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72. -1 -37.2
BOX 26
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IN
It I i IN 1 1 ` = mrT .4 J.
IN
7 I I �T L ' { ; 1 ■ IN
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03183
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Ted & Vicky Becerra
58 Horton Hollow Road
Putnam Valley, New York 10579
Dear Mr. & Mrs. Becerra:
March 8., 2006
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Addition Approval - Becerra
No Increase in Number of Bedrooms
58 Horton Hollow Road
(T) Putnam Valley, TM# 72 -1 -37.2
I have received and reviewed the plans for the proposed addition to the above mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp from the Department dated March 8, 2006. The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at four without prior approval by this
Department.
2. The area of the existing sewage disposal system and its expansion area must be
maintained.
3 - ,1 '�am'~in� f�, -c� d :th a`e i,l
.,.. ^� :r_ust be ui�uate u;..� .w r 5dv�
toilets, restrictors for shower heads and faucets etc.).
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
Any other permits or variances required are the responsibility of the applicant and the
jurisdiction of the Town of Putnam Valley.
If you have any questions, please contact me at your convenience.
Sincerely,
e,
CJosephS. Paravati, Jr.
Assistant Public Health Engineer
JSP:cj
cc: Building Inspector, (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
° SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health. _
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
Count) Executive
Q-,
ADDITION e,
ADDITION APPLICATION RESIDENTIAL ONLY
STREET /�' 0 ��v �Cm Gl' TOWN lG� �n L��I� TAX MAP# /7-,," �.
NAME 4eCe /'r � PHONE S - SaI S- l PCHD#dLQ!2/
/ 411411 0-
ADDRESS .�� /�v/��.� l>�/lew
DESCRIPTION OF
ADDITION
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR
* *Any addition which is considered a bedroom requires formal approval of plans (Construction permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
Please- submit, this, form and the following to Putnam County-Health P » ±_;_t . CtPnev ,g d,
1. Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #)
*Non- professional sketches are acceptable
4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, M'SN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT. OF HEALTH
I GENEVA ROAD *
BREWSTER, NY 10509
To Whom It May Concern:
Re:
Residence
ROBERT J. BONDI
County Executive
TAX MAP# 7p.* 2—
TOWN&!� A 8�— VALZ—E:7
According to records maintained by the Town, the above noted dwelling,
WsTH T.OWN 401.)—
IS NOT IN COMPLIANCE WITH TOWN CODE
LEGAL BEDROOM COUNT IS
11
This information has been obtained from:
CERTIFICATE OF OCCUPANCY: 60 -* 2 oD.W. - () 3
OTHER:
Building Inspector
Date
CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225-5186 Fax (845) 225-5418
lm
Environmental Health (845) 278-6130 Fax (845) 278-7921
Nursing Services (845) 278-6558 WIC (845) 278-6678 Fax (845) 278-6085
Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
�TSION. OF ENNgR,ONMENTA:L F� 14TP,,. Ci'.R d",F. .
CERTIFICATE OF CONSTRUCTION COMPLIANCE FO SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # 1k - dJ ` OZ. D
Located at �'� I��-� \-Zaxr�
Owner /Applicant Named `• ��
Formerly
Mailing Address
M l,,
40:� MALLAZ-�) WA--A
Town or Village
Tax Map 7Z-- Block Lot 3-�-Z
Subdivision Name GDS(: tAe�37—tnZ IA-ul)i)J(--, C_o
Subd. Lot # 'Z IM(-.' 0AQC-EL ,ice
?-Ee(-,5V4 1
Date Construction Permit Issued by PCHD 011 29 /` z
Zip ! ol'5 6(�
Separate Sewerage System built by NJAdt WD WC Address C.OP- 6 T MA)dLYZ, AJV
g Gallon Septic Tank and
��
Consisting of
t p�1+65 SPAce--Q "IfT 69'
Other Requirements:
Water Supply:
Public Supply From,
Address
or: Private Supply Drilled by ORE 5E41, ` 5W5 5 Address 15P.F-L -tea uJ LA 10 ", -
ro
y 1 . F- iD� .�� (/lam -� .iJ_nrn .n n t±�.l_1�0 n l�•�v - a fJ
��a r
-
Number of Bedrooms Has garbage grinder been installed? i� y
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 Aunty Department of Health.
Date: lZ C.Yn ®Z Certified by P.E., R.A.
De, rofes�iio�nal
Address � `� `UJA-16W. rJ L �i4 �' �� License # C&Zf3
/0516
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 w_ hen i ,t i ., judgment of the Public Health Director, such
revocation, modification or change is necessa3 i
By: 44 .'.Title: &IShA Aa 14� 6(4, Date: 3 1103
�G
White copy - HD File; Yellow copy - Building-Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
��PM CpG
BRUCE R FOLEY * * LORETTA MOLINARI R.N., M.S.N.
Director aPatlent Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921'
Nursing Services (914) 278 - 6558 WIC (914) 278 -.6678 Fax(914)278-6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: Theodosio Becerra
TAX'MAP NUMBER: , f 72.- 1.37.2
E911 ADDRESS:
TOWN: c Putnam Valley
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address. is assigned by an authorized town official. This form is to be submitted
with the application for a Certificate of Construction Compliance.
(E911 VERFRM)
1 �.
...� ...: ---- .. v . . - ,- I — v r I � r—. U4/ 04
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALT H SERVICES
GUARANTEE OF SUBStTRFACE SEWAGE TREATMENT SYSTEM
��.' -. a+. ..... :r. ^-:. �.o _.. ♦m- .:s�:_• . -. _...- a: . •-. a�— �:.•.° r. v°-::, �. e' w: i..c- .v�•rmc- ...•= •.a. +a- .�v,.. ;.a » -'.; s,ee >.1.,:a-s:r.= wr_i- sm.r...F...c- .G.:... .. -_.� -•r -.�. t'::g;.e ,..;��r..��rw+r.�a•� =,
Ted Becerra & Vicki Davis 72. 1 37.2
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by
58 Horton Hollow Road
Location- Street
Residential
Building Type
Putnam Valley
Tol nNillage
..-Westchester Holding Co. Inc., Parcel III
Subdivision Name
Subdivision Lot #
K)
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused, by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as conclusive the determination of the Public Health
_ Director of the Putnam County Department of Health as to whether or not the failure of the system .
Ll! VjJGtGL4—V1ct!�lTS�li u'� Z11G'wllli�ti lY1t,Gill aVl �]1 tii" t 'u��u�3a�3ii'uliiic`�iiiiiCY111 u�3c1I11�ti�R ""� -
system. /1
Dated: Month 12 Day _06 Year 02 Signature: /V y
Title: Septic Installer `
General Contractor (Owner) - Signature
----- .- ._..--- -.-... I......--- ..-__._._ _ Primo's Landscaping
Corporation Name (if corporation) Corporation Name (if corporation)
Address: „ Address: 7 ]Kingston Ave, C.ortlant Manor
—Zip_ State NY Zip 10562
Form GS -97
TOTAL P.04
JMS ENVIRONMENTAL SERVICES, INC.
1500 SUMMER STREET
STAMFORD, CONNECTICUT o6905 NELAC, CT and NV State Certified Environmental Laboratory
.... vc . _ Y -r �� r R` •i Mi s - '�. liv'+N.'S .r.. • �. a 9 ., f'M br:'vi+•P1e
n;'f+y:%n o..'+R�Y c- di. -S. M- �"x�fo_.s <. x. v, aic .. r. . • _• � _ .r .. .�.r' wt. v� .ro+ v- tA.'C.v .�tvY..Jr:.�.:.. w.• M' -• -. e• -- -
Mailing Information:
Name: PF Beal & Sons
Address: 4 Putnam Ave
City: Brewster
State: NY
Telephone: 845- 279 -2460
Sample's Information:
Site: kitchn tap
Preservative: HNO3
Temperature: <4C
Client: Primos Landscape
Zip: 10509
Fax: 845- 279 -6613
Collector's Information:
Name: Wayne
Address of site: 58 Horton Hollow Rd
City: Putnam Valley
State: NY Zip:
Telephone:
Date Collected: 2/27/03 Date Received: 2/28/03
Time Collected: 15:30 Time Received: 12:00
Lab No.:
Date Analyzed Test Name
Result MCL
J031078
Method
2/28/2003 12:00 '
'Total Coliform -
- Absent A
Absent S
SMWW 9222B
2/28/2003 C
Chlorine Free Residual <
<0.1 mg /L N
N/A S
SMWW 4500CIG
2/28/03 C
Color N
ND 1
15 Units S
SMWW 2120 B
2/28/03 O
Odor N
ND 3
3 TONs S
SMWW 2150 B
2/28/03 I
Iron -
- 0.115 mg /L 0
0.3 mg /L S
SMWW 3111B
2/28/03 —
— Manganese -
- 0.018 mg /L 0
0.3 mg /L S
SMWW 3111 B
2/28/03 -
- Sodium -
-17.4 mg /L N
N/A S
SMWW 3111 B
2/28/03 C
Chloride 8
83 mg /L 2
250 mg /L S
SMWW 4500 Cl C
2/28/03 -
- Hardness -
- 180 mg /L N
N/A S
SMWW 2340 C
2/28!03,._
10: -1w4
N
- 1
3/11/03 - Alkalinity
-120 mg /L N/A
At the time of analysis the sample was acceptable for total coliform
N/A = Not Applicable
S.U.= Standard Unit
MCL- Max. Contaminant Level
ug /L- micrograms per Liter
mg /L- milligrams per Liter
NTU- Nephelometric Turbidity Unit
TON- Threshold Odor Number
SMWW 2320 B
ND- None Detected
Signature. 7'. ; �. { ' -� `� State #: PH -0218
Michael Lapman ELAP #: 11715
President
Tel 203 961 9911``:T61l Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com
PUTNAM COUNTY (DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
W
lWell
Hxtm HD11CW FWd
Patim Valley, NY Map Block Lot(s)
Owner:
Name: Address:
Prirno-s IandXEW & Oatracting 7 Kirgkm Avenge, axtlm& mmw, NY 10567
Use of Well:
I-primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary _ Cable percussion X Compressed air percussion — Other (specify)
Well Type,
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 42 ft.
Length below grade 41 ft.
Diameter .6 jn.
Weight per foot lg_lb/.ft.
Materials: =y Steel Plastic Other
Joints: Welded X_ Threaded Other
Seal: X . Cement grout Bentonite Other
Drive shoe: X_ Yes. No
ILiner: Yes X No
Screen Details
Diameter (in)
Slot Size
ILength(ft)
Depth to Screen (ft)
Developed?
First
— Yes—No
Hours
Second
I
I
Well Yield Test
Bailed X Pumped X Compressed Air
Hours 6
Yield 10 gpm
Depth Data
Measure from land surface-static —(Specify ft-)-
308
During yield test(ft)
1400
Depth of completed well in feet
2MI
Well Log
If more detailed
information
descriptions or
sieve analyses ..-.-.,.
a7a V —i 7- -
please attach.
Depth From
Surface
Water
Bearing
Well
Well
Fia Wme t e ;r(i n)
Diameteron)
Formation
Description
Land Surface
41
Ddiling
41
Hit Fbck at 41
4 . I
r n
A) I
TVri 11 jM i M XC;k
gL-,apA;W
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump/Storage Tank Information
Pump-Type Sub Capacity 10:p,
Depth 160, Model IOM412
Voltage 230 HP 3
Tank Type 'WX 251 U W4
I
Date Well Completed
09/21/02
Putnam County Certification No.
002
Date of Report
10/23/02
Well Dr S*
%a%,1 us.4LIVII V1 WV11 WIUI U15MMUS LUAL 1 two permanent t am rxs to ne proyfaea on a separate sheeVplan.
PX �7
Well Driller's Name Address: 4 Rtnm b 1)
Signature:
Date: 10/23/02
FerrY
White copy: HD File; low 'copy - Buildiii 1 9 inspector; Pink copy - Owner; Orange copy - Well driller
Form WC-97
BADEY & WATSON
LETTER of TRANSMITTAL
Surveying &Engineering-
'3063 Route 91" Cold Spring, New York 10516 . �
Date: 13 Mar 2003
File No. 98 -105
W. O. # 15438
RE: Certificate of Construction Compliance
Becerra
TO:
Horton Hollow Road
Joseph Paravati, Jr.
Westchester Holding Co., Inc. Par Subd. Lot No. 2
Assistant Public Health Engineer
Tax Map 72.4-37.2
Putnam County Department of Health
PermivTidell'O # PV -5 -02
1 Geneva Road
Sent via:
Brewster, NY 10509
US MAIL UPS -NIGHT
MESSENGER fI UPS -2 DAY
❑
PICK -UP El UPS -3 DAY
II
FAX UPS -GRND
We are sending:
UPS -COD
copies date description of document
❑1 04- Mar -03 --- I JApplication Fee of $200.00
❑1 06- Dec -02 Certificate of Construction Compliance for Sewer Treatment System
F-11 22- Nov -02 E911 Address Verification Form
0 06- Dec -02 __� lQuaritntee of Subsurface Sewage Treatment System
❑1 27- Feb -03 Well Water Test Results from JMS Environmental Services Inc.
F-11 23- Oct -02 lWell Completion Report, from P.F. Beal & Sons Inc.
06_Dec -02 — SST.S.." es_}3uRV,
REMARKS:
f
Copies to: File
Yours truly:
Jason R. Snyder, Jr. Engineer
Tel: (845) 265 -9217 ext 13
Fax: (845) 265 -4428
Email: jsnyder@badey- watson.com
40 40.05 498572 624187 20991
BRUCE R. FOLEY
Public Health Director
— - P - . •- • .� "qe to M lfFW s.^A.Y. r vR r
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
December 9, 2002
John Delano; PE
Badey & Watson Engineering
3063 Route 9
Cold Spring, New York 10516
Dear Mr. Delano:
Re: Field Inspection - Becerra & Davis
Horton Hollow Road, (T) Putnam Valley
TM# 72 -1 -37.2, Permit # PV -5 -02
A site inspection was made for the above referenced project on December 6, 2002. The
following comments must be corrected in the field.
` =4 - T1k; Ri sl lour trenches at`the high end of the system were installed almost 3 feet deep
However, since the deep holes and soil conditions are adequate, an additional deep hole is
not necessary.
2. The well casing needs to be raised so it is 18" above grade.
3. The silt fence needs to be repaired and part of the silt fence is staked right in the last
trench. This needs to be removed as quickly as possible.
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: ej
NOV -27 -2002 13:47 BADEY & WATSON, PC
P.01/01
PUTNAM COUNTY DEPARTMENT OF HEALTH
:.. Y T;: ;ISi" 0 r- ' =
REQUEST FOR FINAL - INSPECTION
Date: 11/27/2002
PCHD Construction Permit #
Located:
Owner /Applicant Name:
PV-6 -02
Horton Hollow Road
Ted Becerra & Vicki Davis
For; Fill _
Trenches
(T) (V) Putnam Valley
TM 72 Block �_.,,.... Lot 37.2
Formerly- n/a . Subdivision Name: _ WestchesW Molding Co. inc., Par"I iii
Subdivision Lot # 2
Is system fill completed`? _... , n/a .......... hate: _. _..._._ n/a
Is system complete? Yes Date: 11/2712002
Is system constructed as per plans? no
Is well drilled? _ ... .......... _..7► Date: 1112212002
Is well located as per plans ?!h►
Are erosion control measx= in place? Yes
I certify that the systwXs), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Health.
Date:_ _ _ 71/27/2002 Certified by: John P. Delano, P.E. PE X RA _
Address: Badey & Watson, P.C. 3063 Route 9, cold spring, NY
fence to be reset.
_n�n✓L �L� � �l
Lie. # 062505
FOR ❑ ADAM ❑ GENE ® Joseph Paravati
(NAME)
Form FIR -99
TOTAL P.01
NOV -27 -2002 WED 14:39 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1
PUTNAM COUNTY DEPARTMENT OF HEAL
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date: 4c-) �o
e) 1 Owner
Town Permit # P
TM # _ 79 i -'3 ^7..2 Subdivision Lot #
1. Sewage System Area
a. STS area located' as per approved plans ........................:..
b. Fill section, - _date- p acement
3a- YS9rier Lgth. Width Avg.Dpth
c. Natural soil.not stripped... .... l ........... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e.. 100' from water course/ wetlands...... .... .. ..........................
H. Sma a _S.yste�
a. Septic tank size - 1,000 ......... 1,250... ✓other ................
b. Septic tank installed level .................................... :..........
c. 10' minimum from foundation .......... ...............................
d. Distribtuion Bo
1. All outlets at same elevati ater tested .................
2. Protected below fr ...... ...............................
3. Minimum 24t,0riginal soil between box & trenches
Junction Box - roperly set ...... ..............................
1. gtri t7 Len instai ed i�(y
—Len required � � gth
2. ..........
3. Installed according to plan .......... ...............................
4..Slope of trench acceptable 1/16 - 1/32" /foot .............
5. 10 ft. from property line - 20 ft.- foundations..........
6. Depth of trench <30 inches from surface ..................
7. Room allowed for expansion, 100 % .........................
8. Size of gravel 3/4 1 %z" diameter clean. ...................
9. Depth of gravel in trench 12" minimum ...................
10. Pipe.ends.capped..... �.�' .. .....
.. �: F�in,,;t; ur �useii SXsems�'"- ..• ." , .: ,.. _...,. _ ._..... ,
i . size or pump c uer ................ ...............................
2. Overflow ............................. .....:.........................
3. 'Al , visual / audio .................... ...............................
4. P p easily accessible, manhole to grade .................
5 first box baffled ............:............. ...:...........................
6. Cycle witnessed by H.D.estimated flow /cycle...........
a: House locat6d per approved plans .......................... .
b. Number of bedrooms .... ..........................................
........
IV. �WeR
a. Well located as per approved plans ...............................
b. Distance from STS area measured -1 / 0 Z? 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
f.. Curtain drain outfall protected & dinto exist wate course
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate... ..... ..........................
i. Erosion control provided ................. ...............................
Rev. 1197
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- _ws-� .ti ♦1 .V_.115 �.: . �c2— �- a1.J.!_• ` -T..� � ..soi.:6'so r..a�.V.s': rr..: ar�a�. rrRY `�.• - "v .'a� �.8. -iwvo iy"�v -r. 66'Oa'r+�4'P n: '+ ..rs- i•o.1^���.. ^•fch J.St..:aY•�. �. �.T:i+'�r M- ,•.pv.,
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT #
Located at ` .43 &J-W &AO _L 2L) V 1ii or Village &
W6sTG1 69T,eA AOi AfA e
Subdivision name P4Ac&, 11L Subd. Lot # Tax Map 2 Block _ j_ Lot S7. Z,
Date Subdivision Approved CAB/ o8 %o1 Renewals Revision IJIA
Owner /Applicant Name _8&.9&2A i DA-A& Date of Previous Approval
Mailing. Address 10-7 -IA p� � �,�LTl j j fig Zip /per
Amount of Fee Enclosed 4 2M.
Building Type Aawy&mm- Lot Area g. t4c, No. of Bedrooms q Design Flow GPD 8,00
_ Fill Sectio epth
PCHD NOTI CA ON IS UIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist ofd gallon septic tank and �10 Lr-
Other Requirements: A� E
To be constructed by gAft4p Ly� Sr S %G. Address -3�1J RTr 9 r"Ld SMA6*� , 1J y
Water Supply: Public Supply From Address
3 apply ~DrBca'uy'
,d
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 1 O o
License # 06£S-b5
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 rmit. ApproveA for discharge of domestic sanitary se7lage only.
Al
By: � Title: Date: � 2.. —0
White copy - HD F e; Y llo copy - Building Inspector; Pink copy - er; r ge copy - Design Professional
Form CP -97
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-LI 'A'TION TO 6_'O�TS''��T� -T - •� ®�'��; ��.sgc �, • r .- ; � _.:,r.._...
3- . ,... .._s:. . —. _. c�".�,.: �.e:- .:�:.•.s....•i- 'a<.•f•r ..;:+o•..^r te. .n., �.. �..r....r., .:.J..._ �..r -.= .... � n •.rn.:w� ..tic_
please print or type PCHD Permit #5—
Well Location:
Street Address: Town/Village Tax Grid #
Map 2 Block 01 Lot(s) "
Well Owner:
Name:
Address:
6E
q01 V
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 S gpm # People Served �j Est. of Daily Usage al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
U
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision "8S7 d 001PInDv CO. -nip , Cfi1-Z Lot No. 2
Water Well Contractor: &ICA , 0 6 ;os Address: At%,g4 < <t,.g N'4
Is Public Water Supply available to site. Yes No
Name of Public Water Supply: ZVA Town/Village A11A
Distance to property from nearest water main: %„U, .
Proposed well location & sources of contamination to be provided on separate sheet/plan.
- f` �,• r T __�F _�� _ _- 1
1 ?d. - Ainti;i� ii �
aw: .gr�.E� . .`,csf.�t "t?:- ._. ti - �..
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County. A .
Date of Issue —,Z 0 Z Permit tng Official: r
Date of Expiration — Title: —
Permit is Non - Transferrable
\White copy - HD file;
Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
co
I
. ...... . ......... . .... . ....... .................... ............. ---- . . .. .....................
------------ - - ------------ - -------- — ---------- - . .....
't nrmwoms
SUBSEQUENT REViSIONIALTERATIONS TO THESE HOUSE
qs MUST li )SUBMITTIl) TO T"' PCDOIl FOR APPROVAL
jC0PyR:GF.7 2001 By SAIXY & %USON, SURVE-YING & F/C. .;
BADEY & WATSON, s,�.mw & Akea--j.,4 pc
1-0.
3063 Route 9 (845) 285 -9217
Cold SpAn New York 10516 (845) 225-3312
(8'rl) 3114-1593 Toll-Frw
(914) 63- IWO
(845) 26.51- 4428 (Fa.) (914) 739-3577
SCALE: 1/4" = V-0"
DECEMBER 3, 2001
NOTE: A MPY OF THE HOUSE PLANS SUBMITTED TO'
THE BUILDINIVIhNSPECTIOR, WHEN FILING FOR A BUILDING
PERMIT, MUD�;, BE SUBMITTED TO THE PUTNAM COUNTY
HEALTH OE,ARTMENT TO AIFRIFY 111E BEDROOM COUNT.
OWNER/APPLICANT
TIHEODOSIO J. BECERRA & 'vlCKI A. DAVi-.S
407 MALLARD WAY
PEEKSKILL, NY 10566
LOCATION
HORTON HO.LOW ROAD
WES'I"CHESTER HOLDING CO. INC. PARCE" III
LOT #2
TM# 72 01.- ..37.2
clE NO. 98-105
-- - - ---- . ......... . .............. ... . .................................. . .. ....... .................................
11
f
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
���= .4�i:�i =��u�- -; �' Ll�i�: �i��" �.. i`` v,") ��7�a�i��` c` �► lL' Si.' �✓ iA�lSi�' 1' Y� `.2�'�'�`i�'.1�IS��►�'���Y'drl` .►..�z,..
407 Mallard Way, Peekskill, NY 10566
Owner Theodosio J. Becerra & Victoria A. Davis Address
Located at (Street) Horton Hollow Road Tax Map 72 Block 1 Lot .37
(indicate nearest cross street) Lot 2
MUn1C1pa11ty Putnam Valley Drainage Basmi Hudson River
SOIL PERCOLATION TEST DATA
Date of Pre- soaking 10'/19/00 Date of Percolation Test 10/20/00
Hole No.
Run No.
Time
Start - Stop
Elapse Time
(Min.)
Depth to Water
From Ground
Surface (Inches)
Start - Stop
Water
Level
Drop In
Inches
Percolation
Rate
Min/Inch
C
1
2:49 3:04
5
19 — 22
3
2
C'
2
3:05 — 3:24
19.
19 — 22
3
6
C
3
3:25 — 3:46
21
19 — 22
3
7
C
4
3:46 4:07
21
19 — 22
3
7
5
—
—
D
1
2:57 — 3:01
4
19 — 22
3
1
D
2
3
..:3:02 -- ..3:!36
3:07 3:13
4
.6
19 _ 22
D
19 22
3
2
D
4
3:14 3:20
6
19 22
3
2
5
—
—
1
_
—
2
—
—
3
—
—
4
—
—
5
NOTES: L�' :Tests to.b`.eeieate
'" .per'�olatiot °tesfh
`submitted for`revi
2. Dept 'measureme
at same depth until approximately equal percolation rates are obtained at each
e. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be
to be made from top of hole.
Form DD -97
2
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
PT
H0LF -NO- — .
' u.4 _�...._._ - HOLTM.
HT p.N - - — =
= x
G.L.
Topsoil
Topsoil
0.5'
Fine Sandy Loam
Fine Sandy Loam
1.0'
V
V
1.5
V
V
2A'
y
V
2.5'
V
V
3.0'
V
V
3.5'
V
v
4.0'
V
Sandy Loam w/ Stone
4.5'
V
V
5.0'
V
V
5:5'
V'
V,.
6.0'
y
V °
6.5'
V
V H2O 6' -9"
n
7.0'
V
V
7.5'
V r
8.0'
V
8.5'
e< .
(9.0'
10.0'
Indicate level at which groundwater is encountered #4 6' -9"
Indicate level at which mottling is observed not observed
Indicate level to which water level rises after being encountered #4 6' =9"
Deep hole observations made by: J. Delano, P.E., Badey & Watson, P.C. Date 11/06/00
witnessed by A. Stiebeling PCDH
Design Professional Name: John P. Delano, P.E.
Address: Badey & Watson, P.C..
3063 Route 9, Cold Spring, NY 10516
Signature:
Design Professional's Seal
'�pF
SIR
DQ
w
11.16 -4 (11/95) -• Text 12
PRO,ECT I.D. NUMBER 617.20 SEAR
Appendix C
State Environmental Quality Review.
OR'i' "81'V ROi FJNl 1 CA: E§ 98t .�-
For UNLISTED ACTIONS Only
PART 1-.-.PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1 . APPLICANT/ SPONSOR
2. PROJECT NAME
Theodosio J. Becerra & Victoria A. Davis
Becerra & Davis
3. PRO,ECT LOCATION:
Municipality Putnam Valley County Putnam County
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
( See Map Provided )
5. IS PROPOSED ACTION:
'MN,. ❑ Ex ansion ❑ Modification/ alteration
6. DEi9CRlEEF1RC)J3.;TEIRIEFLY-
Construction of new single family residence, septic system & well.
7. AMOUNT OF LAND AFFECTED:
Initiall <2 acres Ultimately <2 acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
®Yes* [:]No If.No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PRO ECT?
®Residential F-1 Industrial - ❑Commercial ❑Agriculture' ❑ Park/ Forest/ Open space ZOther
Describe:
Single family house on 5+ acre lots.
rnE,l;.A..Tiin% i i. nY � ._ .. A... ii..:n _J,
6'.. ! f l._ ), �i : ?� .9_ =
STATE OR LOCAL)?
®Yes ❑ No If yes, list agency(,) and permit/ approvals
Putnam Valley - Driveway, and Building Permits .
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes ®No If yes, list agency name and permit/ approval
12. ;ASA.RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
❑Yes ®No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/ sponsor name: John P. Delano. P.E. Engineer f/a0plicant Date: Dec. 03, 2001
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
- 1
PART II - ENVIRONMENTAL ASSESSMENT (To be completed by Aaencv)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF.
❑Yes, No
"c. °tiiiX[' ACn'10N iiu:eivECOGIRDiiNgi H) RIEV EW ACS FW)VI611 i Gk UNLiST E) AC'riux IN ii iv1'Viit� FHrZr 6 i i.6? " if'ivo; a negative declaration
may be superseded by another involved agency.
❑ Yes ❑ No
.C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic agricultural, archaeological historic, or other natural or cultural, resources: or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly.
C6. Long term, short term, cunmulative, or other effects not identified in Cl- C5 ?Explain briefly.
C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly.
D. WILL THE PRO ECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTEPJSTICS THAT - CAUSED THE ESTABLISHMENT OF A CFA?
❑Yes No -
E IS TH6RF_ OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? y,
El Y,& ❑Nc.:.:.If Yes. explain-briefly
.
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
IIVSfRX,'T1t7NS For each adverse effect identified above, determine whether it Is substantial; lags, important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. ueban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments,or.reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If
question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action
on the environmental characteristics of the CFA.
❑ Check this box if you have identified one. or more potentially large or.significant adverse impacts which MAY
occur. .Then proceed directly to the FULL FAF and /or prepare a positive 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:
Rint or.Type Name of Iasponsible Officer in Lead Agency
Signature of .Responsible Officer in. Lead Agency
Date
2
:Title of Responsible Officer
Signature of Reparer (If different from responsible officer)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
17 tw'sl . SISTM
1. Name and address of applicant:
Theodosio J. Becerra & Victoria A. Davis
407 Mallard Way
Peekskill, NY 10566
2. Name of project: . Becerra & Davis 3.LocationTN: Putnam Valley .
4. Design Professional: — John P. Delano, P.E. 5. Address: B . adey & Watson, P.C.
6. Drainage Basin: Hudson River 3063 Rt. 9, Cold Springs 10516
7. Type of Proiect:
X Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ------------------------------ Type I — Exempt
Type H Unlisted _K
9. Is a Draft Environmental Impact Statement (DEIS) required? - - - - - - - - - - - - - - - No
10. Has DEIS been completed and found acceptable by Lead Agency? - - - - - - - - -- N/A'
11. Name of Lead Agency Putnam County Dept of Health
12. Is this project in an area under the control of local planning, zoning, or other
Of C1a1S, or &'Mces?,
-Yes.-.
13. If so, have plans been submitted to such authorities? - - - - - - - - - - - - - - - - - - - --- -- No
14. Has preliminary approval been granted by such authorities? N/A' Date granted: N/A
15. Type of Sewage Treatment System Discharge - - - - - - - - - - —surface water X groundwater
6. If surface water discharge, what is the stream class designation? - - - - - - - - - - - - - N/A
17. Waters index number (surface) --------------------------------------------- N/A
18. Is project located near a public water supply system? - - - - - - - - - - - - - - - - - - - - - - - No
.19. If yes, �name of water supply. N/A Distance to water supply N/A
20. Is project site near a public sewage collection or treatment system? - - - - - - - - - - - No
21. Name of sewage system N/A Distance to sewage system N/A
22. Date test holes observed 23. Name of Health Inspector
11-06-2000 A. Stiebeling
24. Project design flow - (gallons per day) -------------- * ----------------------- 800
25. Is State Pollutant Discharge. Elimination System (SPDES) Permit required?... No
26. Has SPDES Application been submitted to local DEC office? - - - - - - - - - - - - - - - N/A'
Form PC-97
2
27. Is any portion of this project located within a designated Town or State wetland? YES
28. Wetlands ID Number N/A
-------------------- -----------------------------
---------- "--- - - - - -------------------- No
Has application been made to Town or Local DEC office? - - - - - - - -- - - - - - - - - - - . _N/A
30. Does project require a DEC Stream Disturbance Permit? - --- - - - - - - - - - - - - - - - No
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards. or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? - -- - - - - - - - ---- - - - Yes/No. No
32.1s 'ect located within 1,000 feet of existing or abandoned landfill,
pro)
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? - - - - - - -- -- - - - - - - - - - Yes/No No
It 1-041 0_1
N/A
33. Is there a local master plan on file with the Town or Village? - - - - - - - - - - 7-7.- es
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ------- No
7 - - - - - - - - - - - - - - - - -- - -- - - -
35. Are any sewage treatment areas in excess of 15% slope? - - - - - - - - - - - - ------ -
36. Tax, Map ID Number -------------------------------- Map BI _12 ock"01'' Lot 37.2
37., Approved plans are to be returned to Applicant X- Design.Professional
NOTE: All applications for review and approval of a new SSTS.to be located within the NYC Watershed shall
m -pro
gblk joct-vT 1,tqyire.Dj�D,
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 storinwater 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 I.,the application must
be accompanied by a Utter of Authorization (Form LA-97). Failure to comply with this provision i
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 ndsdemeanor pursuant. to Section 210.45 of the Penal Law.
SIGNATURES& OFFICIAL TITLES:
Badey-& Watson, P.C.
Mailing Address: - - - - ---- - - - --- - - - - - - --- 3063 Route 9
Cold Spring, NY 10516
I
Located at ......
T/V Putnam Valley Tax Map 0
Subdivision of
Subdivision Lot #. 21901...
Gentlemen:
Horton Hollow Rd.
72 Block-'. 01 Lot
Westchester H I oldifig Co. Inc., Parcel 11
Filed Map # 2824A . Date Filed
kkk
08108/01
This letter is to aAorize John P. -004no) P.
.... . .....
a duly licensed Professional Engineer X 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.Publi.c Health Director of the Putnam
County Health Department, and ib"'ii'90'a my behalf in connection with this
matter and to supervise the construction of said wastewater treatment and/or water supply systems
in conformity I with the provisions ofArt Article 14 1 5 and/or 147 of Education Law, the Public Health
Law, and mitna. S n - Code, -
...1-theT m. -Courity. Sanitary
4
Countersigned: ,
�� %�
Mailing Address Bade.y & Watson, P.C.
3063 Route 91 Cold Spring,
State N.Y. Zip 10516
Telephone: 845-265-92.17
Very truly yours,
Signed:
(Owner Of Propem)
Mailing Address: 407. Mallard -Way
State
Telephone:
Peekskill
W, zi 1 OW
.... . ...... P-.--.. 4 _
914-924-3879
Fom LA -97
k saneal —I L/W U;QN Xtf--J ;A!-Pfud
TO/10'd Od 'NOSIUM *8 A3GUS 8F :9T T00Z—ZI-03a
LZ {71 � # xv�
# OU04d
0 Guotid
O%AL 17 31 of
Very truly yours,
Signed:
(Owner Of Propem)
Mailing Address: 407. Mallard -Way
State
Telephone:
Peekskill
W, zi 1 OW
.... . ...... P-.--.. 4 _
914-924-3879
Fom LA -97
k saneal —I L/W U;QN Xtf--J ;A!-Pfud
TO/10'd Od 'NOSIUM *8 A3GUS 8F :9T T00Z—ZI-03a
r
PUTNADI COUNTY DEPARTMENT OF HEALTH
DMSION OF ENVIRONMENTAL HEALTH
LN- DWIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
REVIEW SHEET FOR CONSTRUCTION PERMIT _
.. �_.. ... � - - .._ A ;.- ... -•� ,_i,rY•:..+,.-- >..... -� ' c.:• -`..- ° -- +.:.._R s^ y !.a. .a a.P �: e,.�:.a- - '+a ".. .w�s•.o'
NA`TE OF ORNtER:�1 �..-ci STREET LOCATION:
REVIEWED BY: R,�L OR, AS, ATE: I �� TAX MAP': (CONFIRMED)
Y N DOCU` 'EN-TS
(nUPER:tiITT APPLICATION
LZUNti7ELL PERMIT ORPWS LETTER
/(_,,,)UPC -97
(,(__)LETTER OF AUTHORIZATION
(,!nUDESIGN DATA SHEET (DDS)
)CORPORATE RESOLUTION
UUSHORT EAF
(j)L_)PLANS -THREE SETS
UUHOUSE PLANS -TWO SETS
L_)L,6VAR4ANCE REQUEST
SUBDMSION
(ZL jLE G_AL SUBDIVISION
UUSUBDWISION APPROVAL CHECKED
(�j(,•�PERCRATE v2
U(�FIILREQUIRED DEPTH
(J(rjCURTA)il DRAIN REQUIRED
GENERAL
LOCATED Lei NYC WAT D
( )( NS SUBM 0 DEP
r P APPROVAL, n —REQ'D
EP TEST HOLES OBSERVED
RCS TO BE WITNESSED
- APPROVAL SSDS ADJ, LOTS
(�j(___ NVETLANDS (f OWN/DEC PERMIT REQ'D ?).
(1jL jDATA ON DDS PLANS & PERMIT SAME
(-_ Le PRE 1969 NEIGHBOR NOTIFICATION
C_ )L/jLETTER BUZBA
FLOOD
'Y.- N (REOUTRED DETAILS ON PLANS CONT'D)
(„_jLHOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON
CZ
j(_JNO BENDS; MLAX BENDS 45° W /CLEANOUT
RENEWALS
UUSITE N2NT -INGE)
FILL SYSTEMS
U(__)10' HO AL; PAST TRENCH SLOPES 3:1 TO GRADE
U( FILL SP CSI FIL 0 S 1 -5
UUFILL PR IL D NSIONS
(�L)FILL LN E SI AREA
U CLAY B RRIE
(—jEFILL CE TIF ATI N NOTE
UUDEPTH G GES
U JVOL. ON R.O.B., UNCLASSIFIED & IMPERVIOUS
UUSEPARA ION DISTANCE FROM TOE OF SLOPE
TRENCH
�ULF TRENCH PROVIDED y112 60FT MAX.
(PARALLEL TO CONTOURS
( f�( J100% EXPANSION PROVIDED,
/)LjDETARMUST FREE CRUSHED STONE ORWASHED GRAVEL
(I/')(_)GEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FROM 52—TS
(J10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
L j20' TO FOUNDATION WALLS
(J100' TO WELL, 200' IN DLOD,150' TO PITS
(L)100' TO STREAM, WATERCOURSE, LAKE (mc. ezpan)
U50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
TO WATER LINE,.( pits- 20').- :._._,_... -:_T -
' - - X50'= �ii•LnvlTir.cr �- i�Rt,ulAi�n c::uu- Fc��y.�"`- "°`•`•'°`• ._., _ .. _
U(Q50 TEST G LOTS>IO YEARS OLD
0200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS
)tEOUMED DETAILS ON PLANS
_
10' MIN TO LEDGE OUTCROP
( Zj(JSEWAGE SYSTEM PLAN- (NORTH ARROW)
SEPTIC TANK
(fiUSSDS HYDRAULIC PROFILE
(� 10' FROM FOUNDATION; 50' TO WELL
(UL)GRAViTY FLOW - -
UCONSTRUCrION NOTES i -15
WELL
/ TO PROPERTY LINES -- -- - - - -- ''
VJL jDESIGN DATA: PERC & DEEP RESULTS
Z_JLOCATION L)DItiTENSIONS
. OF SERVICE CONNECTION
0_JDRIVEWAY L j2' CONTOURS.EXMI`iG & PROPOSED .. _._
(,lL jMIN IT TO PROPERTY LINE
- `�
& SLOPES, CUT
SLOPE
L )FOOTING /GUTTER/CURTAIN DRAINS
, ` v/
jsLOPE IN SSTS AREA
(___)USDA SOIL TYPE BOUNDARIES
(Lj( BLOCK; OWNERS NAME ADDRESS
U�REGRADED TO 15%, IF REQUIRED
_jTITLE
This E , PE/RA; NAME, ADDRESS, PHON
DOSE/PUMP SYSTEMS
UUPUIIP NO S
s/ (_ JDATE OF DRAWIYG/REVISION
UUDOSE 75% F PIP OL /DOSE VOLUME NOTED
j(_ )DATUl1 REFERENCE
�(_ jLOCATION OF WATERCOURSES, PONDS
(- -)UDETAIL TO CE , (PIPE TYPE, ETC.)
j LAKES,WETLANDS WITHIN 200' OF P.L.
UC�PTT AND D -B & DETAILED
UU1 DAY STO GE ABOVE ALARM
( jL jPROPOSED FINISH FLOOR AND
BASEMENT ELEVATIONS
(/ J(�WELLS & SSDS'S WAN 200' OF SSTS
CURTAIN DRAIN
--- )(-- )STANDP S, S BOT ,DETAIL
( L jPROPERTY METES & BOUNDS
C_ jL j15' MIN to S=> o, 20'-4°/ , 25'-3%,35'-l%, 100 % -<1%
�TpSioa.,
UL j20' MIN to CD 100' with 182 cons day discharge
(�L�10' IVMN to N 1 - PERFORATED PIPE
COMMENTS:
(REVSHEET)
BADEY & WATSON LETTER of TRANSMITTAL
Surveying & Engineering, ..P._C,
> Date . Q: .., , r.. ... _.. - .....
'M63 Route 9, Cold" pririi, 1Vew 4York f631&--
.... _ ..., -. . .... „ .
(845) 265 -9217" (914) 628 -1800 (914) 739 -3577
File No. 98 -10 98-10
(845) 225. -3312 FAX . (845) 265 -4428 5
W. 0. #
RE: Becerra & Davis
TO' Horton Ho Row Road
Adam' Stiebeling
Subd. Lot No.
Putnam County Department of Health Tax Map 72.1 -37
Permit #
1 Geneva Road
Brewster, NY 10509. Sent via: US MAIL
❑ UPS -NIGHT ❑�
MESSENGER
❑ UPS -2 DAY ❑
PICK -UP
❑ UPS -3 DAY ❑
FAX
❑ UPS -GROUN ❑
UPS -COD ❑
We are sending:
copies ' date description of document
12- Dec -01 lApplicdtion Fee
. 03- De6-01 Construction Permit for Sewage Treatment System
--
12- Dec -01— Etter of Authorization
F-11 Application for Approval of Plans for a Wastewater Treatment System
01 03- Dec -01 Short Environmental Assessment Form
1 06- Nov -00 Design Data Sheet
:n. ' 103- Dec -01- A licatior, tn,Constrwt a.Water Well
--
' 03- Dec -61 � Separate Sewage Treatment System Sheet 1 of 1
722 IFloor Plans
— — — - - - --
El
" REMARKS:
Signed: John P. Delano, P.E.
Copies to: File
6140
2 —RD1 Layout: N/A W.O. NO. 15438 CHECKED BY JPD DRAWN BY JRS Fl
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AS -BUILT
RELOCATION - DIMENSIONS
1A
26.8'
DROP BOX
1B
55.9'
DROP BOX
2A
30.5'
DROP BOX
2B
47.3'
DROP BOX
3A
41.0'
DROP BOX
3B
44.0'
DROP BOX
4A
50.1'
DROP BOX
4B
42.9'
DROP BOX
5A
60.0'
DROP BOX
5B
43.2'
DROP BOX
6A
69.4'
DROP BOX
6B
41.1'
DROP BOX
7A
33.1'
END LATERAL
7B
38.2'
END LATERAL
8A
44.1'
END LATERAL
8B
29.2'
END LATERAL
9A
51.4'
END LATERAL
9B
24.1'
END LATERAL
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AS -BUILT
RELOCATION - DIMENSIONS
10A
59.3'
END LATERAL
10B
17.8'
END LATERAL
11A
65.1'
END LATERAL
11B
14.3'
END LATERAL
12A
104.7'
END LATERAL
128
94.2'
END LATERAL
13A
92.5'
END LATERAL
13B
92.9'
END LATERAL
14A
80.0'
END LATERAL
14B
84.1'
END LATERAL
15A
63.4'
END LATERAL
15B
74.9'
END LATERAL
16A
44.0'
END LATERAL
16B
64.2'
END LATERAL
17C
34.8'
SEPTIC TANK
17D
24.5'
SEPTIC TANK
18C
40.2'
SEPTIC TANK
18D
32.0'
SEPTIC TANK
WC
101.0'
WELL
rWE 1
97.6'
WELL