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03417
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POU"COUMDRAMMOF
N.Y. AS12
MCEM
P,
WOR 59WAGE.PMOSA;.STUM,
0
Wta
APPROVE
iwOCabie
R6v,.
for the deiign uW,,loutiort:, of the; ;proposed
ICa, beta 7j of " "tM ijifial'iyo
app►ovid Plan and that i:id welt wilt W led 'do
instal in. &C'
�j WOO
Tit
%
lid tiuIW4i'.%Vl.Il
ite of the Isam.
iavtt►ad above
the Putnam
!ertaken and-it
if construct Ion
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
e
WELL COMPLETION REPORT
Well Location
Street Address:
Town/Village:
Tax Map #
Depth Date
Measure from land surface-static (specify RI
40
Depth of completed w=en
q-
Map-3./ lock Lot(s)'24
Well Log
If more detailed
information
de -sdtij
sieve analyses
are available,
please attach.
Depth From Surface
Well Owner:
Name: U Address:
Formation Description
�)) 4
ft.
Land Surfa6e
Use of Well:
-�} esidential Public Supply Air cond/heat pump _IrrigatioAlli,
1- Primary
i'ify)
Business Farm Test/monitoring —Other(sp eic
l.. -
2-Secondary
Industrial Institutional Standby
Drilling Equipment
R/otary _Cable percussion Compressed air percussion _Other(specify)
Well Type
Screened V/Open end casing Open hole in bedrock Other
Total Length At 0 ft.
Materials: Steel Plastic Other
Casing Details
Length below grade _ft.
Joints: Welded ✓ Threaded Other
Seal: dement grout _Bentonite Other
Diameter in.
Weight per foot lb/ft
Drive shoe: —Yes ✓I o
I Liner: Yes _L_/No
i
I Diameter in
Slot Size
I Length (ft)
Dept to Screen (ft) JDeveloped?i
Screen Details First
—Yes —No
Hours
Well Yield Test
—Bailed _Pumped _compressed Air
Hours -7 f
Yield 7 — gpm
Depth Date
Measure from land surface-static (specify RI
During yield test (n)
Depth of completed w=en
q-
Well Log
If more detailed
information
de -sdtij
sieve analyses
are available,
please attach.
Depth From Surface
Water Bearing
Well Diameter
in
Formation Description
ft. ,
ft.
Land Surfa6e
L
-
l.. -
If yield was tested
at different depths
during drilling
list:
ns Per Minute Pump/Storage Tank Information
Pump Type L6_6 NA �4t Capacity — -jr-
Depth !4po• Model 5707-/9
Voltage X30 Hp��
Tank TvDe Lv y ac-v Volume _sue
hbkVivl- M., P-7 .m R
'NOTE: Exact Lbcation of well with distances to at least two permanent landmarks to/be provided on a separate sheet/plan.
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC-97
Rev. 3/06
z 'yi
d wl I ids `4 ► k�
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
]PCHD CONSTRUCTRON PERMIT # 5
Located at Town or Village
Owner /Applicant Name �Ol�//1� -�` °s Tax Map 73./7 Block % Lot
Gov' CTS
Formerl -3 ,,.,vcud u,,K, �� s ��1 n, 4 w-, to s-& 2 Subdivision Name
Subd. Lot #
Mailing Address � � O 5'sr�✓j��' Zip /Q S-i� Z
Date Construction Permit Issued by PCHD
Separate Sewerage System built by TO4 Ca>t x cam/ Address
Consisting of Gallon Septic Tank and Zh' *wW4 Z 'J1N1- J,6'tLDS'
4-0 0 6 -l"OL ask- � Des-7z • 6 d x
Other Requirements: 2 A- a1. 'Iwor-f r&a 40 Win- S I- e f
Water San ® ®9w: Public Supply From.
Address.
or: V Private Supply Drilled by &IoAm L,v ANQ A4i U J Address /S -z 4i¢ t 61--4 S
= B�aad }ng-T3 r Has erosion control�been <completed? �y'S"� _ .... _ , I
Number of Bedrooms 3 Has garbage grinder been installed?
.4/0
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 regulatio the Putn County Department of Health.
Date: tLq ®Certified by P.E. I.A.
(Design Professional)
Address ��0 (�lC !0y � w /L�o ,4 C?— 0X77 _License # `�i 7 �3
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
lecopy , modification or change is necessary.
01 Title: �!'� Date: ��
—a
- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245 -2800 ._
ert H': Padova7r�; "fi?i:'rect'or""
LAB #: 1.506485 CLIENT #: 2173 NON STAT-PROC PAGE: 1 of-2
NORMAN ANDERSON INC. DATE /TIME TAKEN: 09/20/05
152 BARGER ST DATE /TIME RECD: 09/20/05 02:50
PUTNAM VALLEY, NY 10579 REPORT DATE: 12/06/07
PHONE: (914)- 528 -1491
SAMPLING SITE: EDWARDS
52 LUIGI ROAD
COLD BY: SARAH ANDERSON
NOTES:..: KITCHEN TAP
DATE FLAG PROCEDURE
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE...: < 4C
COLIFORM METH: MF
----------------------- -- ;--------- - - - ---
RESULT
PUTNAM
CNTY PROFILE
09/20/05
MF T. COLIFORM
ABSENT
/100 ML
09/27/05
LEAD (IMS)
<1.0
ppb
09/22/05
NITRATE NITROG
1.94
MG /L
09/22/05
NITRITE NITROG
<0.01
MG /L
09/22/05
IRON (Fe)
<0.060
MG /L
09/28/05_
MANGANESE (Mn)
<0.010
MG /L
09/28/05
. SODIUM '(Na)
19.7
MG /L
09/21/05
pH
6.0
UNITS
09/26/05
HARDNESS,TOTAL
101
MG /L
09/27/05
ALKALINITY (AS
42.0
MG /L
09/26/05
TURBIDITY (TUR
<1
NTU
NORMAL - RANGE
ABSENT
0 -15 ppb
0 - 10
1.0 MG /L
0 -0.3 mg /1
0 -0.3 mg /l
N/A
6.5 -8.5
N/A
N/A
0 -5 NTU
METHOD
SM 18 -20 9222B
SM 18 -19 31133
SM18- 20450ONO3
SM18- 20450ONO2
SM 18 -20 3111B
SM 18 -20 3111B
SM 18 =20 3111B
SM18 -20 4500HB
SM 18 -20 2340C
SM 18 -20 2320B
SM 18 (2130B)
..�. _.. s. >...o_w . +• .-• .- .... .. - ... > , ..rte ....- .s..w..,......ti. .. .. . - - -_ _ i . ..- --
COMMENTS:
MFTC THESE RESULTS INDICATE THAT THE WATER 0-�ODTHE WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDI NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED,;AT THE TIME OF COLLECTION.
Pb /Cu LEAD limits for p
EPA Lead & Copper
than 100 of their
than 15 ppb and a
treatment must be
potential.
ablic schools are set at 15 ppb.
Rule for Public Systems requires that no more
distribution points have a LEAD value of more
COPPER value of 1.3 mg /L, else water
undertaken to reduce the waters corrosive
Fe /Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg /L.
Na No limits for.Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg /L of Sodium. For those on a
moderately restricted diet, a maximum of 270. mg /L of Sodium
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
„245 �a 00.
Albert• H . Padovani Director
LAB #: 1.506485 CLIENT #: 2173 NON STAT PROC PAGE: 2 of 2
NORMAN ANDERSON INC.
152.BARGER ST
PUTNAM VALLEY, NY. 10579
SAMPLING SITE: EDWARDS
: 52 LUIGI ROAD
COLD BY: SARAH ANDERSON
NOTES...: KITCHEN TAP
DATE FLAG PROCEDURE
is suggested.
DATE /TIME TAKEN: 09/20/05
DATE /TIME REC'D: 09/20/05 02:50
REPORT DATE: 12/06/07
PHONE: (914)- 528 -1491
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..:-<-.4C
COLIFORM METH: MF
RESULT NORMAL - RANGE METHOD
pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5.
Hd 'TOTAL'HARDNESS IS DEFINED AS THE SUM-OF THE-CALCIUM & MAGNESIUM
CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE
HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE
SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L
.;MODE-RAT-ELY HARD. WATER.-:, 70-140 MG /L MG/L;,= MILLIGRAM PER LITER. :. .
'HARD
,1
SUBMITTED BY:
Albert 3' Padovani, M.T.(ASCP)
Director
ELAP# 10323
t,
Dee 11 07 02:15p BUILDING DEPT
i
9145268806
=- •.SY.. THIS — CEIVT- IFICATd'
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET — NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of
NABER ELEC. INC.
5 SCHUMAN RD
MILLWOOD, NY 10546,
Located at 46 LUIGI RD PUTNAM VALLEY, NY 10579
Application Number:- 2060371
upon premises owned by
JOA CONTRACTING CORP
46 LUIGI RD
PUTNAM VALLEY, NY 10579
Certificate Number: 2060371
p.1
,Section:; .. 00.73. Block:,... • 1.:. Lot: :.24,..; Building Permit: 2004-473 BDC: W106
Described as a Residentia1600 -1199 squareft. .occupancy, wherein the premises electrical system consisting of
electrical devices and wiring,'described below, located Won the 'premises at:
Basement, Attached Garage, Outside,
A visual inspection of the premises .electrical.system,..limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the . applicable code and /or standard
promulgated by the State of New York, Department of-State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in• compliance therewith on the 21st Day of 'November, 2007.
Name OTY Rate atin Circuit Tvoe
CONTROL # 817 -05
MODULAR HOME..: ;
EXTRA VISIT
Alarm and Emergency Equipment
Sensor 2 0 Smoke .
Appliances and Accessories,
Furnace 1 0 BOILER Oil
Pump Motor 1.0 SEPTIC F.H.P.
Panels
1 200 40
1 100 4
Wiring and Devices
Fixture 11 0 Incandescent
Receptacle 3 0 General Purpose
Switch 4 0 General Purpose
Receptacle 1 0 GFCI seal
Switch 1 0 WELL Motor Control
Continued on Next Page . , 1 . of X
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
A
Dec 1 1 07 02:15p BUILDING DEPT 9145268806 p.2
5 ISY 1" d -hrid,a-ro ur lAi as -,
5 NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF' . ELECTRICBTY
40 FULTON STREET NEW YORK, NY 10038.
S CERTIFIES THAT
Upon the application of
NABER ELECANC.
5 SCHUMAN RD
MILLWOOD, NY 10546,
Located at 46 LUIGI RD PUTNAM VALLEY, NY 10579
Application Nutter: ` 2060371
upon premises owned by
JOA WNTRACTlNG CORP.
46 LUIGI RD
PUTNAM VALLEY, NY 10579
Certificate H6M' b P: 2060371
Section:.:. 00.73, Block: 1 Lot 24 Building Permit: .2004-473 BDC: W106
Described as a Residential 600 -1199 square ti. occupancy, wherein the premises electrical system consisting of
electrical devices and wirinj,`described below; located in /on the premises at
Basement, Attached Garage, Outside,
A visual inspection of the premises electrical system, limited.to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and /or standard
promulgated by the State of New York, Department;.of. State., Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 21st Day of November, 2007.
1� QTY -Bate- - .. Cucuit ...T .. . .
Arc Fault Circuit Interrupter 3 0 `15 A
Disconnect 1 0 SEPTIC Motor Control
Motor Control Center 1 0 SEPTIC Special
Service
1 Phase 3W Service Rating - Amperes..
Service Disconnect: 1 200 CB
Meters: 1
Defects previously reported, as items of non - compliance, have been corrected. A visual inspection made of the exposed electrical equipment in
the premises indicated found no obvious unsatisfactory condition.
seal
r
2 of 2
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the, location indicated.
PUTNAM COUNTY DEPARTMENT OF HEALTH
PA)IgPN�WKP�,�WRONMENTAL-.HEALTIL.V] liC S
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
�Ownje, Purchaser of Building Tax Map Block Lot
Building Constructed by TownfVillage
Location -Street Subdivision Name
Building Type Subdivision Lot
I represent that I am wholly and completely responsible sible for the location, workmanship,. material,
construction and drainage of the sewage treatment system serving the above,-described property, and
that is has been'-constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
e.
herebyguarantd,to the..owner, his..successors, heirs or assigns, to place in good operating condition
any part, of said system constructed by me which fails to operate for a period of two *
years
immediately following the date of approval of the "Certificate of Construction Compliance!' for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system__
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligeni , t . act of the occupant of the building utilizing the
system.
Dated: Mo /2-- Day 1'r Year
Genej&ktontracto
Ww_neq ignature
Corporation Name (if corporation)
Address:,
State - CSXAI,44 zip le
Signature:
Title: O-AIA94-
Corporation Name (if corporation)
Address: .
State —zip
Form OS-97
JAN -04 -2008 03:05PM FROM - ENVIRONMENTAL HEALTH
SHERL,H'YA AMLER, IUD. MS, FAAP
Commissioner of Health
LORE Y 1A. MOLLrII1 ARI, RN, 19 SN
Associate Commissioner of Health
8452787821 T -211 P.001 /001 F -878
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
E911 ADDRESS VERMC&TJON FORM
OV!rT]ERIS NAME. J � /� 6rkT -X&af W '
TAX N1JM BIER: ?3,
E911 ADDRESS: �� L W4/ 41+0
TOWN: A , 4-I &C "
AUTHORIZED TOWN OMCXAL:
DATE:
R®ISERT l !gONDI
County Executtve
ROBERT MORRIS, PE
Director of Environmental Realrh
The Putnam County Department of Health will not issue a Certiflcate 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 Construetiion Compliance.
1E911 addressverification
Environmental Health (845) 218 -6130 Fax (845) 298 -7921
r water Supply Section (845) 335 -5186 Fex (845) 335.5418
Nursing Services (845) 278 -6558 Fix (945) °78.6026 w8C (R15) 078.6678
Nursing Homr Cairn Fax (845) 278.6085
PUTNAWCOUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address:
Town/Village:
Tax Map #
GPyS, y
AL4Xd1ejMap~
!' lock Lot(s)
Well Owner:
Name: Address:
L�
nn el
Use of Well:
Public Supply Air cond /heat pump _Irrigatio
1- Primary
_�-_kesidential
Business Farm Test/monitoring —Other(specify)
2- Secondary
Industrial Institutional Standby
Drilling Equipment
Rotary _Cable percussion _Compressed air percussion _Other(specify)
Well Type
_Screened Open end casing _ Open hole in bedrock _Other
Casing Details
Total Length At C' ft.
Length below grade -ft.
Materials: Steel Plastic Other
Joints: Welded ✓ Threaded Other
Seal: ement grout Bentonite Other
Diameter in.
Drive shoe: Yes +- N'o"
Liner: _Yes No
Weight per foot /' lb/ft
Diameter (in)
Slot Size
Length ft
Dept to Screen ft
Develo ed?
First
_Yes _No
Screen Details
Second
Hours
Well Yield-Test "
.... Bailed _Pumped _I /Eompressed Air
Hours-7 - lYield
-7-" - • .gpm
Depth Date
Measure from an surface - static (specify ft
During yield test ►
ept o complete we n
Well Log
Depth From Surface
Well Diameter
If more detailed
ft.
ft.
Water Bearing
in
Formation Description
information, .: •
Land_Surfgce
_... " .
_, p U2_4- b if
yv
•_
rJ " _ "
i
descriptions or
sieve analyses
are available,
please attach.
If yield was tested
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type - L, 6 yw4 i.Capacity
Depth i Uo- Model 5$07 -1$
Voltage X`30 HP 3 &t- —
Tank Type WY a-TO Volume
at different depths
during drilling
list:
Date WeII�Completed F
i)• h .i<K x
Well'DrilleryPgCCertificate# + /�"
3 d 4'4". .A A.. F 'i..Y �" $ 3 k t V�&� p' '.. A� '.
R N 3"',�'". ,3.
umnstallePCCert(ficate #'J�` o tv
ate # /•';.,p:
.p y+ );� r4 'F i±� ( 3 ....
' f
NYSt to e #4F / "�?,��
;Dateof'
i ...
�F�
Well'D '11-,r*'
8�`Address, „” k g}� # "��
a�•��y- 0.�` Y \' "S1T 'Q'. Y b id I i
��` s,...I +ll
jif i:'- 41Address.
gg
Pry ?:�w` 3�•"X,j 4e�"� k, S -:B �'��'" 2. .It. >, ��I: ij% � 't:,M�
gg'E Y'{[ j Ts'• � a N fl�� �y� t � � y
e+K.a$ •x. a'.'SYe`6." w ra:b fiu'L iww". «e�.. aL: , u'.bm 1:3� axe^..�ar"�i"i :t".':$MN^ x N'ARAY+ -n. iR ''x� .' .+riG u'i
Wy eIlDrlller (stgnature)y,,
�'..: "{ �: X '." F nR
�, a r�
P u rlriistaller,'Na
pf�C� `S a0..F I � �``..�I:F�3.,
PumInstaller,('signafure)t a x�
}t
:f �
�, i
'��`n'. by b'�,.W'r:A,.
NOTE: Exact Location of well with distances to at least two permanent landmarks to/be provided on a separate sheet/plan.
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
Rev. 3/06
AM MUNTY DEPARTMENT OF HEALTFI_ .._:_.._. _.
:i ML ACTIVITY REPORT
NAMF! _l!.___._........
L�1)P
lVAM
State
Zip
TEtT
IS 4
v
... _ PUTNAM COUNT — DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION
COSEPH
REQUEST FOR FINAL INSPECTION
All information must be fully completed prior to any
inspections 'being made.
- -T(6
GENE
For: Fill
Trenches
PCHD Construction Permit # I r,
Located: dui /(1Ah (T) (V) i v-rN 'l V t4
Owner /Applicant Name: A &1wT iia -e•rr vef TM 72,17 Block I Lot
Formerly: Subdivision Naive:
Subdivision Lot #
Is system fill. completed? S Date:.
Is system complete? yIts Date: c�
Is system constructed as per plans?
Is well drilled ? Date:
Is well located as per plans? r
Are erosion control measures in place?
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified .their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
So y - lt�% ...,
Date: $�f S46 Certified by: PE _ RA - -
Design Pro essional
Address: -D. 6ofi W7 C7q;o 776Lic. # 0707
Comments:
Form FIR =99
r
LAOT 41�11►r r0 a� FIT D1 1 MIT ;,INN71IID1 4 M10191aIImIF WR I aIr ii �
loll 1,111
CONSTRUCTION PERMffT FOR SEWAGE, TREATMENT SYSTEN
PEII{IT # _f W -7./,_ f og -- 9 G )
Located at 1 uc,- !� > :i��- s- Town or Village
Subdivision name
Subd. Lot # Tax Map 7-4.17 Block i Lot ;�: 4-
Date Subdivision Approved Renewal _k<� Revision
Owner /Applicant Name ; J e A "7 �i- /� »G��i Date of Previous Approval
Mailing Address ; � / G' r
Zip/�
Amount of Fee Enclosed 4 ee
Building Type i t e' Lot Area `-yl6 a
No. of Bedrooms 3 Design Flow GPD 4 &
FiB Section Only Depth V ®lnnme
PCHD NOTIFICATION IS RE UIRED WIZEN FILL IS COMPLETED
Separate Sewerage System
to consist of / c v
gallon septic tank and
3®v
Other Requirements:
fV Z,/"
/5��f,C , e'
To be constructed by
d {�'� /� �'
Address
wakE Snmmaly:
Public Supply From
Address
®1r: Private Supply ~ Drilled by e %.
... 4 Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatments,, sum 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.
O N ` 1
Signed: f' E. R.A. Date
Address '� .�� -r Gr License #��
APPROVED FOR CONS I RUCTI® i ����y es two years from the date issued unless construction of the
sewage treatment system has been complet the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the irector. Any revision or alteration of the approved plan requires
a new ermit. Approv d for discharge of domestic sanitary sewage only
Q
By:
r Title: Date:
White copy - File; Yell w copy - Building Inspector; Pink copy �wu, Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
rpie�§e"pii�ifot Type 1premo iiiiit
Well Location:
Street Address: Town/Village Tax Grid #
►�° ►° a.! li X Map 7j j 7Block / Lot(s)a
Well Owner:
Name: �/Ayyj��/0 �
Addresssp:
�/y,J, 1r � �p I A%
Use of Welli
Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm # People Served __* Est. of Daily Usage 10p gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
1--"New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ..................... ............................ ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes No �✓"
Name of subdivision Lot No. d-
Water Well Contractor: A/ i r5 o Address: -.fig' r jv !-
Is Public Water Supply available to site? .................................. ............................... Yes No-
. a/
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:,��'
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date:.; d. Y .� ,Applicant Signaure :=—- !?��f °J��__
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a w ter well driller certified by Putnam
County.
Date of Issue, Permit IsLng Official:
Date of Expiration Title:
Permit is Non- Transferrable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owr#; Orange copy - Well driller
Form WP -97
METE. XR I �
1.
DIVISION Of ENVIRONMENTAL HEALTH SERVICES
RE: Property of
Located at
T //uA 1; If
`
Subdivision of
LETTER OF AUTHORIZATION
Tax Map # / Block Lot
Subdivision Lot # Filed Map #
Gentlemen:
This letter is to authorize d o � e r
Date Filed
a duly licensed Professional Engineer or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity, with :the- provisions -.of Article..145 and /or _ 147 of the Education`Law,=the Public,Health.
_ p_ r —
Law, and the Putnam County Sanitary Code.
V�
Countersigned:
#
Very truly yours,
(Owner of Property)
Mailing Address e Mai Address: ��r� S� �r,;re-
�s�
-.
State
Telep
State
Telephone 317:
Form LA -97
13
Foli K ikte I I �1,
774?n�p Aalle-y Ck,
PLAS.- T11ko F1111DE
F R I C I I � 0, N 1..086; 1 � ME R, 1 113111
GPM
GPM.
3/4
--
--- ------ - -------
Ff.. F1, Lbs.
.................
Ft.
Lbs.
Ft.
Lk.
Ft.
Lbs.
Ft.
Lbs.
60
5
1,85
1.3f;
.60
.366
.166
.11
.0118
2
'12G
115,13
6.58
4.812
2.10
1.21
.526
.36
.164
3
180
31.97
13.9
9-96
4.33
2.51
1.09
.77
.336
... ..........
J 043
5 071
4
240
54.97
23.9
17.0111
7.42
4.21
1.83
1.30
.565
5
300
64.41
361
2516
11.2
6.33
2.75
1,92
.835
.104
.145
-15118 .241
-7.1-4 .361*
6
360
36.34
15.8
8.83
IN
2.6S
1A7
.7
8
480
63.7-1
27.7
8.18
6.60
-4-. 5-E
1.99
1,11D
10
600
97.5' 2i
42A
26.98
11.27
8 Elt
2.99
1. 7B
15
20
25
so()
1,200 1
1,50C!
40.68
86.94
21.6
X'. 8
14. K;
25,V
38.41
6,36
10.9
16.7
US -1.63 .756
6. P 1 2. N
9.7': 4. 4 93
2. 72
30.
1,300-
35
2,100
--- ----
18,11" "NE.) 3.64
-b � .10.2
23,! J
29144 FAS
16.'JI 7"15
113 21
----------- - ------
40
-45
50
2,400 -
3,000
ff� & 6 r"'poo
1
L9- 3
3/10 .
U11111
2-, 5
�N9
ff� & 6 r"'poo
1
L9- 3
3/10 .
U11111
pr )47� w
PLAsnc PIPE:
61
tit
Loo,
11:01
02
V2
3/4
GPM
GPH-
Ft
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Fl,
--- ----
1 C', 'JI4.
Fl.
--------
1
60,
4.25
1.85
1.38
.60
.356
.155
.11
.048
2
120
6.58
4.83
2.10
1.21
.526
8
.164
3
180
31.97
13.9
9.96
4.33
2.51
1.09
77
.336
.043
.071
.2-A .104
.145
65 .241
.(la': .361
4
24C :
54.97
23.9
17,07
7.42
4.21
1.83
1 0
565
5
300
84.41
36.7
25;76
11.2
6.33
2.75
1.92
.835
.51
1.19
1
22, 3,
511.,1
6
360
36.34
15.8
8.83
3.84
219
1.17
8
480
63.71
271
15.18
6.60
4.58
1.99
10
600
97.52,*
'42.4
25.98
11.27
6.88
2.997.
15
906
49.68
21.6
141113
6.36
i 3.7",
6.;'[►
- f ...............
9.1:;"1 i 4,';!':;,
ai-iit. 5,.)2
J5.5
4.46; 1, 1.93
232
20
1,200
86.94
37.8
25.07
.. I .
10.9
-
25
1,500
38.41
16.7
30-
1,800
35
2,100
18.17 7. i 1.1
45
2,700
Al -Al
l ctii�.Eje-l..�
711 4. 6 5
.4
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-.
5 7.15
60
3j60.0
10. 21
02
5 X
4" 1
V
/Y
14
1
r :r � _ I_. ,�;11
PARTS
Item No.
Description
I
Impeller
Goulds
6si 11
A.C� Ing.
3
Mechanical seal
"A
mp.
Shift'
V,.
Motor
6
I
Bearings - upper and
lower
7
Power cable
0 -ring
7
5
8
1
2
I
ii
30
25
I
a
10.6
208-7230 3
WE153f
Goulds
WEI 5&e
Submersible
WE1534
"A
mp.
Car
6 11
WE15881
460
WE15321
4
3
3885.
7. 7
MMRS.'
I
ii
30
25
I
a
10.6
208-7230 3
WE153f
, 460
WEI 5&e
- ."230, .1
WE1534
200. -
WE15121
3
WE15881
460
WE15321
7. 7
MMRS.'
MODELS
PERFORMANCE. RATINGS (gallons per minute)
Order No.
HIP Volts.
Phase
Max..Amp.
RPM Solids WL (lbs.)
W.E0511N WE0511HH
WE1012H WE0512NN
WE0311 L'
115.
9.4
War
WEPS12H WAN WE1612H WE1612NN
5 WE0739H W.E1038H WEMSH WE0538HH WEM38HH
WE0312L
230
4.7
1750 56
'M
WEWU 1WH WE0732H WE1032H KIM W0632HH WE15WH
M�
WE031 I M
1115
9.4
WM12L %WED3124, H WE0734H MM03411 WE153�0 WED534NN WE10UHN
lid
WE0312M
230
-4.7
-HP
'A :�:W' 1/1 3
. /, .1 1'r4 'A ..11/2
WE0511H
-
115
..13.0
Rpm -
1750 1750 3500 3500 3500 3500 3500 3500
-WE0512H
230
6.5
5
.60.
--WE(3538H
900
.3.9
10 80 65 56 84
-WEO532H
230
3
-3.4
--.15-
60 5Z..' Ag -911. 104 128 53 82
WE0534H
480
1.7
20
122 48 77
36 45:--.� 60-- 83 9& -
11HH
`115
13.0
60 .25
:25. i .50 76 -92 116• 45 75
WE0512
-230
6.5
-30. .
311 67 .:-.•86 109 40- 72
WED538HH
zoo
3.8,
3: -35
26 58 , 58 -.102. 35 70
WE0532HH
.230
.3
3.3
A
15 ... 47 70. 94 An 6T
WE0534NH
--460
- �J
1.65 -
45-
36 .62 86 25 64
M7
01 2H
236
A--
10.0
X4 77T2 '77 18. -W.
WED738H
200
6.2
V4
17 -4 67 12.
-90732-H
208-230
'.:'.,.:460
3
54-
60
3500, P-'
3 -54:
46 -51,
VE873411
2.7
.65-
-WE I 012H
230,
- V ,
12.5 .
70.
11 35 .47
WE1 038H
25 43.'
.d,? .:
�-032�H_
208-r230.
:3
.80" 40
VVE1034H
---7460
3.5
:gov.
-33-
ion
24
I
ii
30
25
I
a
10.6
208-7230 3
WE153f
, 460
WEI 5&e
- ."230, .1
WE1534
200. -
WE15121
3
WE15881
460
WE15321
WE15341
MMRS.'
I
ii
30
25
I
a
IU6-v 4: aft n�&* i I I Ed a
OMEN
;,Mmmmmmmmmm MEMO
mosommoman MEMO
11111111101111111MM No
onwomm■ nommmmmu►momm
0 10 20 M21h
CAPACffY
LqWAlrElif 11CHNOLOGIESAIROUP
80
(All dimensions are In'ln"c* hes.- Do'not use''fdr•con.structIon purposes.)
W 'A' and I HP.- 15'
except for model WE0712H and WE101214.= 18',: IIAHP 18'
: I. . .. ..
2V I-
r- ROTATION
UPT.
8w
3W
KICK-BACK
EFFLUENT EJECTOR SYSTEM
Effluent elector system Package Includes,
offers ease of•ordednd submimle Effluent Pump WW I L.
and instillation. A single 121. or WE031 I M, 12M,.WE051 I HH, 12HH,
ordering number specifies Mercury level Control Switch
A2-5 (115V). A2-6 (23"
a complete syitem ' designed IiaslrIA7.4801S, Basin CoveiA8-1822
for most'residentiall and Check Valve A9-2P
.Commercial sump and. Order No.:.SWE0311 1. SWE0312L,
effluent pump applications. 0011M.SWE0312MI,
10.6
208-7230 3
91
, 460
4.6
- ."230, .1
15.0
200. -
10.`6
3
.9.2
460
4.6
IU6-v 4: aft n�&* i I I Ed a
OMEN
;,Mmmmmmmmmm MEMO
mosommoman MEMO
11111111101111111MM No
onwomm■ nommmmmu►momm
0 10 20 M21h
CAPACffY
LqWAlrElif 11CHNOLOGIESAIROUP
80
(All dimensions are In'ln"c* hes.- Do'not use''fdr•con.structIon purposes.)
W 'A' and I HP.- 15'
except for model WE0712H and WE101214.= 18',: IIAHP 18'
: I. . .. ..
2V I-
r- ROTATION
UPT.
8w
3W
KICK-BACK
EFFLUENT EJECTOR SYSTEM
Effluent elector system Package Includes,
offers ease of•ordednd submimle Effluent Pump WW I L.
and instillation. A single 121. or WE031 I M, 12M,.WE051 I HH, 12HH,
ordering number specifies Mercury level Control Switch
A2-5 (115V). A2-6 (23"
a complete syitem ' designed IiaslrIA7.4801S, Basin CoveiA8-1822
for most'residentiall and Check Valve A9-2P
.Commercial sump and. Order No.:.SWE0311 1. SWE0312L,
effluent pump applications. 0011M.SWE0312MI,
PUTNAM COUNTY DEPARTMENT OF HEALTH
!
DIVISION OF ENVIRONMENTAL HEALTH 'A RV
CONSTRUCTION t I E {1►`. i'I "± ; Iii` "' I `` \a, I ICI \ I X11 i S1 S! " '1
a.
Located at zs r y i d' own or Village / cQ ��► da c�R l G-
Subdivision name m Subd. Lot # Tax Ma .0 o � 6
Map � Block e Lot Z-4
Date Subdivision Approved Renewal Revision
Owner /Applicant Name d ,4 rr &/-/.r r�, d.6 Date of Previous Approval
Mailing Address ✓`� tj J` A-17 a Zip /&�"'
Amount of Fee Enclosed o
-114
Building Type �'�si��n C� Lot Area No. of Bedrooms .3 Design Flow GPD 6 (>C-?
Fill Section Only Depth Vollume
PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of C/ gallon septic tank and
- a y 7-W-0 y� �..�� �- e5 4 e_,:� - --
Other Requirements: 1006e
To be constructed by
fqU,
a A''// e- Address
Water Supply: Public Supply From
Address
a�tre; 1" Piate supply Dr I_ /yy /} per:. >:Addres "s_'
�/� 4/ f /O� /'��%�� (/� Imo- 1 !. •-,.
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 s,, syy tern 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
systan or any repairs thereto.
Sigred: R.A. Date C>
License # y
Adlaess���✓-�
�s
APIROVE ®R COPISTRIXTION: is approv ' s%11ye _ m the date issued unless construction of the
sevv►ge treatment system has been completed and inspected is revocable for cause or may be amended or
mo dfied when considered necessary by the Public Health Dire s vision or alteration of the approved plan requires
a new pe .. pppoved for discharge of domestic sanitary sewage only.
Bar: Title: Off —Date:
WWe opy - HD File, Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
Public Health Director
NAME:
ADDRESS:
IRETTA'" OTINARI' R.N, M.S.N. -r
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York. 10509
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
`/ SPECIFIC WAVIER
SITE LOCATION:
DATE:
Gr%s,
1.115 v ` 04- 1&.e..
dA-
ev-I
)L)Y Af-� y'
STAFF PRESENT: Bruce F. Rob M. Mike B. Adam S. Gene R. Shawn R. Bill H.
SPECIFIC WAVIER. fly
REQUEST:
DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR
ENVIRONMENTAL CONTAMINATION PROBLEM?
YES NO
WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP?
YES NO
DISCUSSION
REQUEST APPROVAL OR DENIED
DENIED
REASQN FOR DENIAL
DATE:
DII,CTOROOP PUBLIC HEALTH
(SPECWAIVER)
5W -._a1 -L-)Z
NEW YORK STATE DEPARTMENT OF HEALTH Specific Wary ®r
• 43uneat� of�6o i nity6enilatfarr ar+d Food f'rolect srt -» = " from Requirements of"Part.75 and Appendix 75= , IONYCRR
for Individual Household Sewage Treatment Systems
Name of Applicant
No. Street Cily/Town State Lp .
i
Address f Iu� i ,.E, �, �%. Of-If
No. Street cityrrown Slate Zip
Site Location ��✓ S,
1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)):
Separation distance cannot be achieved.
1 xcessive.slope.
J High groundwater.
Inadequate depth to bedrock or impermeable layer.
Soil unsuitable.
Other(explain) ... . ......... ................... ...:.................................................................................
2. Proposed design or conditions of waiver:
:.-:r s -. rp. ............;r. r _ ' � ..... •'..
........... .................................... �� .. .. . . . . . . . .............................................
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.
t.
Operation of sewage system is subject to mechanical problems.
Other(explain) .................................................................................................................................................:........... .............................__ ....
...................... . ....... :....................................................................
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 be revoked by t"uing official fora change in conditions for which this waiver was granted.
ORIGINAL - Local Health Agency
COPY - Applicant/Design Professional
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_ APPLICATION TO CONSTRUCT A WATER WELL
a +.s ado +sec � ..�� a �°. .,•. L't.'" :�! y,•'ir,. ...MV ,ir;. ;r0 viv =wee r.,o...a..~•.s iC ��'i +..._ .�v:a._ ^,.� � � a �. .. .. �iSi ii�v w.- ',w- .�.�ana.e
pl��"se"�Fiiftor type PAID P�r`init�� "� V `��
Well Location:
Street Address: ,V,; TownNillage Tax Grid # 7 3• 7- i ' Z y
��"
�� % / N�1911� l✓ G Map 131ock Lot(s)
Well Owner:
Name:
Address:
Use of Well;
esidential 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 ,r gpm # People Served 4- Est. of Daily Usage dp P gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
✓1 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 e'
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision --• Lot No. y-
Water Well Contractor: N°� Address:
1�!
Is Public Water Supply available to site? .................................. ................................ Yes No ✓'
Name of Public Water Supply: Town/Village �--
Distance to property from nearest water main: /y
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date: I _Applicant Signature: ; %w� ✓��,�
�. �!!�erq+..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 Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water driller certified by Putnam
County.
Date of Issue 'I S� 0Z Permit Issuing icial:
Date of Expiration t'j L/ Title: ,rte , r
Permit is Non- Transferrab e
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
BRUCE R FOLEY
Public Health Director
Ir
DEPARTMENT OF BEALTH
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 July 9, 2002
Frank Sullivan, P.E.
2972 Fernctest Drive
Yorktown Heights, NY 10598
Re: , Waiver Determination
Orlando
Luigi Drive
(T) Putnam Valley, TM# 73.17 -1 -24
Dear Mr. Sullivan:
The Putnam County Health Department reviewed the waiver request for the above regarded project
on July 9, 2002. The following determination has been made:
❑ The Waiver request was approved.
_ �Ty .
® . -• -The Waiver,requet was conditiorfally approved. w
❑ The Waiver request was denied. An explanation has-been noted below.
0 The Waiver request was not voted on. Explanation noted below.
1. It should be noted that since this lot is not part of an approved subdivision and
classified as an "Individual Lot" by this Department, no guarantees can b e made for
future approvals of waivers.. In short, the owner is encouraged to build this lot in the
next two years.
If there are any questions regarding this matter, please contact me at (845) 278 -6130 ext. 2159.
Sincerely,
Shawn Rogan
SR:tn Public Health Technician
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONIIE\'fAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
/1 REVIEW SHEET FOR CONSTRUCTION PER IT q Y
- .. .. r -iu..i as'•t -r , :,.,.- Ts.r:a or r.r = • '®C -,
NANIE;'Wbb ; ER. c:� �'�- �' STREET LOCATION: - tJ -� G-I �2
REVIEWT -1) BY: RNL GR, AS, MATE:
Y� • DOCUb>E \TS
PERbITT APPLICATION
t_)WLI:EERMIT OR PWS LETTER
TER OF AUTHORIZATION
UD GN DATA SHEET (DDS)
(_J CORPORATE RESOLUTION
SHORT EAF
UUHOUSE PLAAINS -TWO SETS a'�
(__)(_JVARLMNCE REQUEST
SUBDIV
UUI EGALSUBDIVISIdS
U %SUBDIVISION APP OVAL CHECKED
RATE
, DEPTH
AP1i DRAIN REQUIRED
GENERAL
L CATED IN NYC WATERSHED
;NS SUBNfIITED TO DEP
(� EGATED TO PCHD
EP APPROVAL, IF REQ'D `�{o
P TEST HOLES OBSERVED
(� ERCS TO BE WTMISSED
(�(___)EX- APPROVAL SSDS ADJ, LOTS
(__)(_)WETLANDS (TOWN /DEC PX�0* REQ'D ?)
1969
mw.�4 AM-�Fulvi 060 -
SWAGE SYSTEM PLAN - (NORTH ARROW)
,SHS HYDRAULIC PROF
'RAVITY FLOW
' ONSTRUCTION NOTES 1 -15
IESIGN DATA: PERC & DEEP RESULTS
'CONTOURS EXISTING & PROPOSED
LNG /GUTTER/CURTAIN DRAINS
SOIL TYPE BOUNDARIES
BLOCK; OWNERS NAME ADDRESS
'E/RA; NAME, ADDRESS, PHONE#
EZ- e WIti G/REVLSION
OF WATERCOURSES, PONDS
ENT ELEVATIONS
& SSDS'S WAIN 200' O
ITYMFTES& BOUNDS p 0*4i0 t
MOM
COMMENTS: `Scfz t ' Jv 2�1
(REVSHEET)
TAX MAP=: (CONFIRMED) 7 3. 12 � -Z /
1
FOITTRFn T)F.TAIT.S ONPI.ANS roNT'n) C
ZJ HOZ;SE SEWER -'/I' FT. 4 "0'; TYPE PIPE CAST IRON73 ./7-/-z
UN 'BENDS; MkX BENDS 450 W /CLEANOUT
RENEWALS
SITE NOTE (NO CHANGE)
FILL S S
�10' HORIZONTAL; PAST TREN SLOPES 3:1 TO GRADE
F7L FILL SPECS' FILL ES a
FILL PROF , & DIN SION
50L. IN EXP
c N 2 FEET
BARRIER
CERTIFICATION NOTE
fi GAUGES
ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS
SEPARATION DISTANCE FROM TOE OF SLOPE
TRENCH
LF TRENCH PROVIDED 60FT NIAX.
?.R4I LEL TO CONTOURS
0% EXPANSION PROVIDED Sc ��
(�( DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL
( EOTEXTILE COVER Q�
SEPARATION DISTANCES ON PLAN -FROM SST S K Y
( 1 'TO P:L. DRIVEWAY, LARGE TREES, TOP OF FILL
0' TO FOUNDATION WALLS f >�►Gi�TL
100' TO WELL, 200' IN DLOD,150' TO PITS
100' TO STREAltil, WATERCOURSE, LAKE (mc. espan)
0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
U 10' TO WATER LINE (pits - 20')
50' INTERMITTENT I)RAWAG_ E COURSE°
O07'1)0'- R)S'EVOIIt ETC° - 150' GALLEY SYSTEMS -
'INILN TO LEDGE OUTCROP
SEPTIC TANK
)10. FROM FOUNDATION; 50' TO„WELL
OF
SLOPE
DPE IN SSTS AREA i (520 %)
I L
GRADED TO 15 %, IF REQUIRED
DOSEAPUMP SYSTEMS
U( _)PUMP NOTES
( _)( _JDOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED
UUDETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.)
(_)( _JPTI AND D -BOX SHOWN & DETAILED
(_-)(____)1 DAY STORAGE ABOVE ALARM
CURTAIN DRAPE 1
U(__)STANDPIPES, 5' BOTH SIDES, DETAIL
(_)(_--)15' Mh 1 to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %,100 % -<1%
(-- __)(___)20' tilIN to CD DISCHARGE /100' with 182 cons day discharge
(_)( _J10' 1IIN to NON- PERFORATED PIPE
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
,; :�:: �a ::��- -.:;�•.�.�:.;�, -- .--.-: ��1�FIGY���l�r� +'�R= e4IisP�,O��g.;� ®�.�IL - ..- �:,.'..,.';�.;:�;...� .�:::r; _= �_,�:�._�_ ..
A WAS'T'EWATER TREATMENT SYSTEM
1. Name and address of applicant:
u 47;14? '%%
��y
2. Name of project: S 'T
3. Location a
4. Design Professional: 5. Address:
6. Drainage Basin: �-
7. lype of Project:
_Z Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEAR)? i✓l
Type Status (check one ) ............................ .......................... 'Type I Exempt
Type II Unlisted
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Ale,
10. Has DEIS been completed and found acceptable by bead Agency? ...............
11. Name of Lead Agency
12. Is this project in an area under the conti of of local planning, zoning, 'or other
oh�cials, osdinances? :.. .....................................::.......... .......:.................r:::..
13. If so, have plans been submitted to such authorities? wa -
. ........ ...............................
14. Has preliminary approval been grant ed by such authorities? Date granted:
B. 'Type of Sewage Treatment System Discharge ................. surface water v" groundwater
16. If surface water discharge, what is th ; stream class designation? .................... 11114
17. 'Maters index number (surface) ........., . ................................ ............................... A/I
18. is project located near a public water ;�upply system? ....... ............................... Ally
19. If yes, name of water supply Distance to water supply
20. Is project site near a public sewage colltction or treatment system? ................ /Vp
21. Nance of sewage system '-" Distance to sewage system
22. Date test holes observed If %Z _ 23. Name of Health Inspector 9.4
24. Project design flow (gallons per day) .. ................ 100...... ...............................
25. Is State Pollutant Discharge Elimiiatton System (SPDES) Permit required ?... Aly
26. Has SPDES Application been subn iitied to local DEC office? .........................
Form PC-9T
2
27..Is,anyportion of this project located within a designated Town or State wetland? /✓e
28. Wetlands ID Number .......................................................... ...............................
29.. Is Wetlands Permit required" ....' .... .:. :..:: `::::::... ............. ' . o
Has application been made to Town or Local DEC office? .................. .............. —'
30. Does project require a DEC Stream Disturbance Permit? ... ............................... Nd
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................ Yes/No �d
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes/No
DESCRIBE:
33. Is there a local master-plan on file with the Town or Village? ......................... /V'd
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................. ..............................O
35. Are any sewage treatment areas in excess of 15% slope? .. ............................... � y _
-
36. Tax Map -11) Nurnber .......................... ............................... Map73. Block / Lot 2
37. Approved plans are to be returned to ..... Applicant kef Design Professional
NOTE:.All applications for review and approval of a new SSTS to be located within the NYC Watershed sha�I
be sent to the Department, and need not be sentin- duplicate tq#kc� EP�;altho0gh-the prdject niajr r ui a DEI'
a*6va14- the - &S3'S ,ri 'to°fmal approval` by the Department. Projects within the watershed may. also
require DEP review•and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities frorn.
DEP and submit-those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item I:,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
1 hereby affirm, under pen afty of perjury, that information provided on this form is true
to the best of my knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 214.45 of the Penal Law.
SIGNATURES,& OFFICIAL TITLES: 4
Mailing Address:........... ........... .......... N'), 27
-1 -- f
BRUCE R. FOLEY
Public Health Director
�..< �.xra`H,.•L�.7D'i1�.tiYA.- .�Pe:4 ' �.q'di r�s e., t'J..�ss:ezfG ie-- i+.�17w.;�•MG1- -..-
LORETTA MOLINARI R.N., . M.S.N.
Associate Public Health Director
Director of Patient Services.
1 Geneva Road
Brewster,. New York 10509
Environmental Health (845)278-6130 Fax(845)278-7921 "C0 0 Lj
Nursing Services (945)278-6558 WIC (845)278-6678 Fax(845)278-6085 ��
March 14, 2001 Early Intervention (845)278-6014 Preschool (845)228-6108 Fax(845)278-6648
Frank Sullivan, PE
2972 Ferncrest Drive
Yorktown Heights, New York 10598
Re: Luigi Drive, Orlando
Permit # PV- 20 -96, TM# 73.17 -1 -24
Town of Putnam Valley
Dear Mr. Sullivan:
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
Docu ents:
Application Form PC -97 requiring Form PC -1 be submitted has been superseded by PC-
97.
--- The -c,onstruction`of this - 6wage'�disposal system -maybe subject to'locai wetlands
regulations. You should contact local wetlands officials regarding this matter.
L3� Please provide a certified copy of the survey pursuant to PCHD Bulletin ST -19. The
survey is to include flagged wetlands validation. The lot is not subject to a filed map.
(4--- Provide proof (copy) of neighbor notifications.
Plan:
1. Plan is to include "legible" topography /contours of existing and proposed grading.
2. All wells and separate sewage treatments systems within 200'0" of subject property are to
be shown and the following note is to appear on the plan. "There are no additional -
wells /septics within 200'0 ". of subject property unless shown."
3. Fill pad area is to be dimensioned.
4. Location of the well to be provided with dimensions to locate from property lines.
5. Please show the well service line, well to house.
6. Existing grade of proposed separate sewage treatment system exceeds current maximum
allowable of 15% maximum. A waiver will be required.
N 11
Page 2
...� Qrland'c - .. :. -.. .,
March,14, 2001 .
Upon receipt of consideration of the above stated comments, this office will continue its review
and "formal" denial of the current proposal based on the fact that the design does not meet
current PCHD policies and procedures and waivers are required.
Please feel free to contact me at ext. 2157 if any questions arise.
Very truly yours,
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
I. ,� - v .. — __ .:• a u -... ..... . -. .> .p....r .- ^ -r s. •..� ~.. - �T.'..r... xe... v.o.. ....... ,a.y...:. «..: ,.. .�)
BRUCE R FOLEY
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
March 14, 2001 ]Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
Frank Sullivan PE `
2972 Fernerest Drive
Yorktown Heights, New York 10598
Re: Luigi Drive, Orlando
Permit # PV- 20 -96, TM# 73.17 -1 -24
Town of Putnam Valley
Dear Mr. Sullivan:
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
Documents:
r Application Form PC -97 requiring Form PC -1 be submitted has been superceded by PC- a/
.� .The construction of fbi sewage disposal- system maybe subject to local wetlands t✓
_
regulations `'ou sfiou7d "c'onfact local wetlands oficiaps regarngnaiter ° "T"' �-y""" "`
` Please provide a certified copy of the survey pursuant to PCHD Bulletin ST -19. The
survey is to include flagged wetlands validation. The lot is not subject to a filed map.
4 Provide proof (copy) of neighbor notifications. - P-'
Plan:
1e 1. Plan is to include "legible" topography /contours of existing and proposed grading.
le�'. All wells and separate sewage treatments systems within 200'0" of subject property are to
be shown and the following note is to appear on the plan. "There are no additional
wells /septics within 200'0" of subject property unless shown."
Fill pad area is to be dimensioned.
Location of the well to'be provided with dimensions to locate from property lines.
Please show the well service line, well to house.
Existing grade of proposed separate sewage treatment system exceeds current maximum
allowable of 156/o maximum. A walverw111 be required.
a
� +6
Page 2.,,.:�.�
Orlando
March 14, 2001
Upon receipt of consideration of the above stated comments, this office will continue its review
and "formal" denial of the current proposal based on the fact that the design does not meet
current PCHD policies and procedures and waivers are required.
Please feel free to contact me at ext. 2157 if any questions arise.
ABS:cj
Very truly yours,
Adam B. Stiebeling
Assistant Public Health Engineer
JOSEPH ti
F. SULLIVANn , P.E.
Con4uf
2972 FERNCREST DRIVE
YORKTOWN HEIGHTS, N.Y. 10598
(9 14) 962-4248
r r
-- �� � � /�,-1 �-� /mow' � ��'✓� 1/'Gt I% � � `'���
I �-T -
PC-J'
1.
PUTNAM COUNTY DEPARTMENT OF HEALTH
ON-FOR APPROVAL. :OF.PLANS FOR A WASTEWATER DISPOSAL SYSTEM
Name and Address of Applicant':.` .'� µ ' c' Ci
2. Name of Project: S 3. Location T /V /C:
4. Project Engineer: 5. Address• z97,; —" -s
Dom/ .}`Zsu�/1� ) P/
License Number.: Phone: q6 z y a y
6. T� of Project:
�rivate /Resi dent ial Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision .Other (specify)
7. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. N O
9. Has DEIS been completed and found acceptable by Lead Agency? ...........
10. Name of Lead Agency
11. Is this project in an area under the control of local planning, zoning,
;.. - or' other. off i.cials:,..:ordi;nences. ?. ,...:...,.:,.:.. _ .... ...�..... ► cs
12. If so, have plans been submitted to such authorities? ...................�
13. Has preliminary approval been granted by,such authorities? Date Granted:
14. Type of Sewage Disposal System Discharge......;. Sueface Water l�Ground Waters
15. If surface water discharge, what is the stream.class designation ?...:....
16. Waters index number (surface) ............................
17. Is project located near a public water supply system?
18. If yes, name of water supply Distance. to water supply /mil; /oS
19. Is project site near a public sewage collection or disposal system ?..... 461
20. Name of sewage system Distance to sewage system
21. Date test holes obterved: 22. Name of Health Inspector: /90y
23. Project design flow (gallons per day) ...... ......K4?9 .....................
11/93
a. a
2e
24. Is State Pollutant Discharge Elimination System (SPDES) Permit required?... Ala
25e Has SPDES Application been submitted
26e Its any portion of this project located within a designated Town or State . e,
wetland? e c o e o e e o 0 0 0. o e e o 0 0 0 0. 0 0 o e o o e o 0 0 0 o e o o e o e o o e e o e e e o o e e o e e e o e e e e o e e s e
27.
Wetland ID
Humber oeeeeoeoo e e o e
eeooe000ee0000e0000000ee000....
a o e o e o o e o 0
Is Wetland
Permit required? e e e
4,6$14/5
4tj /�a.
Y�e o �,�28.
Has application been made to Town or Local DEC Office? /0
o e e o e o e o e o o e e e o e s a
29e Does project require a DEC Stream Disturbance Permit? ..........eee.eee..
30. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal, �U
landfilling, sludge application-or industrial activity? eeeee... YES or N0
31. Is project located within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or A40'
any other potential known source of contamination? ..e°e.eeeeoe..YES or NO
DESCRIBE:
32e Is there a local master plan or.file with the Town or Village? eoeeee.eeee
!� 33. Are community water, sewer facilities planned to be developed within 15 years? _
34e Are any sewage disposal areas. _in excess of 15% slope? eee.eeee e. <e
35. Tax Hap %D 'Number .e. 1e ..e.eeeee. . .e. eeeee:......
36e Approved Plans are to be returned to:`ee.ee.eeee.ee... Applicant Engineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
% hereby affirm, under penalty of perjury,' that information provided on this
form is true to. the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Penal Law.
SIGNATURES& OFFIC %AL TITLES: e.
MAILING ADDRESS:
��.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIV' ISION O.F' .ENVI')�O1 TgEq N-TAL .14EY ALTH -SER VECE
RE. Property of
LE T'T'ER OF AUTHORIZATION
Located at .4 C4 i q,' . -, " V e—,
%- .Tax Mali # :73j 7
Subd'v's'orl of °'
Subdivision Lot — filed Map ##
Gentlr,n-1611:
This letter is to a.utllorizc
Block
Date Filed .
L4-
Lot ��'�:2_
a duly licensed 1'rolessional Lngineec Uor Registered Arcll`rtect to apply for the required
wastewater treatnie_lit andlor to serve thy; above -noted property in accordance
With lVw, st'andmds, rules or regr.ulatlons as promulgated by the Public health Director of the Putnam
Counly ]- ealth I)epartnlent, and to sign att necessary papers on my behalf in connection with this
I1lalier and to sLIPe1-Vi.se fhe Co1IS11-LIC1io1? ol's'aid wastei. -Y ter lretlllcnt and /or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
i
CounLe signed:
I
Very truly your
SigrIc(1: — tl ��
(011W, of Property)
Mailing Address 7Z.�/���1'�� Mailing Address:
State - �_. lip�O��_ Suite . � Zip )0��_
^l clephone: _ rone � S2. 6 ✓ 1
1,
/ Form LA -97
BRUCE R FOLEY LORETTA MOLINARI R.N., M.S.N.
Public Health Director w 04 Associate Public Health Director
Director of .Patient Services
DEPARTMENT ' OF HEALTH"'
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 .
MEM%-R
To: Gene, dam and Shawn
From Ro
Subject: Determination of Slope in the SSTS Area
Date: January 19, 2001
Mike stated that when determining slope in the SSTS area for fill section greater than 2 feet, take the
slope from top of system (first d -box or trench) to the toe of fill.
4 When determining the slope in the SSTS area for fill sections 2 feet or less, measurements should
be taken from the first trench to the last trench, (including expansion trenches).
When contouis'are not uiiffoi7nly spaced along the'leng6of the SSTS; det- erniination df the slope= ` -
should be made at the center and ends of the SSTS.
Any questions please see me.
RM:tn
cc: Mike, Bruce
J
Ly +�Slj f
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
" - APPLICATION T0" CONSTRUCT "A- WATER -WELL
PCHD PERMIT #
WELL LOCATION
Street Address Top/Village/ C y Tax Grid Number
41
WELL OWNER
N
Mailing Address rivate
erg r %a.�c� :_ �� v°�! O Public
USE OF WELL
1 - primary
2— secondary
,RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
U INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED ,_3 /EST. OF DAILY USAGE Sal
O REPLACE EXISTING SUPPLY (3 TEST/ OBSERVATION 13. ADDITIONAL SUPPLY
&NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
MRILLED
13
DRIVEN DDUG O GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name ..� . %���r'S ui Address:�J�%�1���'� -�
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ice' NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
"' ;DIST,ANCE. TO..PROPERTY' FROM NEAREST WI�TER':MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
XON 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
thirty (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
Department attached to this permit.
3. Submit a Well'Completion Report on a form
requirements of the Putnam County Health
provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall Ata appropriate action to assure that
any and all water or. waste products from such well drillerations be contained on this
property and in su /ch a nner as not to degrade or otherontaminate rface or groundwater.
Date of Issuer ( 1 19
Date of Expiration 19 Permit Issuing Official
Permit is Non- Transferra le White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
t A
PC -1
a
PUYNAM COUNTY DEPARTMENT U OF HEALTH
APPLICATI -d POR APPROVAL OF PLANS FORMA
WASTEWATER-DISPOSAL-SYSTEM ^"�` ` - -' "• - ' •-
1. Name and Address of Applicant: i 17 �7 �� a -� cie
5' 2
2%
/ /
2. Name of Project: S �-�� 3. Location T /V /C: IwIl i ew
4. Project Engineer: ���1��� 5. Address: 7972- �"�L�r -5
f. t-' d'� �u✓� fir° .� �/
L i can se Number: �i' ��.5 Phone: �� . z
6. Type of Project:
T�Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject to State Environmental Quality Review (.SEAR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted
8. Is a Draft Environmental Impact Statement'(DEIS) required? ............. W62
9. Has DEIS been completed and found acceptable by Lead Agency? ..... :.....
10. Name of Lead Agency
proj9j;t- .-JLn'• an- area._under -;the: control -of 'local planning, zoning,._:: :..
or other officials, ordinances? . >> . e ........ e . ............ a ... a �.x.�:i i✓�5- :._...=�::_:::.�
12. If so, have plans been submitted to such authorities? ->
13. Has preliminary approval been granted by-such authorities? e-> Date Granted:
14. Type of Sewage Disposal System Discharge ......b Surface Water drGround Waters
15. If surface water discharge, what is the stream class designation ?........
16. Waters index number (surface) ........... ..............e..............
17. Is project located near a public water supply system? .................. . 4/0
18. If yes, name of water supply Distance to water supply
19. Is project site near a public sewage collection or disposal system ?..... �p
20. Name of sewage system Distance to sewage system A%/ 5
21. Date test holes obterved: 22. Name of Health Inspector:
23. Project design flow (gallons per day) ..................... .............. _ --
11/93
� a
2.
24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. Al-el
..•..i a '.sw+1r�_ -.;, ... _. � .�. ...�
25. Has SPDES Application been 'submitted' -to - l -ocal' DEC"0`�f e?°`:'::::T........:
26. Is any portion'of this project located within a designated Town or State i _>
wetland? .................................. ............................... _
27. Wetland ID Number ........................................................
28. Is Wetland Permit required? ....... J.IP.41 `"l 'n !:3.1':1: f - 1./.71, /
Has application been made to Town or Local DEC Office?
29. Does project require a DEC Stream Disturbance Permit? 6
30. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ........ YES or NO
31. Is project located within 1,000 feet of existence of abandoned landfill,
hazardous'waste site, salt stockpile, landfill, sludge disposal site or A1,0'
any other potential known source of contamination? ....'..........YES or NO
DESCRIBE:
32. Is there a local master plan or file with the Town or Village? ...........
33. Are community'water, sewer facilities planned to be developed within 15 years?
34. Are any sewage disposal areas in excess of 15% slope? .............
35. Tax Map ID Number .. .... ........b.�I y ............................ _. _.....
36. Approved Plans are to be returned to: ................ Applicant V Engineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply with this
provision may be,grounds for the rejection of any submission.
I hereby.affirm, under penalty of perjury, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Penal Law..
SIGNATURES& OFFICIAL TITLES:
%d'�G'r
MAILING ADDRESS:
I b
PUTNAM COUNTY DEPARTMENT OF HEALTH.
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of Ye
Located at 'Pr.; "Z.
SectionPI 12 17 Bl o c k— Lot
6�
Subdivision of
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize ew WA y4a *-I
'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
system or systems in conformity with the provisions. of Article 1 5 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
V
Countersigned:
P . E . , R/Ao, #
co
0
2-3777,
Address
Telephone
Very truly yours,
Signed
&Ownerl'of Property
Address
-)V7"
Town
f 6 - 2- LA-3
Telephone
DEPARTMENT OF . HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank Sullivan
2972 Ferncrest Drive
Yorktown Hts., NY 10598
Dear Mr. Sullivan:
a:Q; ..:.9RUCE; R.,-;FOLEY•, _R.S..
Acting Public Health Director
August 26, 1996
Re: Proposed SSDS:
Orlando
Luigi Drive
(T) Putnam Valley
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:
"The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in this regard."
1. The SSDS is proposed on a slope greater than 20 %. Current codes do not allow for the
installation of SSDS on slopes greater than 20 %.
2. All separation distances are to be from the toe of the fill section.
Upon receipt of a submission, revised to reflect the above, this application will be considered
further.
V truly yours,
Robert Morris, P. E.
Public Health Engineer
RM/jP
4:
e
�1.:T k'II• >'� � /u /'.• • .<./ ._J .�•w. .:��/�!�^.OmiT:.'�= �'SM1����. r1'�., .ii �' - .
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank Sullivan
2972 Ferncrest Drive
Yorktown Heights, NY 10598
Dear Mr. Sullivan:
``"'a-- +0L•EY.,; -R.S: - . p,•;:.. I
Acting Public Health Director
October 10, 1996
Re: Proposed SSDS:
Orlando
Luigi Drive
(T) Putnam Valley
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:
"The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in -this regard."
1. Standard form PC -1 has not been submitted.
Upon receipt of a submission, revised to reflect the above, this application will be considered
farther. _ - - -
Very truly yours,
Iw 0*0
Robert Morris, P. E.
Public Health Engineer
W&jp
I
APPENDIX 3
PUTNAM COUNTY. DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVI UAL W SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
_:- ;R VIEW, SHEET, for CONSTRUC iOW RMIT
.., asha`..Sf =I' =•t•, -. .. r% Vii. E YYY /FFF' E.-r. r.iar.tli ...r... ... rr. ...s ".•1 '. J ...J .T I�;±a.Sr S'YYS•t
STREET LOCATION ' .� r NAME OF OWNER K—
BY B. HEDGES i R.MO OTHER DATE 2--5 TAX MAP # -�- .2
DOCUMENTS.
PERMIT AP LICATION
gym— C-1
m-WDE,PE-x#i T m PW S LETTER
_m ENGINEERS AUTHORIZATION,
0:1 DESIGN DATA SHEET(DDS)
M CORPORATE RESOLUTION
M PLANS THREE SETS
m HOUSE PLANS - TWO SETS
m VARIANCE REQUEST
SUBDIVISION
M LEGAL SUBDIVISION
M SUBDMSION APPROVAL CHECKED
m PERC RATE
M FILL REQUIRED DEPTH
m CURTAIN DRAIN REQUIRED =STANDPIPES
GENERAL
YN
M EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
M IF PUMPED PIT & D BOX SHOWN & DETAILED
m HOUSE - NO. OF BEDROOMS
IT—] WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
m PROPERTY METES & BOUNDS
m HOUSE SETBACK NECESSARY (TIGHT LOT)
m HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE
m NO BENDS; MAX. BENDS 45° W /CLEANOUT
FILL SYSTEMS
m CLAYBARRIER
m 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE
m FILL SPECS m FILL NOTES
m FILL CERTIFICATION NOTE_
m DEPTH GAUGES
m FILL PROFILE & DIMENSIONS
m VOLUME
m FILL IN EXPANSION AREA
m EX- APPROVAL SSDS ADJ. LOTS
m WETLAND ( TOWN/DEC PERMIT REQ ?)
ENCH
TRENCH-
I17 DATA ON DDS PLANS '& PERMIT SAME
DATA
m LF TRENCH PROVIDED =60 FT MAX
M PRE- 1969 - NEIGHBOR NOTIFIFICATION
m PARALLEL TO CONTOURS
m LETTER BUZBA
m 100% EXPANSION PROVIDED . s:
M °100 YR. FLOOD ELEVATION
SEPARATION DISTANCES 'SPECIFIED. ON PLAN
REQUIRED DETAILS ON PLANS
m SEWAGE SYSTEM PLAN - (NORTH ARROW)
FIELDS
m 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL
m SSDS HYDRAULIC PROFILE m GRAVITY FLOW
m 20' TO FOUNDATION WALLS ft 15' WELL TO P.I
C2] CONSTRUCTION NOTES, (GRINDER NOTE)
m 100 TO WELL, 200' IN D.L.O.D., 150' PITS
m DESIGN DATA: PERC AND DEEP RESULTS
m 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)
m TWO -FOOT CONTOURS EXISTING & PROPOSED
m 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
m DRIVEWAY & SLOPES CUT
m 10' TO WATERLINE (PITS -20')
FOOTING /GUTTER/CURTAIN DRAINS
m 50' INTERMITTENT DRAINAGE COURSE
m EROSION CONTROL; HOUSE,WELL, SSDS
m 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS
m EROSION CONTROL NOTE
m 15' MW TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1%
m PERC & DEEP HOLES LOCATED
m 20' MIN TO C.D. DISHARGE A 00' WITH 182 CONS DAY DIS.
m REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK
m LOCATION MAP m 10' FROM FOUNDATION; 50' TO WELL
COMMENTS:
J�
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date:
JJ Inspected by: s/'
Street Location Ownerc
-'
Tow
_ .n
T1Vj # 3.17 - -.2 V Subdivision Lot
1. Sewage System Area
a. STS area located as per approved plans .......... .. ................
b.. Fill section - date of placement
3:1 barrier Lgth. Width .Avg.Dpth
c. Natural soil not stripped ................... ........................:......
d. Stone, brush, etc., greater than 15' from STS area....:.:...
e. 100' from water. course / wetlands ..... .....................:.........
IL Sewage System
a. Septic tank size - 1,000 ....'......1, 250 ......... other .................
b. • S eptic tank installed level .....:.................,
. .......................
c.' 10' minimum from foundation. ....... .......:.:.....................
d. Distribution Bog
1. All outlets at same elevation -water tested .......:.. .:.:..
2. Protected below frost ...........:.::... ........,......................
3 Minimum 2 ft.Origina soil between box & trenches.
e. Junction B.ox - properly set...... •.. .................. h..�.
6, renc es
1. Length required mac' Length installed 7 °G`
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 1�/2" diameter clean ...................;
9. Depth. of gravel in trench 12" minimum .......:...........
10. Pipe ends capped.. .......... ............................_.. ; -._...
F .- .Pumn...or..Dose vstems•
"_l._- Size or p p chamber ................ ...............................
2. Overfl ow tank .::..............:.......... ...............................
3. Alarm, visual/audio ........:............ .....:....'.•..................
4. Pump easily accessible, manhole to grade .................
5. First box baffled .......................... ...............................
6. C�� yycle witnessed by H.D:estimated flow /cycle...........
M11ouse/Buildidg
;: a. house located p er approved plans' .... ...............:...............
b. Number of bedrooms ........................ ...............................
IV Nell
Well located as per approved plans .......:.......................
b. Distance from STS area measured O - ft ...........
c. Casing• 18" above grade ..............................
d. Surface drainage around well acceptable .......................
V. Overall Workmanship ' .
a. Boxes properly grouted ....................
. ..............................
b. All pipes partially backfilled ........... ...............................
c. All pipes flush with inside of box ... ...............................
d. Backfill material contains stones <4" diameter ..............
e. Curtain drain & standpipes installed according to pl /
f Curtain drain outfall protected & dir.to exist water Se
g...Footing drains discharge away from.S.T.S -. area ................... .. - - -.
Ii: Surface water protection adequate .... ....:..........................
i. Erosion control provided ................. ...............................
Rev. 12/02
NO I COMMENTS
I V • 1 1 -iz )Y 0011100.1
1/
orm 61-
SM INSP�+:C'>l'Y ®1V ®R.Y`1bJJ.� �Y
Date:
Inspected by:
Fill pad located per.the approved plan
Fill Pad Length Required Length
Fill Pad Width Required Width
Fill Pad Depth Required Depth
Run -of -Bank Fill Quality
Slope from Top to Toe
Impervious Layer Installed
Erosion Control Installed
Sieve Test Results (if applicable)
A_ dditional Comments: _
Reserved for Field Sketch if Applicable
14-11" (2187)-Toirr 1Z
PROJECT 1. G, NUMBER
SHORT ENVIRONMENTAL ASSESSMENT FORM
r -or UN
usnm Amoms 0"iT
PARTI— PROJECT INFORMATION (ro be completed by App0carit or Protect sponsor)
1. APPLICAN7.J5PQNS,OR-- CT NAME.:
aw ate
7 PROJECT LOCATION-
MUMICI County
PaIlly , 1 -4/
—&ZZV-- ZO-./Zr — - -
4 PRECISE LOCATION (ISI I "I add roe and road Inter mt�;C�romlnlmi T;n�rkvi. mc., or provIdej map)
S. IS PROPOSED ACTION
&W Expomelon Q Modifleation4itoestlon
6. DESCRfBE PAOJECT BRIEFLY
0 Ile
.%muuNj vr LANU
in)(1411y I.
WILL PROPOSED AMON COMPLY WITH EXIS•
:--7
(;Yea.' No ..'- I't'. No, 64cribe briefly
EXISTING LAND USE'RESTAIJCTIONS?
9- WHAT IS PFIESENT LAND USE IN VICINITY OF PROJECT?
F IndultIJAI 00ornryisrclal D AgrIcullure P&rkjF0i**t/Op*n 1pi6a. o-0th.,
rIbu,
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY PVIO. ANY OYHeR GOVEPINMEkTAL AGENCY
STATE: OR LOCA.Q7.
Kyea n- Nb lf'yoth, )Is# *V&my(s) wKi pmiryrflWtppf ovals
11. DOES;IANY ASPECT OF THE ACTION mAve A CVR1iIENTL`I'VALIL) PiEpwi'r OR APPAL)VA.-'�-'�
VTY#1S No it yes, 0#1 mp"oy narms and pormWapproval.
12 AS A AESULT''OF -PROPOSED ACTION WILL -EXISTING PERL41TIAPPROVAL REQUIRE MODIFICKTI.ON7
ye, -mNb
CERTIFY THAT THE INFOMMATION PROVIDED ABOVE IS 'RIJE. TO THL OCST OF MY KNOWLEDGE
Appllcant,'Sponsor namc
00
Signatum
11 the. m6flon It in'thil'Coi'aital -Ar'o-m'y aod yoI mvj a atmW *99rocy, complete tho
Cosstol Assagamem Form before proceeding with this asulsoment
11VER
I
.A. > -1
PART II - IMPACT ASSESSMENT (To be comn late d by Lead.Aaer,r_'v��..._,
A. DOES ACTI N E EED ANY TYPE] THRESHOLD IN 6 NYCRR, PART 617.4? -If yes, coordinate the review process and use the FULL EAF.
Yes -
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6 ?. tf No, a negative
declaration may be superseded by another involved agency. -
Yes No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing'traffic pattern, solid waste: production or disposal,-
potential for erosion, drainage or flooding problems? Explain briefly:
d •
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or comrriuriity or neighborhood character? Explain briefly: •
-
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: .
C4. A
community's existing plans or goals as officially adopted, or a change in use or intensity of.use of land or other natural resources? Explain briefly:
C5. Growth, subsequent d9velopment, or related activities likely to be induced by the proposed'ai;tion? Explain briefly:
C6. Long
term, short term, cumulative, or other effects not identified in C1 -05? Explain 6defly:
3.
J.
C. T.
Other impacts (including changes in use of either quantity or type of energy? •Explain briefijc? i
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
.. - .ENVIRONMEN AREA CEA ? _ IL es, explain briefl : -� ___ ;......:. -,_ , .:..- -._.._ _:: ;.. • : • - -; :. _- .. _ - _ _ _
-� Yes o
E. IS THERE, OR I§qHERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if, es ex lain:
Yes o
PART III • DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring: (c) duration; (d) irreversibility; (e)
geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials: Ensure that explanations contain
sufficient4etail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of theCEA.'
Check this box if you have identified one or more potentially large or significant adverse inipacfs which MAY occur. Then proceed directly to the F
EAF and/or prepare a positive declaration.
Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed ai
WILL NOT result,in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting
determinatiopa
Name of Lead Agency : g 1a eT—
ANZ4
Print or Type/Name f Responsible Officer in Lead Agency Title of Responsible Officer
Signal re of Respons le Officer in Lead Agency Signature of Preparer (if different from responsible officer)
= BU LIN
DESIGN DATA S.HEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0.
Z17& �L) Address t_
Located at (St±eet) )—Zf Sec. Lot
(indicaM nearest cross street)
Municipality
Watershed
SOIL PERCOLATION TEST DATA RBQ=ED TO BE SUBMITTED WITH APPLICATIONS
'Date of Pre--Soaking Date of Percolation Test,
HOLE
NUMBER Cl= TIME PII20QLATION PERCOLATION
Run Elapse Depth to Water From Water Level
No. Tinv-- Ground Surface In Inches Soil Rate
Start-Stop Min. Start— stop Drop In Min/In Drop
Inches Inches Inches
4
5
NOM: 1. Tests to be repeated' at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to' be submitt�d
for review.
2. Depth measurements to be made frani top of hole.*
rev. 9/85
3
42-
4
5
NOM: 1. Tests to be repeated' at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to' be submitt�d
for review.
2. Depth measurements to be made frani top of hole.*
rev. 9/85
TEST PIT DATA REQUIRED To BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
'SOLE .^' �•�:.':�t�e :� _.,.: -= ,.
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10°
12'
13'
1,3olti /�
7.
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED /z7& If
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY. DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 1a0a gals. Type .
Absorption Area Provided ByOc�� _ L.F. x 24" width trench
Other 1el-3 4// 4_
Name
in ME . /
Signature
i 4,% .. /J �..
/, ffr
d -
!� Y. k�
THIS SPACE FOR USE BY HEALTH DEPARIMENT ONLY.
Soil Rate Approved sq.ft /gal. Checked by Date
Stone Wall — — i ' - Gen ero a .
Generally On Line ra y On n - Line
LOCATIONS
A
B
1
44'
32'
2
40'
35'
3
32'
43'
4
100'
-531 -
5
.106' :
SY
6
111'
66'
j
117"
73'..
8
123'
80'
9
166
104'
10
161'
98'
11
154'
93'
12
157"
87'
13
148'
83'
RIVAT�
ROAD
PREPARED BY.'. STEPHEN J. FERREIRA, P. E.
7= Is-To cmw Mff.m:sma mow AL 818lf0[ TAS mmmm.m
mum ON = no m. =a = Emu Was nmwm " a Imon
a nm oovmm ovm m-mm ens cmmwm » moosoun in AL
m mm ao» = Boas of as rumm oo=ff >weseem or mats
eem as Weer "as area_ m1pumm of anml
°NO:GARBAGE GRINDER WAS INSTALLED'
Tax Lot .24
Area =. L A
?194. 29e, SQ.Ft. ,1dp,•' `5`J(bp�ce
of O
WOE:
Fco,P4
1%09
F
�d
'�1 P
7" 1-" K
1 [[
l j% /%ji
ID
FLas(rYP•�
�P ✓c 4 a„ cT2 . !3e u
R,A*M—C SCAuZ_
30 w
c n1 Mr
f f Inch - 30 !t
c -
R'
i •-
WATER SUPPLY.•
PRIVATE TEEIL HY
NORM ANDERSON, INC.
152 BARGER STREET
PUTNAM VALLEY, NY 10579
AS -BUILT SURVEY BY? . '
TH01M C. NORIM LAND
G, P.C.
KY.& W. No. 49510
,
394 BEDFORD ROAD_
I'
PLSASANTV= NY 10570
%may\ '
f
' . PREPARED BY.•
PUTNAM COUNI
DIVISION 0 - ENV ONMENT zL I-IEAQTH SERVICES.
/�5 �r• �Lt1-� oa
APPROVCD AS NOTN I0 -, CONt OR ANCE WITH
AP LICABLE RULES AND REGULATI�]NS OF THE
PUTNAM COuwTY AALTH DEPARTJIENT.
NA R T T „ I. ATE
„
S �,AbUT A•• , —BUILT
PREPARED FOR
JDA CONTRACTIN.�G CORP.
SITUATE IN .THE
TOWN OF PUTNAM', VALLEY
PUTNAM CO WNT Y
NEW YORK
PERMIT: PV `20— 96
SECT 73.17 BLK.• 1; 'LOT. 24
yh,
}
•u
is
4
'i.
�I.