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HomeMy WebLinkAbout3185DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -37.4 BOX 26 03185 �} a ra �. Jr 03185 'UTNAM COUNTY DEPARTMENT OF HEAL DIA.7 -1- —1 0- N_OF.ENVIRONMENTA.L...HEA.L- TH..SFRVI( CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # � — I l I d6 Located at '46 14ov-4oyi Ho lI aw R okd Owner /Applicant Name j a g M e M o ire, I OC Formerly Mailing Address i4 Town or Village Tax Map -7-2- Block I Lot 3-1- Subdivision Name Wr- sm1-(esTE K J+ Id, vl,r �' Subd. Lot # �Q�F1 t'6 ( I'D L-) Kneel C, M Vt I ie -t r� y Zip i Os--H Date Construction Permit Issued by PCHD 10 D6 F , � �tJ $T Separate Sewerage System built by �a. 56�6� DNS Address 4b1 —r Consisting of 15- aV GY- ` (• r Gallon Septic Tank and_ add 6 d 1, 4TV1Ct � o f q i1 Other Requirements: Water Supply: Public Supply From, or: Private Supply Drilled by )C ISM iv+ i¢ Address d 'b � !,; -,nntrnl been cnrplerdrL .r Number of Bedrooms Has garbage grinder been installed? /I/D Five `to C.F. W HIA 'er cl 4-e C1 WC 10 21.1 0 Address I certify that the system(s), as listed, serving the above built plans (copies of which are attached), in acco c plans and the standards, rules and regulations Date: 1 / O O b Certified by Address G J d. '- re-AA4% r L. C,�U iWu V ere coflf q essentially as shown on the as- �the ' C C struction Permit and approved n Co 4?l :e artm n Health. I� r P.E. V R.A. 0P' icense Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: Jeco'py - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF...ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building J, -tvx e Aoye_ ko c_L Building Constructed by .TL Tax Map Block Lot -Pt; � � v"c� H� .� TownNillage qt /4T- Y-4-nn A llac-tj R©c.c/ Location - Street Subdivision Name �vl GvY►t e Building, Type Subdivision Lot I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system 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.utilizinQ. thz+- _r= �,._._ Ste The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. tb or (Owner) - Signature Corporation Name (if corporation) Address: State Zip Signature: Title: GlASses,e,_ a4J S� -is Corporation Name (if corporation) Address: 10/ AA"4 S /-- . S4 i` State N y Zip %a y- W Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 LAB #: 1.706173 CLIENT #: 59776 NON STAT PROC PAGE: 1 of 2 MORELOCK, BILL DATE/TIME TAKEN: 11/07/07 01:00 46 HORTON HOLLOW RD DATE/TIME REC'D: 11/07/07 02:15 PUTNAM VALLEY, NY 10579 REPORT DATE: 11/15/07 PHONE: (845)-528-0793 SAMPLING SITE: 46 HORTON HOLLOW RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : BATHROOM VANITY PRESERVATIVES: NONE COLD BY: BILL MORELOCK TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/07/07, MF T.,COLIFORM ABSENT, -/100 ABSENT. SM 18-20 9222B 11/,12/07 * LEAD, -(,.IMS) ,<1 ppb 0.- 15.- ppb SM 18-19 3113B 11/07j,01 E NITRO0 1 1-0•.:.: :,.SM18-204500NO3 11/_.'07/.07 . ..NITRITE �,NITROGi, 0-1-i MG/L = -,:1.'0) MG/L SM18-20450ONO2 11/`08/07 :IRO,N­.(Fe) <0.060 MG/L 0-0.3 mg/l SM 18-20 3.111B 11/08./.07, MANGANESE (Mn). <0..010-MG/L 0-0.3 mg/l SM 18-20 3111B 1.1/08/0,7 SODIUM . -(Na) ' 1 4.2MG/L N/A SM 18-20 3111B 11/07/07 pH 6.8 UNITS 6.5-8.5 SM18-20 4500HB 11/12/07 HARDNESS,TOTAL 160 MG/L N/A. SM 18-20 2340C 11/12/07 ALKALINITY (AS 110 MG/L N/A SM 18-20 2320B 11/12/07 TURBIDITY (TUR <1 NTU 0-5 NTU SM 18 (2130B) _.­­.­..._ CdF4Mffgtr. MFTC THESE RESULTS INDICATE THAT THE WATE] (WAS (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIO T HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE,PAR.AMETERS TESTED, AT THE,TIME OF COLLECTION.. Pb/Cu LEAD limits for p EPA Lead & Copper than 100 of their than 15 ppb and a treatment must be potential. iblic 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, theirtotal value ' - . mg/L. combined shall not' exceed 0. 5 Na limits f or,Sodium-,are pro,scribed.-� Suggested guidelines state'- - for`pegple. on a­ s.odium-,restricted diet, the water should ,.contain no more.,than 20 mg/L of Sodium. For those:-o'n a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914).245-2800 -Irc LAB #: 1.706173 CLIENT #: 59776 NON STAT PROC PAGE: 2 of 2 MORELOCK, BILL DATE /TIME TAKEN: 11/07/07 01:00 46 HORTON HOLLOW RD DATE /TIME RECD: 11/07/07 02:15 PUTNAM VALLEY, NY 10579 REPORT DATE: 11/15/07 PHONE: (845)- 528 -0793 SAMPLING SITE: 46 HORTON HOLLOW RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : BATHROOM VANITY PRESERVATIVES NONE COLD BY: BILL MORELOCK TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER /T. !, 7: 2 -MG/1) _ SUBMITTED BY: CWtl 0 Albert Padovani, M.T.(ASCP) Director ELAP# 10323 RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 Tcl:- 91 7?5 -366 : 93-4z736:3690 - - - - - - - _ January 10, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re. Jayne Morelock Certificate of Constiuciion Compliance One Bedroom Addition 46 Horton Hollow Road Town of Putnam Valley, New York 10579 Section: 72.00, Block. 1, Lot: 37.4 Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project 1. Four (4) Certificates of Construction Compliance 2. Four (4) Sets of "As- Built' Plans signed and sealed by the Design Professional of this office. 3. Three (3) Copies of a two (2) year guarantee signed by the Owner. A. One (!).Copy caf Satisfactory Results of a �^,�ater ^,nalysis -by a NYSDOH Approved, Laboratory:. . 5. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, ames W. Teed Project Engineer. oc: Jayne Morelock- Owner File- Paravati,MorelocK46 Horton Hollow Road,SSTS As -Built Submittal,PCDH,Transmittal Letter,01- 10-08.doc SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ' L:ORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 18, 2007 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Attn: Timothy Cronin Dear Mr. Cronin: ROBERT J. BONDI ,_ DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Morelock 46 Horton Hollow Road (T) Putnam Valley, T.M. #. 72 -1 -37.4 The above referenced separate sewage treatment system can be backfilled. The following com ents must be corrected in the field. 1. Call when r ady for be room count. If you have any further que ions, please contact me at (845) 278 -6130 ext. 2155. JD:ens Sincerely, ph Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Street Location TM # PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Uj Subdivision Lot.# --- 1. Sewage System Area a. STS area located as per approved plans .......... :................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................: d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... IL Sewage System a. Septic tank size - .1,000 ...:.....1, 250 ......... other ................ b.: Septiciank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Bog - properly set . ............................... ..... 6. Trenches � 1. Length required - --�—�— Length installed 2. Distance to watercourse measured Ft..:-..... 3. Installed according to plan . ............................... 4. Slope of trench acceptable 1/16 - 1/32" 56ot ............. 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 - 11/2' diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends capped ..................... ............................... - purnp_or.Dosed Systerns- _ ..�_.�.1. -, Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........:.. ............................... 4. Pump easily accessible, manhole to grade.... ............. 5. First box baffled .......................... ............................... . 6. Cycle witnessed by H.D.estimated flow /cycle........... Ill.. House/Building a.. house located er approved plans :4, .......................:. b. Number of bedrooms ....................... ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured . . ft........... c. Casing 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Worlananshiu , a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... ....... ........................ i. Erosion control provided ................. ............................... Rev. 12/02 Date: :d by: _— . :Z 10 '07 -09 -14 12;00 FROM- 61, , - - Q THE LINDY BUILDING, SUITE 200 2 JOHN WALSH BOULEVARD, PEEKSKILL NY 1056E (PH) 914 -736 -3664 (FX) 914 -736 -3693 0 To: Joseph Paravati Fax: (846) 278 -7921 Phone-, (845) 278 -6130 Pages: 2 (including cover sheet) Date: September 14, 2007 From: Patrick Bell T -531 P001/002 F -371 Re: Request for Final Inspection for Morelock -46 Horton Hollow Road- Tax Lot- 72:1 -37.4 CC: File [] Urgent [] For Review [] Please Comment [] Please Reply [] Please Recycle o Comments: '07 -09 -14 12 :00 FBOM- T -b3l VOO'Z100'L e -371 .., .».-..:....,....�.....:,: -.. .. ,- .._.. ,�� 1' ��iilVl�t�UIV '�L`JV`Lt��I<11W�"�'�i'i ''�rt"•"a'1j'�i�._.. ..._ ._. � . a::� :: r.....- ..�.... � �. ..� DIVISION OF ENMONMENTAL HEALTH SERVICES �e— P. ATTENTION ANW d GENE REQUEST FOR FINAL INSP C;TIC?N For: Fill All information must be fully completed prior to any Trenches inspections being made. PCIAD Construction Permit # A- IN—c)4 Located: 4& i-1 II a o a cl 1 by Owner /Applicant Name: z _ l aGk- TM L Z . Block i Lot 3 /. Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? AJ I;4 __ Date: Al 14 Is system complete? Date: 0 ` Is system constructed asp r plans? s S Is well drilled? m ► Date: AI J)9 _ Is well located as per plans? ITM Are erosion control measures in place? S I cerffy that the s stems as listed at the above remises has been constme a '" 7 s and verified their completion .in accordance with the issued ] ons" , 'P approved plans and the Standards, Rules and Re latio th' 7 Deb _ _. _... . Health .� ?� _ . _, . .. ;�� Date: i �a Certified -bv- , i D Sign P o6 �Dr w y � N FE s�o� Address: 7. y .� �► L+l G �� � I vd. - 1� -�.1G, t.I�11. Lic. a lQY/oU Comments: Form FIR -99 it and ant of SHERLITA AMLER, MD, MS, FAAP Commissioner of Health_ __ _ _ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jayne Morelock 46 Horton Hollow Rd. Putnam Valley, NY 10579 Dear Ms. Morelock: a ROBERT J. BONDI County ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 18, 2006 Re: Addition A- 114 -06 Morelock, 46 Horton Hollow Rd. Increase in Number of Bedrooms with additional SSTS (T)Putnam Valley, TM #72. -1 -37.4 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 this Department dated October 17, 2006. The addition is approved with the following conditions: T 1.� The total number of bedrooms must remain at five without prior approval by this 2. }� /3. /4. 5. department. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets, etc.). Approved SSTS must be constructed according to the approved plans certified by Timothy L. Cronin Jr. Any deviation from the plan requires a revision be submitted to this Department. SSTS must be inspected by this Department before any backfilling. The house must be inspected for bedroom count before compliance is issued. 6. Once SSTS has been inspected and backfilled, a construction compliance package must be submitted for review and approval before operation of the new SSTS and a water test for bacteria must be provided from an approved NYS lab. 7. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. 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 4' . 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. JP:lm cc: BI (T)Putnam Valley Timothy L. Cronin, Jr., P.E. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _o PERMIT Located at ( W6R'r-61J d 6 LL0W Subdivision nameWeS-f(-NCS'(6R Subd HoLpi G cv- Date Subdivision Approved 1 r Village PU —ivA 'W4 LC E Lot # Tax Map 12-- Block ___l___ Lot S-7 Owner /Applicant Name Z-Iyn1t� A 0Qt L o C-o-c Mailing Address 46 0o2T011-) Ho LLow Amount of Fee Enclosed �1 v 0 Renewal Revision_ Date of Previous Approval - 2 I- Z o O Z ., rti -VALLEZ tJZ Zip 1o57 Building Type St`a6 4.e Fcg 41 t, V Lot Area No. of Bedrooms -!�— Design Flow GPD %006 Fill Section Only Depth Volume Separate Sewerage System to consist of /5-0 0 (F- AUT)gallon septic tank and _6Y I J` T I &l C 90 q t i _ WITH Ap0ITIoNA1- 96�L.� of 4,rO'PERFo1AT1:�!D PVc it..) IM OC (aAyLrL 1acAicA Other Requirements: To be constructed by (To rge Address Water Supply: Public Supply From Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the ,af Elie jss, pan the approval of the Certificate of Construction Compliance of the original f. � system or an y re irs the r Signed: Address 2 TolftJ Lal L.A. Date /G License # APPROVED FOR CONS �b,�v"ndpproval xpires two years from the date issued unless construction of the sewage treatment system has bee insp9ctei I by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health irector. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By' 6., - Title: Aa Date: (7 06- Wh opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 "Im " M, 0.t PUTNAM COUNTY OF HEALTh O ROUSE PLANS APPROVED FOR BEDROOAi COUNT ONLY, -0 BEDROOMS TO"I -70-1 - 3 ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL NATU-- I . g .411 \�i I O O cl ail 111 1� j ji Alf (m) ® ®m. PUTNAM COUNTY OF HEALTh O ROUSE PLANS APPROVED FOR BEDROOAi COUNT ONLY, -0 BEDROOMS TO"I -70-1 - 3 ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL NATU-- I . g .411 \�i I O O cl W1W rA5 M! e - a.:�..: _ a.r .r ....: ,.- .- .. ::.. - . - -.-�- .w:, w• s�-w... .:.�u�r�•.�.:.. .:- m �. ".;.. :r az`om.r.....'� +.a.oErt- c--a.� -lr •.. " y§g III a tit ° a! I Jim lit CMiNTYDEPARTMENT OF HEALTH HOUSE PLANS AI't' ,O: P. IFOr BEDROOM COUNT ONLY, 4 "'''l "06 -PU 7a - - 37. K ALL SUBSEO�UE'NT RE';'IS'^I f ? ?'ErF,.I '?C NS TO THESE HOUSE eLANS MUST BE .UBI4,'iTED TO T— E PCDOH FOR APPROVAL SIG ATURE & TI' 'LE - DATE �6- IQ is m a I � 4 os J � 8 IN !FF� ij J�E� 0 h ' � 4 os J � 8 IN !FF� ij J�E� !,;(( rVAOIIcTdV 2104 IIOQOd am 07 aaT•T.'TtI TRS 3�T ,LSIII1t Svv7rI 3.19t en ` i °z SOci lacl =j,tj f.II'sO 1?IIOO T. \CtCIiQTCi lif>;r L? ?.011d3H SW Id 3SOOH s iIT4ii :'f0 :(.!; *:i" ?'•`'I'.':r Tel 'T.PT7C 7 i�. \'V.LC1I F SZ n '4 n vN ¢ T R 3 0 l n II �\ S >p p D V9 •6 & !A ®®U� �{ s �17YF� p33•i 664 � a .IS �g j HUH 3 � [ Li ll H da �I lV� � a�a ll i y II i I 0. IM 51.w 11.6 K I 1 �`l v PUTN 141 COU!,NiTk DEPARii., : ,' -. �r' li flLiki rrJ , ��_... I HOUSE P ANS - PROVED k-AR Pl URI OOM COUNT ' ALL SUBSEA€ ll,N `?_ . ! /:.:� � "'.4L EMATIONN TO THESE HOU, JI r P NS MUST BE U- � "x'T'11"D TO THE PCDOH FOR APPROVAL GNATURE &z TITLE , DA Tasche Pietris Ta,.che s Home Improvement 611- angleglde Rd. p Li Ice Peekskill, NY 10537 _ ;t:`c3 63 --A wall It" Jv J y� Ar k ev - t : T M&A Avolt A# AAZ i r 11._3. 81-9. I-4 — — — — — — 3& *1-ZX-35— k, WWI UP 3" CON IETE OV R GALV. ST EL DECK. Lo m to to Lo N to fo ro to X x X x X 04 (14 R N 04 04 38-4" 10-1 GARD N TOOLS STORAGE 'T F--- - - -- -- -- ------ T------- -- --- - - - --I L-------- - - - - -- I? UNEXCAVATED 1 13'-6Yj' 11' -Y IT-63/j' L-------- - -- F--- - - -- -- -- ------ T------- -- --- - - - --I L-------- - - - - -- - - - - - - - - - - - - - - - - - -- UNEXCAVATED 1 13'-6Yj' 11' -Y IT-63/j' L-------- - -- - - - 7 .7, 7-7 110" — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ; — — — — — — C-4 d. 1. in 9 ?D 5y2" in is CONCRETE PLATFORM SCALE: 1/4" = 1' -0" 4-c i A is r q 5Y2' co I 3 C GARAGE 04 00 DN co 13' -11" 11 " 0 14 101 (3)1 1 7/8 LVL U) 11 -------- (3) 1T7 8 LVL 40 ' rA r.ARAr-.F= FL ® ®R PLAN 5y2" in is CONCRETE PLATFORM SCALE: 1/4" = 1' -0" 4-c i A A M M-I' ATTIC FLOOR PLAN SCALE: 1/4" = v_-o- I D r m n 0 n Z . (� ��— — — ----------- ..e.ia..c�o...r..usw". t )WMMeif wIMN9[.61N �! °c`o'tt°�nero `oto-°M ve w. °.w"�m —� 2X10 RAFTERS 16 "O.C. 2X10 RAFTERS 16 "O.C. II /� -2e4 II II u ol.xsm F—(2—)2X _ 10 TYP N S2RIDGE x L (2)2X1 (TYP) N I i II ,Z7 II 'rl (3)2X10 RAFTERS ; (3) 10 RAFTERS _ N F—(2-)2X 110 TYP N 2X12 RID E l 2X12 R E � i L (2)2X1 (TYP) O II - (3)2X10 RAFTERS R c -(3)2 0 RAFTE- S� +- II N II II �(2)2X 10 TYP N N x_ � 2X1 RIDGE o G) II (2)2X1 J (fYP) II ii it II GERSHON PALEVSKI, R.A. Ev Arrehitect 260 Cmowe Hollow Road Pomam 52 ,N.Y. 10579 Td: 845- 5286073 Pu:845- 5284)409 D A W IJ NEW GARAGE FOR: Mr. & Mrs. Morelock 46 Horton Hollow Road Putnam Valley, New York ..e.ia..c�o...r..usw". t )WMMeif wIMN9[.61N �! °c`o'tt°�nero `oto-°M ve w. °.w"�m �• /� -2e4 u ol.xsm RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736 -3664 • Fax: 914) 736 -3693 September 26, 2006 Joseph Paravati, Public Health Engineer Putnam County Dept. of Health 4 Geneva Road Brewster NY 10509 Re: SSTS - ' Morelock addition 46 Horton Hollow Road Town of Putnam Valley Dear Mr. Paravati: Pursuant to your memorandum dated June 26, 2006 and our subsequent phone conversations, the SSTS plans have been revised and the revisions are itemized as follows: I.' Note on plan that no plumbing. is proposed in the detached garage. Floor plans area also enclosed. 2. Acknowledged. 3. House floor plans are enclosed. 4. The storage room will be revised where the wall will either be removed or the wall will be converted to a knee wall and the door removed. The basement sketch has been modified to note same. .. .. -. -• ^• A � d .i - -: •yi ;f i: c �- sia' . 1• - - al.;c . �_ ' �{ V't • with C11 . ^I ., . . .• - your approval. Should you have any questions or require additional information please contact me at the above number. Thank you for your time and assistance in this matter. Project cc: Jayne Morelock Pcdh- paravati- morelock - horton ssts-09260 Woc submitted, SHERLITA AMLER, MD, MS, FAAP Commissioner of.Health ...,, - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI . Coun .Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 28, 2006 Ken Murphy Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566. Re: Proposed Addition with increase in SSTS - Morlock 46 Horton Hollow Rd. (T) Putnam Valley TM # 72 -1 -37.4 Dear Mr. Murphy: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and. consideration. 1. Floor plans for the proposed 2 story garage need to be provided if plumbing is going to. be provided. If the garage is to have no plumbing, please note on the plan. 2. Why is there a retaining wall over the existing SSTS area? It is highly recommended the wall be removed. - -_ 3. :°1_easetr�wide !oorPlans far±,heenfire,house .- ,._;_...____:. - -- ..... _..__.�.- .,... - - 4. The storage room and guest room in the basement are potential bedrooms. ...._q u r - ✓ This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:Idy Respectfully, (:;oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845)278 -6558 Fax, (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SENDING CONFIRMATION DATE JUN -29 -2006 THU 07:14 NAME . PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -792_1 PHONE 9191.47363693 PAGES I //I START TIME •JUN -29 07:13 ELAPSED TIME 00, J;^ MODE ECM RESULTS 10K F [RST PAGE OF RECENT DOCUMENT TRANSMITTED... i SIIL•'RLITA AMI_6R. MIX, MS. FAAP ROBF.RTJ. BOND, ('n, —WMncr rfHeotrh 4t Cellrov F—fftr 14IN1:1 1'.A Mf 11,1NARL RN. MSN R086R'i' MORRIS, PE i ..:.,,. .- orn(vlserreer oJNeehh r71.MOr .yFmirorml�nrol H.ehh . i DEPARTMENT OF HEALTH 1 Geneve Rudd. Dr ... �Mr. New York I0564 June 28.7006 :•.en Murphy i ( :ronin Engineering i . _. ... _._._ _ ... .... . _.._. - _. ... .. ,•,,.,l;;rf± P:r "'dir^ eu.He 200. — Peckskill.NY 10566 — -,.• - _ ��. Re;' Proposed Addition with increapr in SSTS - Morlo(,k i 46 Horror Hollow Rd. Cr) Putnam Valley 1'M # 7 ? -1 -37.4 )car. Mr. Murphy: rills office bas received and reviewLd the muse recent set of plans for the above mentioned .mjecl. We would like to offer the following comment' for your review and consideration. Flom plans for the proposrx) 2 run, garage need to by provided If plumbing is guiug to be provided If rile garage i5 to have on plumbinv, please n(Re on the plan. A. Why is there a retaining wall over Ib^ existing RXIS area' It is highly rcmmmcndcd the wall be removed Please provide floor plans fnr the entire house. •1. Tlar Rtorago room and guest Rlom in the basement we potential bcdrouru:. Cris Witte, will continue its review upon considetation of the al)(we mentioned comments. Please t:�cl fret to contact mr. at ext. 2157 if any yuestitm.5 arise SP:kl) Rle/- pcctritll). e.�c.....1... -.f7 - Caseph S. Paravati. Jr. Asc64tala Public Health Enginev: Ewircalr 11ut Rollb (845177&41!0 F- 1141)VII -7921 Wow Supply SKUo4 (144) 225.3116 Fa (8451225 -5418 nbntlg R— Im(MS)279-6518 Fox (9451278d02h WIC IM!I2'18 -6679 Narrt4p Item. C— Fo (81512764085 F rl5•Inlelreea4.lAa4ehoo11945) 219.6014 F•v(9451278 6646 3 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 . .10 (914) 756-3664 o Fax: •(9i4)736 -3692 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: Currently PCDH #PH -35-85 SSTS Construction Addition Application 46 Horton Hollow Road Town of Putnam Valley Dear Mr. Paravati: 1p6 Please find enclosed as required the. application for the proposed addition and the $400 application fee for the above referenced project Kindly review and if you should have any questions or require additional information please contact m? at the above r,urnber. Thant: you for your time and assistance it this matt-,.. Respectfully submitted, Kenneth M. Murphy Project Engineer SHERLITA AMLER, MD, MS, FAAP Commissioner of Health r'r . .�.. �E4�L L Z.. `l�lV►J%'��: [A�V�i�Oi , .A'I�i::i ].:� -� .. .ssociate Commissioner ojHealth ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET AG PoRToN Ho«ow VoAD TOWN U1-NA VALC TAX MAP# NAME ILL.IAMf aAY1"J6 &Cby( PHONE PCHD# 'P V - Z 1- o MAILING Lt� Holz 1 oN NoL LUw 2tson ADDRESS ?U-TMI '"I VALLCV. ��/ 1 U S 7 Cj DESCRIPTION OF ADDITION r11.11 S N 19 �►� S�rti �� `j 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 Dept., 1 Geneva Rd, -- 3rewster, NY l�?.S.O-9,,Phone: (845) 278.6 Z,, _ .. - .n c+.. �- >...�.. -o ...._ -:tr -- ^ .-. .... ..,,.- .-.. .,r -. ... _.:... - _._�.. �,w <-ev v.. w.. r -.,y. . -... ...�- .y. . -. :C .. ro_�- .,. -. .. �....- .- .a -...- .. ...>....- ...• -. .. .���..- .f,-.^ 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) 275 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845)'78 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 27S -6645 CERTIFICATE OF OCCUPANCY i E:ET 0/2/20192 PEPJvM NO: 2002 -113 TAX MAP #: 00/72. -1 -37.4 LOCATION: 46 HORTON HOLLOW ROAD ISSUED TO : MORELOCK, WILLIAM D.JR. MORELOCK, JAYNE M. 46 HORTON HOLLOW ROAD PUTNAM VALLEY, NY 10579 This certificate covers the construction of: ONE FAMILY RESIDENCE W /TWO CAR GARAGE; FRONT /SIDE PORCH (440 SF); SCREEN PORCH (16' X 141); REAR DECK (38'X 14'); FOUR BEDROOM; FIREPLACE (2); UNFINISHED BASEMENT. The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary Code, the Uniform Building & Fire Code and the Laws in effect in the Town of Putnam Valley, Putnam County, NY, having paid the required fee therefor and the undersigned having by is in compliance with the requirements of the laws as aforementioned; that the said work and materials meet every requirement of the laws as aforementioned and that the premises have now been fully completed and are ready for. occupancy pursuant to the provisions of law. Now, therefore, the Certificate of Occupancy is hereby issued under the seal of the Town of Putnam Valley. TOWN OF PUTNAM VALLEY, IVY By Code Enforcement Officer LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 To Whom It May Concern: ROBERT J. BONDI County Executive Re: 1' 1 WQA Residence Tax Map 92- : 4 Town U hc, r- According t/9 records maintained by the Town, the above noted dwelling, ...,.. .� .... �1J ..... �.<.��� . ., _...- - • --,. s .�. .. _ ._ •- ........- �,>.�...._._...v..- :.c� -.... tee. .. IS NOT In compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: 'Y ASSESSORS RECORD: OTHER: �1 / (Ok Building Inspector houseguidelines 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -VE-SW -114�'VATA�Sllttf - am8towu --S-Ev--�AtttREXTMtWg�� EM 46 NORTON HOLLOW ROAD Owner JA YNE MOREL OCK Ad8ress PU77VAM VALLEY, N. Y 10579 Located at (Street) 46 HORTON HOLLOW ROAD Tax Map 72 Block 1 Lot 37.4 (indicate nearest cross street) Municipality jT) PU77VAM VALLEY Drainage Basin HUDSON RIVER SOIL PERCOLATION TEST DATA Date of Pre-soaking MARCH 16, 2006 Date of Percolation Test MARCH 17, 2006 2 K 4 NOTES: I Tests to be repeated it same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 's I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review: 2. Depth measurements to be made from top of hole. "__ r%m n-1 Dipth to Water Water rom Ground Level Percolation Hole No. Run No. Time Start Stop ElaNe Time Surface (Inches) Drop D In Rate - n.) Start Stop Inches Nlimdnch Pi 1 1200 1209 9 16 19" j j 2 12.• 09 12. • 18 9 .1 1 12.• 18 12• JO 12 4 2 K 4 NOTES: I Tests to be repeated it same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 's I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review: 2. Depth measurements to be made from top of hole. "__ r%m n-1 TEST PIT DATA, DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ......... . DEPTH HOLE NO. DI HOLE NO. HOLE NO. G.L. TOPSOIL 0.5' 1.0' 1.5' SAND ` & GRA' IIEL 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.5' 8.0' 8.5' 9.0' T 9.5' 10.0' Indicate level at which groundwater is encountered NONE ENCOUNTERED 111U11.al1, 11 -VG.1 Ill VV111b11111U11111161A VVJbL V%.0 NONE OBSERVED Indicate level to which water level rises after being encountered N/A Deep hole observations made by: CRONIN ENGINEERING, P. E, P. C. Date MARCH 16, 200E Design Profess i9nal,Name: 'TIMOTHY L. CRONIN Address: 2 JOHN WALSH BOULEVARD PEEKSKILL, N. Y: 1056,6 ` �4 Gt L `- Simat�rr. IVA 3� -P-UTNAM - COUNTY - DEPARTMENT - -OF -= HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of W1 L L I /-) c MoR (FL o c Located at 4C AoRlohS {-I o L C. 0 w Q o T/V VALL Tax Map # Block ( Lot 1 Subdivision of WO L D nJ 6 o IIJC . bQ 12C L L Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize —TJ m o-rH k/ L • C ?o N ( "J a duly licensed Professional Engineer o matt to apply for the required wastewater treatment (s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health �..,..._.. - I'aad tii� ��i indrn Coiiil�y aalilLaiy 1,0 uc:`� Countersianoew. 10 U&k �'° P.E., Mailing Add sus '4 State jatC,,;,iC t L L, _?dWXFfrj 0 Very truly you -rs, Signed"' L __ (0 1'ei r of Property) 7 Mailing Address: 46 Uo A—ro t4 Pri c c a w RD Stat o L L 4ZV fj Zip Telephone: (a 14) 73 6 - 3 6C'�/ Telephone: /os7 1 Form LA -97 q ti Tasche Pietris Tasche's Home improvement 61 Tanglewylde Rd. Lake Peekskill, NY 10537 PG ZS 39• Vp0 15-1- C-j �' "S r -. r.._ C- C, S "- I V 0 \pk TasVche Pietris 'rasche's Home improvement 61 J'anglew y1de Rd. ;LLaf(e Feekskill, NY 10537 witt, VC 3 7, cl 1 d40 M Al —S El RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel.. (914) 73C -5664 a R.Y. (9 14) 73C-M95.. r .. April 13, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 Re: SSTS Construction Addition Application Currently PCDH Permit #PV -21 -01 46 Horton Hollow Road Town of Putnam Valley Dear Mr. Paravati: Enclosed is the following information necessary to process the revision for an SSTS to be constructed on the above referenced lot. 1.) Three copies of the revised subsurface sewage treatment system plan 2.) Four permit applications 3.) Letter of authorization 4.) Updated survey t"- JDuilt p.au► 6.) Two sets of finished basement floor plans 7.) Copy of cert of occupancy with.legal bedroom count. 8.) $100 addition application fee The enclosed information has been submitted to show the proposed improvements to the existing 4 bedroom residence and the existing septic trench layout. The home owner plans to finish the basement and create a potential bedroom. This addition would require the installation of additional fields necessary for a 5 bedroom septic system. Please review at your earliest convenience. If there are any questions or if additional information is required please do not hesitate contacting me at the above number. Thank you for your assistance in this matter. Respectfully submitted, e KennetfM. ur phy Project Engineer '0, 02112006 1.9: BRUCE R. FOLEY Public Health Director 1:147363693 CRONIN ENGINEERING 1 PAGE 01 ... .� DEPARTMENT OF 1 Geneva Road Brewster, New York 1 i tI' ..c ..- iii • _ ... .�. s. - i .. _ .... . . i { LORETTA MOUNARI RN-, M.S.N, Associate Publik Health Director Director of Patie»t Services I-MAI TH 10509 Mt 94T- L.OK40- AT'TENTION o GENE All information below must be fun completed prior to.aay sche ENGINEER OR FIRM: if aVIA N f IU�ER,(A�4 REA;StaN: DEEPS PERCS: 0 PUMP I ROAD /STREET: liTbJUW DATE: Q3-Z(-06 PHONE 0: Ch 0 TOWN: t i..t TXX -1�PR: ~7 7.61 - SUBDIVISION: TVVt- l4X. ArR LOTM: OWNER: 0 ACaL4- YES NO _ � B�vSC`u `ni�iii :i Cie' uS b,rn�E'�i:5iu f/l vYeSt -BPi o (f Proposed SSTS within 500 feet of a reservoir, reserve 0 Proposed SSTS within 200 feet of a watercourse or a 0 Proposed $STS design flow greater than 1000 gallon 0 Proposed SSTS fora Commerical Project. . iyps l:orner �eS`e`rv0iis :' stem or control lako. :C wetland. ay or SPDES Permit required. It is the responsibility of the design professional to provide the abov information prior to soil testing. This .Department will determine the NYCDEP project status (J int or Delegated) baked ork the response, If you answered pet to any of the questions, NYCDEP a ust witness the soil testing. This Department will coordinate a mutually suitable time for field testi ig with the PCDOH,;the Design Professional and NYCDEP. If a project has been determined -to be Delegated based on the abo a response and then tsubsequent information indicates NYCDEF is required to witness the soil testin , it will be the sole responsibility of the design professional to. schedule re- witnessing of the soil-testing th NYCDEP. FOR COUNTY USE ONLY i DATE -i _ TIME: 1 i T -+ I (FIEL'�L. " -1-.S , 13'\ _ . — IT,. 1^K1 ^f11 Il ITIJ I1r'I'1/111TMrl IT 03-#21/2006. 19: -=� 1147353693 Gra gel _ -r— Rom Cuy b E,risbng (del/ C.RONIN ENGINEERING 1 i\ g r• deg 0115 1 4" CI1' TO SDR -35 � - _ SFPTIC T-ANK. -- .__._ ...- vSGR -35 F=ROM .. ;, ....__ _ _...�.. _ .. 3 404 EF OF ABSORPTION 4 � � TRENCH �t 4 lo 12 1t 10 9 � r 00 Bpi .� E m z J F- w i i I i 4 !/1Mr . r�l ITV Ir.V.I �1 4 IT, � nrn ^nTMrV IT nr n °'� 'PUTNAM COUN'T'Y DEPARTMENT OF HEALTH V . DIVISION OF, ENVIRONMENTAL, HEALTH .SER.VICES. -_ INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project MCV) d° V. County Site Location Building construction begun Yes Extent Is property within NYC Watershed ? ................. 0 Yes �No. SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. ' ly ' Rolling 0 Steep slope Gentle slope Flat ' 2. Evidence of wetlands ( .1 Low area subi'ect to flooding F-7- Bodies of water 0 Drainage ditches ©' Rock outcrops 3. Property lines or comers evident ....................... ............................... es No 4. 'Do water courses exist on or adjoin the-property? .......................... 5. Will these affect the design of the sewage system facilities ?.......... 6. Do watershed regulations apply in this development ? ................. .... 7 Will extensive grading be necessary? ................ ............................... extensive fm 6necessary for Sg fS....................................... Yes Yes aYes Yes Yes a0 No �.N o No No 9. Do filled areas exist within the SSTS area? ....... .................. ........ ...:... 0 Yes . �No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: E29and Gravel Loam Clay Hardpan 0 Mixture 11. Observed from: Borings Bank cut Backhoe excavations 12. Soil borings /excavations observed by %11 Lk, - on 13. Depth'to groundwater G on, L3 23 06 .14. Depth to mottling /fir on 15. Are test holes representative of primary & reserve areas.....; ................................ Yes = No Lb Soil percolation tests made by on 17. Soh percolation tests witnessed by SECTION D (on back) on Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? = Yes [io 19. Will groundwater or surface drainage require special consideration? ....................... Yes l'� 20. Will gullies, ditches, etc:, be filled and watercourses be relocated ? ......................... =Yes �No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities ? ............... ... Yes No .............. ............................... Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Fzres =.-No 23. Additional comments 24. . Site observer /inspector and title 25. Date(s)-of o-bservation(s)inspection(s) 3 L-Z#O TEST PIT PROFILES Hole # Lot # Hole # �_ Lot # 'Hole # Lot -u ./ eDepth to water -- _ . Depth to mottling LA'.d_ Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rocklimp. G.L. 0- Z G.L." G.L. 0.5 1.0 2.0 3.0' 4.0 5.0 0.5 1.0 2.0 3.0 4.0 5.0 r 6.0 S `1 ero 6.0 7.0° 7.0 0.5 1.0 2'.0 3.0 4.0 5.0 6.0 7.0 8.0. 8.0 8.0 9.0 9.0 9.0 10.0. 10.0 10.0 Or A-i� ! J W 00 1 '= pa.._ 4 0.5 1.0 2'.0 3.0 4.0 5.0 6.0 7.0 8.0. 8.0 8.0 9.0 9.0 9.0 10.0. 10.0 10.0 Qv PUTNAM COUNTY DEPARTMENT OF HEALTH „T, AL HEALTH SERVICE CONSTRUCTION COMPLIANCE H MVill,age TREATMENT SYSTEM CERTIFICATE OF CONS PCHD CONSTRUCTION PERMIT # I - O\ rTown Located at �b l�c���'c�i � I Tax Map Z _ Block ___1___ Lot 3d Owner /Applicant Name c�Jlw O- `�p'�'`t �- A. � -•�0� r �;....C•�P' r7 i�n.1 fi11rC'� t.A/ ".'' ^C�" Formerly _ Subdivision Name p Q -u Subd. Lot # Zip - Mailing Address ALo Date Construction Permit Issued by PCHD C o-z c�Z Se ara e S stem built by �''�' °' ° r' °" Address � �+��"►� a�S D to Ss,�raa y rr[ A„x - 4.4L �l Consisting �f 1, -t53 Gallon Septic Tank and 24 tnr• or Z4 �Jr0 Other Regirements: From Address Water Su l ; Public Supply private Supply Drilled by r- Sor.►S ,�, Address 7y ' begin ^orn pleted? `45 ._. ._ - ._ ».c - ^•_.a ._...__-_;__._,_ .. -.... .._. «,._. ..�.. r _ 'Bedrooms y Has garbage grinder been installed? Number t 3 a I certi�, tit the system(s), as listed, serving the above premises were constructed essentially as shown on he as Huift of which are attached), in accordance with the issued PCHD n of Health permit and approved pl�(copies De artment Plans ��he standards, rules and regulations of the Pu am County p P.E. � R.A. C�•`Z Certified by (Design Professional) � y License # Addrea f .5" - Q Ski Are remises served by the above system(s) shall promptly take such action as may be necessary Y pin occupying p royal of the separate sewage to S� -utlle correction of any unsanitary conditions resulting from such usage. App tre�o sewer becomes available and the approval system shall become null and void as soon as a public sanitary me null and void when a public water supp 1 y becomes available. Such °f t�e¢vate water supply shall beco a t to modification or change when, in the judgment of the Public Health Director, such peas are subject modifica ' n or change is necessary. ` Date: B (� Title: Own r• Orange copy - Design Professional -e1py - HD ile; Y w copy - Building Inspector; Pink copy - Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street 2Z^���8O0- Albert H. Padovani, Director LAB *g 32.205250 CLIENT Q 55751 NON STAT 1:11-'�OC PO C-3 E I MORELOCK, JAYNE DATE/TIME TAKEN: 07/19/02 01:18P 410 LAKE SHORE RD.' ' DATE/TIME REC'D: 07/19/02 01:50'' PUTNAM VALLEY, NY 10579 REPORT DATQ 07/26/02 PHONE: (914)-772-3678 SAMPLING SITE: 46 (LOT 4) HORTON HOLLOW : PUTNAM VALLEY N.Y 10579 COL'D BY: DAN MUNSEL NOTES...: WELL SPICKET ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE BASIC PROFILE NMS RD. SAMPLE TYPE,.: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFDRM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANBE METHOD -07/19/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/19/02 COPPER (Cu) 0.058 MG/L 0-1.0 mg/l 2037 -07/19/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 07/19/02 TDS 114 MG/L N/A 9064 07/19/02 CONDUCTIVITY 156 N/A ~07/19/02 HARDNESS,TOTAL 78.0 MG/L N/A `07/19/02 OH 7.1 UNITS 6.5-8.5 9043 ~07/19/02 LEAD (NMS) <1 ppb 0-15 ppb ` E AND EPA-FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED;;AT THE TIME OF COLLECTION. ��� Fe/Mn Jf� bo°., iron and manganese are present, their total value cpmbinfd shall not exceed 0.5 mg/L. . TDG AS IS�A DIRECT MEASUREMENT OF CHEMICALS DISSOLVED IN WATER. WATER WITH HIGH DISSOLVED SOLIDS GENERALLY ARE OF INTERIOR PALATABILITY AND INDUCE AN UNFAVORABLE PHYSIOLOGICAL REACTION IN THE TRANSIENT CONSUMER. FOR THESE REASONS, A LIMIT OF 500 MG/L IS DESIRABLE FOR DRINKING WATER. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) YML ENVIRONMENTAL SERVICES 321 Kear Street YorktoqpHei ht N y 105ria Albert H. Padovani, Director MORELOCK, JAYNE DATE/TIME TAKEN: 07/19/02 01:18P 410 LAKE SHORE RD. DATE/TIME REC'D: 07/19/02 01:50P pUTNAM VALLEY, NY 10579 REPORT DATE: 07/06/02 PHONE: (914)-772-3678 SAMPLING SITE: 46 (LOT 4) HORTON HOLLOW RD. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY N.Y 10579 PRESERVATIVES: NONE COL'D BY: DAN MUNSEL TEMPERATURE..: < 4C NOTES,..: WELL SPICKET COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WJTH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Pb/Cu LEAD limits for p EPA Load & Copper Kin 10% of their than � b d ' ��o pp and treaSent must be , potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive SUBMITTED BYg-. Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights N.Y. 10598 Albert H. Padovani, Director LAB #: 32.205596 CLIENT #: 55751 NON STAT PROC PAGE MORELOCK, JAYNE DATE/TIME TAKEN: 08/01/02 05:27P 410 LAKE SHORE RD. DATE/TIME REC'D: 08/02/02 01051:'' PUTNAM VALLEY, NY 1V579 REPORT DATE: 08/08/02 PHONE: (914)-772-3678 SAMPLING SITEg 46 HORTON HOLLOW RD. PUTNAM VALLEY N.Y SAMPLE TYPE..g POTABLE: : PRESERVATIVES: NONE COL'D BY: E MORELOCK TEMPERATURE..: < 4C NOTES.AvWELL SPIGET ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: N/A DATE) FLAG PROCEDURE � ` . RESULT NORMAL - RANGE METHOD `- ' �D8/02/02 MANGANESE (Mn) 0.015 MG/L 0-0.3 Mg/1 2037 /02 SODIUM (Na) 1.92 MG /I... N/A A/O2/O2 ALKALINITY (AS 68.0 MG /L N/A -' -000 /02 TURIIDITY (TUR <1 NTU 0-5 NTU ~08/02/02 NITRATE NITROG <0.2 MG/L 0 - 10 9139 ~08/02/02 NITRITE NlTROG <0.01 MG/1- N/A 9146 COMMENTS: 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 dietp a maximum of 270 mg/L of Sodium SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT vveii Location ` Street` Address: `- H bm Hollcw Read, Lot #t4 ,6wn/ViI!age: Putnam Valley Tax Grid * Map 4Z.Block i Lot(s) Well Owner: Name: Address: Phoenix Const. & Dan Munsell, 20 Kramers Pond Rd,--Putnam Valley, NY 1057 Use of Well: 1- 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 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 440' Depth of completed well in feet 505' Well Log If more detailed information descriptions or sie-ve atlaivses. _ .... are available, please attach. Depth From Surface ft. Water Bearing Well Diameter(in) Formation Description ft. Land Surface 15 Drilling in ove arden clay d boulders Hit rock at 15' i3 . 32 ; aril..l,irici- Itr��:r, ^1 .t:' ai. ra5i,r ... rr�iallN,I 32 505 Drilling in rock 6ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5n Depth 460' Model 5GS10412 Voltage 230 HP 1 Tank Type NX302 Volume 86 gal . Date Well Completed Putnam County Certification No. 002 Date of Report 7/16/02 f [Adam Driller (sig �tu5/14/02 L. +Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F. Beal & Sons, inc. Address: .4 Putnam Ave . , Brewster Signature: & Date: 7/16/02 Adam L. Beal White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 AUG -02 -2002 10:15 BADEY & UATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALT H SERVICES . ' , .. Nf F� 1E NT M- P. 01./01 William _& Jayne Morelock 72. _ 01 37.4_ Owner or Purchaser of Building Tax Map Block Lot Phoenix Construction Building Constructed by 46 Horton Hollow Road Location Street Putnam Valley Town/Village�� Westchester Holding Co. Inc_., Parcel_ III _ Subdivision Name Residential 4 _ Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system 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:ur_1 ,rsigned.further.agrees to accept as conclusive the_.determination. of the.Public Health Uixector of ttie Putnam Uounty' Department dt Health as to whether or riot ttie talture of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated; Month _Day _L.CYearv?_--Signatu , Title: General Contractor (Owner) - Signature NIA Corporation Name (if corporation) Address: 410 Lakeshore Drive, Putnam Valley _Phoenix Construction Corporation Name (if corporation) Address: 24 Kramers Ponds Rd., Putnam Valley State w.. , New York _ _ _ Zip 10579 _ State New York _Zip 10579 krrn GS-9' . TOTAL P.01 BADEY & WATSON LETTER of TRANSMITTAL en- _g; 3063 Route 9, Cold Spring, New York 10516 Date: 16 Aug 2002 File No. 98-105 W-04 15173 - RE: Certificate of Construction Compliance Morelock TO: Horton Hollow Road Shawn Rogan Westchester Holding Co. Inc. Parc Subd. Lot No. 4 Putnam County Department of Health Tax Map 72.-1-37.4 1 Geneva Road Permit(ritle/P0 # PV-21-01 Brewster, NY 10509 Sent via: US MAIL EJ UPS-NIGHT MESSENGER El UPS-2 DAY El PICK-UP F-1 UPS-3 DAY FAX UPS-GRND We are sending: UPS-COD copies date description of document F 1] 116-Aug-02 I [Certificate of Construction Compliance for Sewer Treatment System F-31 115-AuR-02 —1 IGuarantee of Subsurface Sewage Treatment System F�i 108-Aug -02 lWell Water Test Results F-11 116-Jul-02 lWell Completion Report F31 116-J,1-02 ISSTS "As-Built" 51 101-Aug-02 I [E91 I Address Verification Fprm 1 F_ E-1 I __1 I F-1 I REMLARKS: Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265-9217 ext 12 Fax: (845) 265-4428 Email: jdelano@badey-watson.com 40 40-05 498572 6*24197 13270 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .1 - - - � nspecte�liy - =� Street Location _116 -XTo Al {,l ©G Loe 1 ZZI, Owner �'o�E Go pe Town T/Vqw U.d LZ v Permit # 'PV—;L/-,0/ TM # 72-- Subdivision Lot # �¢ 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Swage System a. Septic t size - 1,000 1,250 ......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ........... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. -Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renc es 1. Length required qQD Length installed gOO 2. Distance to watercourse measured+100 Ft.......... 3. Installed according to plan ............... ........................ 4. Slope of trench acceptable 1/16 -1/32" %foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size -cif gravel 314 -1' /2" -liar ete .char::....:..:::::::<- �9.,Dldptti'of gr'avelin- bench "12 iri nimum.: e:.:: �µ 10. Pipe ends capped .................................. :.................... g. Pump or Dosed Systems 1. Size of pump c am er ................ ............................... 2. Overflow tank ............................. ............................... _ 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ : .......... ......... 6.- Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBui�lding a. House located per approved plans....... b. Number of bedrooms ............... .......��...�.................. . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured 7- / OE ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............ .................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercours( g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate... .. ............. ....... ....:....... t Wrncinn r.rm,;r1aA JUL -26 -2002 08 46 v BADEY & WATSON, PC P. 01/01 - . tR'�:I . .. . T P DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL - INSPECTION Imo: 7/26/2002 PCHD Construction Permit # PV -21 -01 For: Fill Trenches X Located: Horton Hollow Road (T) (V) Putnam Valley Owner /Applicant Name: William & Jayne Morelock TM 72 —;...� Block 01 Lot 37.4 Formerly: N/A Subdivision Name: Westchester Holding Co. Inc., Parcel III Is system fill completed? WA Is system complete? Yes. Ts system constructed as per plans? Yes Ts well drilled? Yes Is well located a$ per plans? Generally Are erosion control measures in place? Yes Subdivision Lot # 4 , Date: N/A Vie: 7/2512002 Date: 7/25/2002 I certify that the system(s), 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. ..... -.,. �.....n...r•.��� �i ������.1Y�M 1 N �: • • ���.:• �..���- 73 l•.rc Y- c+.. v .�� � . ... ..r r- ..... -. Design Professional Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY Lic. # 62505 Connnts: FOR: C7 ADAM ® GENE ❑ (NAME) . Form Flit -99 -- ..-.:- — r--- --- '1r-- ---w�a Public" Health Director July 29, 2002 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278,- 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Delano, PE Badey and Watson 3063 Route 9 Cold Spring, New York 10516 Re: Field Inspection - Morelock Horton Hollow Road, (T) Putnam Valley Lot # 4, TM# 72.-1 -37.4 Dear Mr. Delano: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. .. � _.- ......_._ -.. �. -�.o- -a v- ..�.�__. ...-- .mow.., v.� � .,.....y....r......_ ....... ._ . i . _..... _ .v ,. . � �.-- ..... -_. - .- ...,......- N...e- _ �. .- -- ..- ... -...r - ..... _ ..--- ... .. .. _ : t �....< If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide n SENDING CONFIRMATION DATE : JUL-30-2002 TUE 08:59 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 92654428 PAGES 1/1 START TIME JUL-30 08:58 ELAPSED TIME 00'20" MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. BRUCE IL FolEy LOPM7A HOLMAJU R.N.. MAN; A..d.. P.Uk H d h Do- lf..kb V&— p&ww qf ?a*. &1w— DEPARTMENT OF HEALTH 8MWL,Gcnav& Road Niw y0A 10509 %1—.kd9—k.(U3)279-6S$5 VIC(949)271-6671 Fu(845)Z71 -W25 Rrrehesl (94321.5919 Fft(145)221-9113 July 29, 2002 4-- JohaDd=4 -.-'7 ey add Walson 3063 Routs 9 Cold Spring, New York 10516 Re: Field Inspection - Morelock Horton Hollow Road, (T) Putnam Valley Lot 0 4, TM# 72,-1-37.4 Deer W Delano; The above rdl:rcriced 30PILMO s*w495 treatment rystem can be badcfilled. The following comments =9 be corrected in the field. No comments. if you have any 6irther questions, please contact me at (845) 278-6130 art. 2261. sLncw* ,44. Gene D. Reed GDk.cj Environmental Health Eo&wming Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..:r,:= ...+s_a.6: �.'.i. �...n�.:. �;s�can•r -»7 a: .... ', ;ziF.,i=Zo:ro....e.w.r:�v:..ii -ra CONSTRUCTION PERMI � TREATMENT SYSTEM PERMIT # �' —�0 —C) l - Located at H0(Z- tlf1J 4OL-L-yu3 (2©A-C) Town or Village FtA`i 1 ,W6,-?TL We— I i" Subdivision name me a `lam Subd. Lot # 4 Tax. Map "('Z Block i Lot 7v°7.4 Date Subdivision Approved 0 °Z101 Renewal Revision _ Owner /Applicant Name Nr—t- \N(ULA MO( CY—Date of Previous Approval ocl 12A IPA Mailing Address 4 (o el f Mhj e . PUT6�P� 1/ � Zip 51 Amount of Fee Enclosed l 5n . e o Building Type Lot Area .'Z 'No. of Bedrooms _4 Design Flow GPD O® Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 9 , ?-GO gallon septic tank and 4co 1r Other Requirements: To be constructed by fW L%> l qolyS 5ONJ S Address QT- r q . COLD SP2t 1 SCa N S Water Supply: Public Supply From Address or: C Private Supply ^Drflleci.by_1IC,C2 �idclres- s "`pn6i�'S "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 s,, em 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 tiereof 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 OO I C O License # t�r 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 hrmit. Approved fal discharge of domestic sanitary sewa a only. By: G Title: Date: White copy - HD Fd, Yel o copy - Building Inspector; Pink copy - Ow r; Oran copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _APPLICATION APPLICATION TO CONSTRUCT A WATER WELL _. %please print or type , -�; l'erlTllt # _�L–(7 0' y - • — Well Location: Street Address: Town/Village Tax Grid # 1401ZMKI 40"vJ 120, A Map '12- Block 0 Lots) 31.4 Well Owner: Name: %Ntt,.i._iPcM 4 Address: 3kgmf— moat "U_ 1410 LM44 M W-5\0— Pub Use of Well: Residential Public Supply Air /Con eat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought Fi gpm # People Served Est. of Daily Usage LCO gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling K New Supply (new dwelling) Deepen Existing Well Detailed Reason Pwitp& forAPN-P, W 'SU Pt; FV(Z_ i4lkA) .1VE l\iC 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 _X Name of subdivision W l {0L 4J6 CO. W(, - PACZefL = Lot No. Water Well Contractor: BRO5 . Address: 0z f k'30t') Is Public Water Supply available to site? .................................. ............................... Yes No 'x/. Name of Public Water Supply: f�/�� Town/Village i.JZP• Distance to property from nearest water main: '9 1 M %Lf:n Proposed well location & sources of contamination to be provided on separate sheet/plan. ,L' al, e:.�n.�,..^C licant Si naturc: _ _ .�.. - �i— . f . — +.� . a... —_.... - —.-.w - ..-.�. - rs...•�. h.•-- ......,ors_.. —_ •ys— ,+s.L,� ..- ...... _... 'p. ... F T _...e...� - a 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 w Wwell lle r certified by Putnam County. Date of Issue 7 --e7 �- _ Permit Is ng Official: Date of Expiration.. — -- Title: a Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �o BADEY & WATSON. LETTER of TRANSNHTTAL A(itt'�Q?fat�.._ 3063 Route 9, Cold Spring, New York 10516 Date: 25 Jan 2002 (845) 265 -9217 (914) 628 -1800 (914) 739 -3577 File No. 98 -105 (845) 225 -3312 FAX (845) 265 -4428 W. O. # 1302 RE: Morelock, Jayne Badey & Watson TO: Sean Rogan Subd. Lot No. Putnam County Department of Health Tax Map Permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT W MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑. UPS -GROUN ❑ UPS -COD ❑ We are sending copies date description of document F-1] 19 -Jan-02 FA-pplication Fee ❑ 09 -Jan-02 lConstruction Permit for Sewage Treatment System 1 09 -Jan-02 ___j jApplication to Construct a Water Well ❑ 0 09 -Jan-02 Separate Sewage Treatment System Sheet 1 of 1 "REVISED" El I ❑ F ❑ 1 REMARKS: Sean, We have all had conversations regarding these plans (Ms. Morelock, you, Mike and myseM. These are revised as required. Please do not let these get lost in the pile. This can be expedited quickly. Thank youl Signed: John P. Delano, P.E. Copies to: File 6529 PUTNAM COUNTY DEPARTMENT OF HEALTH Y DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR REATMENT SYSTEM PERMIT # V' o 1 Ci l F 33- J 1 Located at "t z-rvK3 RvL-txt-o Ei2lod& Town or Village FVTVJAUA \ ,rt --P-y k)S9 —8c. 14S-T j ET2, Subdivision name HOL.f i .\)4 'Tip- Subd. Lot # Tax Map -7Z-Block I Lot 37 Date Subdivision Approved W, / O -,p 101 1 Renewal Revision Owner /Applicant Name ` i , iA K& e Jqi&n:5 o 7,Lyc Date of Previous Approval Mailing Address 440 LAke- <LioRc jbp t V6 , po'r-tj &K M.&Ey k,Y, Zip 05-7 9 Amount of Fee Enclosed -300. 00 Building Type Lot Area ¢3, No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume Separate Sewerage System to consist of [ 1 2-.5 -V gallon septic tank and 400 L, F, — Z.4- i, w o bE- ASP R 6' i I �e.J "i'�' n1r l -mss S PAe-C.i�s & Fee r 0, C. Other Requirements: To be constructed by b4-p, L-b LYn&j s j SoijS, Z�ir Address l -r, c) . Goy -CP21 nzc j &)-y� F11. Water Sup&: Public Supply From Address riivai� �uppiy °Liri eii IZi� K5Onl �. jZi?S' -- ___. _ Addresss` "(aF� 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: Address R.A. Date 08 -2,3/01 License # O!o-2 -!; � APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by a Public Health Director. Any revision or alteration of the approved plan requires a new pe Ap oved or isch ge omestic sanitary sew a only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Wrofesdional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ '/ 1 pieiie print or type - PCHD Permit # H ', a Well Location: Street Address: TownNillage Tax Grid # ,,AA 9 YVO HOL,LVPJ (��, Pik NAM VP' Map 72, Block Lot(s) '3i, Well Owner: Name: vgiw- Irv-.- - AYN£ Address: P-CLO C-K 14112 LAgzsH vP---- -bp-., ft OAN) VAa-Lc-Y �J Y 101-79 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought `- gpm # People Served to Est. of Daily Usage �- gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason P�P4,br-7 �'o W Sv L- FJO2 NC-7w i for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No �C Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision PAP- c.G6, -1T-r Lot No. _ Water Well Contractor: SP- tcKspti Qp-oc. Address: • 4&k4 i&:0 t'3 , �) `( . Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Q /A Town/Village AJ A Distance to property from nearest water main: > i M i L Proposed well location & sources of contamination to be provided o separate sheet/plan. Date: 08 Z 3 �1 A 1lcant. S��*natun: pp - - -- .. _ -�: a .. -- �- - - - I lW 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 alterati n of the approved plan requires a new permit. Well to be constructed by a water well driller certified by am County. Date of Issue Z-11 o Permit Issui Official: Date of Expiration 7,S I o 3, Title: Permit is sferrabli 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 - •. �.,' � .. �- �.cs.., r. �,rc -_... �- •�c�an' �•ti.4. [.-. w..'a � .... s. v..��.o.. �- s :.~ �. � .-e [.c. w .. [. i .. - _ ... .... LETTER OF AUTHORIZATION RE: Property of William & Jayne Morelock Located at T/V Putnam Valley Tax Map # Horton Hollow Road 72 Block 01 Lot 37.4 Subdivision of Westchester Holding Company Inc. Parcel III Subdivision Lot # Filed Map # 2824A Date Filed Gentlemen: This letter is to authorize John P. Delano .08/02/01 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 Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health i-aw;:�tind.lhe TMat Cunty Countersigned P.E.,!# 062505 Mailing Address Badey & Watson, P.C. 3063 Route 9, Cold Spring State New York Zip 10516 Telephone: 845- 265 -9217 Very Signed: Mailing 410 Lakeshore Drive Putnam V, State NY Zip 10579 Telephone: 914- 528 -0793 Form LA -97 BADEY & WATSON LETTER of TRANSMITTAL Surveyiilg- E*i4^ 3063 Route 9, Cold Spring, New York 10516 Date: 28 Aug 2001 (845) 265-9217 (914) 628-1800 (914) 739-3577 File No. 98-105 (845) 225-3312 FAX (845) 265-4428 W. 0. # 14359 RE: Morelock TO: Horton Hollow Road Adam Stiebeling Westchester Holding Co., Inc. Par Subd. Lot No. 4 Putnam County Department of Health Tax Map 72.-1-37.4 Permit # f Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT V MESSENGER ❑ UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ UPS-GROUN ❑ UPS-COD ❑ We are sending: copies date description of document _—] 01 128-Aug-01 Application a123-Aug-01 lConstruction Permit for Sewage Treatment System Letter of Authorization =1 L lication for Approyal of Plans for a Wastewater Treatment System a23-Aug-01 Short Environmental Assessment Form E 1] F06-Nov-00 IDesign Data Sheet I JLI 14j- =51 123-Aug-01 =2:, R-ENNRKS: jAVFnvdL1V11Lv%,viiaauC,La I Separate Sewage Treatment System Sheet 1 of I [Floor -1- 4 A, Sigtd: John P. Delano, P.E. Cop's to: File Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r-n-ON FOR AXPROVAL.- -S A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: William & Jayne Morelock 410 Lakeshore Drive Putnam Valley, NY 10579 2. Name of project: Morelock 3. LocationT /V: Putnam Valley 4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson, P.C. 6. Drainage Basin: Hudson River Rt.9 Cold Spring, NY 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 (SEAR)? Type Status (check one) ---- ------ ----------- --- - - - - -- Type I Exempt Type II Unlisted _ 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 Department of Health 12. Is this project in an area under the control of local planning, zoning, or other - cs� i 13. If so, have plans been submitted to such authorities? - - - - - - - - - - - - - - - - - - - - - - - _ No 14. Has preliminary approval been granted by such authorities? No Date granted: N/A 15. Type of Sewage Treatment System Discharge - - - - - - - - - . surface water X groundwater 16. 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 >1mi 20. Is project site near a public sewage collection or treatment system? - - - - - - - - - - No 21. Name of sewage system N/A Distance to sewage system >1mi 22. Date test holes observed 23. Name of Health Inspector 11/06/00 A. Steibeling 24. Project design flow (gallons per ay) ---------- ------ --------------- - - - - -- 800 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? --------------- NSA Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? Town 28. Wetlands ID Number. -' v - •t•, . - f. — _. ... ... ..�. w _ ar ., •- .._ ..RAY.•..- .�.S.t• .e , � r... , 29. Is Wetlands Permit required? ____ ______ ___________ ________ _ _____ 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. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any_ other potentially known source of contamination? ------------------ Yes/No No 2 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? --------------- Yes 34. Are community water and/or sewer facilities planned to be developed, within 15 years in or adjacent to project site?_________ __ _______ _____ ___ ____ _____ ___ No 35. Are any sewage treatment areas in excess of 15% slope? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ No 36. Tax Map ID Number. _ ____ ____________ __ --- _____ _____. Map 72 Block 1 Lot 37.4 37. Approved plans are to be returned to --- Applicant _X_ Design Professional NOTE; All applications for_reviev and approval of_a new.SSTS,to be located within the NYC Watershed. shall i7epaiet;-&i`neeu riut''o en in aupuca�c tci tae -DEP, artauu�h±ine prujec ivay ri�uirc litrr=�°° �°° y approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwateir plans or the creation of impervious surfaces, and the project applicant should. obtain the appropriate forms for.such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made. herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal La . SIGNATURES & OFFICIAL TITLES: V �=• Badey & Watson, P.C. 3063 Route 9 'il'd Cold Spring, NY 10516 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • :r ..::;.�� _., �l��Y��� '��A "�•r�-�'- '`�°'�.I��C� ���AliiArrr�l��s�v _� , ��= .:.:`,.,p_. �r 410 Lakeshore Drive Owner William & Jayne Morelock Address. Putnam Valley, NY10579 Located at (Street) Horton Hollow Road Tax Map 72 Block 1 Lot 37.4 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 08/07/00 Date of Percolation Test 08/08/00 NOTES: ,.:.> "Tests. to be' 'repeated at same depth until approximately equal percolation rates are obtained at each .. cola#on test hole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch All data to be w submitted :for review. Depth'measurements to be made from top of hole. Form DD -97 Depth to Water Water From Ground Level Percolation Time Elapse Time Surface (Inches) Drop In Rate Hole No. Run No. Start - Stop (Min.) Start - Stop Inches Min/Inch A 1 1:14 1:17 3 19 — 22 3 1 A 2 1:17 — 1:20 3 19 — 22 3 1 A 3 1:24 — 1:27 3 19 — 22 3 1 4 5 — — B 1 1:38 — 1:44 6 19 — 22 3 2 _1'.0 ..- �..�... wr=y, •- .. .5�... -..y. ..0.. �.2rc^s.. - :2 -. -: >a ..oa. - .,.�:�•- r-- ae.�_� B 3 1:54 2:02 8 19 — 22 3 2 4 2 3 — _ co f 4 — 5 NOTES: ,.:.> "Tests. to be' 'repeated at same depth until approximately equal percolation rates are obtained at each .. cola#on test hole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch All data to be w submitted :for review. Depth'measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 Indicate level at which groundwater is encountered 6' -0" Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered.' 6' -0" J. Delano, P.E., Badey & Watson, P.C. Deep hole observations made by: 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 Ile, � .. e` FA 'p• ILSW 'L iff: G.L. Topsoil Topsoil 0.5' Sandy Loam Sandy Loam V V 1.5' V V 2.0' V V 2.5' V V 3.0' V V 3.5' Loam V 4.0' V V 4.5' V V 5.0' V V 5.5' V V 6.0' Clay Loam H2O V H2O 6.5' V V. 7.0' V V 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered 6' -0" Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered.' 6' -0" J. Delano, P.E., Badey & Watson, P.C. Deep hole observations made by: 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 Ile, � .. e` FA 'p• 1 � . 1416 -401/W —Ted 12 ^p PROJECT-I.D. NUMBER 617.20 SEAR Appendix C State Environmental Quality Review ' - ....►;,.............. ..T........ .. r •.., _ ...�...i �w:, ., _... "" � F 0 4T,.; C -•+T'� ct i "1 !'S CSS1VlF`IVw. :E11 I h'IJKI� For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT /SPONSOR 2. PROJECT NAME William Morelock William Morelock 3. PROJECT LOCATION: Municipality Putnam Valley County Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) See Map Provided 5. IS PROPOSED ACTION: ® New ❑ Expansion El Modification/alterdtion 6. DESCRIBE PROJECT BRIEFLY: Single family residence, SSTS and well 7. AMOUNT OF LAND AFFECTED: Initially <2 acre acres Ultimately <2 acre acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes QNo If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential Industrial Commercial Agriculture Q Park/ForestlOpen space ❑ Other Describe: Single family residences on 5+ acre lots .'iG. Dt7ESAG IAN INVOLJJ2 A RERCVii7vAFi'FnVbi_rOR FI`N -jlNf:, N(1W OR i OUT - (MATE! Y !:ROAi ANY n ry. E4 G�`!E ^ "ffAElJ7:,L AGLFJC � (1 �DEw;L; I 'STATE OR LOCAL)? ®Yes ❑ No If yes, list agency(s) and permit/appirovals Putnam Valley building & driveway permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? El Yes -®No If yes, list agency name and permit/approval 12. AS A 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 for A licant. Date: 08/23/01 .Signature: ` V If the action is in the Coastal Area, and you area state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 —:t •- f PART 11 . FNVIRANMFNTAL ASSESSMENT [To be Completed by Adencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAR El yes, ❑No -,_ - d:11viCCilCi7i5N'r�ii. DIVE 'COCirtlSiliiti)'R'Eii%SY'AS Pr�OViDED Fiii U3Lf E �i4TCTit NB YCrR, FAiT i 97. ve'dei i5 �iaraiion' 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 J C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. E: co G D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSEDTHE ESTABLISHMENT OF A CEA? El Yes ❑No. EAS THERE, OR IS THERE LIKELY TO BE; CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes �No: - 1 ="es. ex�- '= inibrtsflY -. sue+.. .w- ..•.� ..tea.. .,.._Ri -+r u.c a's .....�,,, .o .... .. -.y. ....- .t.. ®- r.. r. .- .............4Y . vr+ r� ... �.••i..�ar� - +t•Sv 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. 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 CEA ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration: ❑ Check this box.if you have determined, based on the information and analysis above and any supporting . documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide.on attachments as necessary, the reasons supporting this determination: Name of Lead Agency. Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date J .y j Z -C Ori tre Y 0 Existing We# 4" CIP TO SDR -35 - 1500 GAL SEPTIC TANK SDR -35 FROM 304 LF OF ABSORPTION - fRENCH zo A0( 5e �a'00 ,O0�Stfo GO " oM ,moo i, �) e 0 t, t' t.v la l yi. +i rl� R I; 1.' r' t t •< 1 +" 1'1 t i' 7• •11 t' i i C+ i R' 1 �i pt i; �l. n, �1 t� �l �1 r ;t �i Yt LOCA'` N 46 H(z;;TON HOLLOW ROAD TOWN:'OF PUTNAM VALLEY COUNtY OF PUTNAM T.M. Up 72. -01 -37.4 STATt..6F NEW YORK yl ,1 FILEDIAAP DESIGNATION . SUBDi'v1510N NAME WEST.Cl LOT t �ci 4 MAP ,I� 2824A��;'g =i Y� V• �A