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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -21 BOX 27 I ro ki. " li' 0 ml ,. . , 1.6 oll Ike }■ , ■ 03452 ,APB" I'll; M COUNTY DEPARTMENT OF .HEALTH DIMS O T OK ENVI O.MMENTAL HEAL�Ti..S RVIC.ES �'-. ; <> - -."`r., ..I.�, .a ..�, •x.a•v::wdao.� w v� �•7a.�wz..n.a...o.,._. _.. _ c..,:...,. -• v r,wi.::�iirai:':.:viti�::..di CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PU' `f - i i ijatA -YL rtus.- X.A" Located at i (f&4-"- 7 01"t' Town 9r Village V* Owner /Applicant Name MU -,74,0 Tax Map -73,(2' Block �_ Lot -z-I Formerly Subdivision Name 75 Subd. Lot # It Mailing Address A-vt-,t tZc, , p 55 c Nc ^z , OJ Zip Date Construction Permit Issued by PCHD f r Z Separate Sewerage S s� tears .built by 37 P," /lam &W,, Address Consisting of / 2 5a Gallon Septic Tank and ` f — 6F z- ` c✓ p �G K t a S&Z, Other Requirements: O 5 9.61.0, F 1 c C, Water Supoly: 'Public Supply From Address 4 ►�'��, or: Private Supply Drilled by Y. r ee-r, SW5, t-aG, Address tfk�.rr,-r�. e C, 5-V7 Slia3g x :: / ! Pe' . VA-C . L:: = Has erosion.cbntrol been i'• v. tC• Number of Bedrooms GeA,cva„, b of &7,J Has garbage grinder been installed? iv a I certify that the system(s)l 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: 1 5 Certified by Address /NSrrV' P.E. X R.A. License # 6,('331 zezi Sir Any person occupying premises s6rved by the abov6 syst7m(s) 7hall promptly take such action as may be necessary orrection of ,to secure the c 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 'revocat'on, modification or change is necessary. By: Title: Date: 7? White copy - HD File; Yel opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ;:A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT e ee�`7Cdai• ss '�' ' -T-- ^' - = ramers �orid Rd oodland Es ate Tow � - illage: Putnam Vale Tax. Grid # 5V Le T I$ Z.1 Map73 +t(j Block ( Lot(s) WellOawmer: Name: Address: Use of Weill: =-primallry 2- secondary X Residential T Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby BDrilling 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 53 ft. Length below grade 52 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 Screem Details 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 7 gpm )iDepth IfDita Measure from land su ace- static (specify ft) 60' During yield test(ft) 200' Depth of completed well in feet 265' Well Log If more detailed information descriptions or sieve analyses. are available, please attach. Depth Yrom Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 3 Drillin a in ove burden clay and boulder 3 Hit roc at ' 53 265 granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5abm Depth 220' Model 5GS05412 Voltage 230 HP z Tank Type WX302 Volume 86 Date Well Completed 8/24/98 Putnam County rtif+cat+on No. 002 Date of Report 10/30/98 Well Dr' a s r IVQ➢rz: ]exact location or well Wltn instances to at Well Driller's Name Signature: two permanent lanamarxs to De provttga•cwa separate snpevptan. Address: 4 Putnam Ave., Brewster, NY 10509 Date: 10/30/98 White copy: HD File;/-Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 41 NORTHEAST LABORATORY OF DANBURY CT. Cerk Yff_0404 ILL- ALN AD DA�SIIRY0'e:`I O 1 NY Cert: 11471 IABS (203) 748 -7903 - FAX (203).748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL•& SONS DATE SAMPLE COLLECTED: 1.0/15/98 4 PUTN. M AVENUE TIME COLLECTED: 10:00 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES DATE RECEIVED @ LAB: 10/15/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 10 /26/98 SAMPLE SITE: VS CONST., LOT #14, WOODLAND EST., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: TotalColiform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 7.18 no designated limit Turbidity 0.34 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N 11301 - Nitrate N 0.65 mg/L as N 10 mg/L as N Alkalinity 100.0 mg/L no designated limits Hardness 108.0 mg/L no designated limits Iron <0.03 , ing/L 0.30 mg/L. ..__ , ... __., -, . r . � - ,:Ivlaagariese °-'" -- `0:022` .mg/L.,:.:....� u.. =0.30 mg/L - ;�.- '`-.• s- �� -.. :.__.�..- �.ri�. �,.A.- ;.9a�_�, , . [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 4.1 mg/L 20 mg/L ** Lead <0.005 mg/L 0.015*** m1= milliliter mg/L milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 10/15/98 SAMPLE; AS TESTED ABOVE: OTABLE or OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) - • � I 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 P. 03 UO2 ova: — :L—Ammeaw Public Supply Air condthent pump ---WlpdQo 04qft Q Racal CAle Vision Comp esud aff PUMSIN Odw ($PC*) om aw casi= x Opan hole inbodmCkI.— -Otber Tow BMS& 53 ft matcriab. odwr ToB iW-- wimad —X Th—ros&d Othu hL SQd: eta t Bmtonft Otha gbog: I Yes NO scrm (it) Wool . ..................... =W4 Homi & I Y iejd aff oap � a 20-SCI Homi & I Y iejd aff oap � a 20-SCI • P. 04 KhRTIR&AST k".0RAT01ty OF DANDu I CT Owt IP114NO 394vh&PLwa0jw-DiMw"'cT06811 NY COW. 11471 ORATORY REPORT — WATER 8MLY TZ&MG Eglew MLI Pf.'BEAL & SONS DATE SAMPLE COLLEZM: 10/15198 4 PMAM AVENUE TDG COLLEL-W. 10:00 A.M. BREWSTM N.Y. 10509 COLLECTED BY: W. MAYES DATE RECEIVED @ LAD: 10/ 1 5M TESM BY: LA)N 11471 & 11301 REPORT DATE: 1046M §Ab VS COW., LOT #14, WOODLAND EST, PUTNAM VALLEY, N.Y. MWWROINT: ROSE BID NONE i;, ST r mowwam BA . TOW Cohfbfm (Soda* PMMjQu: go-MiL., 0 per 100 ad I pH 7.13 turbidity 034 NTUI 0 per 100 01 nodes4maWlimit 5 NTUs RF,sum BASED ON sAraus summrrva.a.0/ism SAMPLE, AS TESTED ABOVE: M x ABLE or DOT POTABLE w (PER NEw YORK $T^7 DEPT. OF WMTH $ERVXM3TAXDAKV9 FOR MAKE W•M Labomtm Difwtor L: RATORY. 129 MU STREET. BERIM. CT 05037• (860)828 -9797 - FAX (%0)829-1050 TOLL MM WITHIN CT; 800-826-0105 9 OUTSWE CT: 800-654-1230 Nitrite <0.01 mgtL as N I mg/L. as N 11301 - ;Nitrate N 0.65 mg(L as N 10 mg/L as N pwiwty 100.0 Met no &S40" SMitS Hw&= 103.0 mwL no daigndW limits -4.03 u1A .030.10A Manpnm 0.022 MWL 0.30 mf)L [Now Combined Limit for Iron plus Sodium 4.1 mg/L, LAW 4.005 mg(L 0.015400 WD=wmdcftcW NTU-Uaits 0*14ad rxmWn Lavd Lud RF,sum BASED ON sAraus summrrva.a.0/ism SAMPLE, AS TESTED ABOVE: M x ABLE or DOT POTABLE w (PER NEw YORK $T^7 DEPT. OF WMTH $ERVXM3TAXDAKV9 FOR MAKE W•M Labomtm Difwtor L: RATORY. 129 MU STREET. BERIM. CT 05037• (860)828 -9797 - FAX (%0)829-1050 TOLL MM WITHIN CT; 800-826-0105 9 OUTSWE CT: 800-654-1230 o IN SST E ENGINEERING, SURVEYING& LANDSCAPE Ad. LETTER OF TRANSMITTAL -4990 -9 `( 34 )',/- 7 8 Brewster, New York 10509 (914) 278-6392 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: Date: S -`jg T — Job o. (W1,3 Attn: A4-P, -sveee-uo� Re: (,11)CA,e C0-1J'tjk1JCC ................. .................................. . ................................................ ..................................... ............ .. ...... . ....................... ......... . ...... ......... ................. . .. ..... .... . . ....... ..................................................................... ........................ . . ............................................ . ....... . .. . .. .... .......... . ............ .......................... ....................................................................................... . ................................. . I .. ................ .......................... . .. ............................ .............. WE ARE SENDING YOU EAttached ❑ Under separate cover via ❑ Shop Drawings 3"P'rints ❑ Plans ❑ Samples ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Specifications COPIES DATE (0 -G-Ole, NO. ----- ------------------ A01-1 DESCRIPTION tf15 i5u I 1-T -.:r- 913 J a-17 ce"', 5;mvz-T % co &I e C', 0 - (0 100 165-17 6 GJAYLA-vi T-L—Off A TV7Z TL 65 4) tTl� 10 -3 0 ................. .................................. . ................................................ ..................................... ............ .. ...... . ....................... ......... . ...... ......... ................. . .. ..... .... . . ....... ..................................................................... ........................ . . ............................................ . ....... . .. . .. .... .......... . ............ .......................... ....................................................................................... . ................................. . I .. ................ .......................... . .. ............................ .............. THESE ARE TRANSMITTED as checked below: Q.Appr9vedassubmitted. ❑ [],Resubmit- _cop P P -,154' �9r.ppproval - ie.,sj r pprovaI.,...,.:.. ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL. HEALTH •SERVICES,.- .. . ,S�b+ -s. aruev:,:_„ ��. a- ., - -f•l' R- r-i.r� .r .a�� ..,��':�::•t{". .�'� -t•,.. r T. a..i^.::�s.�n..•�. y+u ^� .�ti,>. u - r�s;�,'r�.:.�r, erAa.n ia.+�'�,s ';,..,�•.� ��+ti;�.....- :.%..r ��,,4•.. ::,r%.: ...u._ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM V^L c> SatuTdccl 21 Owner or Purchaser of Building Tax Map Block Lot 37Guororj `D,raM Vz o C ziso, VarNapit VA.LLC�y Building Constructed by TownNillage 13'31A1Z'a,t1_RD, lro2sw+4LY [3ime -14 R. ,U iZU 5o,,+1) '�1NC- 'Q _t= Location - Street Subdivision Name lies 7G1'Qr1 r-%L 14 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construct on 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 i 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 atioh of the b c Health Director t Putnam County Department of Health as to whether orj of t,'e fh�lur Eon he system to ol*rat w ca by the willful or negligent act of the occupant' of tl bujldi g utilizing the syst m. y i Dat ;: � Day � Year 9 �' Signature:I Genei%l Con? ractor (Owner) - Signature VA[ 141 O 5,4 iV r u c c l Corporation Name (if corporation) co2v, Address: 37 nr p� T State QsS i XN4 IN 6 iq\' Zip 1 n S 2 I i Title: r Corporation Name (if corporation) Address: State Zip Form GS -97 i,r ;�, apt I ►rn ,n� II��� w �I�+��� mE r =.iF �; rr:1 r / bh , iues+a and �`� . � rr _.xa+u e I -' a.w � ►..rno.r„ `� T 1 P:• I : I' r -- mx.r � . � r: : ; i -nmk� o I� e. WF�A& G I' 11 �i i r Ike F (►,.�;' Ir � q •� ��!'�: Pips Stg p' U i�ilIIZ ,a.l S's '+TY » ^,1 PCIMD Ift9kaMam Bo Moga>i!z" Wb FE Is @� d V a F sTamr,r�1�-�g4 L cad 2'y�tDE l�x»<ca�Pttom,4� '�2El of UNK o�ty , i►Nt U . t I:roprosOnt that 1:pm arholly and compbtoly rofponsrblo Poi the design and location of the propomd systom(s); 1) that tho 900arate amid disposal system . abovo ddssii0od raiil be constructod'as shoarn oa the approved am�nginon4 th®re to, and in accordance with the stnngorgs, rules a ►ogu nso, o, nam _, County, pOplvtwicm4, oP t�0�lth. anm that on eompbtion 4hovaot a • Cortifrca4o oP'Cons4ructtoei Compliar;co"._PatiaPactory to Oho Coinmiasioilov.ot FPOmlthwlll aiebwlgEtc 4o taoo DolAartrvlcae4 areal: a r7vitton guaiahtoe grill ®o Furnished 2M ocpnca, his meeo 4 hoivs or awfanc by tho buiedc7,'thot, wit buitdor will Do= is „pow ogovb4 up e®w@i4ion =any govt o4 aai8 � ragri diapo�l 'syss¢ ©m "durloej . tho_p6rled o9 two'(8) yodra immodiotoly PotCO��irgg,thedato of 41to imtta- LiaxO o6ho Dipw ;iol of the; Covtr4kA40 oP Cgnstruc4ion' Compliance of the original system of any ropobathc7oto.2) tho4 tho drilled %roll do wm2d a6ovo t x600 CDO CgCGtOd as l391Q7rR, on tOgci Opg�070d1 plan and that sale r:roll rai116io Instal" in accordance •arith_ tow: stareda►ds, vubs and. regie one 04 the pu4Ram County Dcpnrt OraQ.o9 POa1Qh ; 5 In t Addvom L t Liconso No �12x"ROVED FOR COPoSTPdUCTlOh1 :T• a _ov0 ettp, _ tar Dale m � fon'04 the building .has b0S1f1 undortiiken and is ... POVocoblO 9or "wo'Or may BGi DmondCd or mod /4icd arhen consrd0rJW nocesW b the Co ono► OP Health. Any change or alte7ation 04. construction Pcmuiroa a nos, par' i4. ®ipprovo® -tor d 0a1, oP domestic son tovy a date issued unless construct ReV. �+' .:/ �y TRIO 10/88 OatO�. _ I �' :91W V"'% .: VJ11: 4y� � .•:'� �.. •� RN ...r.^ ..ry -. ! '%R -,i � Y W^ ma+ �. w . r-I IFMh Y,+A ,�.. �r. '�..�y. L"3' t"' )w� r. �!+"K.7 ..� -_ w k r Ci qt' rbma i la Ow Ton Rkv EMU= D 4 IDotm m(f P4ra'Um Date Subdivision ARproved �'"s �� ( "� (L' � Fee Enclosed ® Ammint 7k,6 i t> E Y' S `t g -: pry Aa�a : I - �8'� L� Im 6* V(Clhwa PCIMD Ift9kaMam Bo Moga>i!z" Wb FE Is @� d V a F sTamr,r�1�-�g4 L cad 2'y�tDE l�x»<ca�Pttom,4� '�2El of UNK o�ty , i►Nt U . t I:roprosOnt that 1:pm arholly and compbtoly rofponsrblo Poi the design and location of the propomd systom(s); 1) that tho 900arate amid disposal system . abovo ddssii0od raiil be constructod'as shoarn oa the approved am�nginon4 th®re to, and in accordance with the stnngorgs, rules a ►ogu nso, o, nam _, County, pOplvtwicm4, oP t�0�lth. anm that on eompbtion 4hovaot a • Cortifrca4o oP'Cons4ructtoei Compliar;co"._PatiaPactory to Oho Coinmiasioilov.ot FPOmlthwlll aiebwlgEtc 4o taoo DolAartrvlcae4 areal: a r7vitton guaiahtoe grill ®o Furnished 2M ocpnca, his meeo 4 hoivs or awfanc by tho buiedc7,'thot, wit buitdor will Do= is „pow ogovb4 up e®w@i4ion =any govt o4 aai8 � ragri diapo�l 'syss¢ ©m "durloej . tho_p6rled o9 two'(8) yodra immodiotoly PotCO��irgg,thedato of 41to imtta- LiaxO o6ho Dipw ;iol of the; Covtr4kA40 oP Cgnstruc4ion' Compliance of the original system of any ropobathc7oto.2) tho4 tho drilled %roll do wm2d a6ovo t x600 CDO CgCGtOd as l391Q7rR, on tOgci Opg�070d1 plan and that sale r:roll rai116io Instal" in accordance •arith_ tow: stareda►ds, vubs and. regie one 04 the pu4Ram County Dcpnrt OraQ.o9 POa1Qh ; 5 In t Addvom L t Liconso No �12x"ROVED FOR COPoSTPdUCTlOh1 :T• a _ov0 ettp, _ tar Dale m � fon'04 the building .has b0S1f1 undortiiken and is ... POVocoblO 9or "wo'Or may BGi DmondCd or mod /4icd arhen consrd0rJW nocesW b the Co ono► OP Health. Any change or alte7ation 04. construction Pcmuiroa a nos, par' i4. ®ipprovo® -tor d 0a1, oP domestic son tovy a date issued unless construct ReV. �+' .:/ �y TRIO 10/88 OatO�. _ I i/ N.. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 ' "" •APPLrCATTON TO'�mNST R- WELL - T� -. •.d....... ___, PCHD PERMIT W I-git WELL LOCATION Street Address. Town/Village/City Tax Grid Number - e� _ I _2 WELL OWNER Name Mailing Address 4 rivate O Public USE OF WELL primary 1,2 - secondary ;,RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION O INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O ;AMOUNT OF i USE YIELD SOUGHT_ gpm /# PEOPLE SERVED A- /EST. OF DAILY USAGE�al ❑ REPLACE EXISTING SUPPLY 'O TEST /OBSERVATION Q ADDITIONAL SUPPLY EW SUPPLY NEW DWELLING)- CI DEEPEN EXISTING WELL 'REASON FOR DRILLING. 'DETAILED REASON FOR DRILLING WELL TYPE! RwJDRILLED DRIVEN EIDUG GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES >< NO IF WELL IS LOCATED IN REALTY SUBDIVISION, NAME OF SUBDIVISION: LIN)c,&(z M: Lot No. WATER WELL CONTRACTOR:! NamekA. jkKh \J9 Address: L)4y_Mo ti1k� IS PUBLIC WATER SUPPLYAVAILABLE TO SITE: YES KTNO NAME OF PUBLIC WATER SUPPLY: �� /,t� TOWN /VIL /CITY DISTANCE' TO . PROPERTY - FROM- NEAREST"NATER•': MIN:. LOCATION SKE CH SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) signa ur ) 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 aanner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: C:�" ,�� 19�� Date of Expiration 19 Permit Issuing Official Permit is Non-Transferrable White copy: HD File Pink copy: Owner 3/.89 Yellow copy: Bldg. Insp. Orange copy: Well Driller I L r a CA e, -Mr L.d I ` � DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 5= ' APPLICATION :TO CONSTRUCTr 6JELL A`WP, TER' Prmn PRRMTM A p /� � k TELL LOCATION Street Address %$1 G A06,,. p Sm v Town/Village/City V u.11 It Tax Grid Number i3- ! - 1- Z WELL OWNER Name Mailing Address t�ivate 4~jq ®svEG oPmveWr- co. fit. Zal L'i 8 $P." 4J7rLf p�EXZ �� 176443 ® Public USE OF WELL - primary 2 - secondary ENTIAL D BUSINESS 0 INDUSTRIAL ® PUBLIC SUPPLY _ O AIR /COND /HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify, O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT `JS gpm /# O REPLACE EXISTING SUPPLY W SUPPLY NEW DWELLING1 PEOPLE SERVED /EST. 0 TEST /OBSERVATION 13 DEEPEN EXISTING WELL OF DAILY USAGE 300gal GP ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE IMDRILLED O DRIVEN ®DUG O GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LIJIV CA K Lot No. WATER WELL CONTRACTOR: Name yfyAr/VoC.)eo Address: G4'wow ®eJn) IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES `- INO MANE OF PUBLIC WATER SUPPLY: /+��� TOWN /VIL /CITY rJ l DISTANCE. TO PROPERTY FROM NEAREST WATER. MAIN.: ` LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET (date fisiziatureb 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 suc a manner as not to degrade or otherw contaminate surface or groundwater. Date of Issue: 2 °1 19 Date of Expiration 19 Perm ft Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller L_ r /Vl1_/V1 s._L u? I I PUTNAM i COUNTY .DEPARTMENT OF HEALTH •'.iv .'v 1 ;e. p.^^7.wm..'.na...a o.a w•.....^µ •wi r.a.rn� �kPP�E$'�A %rbN ��'OR` APPROVAL: °`OF °'PLANS °'P�JR' A V�ASfiE1iVATfft` DISPOSAL °�-SYSIKEM� 1. Name and Address of Applicant: ZBr caaexry sr. s Lime Fez_m% , N.S. 17e-V.5 2. Name of Project: SSDS fi�C Gr-A,c Do-v¢oFno0r 40.0 =H c. 3. Location T /V /C: Purwm4 VAGiey 4. Project Engineer: •ZAwrE ENi.�NEERI�✓6 ,fv�v w_T c,5. Address: iZo ZZ License Number:-- i(o I T 31 Phone:, 61. Type 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? .............. ND 9. Has DEIS been completed i � 'ted and found acceptable by Lead Agency. ........:.. A11 A 10: Name of . Lea& Agency ; N/A 14 is i:k�i5 pxoject�in °3n area-under- the control ofd local pl;ann.i:ng; zoning;:. a6�t�T - _der- p— or other officials, 'ordinances? .......: ...................... ..........Fob sue• E�^ r 12: If so, -have plans been submitted to such authorities? .................. No 13.! Has preliminary approval 'been granted by such authorities? wA Date Granted: 14: Type of Sewage Disposal System Discharge...:... Surface Water X Ground Waters 15, If surface, water discharge, what is the stream class designation ?........ /VIA 16. Waters index number ''(surface) ....................................... ...,.. N 17. Is project located near a public water supply system? .................. AJO 18: If yes, name of water.supply N /i4 Distance to water :supply N1,4 19. Is project, site near :Ia public.sewage collection or disposal system ?..... N 20. Name of sewage system N /A Distance to sewage system N�A 21. Date observed: uNKNOtoa 23. Name of Health Inspector: 4(tV1<A � 24. Project design flow '(gallons per day) ... ............................. ,f 2. X25. Is State Pollutant Discharge Elimination System(SPDES) Permit required ?.. NO q�""�s.�`a, �`.►:l�l '�: �..;i. --�' _. :.,. ,:-- 'vT':c s7Vr- r.4`^'. r,.wia�•� .,a...'a a.: -arc •:. r�i K.:s J�4- C•5ID`�'��,iE /rt.l�i !" 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? ............................. ..............o................ 28. Wetland ID Number ....................... . ...u....u.n..n.u............... A)1 A 29. Is Wetland Permit.required? ......o... ... ............o..o............... A(0 Has application been made to Town or Local DEC Office? .................. IVIA 30. Does project require a DEC Stream Disturbance Permit? ..................o 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 A10 DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... DES 34. Are community water, sewer facilities planned to be developed within 15 years? A/P 35e..yAr..e .any . s wage d.ispo al, _areas in„ excess of 15% slope? ....40. � 0 �.-� W _ .. . 36. Tax Hap ID Number ........ ............................. .....p...............'73�1e3�1- Z 37. Approved Plans are to be returned to: ................ Applicant X 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 fora is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.43 of the Penal tad. SIGNATURES & OFFICIAL TITLES: 6100 „,J6 SurZVCY110e P.C. MAILING . ADDRESS: 9 0 ZZ rt.e�s i y . •� �$o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , v�..nr•:.;...� v. �;� �:a. .. -. 'i. _ _ .—; -y- ,�;.:'.Dat.e ...,.;.%YI''�Ir�� . -,:s - •.• =•' ,. .:�. t .. tii• ..�;c:..r.`>ici i j I Re: Property of L►R P r'yscGPr+►� -� C,ti -� S, n1C-.. Located 'at (T) Py'rn1,,A V1 VA U& Section 7 �S Block ( Lot `Z :Subdivision of Ca ,J e-A R IIC S v Li D i v r 5 r G� 'Subdv. Lot Filed 'Map #J Z`� 33,i4 Date 5� Gentlemen: This letter is to authorize yy � a duly licensed professional engineer i\ or registered architect (Indicate to.ap ply 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 i i,ri:tlb:`.:the., -jA- .'.A!-- .ire::.'. dr- :;�.w..__.,...._.. 1479 Education Law, the Public Health Law, and the Putnam County Sani- tary Code. r +! . Very truly yours,"/ � Signed Countersigned* P D.E , ir• , f Address rf- If C X,•-7 1z. ivy iast Z. I Telephone Address 4 i r/-Z- C fuzz. j/ , y� r -76, y 3 Town 4( 700 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION y"._- t4. .;.:.- a_.- �/'- ...��.C�.s.k•a�V. ' ^.'Yi. /. �¢9u � .+. t Y�.�n�:l- ,�i�-'..MS.ali. f.;i:.. Ai'.ie y.yti ,� .n�.l FOR PERyIT APPLICATION SUBKITTED TO T PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: ' I C) 0 rU AL-J> N "C 1<' L D represent that I am an officer ,or employee -of ghe corporation and am authorized to 'roc_ for L/,�Jcr'tK DeiJ o�t (Name of Corporation) Braving offices at Z8 � Ll BE�Ty S- Li rnnac Fe-;r—rc y , IU;:�_ 17 L 3 Vh,ose officers are: President• voNftc.a �s�cK��. Z•8 CJGEI . (Name and Address Vice- President: (Name and Address) u rr-cx— FErz(zy) A) T /7611 Secreaary - -a -and Ar - Treasure:: (Name and Address) and Chat I am and will be individually responsible for any and 4acts Cie corporation with respect too the approval requested and all sub � uent ag fi elat thereto. / r' S6ora to before me this l/ day 1) f 199 1Bot3:? Public.. ARLENE FAUST"' NOTARY_ PUBLIC OF MEW JERSEY Nly Commission Expires Jung 24' 1 W6 F -s= Signed: 111 o Title: o 0 Corporate Seal PUMM COUNTY DEPAFMKM OF HEALTH DIVISION OFRWnUMn%L HEALTH SUMCES r LO DISPOSAL `SYSTEK DESIGN 'DAM-,SH1=-S;JBSMOE SEWAGE FILE NO*,-' -Z-0 I I- i Tr -5T7t-rr7— -E?UC 1-76q-3 Address e-17mc- Owmer, Located a t (Street) je J9 co kt,,,c- Sec. 73�Jg Block I Lot 21 (indicate nearest cross street) mmicipality PO -riV41"I VA LXZ Watershed SOIL PERbOLATION TEST DATA PBDUIM TO BE SUBMr= WIM APPLICATICNS I Date of Pre- Soaking_ IV LA Date of Percolation Test —N A SOLE NLEBER CLOCK 1 TIME PERCOLATION PERCOLATION Run i Elapse Depth to Water Fran No. Time Ground Surface Start-Stop 1. Min. Start stop Inches Water Level In Inches Drop In Inches Soil Rate Min/In Drop 2 q 3 -�14P J10, ZIY33��-, 4 5 2 3 4 5 N=S: 1. Tests to be repeated'at same depth until approximately equal soil rates axie! obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMI= WITH APPLICATION DESCRIPTION OF SOILS ENOOUNPFRED IN TEST HOLES DEPTH HOLE NO. _(D t BOLE NO. (� MOLE NO. s a z ., �'_nCJ:a.M- :.:.,.j ,s _...: 'V���!�{. "C.: ..r .v.w_'i�r- ..'.eY_•o. c . .t �rYw •..� j.lT�:.i.,�1 i - a�..='�.f: *,t."[ ? {y..0.A..T:»�r= .. -'P� 1�i....; ., �'r G.L* _ Lo 10 , 29 3' Co CA 4° 5° 6° 7° 81 9° 10, 11° 12° 13' AVE M1 IN a OR= 1Z., e- 6.5" Iff i h l s 111 E It/ &C,K e 6 •s' r 14' INDIiMTE -LEVEL AT 6VHI i GE�'Otl'. iATr"F, t IS -EtJGOUNT tEO- /i% - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING MMUNTERED DEEP HOLE OBSERVATIONS MADE BY: Cozy eu vs f-• DATE: - DESIGN Soil Rate Used �'�� Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms _ _ _ Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other ®• j�f�y�i27 fica` 4E ¢f$fy 3. Go,J'nE Lqn C, Pte, Name --cNsji'r ewe- bjcCmt x- :5urvtyi.&; FC, Signature , Address ,`Vv7r�7 Zz SEAL .'_ .F THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date Re: I I �, ..1.i•c� r r _ cJc, , , � PUTT- _.':aM COUNTY DEPA.RTMETT OF HE/ - -TH DIVISION OF ENVIRONMENTAL HEALTH SERVICES i .� y.- i..,'. 3tVi�.7a. ✓'re •.. s. ..ro.,_7j - ;-•. .:.> •n• e: �. a�i ' f i. -vM ..�vs :..qr ,;..,:e ... ..+.i «.�.�L�. h. .. 1 1 ert` of l_iNcaR n�F-VEa,rn7c-n�; _, ]Property Located at f� /iuK li cc si A So ., r" (T) Pyrn1A VA UXTY Section 73 r8 Block Lot Z � Subdivision of Subdv. Lot # Filed Map Z`i 33A Date S Gentlemen: This letter is to authorize '0Gr.JE- -TtAX, >«VCY)Ak B duly licens''ed 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 I 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 I . 'o rs#ems, i onfU-rm_ty� w- it.h.., .t.h-. e prv_i._ i ..o. n._s.a r;of sys Article ... 147, Education Law, the Public Health Law, and the Putnam County Sani- i tary Code. j I - i Countersigned'- 1 � � y Wa 4Tr E Frn'ak A-- 15 -w yeyewc., Pk - Address `W , ZZS- CZCC) Telephone Very truly yours,' Signed r o f� L • °'. •7� V Vk Address Town Telephone 5 Tfz tz-T PUr 4M COUNTY DEPARTMENT OF HEALTH Division of Environmental Health �ervi �s } AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT T0: Commissioner of Health In the matter y of application for: ' L, ,ocAr, NEZoPme-.w -r- ?—NC ctc tit L represent that I sm an officer or employee of -the corporation and am authorised to act for'. (._(iJC/i'R ��Jez-are,7 eV (Name of Corporation) having offices at aE-r-Tj/ 57- L� mcc FEx-=-rz y , rrl s ! 7 `/ 3 V ose officers are: - P r e s :dent • vo N1 A c. a l-j t3� �'r c� zr- c,r. �E1Ztzc NS 76 y3 (Name and Adaress) / Vice - President: (Name and Address) Secretary: Treasurer: (Name and Address) and that I am and will be individually responsible for any and ..I vent ac /r Facts oI e eor ?oration with respect to the approval requested and all subsp e thereto. lief g� /, i. / Sbor-a to before me this — day of hVota: Public . ASLENE FAUSTIN! 'Nor R`r PUBLIC OF NEW jjRSE`f ply Commission Expires June 2a• ti�6 Signed: Title 0 a.orporare *tai 7: I i DEPARTMENT OF HEALTH BRUCE- Acting Public Health Director Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278-6130 I December 16, 1996 Jeff Contehn o Insite Engineering Route 22 Brewster, NY 10509 Re: Proposed SSDS: Lhicar Lot # 14 Birch HM Road South (T) Putnam Valley Dear W Contelmo: Review of plans and other suppofting, 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. Ybu should contact local wetlands officials in this regard." current ennees:authoraion le_qer-is sm ubite 2. Erosion control measures for the house and well is to be shown on the plan along with a note stating all erosion control measures.are to be installed prior to the start of any construction. 3. All erosion control measures are to be detailed. Upon receipt of a submission, revised to reflect the above, this application will be considered Rulber . veq�." yolz", Robert Morris, P. E. Public Health Engineer RNVjp I NSITE R �NGJ,� . �NG NEE I SU V I P. C. R ffiNG x849, Route 6 (9Z4) 223-6200 Garznel, New York 10,512 FaV (914) 22_5-6438 71,7,17,_7X.�7 -.'y C.:-,z7,17_.;i T Zr"- Wappingers Falls, New York 12.590 (914) 297-1742 TO P0 7-P)A71072 WE ARE SENDING YOU Attached ❑ Under separate cover via_ K ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LIEUTER VF UMMSEMAL DATE DATE NO. RE: /r7 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION /r7 -,r U C-IT CD P -P.L ,A v Lerrez C) r A-w77V c? tZ i -?- A -,-I re--'> Af-FA r_>, v i-r n� 60rzFC:,&A-r5 ;E3 Id-.O P A-M -5 4-1 CZ-7— -300- 00 F� L?00., oc Gk (2.e A.;' 5 TT_' V C17 ep THESE :ARE -TRANSMITTED as 'checked - below: approval ❑ Approved 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 ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO (T,-4 C.) SIGNED: I It enclosures are not as noted, kindly notify us at once. \ x 'ONI `S31mom uyinooV U3lS3H3IS3jjj t i I ✓�� :v'iJw . tr'." u','A+'•._ � "'ts i'.• I .. { "�_' y •...+w ... \ II � I . Second Floor± ... - ,._ - ., ,.. _ �;,�,:<•. 4�:1�;�;4; >.:�..� . r - =.� .: . o jl 27'8" First Floor PUTidr: i COUNTY 1?E P 27'8" X 44' ®2434 Sq. Ft 27'8° Y' OEDROOME ' O �� or7loN.a a.TN 10r le' -o'ie Xla.e• n 1� DEDR000 a corn To MPSTER DEDROOM 13', ' f la' -N E• X IE' -01 OPTIONAL enOLf "'.. 44' i�0 _.' IXITCNER -SRFBT U IXp lIILP POOtl I6' -0•X la' -O• 17' -7•X IB' -O• - yan•rI _ ._ { r0� OP1ION.L }F HEA'�i� DININ ROOI4 LIVING ROOp Ia' -oye la' -o• IO' -s'X la' -O• 44' — 44' -- — 12ot _ STANDARD tug � � ISO F' TMUS © 3 or 4 Spacious Bedrooms o 2%z 13aths o Open Two -Story Entry Foyer 13 Bedroom) o Formal Dining Room o Formal Living Room o Spacious Country Kitchen Features Island with Real Butcher Block Top and Pantry o "Cottage- Style" 3056 Lower Level Windows with Architraves on Front o Framingham Pediment on Front Door o Fireplace Options Available o "Boxed -out" and "Angle Bay' Options Available o Consult an Authorized Westchester Builder for a Complete List of Options o Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract. No oral conditions. ESTCHESTE� 0 ®ULAf� ODES, U. X P.O. Box 900 G Dover Plains, IVY 12522 101211 fprnl I L� BKFST orTioN., KITCHEN aun•cr FAMILY ROOM W.9" I!' -U' IT•9 • D 0' Oanlrr - - I DINING ROOM 1 L�V,I,'IG I OOM - B�i=t�L,RIw. w � C7y1 27'8" First Floor PUTidr: i COUNTY 1?E P 27'8" X 44' ®2434 Sq. Ft 27'8° Y' OEDROOME ' O �� or7loN.a a.TN 10r le' -o'ie Xla.e• n 1� DEDR000 a corn To MPSTER DEDROOM 13', ' f la' -N E• X IE' -01 OPTIONAL enOLf "'.. 44' i�0 _.' IXITCNER -SRFBT U IXp lIILP POOtl I6' -0•X la' -O• 17' -7•X IB' -O• - yan•rI _ ._ { r0� OP1ION.L }F HEA'�i� DININ ROOI4 LIVING ROOp Ia' -oye la' -o• IO' -s'X la' -O• 44' — 44' -- — 12ot _ STANDARD tug � � ISO F' TMUS © 3 or 4 Spacious Bedrooms o 2%z 13aths o Open Two -Story Entry Foyer 13 Bedroom) o Formal Dining Room o Formal Living Room o Spacious Country Kitchen Features Island with Real Butcher Block Top and Pantry o "Cottage- Style" 3056 Lower Level Windows with Architraves on Front o Framingham Pediment on Front Door o Fireplace Options Available o "Boxed -out" and "Angle Bay' Options Available o Consult an Authorized Westchester Builder for a Complete List of Options o Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract. No oral conditions. ESTCHESTE� 0 ®ULAf� ODES, U. X P.O. Box 900 G Dover Plains, IVY 12522 101211 fprnl APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS 2'Ey_IEw H.EETj -jfgT M- 14,uj� , P�6Ahff T, .. _ NAME OF O STREET LO BY DATE TAX MAP #dc&t-A,/ G4� DdC6MENTS. fMIT APPLICATION, 1 LL PERMIT; PWS LETTER GINEERS AUTHORIZATION SIGN DATA SHEET(DDS) EP HOLE LOG NSISTENT PERC RESULTS (3) C HOLE DEPTH RPORATE RESOLUTION. NS THREE SETS HOUSE PLANS - TWO SETS CD VARIANCE REQUEST 9SUGENERAL GAL SUBDMSION BDIVISION APPROVAL CHECKED PERC RATE LL REQUIRED CURTAIN DRAIN REQUIRED STANDPIPES EX- APPROVAL SSDS ADJ. LOTS i WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE- 1969 - NEIGHBOR, NOTIRFICATION LETTER BUZBTIA IOQ.YR,LOO✓'ELVATION' - SEWAGE SYSTEM PLAN! - (NORTH ARROW) t,DRfVEWAY'& S HYDRAULIC PROFILE ED GRAVITY FLOW BOXED TRENCH/GALLEY m P- PIT DETAILS TIC TANK -SIZE, DETAIL LL DETAIL, SERVICE; LINE IF OVER NSTRUCTION NOTES .(GRINDER RATE) SIGN DATA: PERC AND DEEP RESULTS- TWO-FOOT CONTOURS EXISTING & PROPOSED SLOPES CUT OTING /GUTTER/CURTAIN DRAINS COMMENTS: j DISCHARGE (OK) [� P C & 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 MWWELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4"0; TYPE PIPE V BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS YBARRIER T HORIZONTAL: SLOPE 3:1 TO GRADE L SPECS TH GAUGES L PROFILE & DIMENSIONS LUME TRENCH LF TRENCH PROVIDED 60 FT MAX PARALLEL TO CONTOURS m 100% EXPANSION PROVIDED 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL �` l5;00 0' TO FOUNDATION WALLS 00 TO WELL, 200' IN D.L.O.D., 150' PITS 00 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER O' TO WATER LINE (PITS -20') 0' INTERMITTENT DRAINAGE COURSE FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS SEPTIC TANKS EbIO' FROM FOUNDATION; 50' TO WELL WELLS X15' WELLTO P.L. �, bAPPROVEOPo0: CON Vevocablo for Cauca or,' l uisqukos a now mit, RE? V e 1Q�88' �c¢o m ry to the:Cominiabeoer of mailthwill 1'.tDY. tho lsulkler.' that - sagdiulmw will 0:11oly toiloiui'i/ t1ie laii ii tea Isar imi,Aho drillae ureil Aesrsi6eA aioem i tho';m®aroeriau platy and tha4 �iiA 6Ye11 grill po Ins4ali®d in aceoi®enoo uiith the 'Qanslal®6 ru93s aid roeu ns of, Alie ®utnom S dined P.E. _ N.A. SERry S Gv a d2°`. ZZ. N Lieeme No �o (� a? y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION "Stre6t-Lo,eati I Cj=-1 Owner Town Permit # ?\4 TM#—; -73. 18- I -?-I 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 I stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area .......... e. 100' from water: course/wetlands II. Sewage System .........other ................ a. Septic tank size 1,000 ..... b. Septic tank installed level ................................................ c. 10' minimum from foundation ......................................... d. Distribtuion Box 1. jAll outlets at same elevation-water tested ................. 2. Protected below frost ................................................. 3. 'Minimum 2 t.0riginal soil between box & trenches Junction Box - Properly set. * .41 ................................... I . Length required 4 Length installed 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 30 inches from surface,........... 7. Room allow6d for expansion, 100% ......................... 8. Size of gravel 13/4 - I %2" diameter clean .................... 9. Depth of gr#el in trench 12" minimum ................... 1.0. Pipe.ends. capped:... - - .1 .. - - . � - - . ...; ............ . .. ..................... . •••. ..... 'Pifbr) or Doscid S stems I - Size of pump; -c'hamber ............................................... 2. Overflow tank ............................................................ 3. Alarm, visual/audio ................................................... 4. Pump easily Accessible, manhole to grade ................. 5. First box bafhed..* 6. Cycle witnessed 111. House/Building a. House located pdr approved plans .................................. b. Nuffi ber of bedroons ...................................................... IV. Well a Well located as per approved plans ................................ b. Distance from STS area measured ft........... c. Casing 18" above grade ................................................. d. Surface drainage' round 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 & dinto exist watercourse g. Footihg drains discharge away from STS area ............... h. Surface water protection adequate .................................. i. Erosi 'on control provided ................................................ Rev. 1/97 Date: -711 -y F FormT M- ,0.z'. -- Date: I . I To: 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 From: Adam B. Stiebeling Asst. Public Health Engineer Fax #: No. Pages (Including cover sheet) -FoXy rinformation 0.0 -..,.-,.ease,.respcin For your review A <A s discussed Attached as requested Please call I t CaT Notes/Messages U �-( UL `� , 10 e- I f r- kls,6011C If , tq q1L, 20 2rAc C BRUCE—R,- - FOLEY In the event of transmission/reception difficulties, please contact this office at (914) 278-6130 ext. 157. 4-iE 1,4 C. (C G ,Lf 6z(-, LOTS I .n ... 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(�� A l IV ' s��} ,T y 5 / 1tyFt ✓, 3' T ? l T ASS:( ILT MEASUREMENTS NO' ; A B ; , , REMARKS - 4. f. 1 27' - 41 125'0 GALLON `SAP 17C TANK 169` DROP BOX 166' 175' DRQP BOX f 1.72 181 ' DROP BOX - 5 ; : 179 188 DROP 'BOX 195 DROP BOX TRENCH 8 165 " 185' END OF - TRENCH 9. 173' 192' END- OF TRENCH 10 178' 197'; END, OF,: 11 172' 170' END OF TRENCH 12 ' 17T 176 ` END OFS FRENCN �a, 13': 183' 1820 ' END` OF" `FRENCH 14 190 18 &' END OF :TRENCH ,. t 5 1961-1., 95:' END OF TRENCH .` 16` 651:, 73' CLfANQtJ T 107 117' CLEANOUT 4 % I W+ ^." a "%4!'I '4 •ll- y+^i7"hi —t it n . �, •v u.`ary', a•'•2xy rc }w^�"t"•1+` "t r 'i�REA , � •: r r : x, �,•a AA C ' 1 1 i SHERLITA AMLER, MD, MS, FAAP I Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 21, 2010 I i Kenneth J. Millett 44 Briar Hill Drive Putnam Valley, NY 10579 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition- A- 005 -10 No Increase in Number of Bedrooms 44 Briar Hill Drive (T) Putnam Valley, T.M. # 73.18 -1 -21 Dear Mr. - Millett: I have received and reviewed the revised plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp, from this Department dated January 21, 2010. The addition is approved with the following conditions:. 1. The total, number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. :..3: All_- plum -bing.fixtures must be-updated with water saving:devices,-i.e., new low flush toilets, restrictors for shower heads and faucets etc. 4. : The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals Any other permits',or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you,have.any questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, C,� "t..� , Gene D. Reed Senior Engineering Aide GDR:kly cc: BI; (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 v n SHERLITA AMLER, MD, MS, l♦AAP Commissioner of Health LORETTA MOLINARI, RN, MSN�' Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road: Brewster, New York 10509 ROBERT J. BONIDI County Executive Director of ADDITION APPLICATION RESIDENTIAIL ONLY ei I Health STREET� �3 (, l l T ®WN V414 TA MAP # 73018 -1- 1 NAME. 1�P �P, ► �": �'i l PII ®� Ys'sa6.7�� i >PCID# 005-0 MAILING ADDRESS DESCRIPTION OF ADDITION Fk'J & NUMBER OF EXISTING BEDROOMS' .3 : PROPOSED # OF BEDROOMS (FROM-CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroorn requires formal approval of plans .(Construction'permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam .County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 2j78- 6130. 1. Certified check or money, order. for $100.00. „ 2: Sketches of existing Hoot` lanr(drawn to scale, all, living ,Area including basement, .to be - _ -showrr and diiriensioned grid use 'of each room specified): (See' Section 3.c of Bulletin' HA -1) V3. Two sets of proposed floor plans (drawn to scale — with name, street and tax' map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) J4. Copy of survey showing all well and. septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. .Copy of Certificate of.Occupancy from the Town or Certification from the Building . Department with legal bedroom count of dwelling: OFFICE USE . COMMENTS 5. Environmental. Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845)225 -5186 Fax (845) 225 -5418 Nursing Services (845).278-6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 I � Co J Gam. SHERLITA AMLER, MD, MS, FAAP q ROBERT J. BONDI Commissioner of Health \ * County Executive tOR:-.Y, •-.. h � • r•r�ONiw -.�. n C.n •.:.�.xYl� .. ... ..s �•kv�l ... ~YF. •'. .. ` 1'"A MOLINAR I2T l MSN . ' _ Ft{. YO '....: ROBERT 1V CDRRIS, PE Associate Commissioner of Health Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 i January 12, 2010 Kenneth J. Millett 44 Briar Hill Drive Putnam Valley, NY 10579 Re: Addition — Application Incomplete - Millett 44 Briar Hill Drive (T) Putnam Valley, TM # 73.18 -1 -21 , Dear Mr. Millett: Review of plans and other supporting documents submitted at this time relative to the above regarded project has,been completed. The following was not'submitted with your application: 1. One set of, existing floor plans showing existing conditions- only. The plans must reflect all floors in the house, including the.basement, with all rooms noting their dimensions and use. The plans must also be noted as existing showing owner's name, .address and °tax, map number 2J Two. sets of proposed floor plans. ' The plans:must show all proposed changes as a finished product. These plans should also reflect all floors in the home including the basement, with all rooms noting their dimensions' and use. The plans must be noted as proposed, showing owner's name, address and tax map number. Upon,receipt of a submission, revised to reflect the above comments, this application will be considered further. Sincerely, I f Gene D. Reed Sr. Environmental Engineering Aide GDR:kly Environmental Health (845) 278 -6130 Fax (845) 218 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax• (845) 278 -6026 Nursing Home Care Fax .(845.) 278 -6085 Wit- (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 I a 4 SHERLITA AMLER, MD9- MS, FAAP Commissioner. of Health LORE'I I'A MOLINAli I2N, MSN Associate Commissioner of Health ROBERT J. BONDI .County Executive RUBERTMORRIS, PE Director of Environmental'Health DEPARTMENT OF.HEALTH I Geneva Road. Brewster, New York 10509 Town (Legal Bedroom Count & Proposed Addition Status Re: I LL.E I (Owner's Name) Tax Map # 3 , 2 Address: �- Town: �� T VAL-LGO Year Built:. I.A. IS According to records maintained by the Town, the above noted dwelling, is . in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: 3 This information has.been obtai ed from: Certificate of .Occupancy: Other: The plans for the proposed addition are considered: _ New Construction Addition to existing house only Teardown and /or re -build allowed under Town Regulations fog Building Inspector _Da 6. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing.Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 s° I� —— —— — - -- EXIST SASEMENT 0 UNEXGAV%�TEfl y1y� EXIST OIL TANK t• • :f UNE AVZC I SGAL.Et V6tlol1 -0b O 2' 4' i �Js Ci4 I ' 4. r _. �X��T ' KITS U EXI J V C7ARA S `I EXIST , EXIST `1 t VF } r T T L. SC ALEt ,r 'S t r r r=E UP I MA 12 O i' 4' 8' 16' i. 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