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HomeMy WebLinkAbout3297DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdoes.com 631- 589 -8100 73. -2 -30.5 BOX 26 03297 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location S�tAre t A dres : ~ i Q I wr /Willa e: Tax G_ rid # g / j '� k 1� 4 ht 1/C`/ Map ., � Block � Lot(s) j,0 Well Owner: Nam : ddress: 14 b<41 Uet Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion _X Compressed air percussion Other (specify) Well Type Screened Open end casing __& Open hole in bedrock Other Casing Details Total length Length below grade Diameter Weight per foot b ft. .J ft. �in. lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded __X Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: _X- Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) /0 During yield test(ft) Y� Depth of completed w in feet �Yf Well Log If more detailed information descriptions or sieve analyses are -.4yailable, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface h l a 70 C vNt.c .- 4 e ✓ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth ' -Lr Model Voltage —!.Lei HP Tank Type t,,)14 Y y Volume Date W II Completed Putnam County Certification No. /o Date of Re ort Well er (signs NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan n Well Driller's e V) c V uK r r Address: 1< e li L-t v Signature: GL !it/ Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 4 AM COUNTY DEPARTMENT OF DEAL _N OF ENVIRONMENTAL HEALTH SERVIC CERTIFICATE OF CONSTRUCTION COMPL ANCE PCHD CONSTRUCTION PERMIT # -D _JD FOR SEWAGE TREATMENT SYSTEM Located at if- 1u CL Ik Town or Village vht C,91:�, Owner /Applicant Name Lij�'— , ( Tax Map 1"7-3 Block Lot 30 - , ,7 Formerly Subdivision Name �- Subd. Lot # -� Mailing Address 5��3 11i�- �� -`�.� ,%V"V�� i� I''v yl f l �+ Zip Date Construction Permit Issued by PCHD 3 b I— Separate Sewerage _System built by �GAddress �q 1J� Consisting of fd. TD Gallon Septic Tank and_« Other Requirements: Water Sunuly: Public Supply From Address or:` _ Private Supply Drilled by !A/V^ !a Address Vv � r O Building_Tve -,�,, l J J-0 Has erosion..-control beencor vleted? Number of Bedrooms / Has garbage grinder been installed? V IV , 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 andithe standards, rules and regulations of the Putnan (,County Department of Health. Date: 14, Address k Certified by P.E. X R.A. License # S Z 7 7. Any personoccupying 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 'ipprovals are subject to modification or change when, in the judgment of the Public Health Director, such `vocatq'gn,nodificatiowQr change is necessary. Title: &41C Date:...:. D .. Y HD File; Yellow copy - B�ui ding Inspector; Pink copy'.- Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location S tr ec Is. tA wk Town/Village­ LMap T4N.Qrid.,#,,, ? Block Lot(s)II Well Owner: N Address: tf Use of Well: 1-primary 2-secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monit6ring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _ Cable percussion _V_ Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length — ft. Length below grade 5vf� ft. I Diameter in. Weight per foot lb/ft. Materials: —)(,,Steel Plastic Other Joints: Welded _yThreaded Other Seal: _X Cement grout Bentonite Other Drive shoe: -YYes No ILiner: es _�( 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 -XI Hours Yield gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are, available; please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Descrip;ion ft. ft. Land Surface ? 0 k- - ve k-t It If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump T Capacity Depth Model Voltages lip Tank Type �fy Volume Y(/ Date Wei) Completed Putnam County Certification No. Date of R ort Well ller (sign )wle) blx� ew NOTE: Hact location of well with distances to at least two permanent landm ks to be provYded on a separate sheet/plan.' Well Driller's Name klvtey Address: Signature:, P ory Date: — White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ WELL COMPLETION REPORT Well Location Street Address: A KocLO' Town/Village: CJn11141 A Tax Map # Map Block 2- Lot(s) GPSx Well Owner: Na e: Address: Off, gol✓k -(kv - LIL - S3 tC6446r ble, - 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 YRotary _Cable percussion Compressed air percussion Other(specify) Well Type Screened _Open end casing A Open hole in bedrock Other Casing Details Total Length jLft. Length below grade6f6t. Diameter in. Weight per foot lb /ft Materials: ) Steel Plastic Other Joints: Welded Threaded Other Seal: A Cement grout Bentonite Other Drive shoe: Md es _ No Liner: _Yes No Screen Details Diameter (in) Slot Size Length ft Dept to Screen (ft) Develo ped? First •— & I I I I—Yes No Hours Second A — Well Yield Test _Bailed _Pumped Compressed Air Hours &_ Yield gprn Depth Date Measure from land surface-static (specify ft ) -o Dunng yield test (ft :3 &- Depth of completea well in 1 36- Well Log If more detailed information aasdiiptions-or- sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface - If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity__ Depth _3 �' Model -56-S 2- Voltage—L3 —13. H P 5/4 Tank Twe Volu 04&4-1 .vv NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a n. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 Rev. 3/06 ►S`A "t-wowc �459d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURp'ACE SEWAGE TREATMENT SYSTEM bdkk.9_cy_v 73 30' fq Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location — Street Subdivision Name s,)�q V__ ,six T Building typo 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 it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby suarantee to tho owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to_opecate. fora period of two _yws_immediaWy: following the date. ofapprovaY of th� `t, f1:6a�t6-of- Csnstructioti'.r..~ - Z i6ce�-f6 r 'the sewagc' tioatsnent system, or any repair made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system, The undersigned further agrees to accept as conclusive the determination of the Comtnlssioner of Health of the Putnam County Department of Health as to whether or not the faun of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month 0 Day � a year 0 _ I Signature: (Septic System install d ) General Contractor (Owner) -- Signature tilt- kaftj. Corporation Name (if corporation) Title: PCHD License # to (AJ Corporation Name (if corporation) Address: State: N evu zip l Address: ( c7 5 S l2 7' Z Z- S tate: Zip 10 50 FQIM GS -91 GUNMAN « 9VL0 W9"OoZ £/Z d 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 E911 ADDRESS 'VIERIFICATION FORM OWNER'S.NAME: WHITE ROCK ROAD DEVELOPMENT TAX MAP NUMBER: 73.-2-30.4 E911 ADDRESS: 59 White Rock Road TOWN: Putnam Valley AUTHORIZED TOWN OFFICIAL: 11 (Signature) ,57 ROBERT J. BONDI County Executive DATE:-.:-. The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application.for a Certificate of Construction Compliance. E911 addressverification 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert HI.- Padovan i j - Di rPntor LAB #: 1.903007 CLIENT #: 61470 NON STAT PROC PAGE: 1 of 2 M &G ANTOLINO MASONRY I DATE /TIME TAKEN: 07/20/09 12:00 109 FIRST STREET DATE /TIME RECD: 07/20/09 12:30 HARRISON, NY 10528 REPORT DATE: 10/01/09 PHONE: (914)- 835 -6601 SAMPLING SITE: WHITE ROCK RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : LOT 5 PRESERVATIVES: NONE COLD BY': GAETANO ANTOLINO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 07/20/09 MF T. COLIFORM 07/21/09 LEAD (IMS) 07/21/09 NITRATE NITROG 07/22/09 NITRITE NITROG 07/22/09 IRON (Fe) 07/22/09 MANGANESE (Mn) 07/23/09 SODIUM (Na) 07/20/09 pH 07/21/09 HARDNESS,TOTAL 07/20/09 ALKALINITY (AS 07/20/09 TURBIDITY (TUR RESULT PRESNT /100 ML <1 ppb <0.2 MG /L <0.01 MG /L <0.060 MG /L <0.010 MG /L 8.15 MG /L 7.1 UNITS 102 MG /L 66.0 MG /L <1 NTU NORMAL - RANGE ABSENT 0 -15 ppb 0 - 10 1.0 MG /L 0 -0.3 mg /l 0 -0.3 mg /1 N/A 6.5 -8.5 N/A N/A 0 -5 NTU METHOD SM 18 -20 9222B SM 18 -19 3113B SM18- 20450ONO3 SM18- 20450ONO2 SM 18 -20 3111B SM 18 -20 3111B SM 18 -20 3111B SM18 -20 4500HB SM 18 -20 2340C SM 18 -20 2320B SM 18 (2130B) -.._ 07./.2,0./ -.0 CON ___ `..'�. iBSEN 9; E.: C�LI ( FI ABSENT' iO:G /I�iL� �- - COMMENTS: PICK UP COMMENTS: MFTC Total Colifc = This result indicates that the water Jrws� r(was not f a satisfactory sanitary quality according to the New -76M -` tate and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for p EPA Lead & Copper than 100 of their than 15 ppb and a treatment must be potential. iblic schools are set at.15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 ' Director:. -1bert -�zH.:'---P�ido�va-ni-r � -- LAB #: 1.903007 CLIENT #: 61470 NON STAT PROC PAGE: 2 of 2 M&G ANTOLINO MASONRY I DATE/TIME TAKEN: 07/20/09 12:00 109 FIRST STREET DATE/TIME REC.'D: 07/20/09 12:30 HARRISON, NY 10528 REPORT DATE: 10101109 PHONE: (914)-835-6601 SAMPLING SITE: WHITE ROCK RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : LOT 5 PRESERVATIVES: 14ONE COLD BY: GAETANO ANTOLINO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ------------------------------ -------------------------------- I ------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER:. 140-300 MG/L (1 grain/gallon = 17.2 MG/L) THE ABOVE TEST-PROCED RES NET ALL REQUIREMENTS OF NELAC, AND RELATE ,CANTO TIZ� E S' , LES RECEIVED BY THE LAB SUBMITTED BY: "IV Alber_t--Pr. dovani, K.T.(ASCP Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 q - be -rt- �I: P�.�:ovani., .. -Di- rector- .,- : <.,.- LAB #: 1.904128 CLIENT #: 61600 NON STAT PROC, PAGE: 1 of 1 WHITE ROCK RD DEV DATE /TIME TAKEN: 09/29/09 12:55 538 WESTCHESTER AVENUE DATE /TIME RECD: 09/29/09 01:15 RYE BROOK, NY 10573 REPORT DATE: 09/30/09 PHONE: SAMPLING SITE: 59 WHITE ROCK RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: ROSA TEMPERATURE_.: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT 09/29/09 MF T. COLIFORM ABSENT /100 ML gew S: MFTC Coliform = This result indicates that (was not) of a satisfactory sanitary York State and EPA federal drinking this parameter. This comment applies to the only. NORMAL - RANGE METHOD ABSENT SM 18 -20 9222B the water quality according to water standard for Total Coliform test .,� .. .. 5 .. • _ ar —. _: .... t� G— � _� -• -�.. ._ - _ . � .. .. ♦ .. r— .._ _. -r-ra_ - . � .a .1 c i. —..� -.- _ � cr ♦. -. , S . mss. �a ... THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ON TO 3SE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: '` Al bert H. Pa ovani, M.T. ASCP) Director ELAP# 10323 MEMORY TRANSMISSION REPORT TIME-, :-OCTrO872009-D9:54AM TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER 642 —tD, '-IS- L-.=> R. EJ—r— 'lc:>LrN---p-2. 642 OCT-08 09:52AM' 85268806 004 OCT-08 09:52AM OCT-08 09:54AM 004 OK SUCCESSFUL TX NOT ICE R Cb E; E: Ft -r IS. PE COF ;l 3 7 _7 F-1---- a-ply 3— zz:F--, 11• Si'-!E R.LIT.-k AN(LER. MD. MS. F.-k.•k'P 4 ROBERT J. BOOM ROBERT NIORRIS. PE M N C r M a Roac. 7w Frorm Fax: f ro pages: Phone: '2 / 0 ei 3 -7 Date: Re: L"ji, k Urgent Review Please mm' ent = .P tea-se Repiy. Please Racycia III cLle everitoi, difficulties.. ptease contact the j,:air?nmejrjj ETe, h l%-'ris., office at (845, 278-51 -,o. Thank vou. 7 ':/'U ;'S 7 7: !z� J . . iii' .... Tzank vot: onme-mai Health 3 3i7 F 2— W Hc)me mar_ Ear:, lme­ermon/R N DIAL Si h INSPECUON (AIL. 10 Street Location tVA11 Z--LC% Owner (vI411- 5s Town :7 -Az.4� t/A t�L Permit # ? Subdivis bfLbf ## _ 1. Sewage Svstem Area a. STS area located as per approved plans............ .............. b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................ ............................... d• Stone, brush, etc., greater than 15' from STS area........ e. 1 00' from water course / wetlands ... ............................... II, Sewage Svstem 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. .. Minimum 2 ft, Original soil between box & trenches e. Junction Box - properly set ....... ............................... 6. renc es �1���, I t� 1. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ....... ............................... 4. Slope of trench'acceptable 1/16 - 1/32" /foot........... 5. 10 ft. from property line - 20 ft.- foundations......... 6. Depth of trench <30 inches from surface ................ 7. Room allowed for expangion, 10096 ....................... 8. Size of gravel 3/4 - '1'/2' ,c�' ameter clean .................. 9. Depth of gravel in trench 12" minimum .......:.......... 10. Pipe ends ca pped .................... ............................... g. Pump or Dosed §§stems -2 - r� . ; 1 Si7�c�f:u::ck�arnl3e�:. a.',C� ��.- !C.:_�, ....... ............................... 2. Overflow tank ..................... ... 3. Alarm, visual/ audio ........:........ .............................., 4. Pump easily accessible, manhole to grade .............. 5. First box ba$ Ied .................... ............................... 6: C�yycle witnessed by H.D.estimated flow /cycle........ III. HouseBuildinQ a. . House located per approved plans .............................. b. Number of bedrooms .................. ............................... IV. W ell Well located as per approved plans .......:....... .....�.... b. Distance from STS area measured - 20 a ft........ c. Casing 18" above grade ............. ................ ................ d. Surface drainage around well acceptable .................... V. Overall Worlunanship . 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 plat f. Curtain drain outfall protected & dir.to exist waterco g. Footing drains discharge away from STS area........... h. Surface water protection adequate ........:.................... i. Erosion control provided ........... ............................... Rev. 12/02 , ie g C16; ('10- Date: IO .3 o Inspected by: .n .- - .. - •c*r- .1 .`7,> .. �_... .. :. :ia'.: x .. .. .... s. i— .. ... .. -- ta:QC,. _Y_� � - ..n e...`.. 'i ?'. 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMMNTAL.HEALTH SERVICES ATTENTION E3 JOSEPH GENE REQUEST FOR FINAL INSPECTION ..For:' .Fill All information must be fully completed prior-to any : Trenches. inspections being made. PCHD Cons 'on Perunt # P 6) 7. :..Lo } cated: APIA Owner/Applicant Name: GV LTC., TM 7?� Blocky_ Lot Formerly: Subdivision. Name: Lv- Subdivision'Lot # Is system fill completed? Date: 'Is system complete? .Date: AeQ Z ®P 'Is system constructed as per plans? Is well drilled? : If Date: /D�ZI�Z�� Is well located as par plans? Are erosion control measures. in place?. z S I certify that the systam(s), as listed, at the abovepremises hips been constructed and I Have inspected and. verified their completion in accordance with 4 the .issued PCHD Construction -Permit and. approved _plaA- 4nd. the Standards, Rules and Regulations of the Putnam County ?apartment. of . Health. ._ Date: Certtfiod b Y :PE RA, Design Professional Address: �✓"'fl���`"`" 1 I.ia. # �3 Comments: ---- -•--T� - - 0 SHERLITA AMLER, MD, MS, F'AAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 3, 2008 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDII County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — White Rock LLC White Rock Road, Lot # 5 (T) Putnam Valley, TM # 73 -2 -30.5 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. A pump test must be performed. Call for an appointment when underwr4iters certificate is received. 2. Leave access to-d strihdtioii-bbk'fot dump test:" 3. A bedroom count must be performed. If you have any further questions, please contact me at (845) 278 =6130, ext. 2155. JD:kly Sincerel Jgeph Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care F&x (845) 278 -6085 Early intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF- ENVIRONdi1ILNT.4]L - IIEATf�, gtRV CES FIELD ACTIVITY REPORT NATyMr AT)T)RF44, 7� �/-,v,� Street Town State Zip PERSON IN CHARGE PUMP TEST DOSE TEST ,. 3„ REQUIRED' GALLONS` 3 lee, _1 >,< x s vv EL. START - Ga. W'y ey- aK A(n g ev o STOP 7.> %�/'/`p�t /%I j��S �`rt Signature and Title REPORT RFCFTVFT7 BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 2009 -0518 21:50 ti> P 215 BY TMIBCERTIFICATE OF, 0QM NEW YORK ELECTRICAL I N PtCTION SERVIC'S 150`W Ilte Mains Road, Suite 104, Tarrytown, WY 10591 CERTIFIES THAT Upon the application of: , Wata - Andrew $posta 380 King 5treot Port Cheater, NY 10673 Located at White Rook Rd. Lot 5, Putnam Valley, A y Upon pfeMlsee -owned by: Now Oullding - White Rose Std. Lat a Putnam Valley, NY Application Number: 10075589 cer ificate Number- /0075585 Section: Block: Lot: 90c: 108 Pofnlit Numbew 1473 -08 A victual inspection of the electrical system at this premise deaefibed so a Residential occupancy, whomin the promises eloutrical system consisting of allectriusl devices and wiring, described below, located inlon the Premises at: White Rosh Rd. Lot 5, Putnam Valley, ICY Basement, Attic, was inspaated in accordance with the NYS and NPPA 7049 and the detsil of the installation, as stet forth below, was founded( to be in compllame th6ruvAh on the 22 bay of April 2009. :lathe. Date ..Quantity ' Rating Circuit TV•pe N��Rit'rpyielr: I i',yn•cnirn,:e . Pl . i�utrA 4 M! Genenl i� +i hlUh • IYA�Rldlyd JV 11k'JtWCt•L'411 (w1 Ul All .. A l' Curld: dyer - W-Air h0cr 3 l3rl•3au1' I ft', Xql:,; A 1;lrin +. l'unll t t "1t><I I MO AWp .17 Siegly t'IIr+e Rutel I 1110 MIP h Single 1*4 1'l - ReetT"Ov owF 1 Thia corpncutr reay name Memo Ih any way and Is valldatad only dythe pnasenco of a ealoed voW at the tcoutlon ideated. 71tiw 00tocate is valid for wart prOonnod baton dtA of Ins trWlan only. Jealtlaio 18 Put I if 2 2009-05-10 2t50 A 3/6 SHERLITA AMLER, MD, MS, FAAP Commissioner ofHealth LORETTA MOLINARI, RN, MSN ROBERT J. BONDI County Executive ROBERT MORRIS, :PE Associate Commissioner of Health Director'of Environmental Health D MA John Karell Jr., P:E.. 121 Cushman Road Patterson, NY 12563 ARTME1IT OF HEALTH I Geneva Road. Brewster, New York 10509. June 30, 2009 Re:. Construction Compliance— White Rock Dev. LLC White Rock Road, (T) Putnam Valley T.M. # 73 -2 -30.5 Dear Mr. Karell: 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 E -911 form is to be provided and all plans and forms are to note the E -911 address. 2. The well completion report form is not the latest version. Also, the white copy is to be . provided to the Department,. not the pink copy. 3. Only one guarantee form was submitted_. �- - - - - 4.-- The-lab'for4 water analysis is1d the a Laboratory, approved by the 1V3CS Flea l'th - ° - Department "Environmental Laboratory Approval Program '. . 5. Why does the total coliform and E.coli test read N/A and not absent or present? 6. The level of iron and turbidity is above the maximum contaminant limit. 7. The water test did not include lead or alkalinity. 8. It appears the expansion area is less than 50 feet from the house location. The approved plans had a 50' separation between. the SSTS area and the house. 9. As -built dimensions for'Al, A2, B1 & B2 are reversed. This office will continue its review upon consideration of the above- mentioned comments. Please feel free to contact me at est. 2157 if any questions arise'.. V ry truly yo Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly 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 c�G S14ERLITA AMLER, MD, MS, FAAP L a ROBERT J. BONDI Commissioner of Health * County Executive LORETTA MOLINARI, RN, MSN .Y 0�� ROBERT MORRIS, PE Associate Commissioner of Health Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road: Brewster, New York 10509 i June 16, 2009 Jack Karell, Jr., PE 121 Cushman Road Patterson, NY 12563 Re: Field Inspection — White Rock Road . (T) Putnam Valley, T.M. # 73. -2 -30.5 Dear Mr. Karell: A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed in reference to this Department's open work a . inspe--tian. • ... _,_ ... _....... ,_, �... _ .W __._ r - . �...t ... _._._.. ,�._ . . If you have any further questions, please contact me at (845) 278 -6130, exi. 43261. Sincerely, Gene Reed Sr. Environmental Health Engineering Aide GR:kly 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 2009-05-18 21;50 >> P 215 BY THIS CERTIFICATE OF COMPLIANCE THE_ NEW YORK ELECTRICAL INSPECTION SERVICES 150 White Plains Road, Suite 104, Tarrytown, NY 10591 CERTIFIES THAT Upon the application of-, A. Sposta - Andrew Sposta 388 King Street Port Chester, NY 10573 Located at: White Rock Rd. Lot 5, Putnam Valley, MY Application Number: 10075586 Section: Block: Lot; Upon premises owned by: Now Building - White Rock Rd. Lot 5 Putnam Valley, NY . Certificate Number! 10075586 BDC: 106 Permit Number- 1173-08 A visual inspection of the electrical system at this promise described as a Residential occupancy, wherein the promises electrical system consisting of electrical devices and wiring, described below, located inton the promises at. White Rock Rd. Lot 5, Putnam Valley, NY Basement, Attic. was inspected in accordance with the NYS and NAPA TO.99 and the detail of the installation, as set forth below, was founded to be in compliance therewith on the 22 Day of April 2009. Same Dstg Q012111111itV Rating Circuit Type 11C-K%! epuidt I "on%,micnx 4 A:C (imeral 1114 morc • 1Wrn1.'1A)TC 10 ImmkIt>cCal ;'c V iiiT410; 6a�;)j oil A L Carjjznsvr P(',Air lmodiq 2 120-24oV I P-And I NH) ANAV 37 SiAgle Plufw Panel I I 110 Amp n Sin& PhaiC PC-Receptuvic GH'i I This certificate may not be altered in any way and Is validated only by the presence of a raised seal at the locatiortindicated. This cortificate is valid fo(wor% preformed before data of Inspection only. jeannie 18 Mond,o. Artil 27. 2W Page 1 ',(2 2009-05-18 21:50 » p 3/5 ' UTN COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL MEAL_ TIC SERVICES_ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # �1:� _ t. \ Located at �/%�J I+D Town or Village Subdivision -name /Z;'` 61' L SuN. Lot # Tax Map 73 Block — Lot 5" Date Subdivision Approved Owner /Applicant Name Mailing Address ✓Z—j� Renewal Revision Z ZZ6 Date of Previous Approval _ A/t ` ,r 4--c. 6 -&Vj/z__ N Zip 1GT 77 Amount of Fee Enclosed Q, J o " (, Building TypeV`�✓ Q 0 Lot Area °fly No. of Bedrooms Design Flow GPD Sy D Fill Section Only Depth Volume PCIID NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage- System to consist of gallon septic tank and 6, �;?' fig � 6 Other Requirements: To be constructed by t Address Water Suppiv: Public Supply From Address bu': _' Private Supply Dri lied .by I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sMarate 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: Addres Ilk P.E. R.A. Date ov /p / s License # S- 3 L7 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 per)pit. Approved for discharge of domestic sanitary sewage only. I� fV��rij i s w ite opy - 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 APPLICATION TO CONSTRUCT A WATER.WELL — please print or type PCHD Permit # Well Location: Street Address: To illag Tax Grid # (eltl Map7 3 Block- Lot(s) 3 0, Well Owner: Name: ` d ess- 10 Use of Well: Resid ntial Public Supply Air /Con at 11fump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S- gpm # People Served Est. of Daily Usage ZdQj2_gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ><, — Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision Lot No. IV Water Well Contractor: P3x Address: - /�- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: " Proposed well location & sources of contaminatio to on separate sheet/plan. Uprovioedd Date:. 2 _ Applicant Signature: _ � 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 CC) /3t/`>.7 Permit Issuing Offici qA&% Date of Expiration o 3 © Title: S i-5 Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Jr SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 17, 2007 Re: Proposed SSTS — White Rock Rd Dev. LLC White Rock Road, (T) Putnam Valley T.M. # 73 -2 -30.5 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. 1. As per the subdivision plat, a minimum of 50' separation with a clay barrier to the footing drain depth is required between the SSTS.and the house. 2. The overall inside dimension of the pump chamber is 4.75' while the overall pump operating elevations within the chamber is 5.75'. Please clarify. 1, An -all weather_4unction box with an outlet and screwed cover at or above gr.•ade t tb.e pump chamber to allow for a plug in connection for the pump is to be provided. 4. Please provide a note stating the house, well, SSTS, and wetland buffer are to be staked by a licensed land surveyor prior to construction. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP: ens Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 Al PUTNW COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIItONMENTAL HEALTH _ - INIHVIDUAL.WATERSUPPLY :&,SURSURFA,.CE SEWAGE Ti ATMENT'S'tS`TEIVIS FOR CONSTRUCTION PERMIT NAME OF OWNER: dfJh *C- I -lzcc k Dee L L G STREET LOCATION: REVIEWED.BY: RM,. Jet', SRDATE: A07 TAX mAP#: (CONBi mm) 73+ ' Z 3Oo Y DOCUMENTS Y/N tRE0IIII2ED DETAILS ON PLANS COI�T'D1 . PERbffT APPLICATION ✓ HOUSE SEWER - '/,"FT. 4 "0'; TYPE PIPE. CAST IRON LJWELL PEW= OR PWS LETTER �NO BENDS I.�U C.._�U ,MAX BENDS 45' W /CLEANOUT - (__)(CPC =97 •– tt &e RENEWALS LETTER OF AUTHORIZATION '� ° 6 «��. ( 1STTE NOTE (NO CHANGE) UUDESIGN DATA SHEET (DDS) FILL SYSTEMS CORPORATE RESOLUTION • 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( SHORT EAF FILL SPECS / FILL NOTES 1 -5 (�UPLANS- THREE SETTS FILL PROFILE & DIMENSIONS C--)L—)HOUSE PLANS - TWO SETS – .T�71'T � IN EXPANSION AREA VARIANCE REQUEST FIZL GREATER THAN FEET SUBDIVISION CLAY BARRIER ( lY )LEGAL SUBDIVISION FILL•CERI CATION NOTE, UUSUBD'IVISION APPROVAL CHECKED DEPTH GAUGES UUPERC RATE S� L 0'�" �,� VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS U(�FILL REQUIRED 1._a fl DEPTH SEPARATION DISTANCE FROM'TOE OF SLOPE (CURTAIN DRAIN REQUIRED TREN GENERAL �F TRENCH PROVIDED 60FT MAX. "41 ATED.W NYC WATERSHED PARALLEL TO CONTOURS I�DEP P S SUBMITTED TO DEP ° EXPANSION PROVIDED � LEGATED TO PCHD UU100 /° ( Y -_ )DETM[L/DIIST FREE CRUSHEVSTONE OR WASHED GRAVEL APPROVAL, II+' REQ'D �N��.10'170 GEOTEXTILE COVER• EP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN : F12OM -SSTS PERCS TO BE WITNESSED P• ., DRIVEWAY, LARGE TREES, TOP OF FILL . •)(_)EX- APPROVAL SSDS ADJ, LOTS 2A' TO FOUNDATION WALLS �()nETLANDS {TOWN/DEC PERMIT RED 7 100' TO WELL, 200' IN DLOD,150' TQ PITS ODATA ON DDS PLANS & EERMTT SAME (� 100' TO STREAM, WATERCOURSE, ezpacq-:- - PRE 1969 NEIGHBOR NOTIFICATION . ____ jisl''II(3�i: • ='- C__:)U10' TO WATER TINE (pits - 201) _CXJ100 YR: FLOOD ELEVATION W1I 200" C-�,50,: DRAINAGE COURSE. ,SOIL TESTING LOTS>10 YEARS OLD 200'f500' .RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED -DETAILS ON PLANS 10' MIN TO LEDGE OUTCROP - KDESIGN AGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK HYDRAULIC PROL+'II,E (�10' FROM FOUNDATION; 50' TO WELL VITY' FLOW WELL, STRUCTION NOTES 1 -15 DIMENSIONS TO PROPERTY LINES DATA: PERC & DEEP RESULTS OCATION OF SERVICE CONNECTION NTOURS EXISTING & PROPOSED U 15' TO'PROPERTY LINE VEWAY & SLOPES, CUT SLOPE FOOTING /GUTTERICURTAIN DRAINS U OPE IN SSTS AREA USbA SOIL TYPE BOUNDARIES TITLE BLACK; OWNERS NAME ADDRESS L-- REC'RDED TO 15 %, IF REQUIRED DOSETUMP SYSTEMS TM#, PE/RA; NAME, ADDRESS, PHONE# _ r 'v 1P.UMP NOTES -�V 'se- DATE OF DRAWINGIREVISION (� -- DOSE.75% OF PIPE VOLUMEMOSE VOLUME NOTED DATUM SCE • ETAIL FOR FORCE.HAIN, (PIPE TYPE, ETC.) OCATION OF WATERCOURSES, PONDS TT AND D -BOX SHOWN & DETAILED LAKES,WE'TLANDS WTTIDN 200' OF Y.L. (_}1 DAY STORAGE ABOVE ALARM �(y , PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS CURTAIN DRAIN WELLS & SSDS'S WIIN 200' OF SSTS STANDPIPES, BOTH SIDES, DETAIL -}(- PROPERTY METES & BOU2IDS__,,,_,_.,. Allo, 5' Mai to CDS —�'S %, 20' -4 %, 25' -3 %, 35' -1 %,100 % -<1% 1ERDS O Y NI'ROL FOR(HOUSE WELL P.r 0' MIN to CD DLSCHARGE/100' with 182 cons day discharge STS EROSION CONTROL NOTE MIN NON- PERFORATED PIPE MaNTS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: WgIrE ggcr 40 wa'gp M t L-1-c- 9 YF 15"0, N i I O S- 7 3 2. Name of Project: `-O T # J 3. Location: T /V: �t/Tphm 4. Design Professional: z i - o " Y A ' L - e z - - � - ) Tg 5 . Address: I Z I CU, ;0 1I ,/14 6. Drainage Basin: ipEEk -;�a) - iAn►-Loy) eaoog- e5^1 N j 7. Type of Project: _ 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) ? .............. Yes/No NO Type Status (check one) ...................................... ............................... Type I Exempt Type II Unlisted )e 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No /10 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? - ,Yes/No 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No —' 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of sewage treatment system discharge ........................ surface water groundwater 1.6. If surface water discharge, what is the stream class designation? .......................... 17. Waters index number (surface) ............................................. ............................... 18. Is project located near a public water supply system? . ............................... Yes/No A/0 19. If yes, name of water supply Distance to water supply — 20. Is project site near a public sewage collection or treatment system? .......... Yes/No A/0 21. Name of sewage system _ Distance to sewage system _ 22. Date test holes observed 23. Name of Health lnspector46 hi kit 24. Project design flow (gallons per day) ............................. ............................... 9,C) o 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No %/O 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No NO Rev. 11/02 Form PC -97 Pg. 1 of 37. Approved plans are to be returned to ................. Applicant Design Professional 4 ... .. fs �. .s-... .-} - • - mot• - �' .. .. ..c : . �.. .. ♦ ;.. ..� ...... ♦ -...¢ � .r . _ e-a. vs :..y . n...+ ,� •- .�+•_--1r- �_cJ w..•... . ♦ sv ..-. ... a... - < 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 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 1, 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 TITLE Mailing Address: ........................... evEelz Form PC -97 u 27. Is any portion of this project located within a designated Town or State wetland ?.. , Yes/No n /rl�yL v •.. - =4 �. W c- -. r -- - -.+. '�. ., ..; -. -.r- w.�✓.., Q_. r. - n..�... w �.�i .. a•... .. ...__ �iC' O''... \'.. . ..•: 28. .._. r-... .• .!c- a- xa � �. _ ..a ---•.x M1-. Wetlands ID number .................................................................. ............................... --- 29. Is Wetlands Permit required? ...................................... ............................... Yes/No //d Has application been made to Town or Local DEC ........................... Yes/No 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/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� 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 /16 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No 34. Are community water and /or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No /.4 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No N 0 36. Tax Map ID Number .............. ............................... Map �% 3 Block oZ Lot —30-02< 37. Approved plans are to be returned to ................. Applicant Design Professional 4 ... .. fs �. .s-... .-} - • - mot• - �' .. .. ..c : . �.. .. ♦ ;.. ..� ...... ♦ -...¢ � .r . _ e-a. vs :..y . n...+ ,� •- .�+•_--1r- �_cJ w..•... . ♦ sv ..-. ... a... - < 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 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 1, 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 TITLE Mailing Address: ........................... evEelz Form PC -97 COUNTY DEPARTMENT. OF HEALTH o _ ENVIRONMENTAL HEALTH SERVICES 1t: Property of Located at WA 44 e- LETTER OF AUTHORIZATION TNI&Iwm r%1 1e Tax Map # % 3 Block Lot Subdivision of s Subdivision Lot # � Piled Map # 3 0S 3 Date piled S b Gentlemen: This letter is to authorize ��Z C a duly licensed Professional Engineer A. ox to apply for the required wastewater treatment and/or water supply pertnit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity . with. the..prQVi�sions. of Article -14.5 and/pr- 147 of:the.l� dpcation Lqw, e:i? b�' 1 aw, and fhe- 'uthii -( t aaiYitarry Code. _ _ . _ _ W Very truly yours, Signed: (owner of Property) Mailing Address State X dip /-ZJ 6 Telephone., � Y� i � �� � / Mailing Address: 5d 8 We s� 7'l 4 �C State ``C �rn d `' Zip (CE ?3 — Telephone; Fom LA -97 !0-r 5 DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner WHITE ROCK ROAD DEVELOPMENT LLC Address 538 WESTCHESTER AVENUE RYE BROOK, NEW YORK, 10573 Located at (Street) WHITE ROCK ROAD Tax Map 73 Block 2 Lot 300> (indicate nearest cross street) MunicipalityPUTNAM VALLEY-Watershed PEEKSKILL HOLLOW BROOK SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test to Role N Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop I n Inches Percolation Rate 1: Min/In ch 1 3u' �-� 3 Z 1T y 2 37-9 q-16 Z 173)Y 3, q 3 7-q ilk y `� .4 z 1 3zs--3�s� 2 3 Zs ss Z-71 i, 3/ 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. S 1 min for 1 -30 min/inch,-5 2 min for 31 -60 min/inch). All data to be submitted.for review. 2. Depth measurements to be made from top of hole. Form DD -97 Pg. 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES " DEPTH . - _ HOLE NO wH�ZE I�6. G.L. - 0.5' 1.0' M Y C,004 P1 61YV — 1.5' .6f Sl L r 2.5' _ 3.0' _ 3.5' 4.0' 4.5' 5.0' 5.5' _- 6.0' — 6.5' FT 4-i- (o _ 7.5' 8.0' — 8.5' _ 9.0' 9.5' Indicate level at which groundwater is encountered _ Indicate level at which mottling is observed _ Indicate level to which water level rises after being e countered Deep hole observations made by: Date Design Professional Name:.sG/7W JCS¢ � ,. � AEIE�aess: � yid Zi C u 5 l+64 0 124. A D Design Professional =s Seal OF NEw CO KARE << yQp� G p F ��• 5371 14.16.4 (9195) -7e4 12 PROJECT I.D:NUMBER _ _ __ 661740_ _ _ SEQR T. :nwir a" •'•'.:+:.r�:.a. «4. F ^' +ry <s.'. ' `` `'�.w..�i;.w'e►�pI'.tu. »�a.i.:et z•�'a. aF- ••isY•. way. ax. �M." R .i...�<.�GC!'�- �.a�...�s- •:..+i State Environmental Quality Review SNORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME , 3. PROJECT LOCATION: �, / / /jam /� P � � /OL/7-' " hM Municipality ! 1�'�14 V tT�� County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc, or provide map) 5. IS PROPOSED ACTION: Xlew ❑ Expansion ❑ Modlflcatlon/alteratlon 6. DESCRIBE PROJECT BRIEFLY: �iVC / 0 f =• 5' C01,f5 �Uc, ?%01V 4 SC 107 _ S cP7c S � 3i�I V %'.0 ' !V4'_ ,. 7. AMOUNT OF LAND AF CTED: U O 1 Initially o acres Ultimately acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe brlefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 13 indusltl ". acW or�slL4A?03R�CO thor �,.-=- „.•v�C�Jmaterclal .. ,�:.Q.AgrlcuHure;;,,.r_. '_ :0 ' 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL? ❑ %No Yes if yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Yes ❑ No If yes, list agency name and permlttapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICAT(W - ❑ Yes %a 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THEE BEST OF MY KNOWLEDGE j ” JI 1 App(Icantlsponsor me: c ` Date: 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 e r - �SSIZRNG......... . <. _.PJ _ *T .e 0- LL ELEVATION HEAL) LOSSES (ft) - - - -- - -- - -- / - - GRADE AT PUMP PIT ......................... D BOX ELEVATION ............................ BOTTOM OF PUMP PIT ...................... .?O� /p TOTAL HEAD LOSS ..... ............................... ,6. FRICTION LOSSES (ft) AT 7-FGPM 2 INCH PIPE LENGTH OF FORCE MAIN .................. /00 PUMP PIT PIPING ... ............................... 30 FIXTURES IN PIT ... ............................... /0 TOTAL LENGTH..... .. .......:...................... / d ATZ;f GPM WITH 2 INCH PIPE/. Y X .86 FT/ 100 FEET = X0 = 'TOTAL FRICTION LOSS ............. TOTAL HEAD REQUIRED............ 7,x--7- USE HYDROMATIC MODEL DS -25 PUMP RATED AT Z-9 GPM AT-7 FEET HEAD. EXACT PUMP MODEL BASED UPON ELECTRICAL SERVICE AVAILABLE TO THE PUMP STATION. SUMPIEFFLUENT PUMPS - Features and Performance DS25MS25 ""ZER 11" WS25A1 • Completely submersible automatic sump pump. • Available with wide -angle DSIWS25 - 114 HP - MAX. SOLIDS 112^ - 3300 RPM 28 "piggy- back" float switch (WS25A1) or diaphragm type 24 "piggy- back" switch (DS25A1). • Cast iron construction with 20 non - corroding ABS volutelbase. T • ' HP, 115V oil- filled motor o 16 /4 with thermal overload protection. ij? _ 12 • Anti clog vortex Impeller. Y ' 8 211 with wide -angle " piggy- back" =4 float switch (SW models) or t� diaphragm type switch (SD a` models). Also available In 310 manual models. j • 1/4 HP (SWISD25) or 1/3 HP ` (SWISD 33), heavy -duty, 115V oil - filled motor with thermal overload protection. o FULL LW 1m PiSisv. car � 0 + Can be used without switch for portable dewatering pump. 4 • 114" NPT discharge with it!RII adapter Included for 11/P NPT 0 5 10 15 20 25 30 35 discharge. U.S. GALLONS PER MINUTE • 10' replaceable power cord. • Weighs 14 lbs. ��Y'' j �ir�r * *>It'�r* X11`** �k>+ r* �k****** �r�lr�lr�lr* �Ir* ** * *�k>fr*�k��k��r��r•* *>tr�lr* *fir* SW25133, SD25133 I AZER 11!" v� SW25133 7. For• slim and eff�uent use. ..� • Automatic models available 211 with wide -angle " piggy- back" =4 float switch (SW models) or t� diaphragm type switch (SD a` models). Also available In 310 manual models. j • 1/4 HP (SWISD25) or 1/3 HP ` (SWISD 33), heavy -duty, 115V oil - filled motor with thermal overload protection. o • Rugged cast Iron construction. a ,o ,s :o :o x 40 4a 99 U.S. 0AuAN3 nA rINVrc • Non-clog vortex Impeller. .wrsoU -1414P - VAX SOULS I?' -1M4 MV • Long life lower ball bearing. 211 Sintered top sleeve bearing. :4 • Carbon and ceramic tr :o mechanical shalt seal. • 1'/: " NPT discharge. s ,4 • 10' replaceable power cord. j (20' optional). ° • UL listed sump pump. 0 5 10 15 70 n X 35 b b N lift . I � � r U Model Capacities To (GPM) Heads To (MI-1). Solid Handling NPT Discharge Motor HP Electrical Phase - Voltage Controls Auto. Man.. Construction STD. Cord. Ungth GUPIGSPI7 25 gpm 25 feet 1116" 11/4" 116 1d_115 r . ✓. S.S.-.& Plastic 8 It... WSIDS25 33 gpm 26 feet 12" 1 12" 114 1 d•115 r C.I. & Plastic. 10A. . SW1SD25 44 gpm 24 feet VT 11/2" 114. 16.115 r .. r Cast Iron 10 ft." SWISD33 47 gpm 26 feet VT 1 12" W 16-115 ✓ ✓ Cast Iron 11) ft.* OSP33 60 gpm 25 feet W. 1 114" 15 UW5,230 v ✓. Cast Iront . 10 ft., ° SPD50H.. 110 gpm 50 feet 314" 2'1 12 1115,230 ✓ r Cast Iron . 10 ft.*' SPD100H 140 gpm 63 feet 314" 2"' 1 1d-230,36-230,460 r ✓ Cast Iron 20 ft. SKHD150 53 gpm 130 feet 314" 1 12" 1 12 1d-230,36230,460 r Cast Iron 20 ft. SP40 120 gpm 28 feet 1 114" 2" 4110 16115230 r ✓ Cast Iron 10 ft.* SP50 .150 gpm 29 feet 1 12" 2'' 12 1d-115230,36460 r r Cast Iront 10 ft." SEW50 95 gpm 25 feet 1314" 2" 12 1d-115 r ✓ C.I. & Plastic 10 ft.• _.SK50 _ . _ _ ..120 gpm 21 feet 2" 2'' 4110 .1 115230 :. ✓ _ " ✓ . _ Cast Iron 110 ft.* SK60 140 gpm 27 feet 2" 2') 6110 1d-115;230 r ✓ Cast Iron. 10 ft., SK75 142 gpm 34 feet 2" 2 ") 314 1d-230,34200,460- r Cast. Iron 20 ft. SK100 152 gpm 38 feet 2" 2'' 1 14230,30-200,460 r Cast Iron 20 ft. i Fin*cufiq-q�, Loss PLASTIC PIPE: FRICTION LOSS PER 100 FT. GPtA GPH TV 4v Ft. I Lbs. I Ft. lbs. Ft. lbs. I I I Ft. i Lbs. I Ft. 1 Lbs. I Ft. I Lbs. I FL I Lhs., 6 1 360 1 .101 .0441. 1 I- I I I I I 1 1 8 1 480 ( .171 .073 10 1 600 1 .25 .108I .111 .0461 I ( ( I I I I I 15 1 900 '1 .b21 .2241 .221 .0941 I I I I I I 20 1: 1,200 1 .861 .375 1 .361 .1581 .13 .0561 1 I 1 1 1 1 1 25 1 19500 1 1.291 .5611 .541 .234 T .19 f .083 30 1 1,800 1 1.811 .7861 .751 .327 .261 .1141 I 1. 1 I 1 i 1 35 1 2,100 1 2.421 1.05 1.001 .436 1 .35 1 .151.1 .09 1 .041 1 1 1 I 1 1 40 1 2,400 3.11 1.35 1 1.281 .556 .441 .191 .121 .0521 ( 1 I 45 1 2,700 1 3.841 1.67 1 1.541 .668 .55 1 .239 1 .15 1 .064 1 1. 1 11 50 1 3,000 4.671 2.03 1 1.931 .839 1..66 ( .288 1 .17 1 .0761 I I I I I . „60_ �- 70 i _ 3,600 4,200 ..610: i 8.83 2.87._ 3.84 .2J_1., 1, $_, 1 3.661 1.59 °3 1 1.24 .406 1 .540 + .25 .33 .107 .143 1 60 1 4,800 1 11.43 1 4.97 1 4.671 2.03 1 1.58 1 .687 1 .41 .180 1 1 I I I I 90 . 1 5,400 1 14.26 16.20 5.82 i 2.53 1 1.98 1 .861 1 .52 1 .224 1 ( ( I 100 i 6,000 1 I 1 7.11 3.09 12.42 1.05 .631 .2721 .08 .0361 1 1 I 125 ; 7,500 I I 1 10.83 4.71 ( 3.80 ! 1.65 1 .95 1 .4151 .13 1 .055 1 1 1 1;,0 1 .9,000 1 1 1 ( ( 5.15 # 2.24 1 1.33 .580E .18 1 .077 1 ( 1 - 175 10,500 I I I I 1 6.90 -1 3.00 1 1.78 1 .774 1 .23 1 .102. 1 200 I 12,000 8.90 3.87 2.27 .985 1 .30 1 .1301 1 1 1 250 15,000 ( 1 I i I 1 3.36 11.,46 1 .45 1' .195 1 .12 ( .051 1 1 300 18,000 1 1 i i I 1 4.85 12.11 1 .63 1 .2751 .17 1 .072 1 350 j 21,000 ( ( ( I 1 6.53 12.84 1 .84 ( •.367 1:••.22 1•.095 400 24,000 I 1 1 11 1 1 1.08 1:..471•. .,.28 1 .121 1 500 1 30,000 I I I I I I 1 1.66 1• .720 • . ' .42 .162 1 .14 1 .059 550 ( 33,000 ( ( I I 1 1 1.98 11.02 .861 1 .50 .219 1 .16 ( .071 600 1 36,000 1 I I I 1 2.35 ..59 .258 1 .19 1 .083 700 1 42,000 1 1 1 ( i 1 .79 .3-43 .26 1.112 .?3 1.tti3 800 1 48.000 I ( ( ( I ( 1 1 (1.02 .4;31 1 1 1 1 I I I I4 e-Y I c_ 1 I Al 1 179 ._:.:;�¢;�: �:�•:;�,���,F.� - _..._ .� - -- - - - - �� {tin /:3t t�, ( >Ll(1 ."u'A:i...:..' .L:::n.niYCi �..rV.ie'• .::+?•w' :'4z 'W zr ..__- __ _ S - . T . . '- T•'..cY6'• ti.�,o .•w►.'.]•Qiva- .t•ay..� � '-0 ....ww.�� .. _ Diaphragm Switches • Pressure Actuated Switch . • Liquid Level Differential Perranentty Set at 6" • Rated up to Y: HP or - Control /Pilot Circuit up to • Mounting can be directly on pump or independ- entty suspended. • Includes Cast iron Body 15' Poe: er Cord Stainless Steel Strain Revel, Fasteners, and Bracket A24 Equipped with a three pronged series plug (con- figuration per NEMA 5 -15) up to Y HP. 115 volt single phase operation. A2 -2 Equipped with bare leads for direct connection to a magnetic contactor (A3.2012) or a starter (A3 -5034) as a plot switch. A2.4 Equipped with a three - pronged series plug (con- figuration per NEMA 6 -15) up to Y• HP, 208/230 volt, ^.•..1s nhaco nneratlon. Mercury Float Switch A2 -3 • Mercury Fluid Contacts, ® Normally Open Design a 150 °F (65•C) Max Temp. o includes: Polyurethane Foam 151, SJO, Neoprene Cord Lead Weight and Mounting Strap • Suitable for Pilot Control Duty up to 230V Max • Two Required for Simplex System (One Pump) • Three Required for Duplex System (Two Pumps) LIQUID- LEVEL. CONTROL SWITCHES Omnidirectional Diilerential Mercury Switch • Mercury Fluid Contacts . Normally Open Design • 150•F (65•C) Max Temp. • S ,ar /Stop Level Adjus!2ble 5 to 23 in. UL and CSA Listed •. ® ASS *,_�,s;ic Cage • 15* CordSJOW— A /SJOW with tviounling Straps • One Required for On /Off operation A2 -5 wmli three- pronged series pluo per NEMA 5 -15.up to HP, 115v, single phase operation. A2 -6 With three- pronged series plug per NEMA 6 -15 up to 3/. HP, 230 volt single phase oiler aticrL A2 -T With bare leads for dirtscl,•„ , connection to a magn�tiC, ;:. contactor (A3 -2012) or a. s :arter (A3 -5034) as a•Fi1ot s ►•itch. ' A2 -8 Reverse acting for pump-up fr,!ng operation. (Normally ciesedcontac1) Supplied YA!Ji bare leads. Mercury Differential Switch A2 -9 • Mercury Fluid Contac's • Normally Open Design • Start /Slop level Adjustable from 6" to 32' • Rated !or % HP. 115 Vcit Single Phase Only • Includes;._ 10' Cord Three Prong Series Flug -- NEMA 5 -15 P •_ _Fr -terion. - _ .... Loss . �.. EQUIVALENT NUMB ER'OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS ' Size of Fittings. Inches Vz ". z!i" 1" 1'/4" 1' /z" 2" 1 21 /z" 1. 3" 1 4 ". 6 ". 10" 10- 90° EJ 1.5 2.0 I 2.7 3.5 4.3 5.5 I 6.5 I 8.0. I 10.0 . 14.0 15 25 450 Eil I 0.8 1.0 1.3 1.7 � 2.0 2.5 3.0 I 3.8 ! 5.0. ! 6.31. 7.1 9.4 12 Lon S--veep E11 ++ 1.0 1.4 1.7 2.3 tt 2.7 3.5 II . 4.2 ++ 5.2 1 7.01 9.0 11-01 14.0 Close Return bend I 3.6 ! 5.0 6.0 8.3 1 10.0 13.0 15.0 18.0 24.0 31.0 1 37.0 39,0 Tee- Straight Run 1 2 i 2 3 3 j 4 5; I Tee-S' do. Inlet or Outlet I 3.3 I 4.5 5.7 7.6 I 9.0 , 12.0 1 14.0 •17.0 1 22.01 .277.0.1 31.0 40.0 Globe Valve Open 1 17.0.1 22.0 ) 277.0 36.0 1 43.0 1 55.0 67.0 82.0 1 110.0 S 140.0 1 160.0 1 220.0 I Angle Valve Open I 8.4 12.0 1 15.0 18.0 1 22.0 1 28.0 ! 33.0 1 42.0 1 588.0 70.0 83.0 1 110.01 Gate Vaiye -Fully Open I 0.4 I 0.5 0.6 ! 0.8 , 1.0 ! 1.2 , 1.4 1.7 ! 2.3• I '2.9 1 3.5 4.5.1 Check Valve (Swing) ! 4 1 . 5 j 7 ! 9 ! 11 13 i 16 S 20 26 33 .139 52. ( 65 Check Valve (Spring) I 4 6 8 12• 114 19 •1 23' ; 32 43 58 f -- • -� (Aj 100 ft of 2" plastic wifiri`on and one (1) swing check•valve. 80° elbow - Equivalent to 5.5 ft of straight pipe • Swing Check - Equivalent to 13.0 fL of straight pipe 10011t of pipe - Equivalent to 100.0 IL of straight pipe 118.5 ft. = Total • equivalent Pipe Figure friction loss for 118.5 M of pipe. (5) Assume flow to be 80.GPM through 2" plastic pipe. 1. Friction loss table shows 11.43 fL loss per 100 It. of pipe. 2. In step (A) above we have determined total feet,of • pipe to be 1185 IL ' 3. Convert 118.5 IL to percentage. 118.5 + 100 • 4. Multiply 11.43 x 1.185 13.54455 or _13.5 IL - Total friction lost in this system. ,L • �� Goulds • Etfluelft and Sewage Q Slide Rail Systems 11/4" & 20° Discharge -S IMPLEX� DUPLEX Slide Rail Systems. Provides Easy Means of Re- moving Pump From Wet -Well by Utilizing a Ouick Disconnect and Guide Psserribiy. Eliminates Need to Enter Wet -Weil. Corrosion Resistant Design Includes_ Stainless Steel Rails. Cross Brace, Ouick Disconnect Plate, Ease Plate, Vft Cable; Eronze Quick Disconnect Adaptable to All 2 Inch NPT . Vertical Discharge Effluent and Sewage Pumps Designed for use with Horizontal Discharge Systems SYSTEM CUMPONENTc Basic Slide Rail Assembly includ 96- long `Guide Rails. _.._.� Wall.Eracket Top Eacket Ouick Disconnect • Adapter Eottom Pump Bracket Ease Plate - tilting Cable - Check Valve i - - Vertical Pipe Nippies NOTE: standard overall lengtt+otpipingisS6' "...can Lr- te cut down to ao"" nunimum lengtn. U raj length longer than So is needed, consu4 factory for pd6rg. A10- 12,11/4" A10 -20, 2" For Use With Pump Model 11 -.1Y.' C:SCI4ARGE i3-•2- C*CHARGE Simplex System Consists ok 1 -Slide Rail. 1- Simplex Disch. Piping. Simplex Discharge Piping: H12s.114, �ta H2OS, g tT- -1'ti' Q15CM%•nvc Simplex 1911 - F' OtSCF ARGE includes: - t)n;cn - F;pe K. ,-les o Tee Hardie - Gate Vahe W �011 Duplex System Consists of: 1- Duplex Disch:ipirg . Duplex Discharge Piping: HIM, 11A- H2oD. 27 0 21-• r •!.- CtSCYARGE 2314-•2 C SCMARGE Duplex includes • Fipe Nipples o Ur cn; • Gate Valves o Tee lizzel es e' Elbows - F:,e Tes Simplex Syslem •?c - -- , .. - -- Duplex S fslem Size Qty Order No. Description (7;.' Size . Qly Order No. Deseriplie Ordering EP03 ' 1 /�° 1 A10 -12 Slide Rail Information 1 H 12 — :Disch. Piping 3685 ` 1 AID -20 Slide Rail 3687 20 1 H2CS Disch. Piping t 2 A10.12 Slide Rail 1 H 120 Disch. Pip; 2- 2 A10 -20 Side Rail 1 k200 Di=ll. Pip -. Jul 24 06 08:540 Steven Auth zwo* Ike C C X Q45 528 -13,22 j �Tr� ..,., - -• -- - -. ....- �- ... � , .- >,,:••.,- :a��:..._ � :._ rte...._ .. _ . . 8n.I.Y L CRO WDER thsir"n ~Each RAlAw ONDI, xi.:. Vim c1milymn FOLC E4"Y't A ASSOCCr+l3'Fti`i Town D094= NLRY 1, 2006 TOWN OF PU1NAM VALLEY PLANNING BOA" 265 Oscxww a. Lake Road Purnam Valky, NY /0579-2004 4344' n&37'40; Fax. ($45)SZ6.3307 I ilud, t0u1WL' 11? G8yA, rJ1�.14ir[.,�C ..�7^�y�yy�a /��y S- rrJJ**QAA1rr+a�ryl`�'IA�My�iYli7p�7�.Ai'�fT APPROVAL SITE DEVELOPMW PLAN Ar' ROVAL NVETX ANDS pax rOR GRADINIG PEW WTI= ROCK ROAD Tul. 71.230 FILE.' 73.l1170MOW, 1007, 1408 Rigo JOM4ZA:tGW4 AL S.csm-q F WYENE'YE'1"M, AL TOM CARANO (A�i 1<1AC} Lain LUSSMR ¢crk W AS, 'the' applic nt is 'proposing a S-I.at *UWivisiozx on 28.42 (+1 -) acres of land located on Whine Rock Road in the L.CW-Derwity Rezi =c t' (R -3) Zonint District; and W11FDMAS, the site is designated as parcel number 73.-2.30 on the Town Tax .Ndup; wad WHE)3&.AS, dxe applicant previo%z&4 received 0onditional Final Subdivision Approval, Site Development Plan ,PLpprov4 a'Major Grading Permit, s d a Wotlaxzds Permit &OM the Flam. -Uing -.... -. Rofard; bawey r> said apprcyals b.„ ye slu=expired; [end WHMIG AS, with xhe exception Of the requirement for A tree Phan,' which the applit =t ha: provided, xao madpr altomti= to the site dssig-a 33or to the Town's Zoning Ordlwn ace, Subavisio)a R4:ulationa yr other land use xvg Utions have o=ume4 since the original approval; and WRERRAS. The applicant. has stated that Xao additibnal blasting will occur ova or off-site; axxd WHERFA$, the P)Azuing Board has reviewed the proposed action according to Chaptoz 56 "Subdivzsaala R agulatio=,," Chapter 14-4 'Freshwater Wetlands, Watexaomse and Waterbodiers," Chapter 156 "Soil. Erosion and Sediment Contwl," and Chapter 165 *Zoning,'; of the Putnam VaEoy Towo Code; and WHEAUS, the pmpased roaaway desig -&ad to service the subd visiozz is a dead -end road greator t'hazl 1,200 Feet in length; and flgc 1 01'5 Jul 24 06 48t54p ste--gn Ruth 1 84F a28 -1322 p, � W1TbRFAS, rase agpbeaut has requested a waiver of the 1,200 foot road length ii.rait based on extenu,tLtizg dzeumstmms, iucludmg7 the low de=ity and limited additional burd= on public services rapres nted by this project; and WHZERAS, the - Fluming Saard issued .a Neotivro Declaration of Sign4=ce. and graarad PrtllimiAary Subdivai ion A.ppxovsl_un Mauch 13, 2046; arLd V d'.E'1E11 AS, on 1Vla.rch 13, 2006 the Planning Board determined that a final public heariag will ewe be required; and WIDWAS, Qu Mlarcla 13, 2006 the Planning Board Sm ted a variance for relief of §46-5C of tht: SubdivWou RegulatimA selating to the leagth of dead-end stxeece- NO'99'', TMUZ -FOB, BE IT RRSOLVRD THAT, tae Putnaui 'galley PBuuLx;g Bowed hereby approves the Xinal Subdivisiou Plai p;mparEd by Budcy & Watsou Surire�g and Engineering, P.C_, 'titled "FiAal Subdivision Flat prepared fur ! LLC,' last revised March So, 2006: axed BE IT F[aRTM-;R ABSOLVED TnAT, the Putnam 'Valley Planning Board hex*by approves the Site Dovelopment Plon (Sheets 1 through 7 of 7), prepared by Michael P. Stoin, p.E., titled 'W'hite Bock Road SubcUv* ion,' elated i4a'rch 6, P-006. aad BE IT FURTHER RESOLVED THAT, the Site Developmoot Plan is v&Ucl for a period of 1E 1nouths sfur the Sirr: Develop=ent Plan %s been eigxxed by the Chairman and maybe exten4eci once, at the x N- vesC of the appli=t (in writinO, by the Planning Board for a period nbt to exceed six months; and BE IT FURTHER RWOL'V:ED THAT, the Putnam 'Valley Plann,izlg Board hereby issues a. Wetlands Permit "bject to tlze signing of LbK Final Subdivision Plat HAa Site 1'levolopment k'lu;n, by the Chaitsn or his deai.=ee. The Wetl.Ands Perm t shale be valid for a =axiwwn period Of three! 0Y Iro u_ 4; .siping,of the- liknal Subdivisis m.? Lq ..a,nd..%te.J)eY- ,alu��ixn�znt- .tun. Al work ;. d•. =witb -the '°i+i+atlhn F aft anal '1� "ixxn`duo din sti r£ cn`xn�pI sc -wirh t}ic °Saxe' _ J)evelopment .Plap aazd ahnR be completed witbin six months, following the ixxitiatian oi' construction; and 73.E IT Flr97BZR PXSOLVE D THAT, in ac=rd aac a with Chapter 144, the Planning Board, Wetlandb liwpeetor and Code E4�Wreement OMm- r shill have the light w inspect the project from Lime ro time; and B E IT kURMR RESOLVED ' RAT, tho Wedands Permit shag auro=dcally expire upon comp%cian of work; and BE IT FC UTEME PMOL'VED TH&T, the Rtutwm Valley P`lsxa g Board herel y greats a Major Oradiug Permit subject to the sicgzziAg of the Final SubdivisioA Plat and Site Developmont Playa by the Chaixmau or his designee; and RE IT FURTHER RESOLVED THAT. the Major Gradi,tag P==it shall expire six moutlxs after the aigning of the Site DevelopxuenC Plan by the Chairman: and f vxofS JU1 24 06 0a:54p S�a+�sr, AUch 1 e4$ 528 -132^c P,� BE IT )'U'RTHRR R 4LYED THAT, the below-Ustad a=ditioas mint be completed wzxhiu 180 days of the date of this; revolution- Shouid the below- Iisted conditions not be oomplotod win the allotted time fr=e, this rer*lution shall become null arid void unless a 90 -defy oxteniom is requasted by the upphmat in 'w ritixig, prior to said 180 clay period, and granted by the plauniug Board. 1. Submission of ali applicable fees and escrow. '�. Construction blomitoring Escxow in the xcxno =t of $1,500 %h&U be sub=itwd to c � Plane bard Olerk. 3. A :eo=vation fee in the umount of $'5.400 (cextiliied or baaak check) shall be stzbmitted to the ?lwudag Bwrd C1e,&L lo the event that Said fe-e has almady baen paid im full, this COAdxtiou is hereby waived. a. A Band,'or other c*Uateral to grantee installation & xnuintananm of required erosion controls, , acmptable to the Pleun:mj; Board rid in form acceptablu to Pl='Aiag Board Co=wl, shall. be submitted to the Morning Board Clark. Said secuxi.ty shall be in the amount reaoxamended by the Town Engineer and approved by the Planning 30axd. The apA=nt shalt pzvride au action plan for tho sccu6ty i 4catiag. to the aatisfachoxx of PLanning Bccwd Counsel. when the Tcnva bans the righx to utilize the surety aaad TO take tlu: Asc=saxy a mTect7ive Meammes. 5. Completion of all project infrasumeture GLo. roads, drainage, uWities) to the sacisfacriom of the Town Eawguaeer and the Maixiag Board within 184 days froa the date hereof (which may be cxt=ded by ao m.Qre than two additional periods of 90 days each 4 its the Pl xuning Bm,.W& opinion, aurJx exte nsion(s1 ns wu,rranted'by tlae pu-,daultu circiAm cal=ve. S. In lieu of aada6ring condit4oxx #5 prior W obtaining the Planning Board Chairdaan'a signature on the Plat, a perkranauex bcktd or other seauxity suMdexu to cover the fiz cost of the project in&Astructum, in the sum of $271.120 "d in form acceptable w Pluuaing Bow Counsel and the TowA Board, may be furnished to the Town by the applic unt- Such setuz ty shaR be iu ooe of the forms specWed under Section 277(9)(6 of NYS Town Law and for a term of two W. yeaxs. The delivery and acceptance: of such . secu�y . -_B..o. �o. s__ . n- ot re t ;ie :�i igadowth cr- x lcte t ._ . .. .. , irc i i +.trssr, uctts� - 7. engit*erij)ffhaspection fee equal, to 5% of the cost of the above-mentioaed surety shaU be subnop twd to the Planning Board Clerk. �3. Tb;e applicant shall irxstZ aU pwposcd monuments and pins prior to the signing of the Flans by the Charon or his designee. A, letter shall be provided from a Licensed Land Swrveyor cersit iag that all proposed moza=euts have beeza installed. 9. The applicant should submit a report. prepared by a . consulting forester or certised arborisc, xeJa,tjag to the envivanmenW impact of the propa od tree rexuoval, as xoquired under §165 -21.1 of the Zoning Code. IQ. The aipph=t shall saCis&ctorily address oi�tstuuding c:ommenta .from the Town, >au&eer, Town Plaarwr. Town Wetlands inspector, Planning Board Counsel, and Town Rigliway $ltperintendoliz. 11.P`i:uU aPorl:s Addregang resalutiou tx form &zz shza.0 be provided £rvm the Town l;xagiueer,'Towu Planner, and Pla Aing Board Counsel. 12.A Notice of Intent i_N required to be submitted to the Now York Skate Daparement of Envir0n=*atal CWI%erFation (NY'SI)EC) for coverage under Permit GI'-02-01. Proof of coverage sbauld be submitted to the P'l=ning Board aA;i Town. �uaglxacex for review. NP 3 ons Jul 24 J6 08:6Sp St ?n Muth 1 8.4' S2r3. -132 p,i 15.Sbeet 1 of 7 of the Site Developanezxz Plan shall be revised to illustrate topagraphy, as required. 14..All required ewsemeint documentation shall be submit" to Plansaiug Board Couasel for review and also naval including. brxt not limited to. off-site erasemenm 15. S,:Litable legal docu vniation Jprov'idirig for the o'i'+'narsbip uzd permuneat n%ainzon&Ac(,.' of the road, stormwater marlazement faciUtie�, aDd unditrou a waxer storage tank, skull be subxQitxed to Planning Board Gou,nsel for review and approval, 16,The final zub4i'vi8fou plat to be sigxxed by the Pla=ing Board Chair== or bit; dc:signeo shall be produced ed on Mybx. The PianaiAg Uurd Chairman or his designee shall only si,gs� the SjW plat wben Gina plat has been previously aigted by a New York State UceAsed Profeesional u&iueer, New York State Lic erased Land Suz'veyor, the appfiC*Mt aadlor the Owner of the land, the Now York State Department of EnviranmenW Conservation (if applicable) Aid the Putnam County Di pamxiatmt of Health- T)bLe applicant Shall also produce eight oxiginal copies of the final plat and Site Development Plan. eoutpletz- with signatures, to the Pla=ing Board fur the Cktwx=an's or his designee's signature. 17.A note: shall be added 'to the pl$t stating= 'proposed road and draiuuge features will be privately owned and mWatained by the owners of the lots shoal hereon." ,AddLuans.l &a2k ments to hs Sa stied 8mbeeQueat to ..the fiigmine -gLthe Subdivision and %tiY .02yalaa-ment P44: 18, No additional blasting will be conducted on or offisite_ 19.A Commenmmieut of Work Permit is required fr m the Coda 4nforeemimt Qbff=r =de:z §155 -:5 of the Town Code. 20.1n an eMi% to ensure compliance with %he aypnoved Plan, monthly site waits ahaB be ow2ducted with the applicant, contractor, 8u:U(Lng Department, Wetlands Izapector, Town Plenz)or, and Towu Eu& uaeer. 21. In, axx effort to ensure coxuplianw with the approved Plan, a %al site inspectioA shall be conducted with the uppli=t, oexatrxctor, BufkclWg Department, Wetlands Inspector. r'owa'n - -- .._..:. � �'. loan~ zxer,._a�nd'i��!x�,'E�gin�c�er. .._ ._. - .. _ � - _ .. - - -• - L�:� _:e ,` !e)lall'$ °ci tlesYid td�ai g upli fr<ce %,ntb the by z+ave Jia� iCal T shiliiiniti d _ . to the Plaaning Voazd,'down tagineer, Towu Planner, and Code Exxforcemeat Officer prior to the issuance of ;t CertMeate vi Occupancy, 23, Prior to the isuuanca of a Certificate of Oooupancy, the BuiIdbag Depaxtme= sju l confirm with the Plamdag Board Clerk that all e=orw has been paid in RAL Motion' john ZAx,Wr , Jr. Sired' IVlieh�ie�, ir�emdf PabQ 4 Of Jul 24• 06 081 5sp R.uoh 1 8y 528, ?3�2 �.a ..,. . "r'= .,t9„ro-. ii.. ,.. .�.," -. ... :�r._. ... z ,',.? ..o.a c ... ..... o,.,a �.... .. .. ..,-.. .a. ,. w..; .� .. «... .. , 's: • - ... .. :... ... ..... w....R � Ytm Nay A.bsttntiou Ab6ent ` vm Carmao X _ Lugene T, Yaw, Jr. � � `_ - x �. Rice =-d 'ZIll.ljr Krohn ziSLYC'dxw, Jr. x Michael ?4imondi, Jr. x Chairman Billy L. Crowder BY: Qhair=- rL Silly I.. OVOWder Tht Planning Bmzrd C: ere hereby conAmis 1 har. coAditions 1- 17, identified above, have been satisfied and that the Subdivision a a Site Development Plan have been sired by the Chairman of-the Planning Bowl, C:o4rmed BT- Date: Page S ar 5 SHERLITA AMLER, MD, MS, FAAP _j -'_q trmissioner.of Health.. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT.OF HEALTH 1 Geneva Road, Brewster, New York 10509 COVER SHEET PROJECT Owners Name): " l e St o it ROBERT J. BONDI County Executive < -•, "STREET: . 1/", re PHONE #. �1 y MUNICIPALITY: TAX MAP NUMBER /Y dot° �n rox k o v T.- PRDEESSxONAL,.� - -` "'r r ATE: o- y ❑ REVISION ❑ REQUESTED ADDITIONAL INFORMATION Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax.(845) 278 -6085 — . r-1 n...n l0. • -- _. 1-11.190 CLAD i v' SHERLITA AMLER, MD, MS, FAAP Commissioner of Health _. l,ORET' -A MOLIINAIRI {,N, M.�+�I,;,,::_� �• Associate Commissioner of Health September 12, 2007 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 ROBERT J.. BONDI County Executive Director of Environmental Health RE: Application to Construct a Subsurface Sewage Treatment System for White Rock Road Development, LLC at White Rock Road, Lot # 5 (T) Putnam Valley, TM # 73. -2 -p /o 30 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 25, 2007 is incomplete. Please be advised that, the following information is required before the Department may commence its review. V/Questions 27 and 28 on the PC -97 form reference wetlands. It appears that wetlands do exist on the above referenced lot per the subdivision map and therefore would need to be addressed on the PC -97 form. Also question 22 reference the inspector and date. Please be advised that the deep test holes were inspected by Adam Stiebeling on 12/16/99. (Returned for your use). The Letter of Authorization form needs to be fully completed and returned with original signatures (returned for your use and correction). t^ Three:se .`o plans are regi:tred.f4r. subrrii64;t- - G4y- one-se - was- scbnntted. Ouse plans have not been submitted for review. Two sets are required. �'�♦-+-�- .�_.__� .. _.�. )louse control needs to be shown below the house and SSTS. V The typical absorption trench detail needs to note clean dust free crushed stone or washed gravel. P/ Please show a separation distance of fifty (50) feet from the SSTS to the uphill catch /basin. 18! Please show a plan view of the pump chamber with dimensions. W Please revise notes for pump chamber detail (see enclosed). The septic tank can't have an outlet on the side of the tank. The outlet needs to be on the end wall. The tank may have to be rotated in order to connect to the.pump chamber. JA/An equal distribution system using a distribution box is considered preferable by this Department. Please consider changing the design to equal distribution. 1z/The wetland boundary setback line needs to be labeled. ,1?l Please provide the pump chamber height dimension and the wall thickness dimension in the section view. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 •• .;:, • ., 4:'ThE E'�5'a at ins'ide,vv'idth*�t %0" dimenslofls :appears to be incoireci: >' - >:.� 1 lease provide bedding material for the pump chamber. Based on proposed fill contours, it appears there . are some portions of the SSTS area /being cut. e. Please remove any references to the NYCDEP, since the lot is outside the NYC Watershed. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. Sincerely, eq P Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:ens SHERLITA AMLER, MD, MS, FAAP Commissioner of H_ ealth _ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 27, 2007 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Individual SSTS Application for 28A Subdivision White Rock Road (T) Putnam Valley During the review of lots #. land # 2 for the above mentioned applications this Department has been made aware that the above referenced subdivision has not been filed with the County Clerk's office of Putnam County. Please be advised that no further review will be conducted by this Department on any lot in the subdivision until documentation is provided that the ub i i€ on�l?as -bea k ►_ ,de l &gib � fca fats 3;= 4,.an,& . Ai, not respond to any comments submitted by this Department until the subdivision is filed. Please contact us if any question arise. JSP:kly Sincerely oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 lb C3•,, R::2:. Ile. j Id MOM KQ If �e 1 y r� . #0 MT. F 1 ". 4 � i ••'' � �►�.� `"""��j1,� . '� � . • � lam' 1 �.. MWMRPW#' It n AWhOI 4fM t W,x (3) I I a I fill" ,a ..s96w dd^ 1 �■y r 9 WARSAIM I mo W W. 1 pl! M v N Now' itw . ........................ ............... mawm-,M-- i i �? a as � �'N MWWWAW c � �r .. .. 3 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health MOI:INARI, "#IiN; tvISN .. _ Associate Commissioner of Health ROBERT J. BOND] County Executive �_ Y.. _... "ROBERT MOWS, -PE ; - Director of Environmental Health February 13, 2007 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 RE: Application to Construct a Subsurface Sewage Treatment System for White Rock Road Development, LLC at White Rock Road, Lot # 5 (T) Putnam Valley, TM # 73. -2 -p /o 30 Dear Mr: 'Karell: The Putnam County 'Department of Health (Department) has determined that the above referenced application, received by the Department on January 25, 2007 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Questi6ns,27and 28 on the PC-97 form reference wetlands. It appears that wetlands do exist on the above referenced lot per the subdivision map and therefore would need'to be addressed on the IIC -97 form. Also question 22 reference the inspector and date. Please be advised that the deep test, holes were inspected. by Adam Stiebeling on 12/16/99. (Returned for your use). • The Letter of Authorization form needs to be fully completed (returned for your use and correction). �- - °- - C— Fhretr ets of plan~ aee req ia'ad fcir submission Only one set was submitted. • House plans have-not been submitted for review. Two sets are required. I j The review of your application. will commence once the Department receives the requested V��informatjon and determines that the applica.tiori is complete. The Department will notify you ' within 10 days of its receipt of the requested information as to the completeness of your application, Please be advised thai. failure to submit information to the Department or to follow procedures is sufficient grounds to.deny approval, pursuant to the Putnam County Department of j Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed Senior Environmental Engineering Aide GDR:kly 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 A!5Ja`t j fit) 6 7- - ¢�,�;ca I f L LL -, e(vc,4- e-a5 e— S Iu� W c� Saora- m dL �ffS ��KG dl "� © �+ -�- •� t� :r l uf. kill v. Pii rum p c b,e c, ttase- 51.tow [l- PLO-V", j,t ev XMevi ,c.os f SQp%I I:•- e:rflcfi s.. rhz S�a,2 eFffre {zw,k. v ✓r(z•} X15 lac c� -flee I1 e e 1" be ✓vI -,-k.( l !. 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