT ELEVATIONS (/ �WELLS. & SSDS'S WAN 200' OF SSTS .((_) PROPERTY METES & BOUNDS EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 YY N (REQUIRED DETAILS ON PLANS CONT'D) U)UHOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON ( !(ENO BENDS; MAX BENDS 45' W /CLEANOUT RENEWALS «fC__)SITE NOTE (NO CHANGE) FILL SYSTEMS �EFILL 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS/ FILL NOTES 1 -5 C:�FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN 2 FEET (UU CLAY LL CE C TION NOTE (�UDEPTH UUVOL. PL FOR R.O.B., UNCLASSIFIED & IMPERVIOUS UUSEP TION DISTANCE FROM TOE OF SLOPE TRENCH (.e/C__)LF TRENCH PROVIDED Ll IV 60FT MAX. C_,�)(�PARALLEL TO CONTO I 100% EXPANSION PROVIDED DETAEUDUST FREE CRUSHED STONE OR WASHED GRAVEL C_O _)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (�10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD, 150' TO PITS ( �f' )100' TO STREAM, WATERCOURSE, LAKE (inc. expan.). (fj�_)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER _ ';lei(, _)1L` ;T'0:�3�A'; I�R I:�;!, (_ �t._ ?0'):. _ � - ... ___.� -•- .� ...� ... � - _ - ( (_)50' INTERMITTENT DRAINAGE COURSE C.�:�200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS UU10' MIN TO LEDGE OUTCROP SEPTIC TANK U� . 10' FROM FOUNDATION; 50' TO WELL WELL ___)DIIVIENSIONS TO PROPERTY LINES L/� LOCATION OF SERVICE CONNECTION (_JMIN 15' TO PROPERTY LINE SLOPE U6()SLOPE IN SSTS AREA ` =x(520 %) (__)( kEGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS (__)(_)PUMP NOT, S (�(�DOSE 75% P OLUME/DOSE VOLUME NOTED ((__)DETAIL FOR RC MAIN, (PIPE TYPE, ETC.) C—)( _JPIT AND D-B S WN & DETAILED U(�1 DAY STO G ABOVE ALARM CURTAIN DRAIN (__)USTANDP E ' BOTH SIDES, DETAIL C__,)C_)15' MIN 44>5%,20'4%, 25' -3 %, 35'-1 %,100 % - <1% UL___)20' MIN t D ISCHARGE /100' with 182 cons day discharge (�( _)10' MIN to ON- PERFORATED PIPE PUTNAM COMITY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ � - . _ ..- .. ":�� -.. . - . _> ' � -+• _ ryP.. -. . '� o-- ; . .. _ ..a -. . _.._ ,..';t- .... °PCHD Permit # , ..... � ca d.+ please print or e —�,3 -6 Well Location: Street Address: Town/VillagS Tax Grid # //a /4/1 e�r✓ xl , y/ r i t !1 a-1� Map /.X Block 1 Lot(s)2#J7 Well Owner: N �� Add 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 :5" gpm # People Served -�K Est. of Daily Usage d'�lv gal. Reason for Replace Existing Supply Test/Observation Additional Supply . Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No j-- Is well located in a realty subdivision? ...................................... ...........:................... Yes k' No Name of subdivision erg Lot No. Water Well Contractor: ,si0crrrlan e#Zg�Kr,3 e n Address: z% 017 _,V Is Public Water Supply available to site? .................................. ............................... Yes No P" Name of Public Water Supply: —' Town/Village --� Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date; Ydc!r✓ Sal, °sa;.��' ..�'+plicar�t 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 b Putnam County. Date of Issue l 2l ®O I Permit Issuin Offici Date of Expiration I I z o Title: Permit is lion- Transfers ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES t,;a _„r ..�,.u•: ..., cv, ..,.. ,,.� -::..0 ...:.,.- s... -r ss..,..�..r. -, ,: .�.:._, _, .::_v. -: Yrt' - w:...� :.. ... ,:•x -.�... v. ,,... . ea; ..._. ._.:y,. .; ...ti... -. �....- :.... .. — .•u' -. ra: •.. .n_.. ._. APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: 3. Location TN: ° 4. Design Professional: �� /j�/p,✓j 5. Address: 2,97?- 6. Type of Project: /'V, _,4<'Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? i4/01d Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... .✓d 9. Has DEIS been completed and found acceptable by Lead Agency? ............... -Vy .10. Name of Lea - - ..... d Agency 11. If this project,is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... y �1 12. If so, have plans been submitted to such authorities? ........ ............................... t�� 13. Has preliminary approval been granted by such authorities? egate granted: 14. Type of Sewage Treatment System Discharge ................. surface water J / groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? 18. If yes, name of water supply ..... ............................... AA2 Distance to water supply o/ 1;41 19. Is project site near a public sewage collection or treatment system? .............. ... /V'o 20. Name of sewage system Distance to sewage system K40 21. Date test holes observed 22. Name of Health Inspector Form PC -97 , w.. • S.- 2 23. Project design flow (gallons per day) ................................• ............................... do L4. �j4�L,ta..� v�:�:ta:z .., s�. lzarge- �ulai" c�lIu' �: vn�� -Sy..�eti�1- (S "1��D�ES��.•,,r ..�t.re�ut.�d.. .� - -•- /��.,:,;R . . -_ ._ ... �t 25. Has SPDES Application been submitted to local DEC office? 26. Is any portion of this project located within a designated Town or State wetland? Ma 27. Wetlands ID Number ............................•........•.................... ............................... -- 28. Is Wetlands Permit required? ...:.............. . . .. ..... ............................... A110 Has application been made to Town of Local DEC office? 29. Does project require a DEC Stream Disturbance Permit? .. ............................... /✓'o 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous Taste disposal, landfillitig, sludge application or industrial activity? ....I........ Yes/No AI° 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any �V other potential known source of contamination? ... ............................... Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... 4/o 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................................. ............. �✓� t e e y —atn- imt- are asi:in- excess of 152/ * -s . ..�.r -, - .►.-.- ...�. ..-.. ...c y-a-t-rn- . �...`... -+e -�. .y. ......y. . ....p.r�w -�.. -. ... ..- :.'�'.`- er -,.__ �..m � _ .._. y, �.. moo- •-a.- � 35. Tax Map ID Number .......................... ............................... Map 72 Block / Lot 2,Y •/7 36. Approved plans are to be returned to ..... Applicant k--," Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... ,✓ WI-47 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE, SEWAGE TREATMENT SYSTEM Owner Address 3 A6 Located at (Street) cad Tax Map t7�'Block �7 ot nearest cross street) Municipality Watershed i/ SOIL PERCOLATION TEST DATA Date of Pre-soaking :&ZZ1041 Date of Percolation Test .......... De v to .a er.::::::.:.:. Water rom Ground Level -H Run No T ime a EIa pse. Time . Surface (Indies) Start Stop Droppn IncTies Rafe . ..... NO CIZ, 3 -3 2 'lore 122, -2� 4 5 2 23 z3 3. ;F 3 2; 4 5 2 3 4 ..7 NOTES: -L. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s l.min for 1-30 min/inch, 5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA .2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ffoLp G.L.H` Sly : Ord/ Syi i 0.5' 1.0' 1.5' 2.0' S G ,�C K' cl 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' PAI E:1i1 8.5' 9.0' 10.0. ..mac -i z' c� . _ .•q.• .. �. ... .. _ . >��..... .. - �ci �.. ... ._ _.. ':;�._..... -_.__. � ' ° _ -�. .. o- ..... -- ..�.. p�!�A/!� _Y,_,!"'�."'� °,... --- ,... =.vim. Indicate level at which groundwater is encountered c� Indicate level at which mottling is observed �' 1 Indicate level to which water level rises after being encountered Deep hole observations made by: ,�. %/) %aI Date,/ Design Professional Name: V Address: 24 7 Z r y, � •}- O r f ,r e. Y o /.k .kv VIiYi Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E_ NVIRONMENTAL HEALTH SERVICES. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 7e de I Located d t (S t r e 6 t) -Ile i A; e Tax Mal) 92 Block Lot 2*4 7 (indicate nearest cross street) Municipality t �'.,, W J/ /ray' Watershed SOIL PERCOLATION TEST DATA J� Date of Pre-soaking Z�z /z L/, C' Date of Percolation Test Form DD-97 .. ...... .. ...... ep I .to ..... .... .. . .... . . From Grognd ..... .D ... 1 p erc6 * ...... . . ....... ... "une Ufa se Time Surface . n.c es. 'S Dropp In Rate 0: e R, .......... ... .. .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . 3 4 5 z 2 23 3 147Y 4 5 2 3 NOTES: -Tests 0,4eiepeated at same depth until approximately equal percolation rates are obtained at each ...percolAiibntest hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min inch) All data to be for review. 2. _-,.submitted Dipth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. HOL)✓ G.L. r r S %i o f t'd° 5c "; 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7:0' 7.5' 8.0' 8.5' Gly 9.5' 10.0'. ; cla y �. '.. -\ Indicate level at which groundwater is encountered g"® Indicate level at which mottling is observed° Indicate level to which water level rises after being encountered 5 4/, Deep hole observations made by: ) L-alo-Z Date --� Design Professional Name: vj j ;i n r/' Address: W 7- h c ce> r} v' t Signature: . Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- LETTER OF AUTHORIZATION RE: Property of k&--n r CC u d Located at ✓ice - -�� f� /�u �/l! Gr Mfg Tax Map # % Block 1 Lot 1 LL Subdivision of 1 b/) %/c ed Subdivision Lot # 7 Filed Gentlemen: This letter is to authorize cw� a duly licensed Professional Engineer I/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter. and to supervise the construction of said wastewater tretment and/or water supply systems in ronfo _r*r�±��vi ±l� ±he.�rovisions: ►fP* �,le l45,a_nd /or�i'�" y':T C'ilitd�i�U11;L, lkl_: �e.D.i!bl*.; kc;.1� !. - -. - �" ' ^Law; and the Putnam County Sanitary Code. Y Countersigned: P.E., R.A., # _.� Mailing State /% Zip Telephone: Very truly ours, Si ( of Property) Mailing Address: State Telephone: Zip Form LA -97 k T7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH- SERVICES LETTER OF AUTHORIZATION RE: Property of // &-n r Located at a i411"l 0 T/V&/�yr& �f e - Tax Map # Block 1 Lot 1q ° 17 Subdivision of G' 4d% Subdivision Lot # Filed Map # 2 6 35 Date Filed Gentlemen: /JV 9.5 This letter is to authorize a duly licensed Professional Engineer p," or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this R rnatterand to supervise the construction of said wastewater tretment and/or water supply systems in forrr�ity with IQ movis -�o�s of A tic1P 4S: a_c_� /..or...1.47 !n�£thP Fslaaca_ti n L- �y�- t e7 o Q � ;- Ae- �L.J��,L I,aw, and the Putnam County Sanitary Code. Very truly iours, � ell C�outersigned: Si P.E., R.A., # ( of Property) Mailing b� State Zip Telephone: Mailing Address: C C State c Telephone: " \ LOA I —zip s2� �i"IS Form LA -97 " J.fec,28 99 03:52p BUILDING DEPT 91452G880G p.1 TOWN OF PUTNAM VALLEY I- I SEF 0 8 1999 PERNUT WAIVER iJLI;'a`�'' CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANTISPONSOR: PROPERTY LOCATION: September 6, 1999 September 6, 2000 Henry Mauro 375 Church Road Putnam Valley, NY 10579 Horton Hollow Lot # 7 TAX MAP #: 72 -1 -24.17 SIZE OF PARCEL: 8.188 acres ZONING: CD PROPOSED ACTION: Construction of Single Family Residence, SSDS, Existing Driveway within wetlands buffer area MATERIALS REVIEWED: V 1: u Application Materials, file # WT -311, dated 08 -19 -99 DATE OF SITE INSPECTION: September 4, 1999 SITE INSPECTION COMMENTS: 1. The small wetlands area previously flagged with #'s 50 -58, represents an isolated wetland pocket at the bottom of a slope area. It is not large enough to meet the size criteria outlined in Chapter 144. 2. The proposed house location will be moved closer to end of the dirt driveway and be positioned in a relatively flat area that had previously been cleared. The area selected is outside of the 100 ft. wetllands buffer area for the larger wetlands to the south- I paw a re ma P . � uropw Dec'28 99 03:53p • r' BUILDING DEPT CONDITIONS OF PERMIT: 9145268806 1. Construction shall be in compliance with approved site plan. All conditions as noted in above approved site plan to be implemented as shown. 2. Erosion controls to be installed along the entire length of the 100 ft. wetlands buffer line that runs parallel to the proposed house and septic system. When erosion controls are required, they trust be maintained properly throughout the construction process. am remain in place, until final site aupections for compliance with conditions of permit have been completed. All of the above erosion controls must be inspected by the Building Inspector prior to the onset of construction. 3. Existing culvert to be replaced with a new l2 "culvert where wetlands crosses underneath the existing dirt driveway. 4. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. S. The permit shall be prominently displayed at the project site during the undertaking of'the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes, Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. P.2 .__... : ; ► n ieilt- ♦a lvec , dlU I�1) feSUll l a NonCom.pia � n` w �J Z i:u u,•uiluut '0 iL J < Notice of Violation and/or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Pertnit Waiver Prepared: cc: f ►pplicant yBuilding Inspector Planning Board Environmental Cotnatission Page 2 a2 September 6, 1999 Stephen W. Coleman Town Wetlands Inspector uwwopw BRUCE R FOLEY Public Health Director DEPARTMENT 1 Geneva Brewster, New LORETTA MOLINARI RN., M.S.N. Associate -Public Health ._Director OF HEALTH Road York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 ' -7921 Nursing Services (914) 278 —6558 WIC (914).278 - 6678 . Fax (14) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 January 21, 2000 Mr. Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: Re: Application to Construct a Subsurface Sewage Treatment System on Horton Hollow Road, Mauro (T) Putnam Valley, TM# 72 -1 -24.17 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 10, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Well Permit (WP 7.97 required), copy enclosed. • Complete form (LA -97) original enclosed. • Complete form (DD -97) original enclosed. The review of your. coxllmenoe once the.Department receives the - �""�" " �� -` �information'arid`aeteriiiilies "that' "the application is complete:'l�ieDepartment�will notify`you"�"`��` "��"�` -�` within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure.to submit information to the Department or to follow _ procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact meat (914)- 278 -6130 extension 2157. your, Very truly a" 4 - - - -- Adam B. Stiebeling Assistant Public Health Engineer ABS:cj - - BRUCE R. FOLEY - - - Public HealiW-Direcl,'r ' - DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA .MOL?A1- ARI-- R- N- :;:•M.S.N -..n. Associate Public Health Director Director of Patient Services 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 January 21, 2000 '�N�T Mr. Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Application to Construct a Subsurface Sewage Treatment System on Horton Hollow Road, Mauro (T) Putnam Valley; TM# 72 -1 -24.17 Dear Mr. Sullivan: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 10, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. Well Permit (WP -97 required), copy enclosed. Complete form (LA -97) original enclosed. Complete form (DD -97) original enclosed. rhe'review of your appficatiori will commence once' tlie�epartment receives the requested -- -' -- - 'rim' information and determines that the application is complete. The Department will notify you within -10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure.to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (914)- 278 -6130 extension 2157. Very truly yours Adam B. Stiebeling Assistant Public Health Engineer ABS:cj 14-1164 WSII —Taxi 12 PROJECT I.D. NUMBER iii'1� SEQR Appendix C State Envlro m milal OusOt)I Review SHORT ENVIRONMENTAL ASSESSMENT FORM v•a .�F- :_.'+Y'`�- t..�� :,r :yY:.= •....�a.< •s n-v.+..® <. �'�ti ..a.. vr. ....:.p r......_..: i..'. ��.��C•1S� :w�"`^t�. :�.s. -w.s �a..v e. .��•....�. a. ..�.v�t,.. r. -�.. �iti-.� PART I-- PROJECT INFORMATION fro be completed by Applicant or Project sponsor 1. APPLICANT (SPONSOR Z. PROJECT NAME. 3. PROJECT L ION: Municipality a "y v 0 Couni a. PRECISE LOCATION (Street adds" and Ford 111111MOG1110166. PMMWdnt Ilt141"I M- 9110., of PMWIW MV) Lai- Ale % ��•li� � /� �✓ ��, �� /d/ S. IS PROPOSED ACTION: 2�aw ❑ Expansion 0 Modificatlontalt9ratlon 8. DESCRIBE PROJECT BRIEFLY: we'll 7. AMOUNT OF LAND IMF ECTED / Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONIMd OR OTHER EXISTING LAND USE RESTRICTIONS? J2QYe6 ❑ No It No, dMrft 111 WPJ 0. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �*ildenllal ❑ Industrial ❑ Con1m9F W ❑ Aeftoltur9 ❑ P11INFor99tf009n 10809 ❑ oviv _ .._.._. _ 1 ♦'. v... rr�.1.. A - - - Y�_w �w. . ,u � •e v tY � 9Y.g_. A A�2� L� !iKQM!�- .1►�_A�EI3CY STATE LOCAL)? ❑ No If M Ibt aomoyfO end powdUfDOWW&M 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes )�rNo 11 yea, list as w y mm and pennWapvrWW 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yos No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appllcantlspotisor . nam9: Signature: It the action is in the Coastal Area, and you are a state agency, ooaiplete the Coastal Assessment .Form before prooeedinE with this assessment OVER v PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Aaancvl °A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 8 NYCRR, PART 817.127 If yes, coordinate the rwlew process and use the FULL W. ❑ Yea ❑ No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED may be superseded by another Involved agency. ❑Yes.. []No -- IONS IN 8 NYCRR, PART 817.8? If No, a negstive,declaration AULD 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 C5. Growth, subsequent development, or related activities likely to b o Induced by the proposed action? Explain briefly. C8. Long term, short term, cumulative, or other effect& not Identified In C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑.Y04 _ __ _Cl_Na.,_•.: ! . Yes, - expla!n- tM)ef!y,.., PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of ea Agency r ate Title of Responsible Officer Signature of reparer different from responsible of icer NAM COUNTYcl TAR ENT OF HEALTH r� r ION OF ENV : Fib *11t',' AL HEALTH SERVICES CERTIFICATE OF CONSTRUQf'Wrl MWOWE FOR SEWAGE T SYSTEM E, y PCHD CONSTRUCTION PERMIT # y'7 �s Located at �� /�� %� ►.y /� c7 mt Town or Village, -,� a �' Owner /Applicant Name' n , i ; �, Tax Map 72 Block / Lot T Formerly Subdivision Name IX11rx7 Mailing Address Subd. Lot # 7 Date Construction Permit Issued by PCHD i =h Zip c,i��;' M Separate Sewerage System built by i 'eA, t S %,USr� �, /a IX i kV Address gZa Y e&-w-s Ll Consisting of Gallon Septic Tank and ,{e-- Other Requirements:' %- % , 7" Water Sunnly: Public Supply From. Address or: Private Supply Drilled by Al /?z�, c e-'/7 Address /4 %c/' Number of Bedrooms ol Has garbage grinder been installed? Alc' 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: Certified by F y (DeSii Address ? �� /J,�C =•'�' %r�� ' Any pg on occupying premises served'by the aboveE to secure the correction of any unsanitary conditions treatment system shall become null and void as soon of the private water supply shall become null and P.E. d"' R.A. License # ' y j tly take such action as may be necessary ((usage. Approval of the separate sewage sewer becomes available and the approval 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. By: Title: /-�� Date: 120 Wh a copy - HD File; Yellow copy - Building Inspector; Pink copy -Owner; Orange copy -Design Professional Form CC -97 19 1 1 lu:l3l9lq962q2qS*51 P,1/1 BRUCE K FOU-Y LORETIrk MOMWRI• P-N.. M.&N. j7 DEPARTNENT OF FMALTH' 1, ripliala Road - 4. Brewster,- New YdTk 10.509• Xnvlraotuc*AfMl ROAM (914)279.6120 Fax (014) 278.7921. N-aning. ServicrA (914)219-Mit WI(; (914)219-4619 Vax(914) 3".MS WVNE RS NAAM. ' . — �!L i --- • 41—a tf�-4 ; q a TO'VVN- ATJTHO.W7,ED TOWN.,O,Y 'x; to Putnam (c4unty beparpkent of Reailth will not issue a ' , , Certifikate of ConstnictionCohiplancc iiiii iha a boVeforii bcom,pieted,i,e., a leaallol ddres Is i ii*.,sigaed by an a'itihoikid i6w� A Th f �)m is ..b d' _As all witil the 4p Akation f6r a Ceififick-te of -COn**StriicfiaA CoR kt� A 10:Z Rd 1z HAP A v,:!H AU 3 81 S PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT '0 NOTE: Egact -location of well with distances to at least two permanefit landmarks to be proviaea on a separate sneeT/pian. Well Driller's Name a6k= Address Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 . =VRAIVI.,li iMap)d Block Lot(s)Y,17 Well Owner: Tjjtme. Address: y j' Y-11 IK - Use of Well: 1- primary 2-secondary Z#6es= Public Supply Air cond/heA/pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _ Cable percussion _ Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock Other Casing Details Total length 416 ft. Length below grade Diameter in. Weight per foot I b/ft. Materials: _X— Steel — Plastic Other Joints: Welded _Z Threaded — Other Seal: < Cement grout . Bentonite Other Drive shoe: ,Pe Yes _ No Liner:_ Yes __ se No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped I Compressed Air Hours,?-kl Yield 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 are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type &Z Capacity Depth AD Mo Voltage.2-36 HP Tank Type 3407-' Volume ly 31 Date Well Completed e Putnam County Certification No. Date of Report Well Driller (signature) NOTE: Egact -location of well with distances to at least two permanefit landmarks to be proviaea on a separate sneeT/pian. Well Driller's Name a6k= Address Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUYI Y 4 JUN 24 Owner or Purchaser of Building Building Constructed By /. Location - Stree`t Pfd 2 :.f� � �,%,� 7 Section Block Lot •f�� ti,� ;�� -' .mss; � Subdivision Name Municipality ` Subdivision Lot '# Building Type GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the ��C -Arti i oats :of ;.r;�r slruct'z : CX:_:1 'I -f. or !-he sewagc- - 4 _ _xi5a 1_ =y,- tEi1.- C�r''a.�.: repairsrinace by me to such syst�n, 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 Director of the Division of Environmental Health Services Department of Health as to whether or not the failure of the caused by the willful or negligent act of the occupant of th the system. a�9f Dated this day of SAS V 'i Signature C—AeS-elk0-v-1 Valp-L)Skl Title General Contractor (Owner) - Signature T, WT Devbi , f 6 � Ids Co r Corporation (if Corp.) J-00 Cam L.s [60bw �, Q�b,�w Mlle �Y Address I o5 >19 rev. 9/85 mk the determination of of the Putnam County system to operate was e building utilizing Corporation Ndme (if Corp.) g6o 6a^0p.3 �6L6w Fj. Address YML E�UI ICES 321 v(ear �treet Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director ' LAB #: 32.404167 CLIENT #2 2173- STAT PROC PAGE: I NORMAN ANDERSON INC. DATE/TIME TAKEN: 06/16/04 10:35A 152 BAKER ST DA /TIME REC'D: 06/16/04 11:30A PUTNAM VALLEY, NY 10579 REPORT DATE: 06/29/04 PHONE: (914)-528-1491 SAMPLING SITE: 47 HORTON HOLLOW RD :-PUTNAM VALLEY NY COL'D BY: SARAH ANDERSON NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/16/04 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 06/16/04 LEAD (IMS) 1.2 ppb 0-15 ppb 9101 06/26/04 NITRATE NITROG 0.35 MG/L 0 - 10 9139 06/16/04 NITRITE NITROG <0"01 MG/L N/A 9146 06/16/04 IRON (Fe) 0.240 MG/L 0-0.3 mg/l 2037 06/16/04 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2057 06/18/04 SODIUM (Na) 5.97 MG/L N/A 06/16/04 pH 7.3 UNITS 6.5-8.5 9043 06/16/04 HARONESS,TOTAL 112 MG/L N/A 06/16/04 ALKALINITY (#S 80.0 MG/L N/A 06/16/04 TURBIDITY (TUR 1.8 NTU 0-5 NTU ` COMMENTS: FAX TO 845-528-0409 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ubIic 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. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown'He B - ''- ° 05,I4Y~245c186G)`-'-�` Albert H. Padovani, Director LAB #: 32.404167 CLIENT #: 2173 STAT PROC FIAGE.- 2 NORMAN ANDERSON. INC. DATE/TIME TAKEN: 06/16/04/ 10:35A 152 BARGER ST DATE/TIME REC'D: 06/16/04 11:30A PUTNAM VALLEY, NY 10579 REPORT DATE: 06/29/04 PHONE: (914)-528-1491 SAMPLING SITE: 47 HORTON HOLLOW RD : PUTNAM VALLEY NY COL'D BY: SARAH ANDERSON NOTES..": KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD 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. 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 IG 6.5 TO 8.5. H -- .SS -_ I��'�O��'�P�S�0 �G�� 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: 140-3()0 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: "\ Director ELAP# 10323 EN -V `4 EAI 1.1 5F 04 JUN 24 PH 2? Ora Joe Pavarotti Putnam County Health Department 1 Geneva Rd. Brewster, NY 10509 June 24, 2004 Dear Joe Pavarotti, Gershon Palevski, Architect 260 Canopus Hollow Road P imam_ValleyIN, :: X79w Tel. 845.528.6073 Fax. 845.528.0409 Enclosed you will find all the necessary paperwork for the final approvals for the new residence at 47 Horton Hollow Road in Putnam Valley, NY. The closing date for this house is on June 28f. We would greatly appreciate if you could expedite the process to accommodate for this upcoming date. Thanks for your time. Sincerely, Gershon Palevski, R.A. I�; .. +v• o <. _. <o...._<.rlC�. =�-,� . .r'� -. a:.,a -�-: ::.o.. �-w:f_ +r G,r.S. u. .. LORETTA MOLINARI Public Health Director June 4, 2004 :.-'T+ �........o . i - . r a+- s. rr�-n� v .o`-c:.- :rG�,'n:: ►.. -. .._. _ ...'•.a`r- :,...,v ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Iniervendon/#reschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: C"'/ . Field Inspection — Farmiga 47 Horton Hollow Road, (T) Putnam Valley TM# 72 -1- 24.17 A site inspection was made for the above referenced project on June 2, 2004. The following comments must be corrected in the field. " V104 P I Cast iron pipe needs to be inspected when connection to the septic tank is made. Clay barrier needs to be completed for the expansion area. Toren f eet f o trench needs to be adde • ~p - =,/ �li� YiY� 66ir rY uA tt 1`Ltslftt11VL7UIS'CS�A fie�cYs'�c► be iminTa Gp Yh" S. Pipes in boxes 4, 7 and 8 need to be extended so approximately 1/4" of pipe is inside the box. The rocks placed inside box # 4 need to be removed. 7 Regrading around the well is needed to provide adequate drainage away from the well. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj I I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: Street Location C19 V 44 P0 1' 014/ Cu TM # a ('7J Subdivision Lot 1. Sewage System Area ju+' ,1 a. STS area located as per approved plans.... P.V. ` u ................. b.. Fill section - date of placement 9 ',mod 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 ...... ............................... II. Sewage System a. Septic tank size - 1,000 .......... 1,250_4, other ................ b. 'S eptic'tank installed level ................ ............................... c. 10' minimum from foundation ........................ .....::......... ... d. Distribution Box 1. All outlets at same el -water tested...., 2. Protected ost ................ ........................ /..... 3 Minimum 2 ft.Original soil between box & trenches r e. Junction Box - properly set .......... ............................... 6. Trenches � �,�//� �3 1. Length required Length installed 2. Distance to watercourse measured j0/A --Ft .......... l9� 3. Installed according to plan ....... .. .............. �Slope of trench acceptable 1/16 - 1/32"/foot ............. . 10 ft. from property line - 20 ft.- foundations .......... 3 6. Depth of trench <30 inches from surface .................. S 7. Room allowed for expansion, 100 % ....................:.:.. 8. Size of gravel 3/4 - 11/2" diameter clean ...................: i 9. Depth of gravel in trench 12" minimum ....... :............ a 10. Pipe ends capped.........._. �/ ... f Wig.. Pt m .;or; -Dosed S ste^ss /..:... i % %. .� - -� T''Sue of pump c ambe 2. Overflow tank .... ....................... ............................... 3. -Alarm, visu udio ........:........:.. ............................... 4. Purn y accessible, manhole to grade .........:....... (o rst box baffled....:. �g -6. Cycle witnessed by H.D.estimated flow /cycle........... �6�•$i. House/Building a.. House located per approved plans ..................... b. Number of bedrooms .................... ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured D J * - 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 dram outfall protected & dinto exist watercourse g. ,Footing drains discharge away from STS area ............... h. Surface water protection adequate ........:........: ................. i. Erosion control provided ................. ............................... Rev. 12/02 I j `►— I tr -- i M-I NAM COUNTY. DEPARTMENT OF HEALTH ION OF_ ENVIRONMENTAL 'HEALTH SERVICE_ S �CTION PERMIT FOR SEWAGE TREATMENT SYSTEM H v M D PE #� Located at ft/ 1-4? lea Town or Village Subdivision name /w �,4,., &,d /Subd. Lot # -7 Tax Map 7 2 Block _/ Lot 2-4. d 7 Date Subdivision Approved y f f 'r Renewal Revision Owner /Applicant Name C7-11-jili sta j) dor -- �jare ri, Date of Previous Approval s/o Mailing Address _ % Dd re-6-7 �� -y�. -2- WG:s Zip 4j 'e Amount of Fee Enclosed � ' 6> Building Type, � dew -d e Lot Area � 17 No. of Bedrooms Design Flow GPD 0-aei Fill Section Only -- Depth _ Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and s ✓°' -`6 • °= Other Requirements: /jT ldc e4eo 60q To be constructed by (9 fti7 Z�/" Address '°' Walter. Sumnly,,.. Public Supply From Address or: _ PPrivate Supply Drilled by ;iloi ,�2 /me- e ' &� ddress ' - ✓ "`-'-� -- ___ _ _ _� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and -that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. i /OF NEB\ Signed: Address P.E. R.A. Date /� o License # 2, Y APPROVED FOR CONSTRUCTIWuealth xpires two years from the date issued unless construction of the sewage treatment system has been comp by the PCHD and is revocable for cause or may be amended or modified when considered necessary by thDirector. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 w . _. _. DMSION OF ENVIRONMENTAL HEALTH SERVICES LE7TBR OF AUMORELATION RE: Pmerty of Located at /�%�/' /�► �� s✓ �,r� _ TIV A A o . Tax Map # Block � Lot ' of Subdivision of /,_, ��✓ _5�� Subdivision Lot # Z Filed Map # Da e.Filed Gentlem m: This letter is to authorize Lt / a duly licensed Professional Engineer _ or Registered Aiddmct to apply for the required wastewater treatment and /or water supply pamit(s) to save to abovoanW property in acmdance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to suet all necessary papers on my behalf in eeon with this matter and to supervise the conamcdon of said wastewater tntnent and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Heft _ Lai, and the_Puteam. Co=ty. Sarutaw Code.. _ _ _ _ - _ .... _ _ .... Very truly y VCO Signed: (owo.r FMPM) Mailing Addy � ,��' -Ojjlina ddroas: � �er� a ve- r aZ State a - State Zip DOD Telephone: ;&A, y Telephone: (903— Oa�P'" I �� Form [A-" C/ PLASTIC PIPE: FRICTION LOSS; PER 100 FT.' GPM GPH- -3/811 1/2 ff 3/411 VVE 1� Ft. Lbs. Ft. Lbs. Ft. Lbs. Ft. Lbs. R. Lh:i;. Fl. Lbs. 1 6C 4.25 1.85 1.38 .60 .356 .155 .11 .048 2 120 15.13 6.58 4.83 2.10 1.21 .526 S8 .164 .10 3 18C, 31.97 13.9 9.96 1 4.33 2.51 1.09 .7-7 .336 j A90 •160 i .10 .043 i 6 oil 4 -�300 240 54.97 23.9 17.07 7.42 4.21 1.83 U20 .565 K5 5 134.41 36.7 25.76 11.2 6.33 2.75 1.92 .835 12. 3 .2-4 .104 6 360 36.34 15.8 8.83 3.84 2.69 1:17 .71i IC6 .145 8 10 480 600 63.71 97.52! 27.7 42.4 15.18 25.98 6.60 11.27 4.58 6.88 1.99 2.99 1.19 j 1.78 - 1 k- - -5 .241 83 .361 15 901) 49.68 21.6 14.63 6.36 3.75 _1.1) ;'.lt .755 20 1,20o 86.94 37.8 25.07 10.9 6.,4,9 2. 'T' 1.28 25 1,5011 38.41 16.7 4,2,; 30 35 1,8011 2,100 13.62 5,9,2 18. 17 T91) 6.26 2.72' 8.2,7 a.64 40 4i 50 60 2,400 2,700 3,00o• 3,60o 2•filli 10 10.71). 4.65 5.85 -16.45 7.15 10.21 2. Z. 1113- 1 7 i �i 1 06/07/2004 05:56 9149624248 JOSEPH SULLIVAN PAGE 01 rr I PUTNAM COUNTY DEPARTMENT `0FMALTR DrMS-10N OF ENVIRONMENTAL KLA.LTR SgRVICES I certify that the synem(s), as listed, at the above premises has been confticted wild I b&N t. i, qwN whi gad verified their 1: omplefion � in accordance with the issued PCHD C(0mcdon '? e: i ak- u LJ A p p�o y e p I w,- - d; flit - S t e m 0 a r d s, M es and. R o sg uk t io n s c i f t &-j x-A Dw.: JI-100, - Certified by: A.—.1-- /.Zzc 2 PE--" f Deilp ProfeWo=l Aderen: 4Z Comments: 'k-4. ors F01MY[R-99 ATME,N'TION IJ GENE =IIUIM- MAL MR=1QN For. FM All informadon must be My completed prior to any r Trawhas inspe-,fix.s be*; made. PCHD Cons mouon Pcmnit # Loca, ,e : d ..Aa 4 &-, c�- #6 / /, a w Subdivision Nam: Subb isiouLot # Is system fill completed'? Is 3ptew wmp'xte? Is system Constructed its per plans? Is wlffl drilled? Due: Is W.-I locitted iu pc:.plans? - -- Are tro ou cojaol. measures in place? I certify that the synem(s), as listed, at the above premises has been confticted wild I b&N t. i, qwN whi gad verified their 1: omplefion � in accordance with the issued PCHD C(0mcdon '? e: i ak- u LJ A p p�o y e p I w,- - d; flit - S t e m 0 a r d s, M es and. R o sg uk t io n s c i f t &-j x-A Dw.: JI-100, - Certified by: A.—.1-- /.Zzc 2 PE--" f Deilp ProfeWo=l Aderen: 4Z Comments: 'k-4. ors F01MY[R-99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT ` : Y" °= Well Location Street Address: fo-o-1 1:��1 T wn/Vi1 a e: Tax Grid # Map r � Block f Lot(s)d'1,17 Well Owner: me: 6G�4 Address: a y • /0 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/he pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length O ft. Length below grade Diameter in. Weight per foot lb /ft. Materials: LX_ Steel _ Plastic Other Joints: _ Welded _X Threaded _ Other Seal: x Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes _No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield ?"_ gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well itg feet R If Well Log If more detailed information descrtpnons or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface G " -- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _ 7 Depth oZ42) Mo �- Voltage-2 36 Tank Typeo.510?! Volume Date Well Completed A� Putnam County Certification No. Date of Report Well Driller (signature) NOTE: Extact "location of well with distances to at least two permanot landmarks to be provided on a separate sheet/plan. Well Driller's Name lrJ'4Gn- � � Address/-45_ % ;: Signature: ` Zj�= �__ Date: 1%0 White nnnv- T-M FiIP- Vellnw conv - Ruildinq Insnector: Pink coov - Owner, Orange copy - Well driller i ! r �rGa d , l ? /�Gr� J / a,• R K' .� Spa axx ate, � }p� ( � Y+•y,. X mw elf F 4 1 t� 3 6a J" N ! 2 c /A ' OF ti Ci ! co 4sF s is M oftls io to owtiPy, t hat ao ooaade dlo yoeal eyetoa6 �� j w tee• , eonotrueU& as ladioatal.m Wo past and that the- ay$tem ' was luep"ted b7' ma: -b4om it -im" o6vored Drat. 4tle, sys4om coo sonstaaoteld is agoordance with all standard ruled Q334 rodulatios'no of the yutamm County Department 08 t " for lth -t3 the 11vi TOUR 9t�to Per- wtxoant of -HPn1th - �j.• / /,^j}/.J�l ergs `�!','�+ � i1x -:'p ` AM COUNTY DEPARTMENT-OF HEALTH Pj,,•. DPA ION OF EN\ARONMENTAL'HEALTH SERVICES. NUTEJ (' �,<?V -3 -o� s t7GP'ar1 � v rr k iiY App APPROVED S D FOR CONFORMANCE WITH LLLLICABLE RULES AND REGULATIONS TMEN OF THE / AM_C0111dTY HEALTH DEPARTMENT '�p��' ' �+ �' 4 '� � •'�' Cfl TITLE �r� !}this . y. .