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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -18 BOX 27 �L 16 fi all 03449 i r d I PUTNAM COUNTY DEPARTMENT OF HEALTH ION. OF E V�R�NIVI�NTAI, -HE .E.R� SCE . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ?v -- I - g y �37Q.r�R Located at C,'FozavtE m ,V iS j gc_a u,j_L R rn s court! i . or Village Vvr N 6. N& Owner /Applicant Name 1/; cep, Tax Map ? 3. 18 _ Block 1 Lot 16 Formerly Subdivision Name L tojc&g 3 Subd. Lot # I i Mailing Address 3 7 c Ro roW V ,nn CZ'D4 o C, Q IV, t K<Z, N Y Zip t Date Construction Permit Issued by PCHD 8-_.2- -� g Separate Sewerage System built by V- 4 cc%usrtQ or_+ po Address AMP- I Consisting of 1250 Gallon Septic Tank and 9/8' [.F 2` wLbF- - -RriNcKSS Other Requirements: Water Suouly: Public Supply From Address. (A. A V S or: ;Private Supply Drilled by . P—'r i3F7AL_ ¢ son1 S, t w t Address a*o wsr -Q .....:.Bulldi . I�SI t7EPiT� g- Type... - Has rcrasion-control•-beer�•c�d ?° - ' Number of Bedrooms .4 000.l, S, 9 i Has garbage grinder been installed? Q0 I certify that the systems) as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 2- 2 2 ei q Certified by P.E. R.A. �ionai� Address TN r L' „� E y �,,,� ¢ �,u v A,�c K , ef,, License # P, c, ► ` es ?t' ?Z 3aEw, +F-a-, y i osa cl 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 revoca on, modification or change is necessary. B zdz,fl Y' Title: Date: White copy - HD 41e; "11 copy - Building Inspector; Pink copy - Owner; Or ge copy - Design Professional Form CC -97 r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 011''' EIS WRO10 MENTAL HEALTH SERVICES WELL COMPLETION REPORT - ell'7Co r%n �` Street Andress: Woodland Estate Kramers Pond Rd Town/Village: Putnam Valley Tax Grid # �v�, Laf' lj Map 73, to lock k Lot(s) 18 Well Owner: Name: Address: V.S. Corporation, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: Il prnmary 2-secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 43 ft. Length below grade 42 ft. Diameter 6 in. Weight per foot 19 lb /ft: Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes . No Liner:_ Yes X No Screen IIDetalb Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 4L gpm IIDepth Data Measure from land su ace -static (specify ft) 30 During yield test(ft) . 160' Depth of completed well in feet 225' Well (Log If more detailed information descriptions or Aeve analyses z are available,' please attach.. Depth From Surface Water Bearing Well Diameter(in) (Formation Description ft. ft. Land Surface 10 Drilling, in overburden clay and boulders 10 Hit rock at 10' �: }0_`R..: 43 - 43 225 Drillin in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 1_ Ohm Depth 180' ModellOM07412 Voltage 230 HP 3/4 Tank Type WX302 Volume 1, Date We I Completed . 11/12/98 Putnam County Certi ication No. 002 Date of Report 1/5/99 Well er (s' r 1 rqv u m: rxact location or wets win aistances to t least two permanent lanamarKs to be provided on a separate sheevplan. 4 Putnam Avenue Well Driller's Name . F. & s Inc. Address: Brewster, NY 10509 Signature: ZZ,4�� Date: 1/5/99 e a White copy: HD Fil ; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY CT Cert: PH- 0404.. AE ®ir ®® ° 3�3= "3'YiiZIY:I:�PI:1�IN�ROi�I9 "' x�AT�i '13URY�C')�'�b6>�'1I'�' r _ -- _ �.'"... I�i�CC�er {:."1'1'd7',�'.."'• ^�` ^••• _ I (203) 748 -7903 - FAX (203)748 -0652 -LABORATORY REPORT -- WATER SUPPLY TESTING REPORT; TO• PT. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: i TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) ! PHYSICALS: Color Odor pH j Turbidity CHEMISTRY: DATE SAMPLE COLLECTED: 2/3/99 TEME COLLECTED: 3:30 P.M. COLLECTED BY: W. MAYES DATE RECEIVED @ LAB: 2/4/99 TESTED BY:LAB #11471 & 11301 REPORT DATE: 2/9/99 V.S. CORP., LOT #11, WOODLAND EST., PUTNAM VALLEY, N.Y. HOSE BIB WELL -NEW NONE RESULT: MAXIMUM CONTAMINANT LEVEL 0 per 100 ml 0 per 100 ml 0 ND 7.81 no. designated limit 0.37 NTUs 5 NTUs Nitrite N <0.005 mg/L. as N 1 mg/L as N 113 01- Nitrate N 0.99 mg/L as N 10 mg/L as N - Alkalinity 194.0.'_ mg/L no designated limits.. - -_.. _ _- mom._..._......_. � .. �- no desigriafed "limits :_ .:..�_._._.. �. _.,...• . _ .. .._. Iron <0.03 mg/L 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 1.3 mg/L 20 mg/L ** Lead <0.001 mg/L 0.015 * ** m1= milliliter. mg/L, = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level I RESULTS BASED ON SAMPLES SUBMITTED:2 /4/99 SAMPLE, AS TESTED ABOVE: ❑X OTABLE or OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) :Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037. (860)828-9787 - FAX (860)829-1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 I I I`UTNAM COUNTY DEPARTMENT OF HEALTH DIIWSION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �S Goeysr�tuci'1�iy cost P. 73. ,g I l8 Owner or Purchaser of Building Tax Map Block Lot 37 GQoTo N `p Am cozp_ 'F>,T -NACV1 V/a LI-Q Y Building Constructed by Town/Village BVRiA'_ 14,11 Tkv ( FarwML'( 131=CG4 9,LL AD.Scw-r") L NC., rZ 1X.- Location - Street Subdivision Name Building Type N Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed. by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept. as conclusive the determi Director of th utnam County Department of Health as to whether or to oprateva f caus the willful or negligent act of the occupant, Day Year a ) - Signature CC�N STP,0CT, one COZY. Corporation Name (if corporation) ` /c7 3 % CY,O,ro W -pA m Address: 3? CZo-roN DA m 2nh -D State 0-55 IN t NG, N Y Zip I 0s 6,)- Signature: Title: ppG of he P b is Health f 'lure t system bu; gilding I ti izing the Z Corporation Name (if corporation) Address: State Zip Form GS -97 LOT 11 AREA 1.361 ACRES i I oF rpiS-DocumiNr, muss UNDER THE mEcnoN 'SEP PROFESSIONAL ENGINEER, IS A WOLA77ON OF ?09 OF ARTICLE 145,OF THE EDUCATION LAW. 1. P -7 Av N R= 175.00' L=2316' aR P cl + r ti YlY ?Y L �'• k:; f r �r aia 't � a SI .r •�'``•���r� Vii. w 1 I 1 1 1 � T. •: iy � 7 +?- 4y�atrNj 9 3 -N 1 ",• S S,+ u e' ,125Q �ALLtFN �E s J• S �`�• Y i 4 °k° . � RiT�2 .t fi e• } � r .A . . 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CROTON Q. �•�f' s*•+,;x� C ice,::' rr f` o r #,, OSSINING, ^ N� S/TE�LQCA170N TOWN OF'PUT NAM COO x , h ' Ry i°`TIlI .(S^ °TO, CERTIFY *THAT ~FME $EWAFc S 4V S C AS IpfCAED 7R(NSUCENT ON M A �+TfIE Sl'5TE�tl;'I AS C9 ERYED RY.INSIIt. aiR1�EYlJC� �kNL� rCA, NDSCAPE ARCHITE y> � IKfI C 'yEI ED DI/£ x -THE S:Y$TEM , WAS �GENERAI. ACdORDA c WITH ALL .. TAN ° E U A LIONS pE= THE''PU IMAM c,OtJN7Y .4t7IL�AND,3WC�NEW ORK S•IA7 27 BALL F, 0LfRE5:'EXIS77ND, UNLESS NOTE 4RPROPERT,Y LINE, HOUSE, LQ ATItiIV, ;AND•, F FRdlf FIELDWORK PERFOR�E'B BY 7lVSIT S ` f ADSGIPE �lRHlGTl1R, P , 4COMP 7 x i _ 1p 4 v s ti I •t ",t.+yC":.r °'v.;y^w .' %.t ,1 7 a i 4 Zy. 1 x 2 G Y• I I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. .'y ".. ,.r .-• .. �.L..•,.. r.,�j -�.. - ,�.,,._ 1 _ _ :� a ..rt-, , - .!� ^r:z+= �=- e^„n�4.�rS -�x_i c= �C'.xm��:a:+`- - 'v - ,�< _ .� „... �°-S ... .- ti...- r I CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT i Located at ,e.��rz is z-k-q Hsu. 1z**y 5n�r:t Z To or Village Subdivision, name L 1,JC,17'L -:�S Subd. Lot # l 1 Tax Map-13. 16 Block 1 Lot 18 Date Subdivision Approved 5189 i Owner /Applicant Name 3 7 C47VIV M" coitf, 1 ' Mailing Address 37 G,--e p,+rm i24> 955t^14 Renewal Revision Date of Previous Approval b 7'9O M Zip lo�loZ- i r Amount of Fee Enclosed Building Type 14-�l Per-`r701 'Lot Area 1-36" '`No. of Bedroom=4 Design Flow GPD goC7 II _ Fill Section Only Depth Volume Separate Sewerage System to consist of /7,50 gallon septic tank and Other Requirements: -3•S` PC"-- , To be constructed by 1 r Gflorird Pte, 2• Water Supply: Public Supply From C �Address Address _... -. aut•: Fr va:e S�xp iq-Di�i Ie by��r° g�RZ %t- �vs °.� Acidress' f;- .4WSrb't- a/ y I represent that I am wholly, and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the i Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. 1( Date I "Zg`q 7 `�►C �„�►nsty�,{ �,G, License 14-05- 9,�r-' Ze / 4/1 Ir 0 5-of .APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p rmit. Approved f discharge of domestic sanitary se age only. �, BY: Title: Date: al White copy - HD File; ell c y - Building Inspector; Pink copy - er; O e copy - Design Professional Form CP -97 � t I' . B SIGN (0E ]ENVIRONME T7AR HEALTH SERVICES C ®YS1tUCTffON PERMIT FOR SEWAG E TRErA.T. w. V�c-.- E,.- Nv=+cT ..» aSaoY.�.S.Gy T<'e I Located at gill ,SQI, mown or Village Y,(4&in vl t Subdivision name �C a, Subd. Lot # .. Tax Map a lfl Block / Lot Date Subdivision Approved 9%IS q A-/eI Renewal' Revision Owner /Applicant Name ��, S. Ca n; ><rvc. �,�n Ca rte_ Date of Previous Approval Mailing Address .51 C% Zip Amount of Fee Enclosed Building Type Lot Areal , j C-No. of Bedrooms 1—Design Flow GPD_ff epairate Seweir age System to consist of gallon septic tank and r 0 l L 2 W i� Lcn C e S Other Requirements: _ To be constructed by 3% C4n ,A L2 C'or� Address�P 'Iate�° Sinn ®9, ye. Public Supply From Address pye I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the goparate sewage treatment Lystem 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. P.E. --- Date i �{ & dW 1. 4xLe /OCLicense # yyy APPROVED FOR COATRiJ' ft: This ap'p oneexpire7two years from the date issued unless construction of the sewage treatment system has been. completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. ApprovedXor discharge of domestic sanitary sewage only. P By: Title: Date: White copy - HD Fil ; Y low opy - Building Inspector; Pink copy - er; Orange copy - Design Professional Form CP -97 C 4-/^ -L � S -- 4-07 - (1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ n PCID Pem _ it# ,gcpcty WeW Location: Street Address: Tow illage Tax Grid # Ai/t-eK Ha,. f4v*p { vriv p- VA Map-13, 15 Block Lots) 1 WeID Owner: Name: Address: W. S, &Wa ,r 17 e-ewf d PM41 rot 0Sf"j,,V6 // /0- Use of Well: XResidential Public Supply Air /Con eat Pump Irrigation 1- ri Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 4- Est. of Daily Usage 3C40 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling XNew 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 Y- No Name of subdivision Lot No. I i Water Well, Contractor: j yAlx j ow ..1 Address: 9tYKNy4 -*d Is Public Water Supply ',available to site? .................................. ............................... Yes No Name of Public Water Supply: r/ A TownNillage N lA Distince to property from nearest water main: .I-j Profosed well location & sources of contamination to be provided on separate sheet/plan. Date .A licant Signature: v V PERMIT TO CONSTRUCT A WATER WELL Thispermit to construct!, one water well as set forth above, is granted under provisions of Article 10 of the Putarn County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (3 0) days of the completion of water well construction, the applicant or their designated reprsentative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requrements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form pro�ded by the Putnam County Health Department. During all well drilling operations, the applicant and/or welldriller shall take appropriate action to assure that any and all water and waste products from such welldrilling operations be contained on this property and in such a manner as not to degrade or otherwise contminate surface or groundwater. A.PIROVED.FOR CONSTRUCTION: This approval expires two years from the date issued unless commction of the well has been completed and inspected by the PCHD and is revocable for cause or may be atneded or modified when considered necessary by the Public Health Director. Any revision or alteration of 0 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam - Datcof Issue Permit Issuing 0 ci Datfof Expiration V:::7 Title: Pewit is Non- Transferrable W hi copy -'HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I PU7C'NA 1�9 COUNTY DEPARTMENT OF. DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: I, AL- 5.4N 1-0 Ce— i �.ING�I jZ 7 �U (-5 btvi5LVCJ represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V, S, C iS'r-nJC Cisv -� 3� c,�,��,� t;�" yZn, C.0r..� , acav'5r Having offices at: 7 c7Z -- b,-P'" Whose Officers Are: President - Name: Vkl' Address:. '57 GizeTz,,J PA,,i rZ&AD, o�� cNi�E;, iv.,1(, Vice President - Name: Address: Secretary -Name: Address: :__ ._. 4..:.,. -.�T :� - _. -- ;:. _- .:..- :_...o.� _.. Treasurer -Name: Address: and that I am and will be individually responsible for any and a to the approval requested and all subsequent acts relating ther, Signed Title: Sworn to before me this day of (month) (year) No ary Pub i LAWRENCE KALKSTEIN s Notary Public, State of New York Corporate Scal No. 014752767 Qualified in Westchester Count Term Expires February 28 Form CA -97 oration with respect `R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSUR�AMSEWAGE TREATMENT SYSTEM f * Owner X 1 C ' U `� oW vcTl 407'Lj-�'. Address 37 CKato,J DA7✓c IT'D ' i3�zta2 Ntw kzo� Located'at,(Street) s,,! tgoTaxMap 73,10 Block I Lot l °o (indicate nearest cross street) Municipality. rte" VA Drainage Basin V L ofod Ktve 2._ SOIL PERCOLATION TEST DATA Date of Pre- - soaking! cw,` `l Date of Percolation Test w• 3 t- ?8 Hole No: Run No. Time Start - Stop Ela se Time kMin.) Depth to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch j 1 '7;05-- 9,-31 0&' ZZy2 Z✓Z �j % 2 30 2Z V5 3 b (d 103-10:33 'j0 2� ZzS - Z Z (a 4 5 2' 3 4 5 1 2 3 4 5 . P! vitb:• i.. rests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1 -30 minhnch, s 2 min for 31 -60 min/inch) .All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Indicate level t which groundwater is encountered Indicate le el at which mottling is observed Indicat evel to which water level rises after being encountered I., Dee hole observations made by: Date Design Professional Name: -V .. . Address: INSirC jw6weD Z 0�, 56,4-11_65GaOC Signature: Design ]Professional's Seal ly, �.1 ��Essi4 %� .. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION�. OF ENVIRONMENTAL HEALTH�SERVICES - � `�� • .: t.p �1�`..� !6 1-.y�2 .{'-f zy '��J 3ai S�'k �. wF� - .+ •tr ''it r N. Y. 4- 'c . .. _,k 33E •I N °mA`1'A E!T"St*SURF E4TRE ATIVIENI' SYS TEM : Owner-; Address -3? ' camT-o� 0.*-4 aP, 05 e, *4 2,. N Located at (Street), ,;:. 6i t�K ,k i u D s:o. �ml Tax Map?? JP Block..,.: ( Lot' :1.8, ` `. . i (indicate nearest cross; street). Municipality r► LI Drainage Basin. v D S a-)-.) rz i vex—.- SOIL PERCOLATION TEST DATA Date of Pre - soaking I Z `Z9 • �8 Date of Percolation Test t 2 .30 , 98 " Bole No. Run No. Time Start - Stop Elapse Time t�Min.) De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 10: 10 - 10 "Z7 ( s i 3 2 ►o,. Zt - to 3 loW7 - l 4 _ 5 (a.fI - lo.zz _2. 23 - 10, 33 to .. _l.s .... .° :. 3 4 10;- (6 -10:56 lZ rS 1 y 5 1 - 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2 Depth measurements to be made from top of hole. Form DD -97 DEPTH -1;OI E;NO,. ' HOLE ; 40. HOLE N0. Y GL` 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.51 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date f Design Professional Name: Jeffrey J. Contelmo, P. E. Address: insite Engineering, surveying & landscape Architecture, P.C.() o 1:S5� =route 22 Brewster New York-10509 �` Y Signature: Design Professional's Seat M T _- -n CO ` Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date f Design Professional Name: Jeffrey J. Contelmo, P. E. Address: insite Engineering, surveying & landscape Architecture, P.C.() o 1:S5� =route 22 Brewster New York-10509 �` Y Signature: Design Professional's Seat PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' � - - -. i•'. r,. ww. A.• .. a..O •:ylv .. a. _.�. �'c:�r!'6 vk t:4 �. '. j•w.a7. =. ,.. L � i:.f �j .N...::.i�.•. '�:I ",t" � .. •'K^ - ..a, ,�M .r .. -r:. -- }r.T: �r. LETTER OF AUTHORIZATION RE: ' Property of Located at' fs i a-GK H(w ,se -rr-M f/V VrW v Tax Map # Block ) Lot Subdivision of G iN CA-le- Subdivision Lot # L 1 Filed Map # Z4-33A Date Filed 1-5-07 Gentlemen: This letter is to authorize Insite F�rigineering, Surveying & Landscape Architecture, P.C. (Jeffrey J. Contelmo, P.E.: a duly licensed Professional Engineer x . ocRqg==d)0ffrhit0axxxxxto apply for the required wastewater treatment and/or water supply.pennit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems _ he provisions of Article 145 and/or 147 of the d: ti fllaw „the, Public .Health in conforms with t _- _ , _ _ , Law, aind'.the. Pdtn:arn Corari S ita y Cede: 311 Countersigned: P.E., ]K.ai•, # 6 1 9 3 1 Mailing Address Incite ar neering, survevim & La6iscape Architecture, P.C. Route 22 State Nea York Zip 10509 Telephone: (914) 278 -4990 Very truly Aburs,� V 11 Signed: of Mailing Address: '3r7 C42fnr1'c! DA-” g t State N y Zip /U5'L Telephone: `t (4- , -7 31- 7 3G Z Form LA -97 INSI jENGINEERING, SURVEYING & . .i.,�:N ,hY..r3y'f..7' wT,q�.+7[pe ie•n.. R"N- :T ^+�mEt*'J&� !Y: c: %�t: i.�•,T'.�L•�7V✓V'{J/i - f- y'i:jRw%\�. ��.r.rSQ�lt •aaY.i�isi 1':i �.iaJ7:M- :�a..�.ma,:. i¢E�•R�HP�E�TU�C' August 6, 1998 Mr. Adam Stiebeling Assistant Public Health Engineer Putnam County. Health Department Division of Environmental Health Services 4 Geneva Road Brewster, NY 10509 RE: Lincar 3 Subdivision, Lot 11 Town of Putnam Valley Dear Mr. Stiebeling: In response to your July 23, 1998, comments, we offer the following response relative to the area west of the subdivision design area from the final plat. This area is not usable due to steep slopes downhill of the proposed subsurface treatment system. The 3.5' fill pad can not be graded out using the subdivision design area keeping associated grading on the subject lot. Additional deep test holes and a percolation test were performed in the new proposed expansion area. The results were submitted to your department per your request. This letter confirms that the new design area is acceptable for a subsurface treatment system-and -wilLprovide.the:better.design alternative, - -- -. - - - -- - - - Should you have any questions or comments regarding this information,+ please contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. eff r onte • JJC/j ms Insite.File No. 91147.311 080698as.doc 1485 Route 22, Brewster, New York 10509 (914) 278 -4990 Fax: (914) 278 -6392 ❑ 7 DeLavergne Avenue, Wappingers Falls, New York 12590 (914) 297 -1742 www.insite- eng.com N !S'l T E ENGINEERING, SURVEYING& L L AwscAPEARcHITEcTuRE, P.C. -4 Brewster, New York 10509 ~ (914) 278-6392 7 DeLave6ne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: %frC Kr OF TRANSMITTAL Lokur! Date: Job No. 1.1'f 7,311 Attn: Re: 1 ce. WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop Drawings 2' Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO. --------------- DESCRIPTION ce. ......................................... .......... ............................ ..... . ...... . .... ... ............. ........... . .... ........ ........... I .................. . ............................................................................... . ....... ............. ..... . . .............. . .. . ... .................. . ...... . .... . . . . ............................ ................... . . . . ............................... ...................................................... .................... ............. ................ . ................................... . ................................. THES RE TRANSMITTED as checked below: or approval .--Q-AppTved as submitted Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: .............................................. t ....................................... ....................................................................................................................................... COPY TO: SIGNED: Lot98.dot j plij IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES "`Sfree %'Location -\ ,' �1���•t- +Ri���� Town FINAL SITE INSPECTION ,Date•. -- -:ti, m.��,:.�r...:.; r ;� n.- .4��•.. /d...., .- l_:.s�c� fi nspecte( yv: Owner L^ t K C V)I& Permit # P q ° Tiv1 r Subdivision Lot # 1.. Sewage Svstem Area a. STS area located as per approved plans .....................:..... b. Fill section - date of lacement 3:1 barrier Lgth. t Widt1;",rj0 Avg.Dpth 3- c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage Svstem a. eptic t c size =1,000 ........1,25 ........other ................ b. Septic tank installed leve ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2. ft.Original soil between box & trenches Junction Box - roperly 1. set ....................... ............................... engtiPrequired Length installed 2. Distance to watercourse measured \� Ft 3. Installed according to plan ......... ............. ................... 4. Slope of trench acceptable 1116 -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.....,....,.,........._..._...- ' :::...:....:......:. :.:...................... ...... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm; visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. house located per approved plans ................ I................. b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft, ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... - d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 .�r.r pq. ..��' . ri:;. ...+ . -vie -e . ;. ±; '�,'c �l :•.�. �- ;nii'!. .- .:.r.�.irr. i . ...-. John Watson In'site Engineering 1849 Route 6 Carmel NY 10512 BRUCE R. FOLEY ';PiVic' -'Health ' Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva ' Road Brewster, ' . New York. 10509 Tel. (914) 278-6130 Fax (914) 278-7921 January 11, 1999 Re: Lincar III, Lot #11 TM# 73.18 -1 -18 (T) Putnam Valley Dear Mr. Watson: As per our conversation regarding the above referenced lot; please have proposed primary trenches staked out for an inspection by this office. Please also stake an area of equal size (SF) for 100% expansion.-, Please call to schedule an field inspection to review layout. Please feel free to contact us if any questions arise. ASB:tn Very truly yours, Q; Adam B. Stiebeling Assistant Public Health Engineer I .�r.r pq. ..��' . ri:;. ...+ . -vie -e . ;. ±; '�,'c �l :•.�. �- ;nii'!. .- .:.r.�.irr. i . ...-. John Watson In'site Engineering 1849 Route 6 Carmel NY 10512 BRUCE R. FOLEY ';PiVic' -'Health ' Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva ' Road Brewster, ' . New York. 10509 Tel. (914) 278-6130 Fax (914) 278-7921 January 11, 1999 Re: Lincar III, Lot #11 TM# 73.18 -1 -18 (T) Putnam Valley Dear Mr. Watson: As per our conversation regarding the above referenced lot; please have proposed primary trenches staked out for an inspection by this office. Please also stake an area of equal size (SF) for 100% expansion.-, Please call to schedule an field inspection to review layout. Please feel free to contact us if any questions arise. ASB:tn Very truly yours, Q; Adam B. Stiebeling Assistant Public Health Engineer Date: 4 12 1 19 To: To I Kk s I T BRUCE R. FOLEY _ "Fublic Heithh—Directcr DEPARTMENT OF HEALTH Division of Environmental Health Services 4_ Geneva Road Brewster, New York .10509 TeL (914) 278-6130 Fax (914) 278-7921 FAX COVER SHEET[ Fax #: 270•'63?Z No. Pages "-- 2-- (Including cover sheet) From: Adam B. Stiebeling Asst. Public Health )Engineer for your:irform atlOn - For your review Attached as requested 'As Please call Notes/Messages f In the event of transmission /reception difficulties, please contact this office at (914) 271 -6130 ext. 157. LOr.8 4ou j.L 0T 1.2 169.9 \ r 1 1 ``Y A41>. MiT / I 1 LOT 8 iz i _I ZD 1 I N-7 \ 1 \ �- 1 .1•NCT•� ''M. VIII �. LOT 9 0 1\ 1 I� / I R =175.00' D. 10 i I * BRUCE - R. FOLEY Public. Health Director N I :r:�: ..-C.., u.lri:.�- .:.'S:'w..... ��': •l� _-.�r �,;,�'..:. ..� i:.,.o.�= '....a , :'a i�.:`=..... :�'.as_:wo:...:waii�.,�:�i..:.. ...a... DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 . Tel. (914) 278 - 6130 Fax (914) 278 - 7921 . FAX COVER SHEET Date: (%' To: X04 From: i Adam B. Stiebeling t. Public Health Engineer For your information "For your review _ Fax #: Z 7 g L q 2. No. Pages (Including cover sheet) Please respond Attached as requested As discussed Please call Notes/Messages L \ 1 LL 1-2 LL- l COQ 6 On "J In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. Date: To: C" 2 DEPARTMENT OF )HEALTH Division of Environmental Health Services .4 Geneva Road Brewster, New York 10500 TeL (914) 278-6130 Fax (914) M-7921 FAX COVER SHEET Fax #: ? ?a— & No. Pages (Including cover sheet) From: Adam B. Stiebeling A Public Health Engineer For your information Please respond For your review. Attached as requested As discussed Please call BRUCE * R* : FOLEY Public Health Director. NotesliMessages 3 > —F S 1) ren Dc-t -1"b �Ilcl'r-6c�c C- I AU cz� 'R i 5Ca "I-v ( L- t-- J,2 &0 V) to L IeTT6vt' In he event of transmission/reception difficulties, please contact this office at (914) 278-6130 ext. 157. r or 0f, Or I to ■ ".; ENGINEERING; SURVEYING & -- _ _ =s _ _�ayoscae�AACHirEC.ruRE pc. _LETTER ..Of _TRANSMITTAL I Route 22 ! (914) 278 -4990 Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue ! (914) 297 -1742 Wappingers Falls, New',York 12590 H. TO: pig C, H . P, Date: Z -m -O)1 NO. Job No. 9( 14:7 11 Attn: S-rl e -r3 6L1 ,JEj Re: L�ac•�r� GaT $ ST5 co.H ycr�PN�� . 3 � to -'S' -9 8 G5 -9? WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES i DATE NO. DESCRIPTION A15-1 A-5 _. t? yr 4,r Z- 1Z -R`t CC -917 60-�srrz0r70 -) C0rtI-'urty4C6 . 3 � to -'S' -9 8 G5 -9? E, vrt,cs+.✓TE�' ........_. "._..."........_... I Z_ 9 _'q 9 -- c✓ft -r�'z res-r Cc�-s v STS wL1-7 1-7-9c, u00ol e zoc' .00 Fle"r { t ..............................._._: ........�.....�.....- ........_. ._.-............_.......-......................................................... t ............................... ................. .... ......._ ....... ....... ... ........._................... ...... ._ ...... .. ................................................... ............ THESE ARE TRANSMITTED as checked below: ® For approval - _ -' --•Ej-Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ REMARKS: ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints Lot98.dot I r: win Do iocatt®0 aas ahaeiarn I on th.Oepprollod. plan end that aide Well Will bo;l Coiln4y tint Galt of OieaRR:' '.; :, ; Data, A®d-ran ;Z_A lU tr /a rLt 4z 14pRoVE FOR CGNSYRUCTION YAlB appiodoi expUes two years., f rOeroCatllo.PW CAYaa M;:meyftW amando6 Oa modified wham COntiid requires a n,7 per' it.", App rove a for ,diaoia 1, of' dome ap ary' REV . 10/88 �tm in IP Coe}t►uetion ComplWnlce s�tisPadovy_ to the,_CommissiooN:of MeiKhwill w owner hiti futoaware;`hOk6 av a'talgna by. the buikNr, tha1L•riia' builder will urine, the poriod of taro {3) yews- Immediately following thodBto of thO isaea- IginD1 sYaitorat Or Ony r®gpars talovm@oi 2) allot tli d fit" well doMaod above l . alcoordanoai< Muth the- ;standarIlk rubs: and reiiuog a of the IPItnem P.E. R.A. _— mto: issuti� uei®ss cori�PUCtioe' "'of the ;building .has. Mon unldertaken and is y the Commissioner .of HwItil. Any change or alteration of Construction n�q� p►Mat® wato►. CUPPIy only. IOWA DEPARTMENT OF HEALTH Division Of Environmental Health Services Acting Public Health Director 4 Geneva Road, Brewster, New York 10509 (914) 278-6130 December 16'.199/ Jeff Contetmo Insite Engineering Route 22 Brewster, NY 10509 Re: Proposed SSDS: Lincar Lot #11 Birch Hill Road (T) Putnam Valley Dear Mr. Contelmo: 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." 1.1 Current engineer authorization letter is to be submitted. `Cihe, tr'oficbi `pliii be subinift6d I Erosion control measures is to be shown for the well. Furthermore, the plan is to note all erosion i control measures are to be installed prior to the start of any construction. 4. Details for all erosion control measures are to be shown on the plan.. Upon receipt of a submission, revised to reflect the above, this application will be considered fafther. V truly yours Robert Morris, P. E. Public Health Engineer RM/jp BI: "-`:SAM COUNTY DEPARTMENT OF HEALTH Divieaon of Environmental Health Servi(egs AFFIDAVIT - CORPORATE OWNER APPLICATION °- - 'Oft k"illiIT APPLICATION SUBMITTED $0 - PUTNAM COUNTY HEALTH DEPARTMENT -^ `d0: Commissioner of- Health In the matter of application for: L i,o c.A K yeveLo Pm e�T C IID �orVA� -D �ctClStL represent that I am an officer or employee of the corporation and am authorized (Name of Corporation) having offices at 13 67--T-y S i- 174 t/3 Whose officers are: Pres: -ent: D010A(_D Zfl ( cjae-R_7-y .5�, v7,-L— /SAS- /76y,.3- ame and Address Vice-President: (Name and Address) Secretary: (Name .. en. d, �.d�iF� _s- :w-- si- - ti-e..s o- '..q...s. ..r -.. ....o.. -.y.• :. v.y ..2-...�:.......r• .. , ,>.. . .. iv -. ...�.y,'...Qs ..: .... ._..... -:r —. .:.y +....I� -+era. o....:.• Treasurer (Name and Address) and that I an and will be individually responsible for any and all its of the eor ?oration with respect to the approval requested and all $ubseque acts r 1 ing thereto. _J�+ S6oro to before me this i/ day Signed: of -- 716Lr,C / 19 9 1Y Title• Noea: Public , ARLENE FA'JrSE N'1ERC`Y NpT .RY PUBLIC O. s4, Commission Expiras Junt_ - A 6 f *S_ 0 a,orporare heal i L � .Jr�a,� Zff• c-a� • I I ' 1 PUV''�! COUNTY DEPARTMENT OF DIVISION OF ENVIRONMENTAL HEALTH SERVICES 41-�a h. Re: Property of INCUR n�-yEt�P��c -� CO.) Located 'at !°)R..ck .El(C.C- eoap SGVrr! (T) f'V1 VAU -6-Y Section ���) Block Lot 1°v r�•� Subdiv'is'ion of Subdv. Lot #,' Filed Map Z-`i 33A Date 5 T. � i Gentlemen: This letter is to authorize f0.51 T2: 6..), 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 regulation's 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 systeff -b' s "?;teFnS` iYi`"ctsnformity ; iii=tih pi�ovrs~rorr5�of- Ar"ti.c=le* 1$5 -or . 147, Education Law, the Public Health LaM, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned v., ..OAner of Pro 6rty �L`r.J�.a� l7L- V$;trPr�C— ['c�.� Ssj-- . P'E , R -cam,`; f Address y,y,�T�'' E ✓Jr�.ti�r�kw�` `f 5'rzV YIA-, f'�C_ GiTiZ(' j��TC.�� N /-7 ( VS Address ...,,+,,., own... .... �£ jr7 R-6.- Ca a. /V 1' - le=st 2.. �; >. Zv( -. 'yyO - 'Y -7c, o Telephone qtly ' ZZS- 6- ZcC) gelephone I , DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO: CONSTRUCT A WATER- W- EELL=..: %/ / �q_' _ PCHD PERMIT #/ -/ r/ WELL LOCAT ION Street Address �r�c j�ici l�okv Sorrr{ Town/Village/City Tax Grid Number v, A Al. '73 -iO -- - 1 WELL OWNER Name Mailing Address 176'1.3 ORrivate Z413MY57r, Lrmc F My- 0P6blic USE OF WELL 1 - primary 2 - secondary 15 RESIDENTIAL ® PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ® ABANDONED ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify ® INDUSTRIAL O INSTITUTIONAL O STAND-BY AMOUNT OF USE YIELD SOUGHT Jr fpm /4i ® REPLACE EXISTING SUPPLY RNEW SUPPLY NEW DWELLING PROPLE SERVED ! /EST. OF DAILY USAGE al .Sal ® TEST /OBSERVATION 12. ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE [5;;ILLED ®DRIVEN "DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t.J-X4 2 !Zr- Lot No. jJ WATER WELL CONTRACTOR: Name C/���ocJ•� Address: G(N le, tVdeUQ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO MAKE OF PUBLIC WATER SUPPLY: ! 4 TOWN /VIL /CITY ,..:E�ISTIANC JO PPOPERTY FROM NEAREST. WATER —MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED Z 1.59 IDON-SEPARATE SHEET (date) (s 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 requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherw' a contaminate surface or groundwater. Date of Issue: ill 19 z� I%A�. Date of Expiration T 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller I I APPENDIX 3 ' PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET, .for CONSTRUCTION PERMIT NAME OF ER 9�STREET C TION BY DATE G% TAX MQ5L CUMENTS. Y FPERMIT APPLICATION' PC -1 I WELL PERMIT;M PWS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) DEEP HOLE LOG CONSISTENT PERC RESULTS (3) PERC HOLE DEPTH CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST GENERAL LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE l FILL REQUIRED CURTAIN DRAIN REQUIRED EDSTANDPIPES EX- APPROVAL SSDS-ADJ. -LOTS WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE -1969 - NEIGHBOR NOTIFIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION__.,_ SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE III GRAVITY FLOW D/ J BOX TRENCH/GALLEY m P- PIT DETAILS SEPTIC TANK - SIZE, DETAIL WELL DETAIL, SERVICE LINE IF OVER CONSTRUCTION NOTES '(GRINDER RATE) DESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED DRIVEWAY I,& SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: DISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) ® HOUSE SEWER - 1 /4 "/FT. 4"0; TYPE PIPE CD NO BENDS; MAX. BENDS 45 W /CLEANOUI FILL SYSTEMS MCLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS DEPTH GAUGES FILL PROFILE & DIMENSIONS ITIYOLUME TRENCH LF TRENCH PROVIDED 60 FT MAX PARALLEL TO CONTOURS 100% EXPANSION PROVIDED `IOrTO'1'. ; DRIVEWAY,`I ARGE"TREES; TOP-OF FiI L- .,- -� 20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE ED 200 FT. RESERVOIR, ETCM 150 FT. GALLEY SYSTEMS SEPTIC TANKS m 10' FROM FOUNDATION; 50' TO WELL WELLS =15' WELLTO P.L. Li rXAuK IM t vr' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL'HEALTH SERVICES . . [ ^ iR`C..+f +. +e+r: .. c. .t :.. -.i ::`) t ". �A1- IDi:v'. c- tira'v. ;- v�.'.. _'� •[ ^.�f.8 o i " ..... -. �: ��.��. -. Date t Re: ]Property of d- ►n%c�R. PC-yec�PM� =�� Gt% -� S. n��-_ ]Located at e)lzz 1(r COAC, &,Vnq (T) f 0*rA)A,-n VALLCY Section 73, t85 ]Block Lot 18 Subdivision of C�,.)LA2 -5c.,o V ISroZO Subdv. Lot # ]Filed Map Date Ik 1 S ! 7, Gentlemen: This letter is to authorize T 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 systems oi*-gysteuis ,iri `aroiiformit"y "V ttlitiie. §r6va signs "mf: Kl $t 6 e �d5 �mr 5147, Education lLaw, the Public Health Law, and the Putnam County Sani- tart' (Code Ver, Sigr Countersigned: Ci DIEo fl 3 :5-c7:�enq - Go..i��C rrrU 1 iNS 1TE E,&)&I'aeTxV%;c { Sok UEyrnV6, �'aC Address Z- `ttq- ZZS- 6-ZGC) Telephone er. of P 6rty Z�{ LrBe7z� ST�t'�rT Address c: rz� fuzzy, ti f -76, t'3 Town ' Zv I — vYp — y-70 G Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION �;.e>yy%'.a�. ova:.- :..r,.�•.:,•�oci :e�..:�• =.e..c �s• w .. ,.,. _.._..:. n- �o,.:, r....:... �t... nd;,: �._. �... er.r...,... ae;. �: ..�•;.;.�.+�•.e.o��r........... .._ .. r... .- ►•-- +.v:..r -we :•+. FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT •• TO: Commissioner of Health In the matter of application for: ' L. / N cA N` Peyez_o Pr' ewT Ca�,- =/O c- • Lf'v C�� -77r- S vt3 D f V c.o r 1 I, �ONA� -D �tcGISCL represent that I am an officer or employee of the corporation and am authorized to ac �. for L/ ,�o c l-K Dev EL.-P:)7 e;,oi (Name of Corporation) having offices it Z81 (_l awry S Lr rr-�c �-try , /t)s 7,(. V 3 Whose officers are: • a' J)0,VAc Pres-..eat: ,a (Name and-Address) Vice - President: (Name and Address) • r�rcw. : ✓ » :� .... -... .... ems,. ..., s...... ...... ...v... ».....e.... y .. .. .». ...�..... �. _, yy.. -•. ... ...... �. -...► .. .... a p. ' - • (1 \�m�• attd�ALL�r�J, �.,. . w.w .. rp ... •I.' Treasurer: (Name and Address) and tiat I am and will be individually responsible for any' and all corporation with respect to the approval requested and all subsequ there to. Scorn to before me this %/ day Signed: of d 6Lre -A p 9 �f Nota 'Public. ARLENE FAUSTINI A.RY pUBUC OF n!E`1V 1ERS N EY my'commisston Expires JUne 24. Titl Corporate Seal 1� r� jr7-► ENGINEERING & T 11 V 1 1 SURVEYING, P. C. 1849, Roue 6 (914) 225-62oo Carmel, New York 10512 (914).225,6438 7 DeLavergne Avenue Wappingers Falls, New York 12540 (914) 297 -1742 TO WE ARE SENDING YOU kAttached ❑ Under separate cover via_ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ r, DATE JOB NO. ATTENTION- RE: ✓` V � Lr� _111_. ,jv� DtVt3 /afV — C 141D F© izm iC. - 0 l ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION j — C 141D F© izm iC. - 0 l 24,154 � t_ � —mo t r A- i C-I C-A. -171 C9 C-� 411 ill /1 mA- D A tV 17— ©� t -rz PORA T -e 4E-M E" I F' psi GA bA-r7 Sew t- 7e- --- Z/ I5 a t r- fft4 CATI I1 — 3cx_C-�'o FEE- R or t3 360-06 a I6 q �'i i i�S�7(vt✓ilo:a 1� ai�JC- ��ic.�.61� "Z `' eP-�- THESE ARE TRANSMITTED as checked below: 15—FAr approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted Et Approved as noted ❑ Returned for corrections ❑ ❑ Resubmit copies for approval. ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: It enclosures are not as noted, kindly notify us at once. 27'8" X 48' o 2656 Sq. Ft. Second Floor BEDROOM 4 BEDROOM3 II' -0" X 9,- 7, Id-o"K IV-W 27V MAST�RBEDROOM BEQROOM2 "2 16!- 8" 16'-4�2 X I3' -0' 48' First Floor 00 010 0:0 L J KITCHEN i i BREAKFAST FAMILY ROOM I 12'-0'x 1.0,0' 0.5 x IS 0' 20'- 0"X 19 0" 27'8' O 0 'LIVI NG' -'ROOM, Ik 0 up 48' STANDARD SCARSDALE If FEATURES • 4-Spacious Bedrooms o Framingham Pediment on Front Door • 2%2 Baths o Fireplace Options Available • Open Two-Story Entry Foyer o "Boxed-out" and "Angle Bay" Options • Formal Dining Room Available • Formal Living Room o Consult an Authorized Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry 0 Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in ft • "Cottage-Style" 3056Lower Level Windows contract. No oral conditions. with Architraves on Front WESTCHESTER WODULATRffOMESS, INC. z 11 N, P.O. Box 900 o Dover Plains, NY 12522 914) 832-9400 - (800) 832-3888 i PUTNAM COUNTY DEPARTMENT OF HEALTH __ -. _ • - ... __.� , E ..:o .. ... - - -•'s'Ytwr :. ;..M. -'ti^�. . - T'- =.. ^: _ ,�:.k'. t;- �'::� �..� = i �< .,a'•,a �',;.v"tt�':.'1F ,... APPLICATIONTFOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address .of Applicant: X . 7-6t 4- 4seXry .sr. LrrrcE F�,tray � iJ.S. /7 6 ys , 2. Name of Project: SS11S At G.. ,Ac Pexa -moor i2p.T KcKc- 3. Location T /V /C: P6rW, *H VARY 4i Project Engineer: --rNPrE c;5. Address: JZ007 • ZZ. BrLEwsTF7C� /�! f ! • o fit' License Number: '(o .tl31 Phone: 6: Tvpe of Project: X 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 X 8. Is a Draft - Environmental Impact Statement (DEIS) required? ............. NO 9., Has DEIS been compl'e ted and found acceptable by Lead Agency? ........... A 10. Name of Lead Agency N1A = : � i4 s •- p•ro0-e�t i i an sa•=ttr�der or other officials, ordinances? .......................................... FeK 6cD6•Pf.r^T- 12. If so, have.plans been submitted to such authorities? .................. No 13. Has prelimii nary approval been granted by such authorities? Date Granted: f A 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters 15. 'If surface water discharge, what is the stream class designation ?........ NIA 16. Waters index number (surface) ........:.............. ....... ........... N A 17. Is project located near a public water supply system? a ................. 1N0 i 8. If yes, name of water-supply N.�A Distance to water supply N�A 9. Is project site near- a public sewage to or' disposal system ?..... /V° 0. Name of sewage system' N �A Distance to sewage system .NIA 1. Date observed: uNKNn0a 23. Name of Health Inspector: 14NKa��7� 4. Project design flow (gallons per day)...... o ............................. M 2. _ 25., Is State Pollutant Discharge Elimination System (SPDES) Permit required ?., NO 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland ?............a a Q a o o ................ !� 28. Wetland ID Number > ................... ..........o......6000aaaoaDoo.. Q a Q a A) A 29. Is Wetland Permit required? ................ „ ....,......o....,.. „ ...... No Has application been made to Town or Local DEC Office? .................. 101A 30. Does project require a DEC Stream Disturbance Permit? ................ — NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards'or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO No 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO IVO DESCRIBE: 33. Is there a local master plan or file with the Town or pillage? ........... Yes 34. Are community water, sewer facilities planned to be developed within 15 years? Alp ^70 35',--Are:- an�-.sewage rdisposal _areas In, excess of. 15% Slope?-....... _ ear.... .. - - � .. _ _ - x -. 9 ... _ ..r. - �. ... ..e ... _ ��.. .� -r. .�..Aq >. v...._ .. F v. p - .S w war •.. •.. _ ..n 1r .. •n ... �. � - � ems.- � - . 36. Tax flap ID Number ........... ........... ............................... ..7 f0 37. Approved Plans are to be returned to: 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. I hereby affirm, under penalty of perjury, that information provided on- this form is true to the .best of my knowledge and be 1 ief False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: �o �,e Zz 6 awes rE-e .7 i cr LZ L:3 L i. < .ZL�- DPIISICN CP E NI+CNVMMi L F ALY9 MUICFS DES G4 '1,;M' '-,St J SLR ?Ci; -SE;V `L�IS?G�L -SYSTEM- - FLI::" ►A. ' .. _ . . SeA LtgExTy sTrjet-T Cwner lit -1c A?, rf-VELCM -LENT Co.,1rZ- address OTnVE V *zz:f . raJ 1'1(043 �} Located at (Street) e MSM N11-L Pc>Av SouTN Sec, -13.1b Block Lot 'C> (indicate nearest cross street) Municipality AyTr1A*j Watershed SOLE PEROOLATIGN TEST DATA RBQUIRED TO BE SUFMITPED WITH APPLICATIONS Date of Pre - Soaking 1A, Date of Percolation Test N /A HOLE NL?Y.M CLOCK TDIE , PEZCQLATICN PERCOLATION Run Elapse Depth to Water From hater Level No. Time Ground Surface In Inches Soil Rate . Start -Stop Min. Start Stop Drop In MWIn Drop Inches Inches Inches 1 ' 2 A DES1CaN VERwLATiot-1 V,&Tf- of It-4r M114/,N I$ T,&YEW �TZOM THE FIl D M LAP a 214336 3 4 5 2 3 4 5 1 . 2 3 4 5 1. Tests to be repeated' at same depth until approximately equal soil rates 'are cbtained.at each percolation test hole. All data to'be submitted ;for review. 2. ;Depth measurements to be made from top of hole. OL TEST PIT DATA REQUIRED TO BE SUBMITTED WITH OF SOILS IN DEPTH HOLE NO.' DI HOLE NO.; 0Z1 HOLE NO. .D 3 G. L. 1° 2° 3° 4° 5° 6° 7° 8° 9° 10° 11° 12° 13° Q oc g e 7, IZaC 6 C,, 6' goctK & 6' 14° AZ'�TdHICH�- GROgNDWA'.I'ER IS UN�ED ��' �`� INDICATE LEVEL .TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTEM DATE: /87 DEEP HOLE OBSERVATIONS MADE BY: VAL�dJrni �[irZn! El / V S �- DESIGN Soil Rate Used ! / -/ Min/1" Drop: S.D. Usable Area Provided (2<0 $F� No. of Bedrocans Septic Tank Capacity /7-50 gals. Type CAL Absorption Area Provided By Jr-00 L.F. x 24" width trench _✓ ?�.5��cc_ �EQv ri2�-p� �`.�.`� CF NE Other SE f�Rf�/ 5. Ge,a)T£ L9n C� Pt', � f Z`' ,�• ;v �O Name or-r Eacia ��,oc svxdtyt!^&; Signature Address cv SEAL J1ZE�J57, w•�. -Z) CP THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date TEST PIT DATA BE SUBMITTED WITH APPLICATION ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. ��_ HOLE NO. D HOLE NO. �!'i;:::""- .�= ';:.�. "•..•.:: � •_. L.::`f�� :a.4t�.:.•.:- �s_s.t��.. ^:-ir �....r n... ..oi'i} - .. .� .. ..- w:.ri'i :•r.ii`i,_.:r1�ar•rtii;.t::;•- .ir. - .';y -:''` G.L. 1� LORD toAir� 2' 3' 4' i =lij. il( =I1(� Iq �►N 11i�i1'l� 5' 6' 7' 8, 9' 10' 12' 13' 14' INDICATE LEVEL AT WHICH GRUUNDW'ATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: 13ALoc.Js.J �1 Goz..l EL! V S �-• DATE: DESIGN Soil Rate Used 1"1-15— Min /1" Drop: S.D. Usable.Area Provided �v No. of Bedrocros ' Septic Tank Capacity /7.5--V gals. Type eo vc- Absorption Area Provided By S�iO L.F. x 24" width trench Other . 3 5 � u8. ' K�Fuu tkcb N Name �c�vs;rf fNC�.•����ar Sv ,rvc:y/4� PC, Signature Address ..SEAL -6zeiV'5;zm al io5 -a THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate roved APP sq.ft /gal. Checked by Date