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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -26 BOX 28 w 03457 ON ' • 03457 I 1.� WMM[ DOp!fF! D�Al1 ! OF �r1LTH l ( �� DHItfM a[�fi6w�a�Itl Hea116 Sae aml. Cie+" N Y. Ifdl? �r to �wid.,lw�lt fu . i C�'MiGTB 00 11ANC8 �Qal� ram l0i,, 59WAM DW9►L SYli!&It 0,1„tr /Aeiil. u.,JC,9Q' D1vrzoPr�ecrcmc+:. Raft 4 >:etoawad_ o = Itoaae � o Prevbo Approvtl - 'Town 7�p• Date Subdivision Fee Enclose "dAM '.aiiiii t.*. i 3'! 77 RC Lot AimR ' �Jfo C vabm Ntfir�r fist H�ioair Daly Flow. Seat..S�wre�p S7�l a PC�.NotlOatle 4%gi4t�t WFN b oihpld G P D- 09 0111101" ad uc Traet �otL.3"33 L d7c Z` e.� i 4 E /�.� so itpTle. TIZJCk11� . T r: al�ehd bj „I,[�fS�OW .J ' AfLh'fua- .. fil �K n9 y ci:i rJ wow Sll�b: p r gam' ilddrer «t Few �s X57 - O&W 1 npie&Mt that 1 am wholly ana compNbly refponiiple fa the design end location of the p.opofid syftem(s) l) flat thew raH saw di "1 stem atww defuitiid will tN oonstructsi0 aeshown on tM;approw0;amendm�nt tne►a "to and in iccwdan`oe with tM standards, rules a rpu of o ' r. OouMy, l>•WKmant of , tMalth, anq that on compMtion thareof a Ciitifitata pf Conftruetlon.COmpliance. satisf ctory to the "Comniiiiion -of MMlthwill Oe fuemltted'to the t)epartniint, an0 a,writtM;lluarantaa will tN furnished tM ovirnw his fu upo►s, MNsa aifiign>s ey•tM builder, that'fiid'liulkler will ptata` M .good,epar�tinj `eaWitbn any :part of, tii0 fawaje, difpoYf:syft.m AurUp en perio, f two;(2j yfaarf imnledi taly following tMd�ti.of the itau• ants of the' approval. of the :CMtifkate',of Conft ►t"! Co `mplNhco, of tM,,orpinal iystem o► My rt►piNf tMreto; 2) that 3hre drilled: well described a6ow wiN;e Ioeati0 �f ahonni'on tM'ag0fr+ved,Plan aM thit YW_"I will M instalNdy in accoiwnp with tM 1taiWardt,' ►uMa. and' rpu na :,of ,'•the PutMm County rt o1. / mlth. Signed AAdresi rr�. �J 7-e Lice nse No !�J Lice Y C APPROVED FOR CONSTRUCTION TM ovipexpNef twO years;,\rom thee. a Nti eo�i ru n `if tM tiufWing faf been and «ukall a if revouela for Cause or, me, M arMndaO Or modfliid when considered meeffary ny the" Commiifloner. of Naath. Any cfienge of alteration of construction require& a now Psiimit... Approved for" di4"l of Aoineslk wnitary sewage, 'and /or private with suppy, only. :eY .088' pate By 'Tit ' - •r _.. � .. ... - - ._... a ,� e• ..vine .L ..: - ..-... � `d • .. •._ ♦ . LORETTA MOLINARI Public Health Director. DEPARIMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 . Environmental Health (8.45).278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085, Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 ROBERT J. BONDI County Executive April 19, 2004 DeRuggiero 9 Briar Ridge Lane Putnam Valley, NY 10579 Re: Addition DeRuggiero, 9 Briar Ridge Lane No Increases in Number of Bedrooms (T) PutnamValley, TM #73.18 -1 -26 Dear Mr. & Mrs. DeRuggiero: I have received and reviewed the 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 April 19., 2004. 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 plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 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 your convenience. Sincerely, Michael Luke Public Health Sanitarian ML:lm cc:BI (T) Putnam Valley F Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster; New York 10509. LORETTA MOLINARI RN., M.S.N. Associate . Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET TOWN R.�\f\lwj 4 (Ie, X MAPir -77 3,1$ — tv NAB PHONE (7YS) � 2 (,b- 9 190 PeHD# A..11 7—o MAILING ADDRESS �6 c � CQx f �, DESCRIPTION OF ADDITION Q� L Lom �� OQ �"''` �"� ©5�� NUMBER OF EXISTING BEDROOMS--d—PROPOSED # OF BEDROOMS_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom 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 P tram County Health Dept. eneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money oor _rr fvi$100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non-professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *Non—professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property Be. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept'. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Hhouseguidelines Aror 19 04 12:58p BUILDIMG DEPT ..BRUCE R.40LEY' r Public Health Director 9145268806 p,2 LORETTA MOLINA)U R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster,. New York 10509 Eovirottmeatal health (845)279-6130 Fax(843)279-7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Iaterveatioa (845) 278 - 6014 Presehool (845) 27MIZ Fax (845) 278 - 6668 April 19, 2004 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 9 Briar. Ridge-lane Residence Tax Map 73 18 -1_ 26 _ Town of P11IImam y�1 1 ey Gentlemen: According to records maintained by the Town, the above noted dwelling is xx3c in compliance with Town code and the total number of bedrooms on record is 3 This information has been obtained from: CERTIFICATE OF OCCUPANCY: dated 1/21/99 ASSESSORS RECORD: xx OTHER Building Inspector BFhouseguidelines X00- 1�1_aGiGt4 MON 12 :56 TEL :845- 278-7921 NAME: PUTNAM COUNTY DEPARTMENT OF P. 2 Apr 19 04 12:58p BUILDING DEPT 9145268806 p.3 F... . . � r.V ^- -.. . � t� —vr�� 5. �. . ..� I •�. .a .r :�—... - � . ... _ v • • � .. . .. — .. . �— � . ... .. .r.4 `_ .. .. ��i M- .../.G'.� . _- ��'•�. .a �C �i.��... --. -. _._.v...�...�. CERTIFICATE NO.: 99- 9 PER MT NO.: 98- 333 TM#- 93.18 -1 -26 (Lot #20) DATE: Jsinuaq 21, 1999 LOCATI ®N: 9 BRIAR RAE LANE . ISSUED T®: C®RTLAN DT. RACKET CLUB, INC. This certificate covers the construction of: New One - family Residenca W /Deck 1 Family Year Round Three Bedroom The applicant having her filed an application for a building permit pursuant to the .town Code,. .unitary Code, the Uniform Building & Fire Code and the Laws in effect in the Town of Putnam Valley, Putnam County, NY, having paid the required fee therefor and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed structure in compliance with the requirements of the ,laws as aforementioned, that the. said work and materials Diet every requirement of the laws as aforementioned; and that the premises have'now been fully completed and are ready for occupancy pursuant to the provisions of law. Now, therefore, this certificate of compliance /occupancy is hereby issued under the seal of the Town of Putnam Valley. APR -19 -2004 MON 12:57 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 Apr, 19'04 12;-58p BUILDING DEPT 9145268806, P.1 TOWN OF PUTNAM VALLEY T' IRV SEVELOWITZ CODE ENFORCEMENT .OFFICER "(845) 52.6-207 FAX (845) 526-8806 FACSIMILE TRANSMITTAL SHEET, VR 0 MV.) COMPANY; o FAX NUMBklt; 79d I DATE:* TOTAL NO:. INCLUDING COVER: PHONE NUMBER: SENDLR'S REFERENCE NUMBER: 265 OSCAWANA LAKE ROAD PUTNAM VALI.EY, NEW YORK 10579 -APR-19-2004 MON 12:56 TEL:045-276-7921 NAME:PUTNAM,COUNTY DEPARTMENT OF P. 1 1; DIWSRON 1) rON A . HEALTH SERr ( w CONSTRU ,t WAGE TREATMENT SY ! 11 I "6 R',tll I(;1,. r Subdivision It Lot I i1 1 Block Date Subdivision Approved CWMy .r- 9A ®caner /Applicant Name e Mailing Address Renewal Revision Date of Previous Approval Zip Amount of Fee Enclosed Building Type Si e L— Lot AreO/ ?d 6�To. of Bedrooms 3 Design Flow GPD 6d4) ]Fall Section Only Depth � VoRome PCIR NOTIFICATION IS REQUIRED WHEN 1FILL IS COMPLETED Sep_zrste Sewerage fwsteM to consist of gallon septic tank and R3 L-f of 2' wick Sereb.a A 1len cite S Other Requirements: il% 4e q yi-ed To be constructed by 37 Cat tan 12th Ron a{ C gV, Address W &teu° 9ne Public Supply From Address ` S F i��a *�e S apply I3rilled by : "/'� a Z f •Sr ri s Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. P.E. X R.A. Date f " 9 .License # %3 APPROVED FOR CSTRiJCTTI[D Thiapproval empires 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 perftiit. Approved fo discharge of domestic sanitary se age only. By: Title: V � Date: White copy - HD File; ellow - Building Inspector; Pink copy - Awne , Aange copy - Design Professional Form CP -97 SEP-01-1998 14:28 Subdivision name -- Date Subdivision Approved Owner/Applicant Name Mailing A&hvss Perwid, Amount of Fee Enclosed -Wb Building Type Other ReqWrej-Heints: comvrxW by Q, Una. N w k-a; st, Priyaw Supply INSITE ENGINEERING 914-2?8 6392 P-01 WE& T - Of HEALTH TAL-AEALTHI SE S -*JL& S, age tj& jk V� Ile V —,,fd 0Y, -Viu Subd. Lot -#:,X-� Tax Map Lot ,,%= .3,06 0. Of Renewal 6f Previous Approval Bins 3 Design Flow GPP�G�d consist of - AN gallon septic tank and I./;J. AL C., fij- I,-- - -I - C 41%. Rea of C 2.0 Address Supply From Address led by )M, Address 6q,1h' accordme with the lat W dxmf a "Certificoz= ru or Departineta, aud a written ce v builder will p1w is good ca Of L. or say repairs tboteto. Post-Re Fax Note 7671 1pag" To K 3 0 d Ljt7s&-) Cojout tai HO CO. (.4-s ci1 P"M 0 ftwes -00-z-764-11:0 Fax 0 L,7 g -717-1 IF- 11 neat "I a Sul e b1i A 01 nft , wd tW %e-,* - nto and in Campletion itted to the :r, that said (0 (2) years ffiecjiow Signed. P.E. X RA. —Date Address # it" 05 rot - i -, APPROVED FOR C now.. &Vpmval eipires two yam from tho daft issued unless constrqmou of the sewaptratm been AM tl!3 od is yevocable for come or mq be or ent q8tem ho b ended modmed Wh= coos by the Public requirm on the i&ovd P� Approved' V. Anew TIM- -A ofd niestie uWuq,.,., Y: JR.5 Date: White Copy • HD F, Building 1w or, Pink age copy - Design PmfitewW Form CP-97 TOTAL P-01 I , r— ..tea. I . Wjt. , 1jV17LrLrL.LV LNJL�,L %JLI.J. office Use Only a. -4 DEPARTMENT OF HEALTH Division of gnvironmental Health Services SHLEET AGGRESS: WELL LOCATION Kramer Pond Rd. >a Putnam Valley, NY .---'--Lot J20 WELL OWNER MAUL ADOUSS: 0 PRIVATE Lincar Dev Corp_.c/oQo1lins&MeYer,_a32 Anderson St.Hackens'11(plym USE OF WELL I - priimary 2 - secondary E) RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY 0 MOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal- REASON FOR DRILLING 0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 360 — fL I STATIC WATER LEVEL --22-- ft 1 ]�ft. DATE MEASURED 10/20/88 DRILLING EQUIPMENT [E ROTARY 91 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING. 19 OPEN HOLE IN BEDROCK 13 OTHER CASING DETAILS TOTAL LENGTH 30 fL MATERIALS: STEEL 0 PLASTIC 0 OTHER LENGTH.BE OW GRADE 29 fL JOINTS: OWELDED EITHREADED OOTHER DIAMETER 6 in. SEAL: O CEMENT GROUT OBENTONITE []OTHER WEIGHT PER FOOT 191b./fL DRIVE SHOE. El YES ❑ No I UNER:0YES [3NO DIAMETER (in) SLOT SIZE LENGTH (11) DEPTH To SCREEN (ft) DEVELOPED' .SCREEN DETAILS- RRST OYES ONO SECOND.. •.HOURS GRAVEL PACK 0 YES 0 NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH —'fL BOTTOM OEM — IL WELL YIELD TEST It detailed pumping METHOD: 0 PUMPED I tests were done is In- JEKOMP . RESSED AIR formation attached? ❑ BAILED ❑ OTHER ;OYES ONO if more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water Bear- ing We" '�i Dia- meter Irn. d� FORMATION DESCRIPTION DDE tL fL WELL DEPTH DURATXM hr. min. DRAVIDOWN It. YIELD SIPM. Land Surface 7 -J)x na in overburden clay & b1dr§ Hi t r ck at 7 feet 36o 6 340 12 7 30 . DrillLna in rock set casing,grouted, 30 360 DFilling in rock granite. 1 9 U WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS_ ❑ COLORED 'ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAL." PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE — HP W61MULMNAME P.P. Beal & Sons DATE n 1 //f '4 8 ADoMSS P0 Box B S1GFTftRE Brewster, NY 10509 I. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Skt 1 , DAa'ArS>SEE'P..- SUBSURFACE ;SEWAGE TREA >TIVIE�iT °SYSTEM - Owner (Lft�vel__C4v6 lAcAddress o 5-?,7 Located at (Street) 2 t vim Tax Map 73, 1S Block 1 Lot Z6 (indicate nearest cross street) Municipality v vita UTA-t,c Drainage.Basin klvp, � SOIL PERCOLATION TEST DATA Date of Pre - soaking N/* Date of Percolation Test Depth to Water Water From Ground Level Percolation Time Ela se Time Surface (Inches) Drop In Rate Hole No. Run No. Start - Stop Min.) Start Stop Inches Min/Inch 2 3 1 1 4 ,� D EGi 1 F` C D iM 'Z / 3 3 g __. - -.... .2 3 2 5 F 14-164 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 SEQ tR Appendix C State Environmental Ousllty Review _ FORM' For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicantor Project sponsor) 1. -APPk16AN4- /SPONSOR PROJECT NAME . 5vi2v rnlC Gib✓l�s t� �'.G t / 'SSt'5 7 Gf/zrTTaY✓ 0.+1 2D• �c�i'LP, 3. PROJECT LOCATION: Municipality drwA-w-I �i/i"tGG'� County 4. PRECISE LOCATION (Street address and road tersections, prominent landmarks, etc., or provide map) 5 � G���or✓ � � �rJ cpsv:� � n- 5. IS PROPOSED ACTION: fi�LlNlew* ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 5 TYL ✓�Ti�r,l :7/" G°''�"�4� �t pli�/� -P .iJ lil/�o/iy?.aJ�? ✓.R� J T. AMOUNT OF LAND AFFECTED: Initially I. '7704' acres Ultimately �� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ No - If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? WResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Desc?fber. � ✓. ...h.. v f.- �... t- ... _.. •.. : y.. � ..� -. .._.r ..... - ..i'. -�... ... ........._ _w r•re..•- �..... �_� -.�u.e .. ...•A-F ^�....w +i+ .7' wys. ^� .- 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ No If yes, list agency(s) and permit/approvals rv�-r� �C r� .�, •T-- 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes 9ft If yes, list agency name and permitlapprovai 12. AS A RESULT OF RROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? . ❑ Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE App4eenVWnsor name: Date: / �a Signature: If the action Is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 PUTNAM COUNTY DEPARTMENT OF HEALTH } DIVISION OF ENVIRONMENTAL HEALTH .SERVICES APPLICATION FOR APPROVAL OF PLANS FOR 1. Name and address of applicant: 0 ""tee t c1-v1-s 2. Name of project: Locatiot9v /vrw4_-_t Insi.te Fhgineering, &nveyu g & landscape 4. Design Professional: Jeffrey J. Caitelm, P.E. 5. Address: Architecture, P.c. 6. Draina e Basin: fly vs�✓ /2, ✓r- r ate 22 Drainage RroAgtar, Nw York 10509 7. Tyne of Project: X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision 8. Is this project subject to State Environmental Quality Review TypeStatus (check one) ....................... ............................... 9. Is a Draft Environmental Impact Statement (DEIS) required? _ Commercial _ Mobile Home Park _ Other (specify) (SEQR)? Type I Exempt Type II X Unlisted No 10. Has DEIS been-completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency A- 12. Is this project in an area under the control of local planning, zoning, or other V65 officials, ordinances? _ _ ........_..... P�Vr ,. r ..:.� .. ... ............ �- ... -.o... - ._ �. .,. --..�� ~ v • 13. If so, have plans been submitted to such authorities A)o 14. Has preliminary approval been granted by such authorities? ''J /�" Date..granted: 15. Type of Sewage Treatment System Discharge ................. surface water ? groundwater 16. If surface water discharge, what is the stream, class designation? .................... 17. Waters index number ( surface) ........................................... ............................... ,q- 18. Is project located near a public water supply system? ....... ............................... �d a 19. If yes, name of water supply 12 LA_ Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ a 21. Name of sewage system 'A- Distance to sewage system %- 22. Date test holes observed u 23. Name of Health Inspector �� NOc./.✓ 24. Project design flow (gallons per day) �a 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 0 JA- Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH 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: GA R_ U P > I V L 5 L 0 (�j At- 15,+,v T-WC<_j represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V,` , C0f;5T7?VarWJ C,&P_4P, ,37 C&-reA a" np, cwtz-F, gkc!2v�r Ct-rj livc' Having offices at: -7 62o 7v-.-J t>A,,,t,1 lost, Whose Officers Are: President - Name: VArt, Address: '57 Creer&,J c� tZo/cv, rj'y, Vice President -Name: Address: Secretary -Name: Addre,ss:,., Treasurer -Name: Address: and that I am and will be individually responsible for any and a lc� opthe oration with respect to the approval requested and all subsequent acts relating thereto I Signed-, Title: I Sworn to before me this day of (month (year) ...... ...... No ary Pub i&—`�� LAWRENCE KALKSTEIN Notary Public, State of New York Co.rp6rate Scil No. 014752767 Qualified in Westchester C nt Term Expires February 28AW Form CA-97 Z i vc+ j, Lof ?e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION . RE: Property of &,. C. ; Located at G✓f'f N C- PV 1c1-" VA Tax Map # -73,14S Block �_ Lot ZG Subdivision of Subdivision Lot # Z0 Filed Map # `Z -V.4 Date Filed Gentlemen: This letter is to authorize Lnsite Engineering, Surveying & Landscape Architecture, P.C. (Jeffrey J. Contelm, P. E. a duly licensed Professional Engineer _x_ oxRqg&=d.,AxxbdWxxxxxto apply for the required wastewater treatment and/or water supply permits) 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 in conformity with the provisions of Article 145 and/or 147 of the Ed ca j n L the Public Health _ Law, and theTutriam County Sanitary Code. i t Very truly Countersigned: Signed: P.E., 1' x, # 1 (Owner of Mailing Address incite Ehgineeri.nq, Surveying & Landscape Architecture, P.C. Route' 22 resyast—er; RJR Yam 10509 Mailing Address: '>-7 PAP" 2,b �� r.`✓r ,J �� State New York Zip 10509 State A) Zip r° Z Telephone: (914) 278 -4990 Telephone: T 7? 3-? -73GZ. Form LA -97 ,t 4 1� I�,j S � `�1 �� ` � `1 4,1 f. ��' 8 Y'. �'� x .'5 � a t•� � ,ti � � � I �,� 1 it � V� ��A 6 3 I C1ERTIV$CATIE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PER T # i?V- W745 �F •� 0Agi AC D2" i0i Located at dj""r Village rvrw tm �( Owner /Applicant Name 37 GSA) PA01 tom. Cy�, Tax Map- °? '341 lg Block' Lot Formerly Subdivision Name L I/'� CA'-1z. Subd. Lot # 2-0 Mailing Address r7 6 A0T&--'J D$ & % f T?, „», Nrl Zip Date Construction Permit Issued by PCHD 0 -7--q6 Separate Sewerage ystem built by Address r Consisting of 1, Z50 Gallon Septic Tank and Other Requirements: . / • S SOP A, frw Wateir Su nvlv,: Public Supply From Address I P 01r: Private Supply Drilled by l° &RC �� f JS, �"rL- Address Building; Type. 9&5 0elvr * Has efosioii Number of Bedrooms 3 0161"J Has garbage grinder been installed? /00 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date:' Certified by P. E. " f- Address I 1 e-Wht•u„., 5vR62ye^ki , , PG License # 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 revocation, modification or change is necessary. p r ^ e By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 /NS/TE ENGINEERING, SURVEYING & f LANDSCAPEARCHITECTURE, P.C. LETTER OF TRANSMITTAL MRoute 22; Brewster, New York 10509V (914)278 -6392 7 Del-avergne Avenue Wappingers Falls, New York 12590 TO: p, (', M , P, (914) 297 -1742 Date: It-11-1b i NO. AB- ► Job No. 4 "47,3 3 Zo Attn: 5T1 r r3 EL / ,J6I Re: L��c•¢rG LaT r—o Jr 5,75 COia?�t— IlflvCG� I Z - 4 -4 S ` wGg7 WE ARE SENDING YOU Ql Attached ❑ Under separate cover via the following items: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications - ❑ Copy of Letter ❑ Change Order ❑ COPIES € DATE i NO. AB- ► DESCRIPTION M A5 -- rr yr -T- PRAW I N ._ ..__ (t -.If -17b CC -97 6oasrrcvc.-r7oo) _... 12 -1 / -1'B -- 6✓+4'rL�Z TtrST f� v cT� I Z - 4 -4 S ` wGg7 ( GAAr-'-t.<_ CrLr /�t'7o�n% !F-e ; 72T' ........................... ................................ .......... _ ....... _.__ ..................................... _ .............. _ ... __ ............... _ ............................................................. ............. ...... THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ^ --Q Submit - W copies for distribution _ ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Lot98.dot 1. PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES ,� 10. _. .. L: :Lafiw_.i •.:r, "..•'?.a.w. .,ti •- •..fit.. •:w- %"AY••m'�.. 7i';7;d.r� '�t_�;rq.�� w .. Z. "v.v ��:��9. "1 .4 �"i•:'.I GUARANTEE OF SUBSURFACE SEWAGE TR EATM ENT SYSTEM 6011_rL14PT TZgcgae{ CGu$, 3'tuC, Owner or Purchaser of Building 3i cporom DAm TtraA.r) Building Constructed by B R+r -P-711 V C4NE Foa L{� wAY�I� PRtvE� Location - Street 'RgS1V97 NriAL 73, 1a l 26 Tax Map Block Lot b>uT-N is NA VA, I-L-G ! Town/Village Subdivision Name zo Building Type 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 determination f t .b Pu 1' Health Director f th. Putnam County Department of Health as to whether or n�i th I ure o system 4 to gpera w cat by the willful or negligent act of the occupant cth lbu' y�iing; ilizing the Day $ Year Signature: v �tT fl Title: Owner) - Signature Corporation Name (if corporation) Address: 37 elgo ry N Pte` M -R c, A. r State sStN (Ng . N Zip /OS62- Corporation Name (if corporation) Address: State Zip Form GS -97 REPORT TO: NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 34 r�, �lII1l,L i?'bllN:R ;'- . ; AANRuRY � CT-,0.6&-I. (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING P.F. BEAL & SONS DATE SAMPLE COLLECTED: 11 /24/98 & 12/8/98 4 PUTNAM AVENUE TIME COLLECTED: 9:10 A.M. & 10:15 A.M. BREWSTER, N.Y. .10509 COLLECTED BY: W. MAYERS & P. BEAL DATE RECEIVED @ LAB: 11/24/98 & 12/8/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 12 /11/98 SAMPLE SITE: V.S. CONSTRUCTION, LOT #20, WOODLAND EST., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB AT TANK SOURCE:. WELL TREATMENT: NONE TEST PERFORMED RESULT: BACTERIAL: Total Coliform (Bacteria) 0 PHYSICALS: PH 6.70 12/8- Turbidity 0.54 CHEMISTRY: Nitrite N <0.01 11301 - Nitrate N 1.0 ,Alkalinity 112.0 Hardness 122.0 12/8 -Iron 0.071 Maii-gariese` .. 0.058 Sodium 4.2 Lead <0.005 m1= milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/I, [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 11/24/98 & 12/8/98 SAMPLE, AS TESTED ABOVE: MPOTABL I E or OINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH. SERVICES STANDARDS FOR POTABLE WATER) ff V a i //ri 11I WE( Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 Jl UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL )f1[IEALTIHI SERVICES WELL OOMPLETffON REPORT Ye11 LocatjQ ,,,,:; .. -. Sp'oet�. dress '�;;�c�odl�ant Estates Kramers Pond Road --- - - - - -- -- Town/Village:: --Putnam Valley Tax_Grid Map 73, -le Block - / -- L-ot(s)- Q Z6 Well Owner: Name: Address: V.S. Corporation, 37 Croton Dam. Road, Ossining, NY 10562 Use of Well: =ma 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Prilling ]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 30 ft. Length below grade 29 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 Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well, YieR-d lest _ Bailed _ Pumped X Compressed Air Hours 6 Yield 12 gpm flDepth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 300' Depth of completed well in feet 360' Well Log If more detailed information descriptions or sieve analyses are available, .: - please attach. . Depth From Surface Water Bearing Well Diameter(in) ]Formation Description ft. ft. Land Surface 7 Dr' 7 Hit rocc at 7' Drillin ..in .roc , set casin , .grouted.......... :..:..:r :..- ... .. .. _ ... .. _- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5gM Depth 320' Model 5GS07412 Voltage 230 HP 3 4 Tank Type WX3 2 Volu 6 Date Well Completed 10/20/88 Putnam County Certification No. 002 Date of Report JW 12/4/98 I D i er (sign 1 o m Bea , lau.n A m: ZxdGt location OI well W,ID a ces t at, east two permanent ,anctmarxs to be prow on a separate sheevplan. ! 4 Putnam Avenue Well Driller's Na a P. al & So Inc. Address: Brewster, NY 10509 Signature: Date: 12/4/98 Malcolm T. Beal, Jr. White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION inspected by: �v Straet- Locatiorr�°' �': _ "Y►•t �" l�l� Otirmer �k- Town Permit TM r _; . 18 _ I -Z� Subdivision Lot 9 '�►� 1. Sewag6 System Area a. STS area located as per approved plans ........................... b. Fill section-, date of placement 3:1 barrier Lath. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System, a. Septic tank size -1,000 ........1,25 .......other ................ b. Septic tank installed level . ............................ 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 - ro erl set. .......:::.............. .. engtg required _ ..fength.mstalled to 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.......... I.Q.- .. .. ......I ........::::.:::::::.... 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 ... ............................... 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..; ..................................... I .......... 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 ................. ............................... S2ov 1/07 COMMENTS t � Sri t l IMAM SRS 1. _ n{ t Bill Brickelmeyer Insite Engineering 1849 Route 6 Carmel, NY 10512 Dear Mr. Brickelmeyer: t` ,. lL II DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 2, 1994 , ``„ .:: .,�1DNN_ KPRE�.L • Jr.,. P.Q„- M Sr.; ;- Public Health Director Re: Proposed SSDS: Lincar Dev. Corp Wayne Drive Subdivision Lot #20 (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." The SSDS is proposed outside the approved area as shown on the subdivision plat Please revise plan or arrange a mutually suitable time to witness deep test i holes. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very.,truly yours, I �J Robert Morris Public Health Engineer RM/jp . PUTNAM COUNIY DEPARTMENT OF HEALTH DIVISION OF HEALTH SERyIcES L ��vc,a ] Cam%' j DESIGN' DA -l-W-S MT S BSU'r CL:. SEMAGE• DISM.. AL .SYSTER- _ . .,F ,err owner L�,; w? Dr yecap�r& Co -, Svc' Address U7/GE r= � y , Al. X. 1 `13 Located at .. ( Street) 4 y NE` 97z) v c Sec.7-3 15 Block / . Lot Zk, (indicalte nearest cross street) Municipality pU Tn1M11 VA LXZ r . Watershed _ 14ILD5oo✓ /z4 j; L SOIL POt00LATION TEST DATA REQUIRED TO BE SUBMITM WITH APPLICATIONS Date of Pre- Soaking N �LA Date of Percolation Test N HOLE REBER CLOCK, TIME PEROQLATION PERODIATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop. Drop In Min /In Drop Inches Inches Inches 1 - 2 ter- �' _,o ►� N�� 1s 4 5 2 3 4 5 1 2 3 4 5 NC)TES: 1. Tests to. be repeated at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made fram top of hole. DEPTH 2' 31 4' 5g 69 7° 80 go 10, ill 12' 13' 14' TEST PIT DATA REQUIRED TO BE SUBMITTED WITH A DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLE NO. ID k . A O!L(i E (" - HOLE NO. 2 HOLE NO. t> III S IP( =- /q a 1(( INDICATE LEVEL. AT WHICH GRQPNqaT.ZM-.-IS ENCOUNTERED`;-,.:Z,-*. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED a00 DEEP HOLE OBSERVATIONS MADE BY: PC, DATE: /87 DESIGN Soil Pate Used 0 Min /1" Drop: S.D. Usable Area Provided -5rVO 3f!-- No. of Bedrooms Septic Tank Capacity �O _gals. Type CjO--jC- Absorption Area Provided By L.F. x 24" width trench Other Name :5 uxvcyf-&f rc, Signature Address RVC/7E7 ZZ SEAL 6ZIEW57rr- allf THIS SPACE FOR USE BY HEALTH DEPARMAENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date DEPTH 21 31 41 5' 6* 71 81 91 10, 12' TEST PIT DATA BE HOLE NO. HOLE NO. K WITH APPLICATION .51ql,jp Ill =- Of E FOCK HOLE NO. 13' 14' WHIC&MOOMRM. '- -TS-ENM 'ER "J INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUNTERED (57 DEEP HOLE OBSERVATIONS MADE BY: DAM: /87 Soil Rate Used Min/1 Drop: DESIGN 11 S.D. Usable Area Provided No. of Bedroarts J Septic Tank Capacity 10CC gals. Type CAL Absorption Area Provided By L.F. x 24" width trench Other -:rc rrf rcy -s;% ce'd-mel-M& eir Name "r-NSf1,r :rvcyl-k.; Signature Address* )ZVV'7r ZZ SEAL THIS SPACE FOR USE BY HEALTH DEPARDOU ONLY: Soil Rate Approved sq-ft/gal. Checked by Date O C °1 LWIXA-A :M: ca7-'Z0 I -bulr, Akm 00)UMVrW nmPASnIr 4iomvr C)IF II1E�LTH ... •..-, `. _.. ...'�. n.: ",: .'i4�.....ryra ...' :'::�y,.r.,�tiv�%'. .. _,_. -..., r. .:... .»w._. .e Yr•n •-^ ..r �..� .Z APPLICAMN "FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM I 1. Name and Address of Applicant: t- �D C-a,, 2. . Name of Project: .550 Fag &~x 3. Location I/V/C: PvTwAM VA! .a 4. Project Engineer: - 1—more, 957y , yet-,s J.Souvah c,5. Address: fZo07W ZZ• 13rz��sr Y License Number:- Phone: 6 . Type of Project: �_ 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 completed and found acceptable by Lead Agency? � A ........... 10. Name of Lead Agency OJIA -1; I_it5�zrojt;.:ah:area••r€r �he contr- oT` °of local planning; xc•nrn-�""bG•.: or other officials, ordinances? ........................................ Of 6406.PfAnlr- 12.'If so, have plans been submitted to such authorities? .................. No 13. Has preliminary approval been granted by such authorities? ��� Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?.,...... 16. Waters index number ( surface) .. ........o...o .............o.... A.) /A 17. Is project located near a public grater supply system? .................. A/0 18. If yes, name of water supply N /A -Distance to water supply 9. Is project site near'a public sewage collection or disposal system ?..... M° .0. Name of sewage system 4A Distance to sewage system 1. Date observed: UN f{OD04 23. Name of Health Inspector: &(NKA7°4A) 4. Project design flow (gallons per day).....,' :.............................. z. a; i PUTNAM COUNTY DEPARTMEA'T, OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ . .. 1 .yam — q %.Ci _,. = :-�- , ,.: ; ... _- :: >,;;a:.• .. -x . ..Date.. 0.' Re: Property of 1- ►�%c..4R P- VstLPr"� -r Located at G�i�.}�N�" F�i2 ►Jz (T) PU*rfJA^g VACLCY Section 7 3. IS Block Lot Z Subdivision of �"j�2 _5C.,8DIvrsro1 Subdv. Lot { Filed Map j� -Lq 33A Date S J 7, Gentlemen: This letter is to authorize a duly ,licensed professional engineer i\ 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 �.. pyA� EM-,.-or- systems • -in ..sa.onformi-ty. with :the.- .pxovis.io�ns -wo, 147, Education Law,. the Public Health Law, and the Putnam County Sani- tary Code. Very truly your Signe Countersigne P . E , -H•.4 , �N5ih Address t `I et .0? ; Cv ' CA 'Co7cZ - /v Y X0,5 -1 Z. 6Z &O Telephone er oz V/-C- rLy L� ar 51 ,= .r e'n ,fir $TKa Address ti!�y 1-76.q Town Zv ! - vyp - zY 70 0 Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Service$ AFFIDAVIT - CORPORATE OWNER APPLICATION PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT T0: Commissioner of Health f %n the matter of application for: ' i L I N C.A (� � VeL0 Pm �7•T C-0- ?—rJ C , L r NCfI � � �.8 D 1 ✓ C.cn- 7O IIn �O(u -D NCkc �L represent that II am an-officer or employee of the corporation and am authorized to act for L"i J6 EZ�0-em (Name of Corporation having offices at ZS 1 L-( Be-KT)/ S-/-- Whose officers are: Co., ::=A President: L)010Ac.a /,8$CK_r_L.� Z9 C.j13e7e_Ty - r C-i-Pr-tx FEIC4 -ey) Aij /76Y3 ame and Address Vice-?resident: (Name and Address) Secretary: ON Treasurer: (Name and Address) and ghat I am and will be individually responsible for any and all corporation with respect to the approval requested and all subseq� thereto. Sworn to before me this �_ day of MaA cl✓ 19 15� rota: Public , ARL.ENE FAUSTINI NOTARY PUBLIC OF NEW JERSEY My Commission Expires June 24.1WS F 'S= Signed: Title: Wi,iL, COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services pUTNAM COUNTY DEPARTMENT OF HEALTH 010 1VU&MEk WELL LOCATION 1 Kramer Pond Rd. Putnam Valleyq NY _rW Z i -Lot #20 WELL OWNER USE OF WELL 1- primary 2 - secondary Linear De'v El RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL • PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED • FARM 0 TEST/OBSERVATION 0 OTHER (specify) • INSTITUTIONAL 0 STAND-BY 0 VATS AMOUNT. OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR E) NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION DRILLING b REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 360 _fL1 STATIC WATER LEVEL _30 ft- DATE MEASURED DRILLING G9 ROTARY ID COMPRESSED AIR PERCUSSION 0 DUG EQUIPMENT 0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING. I@ OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 30 tL MATERIALS: 91 STEEL 0 PLASTIC C! OTHER CASING CENGTH.BELOW GRADE _____2_9_ tL JOINTS: 0 WELDED 19 THREADED 0 OTHER DETAILS DIAMETER 6 in. SEAL: 0 CEMENT GROUT 0 BENTONITE 0 OTHER WEIGHT PER FOOT 191b./it• DRIVE SHOE IL-)YES ONO-f UNE&-OYES [3NO SCREEN --F— DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (10 DEVELOPED7 : DETAILS MST SECOND .,I,,G HAVEL. PACK I 0 YES WELL YIELD TEST METHOO: 0 PUMPED DCOMPRESSED AIR 0 BAILED 11 OTHER WELL OEM DURATION n. hr. Vim I -36o 16 0 YES ONO HOURS TOP =:, . -60TTQ� SIZE If detailed pumping tests were done is in- formation attached? $D YES ONO DRAY1OOWN YIELD It. I 29M. 2 WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED 'ANALYZED? 0 YES 0 NO ANALYSIS ATTACHED? 0 YES ONO PUMP INFORMATION TYPE CAPACITY MAKER — DEPTH MODEL VOLTAGE—HP- OF PACK In. DEPTH ' -ft. DEPTH — IL it more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. !S:FROM IDEFTH FROM Water we" SURFACE Bear- Dia- FORMATION DESCRIPTION paE tL IL ing meter I 11n STORAGE TANK: TYPE CAPACITY GAL.• , WELLINULIJERNAME P.P. Beal & Sons, Inc DATE ADp P0 Box B SIG?'TUM 8 Brewster, NY 10509 cr I I Hilt rpck at 7 feet 7 30- 1 1 brtill j -na in rock set casing routed o _36 01 D j it ing in rock granite. STORAGE TANK: TYPE CAPACITY GAL.• , WELLINULIJERNAME P.P. Beal & Sons, Inc DATE ADp P0 Box B SIG?'TUM 8 Brewster, NY 10509 cr INSI T ENGINEERING & SURVEYING, P. C. X849, Route 6 (914) 225.62oo Carmel, New York 103X2 FaX (914) 225.6438 j Wappingers Falls, New York X2390 (914) 297 -1742 TO d"Ur'✓A,-" 0 WE ARE SENDING YOU ched ❑ Under separate cover via ❑ Shop drawings ❑ Copy of letter LIETrEa orF U1261060MURL DATE /] .'ll;l.�-_ NO. JOB 1FTTEN TION_.._- ^. ,..: �.:: �.•... RE: For review and comment ❑ FOR BIDS DUE the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES, DATE NO. DESCRIPTION As requested ❑ For review and comment ❑ FOR BIDS DUE �iTZVC-TZe,, Fr1-7-PAvi -r CIF Cam` -r0�rCl*-M_ 1-111C -7ZSH, r� .Tk4NSMIT_TEDro: as eheeked 6el'cw I pproval p For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections 01 19 • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US (TP- &J— SIGNED: It enclosures are not as noted. kindly notify us at once. y , APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAG9 -pISEOS-Ai SYSTEMS; YEW�SHEET'f6 CONTTRL CTION P RMIT, . STREET LOCATION &jAAMt ,) &f NAME OF OWNER 'BY B. HEDGES R.MORRIS V OTHER DATE TAX MAP # - - DOCUMENTS. Y PERMTT APPLICATION PC -1 ED WELL PERMIT . PWS LETTER CD ENGINEERS AUTHOR17ATION m DESIGN DATA SHEET(DDS) M CORPORATE RESOLUTION m PLANS THREE SETS m HOUSE PLANS - TWO SETS M VARIANCE REQUEST SUBDIVISION LEGAL SUBDMSION m SUBDIVISION APPROVAL-CHECKED El PERC RATE M FILL REQUIRED DEPTH M CURTAIN DRAIN REQUIRED MSTANDPIPES YN M EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE M IF PUMPED PIT & D BOX SHOWN & DETAILED M HOUSE - NO. OF BEDROOMS m WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM ED PROPERTY METES & BOUNDS M HOUSE SETBACK NECESSARY (TIGHT LOT) M HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE M NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS m CLAYBARRIER m 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE m FILL SPECS m FILL NOTES m FILL CERTIFICATION NOTE_ m DEPTH GAUGES CD FILL PROFILE & DIMENSIONS m VOLUME GENERAL = FILL IN EXPANSION AREA CIS EX- APPROVAL SSDS ADJ. LOTS m WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH m DATA ON DDS PLANS & PERMIT SAME m LF TRENCH PROVIDED =60 FT MAX m PRE- 1969 - NEIGHBOR NOTIFIFICATION m PARALLEL TO CONTOURS_ ;I= '..:. "l/'4,:` 'i00`% E'A1FISflN'1'Rf9VDED. 100 YR. FLOOD ELEVATION R REQUIRED DETAILS ON PLANS CD SEWAGE SYSTEM PLAN (NORTH ARROW) m SSDS HYDRAULIC PROFILE m GRAVITY FLOW m CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS CD TWO -FOOT CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES CUT m FOOTING /GUTTER/CURTAIN DRAINS CO EROSION CONTROL; HOUSE,WELL, SSDS m EROSION CONTROL NOTE PERC & DEEP HOLES LOCATED CD REPRESENTATIVE OF PRIMARY AND EXPANSION SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS m 10' TO P.L., DRIVEWAY, LARGE TREES STOP OF FILL CI] 20' TO FOUNDATION WALLS W 15' WELL TO P.I m 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) CL] 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER m 10' TO WATERLINE (PITS -20') CD 50' INTERMITTENT DRAINAGE COURSE m 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS m 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35'- 1%,100' <I% m 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: z \ Q J m O L Q \. W S i � 0 ry ry J' r } A -• r. �..y .. � - +r.�:Q:'ar e _ ♦cr .. .vy^r'S nr a. b .'. .� 2�0 c ICIICIYZ! 3.aettye N. V�� N Icy- r,..... _ . .n ,.�- ... -�.... a ".._ .•rte,+ at. - ,YS .*..smw�.n..i.•.. 4 -�. . - t... .�- .+tea >�- n. .rte ..�.......... .... .ter l..vlT �v ..s�J?'�+.•iW .a.. [ As Mrvr 03Np3Hp 0£ _„ [ 37YOS - / �] {-� [ ` V db[Y AMYlvo 96/Z /Z[ 31 VG Of �3�pbd OZiYb[[6 1031ONd 133HS •0 IMV80 �ytot Sad v d7 ✓N��V 0 �•fC7� 1 mil` fff �r 'N JA NXOA N :f317VA WVNind OL 107 'NOISMicanS f dvoNn C r� -�• ;'7 •dO�a! L .1 03rOdd woo•bua- allsul•M,xw 'J'c13H/)1J31 /HJHb'3db'JSONb"7 �' ' xoJ Z6r9-stZ (016) V 0N1A3AYns "JN /H33N /JN3 066b 79,eZ 016) 60,901 AN lads q*j ZZ'a�nob SYI. .(8 NOISG13& 31 d0 'ON I �l LOT 21 TERA 77ON OF THIS DOCUMENT, UNLESS THE DIRECT70N I , I A I lr�V�n 00rlFrIMMAI Mrl"PrO 1C A �n A r� � BRIAR RIDGE LANE (Formerly Wayne Drive) Al IC- C-AXAAc-T--r JAI L:)11tAtr)r-vT-.--o NO. A B REMARKS 1 26' 52' 1250 GALLON SEPTIC TANK 2 96' 108' DROP BOX 3 97' 105' DROP BOX 4 98' 103' DROP BOX 5 99' 101' DROP BOX 6 i 01' 99' DROP BOX 7 103' 97' DROP BOX 8 130' 151' END OF TRENCH 9 48' 62' END OF TRENCH 10 51' 58' END OF TRENCH it 55' 54' END OF TRENCH 12 58' 51' END OF TRENCH 13 62' 48' END OF TRENCH 14 66' 45' END OF TRENCH OT 19 RECORD OWNER: 37 CROTON DAM ROAD CORP. 37 CROTON DAM ROAD OSSINING, NEW YORK 10562 S17E LOCATION: TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK TAX MAP NO. 73.18 -1 -26 NOTES. 1. THIS IS TO CER77FY THAT 7NE SEWAGE 7REA7MfNT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED BY INSI7E ENGINEERING, SURVEYING AND LANDSCAPE ARCHITECTURE, P.C. BEFORE lT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF 774E PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2. ALL FACILITIES EXISTING, UNLESS NOTED OTHERWISE. J. PROPERTY LINE, HOUSE LOCA710N, AND WELL LOCA710N TAKEN FROM FIELDWORK BY INS17E ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C., COMPLETED 9- 24 -98. 'euruur cau v Loci — ... .... JIV1810n of Eaviroaaeatal Healta Serv.r. AS- 8v«r OPmed ae noted for oonforatnce wlU appllcaDle Maee and Regulation of as 77==:�A*tmeat.. *+imstn x , , _ , Co. 1010294, mt N0. I DATE �dF £14+ REVISION Brewster, l / N S/ T E 1485 ter, N �y x ENGINEERING, SURVEYING & (914) 276 -1 'r L4NDSCAPEARCHITECTURE, P.C. www.inslte -e PROJECT SS TS FOR EOF NE � 37 CROTON DAM ROAD CORP. 4' `C • UNCAR 3 SUBDIV190N, LOT 20 PUTNAM VALLEY, NEW YORK A DRAWING: ^I AS —BUILT t,- ;�c:.__-.::.., . ,� �.l•� y s o." .'r: - .— " '•v `� � - _ s,.`y _rp'"` :e`'�":' �° _.. w "CY'. =:'s _y. •PROJECT . wDRA'M�ING.� . �: - �r •• - .•�� ^ � -S b• �� P. NO. 91147.320 PROJECT MANAGER JJC 'DRAWI 0. DA TE 1212198 DRAWN MAP /� B-, /"I SCALE 1 " -30' CHECKED JW BY M