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HomeMy WebLinkAbout3191DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -46 BOX 26 air . . IN .� -. ,,, Na laaa -_ , . , . 03191 PV "k -AAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONM-ENTAL.HFATaTH.SE W--C ,S_._... ^ _ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWA�, ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # r1q' W— o1 Located at " C�dV�1l;G'- �ca+.i Town or Vi age I Vr tLF-V Owner /Applicant Name JO-!'ax Map TZ, Block i Lot 46 Formerly f5E-AQE71X' ` uAlA G i Watljj Subdivision Name xf'A Subd. Lot # P 1/-k Mailing Address 0� -�� �`T �u�iL�yi � .��D � � C 1�`J , )4,-1 Zip /c,51700 Date Construction Permit Issued by PCHD 08 h6 ° z Separate Sewerage System built by '13 omo CALCU Address M IMEOLA , P-t 165 © l Consisting of It Z Gallon Septic Tank and `� ��~ or:: Z`l u (—^j � Other Requirements: Water Suuuly: Public Supply From Address or: )( Private Supply Drilled by uo&vvW A-mO elf Address 1PU ,,,A M 1.fJMx-e --1, X(`1 /0511 T __. ___!?.�:•_��Y2�- - -.kJZ ___....-_ _....:_.._ ... - =- _ .Hs.c.r�r.;[c�n_c.'ctntrni;he�n c;,,;s;:niarPri9 -- -- - - -- Number of Bedrooms Has garbage grinder been installed? dJo I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: i� `� uZ Certified by C' P.E. X R.A. Address % i i = C (Des* Professional) vtK; , JJY /t ulC4 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 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. By: �� Title: Alo//� Date: White/copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street .Y��1<)598 . '.-^ ' - .v*` -,-~ _� - (914) 245-2850~' Albert H. Pacovani, Director LAB #: 32.306005 CLIENT #: 56788 NON STAT PROC PAGE l CROSS, ANNAMARIE & ROB DATE/TIME TAKEN: 07/29/03 O1:00P 56 CIMARRON ROAD DATE/TIME REC'D: 07/29/03 04:37P PUTNAM VALLEY, NY 1O579 REPORT DATE: 08/06/03 PHONE: (914)-438-5013 SAMPLING SITE: 56 CIMARRON ROAD : PUTNAM VALLEY, NY COL'D BY: ROBERT CROSS NOTES...: HOSE (KIT TAP) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE . TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 07/29/03 -MF T. COLIFORM -ABSENT /100 ML ABSENT 07/29/03 `LEAD (IMS) -<1 ppb 0-15 ppb 07/29/03 -NITRATE NITROG <0.2 MG/L 0 - 10 !NITRITE -NITRITE NITROG <0.01 MG/L N/A 07/29/03 -IRON (Fe) <0.060 MG/L 0-0"3 mg/} 07/29/03 ~MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 07/29/03 -SODIUM (Na) 3.61 MG/L N/A 07/29/03 -pH 7.1 UNITS 6.5-8.5 07/29/03 ~HARDNESS,TOTAL 78.0 MG/L N/A 07/29/03 ALKALINITY (AS 72 MG/L N/A ~�07/29103 TURBIDITY (TUR myTU. 075 NTU --� --'-�-�'--~_-_�_ COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINE�Zf���HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. METHOK 1008 9101 9139 9146 2037 2037 9043 .' -- e r:+ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT VGell . ocation Street Address: - . " ° '" ` 'I n/ V'iicage " .. 'I ax Or - Map Block Lot(s) Li Well Owner: Na e: Address: a F0 u ( Ire j Use of Well: 1- primary 2- secondary Residential Public Supply Air cond /heat pump Irr gation 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 R'S ft. Length below grade T ''"ft. Diameter e..' in. Weight per foot /G lb /ft. Materials: _ Steel _ Plastic _ Other Joints:. _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: 7–Yes _ No Liner _ Yes .5C.No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First S' _ Yes—No Hours Second Well Yield Test _ Bailed _Pumped &Compressed Air Hours 2j Yield )d gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or si:veanayses:.. are available, please attach. Depth From Surface Water Bearing Well. Diamctcr(in) Formation Description ft. ft. Land Surface 1 `' 006 � If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type &12! i C Capacity 0 Depth 944 , Model h_; � Voltage � 30 U HP I Tank Type �,! 3e'�- Volur(ie dc�- j Date Well Completed / 0 LaV C JY Putnam County Certification No. Date of Report /m/1 3 ell Driller (signature) 5- � N07: Fxact location of well with distances to at least two permanei nt lanamarKs to be provided on a supwaM a„cvvYa Well Driller's Name %MMj - Address: Signature: �47 /Qn jg Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 MAY -14 -2003 11:12 BADEY & WATSON, PC PUTNAM COUNTY DEPARTME NT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES �v� A U U . uJ t1t �;It;; i k ` .. A'��1�ENT ��(s'Il'ikw Robert', & A nrnamaria Cross Owner or Purchaser of Building Y-1/l. &Ccam- cv ✓, - " Building Constructed by ._ 56 Cimarron Road Location- Street Residential Building Type P.04104 72. 1 46 Tax Map Block Lot Putnam Valley Town/Village NIA Subdivision Name _ N/A_ 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 undersigned 6further agrees to accept as conclusive the determination of the Public Health tjhe it al i:u�irity "n�ii itetmcni Gi AC, U1'u�iv'troilLdGl Cl6`R1Vi tia�' $ai'a'ilisr'6L,UJL6 byb till to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month 11 Day 14 Year w 02 13n", G^x,� General Contractor (Owner) - Signature d (14 aa. ±r-L, '0 n � ' 2 Corporation Name (if corporation) Address: 2-1i"0 F ad . MiOeo State /V Zip I l SL Signature: Title: e6��5 I Corporation Name (if corporation) Address: State __......__..._.. Zip _.._ Form GS -97 TOTAL P.04 ��pM CpGy � a -e BRUCE R. FOLEY * # LORETTA MOLINARI R.N., M.S.N. Y Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: 2u ? ,41..WAVv1A%ZA CAf55 TAX MAP NUMBER: TZ, _ - q(4 E911 ADDRESS: -?7-2 0.N' AZZ.W QA� TOWN: AUTHORIZED TOWN OF 1 MIX W (Signature) 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. (E91 Iverfnn) YML ENVIRONMENTAL SERVICES ' - 321 Kear Street -137 It Albert H. Padovani, Director LAB #: 32.306005 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CLIENT #: 56788 NON STAT PROC ~~~=~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PAGE 2 CROSS, ANNAMARIE & ROB DATE/TIME TAKEN: 07/29/03 O1:O0P 56 CIMARRON ROAD DATE/TIME REC'D: 07/29/03 04:371::' PUTNAM VALLEY, NY 10579 REPORT DATE: 08/06/03 PHONE: (914)-438-5013 SAMPLING SITE: 56 CIMARRON ROAD : PUTNAM VALLEY, NY COL'D BY: ROBERT CROSS NOTES...: HOSE (KIT TAP) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAb PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFOM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L �ODERATEL���HA 0^M.G/L ILL _ -_-_-__-- SUBMITTED BY: Albert H. PadpyAni,DM.T.(ASCP) Director ELAP# 10323 BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, AC. 3063 Route 9, Cold Spring, New York 10516 Date: 04 Sep 2003 W. 0. # 15414 RE: Certificate of Construction Compliance Cross TO: Cimarron Road Joseph S. Paravati, Jr. N/A Subd. Lot No. N/A Assistant Public Health Engineer Tax Map 72 : 1-46 Putnam County Department of Health Pernritrfitle/PO # PV -14 -01 1 Geneva Road Sent via: Brewster, NY 10509 US MAIL M UPS -NIGHT ❑ MESSENGER El UPS -2 DAY El PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GRND 66 We are sending: UPS -COD El copies date description of document F-11 26- Aug -03 -7 JApplication Fee - $200.00 ❑1 14- Nov -02 Certificate of Construction Compliance for Sewer Treatment System 1 113-May-03 E911 Address Verification Form ❑ 3 14- Nov -02 Guarantee of Subsurface Sewage Treatment System ❑ ❑1 29- Jul -03 —� Well Water Test Results two 2 pages F T 128-Aug-03 lWell Completion Report ® 14- Nov -02 I SSTS "As- Built" ❑ REMARKS: Copies to: File Yours truly: Jason R Snyder, Jr. Engineer Tel: (845) 265 -9217 ezt 13 ) 265 -4428 Email:-jsnyder @badey - watson.com 40 40 -05 499390 625678 22204 BRUCE R. FOLEY Public Health. Director 1= LORETTA - MOLINARI RN.; M.S.N. Associate. Public Health Director _ 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 12, 2002 Badey & Watson John Delano, P. E. 3063 Route 9 Cold Spring, NY 10516 Re: Field Inspection -Cross Cimmaron Road/Putnam Valley TM #72- 1- 46/Permit #PV -14 -01 Dear Mr. Delano: A site inspection was made for the above referenced project on November 8, 2002. The following comments must be corrected in the field. �l The excess concrete near the outlet pipe in the septic tank should be removed. 2. The well casing needs to be extended, 18 above. grade. It is currently flush, with the . ground. . _ .. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157 Sincerely, Joseph Par a v�ati, Jr. Assistant Public Health Engineer JSP /jp PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: cted 'iris .e.. � .. b p Y: Street Location f l c w.^ %LG Owner " 5 Town %� �% Permit # � ( - TM #- ;2. - / - 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.:: ... , 1 ..... ...... ........... ........... ........ d: Stone, brush, etc., greater than 15' from STS area.......... e.. 100' from water course /wetlands ................ .................. H. Sewage S ste a. Septic tank size - 1,000 .``...1, 250 ... ...... other ...............: b. Septic tank installed level .......... ............................... c. 10' minimum from foundation ................ .............. �. d. Distribtuion Box 1 Al ouI tlets at s e elevation -water tested.......... A 2. Protected below ................ ............................... . 3. Minimum 2 10 in soil between box & trenches Junction Box roperly set ... -1: Len- required Length installed ���v , 2. Distance to watercourse measured F�`Tla 3. Installed according to plan .:....... ............................... 4. -Slope of trench acceptable 1/16 - 1/32 "/foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth.of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % .......................... 8. Size of gravel 3/4 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... .. _ 10, . Pipe ends eµn; s. t :..... g. Pump or Dosed Systems . ize o pump c , er ................... .......... . 2. Overflow tank.... .. ....... ....... ......... 3. Alarm, visual/audio ...... ............................ 4. Pump easily ace ible, manhole to grade ................. 5. First box ba ......................................................... 6. Cycle. witnessed by H.D.estimated flow /cycle........... III. House/Bui din a. house located per approved vlanns_. Number of bedrooms ....................................................... IV. Well a. Nell 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 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 & dinto exist watercoursell g. Footing drains discharge away from STS area.........:.:;` „M h. Surface water protection adequate ............................� i. Erosion control provided ................. ............................... Rev. 1/97 orm = 611/V I■ IWM ' 11FAE == r� orm = 611/V OCT -31 -2002 17:27 BADEY & WATSON, PC MrAFnlp - PUTNAM COUNTY DEPARTMENT OF ;;CIE ALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL - INSPECTION For: Fill Date: 10131/2002 Trenches PCHD Construction Permit # PV-14-01 Located: _ Cimmaron Road -- (T) (V) Putnam Valley Owner /Applicant Name: Robert & Annamaria Cross TM 72- Block 1 Lot _46 Formerly: Bennett & Linda Giannini Subdivision Name: _ n/a Subdivision Lot # t/a Is system fill completed? NIA Date: Is system complete? No Date:. Is system constructed as per plans? WA.__,.T Is well drilled? Yes. Date: Is well located as per plans? Generally Are erosion control measures in place? Yes NIA 10/31/2002 10/31/2002 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. Date: 11041112002 .. Certified by: John P. Delano, P.E. PE X R A Address: Badey & Watson, P.C. 3063 Route 0, Cold Spring, NY Lic. # 062605 Comments: 1.) Cover for last drop box needs to be replaced (corner broken off). 2.) Pitch of septic pipe between the 3rd and 5th from the last clean -outs is too fiat in some areas. 3.) Piping from tank to fields needs to be completed. REQUEST TO BACKFILL TRENCHES. FOR: ❑ ADAM ❑ GENE ® Joe Paravati (NAME) Form FIR -99 TOTAL P.01 OCT -31 -2002 THU 18:20 TEL:e45- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 08 Aug 2002 (845) 265 -9217 (914) 628 -1800 (914).739-3577 (845) 225 -3312 FAX (845) 265 -4428 File No. 98 -105 W. 0. # 15198 RE: Proposed SSTS - REVISION CROSS (formerly GIANNM TO: Cimmaron Road Shawn Rogan N/A Subd. Lot No. N/A 1 Geneva Road Tax Map 72.4-46 Brewster Permit # PV -14 -01 NY Sent via: US MAEL 11 UPS -NIGHT El 10509 MESSENGER Q UPS -2 DAY El PICK -UP El UPS -3 DAY F� FAX ❑ UPS -GRND W UPS -COD El We are sending: copies date description of document 5 106-Au-g-02 Construction Permit for Sewage Treatment System 1 I Letter of Authorization ❑ ® 05- Aug -02 Se arate Sewage Treatment System Sheet 1 of 1 F__11 106-Aug-02 jApplication to Construct a Water Well r 02- AuQ -02 A lication Fee - $150.00 - i.�. I I ❑ ❑ ❑ ❑ REMARKS: Signed: John P. Delano, P.E. Copies to: File 7559 AUG -02 -2002 10:12 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL, HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Robert & Annamaria Cross Located at Cimmaron Road o� T/V Putnam Valley Tax Map # 72 Block : 10=1 Lot 46 Subdivision of N/A _ N/A N/A _ _ Subdivision Lot # -Filed Map # Date Filed.._ '�'Ywmber Gentlemen: P. 01/01 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 PLmam_Counnr. Sanita_ . rode. _ Very truly your Countersigne Z&j _ Signed: P.E.,, # 062505 _ (Owner or Property) Mailing Address... Badey & Watson, P.C. 3063Route 9 Cold,SOring State . _New York Zip_.,.._... -10516 Telephone: _ 845-265.9217 Mailing Address: 1543 Hanover Street Yorktown Heights State New York _ Zip 10598 Telephone: 914 -962 -2249 Form LA -97 TOTAL P.01 �1A" PUTNAM COUNTY DEPARTMENT OF HEALTH �\ IE DIVISION OF ENVIRONMENTAL HEALTH SERVICES . ♦ r. .. _ .i r .-. - . . -.� .... �. :.ya...w ... ... a -... . t ... .. r n ... .... .'.M .r µ -.Mn I •.. _. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Dt z Located at - - ,��IZ�[. 1ZC�J � � �'j Subdivision name JA . Subd. Lot # Date Subdivision Approved u I A Owner /Applicant Name Z-d(E C\ ` A Ajo,4ea C t65 Town or Village1•t�M 1..!_.t- -- Tax Map 4Z Block Oi Lot )-(b Renewal Revision Date of Previous Approval 0'5 z5 0t Mailing Address !3 1iibVF-1ZIZNlz 1 jo21CCU6� IY,4-U T5 IJ y Zip Amount of Fee Enclosedi5�s Building Type 1Za1tic�lSl�tL LotArea/0-IJ-11 No. of Bedrooms `i Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of j , Z50 gallon septic tank and �CO 1.,G, or- A, Lj%o F 501-CED A (> i 0,c— Other Requirements: To be constructed by kwuo LA)45 = 5ws Address . C� 0V o5i Water Suouly: Public Supply From Address rCivate'up ly-Driiieu uy.. 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. R.A. Address', , F--1 s vJ `�SCa�I , 5 L, x-, 9. (-.:VD SP2aJCr l.! V License # Date 08 40Z- 0 6 ZSc� �c�SI G 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 p it. Approved r discharge of domestic sanitary sew a only. By: Title: _ Date: a-- White copy - HD ile; ell w copy - Building Inspector; Pink copy - wn • range copy - Design Professional Forn. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ Please iP(:Ieriiiit Well Location: Street Address: Town/Village Tax Grid # C-04 A- "QUi 1RCA13 � ,� ;Jvvi �fA-J-LE4 Map TZ Block 01 Lot(s) Well Owner: Name: tZj3,7a , C Address: k,W4 ^QlA G.tZC65 154-13 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 C5 gpm # People Served 6 Est. of Daily Usage Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _ New Supply (new dwelling) Deepen Existing Well Detailed Reason 1,,) po��6' F iA9--y1E(Z_ EJ'J Q SAC) - rGe for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No �C Is well located in a realty subdivision?i ... Yes No lC Name of subdivision 'I Lot No. Water Well Contractor: 'K1G46,pq -1 v7, Address: 6— �MI5W, alt/ Is Public Water Supply available to site? ..... Yes No 0 Name of Public Water Supply: ,A Town/Village P 14 Distance to property from nearest water main: ? I /A i LF- Proposed well location & sources of contamination to be provided on separate sheet/plan. ;:Applicant Ci fgnaturev::= 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. Date of Issue — d 2 Permit IssuinA Official: Date of Expiration A Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 G 07/2912002 13:18 9145264992 TENDY AND ZARCONE PAGE 03 PUTNAM COUNT. AEPARTMENT OF .HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .g; ,.._. APPLICATION TO CONSTRUCT A WA'l�ll1V•�''" Ant nr 6.iwa PCHD Permit # P V Well Location: : ' F r.... . yr_ Street Address: Tow•nNillage Tax Grid # az> &LA Map 2,,, Block I Lot(s) Well Owner: Name: BeN —" f LI&U tAddress: l l .� T-5 Use of Well: Residential ..'Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm : Test/Monitoring Other (specify) 2- secondary Industrial Instit4tio2 l Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage �gal. Reasop for Replace. Exiking Supply Test/Observation Additional Supply Drillinkti 4. _2N New Suplily (new .dwelling) _ _ Deepen Existing Well Detailed Reason N JA,)1A4LC �~ . for Drilling.f Well Tjrp :� Dri led °� , ;." Driven Gravel Other Is well site•subject'to flooding? ................... ................... ........................................... Yes No Is well located in a•realty subdivision? ... ................. ............................... Yes No Name of subdivision i`� . �" Lot No Water Well Contractor: µ . '1C „ �.I � • � Address: GrPnkf . Q Ni 4QA - Is Public Water Supply available-to site? ................................. ............................... Yes No Name of Public Water Supply:. g. Town/Village Distance to property from nearest water•main:' 1' ffh j Lt Proposed well location & sources of contamination to be provided on separate sheet/plan. }�,: c�plicar e___._...../�'�� 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 (3 0) 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 anew permit: Well to be constructed by a water, well. iller 4N ' ie by Putnam County. 1 10. Date of Issue 1'. ti ?' c' f, Permit.Issuing, aeial: - i N, Date of Expiration . I 'Title: Permit is Non - Transferrable 17 > White copy - HD file; Yellow copy = Building Inspector; Pink copy, - Owner; Orange copy - Well driller " Form WP -97 - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :T . « .: _ :;.► ... ., , A PL1C'AT ID-TY.11. �1. �s'��1��i�R V� i�JL. r0- +PLAN -8- TF OR. A WASTEWATER TREATMENT SYSTEM 1. Name -and address of applicant: Bennett & Linda Giannini 9 Pheasant's Run Buchanan, NY 10511 2. Name of project: Giannini 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 (SEQR)? 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 b Lead A enc P p y g y•------ - - - - -- - - - - -- N/A 11. Name of Lead Agency P.C.D.H. 12, Is this project in:an area under the control'of local planning, zoning, or other "V 11 Va wllaLlv�.J• ...... -------------------------------------------------- _________-- ______ 1vV 13. If so, have.plans been submitted to such authorities? ________ _____________ _ No 14. Has preliminary approval been granted by, such authorities? N/A Date granted: N/A 15, Type of Sewage Treatment System Discharge_______________ surface water X 'groundwater 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, 04/09/01 23: Name of Health Inspector A. Stiebelin 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? ________________________ ___ N/A Form PC -97 NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent ta�the. Department,_and�need not be sent in duplicate to -the DAP, although. the .project may, require DEP provai of iiie 65 prior'to Tiriai approval'u 'ille � iinen�. i�j'Cits i�itlrin l e-a�acershec - nay°als =_- =" �- -- require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the, appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 1, el EF wztu �11, AJ,4,t0 Badey & Watson, P.C. C£ :01 f'ai ' � dress- -------- - - - - -- ---------- - - - - -- -- 3063 Route 9 `�YA d� 10 Cold Spring, NY 10516 .t lino WVNInd 27. Is any portion of this project located within a designated Town or State wetland? Yes 28. Wetlands ID Number N/A , Has application been made to Town or Local DEC office? - ---- --- ------- ------- ---- --- - -- - -- No 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: 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 46 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent ta�the. Department,_and�need not be sent in duplicate to -the DAP, although. the .project may, require DEP provai of iiie 65 prior'to Tiriai approval'u 'ille � iinen�. i�j'Cits i�itlrin l e-a�acershec - nay°als =_- =" �- -- require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the, appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 1, el EF wztu �11, AJ,4,t0 Badey & Watson, P.C. C£ :01 f'ai ' � dress- -------- - - - - -- ---------- - - - - -- -- 3063 Route 9 `�YA d� 10 Cold Spring, NY 10516 .t lino WVNInd r V l l N 1-11V1 %-/ V V 114 1 1 LJlil Al\ 1 1Vlli1.4 1 V 1 11.LAL 1 11 DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM _. �. .ir 1. Name and address of applicant: Bennett & Linda Giannini 9 Pheasant's Run Buchanan, NY 10511 2. Name of project: Giannini 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 (SEQR)? Type Status (check one)----------- -------------- --- - - - - -- Type I' Exempt Type II Unlisted X 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 P.C.D.H. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ---- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Yes 1� Tfcn ,.1�aerF ��aisc..%a?n c�.�L,jn nary to git�_��1.1r -it ern _ vTc:.. 14. Has preliminary approval been granted by such authorities? N/A Date granted: N/A .15. Type of Sewage Treatment System Discharge___ ____________ ____ surface waterX 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? ______________ _________ -I.._......____:_______ 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 24. Project design flow (gallons per dayT -----------------------------------------------------------------= - - = - -- 800 25'. Is State Pollutant Discharge Elimination System ( SPDES). Permit required ?.... No 26. Has SPDES Application been submitted to local DEC office? _____________________________ N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number 29. Is Wetlands Permit required? ________ Yes- No Ir 0 N/A ------------------------------ Yes �, e. ,. .7" •_ Vin.- _... _.._:_. .. ria applica[run eed. -fiaue �c� uwti ur Loyal i�r,� oiii�e: . 30. Does project require a DEC Stream Disturbance Permit? __ ____________ 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 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? ___ _______________________________ DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ______ ____ _ _ __ Yes/No No No 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? 36. Tax Map ID Number _____________________ 37. Approved plans are to be returned to No ----------- Map 72 Block 1 Lot 46 Applicant _X_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to_fnal approval by the Department. Projects within the watershed may also - iGquiie'DEPfc iGW -a-adi V=pi pilqj-eCt, such h-aS dh u cadwi-oi 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 g a Class A misdemeanor pursuant to Section 210.45 of the'PgAal Law. SIGNATURES & OFFICIAL TITLES. Badey & Watson, P.C. 9 Mailing Address- --------------------------------- - - - - -- 3063 Route - Cold Spring, NY 10516 PUTtNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' : l�j�ilri'�I i�l�►�t- i`�ti��l - aUi���YrA�.�+ �l�Wtili��KEA�I�%1�`��i�l �3(�T^IH�VI .. ,.� 9 Pheasant's Run Owner Bennett & Linda Giannini Address Buchanan, NY 10511 Located at (Street) cimmaron Road Tax Map 72 Block 1 Lot 46 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River SOUL PERCOLATION TEST DATA (A) 02/13/98 (A) 02/14/01 Date of Pre - soaking (D) 03/01/01 Date of Percolation Test (D) 03/02/01 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 2:20 2:31 11 19 — 22 3 4 A 2 2:31 — 2:43 12 19 — 22 3 4 A 3 2:44 — 2:58 14 19 - 22 3 _ 5 A 4 2:58 3:12 14 19 — 22 3 5 A 5 3:13 — 3:27 14 19 — 22 3 5 D 1 2:45 — 2:54 9 19 — 22 3 3 i D .. .i' 2 2:15- 4 ::3:0 10: i ...�!D ...::._ E9. i ...o...? _:. V..'. D 3 3:04 3:14 10 19 22 3 3 4 — — 5 — 2 — — 3 4 5 — — NOTES: L -iie§6Ito'be"repeated at same depth until approximately equal percolation rates are obtained at each i.percolation.test hole. (i.e. < 1 min for 1-30 min/inch,. < 2 min for 31 -60 min/inch) All data to be submi ted for review. 1 . Depth measurements to be made from top of hole. Form DD-97 Indicate level at which groundwater is encountered not encountered Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered N/A Deep.hole observations made by: T. Dyckman, Badey & Watson, P.C. witnessed by A. Stiebeling, PCDH '04/09/01 Design Professional Name: John P. Delano, P.P. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: dA:�v), Design Professional's Seal. Cc Y; cL�1. ./ Ile 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _ ��T�T�.:. (4' -:wD :r_ m �__ -s:... - -. Yi :Ys:.! rs. Lv:'� � .a_ - i..v._ � .. �_..: L�• i�eiJ: •_'..�:+.v_� .. =.w: tea.... i.a -: a.�c'� 1r ''. —,.. , ;rim._ :. ... -.-_ ...�.. :'� +. -. G.L. Topsoil (4 ") Topsoil 0.51 Silty Loam Silty Sandy Loam 1.0' V V 1.5' V V 2.0' V y 2.5' V V 3.0' Sandy Loam Sandy Loam 3.5 V V 4.0' V V 4.5' y V 5.0' V V C) rn 6.0' V v �--� -' 6.5' y y 7.0' V V , r.n c 7.5' V �= w 8.01 y ry 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered not encountered Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered N/A Deep.hole observations made by: T. Dyckman, Badey & Watson, P.C. witnessed by A. Stiebeling, PCDH '04/09/01 Design Professional Name: John P. Delano, P.P. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: dA:�v), Design Professional's Seal. Cc Y; cL�1. ./ PUTNAM COUNTY DEPARTMENT Ur' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM -9.Ph.ess itt's Rup.. Bennett & Linda Giannini Buchanan, NY 10511 Located at (Street) Cimmaron Road Tax Map 72 Block 1 Lot \,46 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA (A) 02/13/98 . (A) 02/14/01 Date of Pre-soaking (D) 03/01/01 Date of Percolation Test (D) 03/02/01 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 2:20 2:31 11 19 22 3 4 A 2 2:31 2:43 12 19 22 3 4 A 3 2:44 2:58 14 19 22 3 5 A 4 2:58 3:12 14 19 22 3 5 A 5 3;13 3:21 14 19 22 3 5 D 1 2:45 2:54 9 19 22 3 3 D 2 2:54 3:04 10 19 22 3 3 D 3 i. 3:04 -7 3:14 19.. 7,1 22 3'r 3 4 5 2 3 4 5 NOTES: 1, 46'be� repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1-30 min/inch, < 2 min for 31-60 min/inch) All data to be submitted, r review. 2. Depth, measurements to be made from top of hole. -97 Form DD L TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. DEPTH HOLE NO. 2 HOLE NO. 4 HOLE NO. 0.5' Silty Loam Silty Sandy Loam 1.0' y V 1.5' V V 2.0' w 2.5' v v 3.0' Sandy Loam Sandy Loam 3.5' V 4.0' y V 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' - 8.0' 8.5' 9.0' , 9.5' Indicate level at which groundwater is encountered not encountered Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered N/A Deep hole observations made by: (2) John P. Delano, P.E., Badey & Watson, P.C. on 02/13/98 (4) G. Avalear, Badey & Watson, P.C. on 03/01/01 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 ow or' iEW yo, CC ' l,. 1416 -4 (11/95) - Te)d 12 PROJECTED. NUMBER 617.20 SEQR Appendix C 1i�iEtitui �aL:olily FicVla1M1 SHORT ENVIRONMENTAL ASSESSMENT. FORM -For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)' 1 . APPLICANT /SPONSOR PROJECT NAME Bennett & Linda Giannini F2. Giannini 3. PROJECT LOCATION: - Municipality T/o Putnam Valley County Putnam. 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Cimmaron Road (see map provided) 5. IS PROPOSED ACTION: ® New ❑ Epansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Single family residence, SSTS and well. 7. AMOUNT OF LAND AFFECTED: Initially <5 acres Ultimately<$ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes []No If No, describe brlefly 9. WHAT IS PRESENTLAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial Commercial Agriculture Park/Forest/Open space Other Describe: Single Family Homes on 2+ acre lots 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR-ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ®Yes ❑ No If yes, list agency(s) and permit/approvals T/o Putnam Valley: driveway, building & wetland permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMrr 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 ApplicanUsponsormme: John P. Delano P.E. Engineer for Applicant Date: 04/12/01 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - ENVIRONMENTAL ASSESSMENT (To be completed by Agency) 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 ❑ Yes ❑ No _. B ;VftI'ACTt0KRECENE COORDINATED REVIEW;Q�$.PEc,QVIpED FOR UNLISTED ACTIONS.IN 6 NYCRR PART 617.67 If No, a negative. declaration . . l.. 'e "':s - t^..i _.a- �.r'N ..w... M'Ihsl:x.a..P.: d' + ".>Bc•� -..Y .v.a -.� 1......t,.. ... �... may be superseded byanoine� involved �g€�ncy. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic agricultural, archaeological historic, or other natural or cultural, resources: or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, 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 - -. - _ .�.... ..- .....n.. c .�-.. .>. 4- ..a..._...en.•- cr- x...�+.o-co o..�,..o- t.•....e. -... -- _ _. _ %-a .:•. -.. .- �....- ..•...- r..e..�.... _ .. =" ° -r : -... . .t -✓-v -- •:,cry ,+ao.+ -. 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 True of Responsible Officer Signature of Responsible Officer in Lead Agency Signature,of Preparer (If different from responsible officer) Date 2 op 1416.4 (11/9) -Text 12 > 3ROJECT I.D. NUMBER 617.20 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM _ For UNLISTED ACTIONS ;Only -- .. . . ✓.'." - 'i_._'rr "•.. :- a r. .. .::.G ;. s; .. ,u-., a .. .. -. •. _ - ,.. }PART I— PROJECT .:i.¢INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT /SPONSOR 2. PROJECT NAME Bennett & Linda Giannini Giannini \, 3. PROJECT LOCATION: Municipality T/o Putnam Valley County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Cimmaron Road (see map provided) 5. IS PROPOSED ACTION: ® New ❑ Expansion - ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Single family residence, SSTS and well. 7. AMOUNT OF LAND AFFECTED: Initially <5 acres Ultimately<5 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 Homes on 2+ acre lots 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? 0 l.-o If yes; !ist agency(s) and perrnit/approvals. T/o Putnam Valley: driveway, building & wetland permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Dyes ®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 Applicant Date: 03/23/01 J 41 Signature: '�� i 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 Aqency) 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 ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may.he superseded by another involved agency. Yes i -1No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic agricultural, archaeological historic, or other natural or cultural, resources: or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain.briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, 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 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 ea 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) n JC V 1 NAM CO 4JTN i V DEPARTM �.-'.1-_,.RTT IVISTON OF ENVIRONMENTAL HEALTH SERVICES. iNITTIAL INDIVIDUAL /COMMERC1AL SITE INSPECTION FORAM SECTION A. ,,GENERAL INFORMATION Narhe of Project &I A-um County Site Location ` ri r r AV O*-c`f e::::2 Building construction begun Extent Is projerty within NYC Watershed ? .. ................ ❑ Yes ❑ No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly ❑ Rolling_❑ .Steep.slope.____ -Gentle slope —o Flat--- - 2. ❑ Evidence of wetlands F_� Low area subject to flooding Bodies of water ❑ Drainage-ditches ❑ Rock outcrops . 3. Property lines or corners evident ...................................................... ❑ Yes ❑ No Do water courses exist-on or adjoin tie property? Yes Q y No 5. Will these affect the design of the sewage system facilities ?............ Yes No 6. - -Do watershed regulations apply'in this development ?............ ....... Yes .- _. _.. 5r. nP Ar "i! tn gradrag be necessary......:......... ............................... Ye No ❑s 8. Will extensive fill be necessary for SSTS? ......... ............................... Yes . ❑ No 9. Do filled areas exist within the SSTS area? ........ ............................... Yes ❑ No If yes, what is the condition of the fill? - - -- - - -- J - - - - -- - - SECTION C. SOIL OBSERVATIONS - - - -- - - - 10. Appearance of goil: Sand Gravel Loam Cla . Hard an Mixture - ❑ -❑ ❑_ ..❑ y._❑ p 11. Observed from: ❑ Borings ❑ Bank cut ❑ Backhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater on 14. Depth to mottling on -... - .. . 15. Are test holes representative of primary & reserve areas ...... ............................... ❑ Yes ❑ No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) 01 _ 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Dyes Q No 19. Will groundwater or surface drainage require special consideration? ..................... Dyes No 20. Will gullies; ditches, etc., be filled and watercourses be relocated ? ......................... Q 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? ................................ ............................... F_� Yes a No Inspection data - - - - 22. Do adjacent_wells and/or sewage systems exist ? ....................................... - - -- :................... es No 23. Additional comments 24. Site observerrmspector and title -t - -- 25. - Date(s) of observation(s)in'Vection(s) TEST PIT PROFILES 2 vK Hole # Lot # - _,Hole # -- -Lot # ' ' - -- Hole # - -Lot# Depth to water Depth to water Depth to water Depth to mottling Dev_th to r�aottling �.y _ uepui to `iockfiinp. Depth to rock/imp. Depth to rock/imp. G.L. 1.0 ..2.0 3.0 G.L.. G.L. 1.0 r - :3.0 3.0 4.0 �Gt( — '(o rr 4,0 36 i— 7 — p rr -' 4.0 6.0 5.0'�� 7.0 7.0 5.0 6.0 7.0 7.0 5.0 6.0 7.0 9.0 9.0 ' 9.0 10.0 10.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at T/V Putnam Valley Tax Map # Subdivision of Bennett & Linda Giannini Cimmaron Road 72 Block 1 Lot 46 N/A Subdivision Lot # - Filed Map # - Date Filed Gentlemen: This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer X or Registered Architeci ` 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. .very truly yours, Countersigned: G. Signed: P.E,, Y�# PE 062505 (owner of Property) Mailing Address Badey & Watson, P.C. 3063 Route 9, Cold Spring State New York Zip 10516 Telephone: (845) 265 -9217 I Mailing Address: State New York Telephone: 9 Pheasant's Run Buchanan Zip 10511 914 - 734 -2682 Form LA -97 BADEY & WATSON LETTER of TRANSMITTAL N 7, 3063 Route 9, Cold Spring, New York 10516 R Date: 16 Apr 2001 (845) 265-9217 (914) 628-1800 (914) 739-3577 File No. 98-105 (845) 225-3312 FAX (845) 265-4428 W. O. # 13896 RE: Proposed SSTS Giannini TO: Horton Hollow Road Adam Stiebeling N/A Subd. Lot No. N/A Putnam County Department of Health Tax Map 72.-1-46 Permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT W F MESSENGER ❑ UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ UPS-GROUN El UPS-COD ❑ We are sending: copies date description of document F-]1 112-Apr-01 lConstruction Permit for Sewage Treatment System F-1] 112-Apr-Ol lApplication for Approval of Plans for a Wastewater Treatment System F71 112 -A r -O I IShort Environmental Assessment Form F__11 109-Apr-01 IDesign Data Sheet F-5] 112-Apr-01 ISeparate Sewage Treatment System Sheet I of I E ❑E lApplication to Construct a Water Well -"Survey of Property .. -Wes+ h!,s F-1 I 1 7:71 REMARKS: New original application and plans pursuant to witnessed deep holes on 4/9/01 and conversation on 4/16101, with the exception of letter of authorization and application fee which was previously submitted. Signed: John P. Delano, P.E. Copies to: File BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, , 3063 Route 9, TCold Spring, Date: 30 Mar 2001 (845) 265-9217 (914) 628-1800 (914) 739-3577 File No. 98-105 (845) 225-3312 FAX (845) 265-4428 W. 0. # 13896 RE: Proposed SSTS Giannini TO: Horton Hollow Road Adam Stiebeling N/A Subd. Lot No. N/A Tax Map 72.4-46 Putnam County Department of Health Permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT MESSENGER ❑ UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY ❑ FAX ❑ UPS-GROUN ❑ UPS-COD ❑ We are sending: copies date description of document Fl 123-Mar-01 --- I IConstruction Permit for Sewage Treatment System F-1 ILetter of Authorization F-1] 123-Mar-01 jApplication for Approval of Plans for a Wastewater Treatment System F-1] 123- Mar -01 IShort Environmental Assessment Form 0 102-Mar-O I IDesign Data Sheet 74 127-Mar-O 1 7 ISeparate Sewage Treatment System Fill Plan Sheet I of 2 Trea System Iftpt 2 F-2] F 223- Mar -01 Floor Plans F-1] 123-Mar-01 lApplication to Construct a Water Well F-11 1 lApplication Fee El REMARKS: Signed: John P. Delano, P.E. Copies to: File C W BRUCE R FOLEY Y.OUTrA MOLINAM LN., M.S.N. Public Health Directs AgRactme Public MOM Director Direetar of Padeat Ser Acea DEPARTWNT OF HEALTH 1 Geneva Road Brewster, Now York 10509 REQUEST FOR MUDLIESTING ATTENTION: AM STIEBELING C! GENE TUBED (� All information below must be � completed prior to any scheduling. DATE: l 4 O �a b+r► R De 1"o , P ENGINEER OR F RM: a REASON; DEEPS: )i PERCS: a i'1JMP TEST: o ROAD/STREET: n btim OLM A ILA J TOWN: PO4 mm yo-flee N TAx la 7z) - oil Id SUBDIVISION: � LOT #: — OWNER: &I RN N t IU I - r Z ... 'f. `f BtEgtTE. - ,a.Nli m "�v�. a it r c im: t T a i Tip -. - - - - lf-Molu+ o 42(- Proposed SUS within the drainage basin of West Branch or Boyds Corner Pteservoirs. a g Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. o W proposed SETS within 100 feet of a watercourse or a DEC wetland. 0 Proposed SSTs design flow greater than 1000 gallouslday or SPIDIES Permit required. o Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response_ If you answered yet to any of the questions. NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable tame for field testing with the PCDOIT, the Design Professional and MDR. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soli testing with NYCDEP. Fox MUAti"Y e;se oNLY DATE, rn�: i�c��rnttowrs: -� �- T 70,1TR -,4 '1,4 d King I HM 'Q 1 W7HA 7C-OP rMAa_aM-NN 4H BRUCE R. FOLEY - -'�.- .yryu�:ic'c:�u;t.i• iLi��11f,T. - :,r._,;.::.�,� -. .� , .. .�.. �_ April 27, 2001 LORETTA MOLINARI R.N., M.S.N. :. �... �1:,s661ate' .Pud -My 6i6 r 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) 228 - 6108 Fax (845) 278 - 6648 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: Giannini, Cimmaron Road TM# 72 -1 -46, (T) Putnam Valley Dear Mr. Delano: This office has received and reviewed the most recent set of plans dated April 12; 2001 for the above mentioned project. We would like to offer the following comments for your review and consideration. Plan: 1. As discussed during the filed inspection on April 9, 2001 with Tonya Dyckman, wet areas a.. .,� wicl slrearns,--are­to-be;shovm q- n- the rolan andio ,y da *tJn the 't� err letland .:N..� - Inspector. 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, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONNEENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT s - LoC.aTION:��1 / REVIEt4ED BY: Ri%L GR( AS,/SRDATE: �{O TAX IvLAP (CONFMNIED) ° f Z I ' T� Y 'N ' D'OCUN EYI'S �� .X-' ( REOUIRED DETAILS ON PLANS CONT'D) APPLICATION .RMIT OR PWS LETTER ETTER OF AUTHORIZATION L_)DESIGN DATA SHEET (DDS) � ORPORATE RESOLUTION ORT EAF PLANS -THREE SETS OUSE PLANS - TWO SETS UV ANCE REQUEST SUBDIVISION GALSUBDTVISION SUBDIVISION AP 'ROjVAL CHECKED l� PERC RATE __;1- 11 OL. ON PL�uNTOR RO.B., UNCLASSIFIED & IMPERVIOUS REQUIRED — DEPTH L��EPARATION DISTANCE FROM TOE OF SLOPE . CURTAIN DRAIN REQUIRED TRENCH GENERAL (� LF TRENCH PROVIDED 60FT MAX. ( —)CZ ATED L\ NYC WATERSHED (�PAR4LLEL TO CONTOURS C� ANS SUBNITITED TO DEP 100% EXPANSION PROVIDED U GATED TO PCHD U( ET4IIMUST FREE CRUSHED STONE OR WASHED GRAVEL EP APPROVAL, IF REQ'D GEOTEXTILE COVER TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS L�(S TO BE WITNESS *20'TO ' TO P.L. DRIVEWAY, LARGE.TREES, TOP OF FILL U X- APPROVAL SSDS J, LOTS FOUNDATION WALL,S� Lam( )WETLANDS (TO /DEC PERMIT RE 'D? 0' TO WELL, 200' Pi 1 DL ��,150' TO PITS LJ D TA ON vEXNS XTEUirr SAME U( 1) 00' TO STREA�NI WAT r 969 NEI OR NOTIFICATION SO' TO C BAS ; 35' STORMDRAIN, PIPED WATER. (� TTER BI/ZBA 10' TO WATER L (pits - 20') L� 100 YR FLOOD ELEVATION WQ 200' �; 0: I\ ER-v TTTENT DRAILNAGE OURSE _ ...L, ;SAIL T-rT TIl LOTS l Y aFiS 'I :K.:�,�.� �� - �7U75u� � O "RE'SEFCG`O1K;�,T� "_'130 GALI:EYSY51EiVISM 10' 11IN TO LEDGE OUTCROP SEPTIC TANK L-lvtf')10; FROM FOUNDATION; 50' TO WELL WELL (IEN SIONS TO PROPERTY LINES OF SERVICE CONNECTION LN 15' TO PROPERTY LINE SLOPE (� OPE IN SSTS AREA (5200/6) REGRADED TO 15 %, IF REQUIRED USE SEWER -' /4" FT. 4 "0'; TYPE PIPE CAST IRON BENDS; M,- X BENDS 450 W /CLEANOUT RENEWALS E NOTE (NO CHANGE) FILL SYSTEMS HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS; FILL NOTES 1 -5 PROFILE & DIMENSIONS IN EXPANSION AREA CLAY BARRIER WAGE SYSTEM PLAN - (NORTH ARROW) DS HYDRAULIC PROFILE CAVITY FLOW )NSTRUCTION NOTES 1 -15 :SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED UVEWAY & SLOPES, CUT )OTING /GUTTER/CURTAII DRAINS 3DA SOIL TYPE BOUNDARIES iTLE BLOCK; OWNERS NAME ADDRESS v1 #, PE/RA; NAME, ADD S, PHONE# ATE OF DRAWI1NG/REMON TION OF WOERCOURSES, PONDS S.WETLAMS WITHIN 200' OF P.L. MENT ELEVATIONS ,S & SSDS'S W/IN 200' OF SSTS ERTY METES & BOUNDS COMMENTS: (REVSHEET) (�( PUIIPNOTES - -! (�( DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED U DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) U( JPIT AND D -BOX SHOWN & DETAILED (__)( 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN L j( STANDPIPES, 5' BOTH SIDES, DETAIL Lam( 15' KILN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -I %,100 %-<l% L� 20' tiILN to CD DISCHARGE /100' with 182 cons day discharge (, )( )10' KILN to NON- PERFORATED PIPE V I BADEY & WATSON - Sul'!'eJ'iT;�n re rin _P,.(;. 3063 Route 9, Cold Spring, New York 10516 (845) 265 -9217 (914) 628 -1800 (914) 737 -3577 (845) 225 -3312 FAX (845) 265 -4428 TO: Adam Stiebeling Putnam County Department of health 1 Geneva Road Brewster, NY 10509 We are sending: LETTER of TRANSMITTAL Date: 21 Ma 2001_; Refer inquiries to: Work Order # 14087 Project Director GJW copies document description of document Our File Number 98 -105 revise Sent via: ❑ US MAIL ❑ UPS -NIGHT C! MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY U FAX ❑ UPS - GROUND ❑ UPS -COD ❑ number date of copies document description of document final prelim concep revise ® 21 0 �SSTS for GIANNINI ❑ ❑ CJ se r - - - -–� : — - ❑ ❑ ❑ 71 i_I —� i— —, ❑ ❑ ❑ , —_ —_— �— ❑ ❑ ❑ ❑ ❑ — ! ❑ ❑ ❑ ❑ �❑ ❑ ❑ ❑ REMARKS: Map shnwc_rietails As pai- our 4 COPIES TO: i 5 095 6 56' -0� .j ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE PLANS=ST 14E SUBIKITU-VTO THE PCDOH FOIL APREOVAL ,S'1GNATURE & TFELE Y -� I DPYRIGHT 2001 BY BADEY & WATSON. SURVEYING Ec ENGINEERING, P.C. BADEY do WATSON, bLrRxv s Re ac tags 9089 Route 9 (845) 285 -9217 Cold Sprlog, New York 10516 (W) 226 -.3912 (x771 914 -1593 Toll -hee /ofal "A-tRnn C i FIRST FLOOR PLAN SCALE:. 1/4" = 1' -0" rt MARCH 23, 2001 NOTE: A, COPY OF THE HOUSE PLANS SUBMITTED TO THE BUILkX-JG INSPECTOR, WHEN FILING FOR A BUILDING PERMIT, MUST BE SUBMITTED TO THE PUTNAM COUNTY HEALTH ,DEPARTMENT TO VERIFY THE BEDROOM COUNT. t' !t OWNER /APPLICANT BENNETT & LINDA GIANNINI x• 9 PHEASANT'S RUNS' BUCHANAN, NY 10511 di. L`• LOCATION tj HORTON HOLLOW ROAD v TOWN OF PUTNAM VALLEY TM: 72 -1 -46 'i • CII c Nn. GR-ln5 4, t t �1 l: �1 E V FINISE' SCHEDULE KEY RCOM NAME FLOOR BASE WALLS WAINSCOT CEILING REMARKS 101 E17iRY HALL w000 W000 ''PAINTED G.W.B. PAINTED G.W.B. 101a CLOSET WOOD WOOD - PAINTED G.W.B. j =. PAINTED G.W.B. TILE AT ENTRY AREA 102 POWDER ROOM CERAMIC TILE CERAMIC TILE,COVE - PAINTED G.W.B. ! PAINTED C.W.B. WATER RESISTANT G.W.B. 103 D_NING ROOM CERAMIC TILE WOOD - SPAIN TED G.W.B. CHAIR RAIL +34" TO TOP j 1 PAINTED G.W.B. 104 LIVJNG ROOM WOOD WOOD PAINTED-G.W.B. CHAIR RAIL +34" TO TOP ! PAINTED G.W.B. PROVIDE 6 X 6 CERAMIC 105 Ke, CHEN CERAMIC TILE WOOD PAINTED G.W.B. } PAINTED G.W.B. 106 E:fiRSIZE ROOM w000 WOOD PAINTED G.W.B. PAINTED G.W.B. 107 M;kSTER BEDROOM WOOD WOOD - PAINTED- G.W.B. PAINTED G.W.B. 107a CLQ }SEVDRESSING WOOD WOOD PAINTED G.W.B. PAINTED G.W.B. 5 /8° FIRE CODE GYP, BD. 108 MASTER BATHROOM CERAMIC TILE CERAMIC TILE COVE '.PAINTED C.W.B. PAINTED G.W.B. WATER RESISTANT G.W.B. 109 WA3HER/DRYER CERAMIC TILE WOOD PAINTED G.W.B. S PAINTED G.W.B. WATER RESISTANT G.W.B. 201 ST vas f, WOOD WOOD PAINTED G.W.B. PAINTED G.W.B. 202 MAIN FLOOR HALL WOOD WOOD PAINTED'G.W.B. PAINTED G.W.B. 203 LIN'. CLOSET w000 WOOD PAIN TED'. G.W.B. PAINTED G.W.B. 204 CLC;SET WOOD WOOD ,PAINTED G.W.B. PAINTED G.W.B. 205 BATHROOM CERAMIC TILE CERAMIC TILE.COVE PAINTED G.W.B. PAINTED G.W.B. WATER RESISTANT G.W.B. 206 BEDROOM #1 WOOD WOOD PAINTED G.W.B. PAINTED G.W.B. 207 CLOSET W000 WOOD PAINTED- G.W.B. 7 PAINTED G.W.B. 208 BEDROOM #2 WOOD WOOD - 'PAINTED G.W.B. ,j' PAINTED G.W.B. 209 CL (,15ET WOOD WOOD PAINTED G.W.B. PAINTED G.W.B. 210 PLAY ROOM WOOD WOOD PAINTED G.W.B. PAINTED G.W.B. •h _ 300 UT11 -ITY ROOM PAINTED CONCRETE WOOD PAINTED 'G.W.B. PAINTED G.W.B. ON WALLS AND CEILING 301 GAI AGE CONCRETE W/ SEALER WOOD PAIN.TEO G :W.B. PAINTED G.W.B. ON WALLS AND CEILING FMSH SC.F;EDULE GENERAL NOTES • ALL PAIN TED.Iy,, W. B. SURFACES ARE TO RECEIVE ONE PRIME COAT AND TWO - .FINISH` COATS:;OF_EGGSHELL LATEX PAINT, EXCEPT AS 1NOTED BELOW. • KITCHEN, BA1r:.ROOMS, AND WASHER /DRYER AREA G.W.B. SURFACES ARE TO RECEIVE ONE PRIME ;COAT AND TWO FINISH COATS OF jS(,.MI GLOSS LATEX PAINT. t i 1 r` P/O 61-1.12_ rP /0 61-1.11 I - - - - - ---- °vaw Wit's .1.. 32 , r'. � °4Fy; ��Y /� 26;88, \.,J rozr~•';� 4 y .Ob A y • 41 212 5 .i2+.n r•i Y e 4.56 AC. .i ...4 :1\ 24.2 y OOAC• 5644 AC y 9.12 a :yr i' �,. n .. ••AOO AC / / O zal �90 56.98 AC. 116.77 AC. 57 39 O "AO AC. = r 4 AWW AC ' y 2- 4a C 35 .N . • 29,10 94� y n9°ff �� ze.15 0 39 2187 3m 26.08 26.08 a 3.63 AC tn.ea Ac ' { 5.1en i � %. zety 6.37 AC. n w.o . dy v: /. ���• ffi l .\ 7 / y /, 4'A 265 Aed i a42. a '5.35 Ae�y %! i l / 1 f •. �' I I / /r • «i;,J / /60.61 AC. i 1 45.35 AC. f ✓ �' lV •...� 54y� 10 FRANCISCAN SISTERS laa °a,t .P).ci),. aa7 AC 22 a? z5 12 14.56 AC. CALV Y' • y) +4 Stn. % IS ALn 1. CO $' iig8' U 7 M 1,53 AC ° zg10i 3.18 C. $ y �. % • , /,i' �7z. , e a 16 3.06 ALffi c 29.82 AC. 3,011 ACS • \�' IyA . . '/72.15 72. 16 ni WAG. / 50 /r i ( 110 AL. CAL . 66 L I,Z /y/ a 72.20 { 2.1 � 51 71,.62AC. 91 ;.72. 1 9 I. OPEN SAACE . 1 � � - P/0 63.1.1 y .y \• °zzwlar ------------ - - - - -- -- L--- - - - - -- — -r . `M 6 I_ ... 62 MAPT laO A4° •••••.•• •• oMIM LINE W aIwa PREL I M I NARY SCAaE 1 ;00 73.. " aa551a 1a " TOWN OF RUTNAM' 4ALLEY rm 1.9 VA ' m1R aamwA4A7a3 ImO 12 elmltf un —r— uASAArte 6a K GL °1n111t1 Ur — '. °If31L rnan16 a . , 84 0 PUTNAM COUNTY. NEW YORK an 6 104E nolwlwn_°4w as or �w —i•n . : V nzmt °a°OA11 Fam, own . 83.;,. 105 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # V "f 4--0 Located at (—I M AI A-M N) �-D n or Village N) IN ( S 1 Subdivision name tj P Subd. Lot # �T Tax Map *�'2- Block Lot (� Date Subdivision Approved 1A Renewal Revision Owner /Applicant Name C,-i gip,; f V I tj 1 Date of Previous Approval Mailing Address q E UNWI S R -01v , Rkt-,, -4 AtJ Zip i os l Amount of Fee Enclosed Building Type SIE0TAAf 1._. Lot Area IDILALfflNo. of Bedrooms 'A Design Flow GPD?nO Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ' . gallon septic tank andi� .L �� Other Requirements: To be constructed by 4,P4 Ck--) I j DQ{, . QNS Address CCL-) -KW-4,0&:,fv.,j Water Supply: Public Supply From Address on Private Supply'Dri lfed by 1 i7�'�'� ��� .a ;Address �` 1 r i I represent that I am wholly and completely responsible for the design and location of the proposed systems) 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 t ; c� License #j 5 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 w en considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new =r Appr ed fo i ch r e of domestic sanitary sew a a only. By: _. Title: 4-lv Date: a � White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97( f rl' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION_TO CONSTRUCT A WATER WELL. please print or type' Well Location: Street Address: TownNillage Tax Grid # (J 0 N k' -t> A Map- 7 Block Lot(s) 4 Well Owner: Name: BEN NE TT CW ddress: PAO, LJY ID, 11 Use of Well: --)I— 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 gpm # People Served �J(_ Est. of Daily Usage (og 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ®V b.E NIERLe IAJPT� f E &KI 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 i- Lot No. 1 A- Water Well Contractor: �C —` lam , Address: Q lSt7N N � Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: V\ ► tk Town/Village ' Distance to property from nearest water main: LZ Proposed well location & sources of contamination to be provided on separate sheet/plan. I�atc : > -- — 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 of the approved plan requires a new permit. Well to be constru County. Date of Issue Date of Expiration 'z O Permit is Non - Transferrable Permit Issuing Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health I�TUI;INARI; RiQ, IVISN'`' Associate Commissioner of Health DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 Robert and AnnaMaria Cross 56 Cimarron Road Putnam Valley, NY 10579 Dear Mr. & Mrs. Cross: September 12, 2007 ROBERT I BONDI County Executive ROBERT PE Director of Environmental Health Re: Addition Approval-Cross No Increase in Number of Bedrooms 56 Cimarron Road (T)Putnam Valley, TM #72 -1 -46 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department dated September 12, 2007. 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. _ All;plumbin� fixtures must be updated with water saving dey_ ices (i,e.�new. __. - _ ... h -10—w— :ush tortets;ires nciors fot`shoWer 4. The approval is for the proposed changes only. This does not validate any construction shown as existing that.has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Sincerely, ; f� �oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:hn cc: BI(T)PV 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 SKERLITA AMLER, MD, MS, FAAP Commissioner of Health - Associate Commissioner of Health Robert and Anna Maria Cross 56 Cimarron Road Putnam Valley, NY 10579 Dear Mr. & Mrs. Cross: DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health August 7, 2007 Re: Proposed Addition — Cross 56 Cimarron Road (T) Putnam Valley, TM # 72 -1 -46 The application for the above referenced project is incomplete. Please provide the following: 1. A full set of floor plans showing the entire existing house. 2. Two sets of proposed floor plans that show the addition (in this case the finishing of the basement) together with the rest of the house (i.e. the part of the house that is not changing). Review of your_�pplica:tion will- :ar1,;n1.je:.once.+.ho- aboyc-doc men-tati.on is re c *ivea:.Plea,se do..- ---- - - - -.- -_ ` not hesitate,fo contact us,is any questions arise. JSP:ens Respectfully, Voseph avati, Jr. lic 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 Far (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 FIA f SHERLITA AMLER, MD, MS, FAAP Commissioner of Health. LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI GoUnl�� �xecudi��e -• - ROBERT MORRIS, PE Director of Environmental Health ADDITION APPLICATION RESIDENTIAL ONV STREET' TOWN *1 4:1)740 VAJ _TAX MAP# 7a NAME ',o b"4- Anh YYlGti�ia�rdsPHONE �' 5a� aa� PCxD# AOS-09 MAILING �7 ADDRESS I ✓A6. r 1_0 YI DESCRIPTION OF ADDITION i o i4 �C * YI 61 TV 1plkq Poo M, wo % zr a.Yz ��►vvo �V1` � W (� r ICocA.-(- czy' 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., l Geneva Rd, .. _ _.?�TT17 A. ��pp " , •. 'vJvi, a i "'uv. r✓J'�. �' /U-V iJIi: -_/ 1. Certified check or money order for $100.00. ,,/ 2. Sketches of existing floor plan (drawn to scale, all living area including basement) V3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non- professional sketches are acceptable . ,/4. Copy of survey showing well and septic locations to the best of your knowledge. Include date,of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. ,/ 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA-AMLER, MD, MS,.FAAP--.-,,--,- LORETTA MOLINARI, RN, MSN Associate Commissioner ofHealth DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509• Town Legal Bedroom Count J ROBERT. County Executive Re: C -r c).-, -, (Owner's Name) Tax Map #: 79--1-46 Address: 56 Cimarron Road Town:— Putnam Valley Year Built: 2003 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: 4 This information has been obtained from: Certificate of Occupancy: Co #2003-29-7 Other: Building 7.121.107 Date Environmental Health (845) 278-6130 Fax (845) 278-7921 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 T' n, T's �O� � C) I CERTIFICATE OF OCCUPANCY CERTIFICATE NO: 2003 -297 DATE: 10/3/2003 ..�. - ..........• . _.r..'I'r:iii�i�t l�v: LJC�- •"t.7G` _ ,., . _ ., � ___,...,........._- .....� .. ,> .. , ... -a. TAX MAP # : 00/72. -1 -46 LOCATION: 56 CIMARRON ROAD ISSUED TO : CROSS ROBERT & ANNAMARIA 1543 HANOVER STREET YORKTOWN HEIGHTS, NY 10598 This certificate covers the construction of: ONE FAMILY RESIDENCE W/THREE CAR GARAGE; FOUR BEDROOMS; NO PORCHJDECK; UNFINISHED ATTIC OVER STUDY; UNFINISHED BASEMENT FIREPLACES (3). 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 personal inspection ascertained that improvement of the proposed structure i �— off li 'x f mentioneG th ut �"i5 ui iilriipilallic. v� Itri tl't� iCi�iiii�.iiic iab v� a Cuvv'� uS a Ory 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. TO" OF PUTNAM VALLEY, NY Y Code Enforcement Officer 3 0.1007 . i r PUTNAM COUNTY DEPARTMENT OF HEALTH _ - _ - '.' - .Mi .. 17 :- :J•. ri�,;Y �.J2�,6.i�� �������'i -i i l•�i�� Y�.OJL•, � � � � � ��BJ AJ f' CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # I- Located at �5(0 C"' AAA �ZQJLQ 2-ON Town or Village J�Ai AAA \J•4 LLE \/ Owmer /Applicant Name ` s ` Au''fAvA"JA Ca&Sr'a)eMap RL Block Lot Formerly G 1AAW IIJ i S6aivision Name j Subd. Lot # p �� Mailing Address iL�`l y�.toVS� 2� i `1v2.��p , r 1�;��`iS ,�� `/ Zip /05 Date Construction Permit Issued by PCHD c , Separate Sewerage System built by WQomo CALZ- -0 Address M IMi:Ol.A P`•( 1 l�)Ot Consisting of Z�'° Gallon Septic Tank and qa= Z`! j t. - � rt = `� -1 i=() :'A,C" G ' O.C. Other Requirements: Water Supply: Public Supply From or: �` Private Supply Drilled by Builaiiig T ykC Address Address I ; 4,vVM Has erosion control been - completed? Number of Bedrooms 41 Has garbage grinder been installed? �J0 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 wi6the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putn*'.County Department of Health. Date: ' ` ' y r ° Certified by P.E. u R.A. _ / (Design Professional) Address 'mac`( '•`V` Sow( R C - `� ti/C-' , k( `� /0511 License # OCnZ5o5 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 Hof 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 nee By: - '` `Title: Date: n 3 White%py -'HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 t _ 4.P Me e� r } PEI fi%s'1 nackt' t . e,. 77 m ME s .8, o. .r {.r•.� t *Y ) t x �" � ' 4L F��{ eYT rerS-Yr. ", � } `�fy,.. � r;• .. • . u�+ � r• � fir.. '.'.i;F. .. .. ..<.:�._ T_.. .-- :.,-- ,.._.-- .- -tt.e. °- ..�._:� .. ... .. .. ....:.. ... ,- �-,� —. if - .—+r•- .- 'r -�-''Y "T?'�„c4 t'i_ � r. � ?f, �Jhi4, �f� �� a �:'� :H�' L Y 'il �' A i �'as?". g f����l��,�Lha !c • ��t ,.< L'.aM t r � '� � '�,. '�.i �rXO t� dpgi �' 1, .F'. .'1 ,', '•' v P� � .p� >Kb+r+,�1 �'`G §.. r� ti'`. ^is �� "7t'irt� sC q 4 -.;� %� t'� -tr_ •n.e: _ 1. I � ( �. f r �K +t rJ ii'�� f � r77 :w y,1' •.Zr. �:rr y-�' �} - r; Yd^ p{t eft 9 S; " I L ppz- Fbci::f Z4- ri P, J L_ U _j I . xlli 5to6Lr a ctC— f ill, iii: dr. ij -;i��► Fury -�- .y � ,� . I: ' #�Q4 I -� : Z w 1Z1. , ; l f� 4 r SCALE: 1' = 109 VI li NO EXISTING OR PROPOSED WELL WITHIN 100 FT. OF PROPOSED SSTS in 26" 400 LF OF ABSORPTION TRENCH b LATERAL (TYP) 10 0 0 3 2 A SPIA-e 16'. Oak Spike in 22" Ash in twin 16" & 14 "" Ash CLEAN—OUTS (TYP.) Nd EXISTING OR PROPOSED WELL WITHIN 100 FT. OF PROPOSED SSTS ti : k'i 10.141 Acres Spike 1/7 24" Map/& ti e_-o Spike In Tree N an a 0 z 0 3 a z 0 J � o I L0 a w z z CD z a 0 j e CLEAN -OUTS (TYP.) 1, t NO EXISTING OR PROPOSED WELL WITHIN X100 FT. OF PROPOSED SSTS AS -BUILT RELOCATION - DIMENSIONS 1A 74.5' DROP BOX 1B 24.7' DROP BOX 2A 72.5' DROP BOX 2B 28.0' DROP BOX 3A 71.0' DROP BOX 3B 32.2' DROP BOX 4A 70.0' DROP BOX 4B 37.1' DROP BOX 5A 69.6' DROP BOX 5B 42.3' DROP BOX 6A 25.8' END LATERAL 6B 75.1' END LATERAL 7A 22.4' END LATERAL 7B 77.0' END LATERAL 8A 20.0' END LATERAL 8B 79.3' END LATERAL AS -BUILT RELOCATION- DIME. f ISIONS 9A 18.9' END L}A-tERAL 9B 81.9' END LATERAL 10A 122.6' END L'A'FERAL 10B 32.7' END LATERAL 11A 121.6' END LATERAL 11B 35.8' END Le`k'TERAL 12A 120.9' END Li4TERAL 12B 39.5' END LATERAL 13A 120.4' END CA i'ERAL 13B 43.7' END L.WERAL 14C 57.4' CLEAN- =OUT 14D 55.8' CLEAP -OUT 15C 8.9' CLEAN --:OUT 15D 28.9' CLEAN -OUT 16C 42.2' e , CLEAN -OUT 16D 49.7' CLEAPR =OUT 3i r •t pIi t 6� ii AS -BUILT RELOCATION- DIMENSIONS 17C 90.7' CLEAN -OUT 17D 94.1' CLEAN -OUT 18E 106.8' CLEAN -OUT 18F 169.5' CLEAN -OUT 19E 70.5' CLEAN -OUT 19F 126.4' j CLEAN -OUT 20E 26.3' CLEAN -OUT 20F 97.0' CLEAN -OUT 21E 43.3' CLEAN -OUT 21F 56.5' CLEAN -OUT 22E 85.2' CLEAN -OUT 22F 18.2' CLEAN -OUT 23E 132.3' CLEAN -OUT 23F 46.9' CLEAN -OUT 24E 165.0' CLEAN -OUT 24F 92.3' CLEAN -OUT AS -BUILT RELOCATION- DIMENSIONS 25G 118.8' CLEAN -OUT 25H 116.3' CLEAN -OUT 26G 73.0' CLEAN -OUT 26H 65.8' CLEAN -OUT 27H 14.1' SEPTIC TANK 27J 24.5' j SEPTIC TANK 28H 16.8' SEPTIC TANK 28J 18.1' SEPTIC TANK WJ 82.4' WELL WK 74.2' WELL �g /lJ ^7 J t� Spike i, r, PPLANN ?� SCALE 1" _ 4� i• r' v' '1 r;l I :t Yr r, :i 1;. gg"7 F, 21 1 ;! ALTERAI ANYWAY, I; -,f THE E PROFES 9•r SURVEI {: VIOLATIOI THI 11' r;l I :t Yr r, :i 1;. gg"7 F, 21