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Home My WebLink About3359DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.06 -1 -1 BOX 27 03359 rre L `� �;� , him .„ I a` ��: Is f t - << , 7, ' +�, 03359 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK report of This, report is to be completed by well driller and submitted to County Health Department together with laboratory r -ka is4acto-vybacter.iao-`-quall'ty-,before.cert[fit;,it---.of-construction-co.rnplianmi'&%*,-.su4d.l-z.,..."...... REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER ME ADDRESS .. P\ *' 10 (No. & Street) (Town) (Lot NuMber) LOCATION 0 1 OF WELL 1'T ;1� v� tt �N' — R'Au AL-1-1 BUSINESS V PROPOSED DOMESTIC El ESTABLISHMENT FARM TEST WELL USE OF WELL PUBLIC AIR 11 OTHER SUPPLY El INDUSTRIAL CONDITIONING (Specify) DRILLING COMPRESSED CABLE OT EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION El (SpeHER cify) (f CASING LENG(feet) DIAMETER (inches) WEIGHT PER FOOT pJ E SHOE W G ?JUTED? DETAILS THREADED F-1 WELDED YES ONO OYES NO YIELD HOURS G.P.A. YIELD (G.P.M.) E— TEST BAILED F1 PUMPED COMPRESSED AIR YIELD Depth of Completed Well 4oi,.), in feet below Land surface: MEASURE FROM LAND SURFACE —STATIC (Specify f TEST fleet) WATER LEVEL 15U MAV; ILENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLO .DEPTH FROM LAND SURF/ FEET to FEET IF GRAVEL Diameter of well including PACKED: gravel ravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. Y If yield was tested at different depths during drilling, list below FEET I GALLONS PER MINUTE D�TE WELL COMPLETED DATEOFREPORT I WELL DRILLER (Signature) Mful V!, If- I tyil bAlk-l", xm'_ Pei) 1� ;,' n -0 V\�- 0 �r�.��+K�� ^ ��=�^��|� Laboratory, Inc. ��K~,.6� 1��6�~u x��«��«u��» u..~ 321 KcurStnccx Yorktown Heights, 0'Y'1D598 (914)%45-32O3 � CROCK `_' '`~ L -I _J LOCATIONS: �� w"32nxsAnsr,YonnroWm*sxs*Ts N.Y. 10598 2*5a203 [] 201 BUTTONWOOD Avs_psensnILL. N.Y. 105e6 737-8777' C1*ys MAIN oT, MT. KIScO.m.Y.vm549 666-3335 ' []oTowsLsG' s.< s �w.v.1os1z zn*ezzu ~ _ -DATE7Am ^ DATE RECEIVED: -7 /f DATE REPORTED* li 366 vr REFERRED BY: Collector� LABORATORY REPORT []ACIDITY ........................................................... 0 ALKALINITY ' P= A= 13 BROMIDE ............................................................ O CARBON DIOXIDE, FREE ....................................... OcHuon/os ........................................................... []CHLORINE ........................................................... []C0o -----'--'-~-'-'--------'-----^- � [].COLOR (,units) .... []CYANIDE ........................................................... [] DETERGENT, ANIONIC ........................................... OpLuOmos............................................................ [] HARDNESS ................................................... `....... [] MPN oouponm COUNT/ 1uowm ................................ .;IF Tcouponm COUNT/ 1ou^l ~-`' 6> ~~-'-~'-^--~- oownnmATonvTEST --..-_'- ............................ [] NITROGEN, AMMONIA ........................................... [] NITROGEN. KusLoA*L ........................................... [] NITROGEN, NITRATE ............................................ � []L^x�T9OC3, (lny,-,AN|c� ,-,'.��, []000n (units ................ []ou& GREASE ....................................................... []pn (oolta) ..................................................... O PHENOL -'.._---'---'-----'---~---~'--'--~ O PHOSPHATE (orthv ) ............................................... � [] PHOSPHATE (c"ue^seu}........................................... [] PHOSPHATE hvm/> -.--.-'--.-'--'.'--''-'~~.-' [] SOLIDS, SETTLEABLE, mVL ................................... [] SOLIDS, SUSPENDED ............................................ [] SOLIDS, DISSOLVED ............................................ [] SOLIDS, TOTAL ..................................................... [] SOLIDS, VOLATILE ................................................ [] SPECIFIC CONDUCTANCE (obtdom/cm) ............... [] SULFATE ............................................................ []SuLF|o9 ............................................................ []SULFITE ................................... ~^.,-~_^'_.'-~_^' LJSURFACTANTS.................................................... []ALUMINUM ............................................................... 0 AmT|M0mY '—._-'^`---_--....---_-~____... � � .0 ARSENIC ._-_'..-'-'----.--_--------. OaAn/mw .............................................................. OusnvLumw -._..--._-..-.--.---^ ........ Oo/mwuT* -'----'-_--..-----.--.---_- OBORON ........................................................... .............. []CADMIUM .............................................. 0 ALC/mw ---.--.-----.--.---._-___-. O CHROMIUM hwJ .................................................... O CHROMIUM (x,"avomnt) .................................................... Oooe«cT ---.-..--_.----..-.-----.--_.. OCOppER...................................................... .-__.. Ooou» -------_-------'_`�---------.. O/nOw ---..----.---.----_---..---__ OLsAo-_'-'----'.'~-_-._.---.-...-~.-_.` OLnr*/mw ._.-----'__--'__----.----..--.. OMxomss/Vm ............................................................... C1MANGANESE ................................................ OMsnounY --.-.-.-----_.,-_-.---.----_.—' ,]] NICKEL; .....'/..,..... ,.. .. . .........`''.^ ........ r..:'..``...�''� upALLAomw '^--.--.------_..-.-.--_--..---.. OrOTAss/mw ................... ............................................ On*oovmw '--.._..'_-_----_-..-.---.-.-.-- [] SELENIUM ............................................... ....................... _ 13 SILICON .................... ^.............................................. []SILVER ~_'-.-,.--.--.-_-.''~--..--.-�_----_--- O SODIUM ..~.-....~--~'�--_-.'----....-_.--'--.^ . OT/m '..-"-..-~.'~^'--'-'_----_-----'-----'.-'^ OZINC ........................................................................... [] ........................................................................... r~~' O.--.--...-'-----..-..'`.'-----------.----~~'''' [] REMARKS: .................................................................... 11 ................................................................................... O................................................................................... [] -.-^------.'-'-.'...-'-..^-..-'---.----'.-.~--- O.--.--,-----'.'..~.--..~~'- '...-.-'--..-.'...-~^-^ , O...'..-'~'~..-~~.~~.-..-'--'..,'....---'..-.~--.'-.'.-.,' O'--',~'-',,'__._____~-_~_~_______�~__,___^_~__^,_-_,, | ' . THESE RESULTS INDICATE THAT THE WATER WA OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED THESE RESULTS INDICATE THAT THE WATER DI ry MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED 'WHEN THE SAMPLE W COL ' 0/A = not applicable �~�-� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :�•e.%^ra+ 'a+s�0": ,C 'd'+�EI "�l ': C:i'¢s .("..G�l..L7v:n.'— .`e u�s•.:S'%o:g�.- •F ^:�+1e'�`�e,T. +`.:. R -..;•.R ail .�:1•ci r.. yRS ai 4C r.4��MMD�Y'.V�t ^.•fake c. Date 11/8/84 t i k !, Re: Property of Mr. & Mrs. Bernhard Broer Located at Spruce Mountain Drive (T) .11 Section . - - - -- Block 1 Lot 52 Subdivision of Spruce Mountain Estates Subdv. Lot # Filed Map # Geatlemen: This letter is to authorize Joel L. Greenberg Date a duly licensed professional engineer or registered architect X (Indicate to apply for a Construction Permit for a.- •sepa.rate sewage system, to serve the above noted property in accordance with the 'standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said r. yet. em�. ot. y; s. t► s.` in_. c,, c.;xsforrxai,t.y.•kLith.�tYf provi8*ioisF "= 45ricl 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. C omtersigned: PE. , R.A. , # 11056 _ Muscoot North,RFD #2.Box 488 Adress Mahopac,N.Y. 10541 1914) 628 -6613 `X(.ephorie Very X Sign 50 Wheeler Avenue Address Pleasanville,N.Y. 10570 Town 914 - 769 -8220 Telephone 7 PUTN4M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS, FIELD INSPECTION REPORT ` 12oETA f;�C i'. � PL/ INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES, NOI OAS Wetlands on /or proximate to property ............ >. Property lines or corners found ................... Can estimate house location. ........ o .... o— .... Will driveway need cut..... ... o .............. o ..... Must trees be removed - note these .........o...... Deep holes representative of entire SDS area...... Additional deep holes needed..... >..... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics...... — o. ....e D. H. 1 Lot Depth to G. W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. D. H. 2 Lot Depth to G.W. Depth to rock Soil DescriDtia 0 ft. 3 ft. 6 ft. 9 ft. ,....: 12 ft.l 12 ft. D. H. - Deep Hole G.W.- Groundwater D.H.3 _ Lot Depth to G. W. Depth to rock Soil Descri ti.on 0 ft. 3 ft, 6 ft. 9 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS kJ House SSDS located per approved LO n ............. Length of trench measured r Width of trench average ', Slope of tile line and trench acceptable— ...... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area ecessarly graded.° ............... ........ ft. ma'ntained fran property line and 2-0-ft-."f ran house .................>......o..... Distance well to SSDS (ft-)-o .................. - Number of bedroans checks........ ... Stones, brush, stumps, rubble, etc., greater than 15 fto fran nearest trench....... o— ..... 15 ft. of- peripheral soil horizontally from trench— ........... >....... —oo ........ Boxes properly set . — o .......................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.— Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .............. <. " b 3 ✓` c� PUTNAM COUNTY DEPARTMENT OF HEALTH -,DIV.ISI C JT CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT# FY 20-0 1 E 7n Located at if �flzufe K Tt PZ4 To v J\ LL e- Owner./Applicant Name Tax Map `23, 'Block j Lot Formerly f,'*1WPP4) %e(Z_ Subdivision Name &,p /Z 5VADWObAJ Subd. Lot# Mailing Address 9Lftkzv-r&_46 PyrAiAgAdz!�q. zip 165 q Date Construction Permit Issued by PCHD L25 lo i Separate Sewerage System built by Address 5UPJ eTRILL Consisting of 1260 Gallon Septic Tank and 36o ic. Ab;wPn4u,1y?eAxqe?6 Other Requirements: 2.cr &,c riu WaterSupply: Public Supply From Address or:- Private Supply Drilled by 44*�*,;eM &A,;y u_D(Z(CL I &L, Address 5 2 57. fu&w Uoo lkling T�pp� -e-rosio-ncontrol-beenicOmp Number of Bedrooms 3 Has garbage grinder been installed? 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: 9 1 03 Certified by P.E. 6"R.A'. (Design Professional) Address 7f3 �7 CpIZ Ah. J4AA,7PhtAq- 14)-541 License # &')4511) 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: &1K Date: Z/ecopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES IL O , � IP�D)L . _ IAA. > LO - a.- mom. �.- •K. .;��.a �.�a _ -.�: ..:.,.�...- ,;:..�. Wed Location Str Address: T Tax Grid # Map Block Lot(s) Well Owner: Na Address. 9 Use of Well: I- primary 2- secondary Residential Public ly Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ',91 ft. Length below grade /'A' Diameter in. Weight per foot alb /ft. Materials:J<__ Steel Plastic _ Other Joints: _ Welded :X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: 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) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft, ft. Land Surface ' 3 ?v " If yield was tested at different depths during drilling, list: Feet Gallons Per Minute .Pump/Storage Tank Information Pump Type 4 Capacity _eo-� Depth ` b t7 Model Voltage 'X)5✓ HP Tank Type Volume Date Well Completed 3� v Putnam County Certification No. Date of Report Ell to We Driller (signature) NU E: E�pdct location of well with distances to at least two perr arks to be provided on a separate sheevplan. Well Driller's Name ,•_..� ��— Address: %a %� Signature: /9 _ Date White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 SEP-19-03 FRI 10:58 AM 269 ' FAX:9142327043 'PAGE I kV, I q� trek , _. :�w,.�_--, �e Lear Yorktown Heights. N.Y. 10598 (914) 845-2800 Albert H. Padoveni, Director LAS #: 3E.307679 CLIENT 4: 56BOS NON SEAT PROC PAVE .1 VAN DE VEERVONK, THOMA DAI'LITINE TAKEN: 09/18/03 0a,-00P 8 LOOKOUT. PASS DATE /TIME REC'Da 09/18/03 OP!30 PUTNAM VALLEY. NY 10579 REPORT DATE .. OY/19/03 PHONE; (645)-5�13-3605 SAMPLING SITE.-.11 SPRUCE MOUNTAIN RD SAMPLE TYP5-1 POTABLE PUTNAM VALLEY, NY PRESERVATIVES,. NONE COL 'D BYz SAME TEMPERATURE —i NOTES...: KIT TAP COLIFOIRM METHv N/A ---------- -------- ----------- DATE FLAS. PROCMRE RF--'eULT NORMAL - RANGE METHOD* ovie/013 IRON, (Fe) s:O. "_0 MGA, 0-0-3 Mg/1 PROW 09/18/03 MANGANESE (Mn) <0.010 MG /L 0-0.3 mq/1 20-97 COMMENTS: Fe/Mn ' If both iron and manganese are present. their total value Iamb ihad shat not oxcload 0.5 mg /l.. SUBMITTED BY: , Albert_�adfjvat M. T. (ASCP) Director ELAP4 10325 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r C' _..1�', r_ _ -- rte._•. -t T.�Y;�,rr. .. :S �'L��'�v ..:l Y;`,.. -`,45p Y N.. .' '�,`trj.�V':4 �flC.� �,�x,� �K.�...- �, .... .q.,- y.rGV' s ...ti�ry �i,�: .. L ^...:iJ ' GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM TL-94 U ekb ®a)k. I3; (o Owner or Purchaser of Building Tax Map Block L QM UAN�P ��l�n l L �S�j POINAM 114 "t Building Constructed by TownNillage 11 � j�2ute. � ®�,►�lN �62.1�t -� ��e fZ Sui�t�ly � S1C� Location - Street Subdivision Name . Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewag% 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 The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the. failure of the system to.operate was caused by the willful or negligent act of the occupant.of the building utilizing the system. Dated: Month Day ,j Year 0j General Contractor (Owner) - Signature Signatur / Title: Corporation Name (if corporation) Corporation Name (if corporattion) Address: Address: 5 �"') /'v / ✓I a 07 0� State Zip State �� %� Zip /C2 5'% .Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street '.v.,YorktPw[\ Hq_� (914) 245-2800 / Albert H. Padoyani, Director LAB #: 32.306303 CLIENT #: 56803 STAT PRO(.', PAGE i ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ VAN DE VEERDONK,-THOMA 8 LOOKOUT PASS PUTNAM VALLEY, NY 10579 DATE/TIME TAKEN: DATE/TIME REC'D: REPORT DATE: PHONE: (845)-528 08/07/03 10:00 08/07/03 12:20 08/12/03 -3605 SAMPLING SITE: 19 SPRUCE MT, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : OUTSIDE SPIGOT PRESERVATIVES: NONE COL'D BY: KRISTEN KOEPPER TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ .DATE-- FLAG PROCEDURE ` RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/07/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 08/07/03 LEAD (IMS) 4.0 ppb 0-15 ppb 9101 08/07/03 NITRATE NITROG 0.57 MG/L O - 10 9139 08/07/03 NITRITE NITROG <0.01 MG/L N/A 9146 08/07/03 IRON (Fe) 0.409 MG/[ 0-0.3 mg/l 2037 08/07/03 MANGANESE (Mn) 0.587 MG/L 0-0.3 mg/l 2037 08/07/03 SODIUM (Na) 58.7 MG/L N/A 08/07/03 pH 6.7 UNITS 6.5-8.5 9043 08/07/03 HARDNESS,TOTAL 304 MG/L N/A 08/07/03 ALKALINITY (AS 128 MG/L N/A -08107A03 '' TURBIDITY <TUR - COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI 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. ubliq 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 restripted diet,the water should contain no more than-20 mg/L:&fjjdium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 | Albert H. Padovani, Director | LAB #: 32.306303 CLIENT #: 56803 STAT PROC PAGE 2 VAN DE VEERDONK, THOMA DATE/TIME TAKEN: 08/07/03 10:00 8 LOOKOUT PASS DATE/TIME REC'D: 08/07/03 12:20 PUTNAM VALLEY, NY 10579 REPORT DATE: 08/12/03 PHONE: (845)-528-3605 SAMPLING SITE: 19 SPRUCE MT, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : OUTSIDE SPIGOT PRESERVATIVES: NONE COL'D BY: KRISTEN KOEPPER TEMPERATURE..: < 4C NOTES...: COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5, Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER � HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: ELAP# 10323 BRUCE R- FOLEY Public Health Director LORETrA MOLTNARI R-N., M.S.N. Associate Public Health Director Director of Patient Services I DEPARTMENT OF HEALTH - 1 Geneva Road Brewster, New . York 10509 Enviroamaital Health (914) 218 - 6130 Fax (9.14) 279 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 —6678 Fax (914) 278 - 6085 Early Interyeation (914)279-6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF .(Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned-by an authorized town official. This form is to be submitted with the application for a Cerfficate of Construction Compliance. (F-911VEK1IRivi) YML ENVIRONMENTAL SERVICES 321 Kear Street _ ht /y Y 10598 | Albert H. Padovani, Director ' LAS Q 32.307679 CLIENT Q 56803 NON STAT PROC PAGE VAN DE VEERDONK, THOMA DATE/TIME TAKEN: 09/18/03 02:00P 8 LOOKOUT PASS DATE/TIME REC'D: 09/18/03 02:30 PUTNAM VALLEY, NY 10579 REPORT.DATE: 09/19/03 PHONE: (845)-528-3605 SAMPLING SITE: 11 SPRUCE MOUNTAIN RD SAMPLE TYPE..: POTA8LE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE..: NOTES...: KIT TAP COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 09/18/03 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 09/18/03 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combihed shall not exceed 0.5 mg/L. ' v" SUBMITTED BY: Albert 5!>radova(QM.T.(ASCP) Director ELAP* 10323 SEP -19 -03 FRI 10:57 AM 269 FAX:9142327043 PAGE 1 YML ENV I RONMI ENIAI._ ',c3ERV QES .,_ .=..T ... s.- -3c` I - Kear'Stra6t Yorktown Heights, N.Y. 10598 ( 914) 245- 21:300 AIbert. H. F'Adovani. Director LAB ' #: 32'.307679 CLIENT #P: 56803 NON STAT PROC; PAGE !. N^fNN NHNNI VNN JVMM--------- -NNNNNN--- -- - --JV. ---- f-- --IVNN NKNJVNN--------- V/VNNN N— MNJVNN VAN DE VE5RDONK, 7'EIOhI(1 DATE /TINE TAKEN, 09/18/0:3 022000 B L.00F; PUTNAM COUNTY DEPARTMENT OF HEALTIH[ DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION T Oi �,►9 Inspected by: usr Street Location �,PNce_ GVLOC✓.��z, "y ��, Owner ✓�k�_t�ee,- �(o„ -t Town A v f� w.�► (/„� �L��, Permit # PV TM #- '73,. Subdivision Lot # (� ro ei 5��,,,, �, ,,,,; L� j 1. Sewage System Area a. STS area located. as per ap ro cLplans... ....... b. Fill section - dte -e acement .ji -bafre-r 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 System a. Septic t c size -1,000 .........1,250.: ....other ................ b. Septic tank installed level .................................... ;.......... C. 10' minimum from foundation .......... ...... .......................... d. Distribtuion Bo 1. All outlets at s evation -water tested ................. 2. Protect ow frost ................:. ............................... 3. MhTmum 2 ft.Original soil.between box & trenches Junction Box - properly seta .....:....... — ��Z�ength re uired ,:L ...... ........................,.,,.0 q �� Length uistalled 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 expansion, 100 %......1 .................. 8. Size of gravel 3/4 1' /2" diameter clean .................... 9. Depth pf-gravel in trench 12" minimum ....:.....:.:.:.... ' - -1-07 -Pip`e ends' capped :: : ::::...:...............'. g. rump or juosea a stems 1. Size ot pump c am er ........................!..r... ......... 2. Overflow tank ...... ......... .. ....... ....... :.....:.......... 3. 'Alarm, visuaU dio ...............:. 4. Pump eas' accessible, manhole to grade ................. 5. First b baffled......... .............:.... ............................... 6. 'Cy witnessed by H.D.estimated flow /cycle........... M. Mouse uildin a. House ocated per approved plans -b.- Number of bedrooms.. .. ......:......................3. .... .. ......... l[V. PeWl' ' ell 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 pl f. Curtain drain outfall protected & dinto exist waterco e/� g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 YYE -N(b COMMENTS v y1 71u4i RCM (HON) N0Y 25 2002 3 :30 /ST. 3:26/N0. 6338628472 P 2 S.'f. ti i r�p�� tlir. -a ..r.�P�• V. r -;y- ��Q+r *i(w�, *TAn� C- MIT .J��4_ � �- "`�� rT .YwMnrwi^J" ._ t r .�4 i w: M .. . ;4 .•� • w M n. 'I ENVIRONMENTAL HEALTH SERVICES cPAt�gvA7rl A'[''ETNTIGN M �o" IV GENE For: Fill All information must be hilly completed prior to any Trenches inspections being made. PCfl7 Construction Pemtit # Py'ZD ~O 1 Located: �6 ERS(f Mogh W I)QIVf— ('V� uTU #A \) Wg: f Owner /Applicant Name: Try UAU DUE& bo&k 'I'NI 73 6 Block 1 Lot Formerly; deR PAQ ibLeflZ Subdivision Name: UgJ3 �ObQtu t looj Subdivision Lot # t Is system fill completed? Is system complete? Is system constructed as per plans? Is well drilled? Ma Is well located as per plans? NO – Are erosion control measures in place? Date: Date: «ldz Date: I certify that the systems), 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. ... -- -D$i8: .:. , ..:� -; CfirtiIledaf Design Professional Address; A � rcok kb 14&tPDC ldq t0+1 Lic. # 0)'69' Comments: 7Re"e5 Me 14-W I cZ!, - bJe U A.+v 7—D I t1 Form FIR-99 PUTNAM COUNTY DEPARTMENT OT HEALTH DIWSRON O IENVffRO NMIEN7AL HEALTH SERVICES VICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMffT # Located at 6 2 zc- Town or Village A_?Wr 4q-1-4 � Subdivision name l / 4W I-Vw6C Subd. Lot # �_ Tax Map > 3, Block / Lot h Q Date Subdivision Approved 11,3100 Renewal Revision Owner /Applicant Name ZyQ&4& / 4,,yp6 Date of Previous Approval Mailing Address 4"1016JT 64Sc yoll-E � I/l� 4c 6,K ,�N�' Zip /OS 79 Amount of Fee Enclosed Y-;®0 Building Type M&M FlUme j +, Lot Area J,aSAs. No. of Bedrooms _ Design Flow GPD p 0 Fill Section Only Depth Volume PCID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 360 6F (T % IVOld Other Requirements: &1,6 To be constructed by Address Wateir SuDDIv: Public Supply From Address o1r: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P. E. Q 7 �S R.A. Date 7 �� Address rf J SCc01& /W 1t,JT� f,4 P,4C , IA1,v /d �T` /l License # 07 V1 % 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 Re k it. Ap rov r d' LCR of domestic sanitary se wa a only. By Title: ! Date: P-51S sa White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Prof sional 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 # — 45 —0/ Well Location: Street Address: Town/Village Tax Grid # '5& ;� Map 7.16 Block Lot(s) /o / Well Owner: Name: Address: .0 ookOvl RA Y4 Pjrmo v c a -79 Use of Well:_ Residential Public Supply . Air Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm #People Served -f Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason L& 64 0,,/3r for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision ft)617, Sv/ ,(�,� /f7c7 Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No _Y Name of Public Water Supply: Town/Village Distance to property from nearest water main: So0& Proposed well location & sources of contamination to be provided on separate sheet/plan. 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 b Putnam County. Date of Issue Permit Issui - g Official: l J� Date of Expiration 8 �� o Title: Permit is Non- Transfe ra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 y DIVISION OF ENVIRONMENTAL HEALTH SERVICES +...:,._..APPLICATION -FOR APPROVAL ,DF PLAIN FOR_....._....,. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Tft ( V,.� OL1/EE2t4Uk �Dcl T PY FLUULAP) 2. Name of project: 3 f I s 3. Location TN: PPT &'12 i 1zL6CV 4. Design Professional: ACkfCg leb& �dJ'1?JC. 5. Address: ` 6. Drainage Basin: & htd, ik 101' 10TV �, 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 (SEAR)? Type Status (check one) ...................................... t................ Type I Type II 9.1s a Draft Environmental Impact Statement (DEIS) required ?- :....................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other, ofricidis, ordinarices? ......................................................... ............................... Exempt y Unlisted /'0 �4v 13. If so, have. plans been submitted to such authorities? ........ ............................... n�� 14. Has preliminary approval been granted by such authorities? K Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. 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? ....... ...................:........... 1V6 19. If yes, name of water supply Distance to water supply ° 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector P 24. Project design flow (gallons per day) ................................. ............................... p 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... /�/o 26. Has SPDES Application'been submitted to local DEC office? ......................... — Form PC -97 f4ecel'ved: 3/22/01 6 : 34PM; Beyer & Associates -> Dutchman ojnt rect Ing, Inc. Page 3 From: Chris Caralyus 845-628-1905 To: Tom V' teerdonk Date: 3/22/2001 T" 48:28 PM Page 3 of 3 f �4' ' ' �S��G ?Y�� Liv- ` +�.LYIPt �r. — ..�.:. r- R y 5��~ '..•..; '. ..) a•. b +. .. .. :•t > .. ... .......... OIL-, k.-LAMAIM -111 e. SUM, "17M�=v M ON" A d ft . . . . . . . . . . ............... ......... Lz� v\ . I sq� o Recelv6d: 3/22/01 6:34PM; Beyer & Associates -> Dutchman Contracting, Inc.; Page 3 From: Chris Caralyus 845-628-1905 To: Tom Van,.``lrdonk Date: 3/22/2001 Tlme�1,1:28 PM Page 3 of 3 7,37.= _1 T A x i �qmrqklp I I ill "b r % v -e- � .y � 1 FF7:7, Ell -A 7, i. 70 w7L= 7 7 Lj t4 1-U, 11 4 S "t O 107,- 7PRK �w'1 . �.-a t • BRUCE..Itr >FOEE.".r__ _ -._- Public Health Director - -L;ORETTA -1 0LIMW I N ;- Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH l 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 August 14, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 .r Mike Beyer, PE Beyer & Associates 73 Secor Road Bryant Pond Plaza Mahopac, New York 10541 Re: Application to construct a Subsurface Sewage Treatment System on Spruce Mountain Drive (T) Putnam Valley, TM# 73.6 -1 -1 Dear Mr. Beyer: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department is incomplete. Please be advised that the following information is required before the Department may commence its review. �_...�_1__ � Application Form CP -97 ' :.��ai�. biz: a. tirr�: tra ..�`�- ��arraril•�tnr��- - ----- -�..._,m,�..- ....... ,T•....Q.....:�:.._ -,a -= p'-��- - Lot area to be completed. 2. Application Form WP -97 - Well owner to be completed. - Application to be dated. 3. Application PC -97 - Signature and titles are required on side # 2. 4. Application LA -97 - Subdivision of .............. - Subdivision Lot #............ - Filed Map # ................. - Date Filed ............... All are required to be completed. Please verify Tax Map (73.6 -1 -1) as listed as being correct. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. 4 Please ,b6,advigedfiidt-fgiur;-e�'to-s 6 fiffori "'tiont-the'D' iy ii ma 0 epartrilentof td lalfbw proc ures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 278-600 extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc. CP-97 WP-97 PC-97 LA-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.:.._........ - � C -OtN&M C-TION,PE-WvrilT- OR-SE` AGEi ' T RE TMENT-,SYST E-M :�.; PERMIT # Located at SF'JZt/L /Y1Uvj��✓�Qllj j�C Town or Village ti19� �//fGLG1� Subdivision name % ZQ % 6e Subd. Lot # Date Subdivision Approved / / 3 z (9 D T Owner /Applicant Name TyQ,�y&j V_4,ly/cj6f2g� .Qj c Tax Map 7 3, ( Block / Lot / Renewal Revision Date of Previous Approval Mailing Address &),0i6JT &a- lotlq-1 4A hc(Cy ,�A& Zip 1OS 79 Amount of Fee Enclosed 41%00 Building Type Lot Area No. of Bedrooms _� Design Flow GPD U 0 Fill Section'Only . Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / ash gallon septic tank and 310 Other Requirements: x F/ 4 L To be constructed by Address Water Supply: Public Supply From Address y or: Private Supply Drilled by _ , _ Address M x I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sevi+a,ge 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 submitfed 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. 0 ,Sq 7R.A. Date Address SCco/L 1W -S TCS AV ft c , /n/Y /al-VZ License # 0 yyS 7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT 07 HEALTH IlDMSI®N OF ENVIRONMENTAL HEALTH HI SERVICES APPLICATION TO CONSTRUCT- A WATER WELL please Qrint.or.type . - 1 PCHD Permit,# . _ VI lc 14i 1, Well Location: Street Address- Town/Village Tax Grid # / -61 Map JIG Block Lot(s) Well Owner: Name: Address: ` u Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage co gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reasons for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? .........:............................ ............................... Yes A No Name of subdivision 8g,0 rZ S„/�u,�� f1 c%� Lot No. / Water Well Contractor: Address: Is Public Water Supply available to site? ..............................:... ............................... Yes No Y_ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan.. Date: 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 Date of Expiration Permit is Non-Transferrable Permit Issuing Official: Title: White copy - IAD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 O . 0 Received: 3/22/01 6:34PM; Beyer & Assoclates -> Dutchman Contracting, Inc.; Page 3 From: Chris Caralyus 845 -628 -1905 To: Tom Van srdonk Date: 3/22/2001 Time" 11:28 PM Page 3 of 3 Mhk=.€ n- Yt�w;Rj at r•.a�nrC "':9�Y. ).�' �G�S °N •mss l�,r .��qt?. MAMEMP Ii iel Uri Ve a ft? v . � •�e � J < V �F�r�ran�wawwrrww.yww,,, �fii, F y: '^k ��y:'..e�:�C:a .7:• •IMF. E:p �Sa;'.- 0 rc�at ,�,.r:�*- .,�xs•�'�"�r,.Y�ar.,� v- .�rx�y�r, �c;9,n�es� V _. . -._. .. Mc e .. • r , BRUCE R. FOLEY -'�, '- � _. -= Pubfi6::�ealthY��irector .�-- : �:.: •:-- .r,,..;..x:.. _ — - _ LORETTA MOLINARI R.N., M.S.N. .-.::. :: ��-,: �a : == =:,�4ssociste:�,`?ri6lic =: #feafik <•�rrea`tur � _:- � _ . _ 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 August 14, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Mike Beyer, PE Beyer & Associates 73 Secor Road Bryant Pond Plaza Mahopac, New York 10541 Re: Application to construct a Subsurface Sewage Treatment System on Spruce Mountain Drive (T) Putnam Valley, TM# 73.6 -1 -1 Dear Mr. Beyer: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department is incomplete. Please be advised that the following information is, required before the Department may commence its review. 1. Applic ion Form CP -97 ing type to be completed. 2. Applic tion Form WP -97 :X owner to be completed. /Application to be dated. 3. Appli ion PC -97 Signature and titles. are required.on side .#,2. 4. Applica ' LA -97 division of .............. division Lot #.... ......... d Map # .........:....... e0a to Filed ............... All are required to be completed. Please verify Tax Map (73.6 -1 -1) as listed as being correct. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. y. 1� Please be advised that failure to submit information to the Department or to follow procedures is sufficient _�oun4s..jo.:deny:approval pursuant.to�thezNew'Yor -- City =D�partrrient of�Environmental' K_ .... :.�.,,r.0 -,.,. Protection Watershed and Putnam County Department of Health regulations.. Should you have any questions or care to discuss this matter further, please contact me at (845) 278 -6130 extension 2157. Very truly yours, aL Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc.' CP -97 WP -97 PC -97 LA -97 . .. _ _ _ , �.Y — ...- _ ... f'r arw ..y +�0."'.+N••✓w 0.+.Y w a' ^tii►'... mow. °.... t ..ti �.�..�w «-- ... —w,. � � 0 'k . - I and ,,4ssociates Consulting Engineers _i"778 3 04;2--c' -'O'r TA '(845)' 62M Y Bryant Pond Plaza, Suite 5 Fax. (845) 628-1905 Mahopac, New York 10541 August 20, 2001 Mr. Adam Stiebling Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Fandeveerdonk Residence Spruce Mountain Drive, Putnam Valley, NY Tax Map 73.6 Block I Lot 1.1. Dear Mr. Stiebling, Please find the enclosed updated application materials for the above referenced property. We have made the updates as per your comments dated August 14, 2001: 1. Application Form CP-97 -The building type has been completed -The lot area has been completed 2. Application Form WP -97 -The well owner has been completed -The application has —AppheatioPC -97'.+ been dated. Form n -Signatures and official titles have been completed 4. Application Form LA-97 -The subdivision name has been completed -The subdivision lot # has been completed -The filed map # has been completed -The datefiled has been completed I trust the above materials are adequate for your approval and complete the submission for the above project, However, if you have any questions concerning this project, please do not hesitate to call me @ 621 -4756. Sincerely, Chris Caralyus Project Manager a � Beyer and Associates , Secor. Roa Tel..( _- 78.d,_ - 845 621,4756- -ri. :,� •h, r.. .�. a.T.� •P ... - �.J.��l. 'I�• -no- Jfa� 1tia.• P .. t •k-i�, Bryant Pond Plaza, Suite 5 Fax. (845) 628 -1905 Mahopac, New York 10541 May 14, 2001 Mr. Robert Morris Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Vandeveerdonk Residence Spruce Mountain Drive, Putnam Valley, NY Tax Man 73.6 Block 1 Lot 1 Dear Mr, Morris, Our client, Thomas Vandeveerdonk, proposes to construct a single-family residence at the above address to be serviced by an individual subsurface sewage treatment system and a private drilled well. . We are hereby applying for a construction permit for the construction of the SSTS and drilled well. Enclosed please find a copy of the following items for your review and approval: Construction Permit for Sewage Treatment System 'Lette'r of.4utl�ori atioFa Application for Approval of Plans for a Wastewater Treatment System. Application to Construct a Water Well Design Data Sheet Short Environmental Assessment Form Plan and Profile- Separate Sewage Treatment System (3 copies) Fee - Certified Check in the amount of $300 House Plans (2 Copies) A copy of the original approved subdivision plat I trust the above materials are adequate for your approval and complete the submission for the above project, However if �_._.__. _ - .... -_ ...__- ,_. _ - -• _ �._...- _._- ...__-- _.- .._ - -.- • :. . PUTNAM:COUNTY:DEPARTMENT-OF HEALTH: DIVISION OF ENVIRONMENTAL "HEALTH.SERVICES:,.. ; COUNTY. OFFICE BUILDING, CARMEL, N. Y. .10512 :. "DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILE N0. Owner B: 'Broer " "Address 50 Wheeler Ave, Pleasantylle.N.Y... 10570 Located at (Street').... . Rnt. `Dr `.Sec. " '60" - Block is ; • Lot . 52 .:. .:.• :.;_ clIcate nearest c ss.: s ree ..,.. , . Municipality . Tbwri, bf- Putnam Valley Watershed Hiids,on;. F1ver-::'.. . ',SOIL.PERCOIATION TEST DATA REQUIRED TO BE SUBMITTED•WITH•.APPLICATIONS,`` Hole ... Number .....:..... CLOCK..TIME PERCOLATION ' ` PERCOLATION run Elapse :Depth to Water Water Level, T10 :....... _. :.' Time - From Ground Surface, in Inches'.'.,'. ...Soil Rate Start- Stop. Min. Start. Stop Drop in Min. /in drop Inches Inches Inches PTH #1 ..:1.:.9:45'.* .10 :15 30" 15 17.75 .. 2.75 J6/2.'75=11 2.....10:.1.9........ 10:49: 30 15 17.75 2.75 30/2.75 =11 10:53 11:23 30 15 17 75 2,75 30/2.75=11 5 PTH #2_ " 1..9": 50 . .. •. = ' 10 : 20. 30 16 19 3 30/ 3 =10 2 10 21 n.. 51.. 1n i A 3n,43 -1 0 — 1 n e sg 11:22 30 16 18.75 2.75 30/2.75 =11 5. l 2 ... Notes: 1) Tests to be repeated at same depth until approxima4 -ely equal soil rates are obtaired at each percolation test hole. All data to be submitted for review. 2) Dcrth measurements to be rrade from too of role. 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERRI)NONE INDICATE LEVEL TO-WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NONE TESTS MADE:BY Joel L. Greenberg Date "11 /.7/84 �� .. _ -� a G .♦ • .• - .. .. JJE �lA l'1 - gym.+. -cr �S ' 4•c— A• ~Soil Rate Used 11= •1'5Mi1V1 "Drop: S.D. Usable Area Provided _500 SF No.-of Bedrooms 3 Septic Tank Capacity1000 Gals. Type Precast Absorption Area Prbv ded By 420L.F.x24" xx 3b" width trench. Other f'dame TnPI ` T. C;raanh�rrY� blgnature ` Address Muscoot North RFD#2 E Bx 488 SALL Mahopac_N,Y_ 1� 0541 THIS SPACE FOR USE BY- HEALTH DEPARTIMT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES bESIGN4DAT*SHEET "SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Thomas Vandeveerdonk Address. 8 Lookout Place, PutnamValley, NY10579 Subdivision Located at (Street) Spruce Mountain Drive Tax Map 73.6 Block 1 Lot 1. ( indicate nearest cross street ) Municipality Putnam Valley Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation. Test 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 PT -1 1 3 4 Percolation Rate Used = 8 -10 min/inch and Test Pit Data as per approved plans for Bernhard Broer Subdivision approved 11-2.ry 3. 200_ own ..of.:P.t�tr►.1'�fi�P�.��:_. -. 5 PT -2 1 -- ..2.., 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. 5 l .min for 1 -30 min/inch, < 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1A HOLE NO. 1B HOLE NO. G.L. BOULERS LEDGE 0.5' _ 6" TOP SOIL, 6" TOPSOIL 1; 0' FINE TO MED. SANDY LOAM SANDY LOAM 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0 GW @60' 5.5' 6.0' 6.5 NO GWT 7.0'. 7.5' 8:0' 8.5' 9.0' s ._.49:5' -__�: 10.0' Indicate level at which groundwater is encountered 60" Indicate level at which mottling is observed Indicate level to which water level rises after being encountered N/A Deep hole observations made by: Date - Design ]Professional Name: Beyer andAssociates. Address: 78 ,S'ecor Road, Bryant Pond Plaza, ,Suite 5 Signatu. Design ]Professional's Seal ' ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES ITBScyIrCI+ ACE- StAAOE°TRI;ATM%NT SV- S`I'EiVi Owner Thomas Vandeveerdonk Address 8 Lookout Place, PutnamValley, NY10579 Subdivision Located at (Street) Spruce Mountain Drive Tax Map 73.6 Block 1 Lot 1. ( indicate nearest cross street ) Municipality Putnam Valley Drainage Basin Date of Pre - soaking SOIL PERCOLATION TEST DATA Date of Percolation Test 'k 1 i Hole No. Run No. Time Start — Sto Elapse Time (Mm•) Depth to Water From Ground Surface (inches) -Start Stop Water Level Drop in . Inches Percolation Rate Minch PT -1 1 2 3 4 .: Percolation Rate Used.= 8 -10 Min/inch and Test Pit Data as per approved plans for Bernhard Broer Subdivision approved T rniq:.rv3_ 200.0_` 5 PT -2 1 3 , 4 5 1 . 2 3 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ( i.e. 5 .1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch) All data to be submitted for peview. 2. Depth measurements to,be made from top of hole. X , Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I G.L. BOULERS 0.5' 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5'. 4.0' 4.5' 5.0' 5.5' 6.0' 6.5 NO GWT 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' 6" TOPSOIL FINE TO MED. SANDY LOAM HOLE N0. 1 B LEDGE 6" TOP SOIL SANDY LOAM Indicate level at which groundwater is encountered 60" Indicate level at which mottling is observed N/A HOLE NO. Indicate level to which water level vises after being encountered NIA Deep mole observations made by: Date Design Professional Name: Beyer and Associates Address: 78 Secor Signature_ Pond Plaza. Suite 5 Design Professional's Seal AM 1-1-10.4 (2107)—Toxt 12 F1110JECT 1,0. HUMIJEn GIA-1 SE( A P'p a n (I I X. C,. —.6 nT6' EnOrMimonIn'l 60111yohovi-ow MN!!,li :,;.j SHORT ENVI'H•NM'r--tqrA"U'AS�ESS'M'EN.T'tFOAM` V N LI STE, D:-A GTI-0jq7S-,,,0 n t PART I--- PROJECT INFORMATION (To 1bo 4 com5p_ l ete,d by AppI licrnt-or Pic) cI sponsor), 1. APPLICANT /SPONSOR x 2: `PROJECT NAME" Atin N 86 ex-- 3. PROJECT LOCATION: MunOP014Y, 77Q(,4q C)/,- PU2✓" 'Courtly I'DibrA M M _ - V 4, Pn9CISE LOCATION (Shoal addros3 and road IntorsocItons, promInont lanjdtnnrk3, o1c., or p4vId&* mop) 5PPLUC—M PIOUNTAW P11WS' )2o.4 ;1VrejUj-7,-mW j,IlTlf Pi 2 1 t/9" 5. IS PROPOSED ACTION: ® Now El Expansion 0 ModIfIca Hon/allorn (ion . .. ....... .6. DESCnIdr PROJECT nnIEFLY: 5JZt)IV1DF_ 14A ucre P, aci;_ L, 1w ro 7, '?N XE L - .&C, 2-1 Cc 2P_-5 2- vjitL_ 300 CAcr -e- 7, AMOUNT OF LAND AFFECTED: Initiallyr. % ocros 1.1111maloly 11cfas 0, WILL 1111OPOSED ACTION COMPLY WITIt EXISTING zomNo on oTkn EXISTING LAND-USE RESTRICTIONS?_. y0s, 0 NO if Ida, (103crIbri brially -SENr LAIID usr. IN VICINITY or Pnoicc-r? 9. WHAT IS PnL El A911cultufo OWN noslOonlbl - 0 Musidal El CoInmerdil El PIIM06691/60'00 6pdb.d u0sertuo., 061,15. f=AM%L V . ... ..... 11*0. -DOES ACTION INVOLVE A PEnMI'T APPnOVAL, Oft FUNDING,. NOW on LILTIMATELY FROM ANY OTHER GOVERN461TALA'GCOY(I STATE Oil LOCAL)?. D Yea 19'No" 'If yies, Hsi no1, Cn6v(s) and p6imlflapOkoWli! - it. DOES ANY ASPECT OF THE ACTION IIAVI1 A cunnENtLY VALID PEnMIT on APPnOVAL9 if yos, iiii nooncy vanio and oimIllapproiVa Y03 E]No p -.PUT. r4 -Vft�_e AVM� P?0 12, AS A IIESULt-or- PROPOSED ACTION WILL EXISTING P EHMITIA PPn OVAL nEouinE MODIFICATION! 0 Yog Q0. NO I cEn'Tir-Y THAT THE iNFonMATION PnOVIDED ABOVE IS TRUE TO THE BEST OP MY KNOWLEDGE.. ApplIcant/sponsor namo: S1011nitire: If Ilia action is in ilia Coastal Arco, end you are a slate agency, Complete the Consisl Assessment Form before proceeding with this assessment OVER EDE11— LJ Yus U No � Il. WILL ACTION RECEIVE COORDINATED`Fr. - -:W AS PROVIDED FOR UNLISTED ACTIONS IN G NYCHA, PART 617.67 may be supersoded by another Involved agency. Yes ❑ Pto ; It No, a nogallru doclarallon • : ire , C. COULD ACTION RESULT IN ANY ADVE-RSE".EFFEC.TS ASSOCIATED WITH THE FOLLOWING; (Answorg;In�y:,U Apndwrltlon, al Ioplbio) ... Tdsl1o97a�y►laiilgrsurfaoOf ' Iprovndwatar :'qualitpitr; "qu'anlJly;'nbrso (ovoTs, existing traffic patterns, solid waste production or disposal, polunllffur I.Aloago floago or lo,,orllnolpto�lomshEx �alr� y lolly: ''II rf t.I 1 C2. Aoslhollc, ngrlcullural, archaoologlcal, Ids1o1IC. Or olhot,nalurallOf cullural rosourcos; or contnnunily or neighborhood chaiacior? Explain Wally: frl CJ. Vegetation or fauna, fish, shellfish or wildlife speclos, slgnlllEanl habitats, or Ihroalonod or ondangorod species? Explain brlolly: C4. A comnumlly's oxlsling plans or goals as officially adoplud, or a change In usu or Inlonslly or use of land or olhor natural rosourcos? Explain brlolly. C5. Growth, subsoquorsl duvulopnionl,.or related activities likely to be Induced by Me proposod.acllon? Explain brlully. ; CO. Long lorm, short lorrn, curnulallvo, or olhor 011oe13 riot Idonllllod In C I•C57 Explain briefly. C7. Other Impacts (Including chan(los'ln use of either quantity or typo of energy)? Explain brlolly. U. IS TIIErtE, OR IS T11[nC LIKELY TO UE, CONTROVERSY RELATED TO POTENTIAL ADVEIISC ENVIRONMCNTAL IMPACTS? ❑ Yes ❑ No II Yos, explain brlolly + . •� , _.•.- -_ --- - - 7777 MIT 111— DETERMINATION OF SIG NIFICANCE.(I;o,be compieled by Agency) •., INSTRUCTIONS: For cacti adverse effect Idonlllied above, dolermino whether 11 Is subslanllal, large, Imporlanl.or otherwise signillcani. Each effect should he assessed In connection with Its (a) sotling (i.e. urban or rural); (b) probability of occurring; (c),durallon; (d) Irrovcrslblilly; (a) geographic scope; and (1) magnllude. 11 necessary, add allachrnenls or relorenco supporting materials. Ensure lhal explanations contain sufflclonl detail to show that all relevant adverse Impacts havo boon Identified and adoqualoly addrossod. ❑ Chock Ihis box It you have Idonllfled one or more polonllally, large, or significant advorso Impacts which MAY occur. Thon procoed dlroclly to lho FULL CAF and /pr,proparo a pclsllive doclarallon. ` ❑ Chock this box It you. havo delormIned, basod on lho irltormallon and analysis abovo' and any supporting-' docurnonlallon, that lho proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Nanlu at lead Allency ; !1 '1•. :!•;{'i l;l 1•I V` "lit • }j i ..p ,�•if'• :jt'u•. hful ur I y- N.uur F.,% wmlll117-_1Vf , fY. 11 71.11 Aenm'Y 1 u u lrrpnro i ,I i�Tf rur �� nature at Ilasponsl ht Officer lot Lead Agency r ignaluru o Prepare( I!—Ii I I arc nt from tespons e o ceri —j i Data i , 14.10.4 (2/071 —Taxi 12 (, ,• .;.. t ..,..,.:; f1110JECT I.U. NUMBER G 1711 ::: i I 4 SE( Appendlx.c:.l.. •'. tl'I {I( :. , ,. %J! .i,. ..., 'SItii`e' EnVlrpll'nlonln1 600111 y017104 IoW ,rl {{yu;; y.P;I,.I'. ., . CNVJ ON:MCIVTAL "ASSESSIMENT "FOf M` t For UNLISTEI)-ACTIONS�Only PAnT, 1- PROJECT INFOnMATION (To bo complete by Applic15nl or Prolecl Sportsor)j I. APPLICANT /SPONSOR /y /ej/ 5j_ %30VX 2:' PROJECT NAME..' • " +'t+ `''' : • r,... t..,,•, , 13�12nld.��tZb •.�o�m�a? �B�'i��.- � /�:5:3a/"; �'21��1� St3J�i7�JIuJ.S7ar.�' �' �: 9. PROJECT LOCATION: Municipality, LoW,-j or, pulT /,IPYi • County PU% N,4 m . 4. PRECISE LOCATION (Stroat addrass and road Intoreacllons, prominonl landennrks, olo., or provldo map)*,'.. t 5 'PfRUC PlouNiA101 'PRlQe a Yf M Iix-- P.tzcawl C7 SC A. W4tvA "e- ilvrvriuFCT7cuj j,/ /rbf .��/�vt�i°/1'nJ .,P/21%/K' 5. IS PROPOSED ACTION: ® Now 'Cl Expanslon ❑ Modllicollon /allorallon 0. OESCn1UE PROJECT ORIEFLY: N Lc9 r 1. U�ILt. . &C 2•1 100 c c2S5' 2, PJhL 13C J2,300 i 7. AMOUNT OF LAND AFFECTED: Initially �r. J ocres i.11llmaloly 2 act as 0. WILL PROPOSED ACTION COMPLY WITI1 EXISTING ZONING Oft OTHER EXISTING LAND USE RESTRICTIONS ?... i Yas ❑ No It IJd, doscribo briefly 9. WHAT IS PRESENT LAIIO USE IN VICINITY OF Pf10Jl:Cf ?' ® Ilosldonllal 0 Industrial ❑ Commercial ❑ Agrlcullurb ❑ ParklForoslfOpon space . ❑ Olhor Ooscriboe S IP.6 W F A{V\A%L Y 10. `DOES ACTION INVOLVE A PERMIT APPROVAL, Oft FUNDING, NOW on ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY jFEDEf{ �'. STATE On LOCAL)? „ . Dyes RNo 1f yo S, Ilsl ogoncy(s) end pormllfapptoJAls° ! '' 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT On APPROVAL? (JI Yes ❑ No If yns, Iist a0ancy name and pormillapprpvnl' ?�CEN d�WC ` 1%Pt1.i. �/ • (��• t4. 12, AS A IIESULT'OF PROPOSED ACTION WILL EXISTING PERMITIAPPnOVAL nEOUInE MODIFICATION? 0 Y6 TNo I CERTIFY THAT THE INFOnMATiON PROVIDED ADOVE IS TRUE TO THE BEST OF MY KNOWLEDGE, AppllcanIfsponsor name: — /� t ! ,t Oa1a:. 42 1G. a� .. If the action is in the Coastal Arco, and you are a state agency, Complete the Coastal Assessment Form before proceeding with this assessment OVER I0. WILL ACTION RECEIVE COOn01NATED fi...aW AS PnOVIDED FOR UNLISTED ACTIONS IN 6 NyCim,'PART 617.67 11 No, 'a nopativu doctarnllon . I may be supwsodud by another Involved aguncy, ❑ Yes ❑ No ! i C. COULD ACTION FlESULT IN ANY ADVERSE' EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answe(s may be handwritten, It loglblo) C1. Existing air quality, surfacoror,;grqundwator, qualify or:quanlJly, nolso lovols, oxlsling UAW pallorns, solid waste pfoductlon.or disposal, poluntl�l:lur crgslon,Ids�lnago yc)looillno proLJums ?�Explaln N S lolly; .. Qi�•.I 1 �, a3.ar.,t�,.a•_ }l r.t. !- �+..�, ^►:�'+.,• ti: f; I.. .r. • -9e1�< Y^'l�'• -. '�. i C1. Aoslhollc, agrlcultural, af0woologlcal. Idslodc, or olhof,naluralla( cuilurat resources; or conununily or nolghborhood character? Explain briefly: rl + C9, Vegalallon or launa, flail, shellfish or wlldllfo species, slgnllll:ant habllals, or Iiiroolonod or ondanoorod species? Explain briefly. C4. A cunununlly's uxiating plans or Duals a's officially aduplud, or a change In use or Inlonslly of use of land or other natural rosourcos? Explain briefly. C5. Growlli, subsequent duvulopniunl, or related acllvlllos likely io be Inducud by lhu proposo.d acllun? Explain Melly: CO. Lono lures, shod form, cuinulaliva, or olhur ellocls not Idanllliod In CI-057 Explain briefly. C7, Olhor Impacts (Including clian(los'ln use of Witter quanllly or lypo of onargy)? Explain briefly..• u. IS Tr1EnE, On IS TIIERC LIKCLY TO DE, CONMOVCRSY nCLATCD TO POTENTIAL ADVLHSC CNVIRONMCNTAL IMPACTS? 0 Yes ❑ No II Yes, oxplaln briefly .I ... .. •f,rru..++P.+.+�• 1RT III — DETERMINATION OFiSICNIFIICANCE.(f;o,be completed by,Agency) INSTRUCTIONS: For cacti adverse effort Identified above, determine whether It Is subslantlal, large. Important. or olherwlse. significant. Each effect should be assessed In connection with Its (a) soiling (i.e. urban or rural); (b), probability of occurring; (c),durallon; (d) Irreversibility; (o) geographic scope; and (1) rriagnitude, It necessary, add attachments or reference supporting materials. Ensuro Ihat explanations contain sufl.lcionl detail to show that all roiovani adverse Impacts havo boon identified and adequately addressed.. ❑ Chock lids box If you havo Idonll(lod ono or mor4 polontlally, large, or significant advorso. Impacts) which MAY occur. Ilion proceed directly to Ilia. FULL -CAF andlAr ,pr a positive declaration. ❑ Cliecic this box.11 you. have delormined, based on Ilio 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 delermina(lon:. Nrnw of LeAd Agency (: • ilk. .:a• !� 1'1;! i•r T't'.Zfi.. •i} I.. ij •tt:. :t rlr. 1'1 ul ur 1 yjn• N.nur �f j {rpurnll�l 1�Tf 1 rr n .nad-AruvlrY r n u Irsp�nirih It�iT1T/ rnr naluw u Ilusponn a <ur n ua Agency Ignrluru o reparcr nif creel rem responsible o ccr i • I Date 81 I I I L • /7/.162' ,'�� I (survey) hryf 5 � I e w a IT � .�' _� .; fir. ; . _ .. - .. .G�•• .. . , . ... . ' -' . .; :� _ � -f�.- I 1�1 \11 � � �• ry� a\N � I I IN ;r ♦ F — p i...'/ � — wtU'oe► yl � � ' _ i4YOLF OF I'W100 nwcnw . 1c, �� PaNLw�. DoxN TAN "�`•/ CEL A. . 0 REA =/-0. 522.44- 'ems /S /✓� f � � aN.y,°d �/` Covrr J".. J POO/ � ss� . G Q/b0 9 - - DBFar ent of . He Putnam Ceua ±� � . :' VI l,n- 6- Environme tat Health Servio88 A p ve aso s for onfori�th _i y I livable Rules and Regulations of tho D " am C P nou alth o tm nt. - I . '.1. III L. � . � i�. � I , 2 � ` p ror�:r •�•— �y t PA T tle Date 5 s�0 D qRc Xs%cE GRFF.y�A ti O� do O, y6�0? h F ,�J /+GALE 1':90'_0" '(✓ / VATE. 13186. J05 ar b_ r_sl 01 VNOY: QUO' JOEL LAWRENC GREENBERG ARCHITECT -TOVN PLANNER MUSCOOT NORTH RFD*2,Boa 486 Mohopoe, Now York .10541• (814) 628 0013 S605 CAS BUILT) FOR MR. 4 MR5 8ERNHARP. 8ROER . \6PRxz MOOmmki re LAKE COUeT. PurA/AM vnL se , N.Y• r"s ao.1.52 A !3 SEprIG TANK 0 18!0° SOLD° E 21 9" 3110" 21�r F Z3j9r JIIWcTION 76 =6r G 17 =0° H 31 =0r e0At5 94_6► 7/j.a 1 3G�.Gu J. 43.6° 4Z =4" K I 57L 6` L M WELL N 6G' 10° 77! 1" 2 � ` p ror�:r •�•— �y t PA T tle Date 5 s�0 D qRc Xs%cE GRFF.y�A ti O� do O, y6�0? h F ,�J /+GALE 1':90'_0" '(✓ / VATE. 13186. J05 ar b_ r_sl 01 VNOY: QUO' JOEL LAWRENC GREENBERG ARCHITECT -TOVN PLANNER MUSCOOT NORTH RFD*2,Boa 486 Mohopoe, Now York .10541• (814) 628 0013 S605 CAS BUILT) FOR MR. 4 MR5 8ERNHARP. 8ROER . \6PRxz MOOmmki re LAKE COUeT. PurA/AM vnL se , N.Y• r"s ao.1.52 TE OF PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST Division of Environmental Heig /I�y �� ei� N. Y. 10512 PROVIDE • - - - -•- - �+•..r �re1w♦•C rVFi SEWAGE DOS Located at Spruce Mountain ...Roaid - / Formerly ..j Separate Sewerage System built by Howard Gragert Consisting of 000 Gal. Septic Tank and ZQL of pp& Other requirements Water Supply: Public Supply From XXXX B0= C Private Supply Drilled By Address Building Type One Family House Has Erosion Control Been Completed? PERMIT # .. _ G 3ISAL SYSTEM P -=utnam Va t b Town or Village, Mep y:r��. ...r -1 .. ";i V Block 1 ` Tax Map Lot # S 7 ---- -�.�� sum. Lot # Addres$Osc. Lake.ROad Put No, of Bedrooms-- Date Permit Issued 12/6/84 Has garbage grinder been installed? I certify that the syatem(s) as listed serving the above premises. were constructed essentially as shown on the plena of the completed work co ' Of which are attached), and in accordance with the standard., rules and regulations, in accord Putnam County Department Of Health. glee with the filed plan ( pies / ' . and the permit issued by tno Date 2/3/86 Certified by AddressMUSCOOt. No, RFD$ B 488 Any person occupying premises served by the above system(s) shall prom I conditions resulting from such usage. Approval of the separate sew y e such actjlr available and the approval of the private water supply shall become n a sYSte shall, subject to modification or change when, in the judgment of the C vo when a stone of Hea , Date f By Rev. 6/85 ac P,E. R,A,({ �No. }� 11056 as may be necessary to secure the correction of any unsanitary i ull and void as soon as a b c . public sanitary sewer becomes b water supply becomes available, such approvals c revocatio ^, m Ification or change Is necessarry are Titb A56��_ PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health services, Carmel, N. Y. 10512 Permit # .. {V CONSTRUCTION -PERMIT: FOR - SEWAGE- DISPOSAL. SYSTEM T 4 Putnam Valle Tows. or'-�illage Located at Spruce Mountain Road Tax Map Block I Lot Y Subdivision �pruCe Mnt Estates Subd. Lot # Renewal _� Revision _(] _ - -- -___ B_ Broer . rO Wheeler Ave,PleasantvilleDate of Previous Approval Building Type (1 Pam. -Res, Lot Areal 4 • 2 1C v Fill Section Only ❑ H. D. Notification Required C. Number of Bedrooms 3 Design Flow c /P /D 600 P.420LF of Leaching Fields Separate Sewerage System to consist of 1000 Gal. Septic Tank and Don Head Address Canopus Hollow Rd. Put. V, -QTY To be constructed by y Water Supply: Public Supply From XX Private Supply to be drilled byN�rman Anderson Address Barger Street,Putnam Vall.ey,NY 10579 Other Requirements R n Gravel Fill I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown. on the approved amendment there to and in accordance with the standards, rules an regu a sons o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health 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 disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original syst�m or any repair thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well 4es in acctAitsh the sta Bards, rules and regu a sons of the Putnam County Department of Health. Date L� i S R.A. XX 10541 11056 Address ho C License No, APPROVED FOR CONSTRUCTION: This approval expires on date ))) s construction of the building has been undertaken and is revocable for cause or may be amended or modified when consi by yiie Co oner of Health. Any change or alteration of construction requires a new permit. Approveedd for disposal of domesti s and or p svate upply only. C7 BY ___ " ♦ — Title Date "Rev. 9 -81