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Home My WebLink About3525DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -8 BOX 28 ru ; j Ir �� . 6 1, r L . 4 wrl 03525 PUTNAM COUNTY DEPARTMENT OF HEALTH 1AA7 /��rd'�LT `5- �?. 7 �i : T �' : 4fT /� �f.''Tq i 7�. - 4 ...._. r. >. ..�' t .`. -A- �-'.,. .� Y .1 - -SERA' 1i'�.'��o%:.+.o •,....r c.::�. n 3L i°�1{►� �iii`i 1. "" 3'� 'YlY:i.:B'.it.: Si Y CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # py Ln t Located at 41� Town or Village &I-rivil-MAGG Owner /Applicant Name 7-71& yl,-,fS �� Tax Map Block �_ Lot _ Formerly All S-5' 'A% Subdivision Name /V/ i✓ Subd. Lot # :!> Mailing Address /1%i��0oA) 4%1� ✓�N ��i �l Zip l� Date Construction Permit Issued by PCHD /,0 Cd / S°H,J /3- uS Separate Sewerage System built by b,4 T le-4 -MA4 Address `�%L/� ✓ "i d SS��v�.� -� Consisting of Gallon Septic Tank and��' ✓Lfv�'�1 � f iN� L =1� l G' l �!/N � Tlc,. iS_� �.s ,S' Other Requirements: Water Supply: Public Supply From, Address or: _ Private Supply Drilled by Address /S XA19G /Fit Number of Bedrooms - Has garbage grinder been installed? %V C 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 regulation the Putn� County Department of Health. Date: / L 8 G3 Certified by Address M t P.E. k R.A. if7" License # O 76 7 ?3 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage tr&tment 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. By: ZZ, }� Title: Date: ltqlb 3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional �• Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IDMSION OF ENVIRONMMNTAL HEALTH SEIt` XCES FINAL SITE INSPECTION Date: . I0 -,2y o:3 Inspected by: _ _ ,7 P Street T,�ratiQr� �... rarc�?�> <v 3 _ - {��i11 ^ +�r"7,''` -~ii Sc'dc,ri Jl�,;iSe;9 Town Permit # PV / 0 ° I TM #— -7q - ! - $ Subdivision Lot # /LI- s se j; Laf 0 3 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 / r c. Natural soil not stripped ................. .. .......................... d. Stone, brush, etc., greater than 15' from . STS . .. area......:... . e. 100' from water course / wetlands ...... ............................... H. Sewaze System a. Septic tank size - 1,000 ...:..... 1,250..'�other ................ b. * Septic'tank installed level ................ ...... .......................... c. 10' minimum from foundation .......... ............................... d. (Distribution Box 1. All outlets at same el atrofi'wat� ed V `' 2. Protecteoelev ost .................. ............................... 3.. Minimum 2 ft.0riginal soil between box & trenches e. .I . ction Box - properly set .......... ............................... 6. Trenches 1. Length required 40"0 Length installed 4y t; 0 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ..................... 9. Depth of gravel in trench 12" minimum .......:........... 10: pare end s- cwxFed• -.... .: ...� r • .......... ..... ....n..e ....... . 'Faufti ur-Do"sect SvsteM -- s 1. Size of pump chamber.... 2. Overflow tank. -,,r . ............... .. ............................... 3. Alarm, visual/audio... .....:........:.. .............................. 4. Pump - easily accessible, manhole to grade ................. w 5. Firr t box baffied .......................... ............................... 6. C�yycle witnessed by H.D.estimated flow /cycle........... �[ouse4ucUdifas a. House located per approved plans' .......................:.. . b. Number of bedrooms .............. ............................... . ITV. Well Well located as per approved plans .............. . i ................ b. Distance from STS area measured 00 ft........... c. Casing 18" above grade ................ .............:................. d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan..p /4 f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 yES NO COMMENTS I orm -. 10/20/2003 12:35 1026 T PAGE 01/01 �rr;.C..;X�Y in. +. "�..PT"..5 V.ra .9: P`a.: cOGr. • -•Dp.e "•{. 1' Te� ,TMrr�o.;'�•w'1:irm'.R +?c+':iar noi.ca• �.AProi�:..;.7`-.i. .: _. �. a _: .. .. sn s. +....` i ,�. .4 .• ..fit P•... .::+e p ae:/w�...vn �T.'ti•.�n ...,.... .. �' ,:. "_':... �.�:M`tLb>Oo T2��r4 PUTNAM COUNTY AEPARTWNT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SER'V'ICES ATTENTION *JOSEFIR G REQUEST FOR FINAL INSPECTION For: till All information must be fully completed prior to any Trenches inspections being made. PCHD Construction permit # _ Py JQ "" Located: Owner /Applicant Name: S TM ��, Block I Lot �^ Formerly: 11W ` SS" Subdivision Name: s • Subdivision Lot # Is system fill completed? �'�/� Date: Is system complete? _ Date: /Oh Mej Is system constructed as ex plans? Is well drilled? ,c,s bate: A,7 Is well located as per plans? Are eirosion control meabvres in place? S I certify that the system(s), as listed, at the above prenn ses has been constructed and I hAve inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the P90am County Department of ....r.�..r -' Date: 0 6 Certified by: FIE � RA Design Pr fessional. Address: 4fo AS 1/4 Lic,. # 074 r-3 Comments: Form Flit -99 I_ : - PUTNAM COUNTY DEPARTMENT OF HEALTH IIDffVffSffON OF IENW18®NMIENTAL IHIIEAIL'll'IH[ S EllBWCIES 'APPLICATION TO-CONSTRUCT A WATER W>E]LL_ please print or type PCHD�Permlt Well Location: Street Address: Town/Village Tax Grid 44_e__z Map %o4 Block / Lot(s) Well Owner: Name: Address: L �/ 2 77 /e 5a rY✓ cA w,j .1.5 z 14 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm TesVMonitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _� Est. of Daily Usage gay gal. ][Season for Replace Existing Supply Test/Observation Additional Supply Drilling ^ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No—/--' Is well located in a realty subdivision? . .............................. ............................... Yes ✓' No Name of subdivision e -O;�, Lot No. 1_3 Water Well Contractor: ,�1/'a rrn d rJ /�i� <r�a Address: ,Od.� ei/ � _ Is' Public Water Supply available to site? .................................. ............................... Yes No ✓' Name of Public Water Supply: Town/Village Distance to property from nearest water main: /_i,I�� Proposed well location & sources of contamination to be provided on separate sheet/plan. ` lire' 7,. / ,/ ' /.!✓�ol!J G' �. .��1 ?'v.r',. `1.,,,., ,:: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 1.;2.5-10 Permit Issuing Of cial: 6� Date of Expiration S Title: SSi c h Permit is lion- Transffe>r>rz White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location` - _..pr - ... .. Street Address: -' wn /Village: Tax Grid Map W Block Lot(s)21 Well Owner: Name: Address: Use of Well: 1- primary 2- secondary 7_ Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _> Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing /- Open hole in bedrock Other Casing Details Total length eft. Length below grade ft. Diameter G " in. Weight per foot 16 lb/ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: 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 Yield Test _ Bailed Pumped _ Compressed Air Hours 2? Yield /o gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log . If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well . Diameter(in) Formation Description ft. ft. Land Surface Jar G /I If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity 14 Depth 2 Mode1?4,,Pn aS'u 7- Voltage -jv'3 d HP V Tank Type % Volume Date Well Completed Putnam County Certification No. Date of Report W411 Driller (sig ature) 12- NC/rE: Exact location of well with distances to at least two permanent land'Inarks to be provided on a separate sheet/plan. Well Driller's Name ;L01 Address: �- y Signature: , Date: 2–h�%� r—, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 -_ �.- ��7- �P.•�ee Q4'^PVr..s'..ZY'�v it wy.W'Srf- �SV?:�si'1i�..'ci rcp'> BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental ]Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845)278-6014 Fax (845) 278 - 6648 E911 ADDRESS V ERM CATION FORM OWNERS NAME: 17/e/l/t5 L15,0 TAX MAP NUMBER: y0 1 - 0 E911 ADDRESS: � /VC TOWN: 9- AUTHORIZED TOWN OFFICIAL. _ -m.. r �. -.. r.....R.-✓ ..P.. -« +. _.y. -..w �.a,..>, ...w.....w. jgtn °}..�.1 DATE: / -2-19 The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificatc of Construction Compliance. (E9I 1 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEAL'T'H SERYIC F � _" ti� .::'�F�:..?2 "--:ra�..°:'{�`-L° =... - .�':.� _.^'.: 7, r. 5�. a' .rr.�....r,��....3'.•i,:.':..iy t....•C'•.� ?...�5�' .�"'•.'r'" GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 7- �G�.�ts 1�SSo Owner or Purchaser of Building Building Constructed by Location - Street AT/ Building Type Tax Map Block Lot 7/i Nl9��t 6/ Too illlaa�ge Subdivision Name 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 The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether, or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month /Z Day j Year G3 General Contractor (0 r) - Signature D/9 Cc yT,Yr� -e� i ti� Co4-0- Corporation Name (if corporation) Address: j W +I cyc Uv State SSl dul N Zip CGS (2 2_ Signature: Title: rz/q Corporation Name (if corporation) . Address: State Zip Form GS -97 wnTpaS go •18w OL2 go wnwl•ew u 'qaIp paqn1jqsaj Alaqejapow e uo ascqq 4o• -wnlpoS go 115w 02 ueqq ajow OU uTequo--.) pinoq• walem aqq"qaI-p paqzljqsaj w1i1pos w uo aldcad joy qeqq . aqeqs saullapInB paqsa85nS -paq;j3sojd aje wn1pog wol sqjwTI ON eN -7/8w g-0 pea•a q0U TIeqS PaUTqWoD anIVA JeqOq Qaqq 'JUaSaJd We aSaUeBUWW PUP UOQ qqOq 11 UW/B-':! WISOAMM Waq= aQ SMnPaJ Off, ua•eqjapun aq qsnw quawqeajq Mem asla !/Dw E-1 go anTeA U3djoo e PUP qUU g• W44 ajOW 10 SMIM OU31 e aAeq SqUIOd uoTqnqTjqsyp jIaqq go MoT a_low ou qwqq saiTnbaA swaqsAS Dllqnd joy alnU jaddoo T Peal Wd3 -qdd gy qw 'as aje sl17oq3s mIlqnd jog sqTwTI uvil n3/q..::l 'NOU331103 JO 2WII 3HI W '031SM SH31TWUMd S•I :OA isauvaNVIS MIUM SNINNIM WO W% VdA UNW ."UVIS A80A. I'MNI :. icu,.j000v AimunD AHVIINUS A8013WASIMS 1.71-17 NI.-. W 10 UON SUMIJISMI):UM 3HI iVHI DIV31UNI simsm 3S 3H1 13% ISiN3WWO3 OD1-Ii3W 39NUH - 1VWHM---! imS3-*-..I mm-m---m--m ----- m-mmm ------ > ANON Mn=Obd BVIA M&I --- m ---- — ---- mm ----------- — WH9nuo smimom z ... smoN NOSM30NU HWAVS QS KIM) ANW �11 318VIOd 1'"WAI MMS AN 'A311VA WVNind QNWI MOOM ON 9311S SNIMM''., T65T EO/ 92/ T I 09ZOT MOW! 00101 EO/02/TY -82n-(NT6) 73NOW-i 1 Tivu luodsl-i 50038 WAVI MOOT AN "A311VA WVNin.:.,, WOWS 'NVWUON NNIM) is ussuvs 20T 9NIIIIHO 113M NOSWUNU ---------------------- m—m—m—m—mm _m" ---- mmm --- mm ---- m ---------- m-mmm-mm- T 290:1 30MI MS NOI,,i 0022 Q IN3110 T556002E 10 SWI 104MATa 'TUOAOPUd -H qjaqlt.,;, 0082-2% KY6) JMMj4Q AWN TPC* SMIAWS IVINWAMM3 MA 17 i ATW h.1 IC l; lif I/ sw 0"95 SV) AWNIMAIV EO/ 02/ T'r V/N WSW 0129 IVIOPSUNUUM EO/02/TT 1 9 SIM 9",? Hd E0/02/TI: V/ N l/M NT "S (WN) wmaos EO/02/TT LE02 1/5W E"O-,:) WSW 2U010 (UW) ES3NVSNVW E0/02/TT 1/bw wo-0 WSW Wf (BY NOM E0/0@/T{• 9tT6 V/01 '1/ E)W T 0 * () > 00MIN 31MIN E0/02/TT We.) qT -,0 WSW 991t SOWIN 31MIN E0/02/TT 70•6 qdd OT—) qdd I:::. (SWI) OU37 EO/02/TT i --') { ) C IN3s8v IW OOY/ IN3SSV WMAT103 "I Aw E0/02/Ty 311AOUd AM WVNin,j OD1-Ii3W 39NUH - 1VWHM---! imS3-*-..I mm-m---m--m ----- m-mmm ------ > ANON Mn=Obd BVIA M&I --- m ---- — ---- mm ----------- — WH9nuo smimom z ... smoN NOSM30NU HWAVS QS KIM) ANW �11 318VIOd 1'"WAI MMS AN 'A311VA WVNind QNWI MOOM ON 9311S SNIMM''., T65T EO/ 92/ T I 09ZOT MOW! 00101 EO/02/TY -82n-(NT6) 73NOW-i 1 Tivu luodsl-i 50038 WAVI MOOT AN "A311VA WVNin.:.,, WOWS 'NVWUON NNIM) is ussuvs 20T 9NIIIIHO 113M NOSWUNU ---------------------- m—m—m—m—mm _m" ---- mmm --- mm ---- m ---------- m-mmm-mm- T 290:1 30MI MS NOI,,i 0022 Q IN3110 T556002E 10 SWI 104MATa 'TUOAOPUd -H qjaqlt.,;, 0082-2% KY6) JMMj4Q AWN TPC* SMIAWS IVINWAMM3 MA YML ENVIRONMENTAL SERVICES 321 Kear Street ts.,K). ��p��:��*��`� � (914> 245-280O | Albert H. Padovani, Director | LAB #: 32.309441 CLIENT #: 2500 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 2 ANDERSON WELL DRILLING DATE/TIME TAKEN: 1020/03 1000 152 BARGER ST DATE/TIME REC'D: 11/20/03 10:50 ATTN: NORMAN, SARAH REPORT DATE: 11/26/03 PUTNAM VALLEY, NY 10579 PHONE: (914)-528-1491 SAMPLING SITE: - NO MEADOW LANE, PUTNAM VALLEY, ' NY SAMPLE TYPE..: POTABLE : TANK COL'D BY: SARAH ANDERSON NOTES...: MCCORMICKS DAUGHTER ------ Q ---------- m_mmm._m ----- - DATE FLAG PROCEDURE is suggested. PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: Ml--- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY, WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL P}PEb AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. _ SOFT WATER� ^ ` �VERY HARD ��IER A8OVG {l `-.-� � � �� . � -' "? ONTO -'--- - HARD WATER: 140-300 MG/L (I grain/gallon = 17.2 MG/L) | SUBMITTED BY: Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321Kear'Street yo w (914) 245-2800 Albert H. Padovani, Director | LAB #: 32"310059 CLIENT #: 57183 STAT PROC PAGE RUSSO, TOMMY DATE/TIME TAKEN: 12/16/03 08:00P 5 NORTH MEADOW LANE DATE/TIME REC'D: 12/17/03 10:47A PUTNAM VALLEY, NY 10579 REPORT DATE: 12/18/03 PHONE: SAMPLING SITE: 5 NORTH MEADOW LANE SAMPLE TYPE..: POTABLE : PUTNAM VALLEY NY 10579 PRESERVATIVES: NONE COL/D BY: TOMMY RUSSO TEMPERATURE..: < 4C NOTES...: SLOP SINK COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 12/18/03 IRON (Fe) 0^1O6 MG/L O-0.3 mg /l 2037 12/17/03 MANGANESE (Mn) <0.01 MG/L 0-0.3 mg/l 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ` SUBMITTED BY: Albert (ASCP) Director ELAP# 10323 i Aoiinjpuhlic Health Director Director ofFatientServices DEPARTME 1 Geneva Road, E ROBERT J. 'BONDI County Executive C OF HEALTH wsfer,.New. York 10509 i Environriieatal Heatith`'(845) 278.6130 Fax (845) 278 -7921 Nursing 5erviees (845) 2 ?8.6558 WTC (845) 278=6678 Fax (845) 278 -6085 Early Interveatt6AM a 6661 `(845) 278-'60'1-4 Fax (845) 278 -6648 February 13, 2003 Frank Sullivan, PE 2972 Ferncr°est Drive Yorktown Heights, New York 10598 Re Reitewal to is ' pO roved .SSTs - Nissen Barger'Str'eet, (T) Putnam Valley TM4 74 1 =8, Perrriit # PV- 0 -Of Dear Mr. Sullivan: This office has received and revtewed.`the most recent set of plans for the above mentionedproject, We. would like to offer the following comments for your "review and consideration: /1. The deep test'hole information on the`plan` s�h'ow . at epth of holes at 72 ", while'the'design data sheet shows 84" V2. Part of the system is less than 10 feet from the proposed driveway. There appears to be a X45 °bend :between the septic tank andahe '.first lurlction- box . :If -cl;a��out an 4d ul dC�dii ilecus euSC prvvaed , M....- �. �4 Does the driveway need any regrading. ra ., j Y5� The edge of the driveway`- §houWd'he shown on the profile. The detail for the absorption trench shows `2feet` -6f solid "pipe before the trenches start, but the plan view, doesn't show this:. The plan view should show the 2 feet of solid pipe before { the trenches:'start ` Vf A datum reference :needs to tie provided The label for the pipe between the tank and first junction box needs to include "1 % minimum" +� in the plan and profile view. This office will continue its review upon;,consideration of the above mentioned comments. Please feel free to contact me at ext.'2157 if any questions arise. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj LORETTA MOLINARI RN., M.S.N. Acting Public Health Director Director of Patient Services -E '-. a••7 � ^.t•':!'�. .n.) ~? s..r^ Iv.:l.'t i_'— •.°sa' '� ... A�� .r a — 1 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 February 13, 2003 Early Intervention/Preschool (845) 278 -6014 Fax(845)278-6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Renewal to approved SSTS - Nissen Barger Street, (T) Putnam Valley TM# 74 -1 -8, Permit # PV -10 -01 Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. The deep test hole information on the plan shows total depth of holes at 72 ", while the design data sheet shows 84 ". 2. Part of the system is less than 10 feet from the proposed driveway. �_ Thew r�''Q�ars tc�_l �',a'4S °.lje_n ?oet;ve -t sent ;r. to k (y:.�'nP ,Csr y .1.• e,-�_. e septic -t ar _ f... VOX. tee, a cleanout and cleanout detail needs to be provided. 4. Does the driveway need any regrading? 5. The edge of the driveway should be shown on the profile. 6. The detail for the absorption trench shows 2 feet of solid pipe before the trenches .start, but the plan view doesn't show this. The plan view should show the 2 feet of solid pipe before the trenches start. 7. A datum reference needs to be provided. 8. The label for the pipe between the tank and first junction box needs to include "1% minimum" in the plan and profile view. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP :cj Very truly yours, 4je oseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH p IUD' - • DTVL4ION OF ENVIRONMENTAL HEALTH INN V1DUJkL<�':� TER 1TVi? %v .2..,5??T?ST,?I�� : 57, i' 1;.� P :.;;l:tr'T s' 5'PF:IVI."`s `REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: SO A U 5 55em STREET LOCATION: -!�_f cx-f 7SP REVTEWED.BY: RM, GP, A, SRDATE: ji3 °3 TAX MAN: (CONFIRMED) Y IN DOCUMENTS _),11" PERMIT APPLICATION (WE PERMIT MIT OR PWS LETTER OF AUTHORIZATION DATA SHEET (DDS) LkTE RESOLUTION (Lg6L_)SHORT EAF (1f�UPLANS -THREE SETS DOUSE PLANS -TWO SETS ( J(Z VARIANCE REQUEST SUBDPVISION -/ -(_.)U CLAY BARRIER / (Z�LEGAL SUBDIVISION (___ L -jFII.L ..CE TION NOTE SUBDTVISION APPROVAL CHECKED ( ��DEP UGES / (ZOL ERC RATE _ , ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (jU L REQUIRED. DEPTH SEPARATION DISTANCE FROM TOE OF SLOPE UURTAIN DRAIN REQUIRED TRENCH GENERAL (� LF TRENCH PROVIDED+ 60FT MAX. U(_JLOCATED IN NYC WA T + (f/ PARALLEL TO CONTOURS ' So l, a Ad -i UL:J-PLANS SUB 0 DEP ` 100% EXPANSION PROVIDED PIA-4 V* (--J(.:.JD TO PCHD / DETMMUST FREE CRUSHED•STONE OR WASHED GRAVEL EP APPROVAL, IF REQ'D (�(__)GEOTEXTILE COVER (SEEP TEST HOLES OBSERVED ()(__)PERCS TO BE WITNESSED (�( -)M-APPROVAL SSDS ADJ, LOTS (�WETLANDS (TOWN/DEC PERMIT REQ'D ?) (t�)C_.,)DATA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION �(___)(2,-�00 YR. FLOOD ELEVATION W1I 200' L_) SOIL TESTING LOTS>10 YEARS OLD REQUIRED DETAILS ON PLANS _L/'SEWAGE SYSTEM PLAN - (NORTH ARROW) (� SDS HYDRAULIC PROFILE ✓0(___)GRAV1TY FLOW Y N (REQUIRED DETAILS ON PLANS CONT'D) (�(__) OUSE SEWER - %" FT 4 "0'; TYPE PIPE CAST IRON IVA** (��. . OBEND$ MAX;BEND5- 45�WXCLEAIV'OUTa Avss� (�(r2 I�� RENEWALS �je:�yvecu. h+++'k (_/)( )STTE NOTE (NO CHANGE) as�i Fi " ✓S f Ta FILL SYMEM C_J( -J10' HORIZONTAL; RENCH SLOPES .1 TO GRADE :. L .U( '_,)FILL SPE L 140TES 1 -5 N / - (_ )(� OFILE & DIMENSIONS / I FILL IN EXPANSION AREA .UCTION NOTES 1 -15 DATA: PERC & DEEI (FOOTING /GUTTER/CURTAIN DRAI1tfS 6 USDA SOIL TYPE BOUNDARIES ((___)TITLE BLACK; OWNERS NAME ADDRESS TM, PE/RA; NAME, ADDRESS, PHONE# �✓ TE OF DRAWMGIREVISION _-� Aw M--REFI:RENCE (�QJLOCATION =OF WATF.RC URSES; PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (_•)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S WAN 200' OF SSTS C�., PROPERTY METES & BOUNDS • .(!::�)(,JEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE ,OA'IlMENTS: ( J;0' TO FOUNDATION WALLS 0 100' TO WELL, 200' IN DLOD,150`. TO PITS Lj6U100' TO STREAM, WATERCOURSE,•LAKE: tnc..ex a �� @� TO �O dT•i �T_�1SLRn�YC_'. rr./A�- ":;^..'�C', : IFE;3•� r`i ii2.. („4(_)10' TO WATER LINE (pits - 20') (✓ 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (_)( 10' MIN TO LEDGE OUTCROP Z SE PTIC TANK _)10' FROM FOUNDATION; 50' TO WELL WELL U`� IMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (MIN 15' TO PROPERTY LINE SL PE )PE IN SSTS AREA . %v (520 %) GRADED TO 15 %, IF REQUIRED DOSE MP U SYSTEM /� (_,_)(___)PUMP NOTES 1 " (J(__)DOSE• 75% OF PIPE V OSE VOLUME NOTED ((_DETAIL FO MAIN, (PIPE TYPE, ETC.) UUPIT -BOX SHOWN &DETAILED (_J AY STORAGE ABOVE ALARM CURTAIN D n I (__)(___)STANDPIPES, 5' BOTH , TAIL 1 �+ C_J(_J15' MIN to CD °, 20'- 4 %,15' -3 %, 35' -1 %,100 % - <1% (_(__)20' DISCHARGE/100' with 182 cons day discharge to NON- PERFORATED PIPE tEVS1�ET104 /Ol /00 _ _ _ - r� � i �, •� ,� , � �� r � i � soy � � � •� e�z m > > � � i (�� e a � �� ! � � CDR VRSQ I ...® FNVI R ONMi]ENTAIL IHIIEAILT HI SERWC E.5 RE: Property of Located at X56? ✓ LETTER OF AUTHORIZATION t4-5 ; �s erj a� t T/V ey e- ax Map # Subdivision of 'Y/d 0-�' Subdivision Lot # Gentlemen: .3 Block Lot 47 Filed Map # 2-3 —'�W Date Filed 7// y7/ This letter is to authorize a duly licensed Professional Engineer 6Vor Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in -Co 7.form.itv'�vi��,i t12� ofr�viS]i?Iitioi) Gi: e °1; 5_44d/pl .147. o €the EdL ation T �w, the Public l�:altl�: -. ,: - . Law, and the Putnam County Sanitary Code. �7 Very truly yours, Countersigned: Signed: P. E., R. A., # f , _ (Owner of Property) cis WE Mailing r �-A ---7 t?5� Mailing Address: 27-7 W ca State Zip �1/� j'� State Zip /�� %� Telephone: ��`�� ' 7 Telephone: y� Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH `+DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONST�ION�YERMITM.... ,,.�,..�..�,Y:.�� -: P GE T1tEA1'MEN1' S`YS'��VI' PERMIT # V' Located at ,0By'4 -e� 6; '! ---r174 Town or Village i' wlle- y Subdivision name �;4//-S 5 9:!�� Subd. Lot # 3 Tax Map Block _Lot Date Subdivision Approved .1_/.2,7/ Renewal Revision Owner /Applicant Name 5 o,q jj w_4 /y i`,3�� Date of Previous Approval Mailing Address 7 /. a ✓ �/ �� /`�`t � c "'� A' Zip /oS%9' Amount of Fee Enclosed )03o6J Building Type/ G�i e,- Lot Area 3- 2 No. of Bedrooms _4 Design Flow GPD fo v Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ,gallon septic tank and 400 ) 4f Other Requirements: To be constructed by Water Supply: O WW e= l�- Address Public Supply From Address , .: ;: y � ; : mate is l; ..�ji31YLd- w _.. 'sue -•:_. r- ,%. 6' ': cress_- : . J-#- . 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¢ NEW j0`� If Oc/s Signed: 1' R.A. Date W t Address ��1'J /'� 0 1 License # �'0 24895 APPROVED FOR CONSTRUCTION: This a o years from the date issued unless construction of the sewage treatment system has been completed and ins a 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 t. Ave r .sc ge of domestic sanitary sewag only. By: Title: Date: 3> 1Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fessio 1. Form CP -97 II UTNAM COUNTY DEPARTMENT OY HEALTH DffV gffC `� OY IENVff RONM1ENTAL HEALTH S ERVff(CIES _ O C��T�JC' A please print or type PCHD Permit #� Well Location: Street Address: Town/Village Tax Grid # 90.0_ -e'r ��di74 /"dc � s! d. Map ? Block Lot(s) Well Owner: Nam : A �V-$ X:$.> Address: as ll-7 e.® Use of Well: r Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- seconndalry Industrial Institutional Standby Amount of Use Yield Sought c3' gpm # People Served _40_ Est. of Daily Usage K�.v gal. Reason for Replace Existing Supply Test/Observation Additional Supply IlDIrillIling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Nr Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes P, No Name of subdivision 1:,4,0 e—,P? Lot No. .� Water Well Contractor: /V 14004- -1 V 07 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: °° Town/Village �- Distance to property from nearest water main: HI `elm Proposed well location & sources of contamination to be provided on separate sheet/plan. ��-ii� - ±�,• ';�' %f�. /! _/, _ � /1 i1t11�l�`.`!IZt, Ci'G,Yt C°.� �.�� . � .�` - s_'i �I /, � =5."!" :'��'"p'°rM�ri ,i : ` -' • �,�..� ..�. ,. .. -9 PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property. and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the. approved plan requires a new permit. Well to be constructed by a water well driller ertifie y Putnam County. Date of Issue 317- 7/01 Permit Issuing fficial: , Date of Expiration r U Title: Permit is Non- T>ransffe>r>ra lle White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 s PUTNAM COUNTY DEPARTMENT OF HEALTH DYVISION OF ENVIRONMENTAL HEAL'T'H SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: J�vvl �i ci All, ' 2. Name of project: _ �� 3. Location T%V: *:' r ell y 4. Design Professional: ��r� i �✓�s t::1 S. Address: % -oA�1'7� /�'�� r. 6. ; Te o ' Protect: ' Private/Residential Apartments Office Building Food Service Institutional Realty Subidvision Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? /`'U Type 'Status (check one) ....................... ............................... Type I Exempt. Type 11 Unlisted _ 8. Is a Draft Environmental Impact Statement (DEIS) required'? . ............ I........... N 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency P} t z11f ��,�'� i _ n'varF irr 7 F.� ,�ifir(?1, rif l�i.� :l' nl �lrii. ,?01f'n�0,; -n�,r officials, ordinances? ................................................. : ........... ....................... 12. If so, have plans been submitted to such authorities? ........ ............................... y 4�� 13. Has preliminary approval been granted by such authorities Date granted: 14. Type of Sewage Treatment System Disc-barge; ........... surface water y / groundwater 15. If surface water discharge, what. is the stream class designation? .................... 16, Waters index number (surface) ......................................... ............................... 17. Is project located near a public water supply system? ....... ............................... A1 Y. 18. If yes, name of water supply Distance to water supply LIA�-4 19. Is project, site near a public sewage collection or treatment,system? ................ —/4/0 20. Name of sewage system _ Distance to sewage system /%%`f 21. Date test holes observed ? e— 22. Name off lealth Inspector -31212 Form PC -97 i b f� 2 3. Project -desi yn.f ow (gLtillons per._dCly� ,:E.: _:,Y. % ...._ 4. is State Pollutant Discharge l liriiination System (SPDES) Permit required ?... Has ST)DE,"S Application been submitted to local DEC office? ......................... 6.- Is any portion of this project located within a designated "Town or State wetland? 7. Wetlands 11) Number ..................... 8. is We.tlarids Permit required? .............................................. ............................... Alf' Has application been made to Town of Local DEC; office'? ............................... 9. Does project require a DEC Stream Disturbance Permit'? ......... :..... I ....... I......... AlG 0. Is or was project site used for agxicu.ltural activity involving applictition,of pesticides to orchards or other crops, solid or hazardous waste disposal, A/ U landfilling, sludge application or industrial activity? :........................... Yes/No I. is project located. within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any. other potential known source of contamination? ... ............................... Yes /No DESCR1BFI: Is there; a local master plan on fide with the Town or Village? ......................... We) Are comimmiry water and/or sewer facilities l.)lanned to be developed within 15 year .. ............................... -- s ri1 car rlcl��lcel�it to project situ _ _ - .. Are any sewage treatment areas in excess of 15% slope? ................................ Tax .Map ID Number .......................... ............................... Map Block / Lot Approvec:i. plans are to be returned to ..... _^ Applicant y1 Design Professional the application is signed by a person other than the applicant shown in Item l.,the application must accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision ty be grounds for the refection of any subniMlon, I hereby q/ under penalty of perjwy, that infbi- matron provided on this form is true ro the best of my knowledge and belief. False statements Wade herein are punishable as a Class ,I misdemeanor pursuant to Section 210.45 of the Penal Laiv. rN,4 TU,RL,S' & t7T FICIAL TITLES: - -. -- � .ling Address:........... - - - -- /!� PUTNAM, COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner r h /_J..$ 7 0 Address Located at (Street) %%;eeq e-,-- —Tax Map Block Lot (indicate n'qares cross street) Municipality IIIIW7_76e IV Watershed SOIL PERCOLATION TEST DATA Date of Pre-soakiniz M 71-41 Date of Percolation Test -.11-J11611 2 3 4 5 2 01 A0 2__Z /15 2 2- 2s 3 4 5 I., Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole, (i.e. , I min for 1-30 min/inch, s 2 min for 31-60 minlinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 I 4 .......... . Depth to Waterll: 4 er, W t From Ground 'Level :--�Verc�l . ...... 'Sto T' Sur face (Tnche�) JD.ro.p In. ....110le'No R'' N Q M Start sto,,.,.. . P:: -.14c -3 -4- 2 )2— 3 may' 4 5 2 3 4 5 2 01 A0 2__Z /15 2 2- 2s 3 4 5 I., Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole, (i.e. , I min for 1-30 min/inch, s 2 min for 31-60 minlinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 I 4 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES `HULE"N'O. b/ HOLE NO. e� HOLE NO. G.L. rre fall 0.5' 1.0' _ 1.5' 14cf am do a 2.0 1 1 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 9� 7.5' 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered ,A"eVe Indicate level at which mottling is observed Al ,ee Indicate level to which water level rises after being encountered ---- Deep hole observations made by: __ ��S�t �%i 4rt- Date Design Professional Name: Design Professional's Seal , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES e ■ LETTER OF AUTHORIZATION RE: Property of 5 a a? 1111Y-5v en U Located at h - ,4-le-1Vi1L T/V� u% Tax Map # _ Block I Lot rs Subdivision of Subdivision Lot # Filed Map # Z Date Filed 7 Z) V/9;-' Gentlemen: This letter is to authorize a duly licensed Professional Engineer ✓ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property, in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and /or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health .,_. < ........_..,.... . ... T•`'- uVr'F`,'Ciri�"i "it +'i�llti�anl 131111'L"�'_J3 arl CLl�'.- aol1.0 ....�., -.w,.- ......�........e -. .:�...�...�r.. -o. Countersigned: P.E., R.A., # _ Mailing A Z//-/ State ?/1 Zip Telephone:�� Very truly yours, Signed: �], max. (owner of Property) Mailing Address: 2�� 1-�q4 - - %A' State Zip /e� Telephone: Form LA -97 14-164 (7ld7) —T*xc 12 PROJECT 1. NUMBER ---°"--^-'— State Envlrwvtwntnl Quail" gavio + SHORT ENVIRONMENTAL ASSESSMENT FORM PAR TI—PROJECT INFORMATION (Co be a;ar ptoted by Appilcant or Project sponsor) 1. APPLICANT )SPONSOR J PROJF& LOCAriON: M4n1c1paII1y _�� — 6t —•u�/ 4 PRECISE LOCATION (Sboat addrm and road {nteisectiona, 6 �� ► /Gruel S. IS PROPOSE(? ACTION New 1_3 Exponslon ❑ Modtticationlalteratlon 2. PROJECT NAME isiiiandmarke. Mc.. Dr provIdd maps � Pi. DE`3CR'tt3E PROJECT BRIEFLY• /1 r. AMOUNT OF LAND A.FFECTEDt 1fI11rnerYaly � Bcro•s b. WII_ PROPOSITION COMPLY WITH EXISTING :CO NO ON OTHER EXISTING LA140 USE AESr41CTIc*467 01a F,l No If No, de"i-lb. bdohy 9. WHAT IS POESENT LAND USE IN VICINITY OF PROJECT? tt��11 RWtidarrtlSSl 0 InduBtrlal CD Gornmarcial C� A®rlcullure parklForastlOpnn apaco l J Othmr ^ u• ras>. a � n a. -.r. .. .v .. �.n.. ♦.. .:.:' �. rM -.. • ,. . � • - _._.+__.. .._w -...s ♦ t _ .... s�.• 10. DUES ACTION INVOLVE A PERMIT APPROVAL, OR FUNCONG, NOW OR ULTIMATELY Fs1Of- ANY OTHER GOVERNMEKTAL AGENCY fFFDIERAL, STATE OR LOGAL }7 u/I 3SJ Yon No It yxo, Ifal ngencY(s) And pefrnivapprovels 11. gES ANY ASPfrt;;T OF" THE ACTION HAVE A CURRENTLY VALID PEPwrr Om APPF4OVA' es No It yoe, ilai .apv+soy nprrlr and p4r7mlUnpPruval 12 AS A AESULT OF -PROPOSED ACTION WILL EXISTING PERMIT)APPAOVAL RE C)UIRE MOWF)OKFION7 r-1 _ L J Yes_.. _ hdo r C ERTIFY THAT THE INFORMATION PROVIDED ABOVE IS 'RUE TO THh BEST OF MY ANOWLE•DGE• Appllcant sponsor name: `:e Signiituw bI the or- -tlon dm in thg Coastal Ayv.m, and you art a oWa egerocy, 00 mP1011 9l'ta3 Comstal Asms. meni Form belots procooding with this sasaeamont 1) VER SAT 1') A14 BRUCE R. FOLLY Pub(Ic lfealM Director PiAINAM UY ENV HEALTH F, A X ki 0, 17112731.1 IDES AWFNMNJ' OF IMALTH I Geneva Road Brewster, Now York 10509 LORETTA MOLA'NAM K'N., WS.N. ,4,ylociars public Health Llirerycr Director of Patient Services M,.LQII M-BIJELD TESTLS-6 M.-fEN-171ON: 0 ADAM STIEBELING 0 GENE RE-ED All 4xfort-nation below must be completed prior to any scheduling. DATE: E NGINEkA0'RF111M: PIIONL(4J f 4 L,,tS 0 N: DEEPS: ��PERCS: rj KRYLP TEST: o ROAws'rman,: TW I— TAX'NL1k1'4; /7 a— ON. f — P�a St;B'DIVISION: LOT#, OWNER: YES NO 0 X Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. 0 X Proposed SSTS within $00 feet of a reservoir, reservoir stean or cont-rut lake, jf Pro, p osed..58Ta within 200 feet of a watercourse or a DE.Cwetljuld. 1g, 4 R Proposed SSTS for u Couirnerical Project. It is the responsibility of the design professional to provide the above information prior to soil ttstina '0' This Department will determine the N'YCDEP project status (Joint or Delegated) based on the mspoitse, If you answered M to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time. for field testing with the PCD014, the Design Professional and NVI'DEP. If a.project has been determined to be Delegated based on the above response And then subsequent information indicates NYCDEP is required to witness the soil testing, itwffi be the sole responsibility of the design pi-ofesAorial to schedule re- witnessing of the soil testing with NYCDEP. o FOIL COU' 0 iqTkl USE ONLY o 10 (VIELDI'EST) 9 BRUCE R.,- FOLEY:... _ t�uolc' IiealtX" iirector March 26, 2001 DEPARTMENT 1 Geneva Brewster, New PITTA. MOLINARI R.N., M.S.N r Associate Public Health Director Director of Patient Services OF BEAI,TH Road York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845)228-6108 Fax (845) 278 - 6648 Mr. Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Nissen, Barger Street, TM# 74 -1 -8 Town of Putnam Valley Dear Mr. Sullivan: We would like to offer the following comments for your review and consideration. o ibFy _� Documentation 1. Application form PC -97 - Please correct/complete item #21. 2. Application form LA -97 - Complete filed map number and date filed. General 1. Deep test holes witnessed on March 22, 2001. Plan r,au _, rC: - vx ` x,�L e""s tiinn�tne .,_.... —... ..,. separate sewage treatment system. 2. Dimensions to locate well required from property lines. 3. Please provide location of well connection service line to dwelling. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public. Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 March 19,200 1 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Mr. Frank Sullivan, PE 2972 Femcrest Drive Yorktown Heights, New York 10598 Re: Nissen, Barger Street, TM# 74 -1 -8 Town of Putnam Valley Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. Fl) c Documentation 1. Application form PC -97 - Please correct /complete item #21. 2. Application form LA -97 - Complete filed map number and date filed. General I Pl�rsiiant to,PW -am Coun *.y Health_..1?epa--tment Bi:lletin ST -19, deep test hol °s are .... .. .. .� .... -.. ...r required i.. i • }.r..+.-r._ - ♦..--v .. -. .r to be witnessed. • Plan 1. Well as shown on plan is less than the minimum required 100'0" separation from the separate sewage treatment system. 2. Dimensions to locate well required from property lines. 3. Please provide location of well connection service line to dwelling. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PU TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �r 19 2. Name of project: -3 3. Location TfV:�ir7jG�' 4. Design Professional: �1�� i ;a P�;F 5. Address: 6. Type of Project: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental -Quality Review (SEQR)? W6' Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted S. Is a Dram Environmental Impact Statement (DEIS) required`? ......................... A/�z 9. Has DEIS been completed and found acceptable by Lead Agency? .............. 10. Naive of Lead Agency ~�-1 IV6 ° 1 dhis °Pro ct is an ar "ea unaeT the control of local planning, zonin g, or other officials, ordinances?.......................................... .................. •r ......................... _ 12. If so, have plans been submitted to such authorities? ....................................... _v o� 13. Has preliminary approval been granted by such authorities )f Date granted: 14. Type of Sewage Treatment SysterrrDischarge ................. surface water y groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ......... I ...... ... .................. 17. Is project located near a public water supply system? ....... ............................... f1Po 18. If yes, name of water supply Distance to water supply Z�2L�� 19. Is project site near a public sewage collection or treatment.system? ................ /_A/® 20. Name of sewage system — Distance to sewage system d'%11r1__0 21. Date test. holes observed 7 — 22. Name of Health Inspector Form PC -97 2 Project design flo Ar (gallons perr. day) Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... Has S1'1)1::S Application been submitted to local DEC office? ......................... A v Is any portion ofthis project located within a designated Town or State wetland? No Wetlands11) Number ........................................................... ............................... Is Wetlands Permit required? ........... Has application been made to Town of Local DEC office? .......... I........ Does project require a DEC Stream Disturbance Permit'? .. ............................... /✓G Is of was project site used for agricultural activity involving applictition,of pesticides to orchards or other crops, solid or hazardous waste disposal, N landfillinl;, sludge application or industrial activity? ............................ Yes/No Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any lvz� other potential known source of contamination? ... ........:...................... YeslNo DESC l.8I -'?: Is there a local plaster plan on file with the Town or Village? ......................... A& Are community water and/or sewer facilities planned to be developed within 15 years is or adjacent to project site? ................... •... .::.1 r�.......,... ._ :. _.....� Are any serval;c: treatment areas in excess of 15% slope'? . ............................... a Tax Map 1D Nurnber ..................................... :................... Map Block / Lot Approved. plans are to be returned to ...... _ _ Applicant 1/' Design Professional e application is signed by a person other than the applicant shown in Item l .,the application must ccompanied by ZI LetteI' of Atlthorizatlon (Form.LA -97).Failure to comply with this provision be grol111l1S for the rejection of any submission, I hereby «f firm, imder penalty of 'peijtuy, that information propided on this f orm is true to the best of my Anowledge and belief. False statements tnade herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Vi1lUlil:,S' OFFICIAL TITLES': �ir��'�ri�� ng Address: ,/�j� ...... 'I'E'U NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH S ERVICIES LETTER OF AUTHORIZATI ®N RE: Property of 30 h dt tis W/JS en Located at T/V�a�jj�' a/Tax Map # 2 Y Block 1 Lot Subdivision of Subdivision Lot # 3 Gentlemen: /l"�s _3 e,' Filed Map # Date Filed This letter is to authorize Jf a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and /or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law : the.,Public.H.galth l✓ r;y v a Countersigned: P.E., R.A., # Mailing I/ /' State i% Zip /L�h`"y Telephone: l� Very truly yours, Signed: , Y- (owner of Property) Mailing Address: Z�� Xq gvv State Zip Telephone: Form LA -97 S � BRUCE : R. FOLEY Public Health Director ti LORETTA MOLINARI R.N., M.S.N. T Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 March 19, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Mr. Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Nissen, Barger Street, TM# 74 -1 -8 Town of Putnam Valley Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer. the following comments for your review and consideration. Do entation "Application form PC -97 - Please`correct /complete item #21. Application form LA -97 - Complete filed'riap number,and'date•-filed. neral 1. Pursuant to Putnam County Health Department Bulletin ST -19, deep test holes are requircd-to -be v/1 1 VPl Well as shown on plan is less than the minimum required 100'0" separation from the separate sewage treatment system. Dimensions to locate well required from property lines. Please provide location of well connection service line to dwelling. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj .1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO\11EN I'AL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION MMIT - -Y „s NAME OF OWNER: 1 STREET LOCATION: BY: Rai, GR AS,JSRDATE: Y DOCUMENTS AV ERMII APPLICATION _ )WELL PERMIT OR PW.S LETTER ( ,)PC -97 )LE TER OF AUTHORIZATION IGN DATA SHEET (DDS) ORPORATE RESOLUTION HC EAF PLANS -THREE SETS yj SE PLANS - TWO SETS RIANCE REQUEST SUBDIVISION GAL SUB DIVISION SUBDIVISION AP OVAL CHECKED �j U RC RATE REQUIRED DEPTH CURTAIN DRAIN REQUIRED GENERAL L--)ATED P; NYC WATERSHED (__JCZP NS SUBJITTTD TO REPJ ( X AURWGATED TO PCHD 3.z lG- TAX IvL4P =: (CONnZ HIED) 74 c HO' SE SEWER -' /I' FT. 4 "0'; TYPE PIPE CAST IRON ( /SIOTF'NOTE NDS; ,K X BENDS 45° W /CLEANOUT RENEWALS Li (NO CHANGE) FILL SYSTEMS (_J 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (__) FILL SPECS! FILL NOTES 1 -5 U FILL PROFILE & DIMENSIONS C__)C FILL D EXPANSION AREA FILL GREATER THAiV 2 FEET (� CLAY BARRIER L_)(_ FILL CERTIFICATION NOTE (__) DEPTH GAUGES U VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS U SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED 60FT NIAX. PAR LLELTO CONTOUR �100% EXPANSION PROVIDED DETAILADUST FREE CRUSHED STONE OR WASHED GRAVEL (�( _JGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL WPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS 'ETLANDS (TOWN/DEC PERMIT REQ'D ?) U r00' TO W LE L, IN DLOD,150' TO PITS �T¢ ON DDS PLANS & PERb1TT SAI�IE — 17 1, WATERCOURSE, LAKE (inc. e=pan) 1969 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER ETTER BI/ZBA 0' TO WATER LINE its - 201) ) ,.Glf R FLOOD ELEVATION W/I 200' DRAIiV'AG� Ct7URSF 1 _ 011i711STPiGLO TS %13Wr.RS vt u U( _00' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS EQUIRED DETAILS ON PLANS L0' ,NMN TO LEDGE OUTCROP SWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK SDS HYDRAULIC PROFILE �O'FROM FOUNDATION; 50' TO WELL .RAVITY FLOW yj CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED P(C-13 RIVEWAY & SLOPES, CUT IN OOTING /GUTTER/CURTA DRAINS SDA SOIL TYPE BOUNDARIES I TLE BLOCK; OWNERS NAME ADDRESS / TM ; PEARA; NAME, ADDRESS, PHOi iE9 U ATE OF DRAWING/REVISION 1G/REVISION ATUM REFERENCE OCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. !JL-)PROPOSED FINISH FLOOR AND ASEMENT ELEVATIONS WELLS & SSDS'S WAIN 200' OF SSTS ( UPROPERTY METES & BOUNDS Ti 15' TO PROPERTY LINE /� SLOPE r O KOPE IN SSTS AREA - (S20 %) 1 LEGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS 'UiIP NOTES )OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED )ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) ?IT AND D -BOX SHOWN & DETAILED I DAY STORAGE ABOVE ALARM CURTAIN DRAIN iTANDPIPES, 5' BOTH SIDES, DETAIL l5' MIN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<1% 7.0' bIIN to CD DISCHARGE /100' with 182 cons day discharge ( (___)( 10' br IIN to NON - PERFORATED PIPE COi� MENTS: �� l• � � ( (t� *P � — �7 r` � S S� (REVSHEET) �N e a. { 1 i 1 040 46.001 s — kiqq 9' M � ooLT PA � CA i^, . V£M ,rNT 37- 22��,�� r e WALL e� r eo ,Ocs l i :t =: q i T S 7 /,--V _CY . CSI a iF �N e a. { 1 i 1 040 46.001 s — kiqq 9' M � ooLT PA � CA i^, . V£M ,rNT 37- 22��,�� r e WALL e� r eo ,Ocs l i :t =: q i T S 7 /,--V _CY . CSI T1 U IT SF Al PUTNA DIVISK t. APPRC APPLK PUTNP J� NA