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HomeMy WebLinkAbout3417DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -24 BOX 27 17-2 koke'l, 11 'Yj Ll 16 1}'l 1 ti 16- 1� _1 03417 2, 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 -��. +J•`��, 50 3,00() -. 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.