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03186
A
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509 Q
ADDITION APPLICATION RESIDENTIAL ONLY t
STREET 32 Horton Hollow Rd. TOWN Putnam Vly TAX MAP # 72.-l-37.5,1
NAME Virginia Joy PHONE 914 -760 -6628 PCHD#
MAILING
ADDRESS A7 unrtnn Hnl l ow Road Putnam Valley, NY -10579
DESCRIPTION OF
ADDITION_ part, a1 Fin; GhPrl R G m nr and iinfinished storage
NUMBER OF EXISTING BEDROOMS' 11 _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,
Brewster, NY 10509, Phone: (84S) 278 - 6130.
1. Certified check or money order for $100.00.
:2. Sketches of existing floor plan (drawn to- sca.le.. all, living. area includiny.hasement, to be.. .
:.- ..
- s i;;VVii aYr�l neJ anu use or eacti'room "specined). See Secnon "s:c of tSullettn
HA -1)
3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
* Non- professional sketches are acceptable and preferred. (See Section 3:d of Bulletin
HA -1)
4. Copy of survey showing all well and. septic locations. on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. Copy of Certificate of.Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling:
OFFICE USE
COMMENTS
s.
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
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 =1580
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
ROBERT :MOPURUS. PE
Director ofEnvironmental Health .
June 6, 2011
Virginia Joy
32 Horton Hollow Road
Putnam Valley, NY 10579
Dear Ms. Joy:
DEPARTMENT OF HEALTH
1 Geneva Road, .Brewster, New York 10509
Office (845) 808 -1390
Fax (845) 278 -7921 or (845) 808 -1937
Re: Addition- A- 070 -11
No Increase in Number of Bedrooms
32 Horton Hollow Road
(T) Putnam Valley, T.M. 72.4-37.51
PAUL ELDRIDGE
County Executive
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 June 6, 2011. 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. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets,
restrictors for shower heads 9rd faucets Pte.
4. This Department recommends you contact your local Building Department to ensure setbacks
and other current codes can be met.
5. 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 (845) 808 -1390, ext. 43261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:cw
cc: BI, (T) Putnam Valley
0
SHERL,ITA AMLER, MD, MS, FAAP
Commissioner. of Health
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: Toy . (Owner's Name)
Tax Map #. 72e'-1-37.51
Address: 32 - Horton Hot low Road
Town: Putnam Valley
Year Built:. g n n_5
According to records maintained by the Town, the above noted dwelling,
is . xx in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is: .3 ( septic 4 bedrooms)
This information has been obtained from:
Certificate of .Occupancy: 2005-46'
Other:
The plans for the proposed addition are considered:
New Construction
xx Addition to existing house only
Teardown and /or re -build allowed under Town'Regulations
4/6/11
Building Inspect„-r.... Date
6.
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
Nursing Home Care. Fax (845) 278 -6085 WIC (845) 278 -667$
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
f
CERTIFICATE OF OCCUPANCY
Certificate No: 200546
Permit No: 2004 -338
Tax Map No: 72. -1 -37.51
Location: 32 Horton Hollow Rd '
Parcel Owner: Joy Virginia
32 Horton Hollow Rd
Putnam Valley NY 10579
Date of Issue: 3/7/2005
This certificate covers the construction of:
ONE FAMILY RESIDENCE WITH TWO CAR
GARAGE; THREE BEDROOMS 4 BATHROOMS;
REAR DECK (14'X 57'); FRONT STOOP (12'X 5'); FIREPLACE;
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 OyF�PUTNAM VALLEY,
`' . f� :�i r �1 t'i r�nt».4��• +na ±� n:n 7 + v '� d'i1c7V'u`: : i}
N. _ . na. ei� e 3 - - .,_„f�.., n,. 'i ;::.tacrs. c 5- c.SonaU Pt.;L1011 .
ascertained that improvement of the proposed structure 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
BY
c4r-4-clow
Code Enforcement Officer
AM COUNTY'DEPARTMENT OF HEALTH
N- 10F.ENV RONMENT- A.L HEAL'
F CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT
PCHD CONSTRUCTION PERMIT # PV- 6-4 - O?
Located at 3Z. ROIRTOM 1(;: =Wv4 ROAD
Town or Village Cry ?v 1 "O"m VA "�`C- "t'
Owner /Applicant Name _V P'C7 Aar a ra -:5-0 \� Tax Map "17— , Block i Lot S-1 - S t
Formerly �,k I A Subdivision Lov S
Subd. Lot # I
Mailing Address 'PC) , ` oy 613 a �a � as ca, �td� � �� V� �i„� YO--k, Zip 1 a's 1 �
Date Construction Permit Issued by PCHD `I i 10, .4
Separate Sewerage System built by Sd A%.& L AL*o % C corm a-) Address t a S 1 `t
Consisting of Ia`2-3 ® Gallon Septic Tank and 5-1 5 L
of ZA ' V/koL A "e- sovv'i'1oaA
Other Requirements: Z v" �� 't o � -Z,o t., . S �2," f.x 4- (1 4-
Water Sup "I : Public Supply From Address
or: Private Supply Drilled by 1S - Y i> Ae-r6, S ion G'a ,Address Cke-ms, (05,z-
Number of Bedrooms _At Has garbage grinder been installed? 6- 0 O
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 P tnam un ep ent of Health.
Date: 2 Z3 � Certified by ' P.E. � R.A.
Design Professional)
Address _940E.Y 1, Q4'n Jill P.C. �A 5Pf= -auc1. Oy. Ie) License # ()62 605
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.
Whlw'copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
a a
BRUCE.R.FOLEY - - * - - - LORETTA MOLINARI_R.N.;- M. &;N..� _
__ - _ •.:.�: �� .� -'�- - Associate �t�ubiic Heiith Direcfor" _ :_ a
- �� °ruGic "iYeuiiriLneei6r" .��. y0
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845} 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME:
TAX MAP NUMBER:
E911 ADDRESS:
TOWN:
John Landi & Virginia M.
72.4-37.59
Horton Hollow Road
TOWN OF PUTNAM VALLEY
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE: November 29, 2004
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)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
NOTE: Exact location of well with distances to at least two permadenf lafidindrks to be provided a separate eet/plan.
Well Driller's Name, /0V S/,/ -9 Address: /f/,
Signature: //) Z Date:
White copy:
Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC-97
Fy–�W.-* - n-V7 I q 111 a'g' re.- 14
11(�]JlVlapV,
i a xUrici 7. 77. 1
Block l Lot(SI
Well Owner:
Nam
'77
ddress:
d&A. P
a.f
& /f\ ` -7
A -�3 0 )65
1)ai)j V
Use of Well:
1-primary
2-secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
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 )/ ft.
Length below grade 90 ft.
Diameter _j in.
Weight per foot lb/ft.
Materials: A Steel Plastic Other
Joints: -=-- Welded _X Threaded Other
Seal: __.X Cement grout Bentonite Other
Drive shoe: -)L Yes No
Liner _ Yeses No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
—
— Yes No
Hours
Second
Well Yield Test
Bailed Pumped k Compressed Air
Hours
Yield --q- gpm
Depth Data
Measure from land su;race -stafic (specify ft)
D'uring yield test(ft)
'7PA/
Depth of completed well in feet
Well Log
If more detailed
information
descriptions or
sieve analyses -
ZJ-a-vailabfie,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
ra
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump/Storage Tank Information
Pump Type&"l #j' Ctpacity L10 A
Sul,"
Depth 140Qf& Model I G& S2.0 q a
Voltage HP ol
Tank Type AM Avl Volume 1?0 C16d
!3
IM
Date Well ompleyd
Putnam County Certification No.
Date of epont
Well rille (signature)
NOTE: Exact location of well with distances to at least two permadenf lafidindrks to be provided a separate eet/plan.
Well Driller's Name, /0V S/,/ -9 Address: /f/,
Signature: //) Z Date:
White copy:
Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC-97
DEC -06 -2004 09:14 HADEY & WATSON, PC
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
P. 06/08
John Landi & Virginia NL Joy _ 72. 01 37.51
eer
®w or Purchaser of Building T Tax Map Block r. Lot
John Landi (T) Patn= Valley
Building Constructed by .�� _ Town/Village� -V-
Morton Hollow Road .. SubdiivWon Lot s weer Hoidin&_
Location- Street Subdivision Name
Residential 1
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.
.,.... _.
�
�_ _.._.__.___...._ _._ - n�e� -_��n �: fi.r�l:- .r....aa - -- -o p ,�� �t riez�%p � jte •m:3�t:�:n -.: -_ k�.Pu. �� :.�e;t +
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 utilizin the
system. / _ _ o
Dated: Mo h 11 ay 29 Year 04
7
��y
ral Contractor ( er) - Signature
Join Landi (Owner)
Corporation Name (if corporation)
Address: P.O. Box 633 Pa imm ValRey
State ,^ New York Zip._ 10579
Signature: V
Titl • Owner
John Landi
Corporation Name (if corporation)
Address: P.O. Bm 6331 Putnam Valley
State _ New York Zip 10579
Form GS -97
� YML ENU�R IAL SERVICES
u�� near �,treet
,^ yprktown Heights N�Y
�_�'�����`�/��������;��������������:�`����z�������
Albert H. Padovani, Director
LAB #: 1.500734 CLIENT #: 58200 NON STAT PROC PAGE�- I
JOY, VIRGINIA- DATE/TIME TAKEN: 02/10/05 07:5O
PO BOX 633 ' DATE/TIME REVD: 02/10/05 08:01-3
PUTNAM VALLEY, NY 10579 REPORT DATE: 02/17/05
: PHONE: (914)-760-6628
SAMPLING SITE: 32 HORTON HOLLOW RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE
: KITCHEN TAP PRESERVATIVES: NONE
COL'D BY: JOHN LANDI TEMPERATURE..: < 4C
NOTES...: COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCEDURE
RESULT
NORMAL - RANGE
METHOD
PUTNAM CNTY
PROFILE
02/10/05
MF T. COLIFORM
ABSENT
/100 ML
ABSENT
1008
02/10/05
LEAD (INS)
<1
ppb
0-15 ppb
9003
02/10/05
NITRATE N%TROG
<0.2
NO /L
O - 10
9052
02/10/05
NITRITE NITROG
<0.01
MG/L
N/A
9162
02/10/05
IRON (Fe)
<0.060
MG/L
0-0.3 mg/1
9002
02/10/05 '
MANGANESE (Mn)
<0.010
MG/L
0-0"3 mg/L
9002
02/10/05
SODIUM (Na)
3.24
MG/L
N/A
9002
02/10/05
pH
7.4
UNITS
6.5-8.5
9043
02/10/05
HARDNESS,TOTAL
86.0
MG/L
N/A
-
02/10/05
ALKALINITY (AS
70.0
MG/L
N/A
9001
02110105.,_
.`TUR8IDITy~(TUR
`. _<1_NTU _ _--_
0-5NTU
'
COMMENTS:
FAX TO BADEY & WATSON, ATTN: NEIL @ 265-4428
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDIN���J=THE NEW YORK STATE
-- AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
Pb/Cu LEAD limits for p
EPA Lead & Copper
' than 10% of their
—than 15 p0b 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, their total value
-combined shall not exceed 0.5 mg/L.
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Mel gh
Albert H. Padovani, Director
LAB #: 1.500734 CLIENT #: 58200 NON STAT PROC PAGE: 2
JOY, VIRGINIA DATE/TIME TAKEN: 02/10/05 07:50
PO BOX 633 � � ' DATE/TIME REC^D: 02/10105 08:08
PUTNAM VALLEY, NY 10579 REPORT DATE: 02/17/O5
' PHONE: (914)-760-6628
SAMPLING SITE: 32 HORTON HOLLOW RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE
: KITCHEN TAP PRESERVATIVES: NONE
COL'D BY: JOHN LANDI TEMPERATURE..: < 4C '
NOTES...: COLIFORM METH: MF
'DATE FLAG PROCEDURE
RESULT NORMAL - RANGE METHOD
Na' No limits for Sodium are proscribed.:Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those on a
moderately restricted diet, a maximum of 270 mg/L of Sodium
is suggested.
pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND _
FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5.
DN�SS� NED~6\S�TH[�SUM
. - . . ' '_ - - `
'-~-` -
RANGE FM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE
SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED.
' SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L
MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER
' HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L)
SUBMITTED BY: WLO -
Albert n. raowvanip n./.`r,oCr/
Director
B-AP# 10323
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
Lr.~ LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
March 3, 2005
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Neil A. Seidl
Badey & Watson Engineering
3063 Route 9
Cold Spring, New York 10516
Dear Mr. Seidl:
ROBERT J. BONDI
County Executive
V/
Re: Construction Compliance — Joy /Landi
32 Horton Hollow Road, (T) Putnam Valley
TM# 72. -1 -37.51
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
1. The Well Completion Report has not been completed. (Pump /storage tank
information section).
2. There appears to be errors in the yield testing section of the report.
This office will continue its review upon consideration of the above mentioned comments. Please
tP,F. i- St'P�'.. t�� -(• Jn; rat. mC
. .._._._. =... .. _. � .:. _... ., __. .. aX f . . .1.. 1 . .G� ' 7 ::fY
JSP:cj
Sincerely,
Joseph S. Paravati, Jr.
Assistant Public Health Engineer
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
MAR -3 -2005 21:41 FROM:BOYD ARTESIAN WELL C 845 2258420 TO:927B7921
I C EYI�m
1054 Rte. 52
Carmel, fr X 10512
(845) 225 -3196
r Fax (845) 225 -8420
fill f)
RR
FROM,
COMMENTS,
P:1/2
PAGE L OF �
177is transmission is intended oniy for the uee of the individual or endry ro w!?•ch P by addrE,esed and may contain information rhar is
prrviieged, conrideniial, and exempt from disclosure urder applicable 14w, ,'the i eaderof this message is not rho intended recipient, you
arc hereby aotiJied rhar any dissemination, distribution, or copying of this cammwnicadpn is strictly prohibited, If ymt have received this
communication In error, please return the original to;the sender by trail
TCt . Qa�_a7l� -74 ?1
HAMF : PI ITNAM rrq INTY DFPARTMFNT OF P. 1
i
zo U I' A:�i 0 pq T' �k -TrN
11
February 23, 2005
Re: 32 Horton Hollow Road
Tax Map # 72.-1 -37.51
Town of Putnam Valley
To Whom It May Concern:
I John Landi did install one 2 Horsepower, 10 gallon per minute, 80 gallon
Amtrol Diaphragm storage tank model # WX302 PRO in the above captioned
residence.
GC>utA 5 -
Co 91
Re pec
Owner
BADEY & WATSON
LETTER ®f TRANSMITTAL
-.0 nee..f-
3063 Route 9, Cold Spring, New York 10516
Date: 23 Feb 2005
File No. 98-105
W. 0. # 16824
RE: Certificate of Construction Compliance
Joy
TO:
32 Horton Hollow Road
Mr. Joseph S. Paravati, Jr.
Subdivision Lot 5 Westcheste Subd. Lot No. 1
Putnam County Department of Health
Tax Map . 72.-l-37.51
Permitrritle/M # 5312-1468617
1 Geneva Road
Brewster, NY 10509
Sent via:
F_
US MAIL El UPS-NIGHT
El
MESSENGER ❑ UPS-2 DAY
El
PICK-UP El UPS-3 DAY
F-1
FAX El UPS-GRND
V
We are sending:
UPS-COD
copies date description of document
71 123-Feb-05 [EertiFicate of Construction Compliance for Sewer Treatment System
71 129-Nov-04 E911 Address Verification Form
F-31 129-Nov-04 IGuarantee of Subsurface Sewage Treatment System
F�l 117-Feb-05 Well Water Test Results (2 Sheets)
F-1] 11 9-Nov-04 —7 Well Completion Report
F�l 123-Feb-05 I Letter From Storage Tank Installer
F 41 123-Feb-05 —7 ISSTS "As-Built"
F-1 I
M 1
REMARKS:
Dear Mr. Paravati, please find the above documentation for your review. If you have any questions please feel free to contact me.
Copies to: File
Yours truly:
Neal A. Seidl Jr. Engineer
Tel: (845) 265-9217 ext 25
Fax: (845) 265-4428
Email: nseidl@badey-watson.com
Virgin M. Joy John Landi 40 40-05 498572 624187 26217
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL. SITE INSPECTION ' 9./3
Date: i1 1 -1 ley
Inspected y.._,
ocation,
.54eet L
Permit # &- 0
_
TM# Subdivision Lot #
S- /_
I Sewaze System Area 6z�-
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 ........................................ I .........
d. Stone, brush etc., greater than 15' from STS area....:.:...
6. 100' from water course/wetlands ..... * ................................
R.' Sewitze System
*'a. Septic tank 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. Nfinimurn 2 ft.Original soil between box & trenches
e. Junction Box properly set .........................................
6. T-r-en-Me—s 7'i
1. Length required Length installed
2. Distance to watercourse measured Ft. 4.1.4` `
3. Installed according to plan .............. .........
4. Slope of trench acceptable 1/16 - 1/3211/foot .............
5. 10 ft. from property he - 20 ft, foundations..........
6. Depth of trench <30 inches from surf1ke ..................
7. Room allowed for expansion, 100% ......................
'
S. Size of gravel 3/4 V/ 2" diameter clean ....................
9. Depth of gravel in trench 12" minimum ....... i ...........
1.0- Pi'w-erlds -cap d
-ktfrn6-of-Dos'e& &Vsteins
1. Size of pump chamber,.-...... ... . .. . .......
2. Overflow tank ...... .......
.3. Alarm, visu o:.,:.,:
4. Pum '�yy A�a�cesisible.' 'm'* 'a'*n'h'* manhole gr*ade-
5. f �box baffled ................................................ ......
Cycle r
e
ycle witness* d by H.D.estirnated flow/cycle ...........
a. House located per approved plans ..............................
'..b. Number of bedrooms ...........................................
IV:' Well
Well located as per approved plans ...................... I ...........
b. Distance from STS area measured ft.. .......
c. Casing -18" above grade ................................................
d. Surface drainage around well acceptable .......................
V Overall Workmanship
a. Boxes properly grouted ..................................................
b. All pipes -partially backfilled .............................. ... ..........
c. All pipes flush with inside of box ..................................
d. Backfill material contains stones <4" diameter ...............
e. Curtain drain & standpipes installed according to P1
f. Curtain drain outfall protected & dir.to exist watercl
g.. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ........ ..........................
i. Erosion control provided ..................... ...........................
Rev. 12/02
10�1
I■
rim
C.
10�1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION X JOSEPH ❑ GENE
REQUEST FOR FINAL -INSPECTION
Date: 11/10/2004
PCHD Construction Permit #
PV -7 -02
For: Fill
Trenches
Located: Horton Hollow Road (T)'(V) (T) Putnam Valley
Owner/Applicant Name: Virginia Joy TM 72 Block I Lot 37.51
Formerly:
N/A
Is system fill completed? N/A
Is system complete? Yes
Is system constructed as per plans?
Is well drilled?' No
Is well located as per plans?
Are erosion control measures in place?
N/A
Subdivision Name: ... Subdivision Lot 5 Westchester Holding...
Subdivision Lot # 1
Yes
Vae
Date: N/A
Date: 11/8/2004
Date:
11/8/2004
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.
Date: —'— f00i2-d64-' -Ferti 71 PE X RA—
Design Professional
Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 'Lic. # 062505
Comments:
Form FIR-99
a PU7�WAM COUNTY DEPARTMENT .OF HEALTH
ry:
_AS OF ENVIRONMENTAL HEALTH SERVICES
� .y .� ... '. -. Q. ..w:�'S ....�4^': .4tr.= •cc..czT n 4-.. ..r tdc... ?•An:.4.�i .'.
r CERTWICA'TE OF CONSTRUCTIONtOMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHP CONSTRUCTION PERMIT # ° 01 .0
Located. at U AGATOM u W ROA0 Town or.Village. ��� -r &i K 6
Owner7Applicant Name y`e o-e r�o a �, a Tax Map Q Z:- , Block Lot
Formerly Subdivision Name ®» � sua wwre�wn� d., ®c
Subd.. Lot # ..
Mailing, Address 6 a 13.E � 3., %t o tv, Vasa �1 rte: taJ Yo - Zip Zi �a"�
Date Construction Permit issued by PCHD `"l 2r1 64
Seaarate Sew System built by o a� - �.ws�0 Address .?Isay ± . to. 1
9S,
Consisting of 'Gallon Septic Tank and'`. 8. "4 b��.�geos
ea
Other Requirements., Z ` � � C� A .1� . � � �. ' U itih
Water Suaimly: Publi Suppiyrn Address.
U.
or .: Pnvate-Suppiy. Drilled by..:�+:p.,.r�'c9�4 .a,,Address�c�.::.ad5,'o
5ff /
u?1'dasg '- nypeet� r as erc�on cor�+rol beencomplet_ed��I�f �]
_
IT—
Number 'of Bedrooms Has garbage grinder been installed? + �► .
t
L cerfifythat the system(s); as listed; serving;the, above premises. were constructed essentially.as s o nzt he.:
built plans; (copies of which are attached),. in accordance with the.issued;PCHD Constru tlon.Perni and approved..
.plans and the standards;. rules and regulations a e o De ment of Health:
Date. Certified by • P.E. � R.A.
V.
esiO Professional)
Address B &DEY. 1 �t'��� 'P.C. a-® PRJat1 &i-Y.. 1dtf 6 License
Any person occupying premises served.by the above,system(s) shall'promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resultuig from: such usage. Approval of the separate sewage
treatment, system shall becoine'null and void as soon as a publ c saiutary.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.
By ;sr ` .� (� Title: _ Date: l C7
Wh copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Professional
Form CC -97
UTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES a
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 1. AMa
PERMIT it N- -� - OZ
Located at CiOZivKc kXwL.') VDX6
... *4 i5i W Lei IS
Subdivision nama VMt ?5W Subd. Lot #
Date Subdivision Approved ca �'D$
Owner /Applicant Name
Mailing Address C�D G33 , �:U. + \/ q
Amount of Fee Enclosed it �(DDac`'
Building Type �1't-
Lea,
Town or Village
Tax Map Block Lot 3Y5
Renewal Revision A
Date of Previous Approval 12- 1 i 2 10.5
PE4,) Zip 105' 0(
Lot Area 1Z-2ALNo. of Bedrooms Design Flow GPD
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
,2-50
gallon septic tank and �' 5 t IF
Other Requirements: Z-0" 022 ate Or- 5A*4rJ - Czn'AQ& - -l^IUL
To be constructed by (8AQ� I-�� ° 15095
Address -)J/ 10,50
Water Supply: Public Supply From Address
°r �vaie-su piy- Lrnid'u by -N:
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:
P.E.
iI,- R.A. Date I-'
Address WO/L -W5t, PC-• cmo 6P74)&--A, ►-H l0Gi(.a License # CCZ505
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 pe it. Approved for discharge of domestic sanitary sewage only.
By: Title: %-Pl+ Date: 7 C, 0
Whi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT T O F HEALTH
DWISBON OF ENVIRONMENTAL HEALTH SERVICES
�. . Q....,..,T QPA:_rA7C��ll '�'•�1 q lu,?'';.4:W_,�' Q?�u'u u T _ ::Z a ... = -.
please print or type PCHD Permit # —
Well Location:
Street Address: TownNillage Tax Grid #
� i j4 E i°1.�J QQ� (J) �TX"N \JALLiEgMap TZ. Block k Lots) 37,51
Well Owner:
Name:
Address:
I�Ik -�Z)`{
0 (53 � iM VAL.L,i ,
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
I- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought S gpm # People Served (A Est. of Daily Usage dal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
J New Supply (new dwelling) Deepen Existing Well
Detailed Reason
'o gg04 f 0E A L'sj.� jg&Z (za5N 9 C_:F_.,
for Drilling
Well '}Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes )C No
Name of subdivision 1AC40iAXz..- Lot No. i
Water Well Contractor: OOP -VIA" MoEesw Address: O ighM \1A 1--F -j, 94 105_M
Is Public Water Supply available to site? .................................. ............................... Yes No }C
Name of Public Water.Supply: 9 %A TownNillage R
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on separate sheet/plan.
qfp t-
EVA
PERMIT TO CONSTRUCT A WA'T'ER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate.surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue A)-7 O y Permit Iss ing Official:
Date of Expiration 9 O; Title:
Permit is Non- Transferirabk_
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
WELL COMPLETION REPORT
..:�.£:: �.,!` �� - ^?e: ...
_ar, c:i �. _ ��: � :%•: r'. i[.a v. latA lJll�l If
�N6diw Mapg, Bock aoW Lots l"�Sf
Well Owner:
Nam : �� �Addre3 Pafnam V0110i ,V � / 657
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion Compressed air percussion Other (specify)
Well Type
Screened Open end casing . _) Open hole in bedrock _ Other
Casing Details
Total length l ft.
Length below grade ft.
Diameter _lin.
Weight per foot _I_Llb /ft.
Materials: ASteel _ Plastic _ Other
Joints: _ Welded _K Threaded _ Other
Seal: Cement grout _ Bentonite Other
Drive shoe: __)� Yes No
Liner: Yeses No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
_ Bailed _ Pumped Compressed Air
Hours
Yield gpm
Depth Data
Measure from land s rface- static (specify ft)
During yield test(ft)
/�
_rol
Depth of completed well in feet
15
Well Log
If more detailed
information
descriptions or
sieve analyses
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
`jam'
r2 A
1,
_
... _
/'� �'• / _; �`f
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type . , S ypacity �;at
Depth 5i� `Model tl$&S LO 1
Voltage 1222 HP oZ
Tank Type44nol Volume �0 <<�
1 WX3" AM
(3�
3J
611'
Date Well Clo mple d
l� lq U
Putnam County Certification No.
Date of eport "�M
Well rille (signature)
I
NOTE: Exict location of well with distances to at least two permanent laridmdrks to be providedAfn a separate 4heet/plan.
Well Driller's Nam a - Address: (� / y
Signature: Date: 44
White copy:
Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
,t BADEY & WATSON LETTER ®f TRANSMITTAL
3063 Route 9, Cold Spring, New York 10516 Date: 20 Jul 2004
TO:
Joseph S. Paravati, Jr.
Assistant Public Health Engineer
Putnam County Department of Health
1 Geneva Road
File No. 98 -105
W. O. # 16606
RE: Permit Renewal/NAME CHANGE
Joy
Horton Hollow Road
" ...Subdivision Lot 5 Westchester Subd. Lot No. 1
Tax Map 72.4-37.51
Permit/Title/PO # PV -7 -02
Sent via:
Brewster, NY 10509 US MAIL UPS -NIGHT El
MESSENGER UPS -2 DAY ❑
PICK -UP ❑ UPS -3 DAY El
FAX ❑ UPS -GRND W
We are sending: UPS -COD E]
copies date description of document
01
20- Jul -04 __j
jApplication Fee - $400.00
Ol
19- Jul -04 =
lConstruction Permit for Sewage Treatment System
Ol
F
ILetter of Authorization
Ol
11 9- Jul -04 —7
jApplication to Construct a Water Well
02
28- Apr -04 Ll
Floor Plans five 5 pages
®
19- Jul -04
Se arate Sewage Treatment System Sheet 1 of 1
U
j�
U
REMARKS:
your review. The subdivision info has been updated, the house footprint has been revised, the name has been changed, and the permit is being
Copies to: File
Yours truly:
Jason R. Snyder, Assistant Engineer
Tel: (845) 265 -9217 ext 13
Fax: (845) 265 -4428
Email: jsnyder @badey - watson.com
40 40.05 498572 624187 24686
JUL -16 -2004 14:56 BADEY & WATSON, PC P.02i02
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
,.n - .;i --..r. :.._w....... ::. .. a:'... -s.. r ya %•�c.'. �i!.vl.;?1 .t- T'
RE: Property of Virginia Joy
Located at Horton Hollow /toad
T/V Putnam Valley Tax Map # 72 Block 1 Lot 37.51
Subdivision of "...Subdivision Lot 5 Westchester Holding..."
Subdivision Lot # 1 Filed Map # 2824B Date Filed 7/8/2004
Gentlemen:
This letter is to authorize John P. Delano, P.E.
a duly licensed Professional Engineer J 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
Law, and the Putnam County Sanitary Code.
Very truly yours,
Countersigned. , Signed:
P.E. RW # 062505 (OwwofRu�x
Mailing Address Badey & Watson, P.C.
3063 Route 9 Cold Spring
State New. York Zip 10516
Telephone: 845 -265 -9217
Mailing Address: PO Box 633
Putnam Valley
She Now York Zip
Telephone: 845- 736 -3651
10579
Form LA -97
TOTAL P.02
DIVISgON OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
i,7 r"-r
MI `t
PERT #
Q I
Located at Town or Villa e 1 s' Lam`
Ca., , i,JC.
Subdivision name �C t1 _ ► Subd. Lot #, Tax Map Block 1 Lot 3�
Date Subdivision Approved aq II Renewal }� _ Revision
Owner /Applicant Name vJjt��- ate of Previous Approval of z`a �Z
Mailing Address � '�� � N Akoe �i �-/ Zip V b��
Amount of Fee Enclosed 15 -�OCL "'
Building Type Lot Area WNo. of Bedrooms A— Design Flow GPD C7LX-.)
Pill Section Only Depth Volume
PCH D NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED
Sepyarate Sewerage System to consist of�j � I I'M �. gallon septic tank and
-
Other Requirements: Z — C7`` 2+J� ' a--1 t-
To be constructed by MQcy-p L16tiQS y '50s,-r6 Address COL-P I01XQ
Water Su]pj2ly: Public Supply From Address
_ ._� : _ - -. -- _- Frivaie�iippiy ilriilec� by: lC�rYi.i "FCr
C, _ _ Acldress� = ice'
`q%75
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
curate 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 ii 15" c7 3
License # (DW-1500
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. Approved for discharge of domestic sanitary sewage only.
B?eC0pVy �� Title: Ap� Date: e2 / v 7)
W - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
P:PLI - T-10N Tn C-0N T—R JCT A WA. �TFR W_F ,I.F,. _ . - - - _
'please print or type . - ..� ....... _ > �PCHD Permit # �� .
Well Location:
Street Address: Town/Village Tax Grid #
ARWW r- Pj \JA.ZV' Map 7Z Block Lot(s)
Well Owner:
Name: c• -)
Address: /D56>1
Use of Well:
1 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 7 gpm # People Served 6 Est. of Daily Usage dal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
F: po � - ,rte fc
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 Q i*7`,T-e _ 1fCL0 jtk< Ko. a.(C�.. C a �-a Lot No.
Water Well Contractor: 1PANJ U22�=j, We . Address: Q wD6l \L ALL", . 4't o5 *9
Is Public Water Supply available to site? .................................. ............................... Yes No G�
_
Name of Public Water Supply: 144 Town/Village
Distance to property from nearest water main: -.- tA,:
Proposed well location & sources of contamination to be provided on separate sheet/plan.
�:
�l. %�i °; _Il i_3�3�1..."._.).. .An�►1�f`.arp �yjiui'1�711TP.: ,�'11'���/%1. <:!: _,R,ll:_�i`.�t /_ !'t _ ...
V
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. In
Date of Issue c C T— Permit Iss ' g Or ial: cLI , ,
Date of Expiration �. Title: 5%s ;-` ��lr
Permit is Non
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
�.•...c. - -n. it �'•"".....w. �..;..q.. ..:. ia•.�._ . a....a .+�rv.. - ..n -t r..n ..
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
December 5, 2003
John Delano, PE
Badey & Watson Engineering
3063 Route 9
Cold Spring, New York 10516
Dear Mr. Delano:
ROBERT J. BONDI
County Executive
Re: Proposed SSTS Renewal — Westchester Holding Corp.
Horton Hollow Road, (T) Putnam Valley
Tax Map # 72. -1 -37.5
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.
XI .. Please provide a copy of the wetlands permit.
n
"4' the bends in the effluent line 45 °? If so, cleanouts and cleanout detail need to be
provided.
This office will continue its review upon consideration of the above mentioned comments. Please feel free
to contact me at ext. 2157 if any questions arise.
Very truly yours,
eTl-
oseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP:ci
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & STTBSUR ,(�'A
,C �- 7T�z� E ���� �.�1�� +:ri c,1.:L+.�Si/m�� _ �:,.,,e,�.;ti, .•N i.......- „ -.•'rx an i-+nse
r .� • _. ti >`:� c ”. • ' �i* I`E E 1 1• U7EF (�NST�tTJCZ ION PERMIT
NAME OF OWNER: Lz,1 `0_1 STREET LOCATION:
REVIEWED.BY: RM, GR, �%� , SRDATE: f TAX MAP#: (CONFIRMED)
�Y� Z DOCUMENTS
Ci: PERMIT APPLICATION
WELL PERMIT OR PWS LETTER
(J(-_)PC=97
LETTER OF AUTHORIZATION
DESIGN DATA SHEET (DDS)
(CORPORATE RESOLUTION
SHORT EAF
(_� PLANS -THREE SETS
( OUSE PLANS - TWO SETS
(�AR7ANCE REQUEST
SUBDIVISION
LEGAL SUBDIVISION '
SUBDIVISION APPROVAL C
HECK
ED
J��PERC RATE.� p n•` /nut`
l:✓JC • ► L REQUIRED D EPTH
(�CUURTAIN DRAIN REQUIRED
GENERAL
(� LOCATED.IN NYC WATERSHED
(��)PLANS SUBMITTED TO DEP
( )DELEGATED TO PCHD
(_J EP APPROVAL, IF REQ'D
( DEEP TEST HOLES OBSERVED
(_ _J(�ERCS TO BE WITNESSED
(-_)L
PRE 1969 NEIGHBOR NOTIFICATION
(_„�tETTF3?,RllZBA
LUUD ILEVATION W1I 200'
((OIL TESTING LOTS >10 YEARS OLD
(� REQUIRED DETAILS ON PLANS
). SEWAGE SYSTEM PLAN - (NORTH ARROW)
�SSDS HYDRAULIC PROFILE
4�)GRAVTTY FLOW
CONSTRUCTION NOTES 1 -15
JJ(��TT DESIGN DATA: PERC & DEEP RESULTS
( ✓� 2' CONTOURS EXISTING & PROPOSED
Q�DRrvmwAY & SLOPES, CUT
(,�t�FOOTING /GUTTER/CURTAIN DRAINS
(�USDA SOIL TYPE BOUNDARIES
(�UTITLE BLOCK; OWNERS NAME ADDRESS
TM #, PEMA; NAME, ADDRESS, PHONE#
(4/ DATE OF DRAWINGaMVISION
DATUM REFERENCE
(__)LOCATION OF WATERCOURSES, PONDS
LAKES WETLANDS WITHIN 200' OF P.L.
PROPOSED FINISH FLOOR AND
BASEMENT ELEVATIONS
'�E�WELLS & SSDS'S WAN 200' OF SSTS
��-�PROPERTY METES & BOUNDS -
)(__)ERASION CONTROL FOR HOUSE, WELL &
SSTS, EROSION CONTROL NOTE `--
)MMEIVTS: ---4 t-`' �1e as
?.lM=cw•r %nnim inn
(�Y �R -EMED DETAILS ON PLANS CONT'Dl
(� OUSE SEWER -'/.'' FT. 4 "0'; TYPE PIPE.CAST IRON
(�(�O BENDS; MAX BENDS 45' W /CLEANOUT
RENEWALS
LLI_USUTE NOTE (NO CHANGE)
FILL SYSTEMS
10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE
(FILL SPECS / FILL NOTES 1 -5
FILL PROFILE & DIMENSIONS
FILL IN EXPANSION AREA
FILL GREATER T9AN2 FEET
CLAY BARRIER
ULUFILL CERTIFICATIO?jN_OTE`�-
L-)(JDEPTH GAUGES-`
UUVOL..ON PiAN FOR R.O.B., UNCLASSIFIED & MERVIOUS
(__)(_�—SEPARA.TION DISTANCE FROM'TOE OF SLOPE
� )LF TRENCH PROVIDED�N� 60FT MAX /�'�G ✓'Lr�C 5"�d
✓( (� l� PARALLEL TO CONTOURS
U 100% EXPANSION PROVIDED
(-L—T( EE CRUSHED'STONE OR WASHED GRAVEL
6GEOTEXTILt FR
COVER
/ SEPARATION DISTANCES ON PLAN - FROM -SSTS
3 (�i 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
()20' TO FOUNDATION WALLS
100' TO WELL, 200' IN DLOD,150' TQ PITS r v
100' TO STREAM, WATERCOURSE, LAKE-(inc - ezpaa),
__)50' -T0 GAT-C'H- 7!A_5,1: 5' SYtZc21i�:�•Ra ? F Er: W =EB
10` 1 ti vV9.TER LINE (pits - 20') '
U50'• INTERMITTENT DRAINAGE COURSE
(� )200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS
v10' MIN TO LEDGE OUTCROP
SEPTIC TANK
(✓U10' FROM FOUNDATION; 50' TO WELL
WELL
CL�- ' IMENSIONS TO PROPERTY LINES
(t/ LOCATION OF SERVICE CONNECTION
MIN 15' TO PROPERTY LINE
SLOPE
�(_ jS PE IN SSTS AREA i0 %)
(_)(� GRADED TO 15 %, IF REQUIRED
DOSE/PUMP SYSTEMS
UUPUMP NOTES .
( )C_JDOSE 75% OF PIPE VOL OSE VOLUME NOTED
((__)DETAIL FOR FOR , (PIPE TYPE, ETC.)
(_- __)(„)PIT AND BOX SHOWN & DETAILED
STORAGE ABOVE ALARM
..-- -- -` CURTAIN DRAIN f
UUSTANDPIPES, 5' BOTH SID AIL , v
(x(_,__)15' MIN to CDS�>5, %� -4 %, 25' -3 %, 35' -lb /o, 100 % - <1%
C_) __)20' MPLU -CD DISCHARGE/100' with 182 cons day discharge
L—(_ NO"MIN to NON - PERFORATED PIPE
NOV-18-2003 17:28 BADEY & WATSON, PC P.02/03
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FOR PERMIT APPLICATION SUBM1TTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for: arste !Lw e trMtMelml fac*ty.
E _M_
1,
Beirde Rath
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: Wesfthwier Holdigg Co., loco
Having offices at: 33 Chester Court, Corflwdt Nftmoir, MY IOS67
Whose Officers Are:
President - Name: Berude Raab, President
Address: 33 Chester Coa•t, Corflandl Manor, NY 10567
Vice President - Name:
Address:
Secretary -Name.
Address:
Treasurer - Name:
and that I am and will be individually responsible for any and all acts of the corporation with respect
to the approval requested and all subsequent acts relating, thereto.
Tide: President
iqqy-,
�worn to before me this day of
tZ (monffi) '-';Z6 (year)
Notary Public
WV -18 -2003 17 :28 BADEY & WATSON, PC P.03/03
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r7 -Ji ETTERACM- 98 , i .! .'►.,s.. pav_,:�. ;�� .... -u fe �.' � ..-s.
RE: Property of Westchester Holding Co., Inc, do Bernie Rath
Located at Horton Hollow Road & Cimmaron Road
T/V (T) Putnam Valley TAX Map # 72 Block 1 Lot 37.5
Subdivision of Westchester Holding Co., Inc. Parcell III
Subdivision Lot # s Filed Map # 2824A Date Filed 08 /02/01
Gentlemen:
This letter is to authorize John P. Delano, P.E. ___
a duly licensed Professional Engineer X or Registered Architect — to apply for the required
wastewater treatment andlor water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public H ealth Director of the Putnam
County H ealth 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
m conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public H ealth
Law, and the Putnam County Sanitary Code.
truly yours,_ - - - - - -.
_.. - -
Count y.
ed:
Sinsi
P.E.;o# PE 062MS (Owner of Pmperty)
Mailing Address Badey & Watson, P.C.
3063 Route 9, Cold Spring
State New York Zip 10516
Telephone: (US) 265 -9217
Mailing Address: 33 Chester Court
Cordandt Manor
StateL New York Zip 10567
Telephone: (914) 739 -3198
Form LA -97
TOTAL P.03
BADEY & WATSON LETTER of TRANSMITTAL—-
C
3063 Route 9, Cold Spring, New York 10516 Date:
24 Nov 2003
File No.
98-105
W. O.#
15705
RE:
Permit Renewal
TO:
Horton Hollow Raod & Cimarron Road
Joseph S. Paravati, Jr.
Westchester Holding Co., Inc. Par Subd. Lot No. 5
Assistant Public Health Engineer
Tax Map 72.4-37.5 ?
Putnam County Department of Health
Pernutfride/P0 #
I Geneva Road
Sent via:
Brewster, NY 10509
US MAIL El UPS-NIGHT
11
MESSENGER El UPS-2 DAY
PICK-UP 0 UPS-3 DAY
E]
FAX El UPS-GRND
0
We are sending:
UPS-COD
El
copies date description of document
FT 120-Nov-03 I FApplication Fee - $300.00
71 118-Nov-03 I [Construction Permit for Sewage Treatment System
F-11 119-Nov-03 Affidavit - Corporate Owner Application
F-11 1 771 Letter of Authorization
F-11 11 8-Nov-03 lApplication to Construct a Water Well
F-41 118-Nov-03 71 ISeparate Sewage Treatment System Sheet I of I
❑ I
El I
F-1 I
REMARKS:
For your review.
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 22883
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # 1� - -�--
j`lG��
Located at H o yroN _�4 0 U- w �� Town or Village P m,,, M iA L1 ;F-a
WUrcwC�-rak 1401,01atr
Subdivision name Co. ., lue_.I PAfg-,, -jK Subd. Lot # Tax Map -17- Block Qj Lot 3`j ._.5
Date Subdivision Approved
�a t lAi t.B
Owner /Applicant Name
Renewal Revision
Date of Previous Approval
Mailing Address 3S GArs ; r& CuM7 , CAMANry MAMDL NJ Zip,,
Amount of Fee Enclosed 2100 `�'
Building Type RriSl,vx„rAA& Lot Area 32.9 A, No. of Bedrooms Design Flow GPD_,M
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of Z,sp gallon septic tank and 515 L F - or n"
Other Requirements: P V IY""t- V-o" M iN- 9-0.8. Gi l.i.-
To be constructed by AgaLn Lma -tjs Sax)c Address 1-15 A-nA . GAGA
Water Sunaly: Public Supply From Address
yr., rivate Supply Dritled'by jtkS0 i hi s; Ad&ess -C ;; ; -n1'9 057,q
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
Wk— Date
License # ®d256f�
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. Approved or discharge of domestic sanitary se age only.
r�
By: � '--- Title: Date: C
White copy - HD File Yell w opy - Building Inspector; Pink copy - O er; 0 an copy - Design Professional
Form CP -97
. PUT NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
.:10411 Permit # .. �� _ v�:
please print or type - r~ ��% ^Yf � .
Well Location:
S eet Address: Town/Village Tax Grid #
AD, P,, , A , VAuo Map I Z Block 01 Lot(s).37.5
Well Owner:
Name: W,n
Address:
PA
I VITA M.). t
S3 ClAalra Coi1�; i i CoqLWT MOdV i og 6 5
Use of Well:
Residentfal Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought _5 gpm # People Served Est. of Daily Usage 00 al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
_ New Supply (new dwelling) Deepen Existing Well
Detailed Reason
PwAC NIML& wAT&& Stmt 71) J&Q A6DO&JC6
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No D
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision`, 6t- IfAfl-S3.0 9o; ML C -0 !NC..,, &Cep_ 11 Lot No.
Water Well Contractor: _ , Address: •
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: WA Town/Village 6&A
Distance to property from nearest water main:t/�
Proposed well location & sources of contamination to be provided on separate sheet/plan.
PELT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED ' FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County. /] .
Date of Issue 1 _2 '—b 2 Permi
Date of Expiration I — Title:
Permit is lion- Transfer able
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
a: r
PUTNAh1 COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
LN-Dn'IDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
R- /E,V, I-EW S[H:EE'TT R
FOR CONSTRUCTION PEP
IN'
Tr
NAB tE OF O��i 1ER:. /�✓�`�J�� / ""�" ITREET LOCATION: y.
REVVED BY: RDL GR, AS, &ATE: r�'- TAX NIAP ": (CONFIRMED)_ 99
1" N DOCULNTENTS -Y N (REQUIRED DETAILS ON PLANS CONT'D)
UUUPERIIIT APPLICATION ((__)HOUSE SEWER -' /," FT. 4 "0'; TYPE PIPE CAST IRON
ELL PER`IIT ORPWS LETTER (:(ENO BENDS; NIAX BENDS 45° W /CLEANOUT
UUPC -97 RfagWALS
(_ZULETTER OF AUTHORLLATION ()USiTE NOTE (NO CL)
J �( )DESIG`' DATA SHEET (DDS) ILL S S EtitS
UL-)CORPORATE RESOLUTION (�U10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE
VJUSHORT EAF U�UFILL SPECS/ FILL NOTES 1 -5
UUPL.A-NS -THREE SETS (� FILL PROFILE & DIMENSIONS
UUHOUSE PLANS - TWO SETS FILL Di EXPANSION AREA
(J(_)VARLANCE REQUEST FILL GREATER 7Wj.,N 2 FEET
SUBDIVISION U' (� CLAY BARRIER
(�(__)LEG_AL SUBDIVISION (___)UFILL CERTIFICATION NOTE
((__)SUBDIVISION APPROVAL CHECEED (__)UDEPTH GAUGES
(/U(__)PERC RATE - 0 {� vUVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & BIPERVIOUS
(U(__)FML REQUIRED DEPTH UUSEPARATION DISTANCE FROM TOE OF SLOPE
U(j CURTALN' DRAT REQUIRED R
GENERAL
(�( CA TED L`. Iv'YC WAT LF TRENCH PROVIDED � 60FT hLAX.
PARALLEL TO CONTOURS
((___)PLAN D TO DEP 0100% EXPANSION PROVIDED.
(�( GATED T_ - - -- ( DETAILIDUST FREE CRUSHED STO`tE OR WASHED GRAVEL
C ( _JDEP APPROVAL, IF RE COVER
CZ __)DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS
(�(__)PERCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
WUEX- APPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS
t .J(__)WETLANDS (TOWir'/DEC PERhIlT REQ'D ?) 100' TO WELL, 200' I`( DLOD,150' TO PITS
(Q(__)DATA ON DDS PLAINS & PERIN= SAME 100' TO STREAh1, WATERCOURSE, LAKE (mc. eipan)
Lj(-,�ORE 1969 NEIGHBORNOTIFICATION a0' TO CATCH BASIN, 35' STORbIDRAIN, PIPED WATER
U(�LETTERBUZBA f10' TO WAiEF�hTi ta4� 2� f:• . - -
_ _C lrtnTj h`iTERiIIITTENTDRAIiAGE COURSE U(USOIL TESTL`iG LOTS >10 YEARS OLD (200'/500' RESERVOIR, ETC. — 150' GALLEY SYSTEMS
REQUIRED DETAILS ON PLANS (�H10' MLY TO LEDGE OUTCROP
( Z(SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK
Y)L.JSSDS HYDRAULIC PROFILE U10' FROM FOUNDATION; 50' TO WELL
(..,6(JGRAVITY FLOW WELL
(,ZLJCONSTRUCTION NOTES 1 -15 UDLNIENSIONSTOPROPERTYLINES -- -- - - --- - --
(�f(__)DESIGN DATA: PERC &DEEP RESULTS L/)ULOCATION OF SERVICE CONNECTION _ _
_j2' CO, 8c PROPOSED _ _._U_ __ vUNM 15' TO PROPERTY LINE
( �IFO DRIVEWAY & SLOPES, CUT SLOPE
OTI ING /GUTTER/CURTAIN DRAINS �(�SLOPE li`i SSTS AREA a—y (0I
(�( _)USDA SOIL TYPE BOUNDARIES
(,L�(___)TITLE FLOCK; OWNERS NAME ADDRESS (_)(QREGRADED TO 15 %, IF REQUIRED
TM;, PE/RA; NAME, ADDRESS, PHONE DOSE /PUMP SYSTEMS
( -Z( —JDATE OF DRAWING/REVISION UUPUitiTP NOT
(�( _JDATU1N1 REFERENCE LU(UD0SE 75 / F PIP OL /DOSE VOLUME NOTED
( -4(—JLOCATION OF WATERCOURSES, PONDS UUDETAIL FO FO CE , (PIPE TYPE, ETC.)
LAKES,WETLANDS WITHIN 200' OF P.L. U-)CUPIT AND D -B SHO & DETAILED
(J (PROPOSED FINISH FLOOR AND UU1 DAY STO ALARM
C T D Iri
BASEh1ENT ELEVATIONS UUANDP S 5' 0TH ES DETAIL
(f�(�WELLS & SSDS'S W/IN 200' OF SSTS UU15' hILY to - >5% 0'4%,25'-3%,35'-l%, 100 % -cl%
(�(�PROPERTY h1ETE5 &BOUNDS �)U20' h1L'i to C GE/100' with 182 cons day discharge
U(�10' NIL`( to ON - PERFORATED PIPE
CONIh1ENTS:
(REVSHEET)
PUTNAM C, 'UNTY DEPARTMENTS )F HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.DESIGN DATA SHEET SUBSURFACE. SEWAGE TREATMENT .SYSTEM
33 Chester Court
Owner B. Rath / Westchester Holding Co. Address Cortlandt Manor NY 10567
Located at (Street) Horton Hollow Road Tax Map 72 Block 1 Lot 3 7
(indicate nearest cross street) Lot 5
Municipality, Putnam Valley Drainage Basin Hudson River
SOIL PERCOLATION TEST DATA
08/07/00 (A) 08/08/00 (A)
Date of Pre - soaking 08/09/00 (C) Date of Percolation Test 08/10/00 (C)
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
A
1
12:10 - .12:40
30
19 - 201/2
1 1/2
20
-A
2
12:41 - 1:11
30
19 - 201/2
1 1/2
20
A
3
1:12 - 1:52
30.
19 - 201/2
1 1/2
20
4
-
-
5
-
_
C
1
12:17 - 12:41
24
19 • - 22
3
8
12:42' .- .• 1.12'
C
3
1:14 - 1:44
30
.19 - 22
3
10
4
-
-
5
-.
-
1
-
-
2
3
-
-
4
5
-
-
NOTES: ° •1 `' { . Vests `toly *rE
' 'percolatronr-:
submitted foi
2. Depth i e6su
ted at same depth until approximately equal percolation rates are obtained at each
hole. (i.e. < 1 min for 1 -30 min/irch, < 2 min for 31 -60 min/inch) All data -to be
to be made from top of hole.
Form DD -97
Indicate level at which groundwater is encountered 41-011
Indicate level at which mottling is observed #2 41-011
Indicate level to which water level:rises after being encountered 41-011
Deep hole observations made by: J. Delano, P.E.' Badey & Watson, P.C. D . ate 11/06/00
witnessed by A. Stiebeling PCDH
Design Professional Name: John P. Delano, P.E.
Address: Badey & Watson, P.C.
3063 Routed, Cold Sprinj, NY 10516
Signature:
Design Professional's Seal
T - -
.4
I
TEST PIT DATA 2
DESCRIPf 1*O*N OF SOILS ENCOUNTERED IN TEST HOLES
DIEPTH—.
NU.
G.L.,
Topsoil
Topsoil
0.5"
Sand & Gravel 1,oatn
Sandy Loam
1.01
V
V
131
V
V
.2.01
V
Loam w/ Clay
2.'5'
y
V
3.0.
V
V
3.5'
V
V
4ff
V H2O
V H2O
4.5'
V
V
5.0'
V
V
5.5'
V
V
6.01
V
V
6.5
V
V U1
7.0'
V
V
7.5'
C-M
8.0'
8.51
9.Of
9--
10.0'
Indicate level at which groundwater is encountered 41-011
Indicate level at which mottling is observed #2 41-011
Indicate level to which water level:rises after being encountered 41-011
Deep hole observations made by: J. Delano, P.E.' Badey & Watson, P.C. D . ate 11/06/00
witnessed by A. Stiebeling PCDH
Design Professional Name: John P. Delano, P.E.
Address: Badey & Watson, P.C.
3063 Routed, Cold Sprinj, NY 10516
Signature:
Design Professional's Seal
T - -
.4
I
14.164 (115-) — Ted 12
PROJECT I. D. NUMBER 617.20 SEAR
Appendix C
State Environmental Quality Review
r -11OP E`v 111 NSh,, r f tSL
For lr�r
-GlvI' 'i` i•l�''T�'Ii V ti '
. -.s .:,. .. ._.
UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1 . APPLICANT /SPONSOR
2. PROJECT NAME
Westchester Holding Co. Inc.
Westchester Holding Co. Inc.
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 ❑ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
Construction of new single family residence, septic system & well
7. AMOUNT OF LAN_ D AFFECTED:
Initially <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 PROJECT?
® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park /Forest/Open space Other
Describe:
Single family house on 5+ acre lots.
ULTic ATELY FPOF AN, . OTijEtZ GOV�-FNENTA t (F� 10. DOES ACjJO";INV0LVE.A FERWT iPPROVAL.' GR FUNDING CV-1 Or
,
YA _
55 OL
®Yes ❑ No If yes, list agency(s) 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. 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 Vapplicant Date: 01/11/02
, a
Signature: ./ /
V
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 Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ No
...y i.' i I r+ -� a A;f , fYti 4 r S t • � V ,. 11 „t% .., >y
AY-
may be superseded by another involved agency.
❑ Yes ❑ No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe 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 ?gplain -briefly
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.
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑ Yes ❑ No
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? .
❑Yes _... ❑No If Yes, explain briefly,_
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
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 enGironmental 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 rile of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL- OF PLANS FOR...
=A:VA 1 "EWATEER TREATMENT SYSTEM
1. Name and address of applicant: Westchester Holding, Co. Inc.
33 Chester Court
Cordandt Manor, NY 10567
2. Name of project: Westchester Holding Co. Inc. 3. LocationT /V: Putnam Valley
4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson Surveying, P.C.
6. Drainage Basin: Hudson River 3063 Rt. 9, Cold Spring, NY 10516
7. Tvne 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 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? ------ - - - _
11. Name of Lead Agency Putnam County Department of Health
n/a
12. Is this project in an area under the control of local planning, zoning, or other
oc?als,or(in�nees?: - - -��
fi .�.
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 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
11/06/00 A. Stiebeling
24. Project design flow (gallons per ' ay _______ ________ ___ ___
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
Ly is VVetarias rerni "t required' % -------------------------------------------- � F � - , �...r
Yes
Has application been made to Town or Local DEC office? _� _ n ?�� a -�------ Yes
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
DESCRIBE: n/a
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 ? ---------------------------------------
35. Are any sewage treatment areas in excess of 15% slope? -------------------- No
36. Tax Map ID Number --------
------------------ - - --
-- Map 72 Block of Lot 37.5
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
LEF, 1 +. - Ugk -4, �.t:r�j��� •,�.; -r _ q ; - i`c �
approval of the. SSTS prior to final approval by the�Department. Projects within the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces; and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l.,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
maybe grounds for the rejection of any submission.
I hereby affirm, under penalty o f perjury, that information provided on this form is true`
to the best of my knowledge -and belief. False statements made herein are punishableca',s
a Class A nusdemeanor pursuant to Section 210.45 of the Penal Law.
SIGNATURES & OFFICIAL TITLES:
Badey & Watson, P.C.
Mailing Address: -------------------- 3063Itoute9
Cold Spring, l@iY 10516
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- AFFT� lVTT - .COIRPf?R- ATE_OWN_ER APPLICA TION_
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for:
I,
CONSTRUCTION PERMITS FOR SEPTIC & WELL
BERNARD RATH
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation:
Having offices at:
Westchester Holding Co. Inc., Parcel III
33 Chester Court, CortlandT, NY 10567
Whose Officers Are:
President - Name:zN�v�,�i9T /�
Address: '3 '3 Cr/C s re 2 �'�' &-011C7c,'AWQ 7- �i'�ivo� AV
Vice President - Name: '41` �C
Address: d
Secretary -Name:
Address:
C •r/90
.T - ..6, «. 'AT,. iii iC' "r1' �. A f✓ iQ .i A:;q .. . -.... ,
• 1 rGA u1�a - ivtCj.iv. .- v�— •; :Y �%•' i...:.r`SE ♦ rY � •. .. - _... .. .. _. -.
Address: / 4- L-/3,*, 00 r //v_?
't." '�'/`/� /va3
and that I am and will be individually responsible for any and all acts of the corporation with respect
to the approval requested and all subsequent acts relating thereto.
Signed: ` '�
Title: s: o 6-A-r
Swo o before me this day of
o e
Notary Public
REBECCA W. LINDA
NOTARY PUBLIC, State of New York Corporate Seal
No. 5004353 p
Qualified in Dutchess Count
Commission Expires November 16,
Form CA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
RE: Property of Westchester Holding Co., Inc.
Located at
T/V Putnam Valley Tax Map #
Subdivision of
Subdivision Lot #
Gentlemen:
5
Horton Hollow Load
72 Block 1
Westchester Holding Co., Inc. Parcel III
Filed Map #
Lot 37.5
e6 /(j401
2824A Date Filed `���'—
This letter is to authorize John P. Delano, P.E.
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
Law, and the Putnam County Sanitary Code.
Countersigned:
P.E.,64�,#25c�5
Mailing Address Badey & Watson, P.C.
3063 Route 9, Cold Spring,
State N.Y. Zip
10516
Telephone: 845- 265 -9217
Very truly yours,
Signed: 21
4_
(Owner of Property)
Mailing Address: Westchester Holding Co., Inc.
33 Chester Court, Cortlandt Manor
State New York Zip 10567
Telephone: 914 - 827 -7469
Form LA -97
13ADEY & WATSON LETTER of TRANSMITTAL
.r_ -_ .�r�.rzU�19�j104�. Fn�iy,��?Or'•31;�.r .. -_'. .: ".. � . .. ......s'.i : ._ -._.. ... ..,.. -. -..`. - _ .i
.....
3063 Route 9, Cold Spring, New York 10516 Date: 14 Jan 2002
.L . �.
(845) 265 -9217 (914) 628 -1800 (914) 739 -3577 File No. 98 -105
(845) 225 -3312 FAX (845) 265 -4428 W 0. # 14380
RE:
Rath
TO: Horton Hollow Road
Adam Stiebeling Westchester Holding Co., Inc. Par
Subd. Lot No.
Putnam County Department of Health Tax Map
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 ❑d
UPS -COD ❑
We are sending
copies date description of document �f
7i ;12- Dec -01 A lication Fee
F1 ;11 -Jan-02 lConstruction Permit for Sewage Treatment System
❑1 ILetter of Authorization
1 106-Nov-00 A lication for Approval of Plans for a Wastewater Treatment System
1 i 11 -Jan -02 Short Environmental Assessment Form
1 i 12- Dec -01 Affidavit - Corporate Owner Application
- --
.-
. �6 >1 lov -c) Sheet
1 11 -Jan-02 A lication to Construct a Water Well
21 IFloor Plans
E 11 -Jan-02 ISeparate Sewage Treatment System Sheet 1 of 1
C�
RENI_?KS:
Sfgni: John P. Delano, P.E.
Copieto: File
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NEW RESIDENCE FOR:
Virgina M.Joy
Horton Hollow Road
mwa
Putnam Valley, New York
6
N
23' -0' 5
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.• - 06- O'f' I - - - -- _-0
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PUTNAM COUNTY DEPARTMENT OF HEALTH w o
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HOLSE PLANS APPROVED FOR BEDROOM COUNT ONLY
x-070-1/
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Al f SUBSEOUENT REVISION /ALTERATIONS TO THESE HOUSE ,�4� ClYj
0`7 I PANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL �V �QN Mlgr
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Monument Set 2002
RecioK"d 2004
S60J0'00T Pin & Cop Set
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Fire Easement to be dedicated to —
the Town of Putnom Valley for the
purpose of Emergency Services.
Area — 0.066 &ms
Under Ground Ton* /ocvted October 2000
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SURVEY OF PROPERTY
i PREPARW FOR
J® lV LANDI & t1 /RGINIA M JO Y
SITUATE ;fl THE
TOWN OF PU VAM VALLEY
s
PUTNAel+11 COUNTY
1VEW X ARK
SCALE 1 inch = 50 feet AUGUST 25, 2004 SEP 22 20
We hereby certify that t&-,'survey shown hereon was
completed by us on August 25, , 2004 that this mop was
completed on August 25, 2004 and that this survey has
been prepared in accordance with, the existing Code of
Practice for Land Surveys odootec' by The New York State
Association of Professional Land 'urveyors, Inc.
Revised September 21, 2004. .Seep note 7
PRINTED
I&A TSON
SV EW ISERING, P. C. SEP 2 1 2004
o
BADEY & WATSON
NEW YO ND SURVEYOR SURVEYING & ENGMERING, P.C.
°X8167 FILE No. 98 -105
1" = 100,
HOLLOW
)�POSFZ __1
41.
2
ROOF LEADER DRAIN
PROPOSED 6",DIA. . 3'
DEEP SEEPAGE'P.IT —
True North of
x
N
... ..........
241.0
241.
39.5
4° LlP OR APPR E VA T
�> $ / 1 /4" PER FT. PITC
125 AL RECAS
.,CONC. TI TAN
PVC *1
FT. "FAIN., PITCi
50 FT.
FOR Cl
'LAN x
STI 39X t!�EIIAFFLE
)o,nNG TO 42 P. -
;PEED LEVELERS'.
PROVIDE 575 \F
LF
ABSORPTION TREIC��(
LATERALS OF 57.5 ,
Jp
H05
Jn
Ln
PVC *1
FT. "FAIN., PITCi
50 FT.
FOR Cl
'LAN x
STI 39X t!�EIIAFFLE
)o,nNG TO 42 P. -
;PEED LEVELERS'.
PROVIDE 575 \F
LF
ABSORPTION TREIC��(
LATERALS OF 57.5 ,
Jp
1 It = 30'
ION AND SURVEY INFORMATION IS AS SHOWN
'RTAIN MAP -n-n Kr) "qi ip\/Fy or Ppe)PPPTY
Sid
.'AS-BUILT
RELOCATION- DIMENSIONS
1A
63.6'
SEPTIC TANK
13A
86.8'
BEGIN LATERAL
1B
40.0'
SEPTIC TANK
13B
115.9'
BEGIN LATERAL
2A.
66.6'
SEPTIC TANK
14A
85.9'
BEGIN LATERAL
2B
44.3'
SEPTIC TANK
I
14B
119.7'
BEGIN LATERAL
3A
82.3'
DISTRIBUTION BOX
15A
153.0'
END LATERAL
3B
83.6'
DISTRIBUTION BOX
15B
169.3'
END LATERAL
4A
96.5'
CLEAN -OUT
16A
150.6'
END LATERAL
46
111.6'
CLEAN -OUT
16B
169.7'
END LATERAL
5A
99.2'
BEGIN LATERAL
17A
148.8'
END LATERAL
5B
113.9'
BEGIN LATERAL
17B
170.6'
END LATERAL
6A
97.7'
BEGIN LATERAL
18A
147.2'
END LATERAL
6B
117.0'
BEGIN LATERAL
18B
171.8'
END LATERAL
7A
95.0'
BEGIN LATERAL
19A
147.3'
END LATERAL
76
119.0'
BEGIN LATERAL
19B
174.6'
END LATERAL
8A
92.7'
BEGIN LATERAL
20A
51.0'
END LATERAL
86
121.3'
BEGIN LATERAL
20B
58.1'
END LATERAL
9A "
" 90.2'
BEGIN LATERAL
2i-A--
1 A
45.4'
END LATERAL
96
123.5'
BEGIN LATERAL
21 B
61.1'
END LATERAL
10A
94.5'
BEGIN LATERAL
22A
40.9'
END LATERAL
10B
108.8'
BEGIN LATERAL
22B
65.5'
END LATERAL
11A
90.6'
BEGIN LATERAL
23A
36.7'
END LATERAL
11B
109.9'
BEGIN LATERAL
23B
70.1'
END LATERAL
12A
88.5'
BEGIN LATERAL
24A
33.3'
END LATERAL
12B
112.8'
BEGIN LATERAL
24B
75.2'
END LATERAL
WC
76.0'
WELL
WD
78.0'
WELL
/: j TJJ7 1 TA
h