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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -9.2 BOX 28 B' Ir -112 ., is 'L *- •k 1 1 r 03526 PUTNAM COUNTY DEPARTMENT OF HEALTH v::v- •n:.. s_. _•..i .w � = '�F.y- %. ".:. .lc v...4�i.:v; +t•'-rs� -,;; �1w J..-.Az :.w:.•i..G .de -iaJ7. F.. R." ICES.._. CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 1�% v�'✓' Town or Village Owner /Applicant Name Zt- Awm ,w e� Formerly Mailing Address / X9 Y :7 X, Tax Map Block _� Lot Subdivision Name urn spa. Subd. Lot # 4Aov 4 G, Date Construction Permit Issued by PCHD li�p 'j Separate Sewerage System built by e ^tee e-Z.- Address _5',ev zb e Zip Consisting of Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From Address or: ' Private Supply Drilled by //�,+�� l�j��So'� Address & _ .._ ,' T . ' -r �i/ j: :;j %Z�%�'`'� rHas eiosloil co'n ali been l`.lUmpleted? ;ctiifuiiig i -i;c - ��. // Number of Bedrooms Has garbage grinder been installed? Ald 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 Departynent of Health. Date: % Z Certified by -- If Address ;�V% ,72 P.E. k'*�' R.A. License # >, 950r 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. By: Title: d� ;s,y l�i3i -,L �7�cl�cr� �� Date: dqq White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL. COMPLETION REPORT I Nur: t pct location of well win aistances to at least two permanentitanamarxs to oe provtaea on a separate sneevptan. r >,j Well Driller's Name Addresa!^�' Signature: - �' Dater I White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 I�E e Tax Grid # Map Block Lot(s) Well Owner: N � ._ . -� Address, � W/. Use of Well: I- primary 2- secondary ._Residential Public Supply kir cond/heat pump igatio Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment ,x-- 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 / f,f: Diameter in. "' Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded -.:. Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: – Yes _ No Liner:_ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed Pumped r!_ Compressed Air Hours Yield � gpm IIDept➢n IIData Measure from land surface- static (specify ft) -2�� During yield test(ft) Depth of completed well in feet D8 Well Log If more detailed information descriptions or ste` a aialyss . are available, please attach. Depth From Surface W ter Bearing Well Diameter(in) ]Formation Description ft. ft. Land Surface g G " t� o �:. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type y wL. Capacity S q_R t't'i. Depth Eu O0' Model' fs f? $ Voltage � ). 0 HP/ Z Tank Type t3 C cl Volume go Date Wel Comp eted _�/11 r Putnam County Certification No. 9 Date of Report % /G h9� Well Driller (signature) I Nur: t pct location of well win aistances to at least two permanentitanamarxs to oe provtaea on a separate sneevptan. r >,j Well Driller's Name Addresa!^�' Signature: - �' Dater I White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 � YML ENVIRONMENTAL S�RVICES 321 Kear,Street (914) 245-2800 Albert H. Padovani, Director ` ' ' LAB O: 0.811798 CLIENT #: 2745 ' NON STAT PROC PAGE 1 VADO-CORP. ' DATE/TIME TAKEN: 03/01/99 01:30P 128 PUDDING ST DATE/TIME REC'D: 03/01/99 01:45P PUTNAM VALLEY, NY 10579 REPORT DATE: , 03/03/99 `~ PHONE: (914) -528-1158 ' ' '--~--R S PUTNAM VALLEY NY' SAMPLE TYPE POTA8LE � SAMPLING SITE: 295 BARGE T., , ,,:` : PRESERVATIVES: NONE COL'D BY: MANUEL VAZQUEZ TEMPERATURE..: METH. N/A COLIFORM ME NOTES...: KT � � DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/01/99 IRON (Fe) 1 <0.060 MG/L 0-0.3 mg/1- 2037 COMMENTS: Fe/Mn If both iron and manganeseare present, their total value � combined shall not exceed 0.5 mg/L. ' ^ � @ r - SUBMITTED BY: Al atert H. aPadovaW4 ' Director ' ELAP# 10323 m , � - SUBMITTED BY: Al atert H. aPadovaW4 ' Director ' ELAP# 10323 m YML ENVIRONMENTAL SERVICES - 321 Kear Street Z:7`:`'�=�=�^+�=�=='�-�.�~-��:��.��ov���o ( 1c 5----O Albert H. Padovani, Director . LAB #: 32.311798 CLIENT #: 2745 NON STAT PROC PAGE l VADO-CORP. DATE/TIME TAKEN: 03/01/99 01:30P 128 PUDDING ST DATE/TIME REC'D: 03/01/99 01:45F PUTNAM VALLEY, NY 10579 REPORT DATE: 03/03/99 ' PHONE: (914)-528-1158 SAMPLING SITE: 295 BARGER ST., PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : FRESERVATIVES: NONE COL�.D BY: MANUEL VAZQUEZ_-- TEMPERATURE,.« NOTES...: KT COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/01/99 IRON (Fe) <0.060 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: Director .- - ^ ELAP# 10323 � 40 « \� YML ENVIRONMENTAL SERVICES ' 321 Kear Street --_ - Y ` -.�an ' Albert H. Padovani, Director. LAB #: 32.807605 CLIENT #: 2745 NON STAT PROC PAGE 1 VADO-CORP. ' . DATE/TIMETAKEN: 09/04/98 10:30A ) ' ME REC D 09/04/98 10 45A 128 PUDDING ST DATE/TI ' : : PUTNAM VALLEY, NY 10579 REPORT DATE: 09/14/98 ` PHONE: (914)-528-1158 SAMPLING SITE: 295 BARGER ST. SAMPLE TYPE..: POTABLE : PUTNAMVALLEY NY FMEbERYH|1VEb: mUmE COL'D BY: MANUEL VAZQUEZ TEMPERATURE..: NOTES...: OUTSIDE FAUCET COL%FORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE RESULT- NORMAL - RANGE METHOD 09/04/98 MF T. COLIFORM PRESNT /180 ML ABSENT 1008 09/04/98 LEAD (IMS) z 2.6 ppb 0-15 ppb 12345 09/04/98 NITRATE NITROG 0.58 MG/L 0 - 10 9139 . 09/04/98' NITRITE NITROG <0&1 MG/L N/A 9146 0004/98 IRON (Fe) 1.19 MG/L 0-0.3 mg/l 2037 0004/98 MANGANESE (Mn) 0.039 MG/L 6-0.3 mg/l 2037 09/04/90 SODIUM (Na) 4.22 MG/L N/A 09/04/98 pH 6�8 UNITS 6.5-8.5 9043 09/04/98 HARDNESS,TOTAL 40.0 MG/L N/A 09/04/98 ALKALINITY (AS 46.0 MG/L N/A 09/04/9B TUR I ITY (TUR =-� ~ 7 NTU ' 0-5 NT ^ 09/04798' � 09/04/98 E. COLI (CONFI ' ABSENT 100/ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Ci LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rulefor Public Systems requires:that no more distribution points have a.LEADxalue of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. Fqr those on a � YML ENVIRONMENTAL SERVICES � 321 Kear Street (914) 245-2800 | Albert H. Padovani, Director | LAB #: 32.807960 CLIENT #: 2745 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ VA DO-CORP. 128 PUDDING ST PUTNAM VALLEY, NY 10579 NON GTAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~~ bATE/TIME TAKEN: 09/22/98 02:45P DATE/TIME REC'D: 09/22/98 03:05P REPORT DATE: 09/25/98 PHONE: (914)-528-1158 - SAMPLING SITE: 295 BARGEN ST. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: MANUEL VAZQUEZ ` TEMPERATURE..: . NOTES...: OUTSIDE FAUCET COLIFORM METH: MY, ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~ ~~~~~~~~~~~~~~~~ ~~~~~~~ DATE FLAGpROCEDURE RESULT NORMAL - RANGE METHOD ` ` ' 09/22/98 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 ` COMMENTS: BACT THESE RESULTS INDICATE THAT THE NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. . SUBMITTED BY: Albe H. padovani, M.T.(ASCP) , Direlor ELAP# 10323 COUPM DEPA1220M OF JEEMTH, Dblo= N.Y. iiidii a mCZKTUWATZOF poilk COMTRUCMN P,XUW FM,UWAGE DMOSAL STaM =7Y usna or vange or Riliawal — '0 Revkioa—o D#" at] MP i add POP& W n F -tteerie ft TM , N=bW ad DWO Flow G P D 49 PCHD 1 -0 fis FM b essispbsted 07 SOPMAWSOWMVSY@O=Ii000mM4iZIg�—aGam&w&Tm*=&— 7e W ffwftwefliid by Adilreiiis W"W IP 'No Sop* Finses Adiltow M —Pill - ma Sw* Dwftd by 6" andlocation of the (6); 1) that the $*Perot 0 di WWI astern I represent'.1hot,l am vi�'Wly, and completely responsible, for th design proposed system(s): . . 16o" described will be constructed as shown on this approved amendment. there to and in accordance with rds. rules and regufations a rulnern County Department of "with. and the . t o . n compsinion,thervof a -certificate of Construction- 4M cry to the Commissioner of Healthwill be submitted to the Department, and a written guarantee oillibc furnished the owner, his sues by the builder, that said bulMor will piece in q6od.opwatl6g, condition any part of *Gsid,siwige disposal system during the period tely following thodate of the inu- ance of the asip --al of the Certificate of Constru , ction Compliance Of the original system of t t the drilled well described above, -UTZM-- WIN be located as n on the approved plan and that sold wolf will be Installed In accordance a equ of the Putnam County Doisitmem ot'moiililft., Date -1 1L - I v6r /v -P.E.- PA. Ad o n /* �Ce-,g NO APPROVED FOR CONSTRUCTION: irTii/8000,val expires two years from the date issued unless C 4 1 been undertaken and is revocable for couse'or m y 'be a too or modified whop consill' i)ecinsai' Commissioner 0 ry by'lle. alteration' of construction oft lic a "Qu Was a nomi oirrhit. for disposal of do. pri4at.4 or supply Rev. &I o.a By 1vtoo t Title BRUCE R FOLEY LORETTA MOLINARI RN., M.S.N. I' e �Asse+ria!e ._P.uhlic- FI��:itA :Qir� ^:e:` _ Director— of Patient Services DEPARTWENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (91.4) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 0a February 24, 1999 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 1059.8 Re: Dominques, TM# 74 -1 -9 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 consideration. Documentation 1. Please complete Tax Map #, Block & Lot on Form CC -97 (original attached). 2. Erosion control completion must be answered. Pump /storage tank inform - tion must :be completed. on.the. Well Completion Report.. (original attached)... Water Quality Test Quality test for iron result was 1.19 mg/1. Acceptable standard range (mcl) 0 - .3 mg/l. Please retest and resubmit. Site Inspection A final site inspection was conducted on May 22, 1998. No additional inspections have been requested. or conducted to date. The following items were noted and commented to the Engineer to be incomplete at the time of inspection: end caps were observed on the laterals. House was locked/boarded at time of inspection. House bedroom count was not possible. Well was not drilled at time of inspection.. re n n. Sufficient area unavailable for 100% exposure (as shown on plan). Wp 5 vUi'A Dominques I T 'PGgp25 Z: sr_ - + off•. �.-. nr a.,`fe�� _W..w `rXy?ur.:- - w+y'.. ci.•... v. o i. .. r+..'. m... t c . :+t• _Kr .. .... .. %.t.,�r c^�..T;.i b:..� .yly February 24, 1999 Will need to conduct a final site inspection to inspect the following: a. End caps on all laterals (please have exposed). b. Bedroom count (as- built). c. Completion of well. d. Erosion control measures. e. Expansion area. Please contact this office to schedule an appointment. A Certificate of Construction Compliance can not be issued until such time as the above items have been satisfied. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant t?ublic Health Engineer ABS:cj PUTNAM COUNTY DEPARTMENT GY HEAL'T'H IIDMSHGN OF ENVIRONMENTAL HEALTH SERVICES -.. •..u.F .'ZS"'� V- w- ./�+I w. 4• .i' ♦Kl� .f.Ti�, •AAA 3!♦ .. _. -. .wi.. •. A -i ' •h��' •�. 1P 11 -`.t♦ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE � rT NT SYSTEM PCHD CONSTRUCTION PERMIT # P� %�- �2 % Located at 3 a YG c-K- �7"�� A Town or Village Owner /Applicant Name ^. :!9G ,momig V Tax Map Block Lot Formerly Subdivision Name �rr� p i•'�a��� IV Mailing Address Subd. Lot # 2, Date Construction Permit Issued by PCHD /_oZ2- S7 Separate Sewerage System built by O' 7 Address G Zip. Consisting of 12ef Gallon Septic Tank and 75— Other Requirements: _ Water Supply: Public Supply From Address or: °� Private Supply Drilled by �rjcl ��"�� a� Address�✓'4 Building TyNe t��. %- ten C -� : ..-Has erosion•contro1,been completed? Number of Bedrooms Has garbage grinder been installed? Ale 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 Putn 'De& tment of Health. Date: 21161 Certified by i "a7 " P.E. R.A. i n (Design Prof . d�j Address 17 2-- .� i-•z G/���ri` f'' :Li t5 cense # Z y �'S Any persofi 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. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE: E� act location of well with distances to at least two permanentlandiharks to be provided on a separate sneetipian. %)� l Well Drillers Name C_ Addresg.•S' Signature: Dater C White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 In Map Block Lot(s) Well Owner: Na J - Address: Use of Well: 1- primary 2- secondary ,4,Residential Public Supply Wr cond/heat pump igatio 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 it Open hole in bedrock Other Casing Details Total length eft. Length below grade Diameter in. Weight per foot / lb /ft. Materials: Steel _ Plastic _ Other Joints: Joints: _ Welded Threaded Other Seal: Cement grout _ Bentonite Other Drive shoe: ;,c -Yes —No Liner _ Yes '>�-,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 Yield j 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 sieve.analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft.. ft. Land Surface 9 ( ' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Weil Completed Putnam County Certification No. Date of Report ? Well Driller (signature) NOTE: E� act location of well with distances to at least two permanentlandiharks to be provided on a separate sneetipian. %)� l Well Drillers Name C_ Addresg.•S' Signature: Dater C White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kea, Street Yorktown Heights . Albert H. Padovani, Director. LAB #: 32.80765 CLIENT #: 2740 NON STAT PROC PAGE 1 ----------------------------- NNNNIVNNNN NNNNNA----- ------- /VNNNN ----NNNNNNn----- VADO- GORE'. DATE /TIME TAKEN.. 09 /04/98 10:3 0A 128 PUDDING ST DATE /TIME RECD: 09/04/98 10:45A PUTNAM VALLEY, NY 10579 REPORT DATE: 09/14/98 PHONE: (914) -528 -1108 SAMPLING SITE: 295 BARGER ST. : PUTNAM VALLEY NY COL'D BY: MANUEL VAZQUEZ NOTES...: OUTSIDE FAUCET NNNNN NNNNNNNN NN NN NN NNN N IVNNNNNNNNN- ----IV DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: MF NNNNNN----NNN NNNNNIVNNNNNIVIVIVNNN---- /VNNNN RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/tr4/98 MF T. COLIFORM PRESNT /100 ML ABSENT 1008 09/04/98 LEAD (IMS) 2.6 ppb 0 -15 ppb 12345 09/04/98 NITRATE N I TROG 0.58 P;G /L 0 - 10 9139 09/04/98 NITRITE NITROG <0.0.1 MG /L N/A 9146 09/04/98 IRON (Fe) 1.19 MG /L 0 -0.3 mg / l 2037 09/04/98 MANGANESE (Mn) 0.039 MG /L 0 -0.3 mg /l 2037 09/04/95 SODIUM (Na) 4.22 MG /L N/A 09/04/98 pH 6.8 UNITS 6.5 -8.5 9043 09/04/56 HARDNESS,TOTAL 40.0 MG /L N/A 09/04/98 ALKALINITY (AS 46.0 MG /L N/A ...:.TL1RB I D I.T`! _(- T-UF: -� 107: NTU `i_5 yT .Oc? /04 /98 r'iF "FEC;A,L C( LIP- ABSENT 100 ML ABSENT 09/04/98 E. COL I (CONF I ABSENT 100 /ML /ML ABSENT COMMENT': PACT THESE RESULTS INDICATE THAT THE WATER (WAS)i S NOT OF A SATISFACTORY SANITARY QUALITY ACCORDING TO ORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /CU LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their- distribution po.ints have a LEAD value of more than 15 ppb and a COF'F'ER value of 1.3 mg /L, else water - treatment Must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For-those on a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of B lding Tax Map Block Lot �4 Building Constructed by TownNillage Location - S eet Subdivision game 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 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. // Da L(, . Dated: Month y � Year /9q9 Signature: Title: General Contractpr (Owner) - Signature . Corporation Name (if corporation) Address: OW ,�;, +_✓' Corporation Name (if corporation) Address: /0'X My /paw je State Zip State1s��/ Zip /os�6 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH Re: Property of 40 HEALZIL-w�-iBRYTC9,5-i;• Located at 15'p"--f ev" (T 601 Section Block Lot Subdivision of 'Pmyew" Subdv. Lot # Filed Map # IF7 - Date Gentlemen: This letter is to authorize d-f a duly licensed professional engineer— r registered architect . (Indicate—o 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 -p system or systems in conformity with the provisions of Article 145--.'or 147, Education Law, the Public Health Law, and the Putnam County Sani- I tory Code. Countersigned:.. OF P*Eoq r?A ess Very truly yours, Signed -ntk I�I;UZU44 VOcaner oY— Prop 0Yjr' Address Town %3'9 Telephone JOHN KARELL Jr., P.E., M.S. Public Health Director :%.ate:. ,r;•x : ...,::r�:�::._:.:.t.,�'.�.C:• ?� - ' - raa- :K`�ij_- •p'*� <�F.'i+`$. •tee. ,: •:.1 •a �.1�, DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 August 1, 1994 Joseph F. Sullivan 2472 Ferncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Domignes Barger Street (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. "' 1. Split system are not permissible. Revise to a Straight Drop Boy System. 2. Provide mailing address on Construction Permit, 3. Provide filed map number on Engineers Authorization form. Upon-Receipt of a submission, revised to reflect the above comments, this r cons wt °�•• �a •cones �..�, ed:' fQtt'IIrer:.. -. - Very truly yours, Robert Morris Public Health Engineer RM /jp PUTNAM COUNTY DEPARTMENT OF HEALTH UR* Date Re Property of qIC/-5;4f PO (4 421 5: Located at 1��Je-t7cllr (TI / el 44 OW ze &—V� — Section- Block---- Lot Subdivision of Subdvo Lot # 2- Filed Map # Date Gentlemen: This letter is to authorize— a duly licensed professional engineer o r 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 promula, gated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in f sistem or systems in conformity with the provisions of Article 145 or 07, Education Law, the Public Health Law, and the Putnam County Sani- tiry Code. C tunt er s i gne d: jj. OF ALrjp 0 Avl�- Lai)" ess 0// 'Plephone Very truly yours, Signed Ca YOcaner of Propq�ffy' Address Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: S Zz _Street I .ovation ABC, S I rr�Ncted by Town 1-/\4 Permit # TM # 7 9 -) - Subdivision Lot # 1. Sewage System Area a. STS. area located as per approved plans ........................... b. Fill section - date of placement 3:l barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... .............:................. d. Stone, brush, etc., greater than 15' from STS area.:........ . e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. 6eptic tank size - 1,000 ......... 1, 250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All out ets at same elevation -water tested ................. 2. Protected below frost ................... ............................... 3. Minimum 2 ft.Original soil be en box & trenches Junction Box - properly set ............. ....................... ......... ... 1Zength required Length install 2. Distance to watercourse meas �! Ft.......... 3. Installed accord?aacNV�t an ....... ........................... 4. Slope O-tren'ch re h _ le 1/16 - 1/32" /foot ............. 5. 10 perty line - 20 ft.- foun ° b�Dept <30 inch fro fa ................ 7. Room allowed for ex1 'i�1 o ......................... 8. Size of gravel 3 �2" diameter ean .................... . 9. Depth lfcal"pped trench 12" mi 'mum ................... P' � ....... ........ ....... .... or Dused_Svs u7s; , _ . . 'Size o} pump cfiamber . ............................... 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. HouseBuildin 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 ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ..:.............. ............................... Rev. 1/97 x' IFUM COUNTY DEPARTMENT OF IHIIEAIL'II'IHI IlDffvffsII® IF IENWRONM EN7AL HEALTH S ERW CIES ...,�.�.....::;i--. . .. •.= :.4 :_'t- ,i�:= y.._... ;:�e.; .:c.,..... -..: .._.;.:e.�"._� %2;;y �_._'. .- vay:;:as`1, I: , ;: '•n,`:....- .:, -:.� .. _:. :.�." VP ICONS ll RU CTION PERMIT FOR SEWAGE TREATMENT SYSTEM PIERI�UT Located at /Sa-'E r✓ .5�4_e -e Subdivision name Jar/ Subd. Lot #_ Date Subdivision Approved I Owner /Applicant Name ; am �4.C-' AV M & 0 J Mailing Address /,;E �p' G j e Amount of Fee Enclosed Building Type A�ICn► z 7 Ce- C Town or Village Tax Map '%!V Block Lot Renewal oo--' Revision Date of Previous Approval i / �� Zip G Lot Area ;INo. of Bedrooms _!!f, Design Flow GPD Few IFiRll Section OaRy Depth VoRume PCHIID NOTIFICATION IS RIE IIJM D WHEN FILL IS COMPLETED Segarate Sewerage System to consist of gallon septic tank and d erf- Other Requirements: To be constructed by CIyY. eY Address e wata s—um -gy Public Supply From _ _ Address out_.. Private Supply Drilled by �" sic t/�s' o _ Address % �a I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate 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 nt system during the period of two (2) years immediately following the date of the issuance of the approva y f Construction Compliance of the original system or any repairs thereto. ,�� Signed: 9 Address 9 72- D z R.A. Date License # fi`" 7 i� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Bye Title: _ �17` Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 F 1 A i 4EIELOSTbNE RD pi TE I CA I, TACONIq GA Z' Cem jrub A FOR ADJOINING AREA SEE MAP NO.6 Ef 'West-, M h `,U t LLowj-RD : , 3eco i ; I 0 OOK,J. Flo "'p, Lake RD LA U. X FERN LA CROSSKILL AD 0, HEATH R U N Ep �6- P LAKE�10 7 - -- - - - - - - - - - - - - e Mahopac scu, Airport -FETriPLACE LA t. 41 c AROLE.PL,� DEER TR'' -S,,, 446 1 r ? An -CORRAL OR 'i 'Ce ��Nu- ,Z M (8,0 CN;?O: Rr. I I 0, OOK E30E WPL AV• r1 F 4 I BRO x PO C' -"O m j - -�QA TIER ................. 0 rz .- V Is m CENTER V 1 m _8 D 81 Lu LINOkLA m W: AR-t 1. SHOPI P �S DR rT 6N V, GOLDFINCH t ,1 1 IL TAURAT pL SHERSaTKE RD 71 7A 0 4 SKYVIEW T_ o 1 NAY L 59. GREEN N BLUE JAy_PL,! ER� I TER If co Z )ST PL: pso% I f`r.. RD._ i I I i , " llijyvalln� 0 R[ o. m DR X vill.ey A N k CO l�aKe 05 767 �__ 9j E XT U 6W A0 A 3: 4� O,p -lee 12 aD FLO 0 cc, ml Lake B ld w a f MwLEO ¢; B —Vn Fg % HIE;KUKTUI UH lDqr g C7 u a E l "5yEN SENECA RD X, FL�O OR !.'40SALL SI 10 PUTNAM COUNTY DEPARTMENT ®IF HEALTH IIDffVIISII ®1Y OF ENVIRONMENTAL HEALTH SIERVIICIES - - � AFPLffCATffCN TO COYSTBQCT, A WAT8 WELL. _ � - .... �;.r please -pant or type PC,HD Permlt Wen Location: Street Address: ) Town/Village Tax Grid # el /e, Map Block / Lot(s) Wen Owner: Name: Address: e�os� AlL Use of Wen: P"Resideintifil Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secomidary Industrial Institutional Standby Amount of Use Yield Sought �°' gpm # People Served Est. of Daily Usage Reason for . Replace Existing Supply Test/Observation Additional Supply ffDr ifling d"1ew Supply (new dwelling) Deepen Existing Well IIDetai]led Reason for ffDr ifling Wen Type E75rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 4-1 Is well located in a realty subdivision? ...................................... ............................... Yes a,° No Name of subdivision ;7 "W rP7 4 -e Lot No. 2- Water Well Contractor: All, 611174K$ r, Address: Is Public Water Supply available to site? ..................... ............................... ........... Yes No Name of Public Water Supply: 144/ Town/Village Distance to property from nearest water main: -.:f Proposed well location & sources of contamination to be provided on separate sheet/plan. Daze:::; �? :r' . _ _._.Applicant Signature: P ERMffT 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 CONSTRUCTffON: 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 / 9 Permit Issuing Official:��� Date of Expiration ,�� Title: Permit is Donn- Tr°a®sff� c White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 �PJ_ -,1CA T ION -. -TO: CONS.T,,RUCT_-_� ; WATFP : W I:Id:;:'r: � , ..,r:.� ::r.:.:�:A.IL, - /��� •. PCHD PERMIT WELL LOCATION Street Address . Town Village Cit Tax. Grid Number / G' r may-- , r-Y', / y , &: a,/ e-c. 7d .- 1' _ 9 WELL OWNER Name•' Mailing Address J; g [i iC X- %. f G �l/%✓� `C�✓J ✓G% � AOrivate O Publ is USE OF WELL 1 - primary 2- secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHTgpm /4i PEOPLE SERVED /EST. OF DAILY USAGE 944> gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION. 11 ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE .DRILLED 13DRIVEN DDUG 13GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? 'YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 2. WATER WELL CONTRACTOR: Name Ael- ,0992 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE:, .TO, PROPERTY . FROM NEAREST WATER MAIN: .......__..�.,. _...,. ,.�....,.�.... t_.. -.: _ _.....:- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE � 3 ON SEPARATE SHEET L (J' (da ) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such manner as not to degrade,,o Date of Issue: Cf 9� l 1' Date of Expiration D 19� Permit is Non - Transferrable 3/89 shall take appropriate action to assure that drilling operations be contained on this r oth w'se contaminate surface or groundwater. Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller DWISRON OF ENVIRONMENTAL H EAILTH, ,. SERVICES _ _ Via._ , _ � _ ..._ .. c: . ;t... -....� - :'..:._ - -:, .. :,.._ .: � � - . _ -_�. r .. - ... - [ »::� _ -. , _.. .,.., ... . � --.,.. • .:— LETTER OF AUTHORIZATION RE: Property of , 0-1 r 7 Located at T/V 144nct 01 1i& t( Tax Map # 7-4 Block t Lot .✓- Subdivision of Cl 'em � -?, Subdivision Lot # �2 Filed Map # r Date Filed 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 treatment and/or water supply systems in conformity with the provisions - of Arti.Qle .145 .and/or .147 of the. Educatior:- L�«v;ahe. P�ablio Health - - -- _._ - —=Law; atr the rumam County Saffifd Code. - � - Countersigned: P.E.,YA•, # :Z y 9 4- Mailing Address 24.9 7 Z �'�����i• State 4�. Zip Telephoner 2—" Very truly y urs, Y ' Signed: 1029t�n (Owner of Property) Mailing Address: / J- �� %��7 Q�'�'Y✓�C ' State -_Zip /'9 = G� Telephone: '731 015- %1 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL.OF PLANS FOR :� « ..r_� n ; . _ _ a •_ A `VVAMQTER'fREATMENT SYSTEM4 1. Name and address of applicant: Se. :w iC 2. Name of project: ! T -,5� 3. Location TN: % u 4. Design Professional:, ���r j /ir�y,� �� 5. Address 6. Drainage Basin: 7. Type of Project: i.-'Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision 'IV A Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR)? .Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ....................:.... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other c?fficials, or ►aar� .. . , / g,..., .... - .. ......... ., yes... �.__... -. .. .. _.. } .. .. .., ... ... ... ..+.>.- .`!. �.�.. :�• � .. ... .u< 13. If so, have plans been submitted to such authorities? ........ ............................... es-'$ 14. Has preliminary approval been granted by such authorities? !/-K� Date granted: ZZX 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) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... /1�a 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ Al a 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) 06'v 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A/� 26. Has SPDES Application been submitted to local DEC office? "—' Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? /110 28. Wetlands ID Number .............. .............................. —� -. , 2 "is" "eilanas'Yermit`required .::........................ . ............................... ...... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Alew 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No acs 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? .................... I.......... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? 34.. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... A,"`l 36.. Tax Map ID Number ....... ... ..F .......................... I Map %y* Blocky Lot 37. Approved plans are to be returned to ..... Applicant _1 Design Professional NOTE: All applications for review and approval of anew SSTS^to be located withii), the-.NYC. Watershed shall b: so-rut Yc -.;h -Dtpal�riiei�t; ai ii,r�eerl-irvi be sent in— lupinCe tai t ie' E itriougri ^the project may require approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. Il hereby affirm, .sander penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. 7 SIGNATURES& OFFICIAL TITLES.- Mailing Address: ................................... DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 ALSust 1, 1994 Joseph F. Sullivan 2472 Ferncrest Drive Yorktown Heights, NY 10598 Re: =- ccos_.. SS;:S: Domignes =ar =er ztre � - ^am ve.'ey Dear Mr. Sullivan: PuDlie fNNtA Oi�ttw Review c"F cl ars and other sGppor i nc at this ` i me the acove- capt-cned project nas been are offerec as fc ':cws: "The ccrstruction of this sewage disccsa- system .zv ce subjec- to 1ccal we- '.ands regula :icns. You should contact lcca- cs cf-I-c'als in this retard." 1. Sc -- system are not perm�ssib'e. -ter �e -c a St-aigh; Grcp 30,; Syste -.1. 2. Prcv=de mailing address on Consz,%,-:--cn 3. Prov=de filed map number on Engireers Au- ^or-z=--icr form. fi s e `sec ._ _ct --e c. mment h.i s �Upori "rle�.y'pS�:�n i 5�cn, 'r.v' ... -.. = c ._. .. - ,. ... _. applidaticn will be considered furtner. Very truly yc °urs. 6 Aq, Robert Morris Public Heal... c- n-ir.eer RM/jp 101,50au "MISAGET-o"'I"ISR DESIGN DATA SHEET-SUBSUFACE SESNZAGE DISPOSAL SYSTEM FILE NO. 291 BARGER STREET Owner JAMES JUMPER Address -PUTNAM VALLEY, NEW YORK 10579 Located at (Street) BARGER STREEr (indicate nearest cross street) Sec. 74. Block 1 Lot —9 Municipality TOM OF PUTNAM VALLEY Watershed HUDSON VA= som Pmoo=cm TEST DATA REQumm To BE suBmiTrm WITH Appmcmoys --Date -of7-Pre=S-oaking, --oate_ of, Percolation Test 1/8/93 TESTS PERFORMED BY GREG HITCHCOCK HOLE NUCM CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. start Stop Drop In Min/In Drop Inches Inches Inches 3B=ON I 12:40-1:10 30 24 25 1/2 1 1/2 30/1 1/2=20 AT 2 2 1:10-1:40 .30 23 3/4 25 1/4 1 1/2 30/1 1/2=20 3 1:40-2:10 30 24 25 1/4 1 1/4 30/1 1/4=24 —4 2:10-2:40 30 24 25 1/4 . 1 1/4 30/1 1/4=24 5 7 2 1 12:41-1:06 25 24 27 3 2 1:06-1:34 28 24 27 1 2R ./ -A-C1 3 - 3 1:34-2:04 30 24 27 3 3011=10 4 2:04-2:34 30 24 27 3 30/3 =10 5 1 3 5 Nam: 1. Tests to'be repeated at same depth until approximately equal soil rates are obtainedat each percolation test hole. All data to be suhnitbed fot review. 2. Depth masurerents to be made from top of hole. TEST PIT DATA RDQUIRED TO BE SUBMITIED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DM>M -_ -HOLE. NO.. DT. -- T HOLE NO. DT _ .2 ..,_. . HOLE. NO., _ •,.- .:;.,:; :.e .;;.,P'r;'�s. �'r�roe- «: _. - .. -. .. vao -. .: • <.iv;_�-- .= :.e._ .:e- ,.�b'r.. -t�.'.,•. -o,,�. t:•1 _. .. .. ...r: , .4 _, ...w.•,. �.. G.L. TOP SOIL TOP SOIL V SANDY LOAM, SOME SILT SANDY LOAM, SOME SILT, 21 AND SMALL STONES AND SMALL STONES 3+ 41 51 V 8' 9i 10' 11 S� OF 12' 13' 141 `'�aaio�►`' T INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED NONE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NONE DEEP HOLE OBSERVATIONS MADE BY: JOEL GREENBERG DATE: `2/'8/93 DESIGN Soil Rate Used 21 -30 Min /1" Drop: S.D. Usable Area Provided 5,000 SF + 1000 - 3 BR. No. of Bedrooms 3 Septic Tank Capacity 1200 - 4 BR. gals. Type PRECAST CONC. Absorption Area - Provided By 500 L.F..x 24" width trench 125 LF OF TRENCH REQUIRED FOR EACH ADDITIONAL BEDROOM WITH DOSING. Other _ - - - -- - - - -- - ..__ Name JOEL GREENBERG Signature Address TWO MUSCOOT ROAD NORTH SEAL . •.. C, NEW YORK 10541 THIS SPACE FOR USE BY HEALTH DEPARTWM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date - -- .`� -- PC -1 \ PUTNAM COUNTY . DEPARTMENT OF HEALTH :J�..�.,.... -L.r. "._. f ._�. � z:•''_ ,r ...., •.r..r'.H_'a .. ' PLI-CA -1—ki FOR APPROVAL -OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address 'of Applicant: L1Ul C" G� t 2. Name of Project. G 3. Location TN /C: 4. Project Engineer: _ bGl�� YG�. 5.' Address: License Number: Phone: Z 2 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)? �U Type Status (Check One.) . Type" I. Exempt Type II. Unlisted y. 8. Is a Draft Environmental- Impact Statement (DEIS) required? ............. Ale,, j 9. Has DEIS been completed and found acceptable by Lead Agency? 10. yName of Lead Agency,-'- - -T 11.' IG tt.js project in an urea under the' c_potrol: of iacal 1a aon °_gag, Qrtjng.� , — or other officials, ordinances? . ............. ..... ........ �. 12. If so, have -plans been submitted to such authorities .. 13. Has preliminary approval been - -granted by such authorities? lk y Date Granted: S _:• , t s 14.Y' Type of Sewage Disposal System Discharge wurface 2Water , Groundl Waters" —_ — A --— - ° s r 15.+ If surface water discharge, what is the sstream cla's's t ? .. ' . ss designatjon ....... 6. Waters index number Js urface) Y ^. ., . 7. Is project located near a ublic waterzsupply,system9 s . ,e p 8 If yes, name of -water supply Distance to water supply - 9 'Is project'.-site, near a osal system. %l pu age olle t sp c r - •f S c ew c c ion or� 1 f 0.fName' of sewage 'system w r Dj stance to sewage system%' r 1 ° Date' observed 23;,-N ame "of Health 'Inspector• r 4 t M 1 Project' roject design flow "(gal Ions per day) �,F4 ..a•:,�{ ,,A� tM 7 T -2. 25.. Is State Pollutant, Discharge -Elimination. System (SPDES) Permit. reGuJred?._t_._ AIC) 26.-Has SPDES Application been submitted to local DEC Office? .......... 27• Is any portion of this project located within a designated Town or'State wetland? ................................................................... 28. Wetland ID Number....'.'... .......... ....•..•.. ....... 0 .......... 29. Is Wetland Permit required? ..... ............... .................. Has application been made to Town or Local DEC Office? .........•..••.... 30. Does project require a DEC Stream Disturbance Permit-? .: ..................... 4 1�e, 2 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ......... T YES or NO 32. Is project located within 1,000 feet. of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential kn . own source of contamination? ................ YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town -'or Village? ,34., Are 'community water, -sewer facilities planned to be developed withip 45 _yiaars. AyrpL"ys e .vage disposal areas p ppLqs Of 5e%; -.41ppo. -7 ,1 36. Tax Map ID Number .......... ............................... a. 37. Approved Plans are to be returned to ................. . Applicant engineer Y' If the application is signed by a person other than the applicant shown in Item 1, the ion 'must' a- it " h application be accompanied by Letter-of -Authoriz'a on - Fa i u re o "comply w h` this s provision may be grounds for the rejection of any 'submission.. - ---------- 7 '5F I hereby affirm, under penalty of perjury, -that - informat ion pi'76V Med on 'this form '.is true to the best of my know7edge and belief Wse_statements made herein are punishable as a Class A Plisderneanor pursuant tti `Si di6h lid. 45 of the Pena 7. Law. -lee 3IGNATURES A. OFFICIAL TITLES: I.AI.LING. 1. a a 1�_"_ DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 November 12, 1991 James & Camille Jumper 291 Barger Street Putnam Valley, NY 10579 Re: Proposed addition - Jumper 291 Barger Street - (T) Putnam Valley Dear Mr. & Mrs. Jumper: JOHN KARELL Jr., P.E., M.S. Public Health Director I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that a two story addition will be added consisting of a family room on the first floor and a bedroom on the second story. The total number of bedrooms will increase from two to three bedrooms. The survey indicates that the parcel consists of 53 acres. Therefore, based, on the information submitted, the above mentioned 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 s' _ ., .the. exi ing- sewage disposal system, :•and..:•ts expa;;s on::area; must. be- maintainedv. _. .._.. .. .... 3. All plumbing fixtures must be replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. 4. The sewage disposal system must be expanded to include a minimum of 300 feet of 2 foot wide leaching trench. Enclosed, please find a repair permit issued by this Department, tc allow. this expansion the system must be constructed, inspected by the Department and a set of "as built" drawings submitted and approved by this Department prior to the issuance a Certificate of Occupancy by the building inspector, Marvin O'Dell, Town of Putnam Valley. Approval is granted for sewage disposal only. 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. 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