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HomeMy WebLinkAbout3368DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -7 BOX 27 rxnlell M 19 6 1. .: i 9% 9 , INN 0 Pei 16 9 'A "� ON ' �,' - 1 .. IN , rxnlell 'PUTNAM COUNTY DEPARTMENT OF HEALTH ' `T,iFF 73 n^<Ti�"i —i►7.: .•vSi iiiivi`�1 �ZI.'1i�Y . �l" , .�i f �l�lvlE�t 11 .i'..�. y`1f'. A�U"'. 11n LI._ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # /OV — — 8 Located at 113 ME/- 44D Town or Village ✓DV1P *t ( Owner /Applicant Name =1e"cgse4 Tax Map _71X'0 Block Lot Formerly &A0 y AJ9,0.1Z4 Subdivision Name Adencj- / " ✓C Mailing Address 5_0 Subd. Lot # /65, /q 4-0 Date Construction Permit Issued by PCHD '%.- 70 - U 3 Separate Sewerage System built by Address Consisting of Gallon Septic Tank and /NF /LTi2 -g 2 C'�A,! tP� ,1 �IJTi�� /gv 7 '�✓ 6c) ,x Zip % Other Requirements: Water Sunnly: Public Supply From Address #,V,47-14,-0 IA-e. or: Z Private Supply Drilled by /ate Xr -7 Address Building Type 1;q041. Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? /VU 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 a Putnam C ty Department of Health. Date: itLB101 Certified by _ P.E. R.A. (D sign Profes tonal) Address License # 076 % �Z Al�iy person occupying premises served by the above system(s) shall promptly take such action as may be necessary td 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 revoc: , modification or change is necessary. B s Title: Date: T L�ti ��' White copy - 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 WELL COMPLETION REPORT -- • . . _ VV eh n,tid antaou Well Owner: street address: rj�{ i owns v silage: 1 ax una /�1 Map %3.0FBlock d Lot(s) 7 Name: U Address: /' S- q1 Y 5 o-k GJ .odsido Ny 1137 Use of Well: I- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter Tin. Weight per foot 1lb /ft. Materials: Steel Plastic Other Joints: _ Welded Threaded _ Other Seal: A Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes Y No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours I Yield _,5: gpm Depth Data Measure from land surface-s static (specify ft) .4— During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or siev;; ana'ysc are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface 04, n :. :. _. �•_:.: _ a If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type , Capacity -P Depth Model 76 16' Voltage HP /�-_ ff Tank Type "W a I Volume Date Well fompVted 6d-. Putnam County Certification No. 06 Date of Report IM/012- Well Driller (signature) rA NOTA: Eiact location of well with distances to at least two permanent4andmdrks to be provided on a separate etxleet/plan. Well Driller's Name Sd hg Address: A1 I+ Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public Health Director DEPARTMENT - OF HEALTH I Geneva Road, Brewster, New York 10509 LORETTA MOLrNARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 -6130 Fax (945) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (445) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6649 OWNERS NAME: .E911 ADDRESS VERIFICATION FORM TAX MAP NUMBER: _ 1- -71. E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: DATE: WOMA I 2 The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed., i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91 I verfrm) JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET �.... .,.. .i'_ .: <:�: i'_... fti• ',j ^I'T'. n,�- - .�•..�..,.., _ %-`9�'•,Cir':'n�:9,�.. .;�.. ���r. i -r ,-s:)�;t. au�±:. j. 1;, .�i� - f�i;..,, s "! =r r0' ^? _O.tir: %;V.- l °1t I LJIn tJ(r-.. . .. Mailing Information: Name: Hyatt Pump Service Address: 229 South Rd City: Holmes State: NY Telephone: 845 - 855 -5136 Collector's Information: Client: Phil Hagen Name: C Hyatt Address of site: Tyler Rd City: Putnam Valley. Zip: 12531 State: NY Zip: Fax: 845 - 855 -5136 Telephone: At the time of analysis the sample was acceptable for total coliform WN N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com Sample's'Information: Site: kitchen tap Date Collected: 10/8/03 Date Received: 10/9/03 Preservative: -HNO3 Time- Collected: 1510 Time Received:- 12:00 Temperature: <4C Lab No.: J037427 Date Analyzed Test Name Result MCL Method 10/9/03 15:00 Total Coliform Absent Absent SMWW 9222B 10/9/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 10/9/03 Color ND 15 Units SMWW 2120 B 10/9/03 Odor ND 3 TONs SMWW 2150 B 10/10/03 Iron <0.03 mg /L 0.3 mg /L SMWW 3111B 10/10/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B 10/10/03 Sodium 6.89 mg /L N/A SMWW 3111 B 10/10/03 Chloride 12 mg /L 250 mg /L SMWW 4500 Cl C - --Hardr -ess - 17� !� .. . N/A .SMWW ?_340 C 10/10/03 Nitrate 1.56 mg /L 10 m4/C­ `SMVVW 4500'NO3E' 10/10/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 10/9/03 pH 7.22 S. U. 6.5 -8.5 S.U. SMWW 4500 H B 10/10/03 Sulfate 33.0 mg /L 250 mg /L SMWW 4500 SO4F 10/9/03 Turbidity 0.49 NTU 5 NTUs SMWW 2130 B 10/10/03 Alkalinity 32 mg /L N/A SMWW 2320 B 10/10/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform WN N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com 12/8812083 14: 41 1126 T PAGE I�4,r D4 PUTNAM COUNTI. (TMENIF OF HEALTH .. - •��Y /L bcuAti-,arEE OF SUBSURFACE SEWAGE TEAiIVEIT SiS EM Owner or Purchaser o Building Building Constructed iby _ Locadon -, Street h.ilding Type Tax Map Block Lot ArMIX, Zx "own; Village �� Subdiv,isi.on Xaxne 7e. Subdiv'si,o .ot # I represcra that I am wholly and completely responsible for the location, workmanship, material, construc1iov a';d drabage of the sewage treatment system serving the above - described property, and that is ims been constructed as shown on the approved plan or approved amendment thereto, and in accordavice -with the standards, rules and regulations of the Putnam County Department of iealth, and hereby gwrantee -to the owner, his successors, heirs or assigns, to place in good operating condition, any pab ofl said system constructed by me which fails to operate for a.period of two ycars irzunediatoly following the date of approval of the "Certi$cate of Construction Compliance" for the sewage, treatment system, or any repairs made. by me to such system, except where the failure to operate. properly, is caused by the willful or negligent aet of the occupant of the building_util izing- th_e The land,- rsigned f!!t ther agrees to accept as conclusive the determination of the Public Health Di=tor of the Putnam County Department-of Health as to whethex o of the fa hire of the system to operate was caused by the willful or negligent act of the oocup nit f tho buildingAtilizing the system. t � Dated: Month _ �_ Day Year general Contractor (Owner) - Signature Corporation Name (if corporation) Address: State - _ _ _ zip Si Title: Corporation Dame (if corporation) Addresq:'L 4(_ M Stae --- )TV V i .zip . . 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J,: fi r t •6 T ,?•P" �, r^ O•ip�ut: it• 'tG i., Kp. � F 9n-i Y . »yq _ � � d �.. ���'�. � ...�c ✓ „f '� ,..r.C'�P.'��r,. � w. �'q� �.. � �� , � h 1 r� •�- g � x F P. ,� �k}yY t _ +i: . t ' , s - y� Re � •� d" It '.ft' 7ir�'WI� "�:h kl,. x$ °�r+� ,�,�W.= °F �T� ��E4�.�*• µ' d•q,�'�,•'^�e`'. sM+. .Mx s -�Y` a�, n.#" Fd .+. � � �. _.�' • _ �R ;E TA.'L ,q 'i w:'T'� :i ii x °��J� 6a�idt`V" it `d'Yy,' w -• �� ,'�',i - 'k'' •Wro � ..:� 1 ..A �, a +,., ,•� i. ,2`��` . � �y *'� a � ; •� � r=� 'Y" a hist y �,.�atY. a3' ����. �. .i5 t'�' a ra5t �, ��1`v' 1� •.,�, �' �` �.t � �t+X� ; � aN`t t is a .,.l !o•Y" ate. ; i�Ye`.� � r I� : R �f k g _ t . y. v � � � r �.- 7w„ YE®y'� -�,W •'r f .. t-.. _ - j��� � i S' a #� y '; t, _ � � . S t _ 4 T .:. ak` at 4 •. ^' ' ^ S trt -a' w 'r C/ ^[� 1 ; + '} 1{ t ..y z .- - .#'. _.sue'„ �.� r:I.. .�N.a 'ivT�� �. _..' > >.. _ ... ♦ - _ r "+l P .. c1c 3a: Y.a.�.ffi'• 61# � � `• i � � � �,t �. � `�; —�� , sl. � ?fix � � ��+� � (�4 � . � � ' i '} DIVISION E ENVIRONMENTAL H_ T SERVICES CONSTRUCTION PERMIT FOR SEWAGE T tSTEM PERMIT # - -20 ) v Located at%� /� Town or Village Subdivision name ` . Subd. Lot # P Tax Map Block Lot — Date Subdivision Approved Renewal Revision Owner /Applicant Name JA ate of Previous Approval 37 n� Mailing Address - i� j �,.�, �� A,0y Zip Amount of Fee Enclosed Building Type -- Lot Area No. of Bedrooms Design Flow GPD OFTO FiR Section Only Depth q-_ VoRume PCHD NOTIFICATION IS REQUIRED WHEN FILL. IS COMPLETED Separate Sewerage yytem to consist of /` O gallon septic tank and i Other Requirements: Rq 141 p ,G S'G we To be constructed by Address Wages Sul Public S amply From a _ AddressM ®�: _ Private Supply Drilled by ,jyvs�vn�� '��Ct w� Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the senara� to sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating. condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date v Address gyp , ,sa l /���� c % r C&7 /(, License # 076713 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 't. Approved for discharge of domestic sanitary sewage only. ley: Title: L/ Date: 1301c, h' opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 :��v:a.a :�: w+��t,a': .'a'a� :•L.a - <:=� �::.�a.:•uizis_:..•.:a� LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services August 1, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 . Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Stephen J. Ferreira, P.E. 103 Perry Drive New Milford, Ct. 06776 Re: Dear Mr. Ferreira: ROBERT J. BONDI County Executive Field Inspection — Hagan/Perez Tyler Road, (T) Putnam Valley TM# 73.08 -1 -7, Permit # PV -20 -89 A site inspection was made for the above referenced project on July 31, 2002. The following comments must be corrected in the field. C/1 Outlet pipe in septic tank needs to be trimmed. ✓1 - s• .. irnii` fr, ie nr Ie-t - n ,o -:�r +.,•. - ?� <<' rP.__'1..,. _ 1_.ed - elmti='. r°' 3pr� :.:�b•,v-v`�u'3`vJ:F.-viiYal between the tank and pipe outlet at the house foundation. Bedroom count needs to be performed before compliance is issued. �I Footing and roof drain discharge location needs to be know n before compliance. � U mu have any further questions, please contact me at (845) 278 -6130 ext. 2157. k O Jrod)644 > " JSP:cj 141-21-3 Sincerely, x�` Joseph S. Paravati, Jr..: Assistant Public Health Engineer f _ ,sit - •. e..'.t-,,:. _ ;.�i -..a.a - =�� Town PUTNAM COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: Permit # - /Dr/- TM # 23, OF - -7 Subdivision Lot # �A 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .......... 1, 250 ..:......other................ b. ' Septic'tank installed level ................. ......,........................ c. 10' minimum from foundation...:'..'..::.:;..... . ....................... d. Distribution Box 1. All outlets at same elevation -water tested.......:......... 2. Protected below frost .................. ............................... 3.'. Minimum 2 ft. Original soil between bp X_& trenches e. - ..... ............... 6. IfFenche s ` 46V: i ��c 1. Length required en installed �V � 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 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10 Pipe,ends ca*�oQd 1,,, .... . -- �;`='Pua&Illii`y[ i�V9elsSVStf'[15` _......__ 1. Size of pump chain ... ............... 2. Overflow t . ........... ............................... ......... 3. Alarm, audio ........:........... ..................:....:....... 4. P easily accessible, manhole to grade ................. firstbox ba$ led .......................... ............................... 6. C�yycle witnessed by H.D.estimated flow /cycle........... M. House/Buildi ig a. Mouse located per approved plans' . ......................:........ b. Number of bedrooms ...:................ ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured 419 d' ft........... c. Casing 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.J{ f. Curtain drain outfall protected & dir.to exist water our' g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........:............... I.......... i. Erosion control provided ................. ............................... Rev. 12/02 '' .C. _ _. K..�:. .r,. «...e. ,a- rv-'. ':r z,. _... ..v _. .., .e.c.,.,..r:.-,r�►,.. -...- ,r ...., a-• • '+' �� C O V E RM S H E E T Fax #: %45--'779 .. ? q '- Subject: -C-Y 4 2 P o g o /j4.14 4& *oJ Date: 7 I zrq fob Pages: e From the desk of... Stephen J. Ferreira, P.E. SJF Engineering Services 103 Perry Drive New Milford, CT 06776 (860)- 350 -2499 /'',- 02-Orr-f'e-n- FAX 1 74 �1 . K` e � V'� s A v �'�4.- � c. .. �. '�.w^'_•.wr •_�.a rK w�ailr -..W\- 1i '� O�i✓,p .`�:. . Q�� /: -sY-� �.c.t w � a. � w. �w i. .bu..I�'_�w". •��... w ftl��v ..�^,�' +.ter. � r, i O PUTNAM COUNTY DEPARTMENT OF DMSION OF ENVMONMENTAL HEALTH SERVICES ATTEN'T'ION XJOSEPH GENE REQUEST .FOR FINA,1_, INSPECTION, For: rill All inforrnation must be Fully completed prior to any Trenches _ inspections beins made. ]PCHD Construction Permit ## ev 2'" r Located: -r9 e, (T) (V) Aym,9M e&k Owner /Applicant Flame: &93k6 �► � _- - TM DS JBlock , i . of —�L- Formerly: 14 -)"- tWZC4 Subdivision Name: ,- r &a�G Subdivision Lot # _�- �/6 "'1 �*:, Is system fill completed? Dat e. 7_ Is system complete? _ kr5 _ Date: � -i® a3 Is system oonstructed as per plans? *S Is well drilled? ..yam Date: Jo3 Is well located as per plans? jl -s Are erosions control measures in place? I certify that the system(s), as tistod, 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 Date. Certified by: PE g A, Design Pro sional _X_ . A ddress: �� �, V410 �! Lie. # 07629 V 00 7 Comments: Form PM-99 PUTNAM . 4'+`a�'...'�.a .. ,•, ;r= n: =.i i = :'�.� • v- t-s:. :.�i: F.:. `_?:� -' . _ �_= �+__ - �.�s . - �.-z, ,K `..:�.. �" 4 v. �v.: �c�n -ar, o `4r Y F. Date: Inspected by:' S p Fill pad located per the approved plan y 1 j Fill Pad Length ! Required Length Fill Pad Width Reauired Width fJ / Fill Pad Depth % Required Depth l✓ Run -of -Bank Fill Quality oo� r Slope from Top to Toe Am / ` 3 — / „'ti P "5 wu- Impervious Layer Installed Brosion Control Installed�S Sieve Test Results (if applicable) -- ....J Additional Comments: _ �. .... . _. s.+_ -y -. ........ -. ... ... _w... w.,._n P ....__.. -_ r. w r.... ..a ..... _ ... e • ��.._ +is-- ..� sr..�.�. -.. w..... - -... w .. -..+. r.. -_ �...... -:t +w.�. -r -rr �.. w .vr� r.... �. P- Reserved for Field Sketch if Applicable j __ 1�$A PUTNAM COUNTY DEPARTMENT OF HEALTH 5/ DWISION OF ENVIRONMENTAL HEALTH SERVICES Owner PUIQP Address Located at (Street) Tax Map Block B Lot indibate nearest cross street) Municipality JA-U."_ �&LC Watershed 10 (1 V SO)OL PERCOLATION TEST DATA ( ,FrLt Pkb) P Date of Pre-soaking 1• /Py Date of Percolation Test 7//Y r4UTF,5: I. I ests to be repeated at Same depth until approximately equal percolation rates are ou.minea at eaca percolation test hole. (i.e. s I min for 1-30 mih/inch,:g 2 min,for:31-60 min/inch) All data to be, submitted for review, 2. Depth measurements to be made from top of hole. FormbD-91 JUL-29-2003 TUE 07:50 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 I U'12: . t h G"J"' d" h: rc ro ne t .2 /V, V - 3 14 0"1 A.) s� 0 91L 4 A) - rz) IkIA1. 7-7 .3 71 fV, 3 tov. 4 ,q Z? 5 2 3 4 r4UTF,5: I. I ests to be repeated at Same depth until approximately equal percolation rates are ou.minea at eaca percolation test hole. (i.e. s I min for 1-30 mih/inch,:g 2 min,for:31-60 min/inch) All data to be, submitted for review, 2. Depth measurements to be made from top of hole. FormbD-91 JUL-29-2003 TUE 07:50 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 I PUTNAM COUNTY DEPARTMENT OF EMALTH DWISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH ❑ GENE REQUEST FOR MLAAL INSPECTION For: Fill - V/ All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # J 0 Located: 14114 SAP (T) iii yTAIWA 4A4CY Owner/Applicant Name: TM -7106 Block I Lot Formerly: Subdivision Name: Subdivision Lot Is system fill completed? V195 Date, 7 115 103 . r% I I Is system complete . Is system constructed as per plans? Is well drilled? q" Is well located as per plans? Are erosion control measures in place? ate. Date, I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Departmeut of iE bate: ZZ 174 l Certificd by: pp. RA Design ProfWssional Address. A�3 - AfMVAC kJ4y A/ C7—AMLic.# Q-Q� IqA Comments: Jr-4 Form FIR-99 I,, • /10V ICI. TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E WRONMENTAL HEALTH SERVICES - -- . APPILICATION TO- CONSTR].UCT A WA7ER WYI—LL A�i:_.:: ��r�= r,";S:;r`u"n...�L"t «• :,iK.:: �..'.i.- -�=..+.e✓a� = ,�i:.:s-�....a=.ip,.'r car,.- o>:�.rtr- .`i...e�.;WL9fR.t,a7' J..:Y, a.�_.0, .. .._ ..� ''��C�P please print or type F'� rill reliilt`#° i 'r7` Well Location: Street Address: Town/Village Tax Grid # /�, y q� (0u,,A*, a 1lA�d,ft Map 3.0f Block Lot(s) Well Owner: Name: &j&,p11,406A Address: ($-o —'q?) S77%F-7- 6RA ® -t- kwo Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation l -p rimalry Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional. Standby Amount of Use Yield Sought S gpm # People Served Est. of Daily Usage �00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type __.Y_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ✓ No Name of subdivision &AL -nk.fE /N e . Lot No. Water Well Contractor: &MA-it/ AX10,w4a% Address: g9/zW/�57� ........ Is Public Water Supply available to site? ......................... ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water mai : Proposed well location & sources of contamination to be provided separate sheet/plan. i•;int C•;�ra�llrP::__- � -' _ ..._ F_ - _ �b�:...,.- ....._ -._ .i- -.0.- .1�....... cam_- -ta2.. a -ter.. ... �.:w - ... / -.�s�� v...... �•+�� ., .... - -:v sae —.. . - . �".� - —.�- 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 Dire tor. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a w er well driller certified by Putnam County. / I6f"L'� c Date of Issue Permit I, uing 0 icial: Date of Expiration Title: Permit is Non-Transferrable 1/J A, V \, White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ALTH P UTNAM COUNTY DEPARTMENT OFHE VICES DIVISION OF ENVIRONMENTAL v�.,S ?'.�i :c:.... -.a'v: x�.'fwP..:A - •,�.v..: ".a.�:1•�e.. i;.i.:.7. -a:: .�rr�v�Yi .'.. CONSTRUCTION PERM HEALTH SER PERMIT # vq v own or Village ✓rN� AIDE Located at % j�L 6e t� /�-A S ubd. Lot #�� "�� l° Tax MaP ���'� Block % _Lot Subdivision name - j �}t.T S Revision Date Subdivision Approved S l�G �S� Renewal PP 1 �S`,4 Approval Date of Previous App Owner /Applicant Name Pl/� /P �lA��A. N ENO zi Id S7 Mailing PuTj P►u-� N P g Address 1-j i f Amount of Fee Enclosed Building Type 5 F Lot Area ' .01 dNo. of Bedrooms L4 Design Flow GPDU F. a Depth �r Volume % C F[ Fill Section Only . N FILL IS COMPLETED PCHD N OTIFICATION 4s7R E UIRED WHE...... N So atgallon septic tank and S '-p g _ Separe Sewer e S stem to' consist of - Other Requirements: To be constructed by _- Water Suuuly• F I represent that lam;; accordance w-itl * stanc thereof a "Geiifi te of,, Department, a1d iVritte builder will -puce good immediate3, , tllotg the systern or- z3LUX-1 rep then Signed: Adc reS:E,"'- - APII'Rq::jW—"°,D sewage stn mocl�� ,h( a new By_ Y.(.r�' Whig -Q--=Py - Address From Address i com letely responsible for the design and location of the proposed systems) and that.the P roved amendment thereto and in 2 described above will be constructed as shown on the app completion rules and regulations of the Putnam County Departml °Directorhwaill be submitted to the traction Compliance" satisfactory to the Pub the builder, that said -antee will be furnished the owner, his successors, heirs or assiseb Period of two (2) Years sting condition any part of said sewage treatment system during of the issuance of the approval of the Certificate of Construction Compliance of the original P.E. D' 7 3 R.A. __ Date 3 �' License # ` v �ISTRUCTION: This approval expires two years from the date issued unless construction of d has been completed and inspected by the PC Any and o or alt ratio for cause app o� a plamended n requir+ I necessary by the public Health Director. Any revision or alteration for discharge of domestic sanitary sew ge only. 10 Title: Date: e co Design Professional CP e ow copy - Building Inspector; Pink cop - Ow Orange PY - SENDING CONF.Ti MATI.ON . 1.'.'~ i iii �c^�Y. --A . . .•.i .jt-iiS^ r , .. ..4s+. 31y 't.s:�x�T '.�A .. .. 1�- �•.�6':'T• _ r>.' .- .�•aN'. � � ►. �.. ,. R. ~ r � to . �-YV V a' +. .i19. .'f Vic.,. V� .1 DATE MAY -5 -2002 SUN 21:10 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 95268806 PAGES : 1�1 START TIME : MAY -05 21:09 ELAPSED TIME : 00'37" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location., Street Address: Town/Village Tax Grid k QdRd V#Oft Map f Block i .Lots) we" own". Nance :NWIY4.4 Address: So y.9 (N/,fol srWwT INrep srq£ Use Orwell: _ Residential _ Public Supply _^k/Cond/Hest Pump _ IMgptiou I- primary Farm _ Test/Monitoring _ Other (Specify) 2-roc Industrial Institutional Standby Amount of Use Yield Son& S 9LM # Poo 0c Served & Fast, of Dail U e 600 Reason for Replace Existing Supply _, Tesr/Observetlon — Additional Supply Drilft New new dwelling) Docpan, ExisgM Well Detailed Reason for DePldaE�:_ weri Dolled Driven Gravel Other Is wall Site subject to flooding ................................................. ............................... Ycs_ No ......................... ............................... Yes�G No sutbdrvision7..Efr Is Name of cared in a realty !f� iionL,re /N a , Lot No. WaterWe�Coasion .. Address :,B4e6�Ss�Lot .Qsaarrr�� Is Public Water Supply availablo to site?.. .............................. ............................... Yes _ No X Nam of Publio water Supply: Town/Village Distance to property from rarest water, maid Proposed well location tit sources of a mumduatien be provideD wparete she"laa. Date: 3 /Y Applicant Slgasturc: -' PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as act troth above, to granted under provisions of Article 10 of the Pt— 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 constructiam, the applicant or their designated reprewntailve shall: 1) Pump the well until the water U clear. 2) DLswm the well in accordance with the requu memts of the Firm= County Health Department. 3) Submit a wall Comp',etion Report on a form provided by the Putnam County Heath Department. Dtmng all well drilling operations, the applicant and/or well driller shall take appropriate action to assme that airy and all water and waste products 8om such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise . eantamlmeto surface or groundwater. APPROVED. FOR CONSTRUCTION, This approval arpines two years &am the data issued unless construction of the well has been completed and mepected by the PCHD and is revocable for cause or may be amended or modlfed when considered necessary by the Public Health D . Any revision or alteration of the approved plan requires a iiew permit Well m be oonsttrcfad by a well driller certified by Putnam Coumgc Date of lasue ���Z Permit o ial: Date of Expiration Title: Permit is Non- Tr'amsfbrrabk , White copy - im dla Yellow Dopy - Building Inspector, Pink copy - 0a ,, Orange copy - Well driller Pd­ WP47 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEAILTH SERVICES .�r Y APPLICATION TO CONSTRUCT A\ WATER WELL pi pq4 :S'„ :;� '•+c:�..: f.'.:^$, .'y- .'.' ,.i.;,r".. : ee:. v;:: w't= .- .*i+xs ..°`_. "aSi?ap �•zs. .,cct ». t, j '�+' =.. is .r".".•- .µ`az:.'sF �•L`.. ..r.+:.a,...> {;Iasi .. print or °type Well Location: Street Address: Town/Village Tax Grid # /L POO ., #rA A VHJ,,f Map 3.6Y Block Q Lot(s) Well Owner: Name: 11,4(p 0,41J Address: �,'o .- /9) Sj 7- 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 S gpm # People Served Est. of Daily Usage 600 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X 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 Iodated in a realty subdivision? ...................................... ............................... Yes %,/'No Name of subdivision LT7r, /PC . Lot No. Water Well Contractor: &,04401) Address: /_U26 4 Is Public Water Supply available to site? ...... ....................... ............................... Yes No X .... Name of Public Water Supply: Town/Village Distance to property from nearest water maid- Proposed well location & sources of contamination t be provided separate sheet/plan. n +P -lf� y'- ; Ar, " �i��art:S.gnall�re: I` 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 Dii7,/ tor. Any revision or alteration of the approved plan requires a riew permit. Well to be constructed by aer well driller certified by Putnam County. .. , /I. Date of Issue Permit I uing Ojfficial: Date of Expiration L Title: Permit is Non- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Bi6i'Ch k. r ULE Y Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax(845)278-6648 Preschool (845)228-5912 Fax(845)228-6113 April 16, 2002 l Stephen J. Ferreira, PE 103 Perry Drive New Milford, Ct. 06776 Re: Proposed SSTS - Perez, Tyler Road (T) Putnam Valley, TM# 73.08 -1 -7 Dear W. Ferreira: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The SSTS must be designed on a 2 square feet per lineal foot basis. An oversight was noted on the previous approval. All previous approvals since 1989 have been for standard 2 feet wide absorption trenches. Please revise accordingly. The current permit (PV- 20 -89) is hereby suspended until this matter is resolved. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. SR:cj Sincerely, Shawn Rogan Public Health Technician �1 Sheet 0 PUTNAM COUNTY DEPARTMENT. OF-VEALTH FIELD ACTIVITY REPORT N A ME' ADDRESS. St et Town PERSON IN CHARGE OR 1NTFRVrF.WFn-. Name and Title TYPE OF FACELITY: WAMMOM I , f AR State Zip T) M X, �/ /�=W e. eZ a Signature artd Title RFPQRT R'F.CF.TVFT)'BV-, I acknowledge receipt of this report: SIGNATURE: 02/96 Title: PLMMM COUMY * DrAIAIZIMMr Or I 1=111 DivisioN Or IT mommm RrAvin sumcEs Owner Q_ Address `r; T4 Located at (Street) ac c sec. 6 Block Lot . . . . '7-0 2- 2 23 2s 2s 3 7.7 23 23 zs Zs 3 .7-7, 4 2 3 4 5 NOTES: :716sts -to be repeated' are obtained at each for review.., 2. Depth measurements to rev.. 9/85 at., same depth until approximately equal Soil rates Percolation test hole. All data to -be submitted be.. node from top Of hole. (indicate nebxest r�� ;street) ossjtrj), Mnicipa.Lity Watershed SOIL -PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Z15 /9.7 Date of Percolation test Z HOLE Na-flm C= ME PERC0=0N PERCOLATION. Ran Elapse Depth to Water Frau Water Level No. Time. Ground Surface., In Inches Soil. Rate Start-Stop Min. Start Stop Drop In Min/in Drop Inches Inches Inches ILI 2 SOO .3 3 -3 c,7 . . . . '7-0 2- 2 23 2s 2s 3 7.7 23 23 zs Zs 3 .7-7, 4 2 3 4 5 NOTES: :716sts -to be repeated' are obtained at each for review.., 2. Depth measurements to rev.. 9/85 at., same depth until approximately equal Soil rates Percolation test hole. All data to -be submitted be.. node from top Of hole. °vs'y / y►i Ki4GtIPi'ION, OF S( HoLr ILI 2° 3° '40 5° 6° 78 8° 90 10° 11° 12° XL '11L DE HOLE taco Z HOLE NO. s: 13° 14 IND7�CATE LEVEL AT WHICH GROUIATER IS ENCOUNTEE2ED NI7r y t INDICATE LEVEL TO WHICEI WATER LEVEL RISES AFTER BEING ENMUNTMED DEEP HOLE OBSERVATIORS MADE BY: 6 - -2 . -_ -- DATE: 'ZA- 6 I DESIGN Soil Rate Used S -(O Min/l0' Drops Noe of Btdrocros Septic Tank Carlac .L� ___�...._..... _. I Absorption Area Provided By ;3 '�> L .. ; ' c Other K 'i i Name Signature ..:.. c:� Address 2q 7- SEAL . �2,ye-xJ��i.•2 ►"�S• �'(!"'�',�"{��� v�a c'`niF9f ��.43136 �rv�� �1�di.nc:cceV(1��Q� -- THIS SPACE FOR USE BY HEALTH DEPAR7.�SEDT1' ONLY: : s:•, 4 ,J �301A�3S a11-,V JH `fVINN Ap�� Soil Rate Approved 03AIl gYg"V. Checked by _ .. Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner OA yc 3 S %-y !ter Rd d �ei lll b e,re Address Located at (Street) j�e�1t s k C! o iZ :� Tax Map ?3. Block I Lot 7 (indicate. nearest cross street) Municipality LT - jar 'n awe ►% y Drainage Basin ;4ud So r R6/ r-, SOIL PERCOLATION TEST DATA Date dPre- soaking G -•12 —o O Date of Percolation Test " Hole No. Run No. Time Start - Stop Ela se Time (ly1in.) Depth to. Water From Ground Surface (Inches) Start Stop Water Level Dro In Inc %es Percolation Rate Min/Inch P t� 12,,�3 2 P -7. Da ZO /4 2.334 3.5 -7,71 2 2�32215� 2-�,dv Zb 23 3.0 5.33 3 Z: 58 3 :2 5' Yz 2-3Y7- 3,0 q.00 4 5 ` - 77 1 .44..: I� 3 /a- ( Z 3 � i .. ___- -_ - ..`2..�:.... �Z:3� 3;d 2-, , - 3z,or� 3.5. `l•�!.4- 3 3�v3 , 3;30 z7,00 Zo 2.3 3 -fl �.ba 4 5 1 2 3 4 � � � • . 5 NOTES:. 1. Tests to be repeated at same depth until approximately equdl percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT 'DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ....w .. .- _ ..,.� _ ..� ..-a �...�....- = . .� > .�.._..y..�.� � .. _-�.x: s.� - ., 4- ,. ::.,....,_ .. . _ .....�:.....�- , _ _ ,, . � e,..,.._...�_ ate-:• _ DEPTH HOL NO. HOLE .0. HOL 0. G.L. 0.5' j 1.0' - 1.5' 2.0 -2.5' �.. 3.0''' ,R 3.5' 4.0' — 4.5' 5.0' er 3 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 9.5' 10.0' Indicate level at which groundwater is encountered D'174' ® t '0 fte Indicate level at which mottling is observed A)p we_ . Indicate level to which water level rises after being encountered Deep hole observations made by:��� ge Date -t® ®® Design Professional Name: Lacrrence belluscio Address: 92 Perks Blvd. C01d Spring, NY 10516 Signature. Design Professional's Seal o� G J. BFI <�G o cP>, �° AE 0°+a� -OF NE :PUrNAM COUNTY DEPAR'BMM OF BEALTH' DIVISION OF EWnnZOML BEALTH SEFMCES LESIGN 1~kbl'1H`� Cl��!°.�i' -.` 1Ly.7iJltil.L :7i vi[�iit� u �v`aciu ►ii.� Ca': u Twi: :� Owner i + Q- Address zso E�S� �7 54, Located at. (Street) �`� der aJ1 Sec. E Block Lot . 1 (indicate nearest cross street) I Municipality �«� iia Watershed SOIL PERCOLATION TEST DATA REOUIRED TO BE SUBMITTED W= APPLICATIONS Date of Pre- Soaking C1 (9 G j Date of Percolation Test G rR g`f HOLE NMMM M= TIME PERCOLUION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time. Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop.. Inches Inches Inches 3 1 Z7 3 2 29 2y 27 72 3 3 2y 27 3 17_..7 4 5 2 3 4: 5 NOTES: 1. Tests to be repeated: at same depth until approximately. equal soil rates are obtained at each percolation test hole. All data to'be. submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNIERED IN TEST HOLES a DEPTH HOLE N0. HOLE NO. y HOLE NO. 1° 2° 3' /d- r s Noz E 4° 3 51 rr 6° 7' _ .�` tom•.. _ _. 10� ti 12° 13° 14° tY.- YJ1.lL'n TO ` --' -' ia✓1\.a i.La:I Ll:.lV l-.Wi aai ' YYa�t.+� .i: \✓IJL�LI'Yt- l:.u\ i✓ a.uYWli11i1...LL�LL/ ' INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED N�A DEEP HOLE OBSERVATIONS MADE BY: ZL y" DATE: i s �y. DESIGN e Soil Rate Used - ° Min/1" Drop: S.D. Usable Area Provided s; No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Address Z7 2oc;, �% \`z .y A,,, THIS SPACE FUR5E ``X; " r ONLY P�0F NEW Signature SEAL "ROFESS10C1NV Soil Rate Approved sq.ft /gale Checked by _ Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 11 "1 Ile J DEPTH a. HOLE N0. - HOLE- N0. .r. HOLE NO G.L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' ill 12' 13' _-.. - r- .-...- _d -1 .. .. ,� _ .., ... ...- ._.y. . .... .. ..... .. ..- . .--.._ INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED �1 CJLJ E� -G `R-t- o f ;5',000-y7>,- J INDICATE LEVEL, TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED % y DEEP HOLE OBSERVATIONS MADE BY: CLA-) DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided _ No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPART ONLY: Soil Rate Approved sq.ft /gal. Checked by Date r r� U' ti7 U7 ILI U, t � EI7 U1 UpV Q P C7 1r� m vvT� e U) C N, ;7 UI A Ul U1j) y M 1-1 a, � vi k1 ry, W l= Q 1— t� V � SI vA71 A •tc ,Y a Vie{ :Y .f 3 I� J r U, C1 W �I J U7 •Ul n U r1 u I-I , -I Li CIO ELI U LV .' 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Zf a • [; ( i U' 3 / • III 1 tl C) .IJ 1t 1 h) 4 1l( �{ t11 (U Cl 1 11 tl C' It G ( : •' (� 111 •1,1 if d' c1' It1 � t-1 l/ � Fr 1 �; ltl ..r IJ �J x U Q U 1 171 :�Ir -I (:' :I C, O .14 - .-I 1 UI 1' nJ N .171 C� '� �-� • Uj V) IU IU ••� 1� •,I •1i 111 I'1 r v. I N '••i U Rs r� � N L.' rI I I IC'J � '�T,, 1.1 p, VI � 6 C: 1. '' •) is r (✓ ( U 4-I C r/ 111 r '� I I If 0 h� ILI : A I- r, i) Ul ttl I r. ;:. o C) r -I u) 01 .. w �J •• + U c� • i "I c; .t.l , 1 t) Irl tl I11 ,f ; w S� U —1' Y. LI • f N t / in •1 L' r'1 S I1 t� V UI 0U U7 w 3 Ia Z rl 1 A -I UI .Ii1.11 a (1 'IJ J C1r r—I r •� a� U 1 ) . l •1 U U 1.1 0--j h .I tl..{ Ul Ul 14� U1 � rU .--I . tl� C LI -1 -1 •Ij t -I n► tli -W (ti p•I o - (I -V I z F I • r r- ►.(. I r ul • c7 r •• I. U) •11 11 t U) G1 U (a 1-1 �j )7 Ill l) 1J (I Its 11 c1 41 01 •1 ry ' 11, • (J �(]� 1 t 1 •• • U S U) w .5r' U tJ tl v r PI W C� .47 b( U o r `� UT 'ter + 1l} r[ i Cl f7 q O r� ,li +( C1 Jd tCll rly •.1 w .1) U� Ul , 1� 4� - - 1) 4 4,!.•:4 V Lv 1 h s hl 1 n 1:• (U Uj Lt>) (ll tU t ' i7UUl - C) o - - •1 '' •U O Ul ,J 161 V •—I RI (I U O rJ C7 C7 C7 O In U7 r7 •tj O Ul rJ •r + O I 1 a lr H 9 .- r) q- 7� ' nJ .-I N r-1 r-4 .-1 r'1 r-4 trl (.1 GUl L+ A Iii W W 3 114 W W tl CL4 Vi 'i - - -- -- - - - - -- — — — — — — — — — — - - -- - - - - -- — -- - QJ i 1 n • t,4 r-I I I I_, I• 1 1 1{ t r � Il � t' h1 ,+li Il 1��i6 th 11 l)I • 1 •r l I I r� II� ul • •t) • -1 7. t ;> lI 1 -I of V 'lI U (Ij i,l Of 1 gE In ull) 41 IJ i� It) r' (:7 J• W 144 1 i J 1 i J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.. •_ .�.: '. , �.,-; .y , +,r a •l.a_ . s „Y .. . p�. v..t .. ,,. -. a. r. =4rr. ., .e ✓' .e ,. +.., .. ..eta �we� CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV 20 -89 Located at Tyler Rdd Town or Village Putnam Valley Subdivision name Tyler Realties, Subd. Lot # 18,19, Z1)ax Map73. 08 Block 1 Lot Inc. Date Subdivision Approved FM 551 5 -16 -50 Renewal X Revision Owner /Applicant Name , David WEinberg Date of Previous Approval 3-15-96 Mailing Address 35 Tyler Rd., Putnam Valley, NY Amount of Fee Enclosed Building Type S.. F D.. $300.00 fee previously submitted. Zip 1 0979 Lot Area 3.02 4 No. of Bedrooms 4 Design Flow GPD 8 0 0 acres Fill Section Only -.X- Depth 3' 0 Volume 700 C.Y. PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by 1,250 gallon septic tank and (5) -50 LF Inf iltr Cluabrs Address Suna IN : ._-:A Public_Sunnly_From _ .. ...... . ........, __:_ _. _ ... __._ _._. _ Address. _......_ ^or: X Private Supply Drilled by - Norman Anderson, Inc. - Address u m jfliy,NY T ~� 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. Si t�- �'0-�- P.E. X Address 92 Perks Blvd., Cold Spring, NY 105.16 X Date 6 -20 -00 License # 49002 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 n essary by the Public Health Director. Any revision or alteration of the approved plan requires a new it. A o d scharge of domestic sanitary sewagf only. By. Title: Date: Z White copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Pr ession 1 Form CP -97 NEW YORK STATE DEPARTMENT OF HEALTH Specific Wainer Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75-A. IONY ORR . `rot indivia'ua1 Househola'Sewaga 1 "r`eattri ni Systems Las Name First M.I. Name of Applicant df-w, C71 No, Street (� Cityrrown State Zip Address No. Street City/Town State Tip Site Location 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. cessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. E] Soil unsuitable. Other(explain) ....................................................................................... ............................... 2. Proposed design or conditions of waiver: ......... 1' a:.¢(..-.... �- .......4 ...................... .: ............°r Q...................... ............................... . . ..... a........... ... _...... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. J Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ................................................ . ...:..........................: :.... ................................................... ............................... D ................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6(b), a waiver is hereby granted. This waiver may revoked by the issuing official for a change in conditions for which this waiver was granted. ...................................................................... ............................... REPRESENTATIVE OF COMMISSIONER OF HEALTH ......................... ............................... DATE ORIGINAL - Local Health Agency COPY - Applicant/Design Professional DOH -1326 (7/92) (GEN -152) BRUCE R ?FOLLY - Public 'Health Director NAME: ... -ADDRESS:-.- SITE LOCATION: DATE: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509. Environmental Health (914) 218 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278-6559 Fax(914)278-6085 Early Intervention (914)278-6014 Fax(914)278-6648 WIC (914) 218 : 6678 Fax (914) 278 - 6085 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER M.1,6- .. : �_ � � . � ►.�_ :.�i� ��: ;�' - .t - � +. ice'%: SPECIFIC WAVIER REQvESr: u 0 1 ova t` � �T ttrhro,i� DOES THE PROPOSED VARIANTCE REQUEST POSE 'A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIG CANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENIED_ APPROVED DENIED N'7 1 , ►! . DIRECTOR OF PUBLIC HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH -_ HOUSE PLANS APPROVED FOR, BEDROOM COUNT ONLY, BEDROOMS ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE PLANS MUST IN SUBKIWED TO THE PCDOH FOR APPRQVAL SIGNATURE a& PLAN 13 (REFER TO.PRICE LEVEL 1.6) o A.cozy porch (2219" x 614 ") invites guests to step up into this country home. A cathedral ceiling adds volume to the great.room, which is further enhanced by a fireplace flanked by built -in shelving and access to a rear neck. o The U- shaped kitchen offers a windowed sink, island countertop and window that overlooks the great room. A breakfast nook with a door to the rear provides an alternative to the formal dining room. The utility room (8'0" x 612 ") has enough space for a sink. o A tray ceiling, walk -in closet (5'6" x 8'8 ") and full bath A FIRST LEVEL Deck o Master Bedroom 15'4' x 13'4' TE (1114" x 710 ") with dual vanity, tub in a box window and separate shower enhance the master bedroom. ® Three bedrooms, including one with a walk -in closet (418" x 4'8 "), share a full bath on the second level. If finished, a bonus room will add 259 square feet. o Plan includes a crawl space foundation. i Parch Great Room Great Room Kitchen + Below 19'4 x 1510° a Brldst. y 9'11'x �$ --� Utility ' . Storage I Dining Bedroom Area it 14'4' x 11'0' 12'0' x 12'4' Lij h Garage 22'4 x 21'0' Ih. s SECOND LEVEL 59'B' I Bedroom 1'0' x 12'0' 1V Q 110 x 12'(' \�AAL EN TPo_�cc'. VVEL 'ls 1 ®a N:'G. -- �5 �� d. B�L� �✓ ` `iYLa7PZ )ZC>, PEOg9o��0�',� F OF NEB TrIA w-. GO u� 6 c ; EL� V Gc� z �t;vo. - a�_�;.5•...�� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �_ xv APPLICATION TO CONSTRUCT A WATER WELL °plea prite�r'ype '` '. �i Yf rPgli iP i - Well Location: Street Address: Town/V4Rep Tax Grid # '%^ ler AR A ndM U M0710e Block 1 Lot(s) "? Well Owner: Name: avid iii a1 � Address: -3-jr f �i ©v 7� 4't �1 i.✓Ct e Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage 4,00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _["New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilliag Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivisio ? ...................................... ............................... Yes No 7'4 �e-241 -1 Lot No. Name ofsubdivision e %L Pic t —S-1, iq w Water Viell Contractor: & rwi�aA Address: ir'cies�.,�✓' P - Is Publi(Vater Supply available to site? .................................. ............................... Yes No gam' Name ofPublic Water Supply: /u 1A. Town/Village Distanetto property from nearest water main: " Proposes well location & sources of contamination to be provided on separate sheet/plan. a �` ?gate:.. ZO Applicant Si na L •�: PERMIT TO CONSTRUCT A WATER WELL This pewit to construct one water well as set forth above, is granted under provisions of Article 10 of the PutnanCounty Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that wiih thirty (30) days of the completion of water well construction, the applicant or their designated represdative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requireuents of the Putnam County Health Department. 3) Submit a Well Completion Report on a form providd by the Putnam County Health Department. During all well drilling operations, the applicant and/or well der shall take appropriate action to assure that any and all water and waste products from such well ding operations be contained on this property and in such a manner as not to degrade or otherwise contarilate surface or groundwater. APPRIVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless consution of the well has been completed and inspected by the PCHD and is revocable for cause or may be arnendi or modified when considered necessary by the Public Health Director. Any revision or alteration of the proved plan requires a new permit. Well to be constructed by a water well driller ce ified by Putnam Count, Date (Issue JL Permit Issuing Official: Date (Expiration / t 9 / Z 710], Title: Periniis Non- Transferra White)py - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Putnam Co. Health Dept. Div. of Ehvrnm'tl Health Sv's 1 Geneva Rd. Brewster, NY 10509 Attn: SUBJECT FOLD HERE DATE Jun 20, FROM LAWRENCE BELLUSCIO, P.E. 92 Perks Blvd. Cold Spring, NY 10516 Ph/Fax (914) 265 -9342 *51 For Fax. Adam Stiebelinq, Re: Renewal of Constr. Permit# PV 20 -89' TM# 73.08 -1 -7 (T)- Putnam Valley 2000 Dear Mr. Stiebeling: Enclosed please find the revised plan—,for the renewal of the above referenced constr. permit. Because the slope in the proposed disposal area exceeds 20%.a Bd. of Health waiver will be required. A infiltrator system and.cutoff wall are proposed inorder to minimize the fill required. All other cri -, teria can be met. If I can be of any.assitance'in your review, please contact me at the above tel. no.. Very truly yours, .r..r� Lawrence Belluscio Incls: (3) SSDS Plan, 2 shts, r'vsd 6 -13 -00 (1) DD -97 (1) CP -97 (1) LA -97 (1) WP -97 (1) Copy of renewal rec'pt (2) Hse Flr Plns cc: David,- We.i.nberg, applicant PUTNAM COUNTY HEALTH DEPT. 021488 4 Geneva Road (914) 278-6130 Brewster, NY 10509 19W Received o. — The Suri Of ��/ Dollars $ - For !~ /q T y�41\1,; /0U_I Cash ^' Check V m.0. 01 Credit Card s �!„ PUTNAM COUNTY DEPARTMENT OF HEALTH VLI0N..:' Fa_iTVT.ONM I. LETTER OF AUTHORIZATION RE: Property of David weinber Located at Tyler Rd. T/V Putnam Valley Subdivision of. . Tax Map # 73.08 Block 1 Subdivision Lot # 18 ,19 , 2 o Filed Map # 551 Date Filed Gentlemen: Lot 7 I� This letter is to authorize Lawrence Belluscio a duly licensed Professional Engineer_ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems , k �1�_ :cle i 1 Z - vG___- -_ -,-Y. �vl :i-C: G,SJ`,1_'`_��1�JiClIIS ����,Cta�� ... �5 r:���J� 'i�7i �(1'�TY1P ft:� �if.,.fil'i_ i_?VcI the-pi i���`5r �r ....._. Law, and the Putnam County Sanitary Code. Very truly yours, Counters " igned: /K :.. P.E.,., # 49002 (Owner of Property) "A Mailing Address . 92 Perks Blvd. Cold Spring State NY Zip 10516 Telephone: 914/265 -9342 Mailing Address: 35 Tyler Rd.. Putnam 'Valley State NY Zip 10579 Telephone: 914/528-5977 Form LA -97 FROM Putnam Co. Health Dept. n, l H l th Sv' i f E ' v. o Rd. ea s LA RENCE �ELLUSC1® 1. E. 1.Geneva Rd. 9 Brewster, NY 10509 92- 13er6ts Blvd. LI Ph/Fax (845) 265 - 9342 °59 For Fax Attn: Adam Stiebeling, SUBJECT A. P. H. E. DATE Dear Mr. Stiebeling: Renewal of Permit # PV 20 -89 Weinberg, TM# 73.08 -1 -7 A formal waiver to the Putnam Co. Sanitary Code is hereby requsted for the above referenced because of the following conditions: a. Slope relief; waiving the current 15% maximum slope to 20% with the use of a dry stone (retaining') cut -off walla b. Allowing the use of plastic infiltrator chambers as per manfr. specifications and Putnam Co. regulations. The above waivers are necessary because of the limited area and should not impact negatively in any way with.the successful opera- tion of this system. Very truly yours, /Lau—" Lawrence Belluscio Incls: (1) (GEN -152) (1) Infltr Chmbr cut -sht, 4 pgs. D--- ; - - v%Teinbera`; „.A - L. G 1"-,. I TW IN,PILTRATOK Ch �mber High;lCapacity Model ,1► f� 16" <4 I, < Chamber End View °) 20° I 16" r. 1.11n C is 34" Note: ilp•.wert heights are based on the measurement from the bottom of the end 51 'e to the bottom of the inner 4 -0ch cutout 14' SDR 351 Cutouts ac- Chamber Side View r EXPANDEDSUPPLV OROWMAC. amoyR�oute 9 (914)0, 10516 r- au(91a)265-3M Closed E:j7d Plate comMf5iiate 4' SDR 35, 4' SDR 40, 4' SCH 40, or 4 corrugated pipe. Call Open End Plate lnfiltr4! Systems for technical service. y. :a SYSTEMS INC The4world leader in chamber technology`" 4t�usiness Park Road • P.O. Box 768 • Old Saybrook, CT. 06475 28 "; 800- 221 -4436 • 860 - 388 -6639 • Fax: 860-388-6810 t U.S. Pelergs:'5;759, 661: 5. 017. 041.5.156.4f16:5.336.017:5.401. 116:5.- 01..59.5. 511,903.5.506.776 Canadian Palenle 1. 329.959: 2.009.564 0lher ,ale perWmg 71 3 t Mralor Ewrrr. and SideWinder are regielerad Trade ks of InfAralor System- Ino, Contour. WroLeachng. PdyTu6. and SnapLock are lradernarks of Inl4hator Sysler- Irc. " C+ �` �+ • ,^�• j Product Information Nominal Chamber Specifications Size (WxLxH) 34 "x75hx 16" _ Invert* 11" _ Storage 122 gal/16.3 ft3 Weight 35 lb 4' SDR 35 pipe Product Benefits • Lightweight units offer easy assembly and installation. • Fully- louvered sidewall provides maximum infiltration. • Open chamber bottom allows additional infiltrative area. • High- density PolyTuff'" polyethylene construction guarantees strength and durability. 01999 Wdvalor Syvt Inc. Rimed m U.S .A C061299AG Eefore You Begin.. - fv�ate►iats arlJ cyu�prr�erii iqeeie`ii ' ' T. These guidelines must be followed when using'con- ❑ 2" Drywall Screws ❑ Shovel struction machinery on an Infiltrator installation site. ❑ Backhoe ❑ Small Valve -Cover ❑ Bull Dozer" Box' ❑ Large wheeled vehicles must never come in direct contact ❑ End Plates ❑ Splash Plates with chambers, especially if the soil has not been ❑ Glue ❑ Spray Paint (for mark- compacted.There must also be a 12" minimum of compact- ❑ Hole Saw /Router Bit ing the trench lines)" ed cover over the chambers. Chambers with this minimum ❑ Infiltrator Chambers ❑ Stakes (4)" covering can support an AASHTO H -10 load rating of ❑ Laser, Transit, or 4 -foot ❑ String Line* 16;000 lb /axle in all soils except sand. Level ❑ Tape Measure o Pipe and Couplings ❑ Threaded Cleanout ❑ Only drive across,the trenches when necessary. Never (4' in diameter for Assembly* drive down the length of them. the header, inlet, and ❑ To avoid additional soil compaction, never drive heavy inspection port) ` Optional vehicles over the completed system. ❑ Screw Gun This document is designed to provide installation Like conventional systems, the soil and site conditions must instructions for Standard and Nigh Capacity InfiltratorO be approved for installation in order to use chamber tech - chambers.These chambers may only be installed nology. Be sure that you or your local health official conduct according to state and local regulations. If you are not a thorough site evaluation and determine the proper sizing sure of the installation requirements for a particular site, of the system before proceeding with the installation. For more - __•. be sure to contact your state and local regulators. information, call Infiltrator Systems Inc. at 1- 800 - 221 -4436. Requirements for Excavating and Preparing the Site. Level the bottom of the trench. . Stake out the location of all trenches and lines. Set the elevations of the tank, piping, and trench bottom. Excavate and level 3 -foot wide trenches with proper center -to- center separation. Make sure the trenches are level or have the prescribed slope. .. - ;l'�?�.3.�bp G- 3���i£�., self^ 3� -.'*,iir•I�'iy�i�`v�.(.UPfeu°' .4... -._._ while excavating. Remove any large stones or other debris. Do not use the teeth of the bucket in lieu of raking to rip ,the trench bottom. NOTE: Raking to eliminate smearing is not necessary in sandy soils. Verify that the trench bottom is level using a transit, 4 -foot level, or laser. Requirements for Attaching the End Plates. Secure the open end plate connection with a screw. ow Screw in the 6" x 8" splash plate at the bottom of the open end plate so that it protrudes into the chamber. Secure the open end plate to the end of the chamber by inserting the tabs on one side of the plate into the slots located on the flange of the chamber. Hold these in place and firmly tap the other side of the end plate until it snaps into the locked position. In NU Optional: Insert 2" screws on either side of the inlet opening on the chamber flange. Tighten each screw until the end plate is firmly secured. Attach the closed end plate to the last chamber in the trench as described in step 2. Requirements for Installing the Chambers. J _.�.- ....� -. .._ y�` ♦ r .....� ��iA�{!CI {n.5i...�t K^.'i. '.f�"CPI'F�i�i lr -w ".: r^�� rS:.r:G�(•�:�'.�Y.�.,.. TyT .•yQI LInY�+`rfY1'f"V'"%i -Mr qP � . Check the header pipe to be sure that it is level. Set the inlet pipe invert at T/<" for Standard chambers. Engage the chamber interlocks by placing one. chamber onto another at a 45° angle. Pack down the fill by walking along the edges of the trench. ® Set the inlet pipe invert at the appropriate height from the bottom of the trench to the bottom of the inlet when installing Standard Infiltrator chambers. NOTE.• For Standard chambers; set the pipe invert at 7'41 ". When using High Capacity chambers, set the pipe invert at i1" ® Place the first chamber with the open end plate at the beginning of the trench. Insert the inlet pipe into the end of the chamber. The pipe will only go into the unit 1" before it reaches a stop. ® Check the first installed chamber to be sure that it is level or has the prescribed slope. 13 Secure the inlet pipe to the chamber with a screw at the 12 o'clock position. ® Lift and place the end of the next chamber onto the previous one at a 450 angle, lining up the notches on the center end of the chamber and lowering it to the ground to engage the patented interlocks. Continue interlocking the chambers until you have installed the correct number for that trench. The last cham- ber in the trench is typically the one with a closed end plate. As you install the chambers, verify that they are level or have the prescribed slope. RA. Fill the sidewall area, starting at the joints where . can cf?a t a�r:in #erlq ^ks_�n }h aaothen by, uIli[LQ -, �ie'sides o the trench with a shovel. Continue backfilling the remainder of the sidewall area. Be sure the fill covers the louvers. Pack down the fill by walking along the edges of the trench and chambers. This step is important in assuring correct structural support. M Proceed to the next trench and begin with step 1. Requirements for Installing the Inspection Ports. ® Using a hole saw or router, create an opening in the pre- marked area located in the center top of the chamber. Be sure to use a hole saw that matches the size and type of pipe that is being installed. ® Glue a 6" long piece of pipe into a coupling. ® Insert the 6" piece of pipe into the opening at the top of the chamber so the coupling sits on the chamber. M Insert another piece of pipe into the coupling and cut it at or above grade. ® Attach a cap or threaded cleanout assembly onto the protruding pipe. 13 A small valve -cover box may be used if the inspection port is below the desired grade. V. -a -.J Requirements for Covering the System. 4 Backfill the trenches. - 14sieFi: iiI— i:t -h16 & &teiU 09, V health official or other official as state and local laws may require.. Backfill the trench by pushing the cover onto the units. Keep a minimum of 12" of compacted cover over the chambers before driving over the system. NOTE: Do not drive over the system while backfilling in sand; since sand does not give adequate support in any septic system. It is best to leave several inches of soil above ground level to allow for settling. This ensures that runoff water is diverted away from the system. After the system is covered, the site should be seeded or sodded to prevent erosion. infiltrator Chamber System Limited Warranty. a. The structural integrity of each Infiltrator chamber and end cap, when installed in accordance with manufacturer's instructions, is warranted to the original purchaser against defective materials and workmanship for one year from the date of purchase. Should a defect appear within the warranty period, purchaser must inform Infiltrator Systems Inc. of the defect within fifteen (15) days. Infiltrator Systems will supply a replacement chamber and /or end cap. Infiltrator Systems' liability specifically excludes the cost of removal and /or installation of units. b. THE WARRANTY IN SUBPARAGRAPH (a) IS EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE CHAMBERS AND END CAPS, INCLUDING NO WARRANTIES OF MERCHANTABILITY OR OF FITNESS FOR A PARTICULAR PURPOSE. THE WARRANTY DOES NOT EXTEND TO INCIDENTAL, CONSEQUENTIAL, SPECIAL, OR INDIRECT DAMAGES. THE COMPANY SHALL NOT BE LIABLE FOR PENALTIES OR LIQUIDATED DAMAGES, INCLUDING LOSS OF PRODUCTION AND PROFITS, LABOR AND MATERIALS, OVERHEAD COSTS, OR OTHER LOSS OR EXPENSE INCURRED BY PURCHASER. SPECIFICALLY EXCLUDED FROM WARRANTY COVERAGE ARE DAMAGE TO THE UNITS DUE TO ORDINARY WEAR AND TEAR, ALTERATION, ACCIDENT, MISUSE, ABUSE, OR NEGLECT OF THE UNITS; THE UNITS BEING SUBJECTED TO STRESSES GREATER THAN THOSE PRESCRIBED IN THE INSTALLATION INSTRUCTIONS; THE PLACEMENT BY PURCHASER OF IMPROPER MATERIALS INTO THE PURCHASER'S SYSTEM; OR ANY OTHER EVENT NOT CAUSED BY THE COMPANY. FURTHERMORE, IN NO EVENT SHALL THE COMPANY BE RESPONSIBLE FOR ANY LOSS OR DAMAGE TO THE PURCHASER, THE UNITS, OR ANY THIRD PARTY RESULTING FROM ITS INSTALLATION OR SHIPMENT. PURCHASER SHALL BE SOLELY RESPONSIBLE FOR ENSURING THAT THE INSTALLATION OF THE SYSTEM IS COMPLETED IN ACCORDANCE WITH ALL APPLICABLE LAWS, CODES, RULES, AND REGULATIONS. c. NO REPRESENTATIVE OF THE COMPANY HAS THE AUTHORITY TO CHANGE THIS WARRANTY IN ANY MANNER WHATSOEVER, OR TO EXTEND THIS WARRANTY. NO WARRANTY APPLIES TO ANY PARTY OTHER THAN THE ORIGINAL PURCHASER. _ or gpecifi-c to grnna!wn,nn ._,e ,:mound, pressure- do- zp- d,-orsan_dy- soils "' "'�'affih'rili`r�tb'r- 5jrsteins I`ric. at 1- �(3b -�1 -4436 � � -�T ^w O SYSTEMS INC The world leader in chamber technology" P.O. Box 768, 4 Business Park Road Old Saybrook, CT 06475 800 - 221 -4436 860- 388 -6639 FAX 860- 388 -6810 www.infiltratoesystems.com Distributed By: EXPANDED SUPPLY PRODUCTS, INC. 3330 ROUTE 9 COLD SPRING, NY 10516 TEL (914) 265 -3771 FAX (914) 265 -3772 U.S. Patents: 4,759,661; 5,017,041; 5.156,488; 5,336,017; 5.401,116: 5,401,459; 5,511,903; 5,588,778; 5,716,163 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, and SideWinder are registered trademarks of Infiltrator Systems Inc. Contour, Microl-eaching, PolyTuff, SnapLock, and ChamberSpacer are trademarks of Infiltrator Systems Inc. 01999 Infiltrator Svstems Inc. Printed In i SA an9n7ooua__ BRUCE R. FOLEY .Public. Health- Dire c {or �.�r �. �ri. dY- f. l� +T'..i \.d3+e...:4�i�`-......v.. .q. •. -.fr 4T_`..�'i• _ LORETTA MOLINARI_ R.N., M.S.N. 35. i. i"lliiiiC !�¢Oftq eGlOr Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845)278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 September 6, 2000 Larry Belluscio, PE Perks Blvd. Cold Spring, New York 10516 Re: Proposed Construction Permit Weinberg, Tyler Road - (T) Putnam Valley, TM# 73.08 -1 -7 Dear Mr. Belluscio: Review of plans dated June 13, 2000 and other materials relative to a construction permit for the above captioned property has been completed by the Department. Based upon such review, and pursuant to the provisions of Article III of the Putnam County Sanitary Code, you are hereby advised that the proposed method providing water.s'upply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. __....� __Store cfthe F,ropo:;ed fi.S'rS area Waiver of current 15% maximum slope rule to allow regrading with ROB back to a. maximum scope of 20% with the use of a stone (retaining) cut of wall. • Use of "infiltrators." • Please provide manufacturers /suppliers cut sheet of design for infiltrators. Please submit a formal waiver request of the two above stated comments and complete the enclosed NYSDOH "Specific Waiver" Gen 152 form, general information section. - .. - .. . This project will be discussed at the September 12, 2000 specific waiver meting of this Department. If you have any questions, please call me at ext. 2157. Very truly yours, Adam B. Stiebeling Assistant Public. Health Engineer ABS:cj Encl. NYSDOH Gen. 152 vy, : RK STATE DEPARTMENT OF HEALTH f Community anitation and Food Protection _ 11; p Y -- ... _ etn�:.;�:�:�.spa_h�:.r�; air °alfii�'Appendtx75- A,10NYCFtR TS for Individual Household Sewage Treatment Systems _ ps'S tiW�a P- :•SP•.'l. Y/6a.`P�M harm of Applicant ''t ` .na. sweet c�rrro+ . sua yp Address 1' Site Location I. Reason why site does not meet tONYCRR.Appendix 75 -A (check appropriate box(es)): L Separation distance cannot be achieved. Excessive slope. � { High groundwater. Inadequate depth to bedrock or impermeable layer. j Soil unsuitable. ' i Other (explain) ....... _. ............................. _._ �_......_..___ _..__._.. _ .. .. ........................................... ..................._......__.._ _ _...___ .... _ _ _ ...._... _.. .............. _... ......... _ __M _ .._..._ __.....__....._..._ _ 2. Proposed design or,conditions of waiver: ( ...................... ....................... i ................_............. .... ....... _ ................. �- �. _., ._.........__ .__ _.__ ............._ 3. The proposed design may have the following limitations (check appropriate box(es)): increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. - Other (explain) ... ............................_............. �— _ ........................................ ............................... Additional information attached 'onstruction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with few York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver nay be revoked by the issuing official for a change in conditions for which this waiver was granted. AEPRES'cNTATIVE OF COM ?AtSS10N "cA OF H'cAt.Tli ORIGINAL - Local Health Agency COPY - Applicant/Design Professional DAT "c BRUCE I . R.L FTOLEY -r rC.`C!h: i�;,�•l %wn�r ..-. `Id.v �..O.Y f: �. 1. �. ?¢.M1.. .44.r .r May 8, 2000 DEPARTMENT OF , HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA IvJQLINARI. R,N:; M.S.N.: -- ° ?aoSttirWC . ttuuc "i�aiin "'Virrctor" Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Lawrence Belluscio Perks Blvd. Cold Spring, New York 10516 Re: Application to Construct a Subsurface Sewage Treatment System on Tyler Road, Weinberg ('T) Putnam Valley Dear Mr. Belluscio: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 26, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. Plans and applications must be pursuant to PCHD Policies and Procedures, Bulletin ST- 19, Revised 12/99. 1'rierevi'ew 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. Please be advised that failure to submit information to the Department or to follow procedures 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 (914)- 278 -6130 extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Encl. Entire Submission BRiJCE R: O EY ��ldutilic- Health Director July 13, 2000 DEPARTMENT OHEALTH Associate Public Health Director Director of Patient Services eneva oa Brewster,: New York. 10509 Environmental health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6,458 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax(845)278-6648 Larry Belluscio, PE Perks Blvd. Cold Spring, New York 10516 Re: Weinberg, Tyler Road TM# 73.08 -1 -7, (T) Putnam Valley Dear Mr. Belluscio: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 27,.2000 is complete. The Department will notify you by August 17, 2000 of its determination. E This office will discuss the required requested waivers at its next regularly scheduled specific waiver meeting on August 8, 2000. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj 03/11/2002 15:26 9147341029 TOWN OF CORTLANDT PAGE 01 PUTNAM COUNTY DEPARTMENT OF-HEALTH DIVISION 0?.k' �E RQNX �- .•t.. ✓. ,a. o. i c � �¢. �.- c < +� ., +•:• �._,� «r ..swain, r�avaA +Y'.•r +s.cl+a-n� T.- ..'w�[. p.... .. • -'�- .- ci• =`�6", •an? -..ry wtKu.. � wsr'.3�� ^ a= +.!yiW' � an�:.x�'�'v n�-v'� LETTER OF AUTHORIZATION RE: Property of P11 /4Li/o J�0ple Located at (S-o --Y9) Ski%r� �,v®oasrpr /�iy TN Tax Map # 73. os Block Lot Subdivision of _.�Z�Ll.,2 45,4671_x .r /ivy: Subdivision Lot # /d-/f-20 Filed Map # Date Filed 016 �sb Gentlemen: This letter is to authorize 57-E Pg�CA (T"_4F1k1+ a duly licensed Professional Engineer X_ or Registered Architect to apply for the required wastewater treatment and/or water supply perrnit(s) to serve.the above -noted property xn accori dance 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 rjcry behalf in connection with this matter and to supervise the construction of said wastewater &eiat6cat and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Saniteq Code. Very truly yours, Countersigned: P.E., R.A., # _ o 76 7933 Mailiug Address 1,o3 &" V-_ A-W Af r -F.9" State - C 7- Zip 0677,6 Telephone: Q Signed:.? 0,*er of Prop") Mailing Address: v� �'�� c5�• State �l Zip 1/3 7-� Telephone: 0 0 X31 Form LA -97 -�-�-• � -� ; ; ��, -�� ; -,�- -•�-• :., �,.���/,�- /°y��tf�l�o yrY�Alill�l'0 �ALTH .> ���-�, - �- �£��- ...•.,�.�.� � ��x y x F n Dltila� ditslral 8•ro0eei'Qz�e1. Al Y ^161?: jai 0118 OF 0O11�IJANCB iw F F 86WA DMOSAL SYM M CO >- i::►Y' rii�'�v'. •.-�'`�cL' �I '3/.+� f =.$�� � a.��.:y es .oZ.._�. a.�•a a+�.' .. � "J 1..:,.. _ .. _. o •d Nar Abut �11�.(3ElzZr Reasin;.t ftevial- P' -►its► a`i.�,: at Subdivision bpX_Ued Fee Enciosed � 4m*nttn*f Il)� rtr c� l . " A e � "? ;gym ead o,ab v Nntt+batr d Haiea•�a " Design bw G P D �a i PCHD No a diva 4IIeyahed Wheel Fnhb S•p�nfe.Swwnp Srb�-a •wit d icot) GG&M Teak 1 �� S '11a b• aai�IwsMd dy `A - Addtr,ap Wier Statpb • Ftrbda Std Fns Ad&vw OIL N•gae�e I Yepr•s•nt tMt 1 am wholly final compNUly nsponsib16 for the do% nand location of th• proposed system(s)s 1) that .the separate _saw •: tlis OYI system above OasaJbW will tN oonstrueted as shown on tM approved amendment these to and in accordance with the titandarps, rules an ,rpu s ns,o • FOR IM t oiinty ppertment of "ith, ana`tuit on eompNtbdtlia•of- a'•Certifkati of Construetian Compliance" satisfactory to the Commissioner of NMlthwiil 16' "Initirid te` tM Oiparlmait an0, a writtp ywran4ee will W, furnished tM own•► 'hirsuccessors. "irs or assipis by tM,twt1AN, tlwt pW Guilder will N pooA oiantina condition any,p 01 sakl sawa4• diapOfal sly tluri h• period of two;(i) "ywe.hnfn.bytehr followin/ tMOati;of tfN ipu- wor any repairs;tAantoi•i) that,the dri11ed.well.dasorM" allow w:._with the. st s, `rules and ►pu aiWns of the Putnam O. O.E. R:A. Lierinse Unless construction of the`buildiny ,has bean 'undertaken and is missioner 'of Health.. Any. change or alt anon of construction to watOf supply only. °DO^ Title m 7A HL4=' PUTNAM lasu siri�a; b1i" xx., (210 AGE 'N A CMW Licans a in of the buildino I i 'filth. Any change or only. Rev. * 10/88 onto of Hoofth will bulkier will to a# the imap Bar ibw above the' Putnam —P..E.— R.A. No 9J3731 a bw m undertaken and is alteration of construction ml ... , . , .. , .. ... .. . «:, ,_ ,:�;; ^, rt ups �:;",x` • � DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (� (914) 278 -6130 At- ��. �.-. ,�::�'`°""'"'"fiiS7C%�f�:t:►"�` PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number Y-' 0�.2 C4- _ �N-W'ikvA V P! k-1 3_ u -1- WELL OWNER Name Mailing Address - W r �� 4E2(r ►- fL iz aTrivate O Public USE OF WELL 1 - primary 2- secondary GlkiSIDENTIAL O PUBLIC SUPPLY O BUSINESS O FARM O INDUSTRIAL b INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT Ova gpm /# PEOPLE SERVED .. �k /EST. OF DAILY USAGE Oo7 gal C_7 tREPLACE EXISTING SUPPLY O TEST /OBSERVATION D ADDITIONAL SUPPLY 614M SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL .0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: FM 551 Lot No. WATER WELL CONTRACTOR: Name 6e Ol+�:�e� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: IJ��} TOWN /VIL /CITY .. 114T 'Pi.',Tp PROPERTY FROM NEAREST.- WATER 11.1L4IN: _Al LOCATION SKETCH §,SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt, (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action.to assure that any and all water or waste products from such well drilli opera er tions be contained on this property and in su h a manner as not to.degrade or othw s ,contaminate surface or groundwater. /� Date of Issue: rl 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 P_,v► APPLICATION TO CrOFiIJCT�pi PCHD PERMIT # WELL LOCATION Street Addr ss own Vill a City Tax Grid Number WELL OWNER Name o' W'.Q \'.e4 j Mailing Address U 3 S` `-,A Liz(?_ Rv - GWrivate O Public USE OF WELL 1 - primary 2 - secondary GvviSIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY E] ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT- (),dj,,tgpm /# PEOPLE SERVED- /EST. OF DAILY USAGE�ffil ® REPLACE EXISTING SUPPLY O TEST/ OBSERVATION E2 ADDITIONAL SUPPLY 009-E W SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN ®DUG O GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES :" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: FM SS Lot No. )�, 1j,2o WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: P P" TOWN /VIL /CITY ... 1�w: - +w TO wnr.wra�r 27 _� u /'LIL'•A•ry L +nm T]AT 9. . ?&. F: I: Lwk 1.4 LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED 4N SEPARATE SHEET (da e (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;• (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such manner as not to degrade or other /i contamina urface or groundwater. Date of Issue: 3 19 '?3 / Date of Expiration 19 71 Permit Issuing Official Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 :L1r pLl 'oi..�.a ... }y ..... .... .... .... ��P ., _. .. ...,... .. , w.a...�,no �:a ::s+.tii•r :wtir.....:w::. �.rv.� w;s� .... .r:,, CATION fd CONS.TRUCTWA WATER�r WELL `. Prue PRRMTT A WELL LOCATION Street Address Town Villag Cit Tax Grid Number —� �f R Rkt t_i �, -1 73-OS-1-7 WELL OWNER Name. Mailing Address ® S y"` L16a {2 / l h4kk VAIPS Y rivate D Public USE OF WELL l.- primary 2 - secondary O'i;fSIDENTIAL D BUSINESS 0 INDUSTRIAL D PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM Q TEST /OBSERVATION b INSTITUTIONAL ❑ STAND -BY O ABANDONED 0 OTHER (specify Q AMOUNT OF USE YIELD SOUGHTB ? $ gpm /# PEOPLE . SERVED_ /EST . OF DAILY USAGE 6� Sal = CE EXISTING SUPPLY 13 TEST /OBSERVATION D: ADDITIONAL SUPPLY SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED -REASON FOR DRILLING WELL TYPE DRILLED D DRIVEN aDUG O GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ''-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: • -VIA 5) i Lot No. 155, 1q, Zo WATER WELL CONTRACTOR: Name °� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: jS ) TOWN /VIL /CITY pnnvwiT-Y FROM :P - "DW_T :? 0 "ER- MA-11; LOCAT ON SKETCH & RCES OF CONTAMINATION ON SEPARATE SHEET C r (da e) 0 PROVIDED / (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt }� (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: Date of Expirati`ion 19_f—;Z Permit Issuing Official Permit is Non- Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services WELL LOCATION 110 OLD ROUTE�SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 tiYpLICi�iTY~O1V -rr CONSTRUCT A WATER E WELL PCHD PERMIT # r IS WELL SITE SUBJECT TO FLOODING.? YES �O IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Md � ar tr Lot No.. WATER WELL CONTRACTOR: Name 'o t Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �O NAME OF PUBLIC WATER SUPPLY:- � �� TOWN /VIL /CITY DISTANCE TO PKUPERT1 FROM NEAREST WATER MAIN: LOCATION SKETCH & RCES OF CONTAMINATION PROVIDED .- N SEPARATE SHEET k (d to (s nature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted L1114er the provisions of 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 s.hall- 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with -the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form pr vided by the Pu am County t Health Department. Date of Issue: — 190 Date of Expiration: P- 19�� Permit suing i Permit is Non - Transferrable �� �PY� H.Do File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller 1 Street A Wdss T wn Villa a ty Tax Grid Number WELL OWNER Name Mailing . Addres ,�// r vats "zed Ta, g� 5� � 0Public USE OF WELL 1 - primary 2 - secondary SIDENTIAL O BUSINESS 13 INDUSTRIAL 10 PUBLIC SUPPLY QAIR /COND /HEAT PUMP ®ABANDONED 0 FARM p TEST /OBSERVATION 0 OTHER (specify O INSTITUTIONAL ® STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /�� PEOPLE SERVED_ /EST. OF DAILY USAGE �0V gal 0 REPLACE EXISTING SUPPLY O TEST /OBSERVATION L7 ADDITIONAL SUPPLY L4W SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR •DRILLING WELL TYPE ILLED DRIVEN E]DUG ®GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING.? YES �O IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Md � ar tr Lot No.. WATER WELL CONTRACTOR: Name 'o t Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �O NAME OF PUBLIC WATER SUPPLY:- � �� TOWN /VIL /CITY DISTANCE TO PKUPERT1 FROM NEAREST WATER MAIN: LOCATION SKETCH & RCES OF CONTAMINATION PROVIDED .- N SEPARATE SHEET k (d to (s nature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted L1114er the provisions of 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 s.hall- 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with -the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form pr vided by the Pu am County t Health Department. Date of Issue: — 190 Date of Expiration: P- 19�� Permit suing i Permit is Non - Transferrable �� �PY� H.Do File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRON- NIPWAL HIP .LTI•I SERVICES - I'�D. W.!. ^.'. .roa '�u.�. - `2'� -.. c#R.i..K ^.'.- ~:f4GSm. �.w.gTl,e wee- e.. =..ter .e- .•i S1:: ,..s ~�JP -.a... _l_�iwai .� a �iRT .r .�i.-+fi •.icy �"u..w. .-.. r_,. K <s.r" •.• �� � •.fawn -.n. •fi Date �,23,��5 u• ''� Property of A-V ob W Ci1J33jF:2g Located at (.T)_FtXPPrOA yALLFf Section `J 3_ p Block 1 Lot. "t ;Subdivision of IF M 551 -Subdv. Lot # i5, IJ 2.0 filed Map # S$1 Date Gentlemen: This letter is to authorize a duly;licensed professional engineer or registered architect (Indicate •t:i.on Permit for a separate sewage system, to to apply for a Construe serve the above noted property in accordan.e with the standards, rules or'regulations as promulagated by the Comu:;.ssioner of the Putnam.County F: ':''Dep'artment of )Jealth, and to sign all necessary papers on my behalf in ac,Q nection with this matter and to supervise the construction of said ;1 7, Education Law, the Public Health Law, and•the Putnam County Sani-tary Code. Very tru'y yours, A Signed_ " �ner of Property Countersigned: / �pJ y ` Address Addr e s's T . own 7�5 -103 1. 1 phone Telephone . s , �42 _ V _ .,vgxs •.�p::�.: mKE�sw- w:�>r4-r:�w*e...x: i+y!w ?r, .wrron.� Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 1.0509 (914) 278 -6130 September 26, 1995 Fred Zenz 292 Main Street Nelsonville, NY 10516 Re: Proposed SSDS: Weinberg Tyler Road (T) Putnam Valley Dear Mr. Zenz: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. Plan is to note all erosion control measures are to be installed prior to the start of any construction. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer RM /jp ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES '��- �- %:�%Aii: ;:.Stiax:A �r�:; :. F�- r..+w::.j�``.� a'x :a-:w. o __ _ .: �;.i:��i r ,.A':, ...i,�r � -.r. .. r�:i:.:�i�;: a:�- .:.,.... -:�.•.:.'is'�.'•..,'�',e �8': ;w."i�. �:' . �,.. .. � ,..,�.:. Date �Z3 !q3 Re: Property of D/+,1 1 ts W E)V-- 1gIf(Z(,- Located at '35- �F -R (T) '?J, Section '13_Q$ Block Lot Subdivision of F 5_5 Subdv. Lot # L114 Filed Map # SSA Date Gentlemen: This letter is to authorize �- ZFYyZ a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate 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 G'.;«.._._ `. � «,,�`SgfS���l l'_'c�2';,. a ''V;St:aR7��'..iiz__��,�;ifnrm' tji..ew i,.�:�SSs- .1FtF•� v��lr_- �2.�.SL�- ••.'J � i�i't;�,v't.0 .i`: j`-'�.<�- •= _ «.. «....�..:,� 147, Education Law, the Public .Health Law, and'the Putnam County Sani- tary Code. Countersigned: P.E. Address ►���Se nav � �c F_, 1J �(_ � os16 Telephone Very truly yours, Signed _1 caner of Property • Address .1421JC6 I Town - —,-- L6 ZL Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONNIENTAT, I-1EAIT1;1 Date 2g /4 Re: Property of t> 4-11, e: 10 � 6N� -T, Located at (T)_ Section �� Bl o c k. Lot Subdivision of F- %4A "Ilk Subdv. Lot %1�14 Filed Map # S'51 Date Gentlemen: This letter is to authorize 9F L P4 24-e- a duly-licensed -professional engineer v----or registered architect (Indicate) to apply for a Construction,'Permit for a separate 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 b*eh'lf in c ' onnection with this.: matter and to system or systems in conformity with the " p r vi ii-, 0 Qns of Article 14*5 or 147, Education Law, the Public Health Law, and the Putnam County ty Sani- tary Code. Very truly yours•, Signed Countersigned: P. E. CA Address eA5 Telephone Telephone Located at -Tyl-F-a (T) Section— Block Lot a. V Subdivision of )q 2L) W50 .Subdv. Lot jLfL Filed Map Date f4 Gentlemen: This letter is to authorize a duly licensed professional engineer �r registered architect (.Indicate)' to apply for a Construction Permit for -a*separate.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 i•n .connection with this matter and to supervise the construction of said conformity with the provisions of Article 145 or 147, Education Law, the.Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: P E . �%173 C ISO Address YO K 10 12- ly Address Town Qe•k5 v t Telephone 410- 0•-(1'19 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 12, Re: Prope rty of--Ro-^'.�k Located at -Tyl-F-a (T) Section— Block Lot a. V Subdivision of )q 2L) W50 .Subdv. Lot jLfL Filed Map Date f4 Gentlemen: This letter is to authorize a duly licensed professional engineer �r registered architect (.Indicate)' to apply for a Construction Permit for -a*separate.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 i•n .connection with this matter and to supervise the construction of said conformity with the provisions of Article 145 or 147, Education Law, the.Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: P E . �%173 C ISO Address YO K 10 12- ly Address Town Qe•k5 v t Telephone 410- 0•-(1'19 Telephone WCOINRIAMV-221 �AWMZOMO SITE I=TION MAILING ADORES$ ee PLMM COUNTY HEALTIJ DEPARTS o DIVISION OF ENVIRONMENIAL HEALTH SERVICES 2257-0310 360n. z IN# y— PERSON INTERVIEWED PCHD Caqplaint Name & Relationship (-e, ownerlterianti. etc.) DATE _-(.7eW/-0 TYPE FACILITY. PROPOSED INS PHONE pr � (include scOch locati ng all,adjac ent wells) NOTE: Repair must Win same location and of same type as original.sewage disposal system. K.7 Different location may require submittal of proposal from licensed professional engineer or registered architect. F- 7- V V:7�. . 10& R V—' . i L V) WC-1 POP <-e6,4M-r kc—k WtUX -ells 17 r le e 1AAr- Proposal approved Proposal Disapproved Inspector's Signature & Title Date Proposal approved with the followinq conditions: 1. Procurement of any Town p-&-mit, if applicable. 20 Submission of as built repair sketch in duplicate showing: a. Owner's name. - b. Site Street Name, Town and Tax Map number. c. Location of installed ccmponents tied to two fixed points d. System description (e.g., 1250.gal. concrete septic tank, drywells surrounded by one foot + gravpl). e. Installer's name and number. (e.g.,house'corners). three precast 61 diam. x 61 deep 3. System repair to be performed in accordance with the above proposal and conditions. I,, as SIGNAT PIPS: Vbite (MV; YeUcw Mm HE); Pirk (Applicant) V the above conditions. TITLE MM L VA, POP <-e6,4M-r kc—k WtUX -ells 17 r le e 1AAr- Proposal approved Proposal Disapproved Inspector's Signature & Title Date Proposal approved with the followinq conditions: 1. Procurement of any Town p-&-mit, if applicable. 20 Submission of as built repair sketch in duplicate showing: a. Owner's name. - b. Site Street Name, Town and Tax Map number. c. Location of installed ccmponents tied to two fixed points d. System description (e.g., 1250.gal. concrete septic tank, drywells surrounded by one foot + gravpl). e. Installer's name and number. (e.g.,house'corners). three precast 61 diam. x 61 deep 3. System repair to be performed in accordance with the above proposal and conditions. I,, as SIGNAT PIPS: Vbite (MV; YeUcw Mm HE); Pirk (Applicant) V the above conditions. TITLE MM m D < 0 C3 ry 0 �0 727• AS-BUILT DIMENSIONS B 1 28'-8" 46'-0" FA 2 36'-8" 51'-4" 44'-10" 57'-8" 4 53'-4" 64'-10" 5 62' -0" 72' -6" 6 41 -8" 27'-10" 7 47' -6" 36'-4" 8 54'-0" 44'-10" 9 61' -4" 53'- 6 " .. 10 6 7'-,g 61'-C 11 40'-6" 23'-0" 12 18' -0" 18' -6" C 1) D _ /V-66 6 8.9 iNAP N 4 5 0,Y 60.91, i 13 2 3= 4= THIS IS TO INDICATED 0! IT WAS COVE STANDARD R) AND THE NE .v54 4