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HomeMy WebLinkAbout3530DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -9.14 BOX 28 03530 It) '� -',• ' � . . � 03530 I> \� PUTNAM COUNTY DEPARTMENT OF HEALTH XME' L MAITY :.s 'ORYWE$ CERTIFICATE OF CONSTRUCTION COMPLIAANCE e ;IR TREATMENT SYSTEM PCHD CONS RUCTION PERMIT # N Nf- J Located at e-w C/ o a✓ a h C Town or Village Owner /Applicant Name�,� e A"W;a a t� Tax Map.' ;- Block / Lot Formerly — Subdivision Name Mailing Address I'Ah fir Subd. Lot #' noll 21v- IIS40 av xw Date Construction Permit Issued by PCHD V % F Separate Sewerage System built by Address g ce.n -e Zip /as 7 Consisting of 1 ,2�U Gallon Septic Tank and 'o o /• , I d /– 'z/ " W,, Cif?" * SYSTe" ' LT I ►vgd f cam; Other Requirements: Water Sunnly: I ee4 /' -4 1v 42-a ""�/ y G Public Supply From Address ?1Z'A0---- Tu or: � Private Supply Drilled by /4/. �O e 0,1-e�S o V Address /ate 'w- .S ✓ N y `..�.__• _ - t .�•. _' /�i ��Q� ��.y?��. I'r/' Maser ninr� ,q/�ri� n ";t i. mra- t �� c�. 8� ��Z19 -TYT e. / '�. � �. aiiJ ioJiJ.i ' o.ix l'.b - r.e e.l : 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 regulation &of the Putnam County Department of Health. Date: / � a*° Certified A4� �� P.E. � R.A. y fessional) ' Address 7 9 7,7 License # /01cculip;ing " %Y �i/ �� =Wtem(s) Any perso premises se shall promptly take such action as may be necessary to secure the correction of any unsani esulting from such usage. Approval of the separate sewage treatment system shall become null and Vol aas 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 modificatio or change when, in the judgment of the Public Health Director, such rev cat* odi do c an s e essary. By: Title: Date: I �/ 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 'Welf'n: icdt;m ''° _° ' tr ef' diir ss: �. ..: ge: ",:� - Tax CJ'rid'# Map - Block % Lot(s)D+ Well Owner: Nam Address: !Use of Well: 11- primary 2-secondary esidential upute 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 Length below grade � Diameter '� in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded � Threaded _ Other Seal: Cement grout _ Bent6nite ' 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 V- Compressed Air Hours Yield /0 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 stove -analyses` are available, please attach. Depth From Surface Water Bearing Well Diameter(in) ]Formation Description ft. ft. Land Su e_ If yield was tested at different depths during drilling, list: Feet Gallons Per-Minute Pump /Storage Tank Information Pump Type 5,201q,/Capacity Depth '. -D Model 0&S LA 9 Voltage ->-3 O HP TanIcrUJ� �� Vol e T 7� 7 G Date Well Complete o"Z d 0 Putnam County Certification No. Date of Report �� OD Well Driller (signature) rs'771 NO'B'LE: a location of well with distances to at least two permanent landm ks t be provided on a separate sheet/plan. Well Driller'$ Name Address: 0 Y Signature: Date: / v v 7%, White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES •�n•. ..._ r .: A_ .t?l•�..:c'... -.. r°"',�'.. v�- .�� _rte .'"'.t..'_. ,.� ,�l:,:s�•.: .`�. �m• . "r °l..r. i'_. '7'4`: ;_ .,,-•: r�`�. r.�. _^., •'v: "n.••�;, "II=I• r .5�• .. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM _ cv5e- /,?e; W. '0 Grre- -,-, - Owner or Purchaser of Building'-' Building Constructed by Location - Street Building Type Tax Map Block of Town/Village Subdivi on Name 4 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 %, Day ) Year ,, c/ Signature: 1 a� r� Title: e General Contractor Owner) - Signature Corporation Name (if corporation) Address: State Corporation Name (if corporation) Address: ;W-Ale A /%tea ",ee Zip State r �� 6'al p Form GS -97 Public Health Director LORMA'MOLINARI ^R.N., "M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental health (914).278 - -6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWfgERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DA'V'E: MING e The Putnam County Department of Health will not issue. a Certificate of Construction Compliance unless the above form is completed, i.e., a legal 1E911 address is assigned.by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) 0 � ^ ' YML ENVIRONMENTAL SERVICES 321 Kear Street . Y�o`r ' t N.T. 10�198 Albert H. Padovani, Director �l��f''. LAB #: 87.000955 CLIENT #: 12690 � ~~~~~~~~~~~~~~~~~~~~~~~~^~~~~~~~~~~~~~~ DONINGUEZ, JOSE 188 UNION AVE. PEEKSKILL, NY 10566 � 74- / ~- �.l 3� NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~r~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 09/25/00 12:00P DATE/TIME REC'D: 09/26/00 10:50A REPORT DATE: 10/05/00 PHONE: (914)-739-6576 SAMPLING SITE: 24 NORTH MEADOW LANE SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY, 10579 PRESERVATIVES: NONE COL'D BY: JOSE DOMINGUEZ TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE PUTNAM,CNTY PROFILE 09/26/00 MF T. COLIFORM ABSENT /100 ML ABSENT 09/26/00 LEAD (IMS) <1 ppb 0-15 ppb 09/26/00 NITRATE NITROG 0.53 MG/L 0 - 10 09/26/00 NITRITE NITROG 0.01 MG/L N/A 09/26/00 IRON (Fe) 0.075 MG/L 0-0.3 mg/l 09/26/00 MANGANESE (Mn) 0.025 MG/L 0-0.3 mg/1 09/26/00 SODIUM (Na) 1.86 MG/L N/A 09/26/00 pH 6.4 UNITS 6.5-8.5 09/26/00 HARDNESS,TOTAL 30.0 MG/L N/A 09/26/00 ALKALINITY (AS 22.0 MG/L ' N/A (.!J7/26 /0C TURBID1T _ - 1'7.NTU�' -_- � - � {+`5`NT��' ` . COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN����THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for-p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. / tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value 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. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. METHOD 1008 9101 9139 9146 2037 2037 9043 I ^ ' YML ENVIRONMENTAL SERVICES 321 Kear Street K! ho�������`������� 014' -'- --'' | Albert H. Padovani� Director. | | - --- | LAS 4:47.000955 CLIENT #k 12690 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ' DONINGUEZ, JOSE 188 UNION AVE. PEEKSKILL, NY 10566 ` SAMPLING SITE:�24 NORTH MEADOW LANE : PUTNAM VALLEY, NY, 10579 COL'D BY: JOSE DOMINGUEZ NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE NON STATPROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 09/25/00 12:00P DATE/TINE REC'D: 09/26/00 10:50A REPORT DATE: 10/05/00 ' PHONE: (914)-739-6576 SAMPLE TYPE..: POTABLE ,PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM,METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~~~~~~~ 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 PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5,T0 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: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L -1���EE��1��Z£]�''_-�.�_-�-�� HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) | SUBMITTED BY: D i r Sit. o r ELAP# 10323 :1 PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES -r. CONSTRUCTION F PERNIIT # Located at % e-o W,- � �0 Subdivisionname - ��' •'v =/ csSubd. Lot # Date Subdivision Approved 1,99-3-- E TREATMENT SYSTEM Town or Village P, "4arn xyf `%-�-y Tax Map 141. -J Block �' Lot 7 A - c�-- 1 Renewal Revision Owner /Applicant Name s /Qd en /v Date of Previous Approval Mailing Address Zip o Amount of Fee Enclosed 3 d a Building Type Lot Area ,Z No. of Bedrooms .44 Design Flow GPD ?ey Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage Sxstem to consist of l 2 SV gallon septic tank and - d� Other Requirements: 7 �z9 / ,'r�^�, �' �;► To be constructed by v Address Water Suanlr Public Supply From Address ot:• - private Soppily railed by ..' .t/' c U ,;'G :,. Address y I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the parate sewagt 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. Signed: e` u � ! � �C �.--� _ w /I)—,,/ r P.E. pNCI Date SG � Address �? %`7� ifaCr�si� J�%i1 re- ) //' )vwo i # a y Js APPROVED FOR CONSTRUCTION: This approval expires two o, sued unless construction of the sewage treatment system has been completed and inspected by the PC cause or may be amended or modified when considegd -nec ary.by the Public Health Director. Any rev' eration of the approved plan requires anew permit. Ap oved to mastic- sanitary sewage only. B Title: `�i�i. Date: -2 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Desig rotes Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLI<CATIOR1 TO CONSTRUCT A dYA'1('IER WELL _ g� lease d of a.,..e's. Weill Location: Street Address: Tow Tax Grid # fn/V,illllage He. �r t l e�ae t.. la/ Map 14,-1 Block Lot(s) ' f WeR Owner: Name: �e�/!a Jh� G � Address: % � � !r! Y! ° 6` ✓a �1`^L', %r(,7T: � /�-' �i�S�/ e�d J° GJ e� A a Use of Wefl: t/`Residential Public Supply Air /Cond/Heat Pump Irrigation I- pn°imziry Business Farm Test/Monitoring Other (specify) 2- secondanry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage Fc o gal. Reason for Replace Existing Supply Test/Observation Additional Supply IIDntilli mg k 'New Supply (new dwelling) Deepen Existing Well IlDetafled Reasoun for DrMinng WeH 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 s n�,�a ��' '� m� r " ¢� s Lot No. -4- Water Well Contractor: N Address: �� �� Ol ec�c A/ Is Public Water Supply available to site? ....................... ..............................: ........... Yes No v' Name of Public Water Supply: --. Town/Village •- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: A.nplicant, Signature: PERMffT 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 .70R. CONSTRUCTIION: 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 Issues �' Permi Date of Expiration f Title: Permit is Non-Trans fferirs Re 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 Tel. (914) 278 - 6130 Fax (914) 278'_ 7921 July 22, 1998 Frank Sullivan 2972 Ferncrest Drive Yorktown Hgts, NY 10598 B/ /RUCE R. FOLEY Re: Jose Dominquez TM# 74- 1,9.14 (T) 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. 1. Please split system as shown on attached copy of plan. This will provide for field testing in both proposed primary and expansion areas of the system. .:__r;r, ti .��..__1fis office will coiifinue'its review -and grant approval upon consideration of tTie above ^mention-eTY comment. Please feel free to contact us if any questions arise. Very truly yours, I s• Adam B. Stiebeling ASB:dk Assistant Public Health Engineer Eric: Plan -.,A t 7 I -cj It qw, 4 ie N X. F" BRUCE R. FOLEY Public Health Director ...::�+�a:� m. >: � r .. `�.d:�� .r��%.iy�i:.. --�� �- �::..'"'•.is.�. -. _• •{r3 ;.,�`.= v.:.f•T d DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914).278-7921 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Dear Mr. Sullivan: June 24, 1998 Re: Domingurs, Meadow Lane TM# 74 -1 -9.14 (T) Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would li to offer the following comments for your consideration. lease show construction conditions of drainage easement, SSTS must be minimum distance of 35' from a storm drain or pipes water. Drainage easement should also be shown on 30 scale drawing. Pl°ase:shRw-la ation of C>?'$ -at- .Meadow. Lane minimum :_distance...of.50'__�:..,,.__. _ must be maintained. appears proposed SSTS is shown more to south, than as located on filed subdivision plan, please clarify. Please correct all application forms, with correct tax map number. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. ASB;tn enc. All Application Forms Very truly yours, �j Adam B. Stiebeling t Assistant Public Health Engineer S •L I,ti'V 6 [InP E6 a't E! i 1 0 - ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERK RT REVIEWED BY DATE S TAX MAP # ?1 DOCUMENTS APPLICATION :RMIT PWS LETTER OF AUTHORIZATION DATA SHEET (DDS) ATE RESOLUTION N' 7, ,AF THREE SETS 'LANS - TWO SETS CE REQUEST t4 It MPEGASUBDIVISION SUBDIVISION SUBDIVISION APPROVAL CHECKED L RATE woo L REQUIRED DEPTH CURTAIN DRAIN REQUIRED GENERAL CATED N NYC WATERSHED ANS SUBMITTED TO DEP LEGATED TO PCHD DEP APPROVAL, IF REQ'D D EEP TEST HOLES OBSERVED St' ERC_S WITNESSED, IF REQ'D. N_4 Y EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP E XK AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE F PUMPED, PIT & D BOX SHO & DETAILED OUSE - NO.OF BEDROOMS tz LLS & SSDS'S W/IN 200' OF MPOSED SYS. ROPERTY METES & BOUNDS 11OUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER FT. HORIZONTAL;SLOPE 3: GRADE FILL CS FILL NOTES STANDPIPES FILL CER ITI A OTE DEPTH GUA FILL P LE & CA D , NSIONS FILL N EXPANSION AREA TRENCH F TRENCH PROVIDED L3DJ 60 FT MAX. $'AKAL1,Ei1T0 CONTOURS - :.._ ETLANDS (TOWN/DEC PERMIT REQ'D ?) SEPARATION DISTANCES SPECIFIED kTA ON DDS PLANS & PERMIT SAME ON PLAN - FROM SSTS ;.E-1969 NEIGHBOR NOTIFICATION 0' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL FrFER BUZBA 7.9,20'TO FOUNDATION WALLS 15' WELL TO PL kYk. FLOOD ELEVATION 100' TO WELL, 200' N DLOD, 150' PITS MR REQ'D PERMITS) 00' TO STREAM WATERCOURSE LAKE (inc. expan) REQUIRED DETAILS ON PLANS 0' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER :WAGE SYSTEM PLAN - (NORTH ARROW) ;DS HYDRAULIC PROFILE_ GRAVITY FLOW INSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED UVEWAY & SLOPES, CUT )OTNG /GUTTER/CURTAN DRAINS COMMENTS: 10' 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2%,35' -1 0/a,100' - <I% 20'min to CD discharge/ I 00'with 182 cons day discharge SEPTIC TANK Ffl 10' FROM FOUNDATION; 50' TO WELL `� 1 ` 1` FORM 5T -2 • —r, rA "'n. �.e �... ..a ry ."��.I ►• ✓Y.a r�r.! neer+r.0 .:u4..r @i BRUCE R. FOLEY DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New . York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 June 24, 1998 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Domi.ngurs, Meadow Lane TM# 74 -1 -9.14 (T) 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. A. Please show construction conditions of drainage easement, SSTS must be minimum distance of 35' from a storm drain or pipes water. _ :._... B.. Drainage easement. should also be shown. on. 3.0 scale ,drawing..: . C:' ika- se`show location of CB's of Meadow Lane, minimum distant c6 of 50 must be maintained. D. It appears proposed SSTS is shown more to south, than as located on filed subdivision plan, please clarify. E. Please correct all application forms, with correct tax map number. 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, U � t Adam B. Stiebeling ASB:tn Assistant Public Health Engineer enc. All Application Forms PUTNAM COUNTY DEPARTMENT OF HEALTH bmSION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION ION FOR APPROVAL �j OF PLANS j�FOR _��Ln ^� w.�+,-.rayg•w .-:- r. _ ;yerC.'.z:.:At�AU' ll'lLJ,ILJ.R TEA tl'liJ�IJ 1. Name and address of applicant: `,lea Ilv s''�'p / f : tltr /' ei "7 LA 2. Name of project: S�''� 3. 4. Design Professional: ; T r S. 6. Drainage Basin: /guy's/ 7. Type of Project:. Private/Residential Apartments Office Building Location TN: Address: -Z yV 7L f���a r��T�s '%fir• Food Service Commercial Institutional Mobile Home Park . Realty Subdivision Other (specify) g. Is this project subject to State Environmental Quality Review (SEQR)? Type Status check one .. ............................... Type 1 Type I1 9. Is a Draft Environmental Impact Statement (DEIS) required? ................... 10. Has DEIS been completed and found acceptable by Lead Agency? ...........7. 11. Name of Lead Agency Exempt — Unlisted 12. Is this project in an area under the control of local planning, zoning, or other ....w...,.a.... ...wp os r..a _,_.a •,,. __....s_ -s.. ..�....�— e.....a�:v...... � .... ..-=+e �.x ...�.rtao n.T,.. �- .c.... ..... -- - c..._. »..- vim. -� -.. .. ��..ra.a.�.. -,. .- - «.:.w +d.. +.+a. �...s�. 13. If so, have plans been submitted to such authorities ?� 14. Has preliminary approval been granted by such authorities? s •,Date granted: J19f4 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? ....... ............................... Al. e 19. If yes, name :bf water supply Distance to water supply mil•/ 20. 21. 22. Is project site near a public sewage collection or treatment system? ................Al Name of sewage system Distance to sewage system A -:�.o Date test holes observed / 23. Name of Health Inspector •v P 24. Project design flow.(gallons per day) ........................... 4f" °c) 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?.._. 26. Has SPDES Application been submitted to local DEC office? _ Form PC -97 z d7.a any portion of this project located within a designated "Town or State wetland? 28. Wetlands ID Number .... ............................... . ........................ ............................... 1! nd. P��it p q0, reds.., Has application been made to Town or Local DEC office? . ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /V-J 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 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? ............................... Yes /Nom DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ... ... .................... Ald 34. Are community water and/or sewer facilities planned to be developed within 1.5 years in or adjacent to project site? ................................ ............................... A141 35. Are any sewage treatment areas in excess of 15% slope? . ............................... A'a 36. Tax Map ID Number .......................... ............................... Map 7W •-/ Block_ Lot , 1,01 37. Approved plans are to be returned to ..... Applicant t' Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall .be sent -to the.:De_partment; and- need.n_ot'.be - ent.in duplicate to-tl;e_IEP; althoug,h-the—project niay..r«auirc approval of the SSTS prior to final approval by the Department. Projects within the �%atcrshed may also w require DEP review and approval of other aspects of a project, such as stomm titer pLu►s or the creation ot' impervious surfaces, and the project applicant should obtain the appropriate forms ti)r 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 1.,thc application n►u�t be accompanied by a Letter of Authorization (Form LA -97). I'ailure to comply with this prop isioii may be, grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information Provided on this f urin is true to the best of my knowledge and belief. False statements made herein cure punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.' SIGNATURES & OFFICIAL TITLES: Mailing Address: l I'" I I NA 'F 1 COUNTY DEPARTMENT 01F I HEALTH AI I i DIVISION O ENVIRONMENTAL HEALTH S I ' A'SHE �: �'. SUB S��i[ �' �C�'.. �E'' �v�� 'YTIAA`7ildi[)�l`dT's STEM Owner Address /�' /�:-� ;`�� ►�'� -%�� Located at (Street) - w- -2,ri-,, e Tax Map % Block _j Lot (indicate nearest cross street) Municipality ,/; /��e;;'/7�7 Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole loo. Run No. Time start - stop >Ela se Time �M1in.) IIDe th to Water )N rom Ground Surface (Inches) start Stop Water ]Level gDropp In Inc�nes ]Percolation hate Min/Inch 2 3 4 Pe, 7e9I*v c t" 5/�`✓` %� �UGo s 3 4 5 l 2 3;- 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 4.. ' . _-.. TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 _' ...'.'. _:. -,.. ...'. � ...�.: - •�. . , . v:'. :::. ": -'w'- tip' /� _ ... _.: °.. c- ..e. ,. _-. 'r.• _. $L;a :�.. i:: Y:..: . +_a.. �is':_^rt.:..: 4 L •�..]:. rir ... ,a. �.,.. DEPTH HOLE NO. ~ HOLE N--O. HOLE NO. G.L. 0.5' ° 1.0' 1.5' �;n j d?i 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' . 6.5' 7.0' 7.5' 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered T1 o n Indicate level at which mottling is observed .'7j Indicate level to which water level rises after being encountered �- �✓� �� Deep hole observations made by: yt,,� 4 /2;p -; %v,� Date % c Design Professional Name: - g i Address: 7. ^,1 `-ri ✓� jr a Signature: Design Professional's Seal of NEW S. G IFUTNAM COUNTY DEPARTMENT OF HEALTH DIIVffSffON OF ENVIRONMENTAL HEALTH SERVICES .,.c: .,e'�:t� ".. �a....yetl' -ars;a '..-.y '�vx S. �:- +�.�••r rah �:.r r ^�i r. u�:�:v<id:::.�w.a c:. ..eC::is '1 v�.:.'�p .r. :o. -....�. � ^v. ... "r.;.�i .r :.:-�:.r.i:v: �•ni �.. LETTER OF AUTHORIZATION V RE: Property of Located at %1C =67 T/V c$� /e, Tax Map # 7d, -° / Block _ Lot s f Subdivision of ` 0_.; . Subdivision Lot # - Filed Map # Date Filed �'dfgd Gentlemen: This, letter is to authorize ,;5 Y 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 Article 145 and/or 147 of the Education Law, the Public Health aw and .,- the --Pu:tlarsa County: - nt any :.6&,'. - 7 _:Zo I � 0 � FILI /,I,/— — Countersigned- NEW P.E., R.A., # Mailing Very truly yours, Signed: _ (Owner of Property) Mailing Address: % �a �� �`dd��► State State Zip Telephone: Telephone: % -3 Form LA -97 14-164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR q Appendix C - .. State. Erttrlra�nno�ntsl;A�allty SHORT .ENVIRONMENTAL ASSESSMENT FORM, For UNLISTED ACTIONS Only" PART 1— PROJECT INFORMATION (To be completed by Applicant..or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT. NAME, 3. PROJECT LOCATION: Municipality' �j�j�d, u /er County 4. PRECISE LOCATION (Street address and road Intersedilons, prominent landmarks, etc., or provide map) 9 5. IS PROPOSED. ACTION: New ❑ Expansion ❑ ModificatioNalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially j acres Ultimately ' acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes No If No, describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? jKlResidentlal ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes, ❑ No If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? as ❑ No If yes, list agency name and permiUapproval KY . ���� % %vas %��r /�- ��r�.��.i• 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No 1, CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name: 1 t7 ,. .Date: Signature:���� If the action Is In the Coastal Area, and you are a state agency, complete* the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS-IN 6 NYCRR,.PART 617.6? If No, a negative declaration .n.u.il'6:1'rJerEcy_ ... ... - Jf n .... .. ❑Yes No C. = C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED.WITH THE- FOLLOWING: (Answers may be handwritten, if legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or`related activities likely to be induced,4y the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. co C- `5 D 'IS'TfiR°OFY j XitiF�iC,Llf} Y.T 7 RK;ytiEi��Qv'.cii Y iL?n�C�: ITi�Tf /Efi�ll�SE�,.h�V.E�NfviFaT4i `IMP .ACTS ?''. ❑ Yes ❑ No If Yes, explain briefly 17. <. PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) co INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials.' Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have identified one oP more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or, prepare a'positive declaration. ❑ Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on `attachments as necessary', the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Off icer Signature of Responsible Officer in Lead Agency Signature 'o Preparer (if different from responsible officer) Date 2 }r"�yk'k •'C ^F cJ,t�, .YY y`7��^' _. `�,'. �i'F ,.S i7 y'/0=W rib!f �.T, i �i K' fry d1 •�„�!" nt �'•'. d k -", 31; v` t �.ur3 aF't'F- •',Kr..�` 6t LrrL..ss5 ?,z fit,�;i1 r t• y �`�.: ,...r -r r;v.+ '�;rk t Qh• ., a >L � 7?!t' 4 � , '�, ? ..x� '•+s5� �.��q� -'t -. �,��y},�,3`..�.r�`��,��v� � x ,.3'tr , � �'�`r c... ,� , S''f;r�^�,`�izt`a 3�Sta r'i f`:'k'"""y 'j�..,.;� xL'`rt:}ry"t t7us `:.rr�3r t fKS^SC ss.! $ v Nf'.` f~ a'• i"2^t�a h O"f�T a �� k. 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