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HomeMy WebLinkAbout3533DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -9.17 BOX 28 koT 11 16se we .41, k4J6 03533 n s PUTNAM COUNTY DEPARTMENT OF HEALTH r4 c lr,:-il,,ii, ki,� -ri a DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Weill Location'*'., JStreet AddF*ess.:.. .....Town/Villagd: Tax Map #• :GR'S' . 4,llti��f 14,42 I'Map Blot Lot(s. Addre Weifl Name: -Matt Japer, 10'Atawd Piece, Valhalla., NY 10595 Use of Well: X Residential Public Supply Air cond/heat pump _Irrigation. 1- Primary Business Farm Test/monitoring Other(specify) 2-Secondary Industrial ;Institutional Standby Drilling Equipment XRotary _Cable percussion XCompressed air percussion _Other(specify) Well Type —Screened —Open end casing ­I Open hole in bedrock Other Total Length 42 ft. Materials: X Steel Plastic - Other Casing Details Length below gradeQ ft. Joints: Welded Threaded Other Diameter 6 in. Seal: X Cement grout * Bentonite Other Weight per foot 19 lb/ft Drive shoe: y Yes No Liner: _Yes _X_No Diameter (in) Slot Size Length (ft) Dept to Screen' ft) 10eveloped?, Screen Details First Yes No -Second �Hours Well Yield Test _Bailed Pumped __X Compressed Air Hours A Yield r% gpm Depth Date Measure from land surface•static (specify ft) During yield test (ft) Depth of completed well in ft. 60' 520' 610, Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description Land Surface A D­4 I I I n�g - vlm�- LSU,--CL11j,7 r 7- dcscriptl'01�13' OP­- sieve analyses Dri 11 j ng in qiat­ rQ.qj 1 ig graisted are available, 42 610 D- rillin in please attach. If yield was tested Feet' Gallons Per Mip4A Pump /Storage Tank Information at different depths Pump Types.ltb_ Capacity sgnm during drilling Depth 540' Model G51 4.12 list: Voltage 230 HP 1.5 Tank Type WX251 Volume A2, "C W` 6 r D@:t*q 0.2,4 ..... .. ... State b§ Pu Installer; ,Mp..! . WrqILDrjII&Name 4"Addie"' s Well ' " D,Qll gdiigurdy R arri.6-:&iAddre"s's U, NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Pink copy Owner; Orange copy - Well driller Form WC-97 Rev. 3/06 Pump. Installer �" r i �`b •� �+ I 6 ��r � °a I i ���' 4 ,1'} •�� i� 9 � � � '� � ��6 : ". � a � 'h l y a CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT# SW 11-06 Located at - oaazi M 661 L&Ye Town or U41age P07 -IVIIsn V14J.L6 Owner /Applicant Name &TC A L&2r=cL _7S20?e(Z Tax Map 7 Block �_ Lot Q d Formerly Subdivision Name all aR/1 -egL Pie �R-Yl 'S Subd. Lot # 7 Mailing Address _ AIV , ,iV e/ Zip 0021 Date Construction Permit Issued by PCHD (� Separate Sewerage System built by D y j? Ea r V417ti" C; Address 6,412n%C,(- _. A/ Consisting of 2 7 Gallon Septic Tank � and. �S 1a.J 6 C� ,,��2 n/» Other Requirements: Wak SUP Ry: Public Supply From. Address or: Private Supply Drilled by 1Urfs Address bjZ- euwsTeF -_ Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: - ©° Certified by P.E. /'t- R.A. (Design Profession Address `�i %� S e' %Z /��5 � . � L®D a 12-e J-t°o * License # 0 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. 41, � Title: Date: © to e copy - HD File; Yellow copy - Lading Inspector; Pink copy - Owner; Orange copy Design Professional Form PUTNAM COUNTY DEPARTMENT OF HEALTH __.. DIVISION OF .ENVIRONMENT L . . .r ... -.... r.�. „��. :.a . �.� >....... ya..a.�.�.y . .., ....- �:x.;,,. --« � .u_�i_c �.e. <..•r �..- r+mr� ^s:•�. ., :•r ';i.:'v °� .a:'..�,'E�:".. `yc 1. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building �JLLn �udu,�aY Building Constructed by N My* A-eacicto 1 Bne Location - Street SANV T&mily k0ek)(P-9, Bui�a— g Type 9H o— I - q0j V Tax Map Block Lot VAarq Ua �e TownNillage I�Opy, Tm>py` 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 erna- 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; M Day Year Signature: (7�1 _ Title: Gbiiim ' ontractor (Owner) - Signature 1 P e xr'A vA 4[A/ Corporation Name (if corporation Address: State e Zip�� Corporation Name (if corporation) Address: State Zip Form GS -97 My 12411 10 1.4 1 11 IR a :... : ' '.. :...:. ".. .. _. .. a. :..... ,a. - .. .. 3... ... ... r TAL_ /•� 1. . -� - •• • GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building kc-d-glar Building Constructed by 1 N Aadow Zap. Location e Street' Alvi�j 1 E Buildi g Type TI,-1 Ro 11 Tax Map Block Lot z6am Va IN Town/Village lumoer TroAVS Subdivis on Name 701 � 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 Signature: / t Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Addre SS � rave, State A Zip lh,� I �_ Corporation Name (if corporation) Address: State Zip Form GS -91 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 VERIFICATION FORM OWNERS NAME: JUMPER TAX MAP NUMBER: 74.-l-9.17 �Clilq I UPI ID ill TOWN: Putnam Valley AUTHORIZED TOWN OFFICIAL: 1 DATE: 7/21/09 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 Certificate of Construction Compliance. (E911 verfrm) Pagel of 2 AN/fJ7 Environmental Services, lrrc. ff�1�N\ 41 Kenosia Avenue CT WATER, 5011 AND AM ANALYSIS Cft�l� Danbury, Connecticut 0_6810 I Telephone 203 -798 -2229 .. C' c.-n >�t- "!'._C'. y4+a. -'Y -. v.. � -�J v...e -�•o<s �'�.. w:,fs ,fin n r+as ,..p+S "�. fAF -.sa. �'� 4:.r- A�.n�.;C �.:C..�.L9-1 [! <�.x .- \f�3,�...'�w w^.O :c4! -�H �'A�C -4 7..t. .f.. e _ P F (Aral and Soaps Inc: Mafthew Jumper Mailing Information: Name: P F Beal and Sons Inc Address: 4 Putnam Avenue City: Brewster State: NY Zip: 10509 Phone: (845) 279 -2460 Fax: (845) 279 -6613 Sample's Information: Sample ID: 1 Collector's information: JMS ID: 086404 Name: Chris Beal Address of site: 14 North Meadow Lane City: Putnam Valley State: NY Zip: Phone: Site: IGtchen Tap Date Collected:. 9/23/2009 Date Received: 9/24/2009 Preservative: N/A Time Collected: 1:00:00 PM Time Received: 1:30:00 PM Temperature: Lab No.: j09O7439 Matrix: Water Date Analyzed Test Name Result MCL Method 09/30/09 Iron <0.05 mg/L 0.3 mg/L 200.7 Rev. 4.4 09/30/09 Manganese <0.05 mg/L 0.3 mg/L 200.7 Rev. 4.4 09/30/09 Sodium 80.9 mg /L N/A 200.7 Rev. 4.4 09/24/09 2:10 PAN E. Coli Absent Absent Colitag 09/24/09 2:10 PAN Total Coliform Absent Absent Colitag 09/28/09 Lead <1 ppb 15 ppb E 200.7 09/24/09 Color ND 15 Units SMWW 2120 B 09/24/09 Turbidity 1 NTU 5 NTU SMWW 2130 B 09/24/09 Odor ND 3 TON SMWW 2150 B 09/29/09 Alkalinity 48 mg/L _ _. N/A SMWW 2320 B _: :...:.. 09n)S/A9 __.. _ ._ . 1lar^� .: <2.., ;cg& 09/25/09 Chloride 20.2 mg/L 250 mg/L SMWW 4110 B 09/25/09 Nitrate 0.774 mg /L 10 mg/L SMWW 4110 B 09/25/09 Nitrite i <0.005 mg/L 1 mg/L SMWW 4110 B 09/25/09 Sulfate 18.5 mg/L 250 mg/L SMWW 4110 B 09124109 pH °10.5 S.U. 6.4-10 S.U. SMWW 4500 H 13 Comments: *ABOVE MCL At the time of the analysis the sample was Acceptable for Total Collfonn At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after the EPA required 1 hour holding time. CFU = Coliform Forming Units MCL = Ma :dmum Contaminant Level mg/L = milligrams Isar Liter WA = M Applicable RID = done Detected NTU = Nephelopmetric Turbidity Unit ppb = parts par billion S.U. = Standard Unit TOM = Threshold Odor Number Units = Units CONNECTICUT, NEW YORK AND NELAC CERTIFIED Toll Free 888 -JMS -5097 I Corporate Fax 203 -798 -2408 1 Lab Fax 203 - 798 -2107 1 %v%vw.jmsen*onn-ental.ccm -0 41 Kenosia Avenue Page 2 of 2 imsEnvironmental Services, Inc. I'VATER, SOIL AND AIR ANALYSIS Danbury. Connecticut 06810 I Telephone 203-798-2229 7- - P F Beal and Sons Inc: Matthew Jumper Mailing Infonnation: Collector's Information: JMS ID: 086404 Name: P F Beal and Sons Inc Name: Chris Beal Address: 4.Putnam Avenue Address of site: 14 North Meadow Lane City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Phone: (845) 279-2460 Fax: (845) 279-6613 Phone: Sample's Information: Site: Kitchen Tap Preservative: N/A Temperature: Matrix: Water Sample ID: 1 Date Collected: 9/2312009 Time Collected: 1:00:00 PM Date Received: 9/24/2009 Time Received: 1:30:00 PM Lab No.: j0907439 .. Signature: Reviewed By: -AkA -A,�An—k 4"�W� Michael Lapman Sharon Houlahan, Director President State #: PH-0218 ELAP #: 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 888-JMS-5097 I Corperate FaX 203-796-2408 1 1-3b Fax 203-798-2107 1 %'v%v%v.jrnsen*Aronrnent3l.00M Page 1 of 1 Environmental Services, lac. 4i Kenosia Avenue . WATERy Stilt AND -AIA ANA -LYSIS Danbury , Gonneatfr�It�Je810 i Tetephane 24o3-7913-2229 -- ,�iP:3 P P Beal and Sons Inc Mailing Information: Name: P F Beal and Sons Inc Address: 4 Putnam Avenue City: Brewster State: NY Zip: 10509 Phone: (845) 279 -2460 Fax: (845) 279 -6613 Sample's Information: Site: Bathroom Tap Preservative: N/A Temperature: 3° C Matrix: Water Collector's Information: Name: Bobby Address of site: 14 N Meadow City: , Putnam Valley State: NY Zip: Phone: Date Collected: 7/30/2009 Time Collected: 2:50:00 PM JMS ID: 084861 Date Received: 7131/2009 Time Received: 2:30:00 PM Lab No.: J0906063 Date Analyzed Test Name Result MCL Method 07/31/09 4:25 PM Total Coliform Absent Absent Colitag 07/31/09 4:25 PM E. Coli Absent SM 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli CFU = Coliform Forming Units MCL = Maximum Contaminant Level - Signature r; - - R3vier�^aza Sy: - ± Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free see- JMS -sow I Corporate Fax 203- 798 -2408 1 Lab Fax 203 -788 -2107 1 www.jnnsen%ironmental.00m I lit i.'m— al �.......r ..... �................ .., e...r..t - - .. -� :- � .. ..mss .... _ , -... - ';t;,.- _ . . �,,. • +fa- _ .. '_,re+ 'x + • + _ _ .. . . 273 Starr. Ridge Road Tel: (845) 278 -6212 Brewster, NY .10509. Fax. (845) 278 -0403 September 23, 2009 Mr. Gene Reed Senior Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: 14 North Meadow Lane Tax Map '#74 -1 -9.17 Town of Putnam valley, Putnam County, N.Y. Dear Mr. Reed, Enclosed please find the following items for the above project revised as per your verbal comments: 1. The field numbering sequence has been updated to include the number 'I L • Four (4) sets of As =built plans dated 918109 last revised 9123109 prepared by Beyer & Associates. I trust the above materials are adequate for your approval and complete the submission for the above project, However, if you have any questions concerning this project, .please do not hesitate to call me. Very truly yours, Michael Be , P.E. Project Manager 273 Starr Ridge Road. Brewster, NY 10509 Mr. Gene Reed Senior Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: 14 North Meadow Lane Tax Map #74 -1 =9.17 Town of Putnam Valley, Putnam County, N.Y. Dear Mr. Reed, Enclosed please find the following items for the above project: Tel. (845) 278 -6212 Fax. (845) 278 -0403 September 8, 2009 o Certificate of Construction Compliance application form. o Four (4) sets of As -built plans dated 9/8/09 prepared by Beyer & Associates. The following Items have been submitted to the PCDOHby the client: o E -911 verification Form _:._...... ..... :.:..:.:..q... Three. (3).Copies qf. anfee of Szsbsa ,ace ,Sex�ssge .Trea'ment stem, ..- _ :... _ . : .- o Water Analysis Report o Letter ofAuthorization is on file. o Application fee —in amount of $300 I trust the above materials are adequate for your approval and complete the submission for the above project, However, if you have any questions concerning this project, please do not hesitate to call me. Very truly yours, Michael Beyer, P. E. Project Manager SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health September 3, 2009 Beyer & Associates 273 Starr Ridge Road Brewster, NY 10509 Dear Mr. Beyer: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Jumper North Meadow Lane (T) Putnam Valley, TM # 74. -1 -9.17 A re- inspection for compliance with the revised house plans was performed on 9/2/09. The construction has been complete in accordance with the approved plans. There are no further comments in reference to this Department's site inspection. If you have any further question, please contact me at 845- 278 -6130, ext. 43261. Sincerely, .. _ .... .. ., Gene D. Reed Sr. Environmental Health Engineering Aide GDR:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 _. . , - -i SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health August 10, 2009 Beyer & Associates 273 Starr Ridge Rd Brewster, NY 10509 Dear Mr. Beyer: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BOND[ County_ Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Jumper North Meadow. Lane (T) Putnam Valley, TM # 74. -1 -9.17 The revised house plans submitted to this Department for the above referenced property have been approved Please call for a final inspection of the proposed changes upon completion of construction; If you have any further questions, please contact me at (845) 278 -6130, ext. 43261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 273 Starr Ridge Road Brewster, NY 10509 Mr. Gene Reed Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Jumper Residence -14 North Meadow Lane, Putnam Valley NY Tax Man 74 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Reed, Tel. .(845) 278 -6212 Fax. (845) 278 -0403 July 22, 2009. Enclosed please find a copy of the following items for your review and approval as per your letter dated July 6, 2009: wised Second Floor a Plan dated 2/28108 last revised 7- 19 -09. (4 copies) I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me. Very truly yours, Project Manager SHERLITAAMLER, MID, MS, FAAP Commissioner of Health LORETTA.MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONIDI County Executive_.__ ROBERT MORRIS, PE Director of Environmental Health July 6, 2009 Beyer & Associates 273 Starr Ridge Rd Brewster, NY 10509 Re: Field Inspection — Jumper North Meadow Lane (T) Putnam Valley, TM # 74.4-9.17 Dear Mr. Beyer: The above referenced separate sewage treatment can be backfilled. The following comment need to be addressed. Revised house floor plans need to be submitted to this, Department showing actua : l .construction.. _. _. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, J24 Gene D. Reed Sr. Environmental Health Engineering Aide GDR:kIy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186, Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care, Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Pres.chool (845) 228 -2847 Fax (845) 225 -1580. PUTNAM COUNTY DEPARTMENT OFIEEALTH DIVISION OF ENVIRONMENTAL HEALTH -SERVICES FINAL SITE INSPECTION Date: _Imqpected by. P61tit 4 see; 0.6 Town TM # Subdivision.Lot # :Z 1. -SewRge'System.Area a, STS area located as per approved plans ...................... b. Fill section -date of placement 3:1 barrier Lgth. Width Avg.Dpth- c. Natural soil not.stripped ........................................... A Stone, brush, etc.,.greater than 15'from:STS. area .... -e. 100' from water course/ wetlands . .. ............................. H. Sewage,Sv§tem a. Septictank size -1; 0.00 ........ I � �,o ........ other......... b. Septie'tank-ifistalled level - ........................................ c. 10'aiihimum-from'foundation .................................... d. .'Distfibution Box ' 11outlets at same elevation-water tested:.: :::: ::: .1. A� st ........... 2. ,Protected:below frost ................................. ........... 3.,.11inimuin 2 ft.-Original.soil between box & trend .e. Junction Box properly set ................................... .6. Trenches 1. LeiF91 required � 7 2 :Length installed 61' 7 .2. Distance-to watercoursemeasured 4- / ® 0 Ft.......... 3. 'installed according to plan ................................... 4. Sloptbf trench acceptable `1/1`6 1/32"./foot ........ 5. 10 K :from,prope�fty he -.20 ft:- 'foundations..... 6.. Depth of trench <3 O.inches from surfice ............. 7. Room. allowed for expansion, 100% ......... ; .......... 8. Size ofgravel.3/4 - Ilk" diameter clean ............... 9.. Depth of gravelin-trench 12" minimum ....... I ....... n ed,.- Pipe.Le ....... ................................... Pu M*"Osi6 vstems - f P ............ Size pump chamber. 2. Dverflowtank ..................................... ?s ... I., Y../ 3. :Alarm, --visual/audio:.:: ......... . e ............. 4. PUMP easily accessible, manhole to,grade ........... 5. First box.:baffied ................................................. 6. Cycle witnessed by R.D.,estimated flow/cycle ..... M House/Building a. .'.House..,Iocatedper,;approved plans...., b. Number: bfbedrooms ...... 3/ IV. W611 Well cated 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 flushwith -inside of box ........ d.. Backfili material contains -stones <4 ".diameter ......... e. Curtain drain & standpipes installed according to pl f. Curtain drain outfall -protected &. dir.to exist waterc g. Tooting drains discharge away from STS area......... h. Surface water protection adequate ......... .. ­­­­­*'*- i. Erosion control provided ......................................... Rev. 12/02 Ye z n SM INSPECTION FOR FILL PAID Date: i O° Inspected by:-6, I • Fill pad located per the approved plan Fill Pad Length 6-/ %-5`9 Required Length_ 5- 1l ' Fill Pad Width Required Width Fill Pad Depth — Required Depth Run -of -Bank Fill Quality Slope from Top to Toe -P— m yt t Impervious Layer Installed i� S Erosion Control Installed X0,45 :s boa JI Sieve Test Results (if applicable), V. . _. Additional Comments: yw Reserved for Field Sketch if Applicable Er la , 0 O -Ci Oil lo� 26.56' • o . t-4 w O WAW 14 ----- yr 1 «i rv) - 4, - r LIZ cL s Ln on /ine 4 59t to . LOT 8. IN to ✓OI ��%�" F�UNaA %7 ON ` • 233.5' ' �`�"�, �2J,6. r 234 5 276 * 235.0233.7 it r r + . f r 23f, 9' ., 1 r '2.319' �`�- - -�`� �� � ! '--- - •- ._.- •- -....� f �^ �- .,..�,_,,,�.,,�,�� -f_�,� � i 232.3'',- rte, _ r -"''- ►.... ��,- _ ♦ 2,12. B 233 4' �-- ,- 233 9' r ►�.. j ^- �`,,� -! -, �!, r ^ r `ter^ X234.9' +� w r �`�- �...._ �. t for ""'-••,.- .. �. t �"_,r""'� -,-� f r '�"'�• 4 230.1 ' + 231. i' ----- - -_�-. �; `-- -.�ti,� 231.9 -�- •�•,ti. . ,��,�. ^. f � b f i r N r ^ - _ �.. '��_�`` v - -`• 232.3' i 232, i 232.6 MAP SHOWING R.O.E. GRADES PREPAR0 M HATTHEF.DUVA J L4 UREN A NMFER P VPEl-'i ! 1 SII V/'9 I'F I COUNTY OF PUTNAM STATE OF NEW YORK SCALE 9 _ 20' 06'� - . _... � ...... _ e ....... lDA tg• APRIL 34..2009 9 9 237.8' 9 2.59, 0' r r r 9' . ;� -�` end of wall 0235.7 Qu N; k r - 23a T " "-"' -- _ 2J2.5, C O i catch basin a s h v '.,:. y .; ..i +fir.• :r ..C" :l ,v Y01? TH Wj�dl Elevations of existing R.O.B. fill pad shown hereon refer to; the vertical datum used on "As —Qulit" survey of road and drainage .. ptipdfed :Dec,--rrher .6rd N.� OV Nell& Only c, Prepared by: E iii survoeyr E siderec Baxter Land Surveying, P. C. Under P. 0. Box 147 ote y d c 'Mahopac, New York 10541 ,4� n Unautr �• ` " . " land at Phone: (845) 621 -8562 RosERTK`°BNC1E; P.L.S. the Ne M.Y.S. Uc. Na 49434 • -.. ..t �.f'7J, rF" a �. y. .. .i r. _. ; .D .Y.'d_ <._����r''���' 'c.� ,i ". -a•• :... ;..-.. � � e"'— •: -::,;' OF 4130 q n IN 1` Yit`•`:. Y` Only copies of the original of this survey Pnap marked with both this surveyor's. embossed .seal and his signature in red ink shall be con- sidered as vdlld true copies. Underground Improvements, structures, utilities or encroachments, and any easements related thereto, are not shown hereon unless otherwise noted. Unauthorized alterotion or addition to a survey map bearing a licensed land surveyor's seal is .o violation of Section 7249, Scab— Division 2 of the Neiv York State Education Lour. 232.7' 7 � w Ic File No. X kq � �' Cornrrt -. n• ( - �Y�Ys 't e .�; PUTNAM COUNTY DEPARTMENT OIF HEALTH A1t"'Il I 1 lI'dOi 5 GENE REQUEST FOR F . For: rill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Perrnit Located: Owner /Applicant Name: 1` 16:1 Y, MME -EA - - -- TM -7!2^ Block 1 Lot � 1 Formerly: _ _- Subdivision Name: -N�uy%H tz .2 LTif4 - - Subdivision Lot # Is system fill completed? Date: d Is system complete? /-30 Date: Is system constructed as per plans? --dP S is well drilled? /�-a (Date: Is well looted as per plans? _ -- Are erosion control measures in place? � I certify that the system(s), as listod, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued FCHD Construction Permit and. apprgved plans. and the Standards, ;Rules and Rr, _gulations of. the_.Putnam- County..Dcparhnetnt of r Date: Certified b / PE . RA D gn P essional Andress: 2 �.� t rZtl)G� �2 . A i►'x Lic. # 0� y IZ Comments: .p L.. �._ Form FIR. -99 . _. t. . • . . .... A.,.. ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH .DMSION OF ENMONMENTAL HEALTH SERVICES 11 ADAM All information must be fully completed prior to any inspections being made. ►,r For: Fill Trenches PCHD Construction Permit Located: I G/Z `'fi l-� Owner /Applicant Name: ZA A t7-- ; i_ . ✓} TM Block `� Lot Formerly: Subdivision Name: L-Am •0Pt'� � ` D Subdivision Lot # _ Is system fill completed? 7-'s Is system complete? : _.S Is system constructed as per plans? Is well drilled? Is well located as Per plans ? - Are erosion control measures in place? _.T Date: Date; Date: a I certify that the systems), as listed, at the above premises has been constructed and I have inspected _.t�. acd: E eTic yd their. cnxnpl --tion'::in accordance. with�� the. issued CHD - "onstructiun Permit and approved plans and the Standards, Mules and Regulations of the Putnam County Department of Health. Date: _ �� �{� Q C7 Certified by; PE RA Desi rofessional Address: G S Lic. # Co ents: Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF.ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM REQUESI.FOR TECTION'- For: Pill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Peniit # Located: "j (T), -e'-70P Owner/Applkad Name: tA&131 2&�yt�_ TM' Block I Lot , Formerly:. Subdivision Na me k.W 02ed—, y?Jg0&_w1-A Subdivision Lot A Is system fill completed? Date. t1 Is system complete?. 5 o Date. _06 _F Is system constructed as per plans? r'k Is well drifted? Date- - co Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCBD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Date: Certified by: P. E RA 4 �esi rofessional Address: 22.22 jg LDgf yq D I - � - Lic. # 07(/ Z ol Vnint, Pnt-w Form Fitt 99 PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVIC -CO-N PRUCTION Pr.Ri' - lt+OR SjE°Wk(;E -` RL'A7M NTS YSTEINI PERMIT # � 1 \ — ®k , / mqa-, Located at �'q' Mr, Town orWilage ,&nlam V &I- �z Subdivision name 70APRZ -WP. Subd. Lot #. Tax Map Block _/ Lot %/7 Date Subdivision Approved G 1 1 1 IS Renewal Revision Owner /Applicant Name HLv= A Lav2w1 SQmeeg Date of Previous Approval ( -149-08 Mailing Address /Jg , , D i suet �45 /Jv t j �b2 &k Ol) y Zip Amount of Fee Enclosed •� Building Type Wooj) Aeg— Lot Area No. of Bedrooms __+ _ Design Flow GPD X00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System � tem to consist of gallon septic tank and %72- 1P" -yZ 2 � siloe &Loma J k�'ey � Other Requirements: To be constructed by 1623P - 41C W 5ze i, c lld "i Address Water Supply: Public Supply From Address _. aY Private 51 ` Drilled y..�:±.C'��_r _. Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished th6 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: Address P.E. _ R.A. Date -27 License # 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. gy Title: l Date: 0 ite py - HD File; Yellow copy -Building Spector; Pink copy -Owner; Orange copy -Design Pro essional Form CP -97 3 -- - _ : - -• . ...._. _. __...__ _ _ -.- -:. � _ tea. _._.__�� .� . ..:, ROMENRUA90 - 273 Starr Ridge Road Tel. (845).278 -6212 Brewster, NY 10509 Fax. (845) 278 =0403. May28, 2009 Mr. Gene Reed Putnam County Department of Health; 4 Geneva Road. Brewster, New, York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Map 74 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Reed, Enclosed please find a copy of the following items for your review and approval for the enclosedPermit application: P Construction Permit for Sewage Treatment System o Plan and Profile= Separate Sewage Treatment System — Trench Layout last revised 518108 (4 copies) o Design. Data Sheets for Fill Pad Percolation Tests. o Copy of Previous Permits dated 619106 I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me. . Michae eyer, .E. Project Manager PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET – SUBSURFACE SEWAGE TREATMENT SYSTEM Owner MATT & LAUREN JUMPER — Address. 180 WESTEND AVENUE, APT 4S, NY,NY Located at (Street) 14 NORTH MEADOW LANE Tax map 74 Block 1 Lot 9.17 (Indicate nearest cross street) Municipality TOWN OF PUTNAM VALLEY, NY Subdivision Lot - Drainage Basin HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pre-soaking 11/11/2008 Date of Percolation Test 11/12/2008 Hole No. Run No. Time Start— Stop Elapse Time Mn-) Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch P-1 1 12:04 -12:10 6 2111 2411 311. 2.0 2 12:11 - 12:19 8 2111 2411 311 2.6 3 12:20 - 12:28 8 21 11 2411 311 2.6 4 12:29 - 12:37 8. 21 It 2411 311 2.6 5 P-2 1 12:07 -12:17 10 2111 24" 311 3.3 .1 12:30 -2 1"' 3 12:32 -12:44 12 2111 2411 311 4.0 4 12:44 - 12:56 12 21 11 2411 311 4.0 5 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.:9 1 min for 1-30 min/inch,:9 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 P TTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENT'AL HEALTH SERVICES z.. ^ ^..:r. °'y'Sy�w; i7:i�k a�_.h= �y.•.'i� .�e�.. :.a'%e �i�ia:, .,- si�..:¢::.+.a.. `.'�i•.�... ..� �: i�.... -�•.. ..�^:; ^' �,�_ .._ _.: - -_,.. _ _ _ �'�•!A TiTi1 �a��...F- ��^.'f�K L;- .:.s%.i'�b:. ,.r s- r......y.... ..ti �;=�. DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner MATT & LAUREN JUMPER Address 180 WESTEND AVENUE, APT 4S, NY,NY Located at (Street) 14 NORTH MEADOW LANE Tax map 74 Block 1 Lot 9.17 (Indicate nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY Drainage Basin HUDSON RIVER WATERSHED Date of Pre - soaking SOIII.. PERCOLATION TEST DATA 11/11/2008 Date of Percolation Test 11/12/2008 Dlole No. Nun Time Start — Stop Elapse T une Depth to Water From Ground Surface (inches) Start Stop Water ]Level Drop in Inches Percolation Rate Nn/Inch P -1 1 12:04 -12:10 6 21 " 24" 311 2.0 2 12:11. - 12:19 6 21 24 °' 3" 2.6 3 12:20 - 12:28 6 21 " 24" 4 12:29 - 12:37 6 2111 24" 311 2.6 5 P 1 12:07 -12:17 10 21 " 24" 3" 3.3 12:18 - 12:30 3 12:32 -12:44 12 21 11 2411 3" 4.0 4 12:44 - 12:56 12 21 11 2411 311 4.0 5 1 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. <— 1 min for 1 -30 minhnch, <— 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 I SHERLITA AMLER, MD, MS, FAAP Commissioner ,.ofHealth . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Beyer & Associates 273 Starr Ridge Rd Brewster, NY 10509 DEPARTMENT -OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 28, 2009 Re: 14 North Meadow Lane (T) Putnam Valley, TM # 74. -1 -9.17 Dear Mr. Beyer: Per your submission of topography for the above referenced property, the existing fill pad was found to be in compliance with the approved plans. Trench permit and plans must be submitted to this Department for final approval of construction -prior to the installation of the separate sewage treatment, system. p�eaS 6t�-ih -di -fie1 -d ttreasli-rerrteriib lyy-this Department in n0` ma j v and location of the fill pad. It. is the responsibility of the Design Professional to ensure, the construction at the above. referenced project is in compliance with the approved plans. If you have any further questions, please contact meat 845- 278 -6130, ext. 2261. GDR:kly Sincerely, Gene D. Reed . Sr. Environmental Health Engineering Aide 0 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 .Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Far' (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 T. SHERLITA AMLER, MD, ISIS, FAAP -. ('or.„ no-ssioner 9f Health LORETTA MOLINARI, RN, MSN Associate. Commissioner of Health' Beyer & Agsociates 273 Starr Ridge Rd Brewster, NY 10509 Dear Mr. Beyer: ROBERT J. B ®NDI County Executive �ti r_ .2' V? - ^� .. " a -. � ?'a9mrt .a. .A ��.•t. 'r•. ..� }`.t n$•�. . ROBERT MORRIS, P8' Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 6, 2009 Re: 14 North Meadow Lane .(T) Putnam Valley, TM # 74.-1 -9.17 An inspection of the fill pad at the above referenced project-has been completed. The following comments need to be addressed. o It appears portions of the fill pad are in excess of the minimum 15% requirement. Please .note that _fiP.lc3:T°asu_r& -by thisDe artrn_ent_in.:�c way..suggest the..exart S1zP _depth and location .of the fill pad. It is the responsibility of t'he Design Professional 'to ensure the` construction at the above referenced project is in compliance with the approved plans. If you have any further questions, .please contact me at 845 -278 -6130, ext. 2261. GDR: kly I Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845)278 -6014 Fax (845) 278 -6648 4"- PUTNAM'COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH 0 GENE REQUEST F_0R_FINAL1NSPECnQN For- Fill All information must be My completed prior to any Trenches inspections being made. PCHD Construction Permit# P-0 Located:, (T) M 1, P-12 I A Owner/Applicant Name: _TM -7 4 Block - .Lot _-V Formerly: Subdivision Name: .:Xuy�\91 (z kaaaa_ Subdivision Lot # Is system fill completed? Ve S Date- Y11 ro 2— Is system complete? bate'. Is system constructed as per plans? S Is well dril)60 Date:. Is well located as per plans? Are.,erosion control measwes in place? I certify that the system(s), as listod, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCH]J Construction Permit and Health, Date. Certified by: PE C RA D essioW gn Pr Address: 2 7 S D. tl _Y24IX-e j2j�!.,dqj�!& Lic.4 Comments: Form FIR-99 i fTO�L 1 V L 3�M COUNTY 1 9.f�.19L:d Yl AR J1 1V E V 1L ®F Ht:���AL J1 2i1�L IO ®F IENWRO �l ENTAIL H EAILTH SERVICE 7'}j���T1 `�l/''�� \�T j�j��/(�{Fp,1'I�''1 R {�R�/�Q/�\ �F�j���� A \P1rylly�, \��/(�{I/�„'/,� \�T [( \�q[ \�y�� \ry/I�'��/� {T T11U �1/ �►I TIO Y 1L E�L�11 111 �®� 91 Y V L G-E TY� E 11 L 1Y E V T ,S 11 ,g Y EM IID– --- Located at 0 �° �1 ®���� ��.. /�I LAWe Town or Vntag& P0rA1fbM N/i4Ld.��! Subdivision nam Subd. Lot # Tax Map 7 4 Block Lot o d Date Subdivision Approved _ Renewal_ Revision Owner /Applicant Name H ATr 4 Lhas) -Yu fAQf�l Date of Previous Approval 4-7-0(0 Mailing Address S Zip: 00 Amount of Fee Enclosed $ 500' Building Type d Lot Area 3 No. of Bedrooms I- Design Flow GPD BCO MIR Section Only Depth l ® 5 VoRu e 907 Ct ROB PCIIIID NOTIFICATION IS REQUIRED WHEN IFIILL IS COM#LETEiD Segarate Sewers - 9 So stem to consist of Other Requirements: To be constructed by Water SupgRy: Public Supply From gallon septic tank and Address Address _ ... K _. - Yi jrilx °vd -hy �_.. _ " i.reu�� 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. Signed. Addres R.A. Date S'�_8 ®08 License # 0 :V,5? -7 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 cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Approv d o discharge of domestic sanitary sew a only. e By: Title: Date: White copy - HD F' e; Y low opy - Building Inspector; Pink copy - ner; ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PPLIy� 'I`g_�N Q CONS_ T-R, 7rT:.,.. W� ' 1 WELL please print or type PCHD Permit Well Location: Street Address: Town/Village Tax Grid # 14 Poa w 6 r-,Apo w L8M Pwmw vkLLa YMap -7y Block Lots) 9,/ Well Owner: Name: Address: � Ai-T 4 u., -, W+P 8o oasmm :f n--w APB #S N) IVY Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _,T_ gpm # People Served __y Est. of Daily Usage 1600 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling C New Supply (new dwelling) Deepen Existing Well Detailed Reason Gv�3 o -NT1 Ai— SLL1N6' for Drilling Well Type_ Drilled Driven Gravel Other Is well site subject to flooding? .........................................:....... ............................... Yes No 1 Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision ',WM? Qa— J9(201P49409-1 Lot No. Water Well Contractor: Z61C> Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: "7 SZxO I Proposed well location & sources of contamination to be provided on separate sheet/plan. I �%tC» Fp=ftui °5igliiiiul'G`� i' 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 c ified by Putnam County. , Date of Issue �n -��r7 Permit Issuin Offici ` Date of Expiration /nom /A Title: Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Grange copy - Well driller Form WP -97 NEW YOB STATE DEPARTT*ENT OF HEALTH Requeug fair Approval of Noncom pUmme via __ -- ._tt4ae nd�ds og f101�ttr �1PRondi� 7�, sa• �d76' �6aka�a3m_ �aai�aaeoa..��&4aeieaasi�se�aS ��?:iitiw�i� _ .. .. ••• r 7 9) /. l:- �•a . �. - ,. �' • tr'a is _ 7.7 . i�„ i ..+� .�rl+ 4' �5 �;�, ?� � �if;Ji e, ,1'.�' � ZU- 1. Ube waslawa w ftetment ®ytemn camot aRmt the ffollowft sWilm do of IONYCRR Appendix 9 &A: 0 Separatimm distncn drat be addeved (715-&4(b), Fable 2, Sepratio n RegWreromtp) Szmdve glue (75-%&4(1� Soil and Site r m as not addrmsed inn Appftdk 75-A m TuhmoloV Is not zaddr=W in ,A mdin 75-A 2• a Other: 3Gue: TRm ffugsMag dear is propond to nMgatbe noccompliam wBtln ,Appamd&z 75-,A. (Wieff one or Noce A'°'i'l�Y� � r ',�' ' � f,l �' .� ; - ,�'r� ' 1/ i{;- + � ` /= r� N _ / ; �i /j•. r I ftporft info don provided: Id IIDetma site k°lm Q Detmw.Dedp - 13 Soo end Site Eva" ® N4hbeft condWm= off co m (e f , Wells, wateirbodlics, wetlamella, etee) . ® Offiefr: ]�gp�alnes Mffi . '_ _ «_ - b Mae P lfor � m�tn4e esva� vetes� � t t&&� r¢� iIIc�s�n'ds ®ff ll ®1��Iitkd, "7�A �m $dam ,dam ]ip °¢ �-{�►e or past) o�nledge that t weaver a en Is became ni *For Imedttb lopsm mint awe bami uapaom & 6 br naadlon proWded in this application to waive ate Wernem®ed sitmidw& of Appnemdk 75°,A, mad an rcde�ce �sl@t 1OIY F§ 75.3 dal 75A (b), the waiver n equte a® laembT. Ap u�vad as p iai, with ,- iitteenn 0 Not AeUd on, bftsume additional lnformHoo is mqda emi: e<Qy e: Nage: This WzhW smay be pev $horeld any <� ( -/0 -a),q Date SHERLITA AM LER, MD, MS, FAAP C.ommisioner orHealth-- _ - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: b'ore"7 Ao-� 45 /V 9 /Co v7 ADDRESS: SITE LOCATION: A),,rH-, DATE: STAFF PRESENT: S4ef4t-a Am4M-B, Michael Budzinski, P.E., Rebef! Map ris,- Gene Reed, Joe Paravati & Larry Werper SPECIFIC WAIVER REQUEST: 18qouk 5&-ple 60 6 m SYo,-Pej bP-Av;e-e0 Q01; -r I/ �2 'A 514 51ol-e-s 1�9 -" MA 51"I"L / L"t-Y DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES ❑ No WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES DISCUSSION REQUEST APPROVAL OR DENIED REASON FOR DENIAL NO ❑ APPROVED LQf DENIED ❑ 11 1 01 DIRECTOR OF ENVIRONMENTAL HEALTH COMMISSIONER OF HEALTH ff= DATE DATE �A Environmental Health (845) 278-6130 Fax (845) 278-7921 (SPECWAIVER) Water Supply Section (845) 225-5186 Fax (845) 225-5418 Nursing Services (845) 278-6558 Fax (845) 278-6026 WIC (845) 278-6678 Nursing Home Care Fax (845) 278-6085 Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648 P UTNAM COUNTY TY D PARTMEI\TT OF HEALTH - -r DIVISION ON OIL' ENVIKb&MEN'II'�CMffEk ..:T H 1 91tR A ES LETTER OF AUTHORIZATION RE: Property of Matthew & Lauren Jumper Located at 14 North Meadow Lane, - Putnam Valley, NY 10579 T/V T/Putnam Valley Tax Map # 74 Block 1 Lot 9.17 Subdivision of Jumper Properties Subdivision Lot # 7 Filed Map # 2617B Date 5/6/1996 Gentlemen: ibis letter is to authorize Beyer dpi Associates Consulting ]Engineers. a duly licensed Professional Engineer X 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 ;onnection 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 Law, and the Putnam County Sanitary Code. .-�.s. ...._._...... :. lsw. r -w r.. v....r r.w ....-- �..�.. ,... ...._r w.I��._ -.... .....� -... � -� .r.F..w- .- ...........n.._•. -Y, tip. r-yw �...r..r r��w... _ Very truly yours, Countersigned Signed: ?.E., R.A., (Owner of Pro rty) TYUCHAEL F. BIEYER, P.E. #074597 Matthew & Lauren Jumper Mailing Address 273 Starr Ridge Road Mailing Address 180 Westend Ave. Apt 4S Brewster New York State: New York Zip: 10509 State: New York , Zip: 10023 Telephone: (845) 278 -6212 Telephone 646 - 345 -2459 Form LA -97 ��, i � -o(�) ._JEW YORK STATE DEPARTMENT OF. HEALTH... _ _ . Specific Wa1V,er 3uaau'ofort�rntiriity 3anitc�t,�ri arr� id r ratctirrn from Ftequirettients of Bart 75 andsppen"1c tx r`5�A`,1QIVY1rRR"' for Individual Household Sewage Treatment Systems Name of ApplicantJin��2 i No. $treat Chy/Town State Tip i Address lcV 141 w � Ny lv.(�.�� i No. Street City/Town stale Tip i Site'Location 1. Reason why site does-not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive.siope. High groundwater: Inadequate depth to bedrock or impermeable layer. Soil unsuitable, Other (explain) ............. ...... ....................... ,........................................................................................................................................ ....................................................................................................................................................................................................... ............................... :............................. : ........ . ................................................................................... : .......... , ................................. ..... ................... __ .......................... ............................................................ :. ........................................................................................ .................................................. ........................ .................... ..... 2. Proposed design or conditions of waiver: ........................................ .....2�J :52 V...... -::�:.....s ....... ,:3.`........... ...................................................... .4�` ... .......`::f....°�: ............ ...,......t�.......... ..:.:. :...: �c<...` .................. ..` ................: 5................................... 1....... )..............................; .............................. _ ...... . ................................................. 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination.. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) .. ........................................... ............I.................. ................................................. ....................._..... :... .. _ ......... .............................. : . . . . . . . .. . . . . . . . . . . . .. .. . . .. . .. . . . . . ... .. . . . . .. . .. .. . . .. .. . . . .. . . .. . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. RE 4 == oAR ATI.V(:'OF HEALTH' " " " " " " " " " " " " " " " iE........... .�. ...................... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional _SgERLITA AMLER, 511), MS, FAAP - •Ctimnission'er oj�?�'ealth- � LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT' J BON01- I ` County Executive _ -- DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: � J Gi--�5 ADDRESS. SITE LOCATION: 1y %193 %7 �' ��`'`' ze, l DATE: STAFF PRESENT: SPECIFIC WAIVER REQUEST: Cc r�� SCam - &V7" slO 'XI-5 cl, 34 DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES ❑ NO ,.( WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO ❑ DISCUSSION REQUEST APPROVAL OR DENIED \ e�-o IUle REASON FOR DENIAL APPROVED `( DENIED ❑ DATE A6 COMMISSIONER OF HEALTH (SPECwAIVER) Environmental Health (845) 278 -6130 Fax(845)278-7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC(845)278-6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 ;OUNTY DEPARTMENT OF HEALTH j ENVIRONMENTAL HEALTH_ SERVICES ... x;7n .. +�- vc:�'o�st. ::': a..�.:: �2:. ? +;C�.:_• :,, lc *.4 -': :..._.: ., ..� '.� _..,R;i "•_. %..X; . ",�: ".:L...i. ri.... .. t �. [ON PERMIT FOR SEWAGE TREATMENT SYSTEM Located at I+ i QJM+ &Aj-y , Lr44E Town or Wlage- %7d1,1.�,9�y, (�A�, Subdivision name �76,,�Xa er w Subd. Lot # 7 Tax Map Block Lot 9, �' Date Subdivision Approved 01195 Renewal Revision Owner /Applicant Name 7 b mys :sShLw r Date of Previous Approval Mailing Address In arow% 1>LflCE upLo u,4A 1\l)( Zip Amount of Fee Enclosed 4co Building Type Vs)pcp C(t e Lot Area No. of Bedrooms _4_ Design Flow GPD o�"M Fill Section Only _K Depth / s " Volume Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by Water Supply: Public Supply From Pi7vate'Supply -Drilledby .. . Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s,, sum 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: Address R.A. Date / /401— License # d 7 Yr9 7 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 p it. A proved r discharge of domestic sanitary se ge only. By: Title: Date: White copy - HD de, 'Yellu copy - Building Inspector; Pink copy - O e copy - Design Professional Form CP -97 1FUTNAM COUNTY DEPARTMENT OIF HEALTH IlDWISIION OF IENWRONM ENTAL HEALTH SERW CIES .� please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # It p S. aTOM&Ugy Map 74 Block Lots) WellllOwneir: Name: Address: - Im umb1 ea ® U Use of Welk Residential Public Supply Air /Cond/Heat Pump Irrigation I -I nimzlry Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought ___5_ gpm # People Served Est. of Daily Usage JV� gal. Reason ffolr Replace Existing Supply Test/Observation Additional Supply IlDniffling New Supply (new dwelling) Deepen Existing Well IlDetanlled Reason S• , ffoir Drilling WeRl Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No )< Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision ; V rhye(_ !,2mea —e s Lot No. r_ Water Well Contractor: I9_0 Address: - Is Public Water Supply available to site? .................................. ............................... Yes No 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. D om:.: y; :i L .._:' .A1'Y:�v lit. Clgn%ti r�i 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 cert'fied by Putnam County. % Date of Issue l �l Permit Issui Official. �A Date of Expiration 119 z z Title: Perrmit is Non-T>ran ffelr zbRe IV 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 ENVIROMENTAL HEALTH SERVICES Owner MATT & LAUREN JUMPER Address 180 WESTEND AVENUE, APT 4S, NY,NY Located at (Street) 14 NORTH MEADOW LANE Tax Map 74 Block 1 Lot 9.17 (Indicate nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY Drainage Basin HUDSON RIVER WATERSHED SOIL. PERCOLATION TEST DATA Date of Pre - soaking 11/11/2008 Date of Percolation Test 11/12/2008 Hole No. Nan S Time Start— Stop Elapse Time Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch P -1 1 12:04 -12:10 6 2111 24" 3" 2.0 2 12:11 - 12:19 8 2111 . 24" 3" 2.6 3 12:20 - 12:28 8 2111 24" 3" 2.6 4 12:29 - 12:37 8 21 " 24" 3" 2.6 5 P -2 1 12:07 -12:17 10 2111 24" 3" 3.3 2 1,.2:.1.8.-- 12:30 .12 21 " 24" . 3" 3 12:32 -12:44 12 21 " 24" 3" 4.0 4 12:44 -12:56 12 21 " 24" 3" 4.0 5 1 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 3 HOLE NO. HOLE NO. 4 G.L. 0.57 1.0' IS 2.0 2.59 3.0' 3.5' 4.0 4.51 5.01 5.5' 6.01 6.5' 7.0' 7.51 8.01 8.5 9.01 9.5. 10.01 Indicate Revel at which groundwateri.s encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Re= and Avyociates Address: 274 Slarr RidZe in ad Brmysmr, ATY F i A /—VIA Signature: 7 J 0,14d 8Z OW 6M7 Design Professional's Seal KAbS i -if `:V311H M]R F. ­_ 617.20 PROJECT ID NUMBER APPENDI SEOR X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for. NLISTIED ACTIONS Only d 6}'A7pOiid6t-b-r'Pt'd'je'c-'t'S"ponsor 1. APPLICANT/ SPONSOR 2. PROJECT NAME Jim Jumper / Beyer & Associates Jumper Residence 3.PROJECT LOCATION: 14 North Meadow Lane, Putnam Valley Putnarn County Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent. landmarks -etc or provide map 500 ft south of Barger Street Intersection 5. IS PROPOSED ACTION: IZI New ❑ Expansion ❑ Modification alteration 6. DESCRIBE PROJECT BRIEFLY: New single family residence with individual SSTS and drilled well. 7. AMOUNT OF LAND AFFECTED: Initially 3.01 acres Ultimately 3.01 - acres 8.'WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [Z]Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑ Industrial ❑Commercial ❑Agriculture ❑ Park / Forest Open Space Other (describe) El 11 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes F0 No If yes, list agency name and permit approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No If yes, list agency name and permit approval: Approved Lot on Filed Subdivision Map V,tAS A RE$ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? as R] No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Nam M!!qha"e�� Date: August 15, 2005, 1z �y�.E. -Beyer & Associates Sig nature z — e�'� If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment M . E'AR -T 11.- 1?AF;At"T ASSESSME% ! e -, °bE cr_m IQt9d bX_ ead.,kF2r,.cjt A. DOES ACTI N VbEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR Yes - No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may superseded by another involved agency. . Yes No' C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity noise'ievels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: FTC-" C2. Aesthetic, archaeological, historic, or other natural. or cultural_resources;.or community or neighborhood character? Explain brietiy- . /agricultural, C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:r 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 by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified. in C1 -05? Explain briefly: C7. Other im acts includinj than es in use of either uah& or Uge of ene . Ex lain briefl D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENT -AREA CEA ? If es, ex lain briefl : (—i Yes No _ S E. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ves e& lain: Yes [[Eallo PART III DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether if 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. If question d of part ii was checked ves, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly EAF and/or prepare a positive declaration. I Check this box if you have determined, based on the information and analysis above. and any supporting documentation, that the proposed act WILL NOT result in any significant adverse ,environmental impacts AND provide, on attachments as necessary, the reasons supporting determination. Name of Lead Agency ate -6/ 'P ` 61',1✓�ZC'i'r1.7 nn or Type Name of e-sp le Officer In Lead Xg-ency Title of R ponsi le Officer Signature of esponsi a Officer in Lead Ageg_cj' nature of reparer i Brent from responsible o cer PUTNAM COUNTY DEPARTMENT OF HEALTH 1DIYI IAN .OF„ NV RBI �TMFNTAId AL?' ,SR1 IrC,F _., . r �yr,.frw'{.fi.M'•i.%V'�1f G' y ..y aS:. 1V• .Ol.. ra!4"'.att y.. ! LETTER OF AUTHORIZATION RE: Property of DAMES TUMPER Located at 14 North Meadow Lane TN T/ Putnam Valley Tax ID# 74..-1 -9.17 Subdivision of JUMPER PROPERTIES Subdivision Lot # 7 Filed Map # 2617 B Date filed MAY 6.1996 Gentlemen: This letter is to authorize Beyer & Associates Consulting Engineers. a duly licensed Professional Engineer X 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 Law, and the Putnam County Sanitary Code. Countersigned Signed: (Ow r Prop ) MICHAEL F. BEYER, P.E. #074597 James Jumpe Mailing Address 273 Starr Ridge Road Brewster State: New York Zip: 10541 Mailing Address 10 Armand Place Valhalla State: New York Zip: 10595 Telephone: (845) 278 -6212 Telephone: (914) 592 -8947 Form LA -97 PUTNAIVI' CO'UNT'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRU CT TON .PER • _ K 1 al.- yC•: %�Y � 4.:e. ..'q/it "' ..'w0. i .,r, -+y . OWNER: STREET LOCATION: IU'' REVIEWED.BY: P14 SP, ; RDATE: � 1 TAX MAN: (CONFIRMED) 7Y �r Y N DOCUMENTS Y N MQUTRED DETAILS ON PLANS CONT'D) PERMIT APPLICATION (:,(HOUSE SEWER -1/7 FT. 4 "0'; TYPE PIPE. CAST IRON WELL PERMIT OR PWS LETTER _(__J(__)NO BENDS; MAX BENDS 45 W /CLEANOUT PC=97 S ,� �. RENRWALS ATIO N UU• (NO CHANGE) DESIGN DATA SHEET DS TE RESOLUTION '� � f_ • � FILL SYSTEMS U 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT EAF FILL SPECS/ FI, 1 -5 PLANS -WEE SETS (; CPROFII.E & ENSIONS c ✓i7 (� HO U E PLANS - TWO SETS FILL IN ANSION AREA V U r REQ � FILL GREATER T&'AN2 FEET ON CLAY BARRIER �dHSUBDIVIKON I,EGAL SUBDIVISION FILL'CERTIFICATIOI�T NOTE APPROVAL CHECKED DEpTg GAUGES (-/ PERC RATE - L' ` VOL. ON PLA1�t UNCLASSIFIED & IMPERVIOUS FILL REQUIRED ?' S DEPTH O% ( SEPARATION DIS TANCE FROM•TOE OF SLOPE U(a% cuRTAIN I} mrr REQUIRED TRENCH , GENERAL {� )LF TRENCHPROVi73ED 60FT MAX. (�} CATED.IN NYC WATERSHED (�L}PARALLEL TO CONTOURS L j PLANS SUBMITTED TO DEP 100 % EXPANSI VID U oN PRO ED D LEGATED�TO PCHD DETA�IL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL EP APPROVAL, IF REQ'D UU --� i (�(�}GEOTEXTILE COVER. �EEP TEST:HOLES OBSERVED SEPARATION DISTANCES ON PLAN, YAOM'SSTS P RCS TO BE wTrNESSED - 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL, �(- APPROVAL SSDS ADJ, LOTS ' 20' TO FOUNDATION WALLS ZWE TLANDS (TOWN/DEC PERMIT REQ D .) 100' TO WELL, 200' IN DLOD,150' TO PITS ATA ONIIDS PLANS dcPERMTT SAME rte 100 ' TO STREAK WA_ TERCO0U, RSE;, . _L.: AER(iac. ezpm), 1969 NEIGHBOR NOTTbICATION (U50' TO CATCSEASIN, 35'.STORVM AN, PIPED WATER TTEIBBA ' its 1 ' FO WATER 1:IN __. 2 , - �1501-*I iTE T�I� DRAINAGE. COURSE ( 'S O,`L''I`1 �51�P1'G lLOT '10 YErO R5 OLD 00'/$00' RESERVOIR, ETC. 150' GALLEY SYSTEMS RMUTRED DETAILS ON PLAINS . l0' M] N TO LEDGE OUTCROP SEWAGE SYSTEM PLAN! - (NORTH ARROW) SEPTIC TANK SSDS HYDRAULIC PROFI (�(10' FROM FOUNDATION; 50' TO WELL Elf, GRAVM FLOW ,� S ! p �D�7 � WELL CONSTRUCTION` NOTES 1 -15 ' x6 DESIGN DATA: PERC & DEEP RESULTS' ULOCATION OF SERVICE CONNECTION 2' CONTOURS EXISTWG & PROPOSED (iO(-) 15' TO'PROPERTY LINE r DRIVEWAY & SLOPES, CUT SLOPE FOOTING/%UTTER/CURTAIN DRAINS SLOPE IN SETS AREA t> ` �(USDA SOIL TYPE BOUNDARIES U 520 /o) v —') (REGRADED TO 1 ° REQUIRED („_}TITLE BLOCK; OWNERS NAME ADDRESS D S STEMS TM#, PEM .NAME, ADDRESS, PHONE# PUMg NOTE )DATE OF DRAWING/REVISION � DATUM REFERENCE ULJDOSF' 95% OF PIPE, VOLUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS U � fP , TC.�f r� LAIM WETLANDS 'WITHIN 200' OF Y.L. U-)PIT AND D -BOX SHOWN &DETAILED U ROPOSED FINISH[ FLOOR AND BASEMENT ELEVATIONS CURTAIN DRAT�I � Q WELLS � SSDS'S W/rN 200' OF SSTs U(_-)S� ANpPIPEs, s' BOTH SMES t- ° l o PROPERTY METES &BOUNDS JL_�15 MRS 4o CDS��5% %, �5' -3 %, ;35' -1 %,100 /0-<1 /o EROSION CONTROL FOxHOUSE, WELL & L-)( --}20' M W to CHA tGEl100, wick 182 cons d .ay discharge SETS, EROSION CONTROL NOTE to N014- PERFORATED PIPE ANTS: I `4NrL h ww° l S %✓ lx M M,�r� lis f. �✓'w;r /n. S r-� ,,� s /%� °; �dt / "� .,,f• lay tfv c�lc z i.ety,ir ' A �. ` Y� � i f '1'�d '''- � E.i.":. 4;7'�G'?- j�/` �' "" -j' ,�••� � '%�wi..�'7> vi"irL U•? C iL 1" G. i C. �'ty �%T . %lmET)09 /0V00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR _.r.,.. _.: =A WA STET HATE R' RFA'Tir�E1`�i�.:SYS 'Eir ' . .. . 1. Name and address of applicant: aj AM—CE S -S ^PFa - -A0 tARZOANI N SCE —LUALMLLA NY 2. Name of project: _-SuW -eA (LCs1WAcR—. 3: Location T/)d: ?tgniorn V1W 4. Design Professional: _ MJCN tEL BeyEA- 5. Address: 273 sTiy Q. Q tee a 6. Drainage Basin: JAAJ so,,� plue 2 I ST Nl/ 1C7� 09 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) .................... ...: ...................... ..::....... Type I Exempt Type II . Unlisted 9. Is'a Draft Environmental Impact Statement'(DEIS) required ?..... ...................... Jo 10. Has DEIS been completed and found acceptable by Lead Agency? ............... ,c.IA 11. Name of Lead Agency 12. Is this project'in an area under the control of local planning, zoning, or other ........ offic- ials,. ordinances ?,...,..... ,:. .. ... 13 If so, have plans been submitted to such authorities? ........ ............................... as 14. Has preliminary approval been granted by such authorities? Date granted: -e (N 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation ?. .................... !4 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? .................. I.................... Aj p 19. If yes, name of water supply` ,,J %/.}- Distance to water supply �J/} 20. Is project site near a public sewage collection or treatment system? .... .... .......... - IJp 21. Name of sewage system %, Distance to sewage system -4i1- 22. Date test holes observed Zt cs 23. Name of Health Inspector S • ?ftaug 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... C� 26. Has SPDES Application•been submitted to local DEC office? .................. ........ d t X��9? 2 27. Is any portion of this project located within a designated Town or State wetland? /J0 28. Wetlands ID Number ........................................................... ............................... 29 Is islet }ands Perrn�t re}nped? ......... ..:.. ....:.....i.................... t d. Has application been made to Town or Local DEC office? .............................. 30. Does project require a DEC Stream `Disturbance Permit? .. .............:................. /JD 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 q 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? ............................... YeslNo. DESCRIBE: .33. Is there a local master plan on file . with the Town'.or `Tillage? ......................... � 34. Are community water and/or sewer facilities planned to be developed within ® 15 years in or adjacent to project site? ................................ ............................... 9 35. Are any sewage treatment areas in excess of 15% slope? . ............................... yes 36. Tax Map ID Number .......................... ............................... Map_Zy. Block _.Lot 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located- within._the NYC Watershed shall_. _ _..' .. ..�.. mow- _. v. be sent�tci tl I-epart�ent,.and:*?cPd"ht be sent in dtpli�;ate fd thc-DEP aitl�ioute project may °iequire DAP . . 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 stormwaterylans 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. I hereby affirm, under 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 2100..45 of the Penal Law. SIGNATURES A OFFICIAL TITLES.- rLiek2 Mailing Address: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESir.NVXTA SIIEE't -- S'U BS-iJk ,ACEy .w- AGE-TItEA`TIiENr Ygtii" " Owner JIM JUMPER Address 10 ARMAND PLACE, VALHALLA Located at (Street) 14 NORTH MEADOW LANE Tax Map 74 Block 1 Lot 9.17 (Indicate nearest cross street) _ Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY Drainage Basin HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pre- soaking 7/7/05 Date of Percolation Test 7/8/05 Hole No. No Time Start— Stop Elapse. Time Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate MinAnch P -1 1 11:49-11:58 9 21 " 24", 3" 3.0 2 11:58 - 12 :09 11 .. 21 " 24" 3" 3.6 3 1210 -12:22 12,_21.11. 24" 3" 4.0 4 12:22 -12:34 1;2 , 21" 24" 3" 4.0 5 P -2 1 11:53-12:11 18 21 " 24" 3" 6.0 :, .. 2 - 12:26 :18 -.21 " . 24,11.31I..._. 6.0 3 12 029 -12:48 19 2111 24" 3" 6.3 4 5 P -3 1 11:54-12:10 16 21 " 24" 3" 5.3 2 12:10 -12:2.8 18 21 11 24" 3 ". 6.0 3 12:28 -12:46 18 21 ° 24" 3„ 6.0 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. 5 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO 2 HOLE NO. G.L. Wooded Hillside Wooded Hillside 0.5' Topsoil Topsoil Lo' Dine: Sandy Loam Fine Sandy ®a�n 1.5' w/ ®bile w/ Cobble 2.0' , 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' butt ®n1 ®t ho" bottom- of hole 7.5 No Ground Water No Ground Water 8.0' 8.5' 9.0' -- -.915' ... _. _ _ _ . - - -- -• -_ _ _ - _._--- __�_._.. 10.0' Indicate level st which groundwater is encountered none Indicate level at which mottling is observed none Indicate level to which water level rues after being encountered none. Deep hole observations made by: Joe ParavatkPCDOH, Michael Bever - B&A Date 6/27/05 Design Professional Planner Bm= and Assadaagn Address: Signature Design Professionsl's Seal NEW F. CC r WWI fl75`�1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES Owner JIM JUMPER Address 10 ARMAND PLACE, VALHALLA Located at (Street) 14 NORTH MEADOW LANE Tax Map 74 Block 1 Lot 9.17 (Indicate nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY; NY , . Drainage Basin HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA. Date of Pre- soaking 7/7/05 Date of Percolation Test 7/8/05 Hole No. u Time Start— Stop Elapse Time Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in .Inches Percolation Rate Min/Inch P -4 1 12:05 - 12:13 8 2111 24" 3" 2.6 2 12:14 - 12:23 9. 2111 24° 3" 3.0 3 12:25 - 12:35 10 2111 2411 3" 3.3 4 5 P -5 1 12:03 -12 :21 18 21 " 24" 3" 6 ? 12:21 -12:40 19 . 2.1 ° 24" 3" 6.3 3 12:41 - 1:00 1 g : 2111 24" 311 �7 6.3 4 5 P -6 1 12 :27 -12 :40 13 21 '` 24" 3" 4.33 2 12:42 -12,57 15. 2111 24" 3" 5.0 3 12 :57 -1:12 15 21 11 24.. 3„ 5.0 4 5 :NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rtes are obtained at each. percolation test hole. ( i.e. :5 1 min for 1 -30 min/inch, 5 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TESTBOLES DEPTH HOLE NO. 3 HOLENO.—A HOLE NO. G.L. Wooded Hillside Wooded Hillside 0.5 Topsoil TQpsoil 1.0) Broivnl- Fine sandy loam Brown Fine sandy loam w/ cobble 2.01 Grey Pine sandy IO-AM 2.51, w/ cobble 3.0' 3.51 4.0 4.59 5.0 5.5 6.0 6.5' 7.0' bottom of hole 7.5' No ground water bottom of hole 8.0.) No wound wafer 8.5 9.09 10.0 ]Indicate level at which groundwater is encountered none Indicate level at which mottling is observed none Indicate level to which water level rises after being encountered none Deep hole observations made by: Joe Paravati-PCDOH, Mchael Beyer - B&A Date 7/8/05 Design Professional, Name: B=andAwadaga Address: Signature )]Design Professional's Seal F. 074 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DES`i�N J%AM'5 '7['= S" "SYT1WxCT; "SE''WAGE'3TiEATMENTS YSTE1PGi ;.,..."_.::....,...."...�.: Owner JIM JUMPER Address 10 ARMAND PLACE ,VALHALLA Located at (Street) 14 NORTH MEADOW LANE Tax Map 74 Block 1 Lot 9.17 (Indicate nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY Drainage Basin HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pre- soaking 7/7/05 Date of Percolation Test 7/8/05 Hole No. Non Start Time — Stop Elapse Time Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch P -7 1 12:29 - 12:37 8 2111 2411 311 2.6 2 12:38 - 12:47. 9 . 2111 24" 3:' 3.0 3 12:48-.- 12:57 .9 2111 24" 3" 3.0 4 5 P -8 1 12:28 -12:35 7 2111 24" 3" 2.3 2 12:36.- 12;44. 8 ....... 2:1 ��. Z4'�. 3.. 2.6 3 12:45 -12:54 9 K 21 " 24" 311 3.0 4 5 . 1 2 3 5 ' Nuirb: t. nests to oe repeatea at same depth until approximately equal percolation rates are obta�ne at.each percolation test hole. ( i.e. :5 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch ) All data to be submitted for- r view. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5 1.0 1.5 2.0 2.5 3.01 3.5' 4.0 4.51 5.0 5.5 6.0. 6.5 7.0 7.5' &W 8.5 9.01 10.0 ffndicate level at which groundwater is encountered I[ndicate level at which mottling is observed Indicate Revel to wh.ich water Revel rises after being encountered Deep hole observations made by: Date Design Professional Name: Bazr and Awrocia= Address: 274 Sin r 2 id" (W) 2784212 signature: rn'v Design ProfessionaR's Seal MEW 273 Starr Ridge Road. Tel. (845) 278 -6212 Brewster, NY 10509 Fax. (845) 278 -0403 June 2, 2008 " Mr. Joe Paravati Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley .NY Tax Man 74 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, The enclosed plans Have been revised as per your comment letter dated May 29, 2008: 1. The seepage pits have been relocated, 100 ft from the proposed•well.' 2. The PCDOH notes have been updated. Enclosed please find a copy of the following items for your review and approval for the renewal of the Permit: • Plan and Profile- Separate Sewage Treatment System -Fill Pad Layout last revised 518108 (4 copies) • Plan and Profile- Separate Sewage Treatment System '— Trench Layout last revised 518108 (2 copies) I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me. ,- ..Verytrulyyours,. _ .__.... >..�.. Michael Beyer, P.E. Project Manager SHERLITA AMLER, MD, MS, ]F'AAP Commissioner of Health ILORETTA-MOLINARI, RN, MSN Associate Commissioner of Health Michael Beyer Beyer & Associates 273 _Starr Ridge Road Brewster, NY 10509 Dear Mr. Beyer: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. H ®NDI Country Executive.. . ROBERT MORRIS, PE Director of Environmental Health May 29, 2008 Re: Proposed SSTS — Jumper North Meadow Lane (T) Putnam Valley, TM# 74.4-9.17 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. 1. The well needs to be a minimum of 100' from the seepage pits. 2. The updated PCDH construction notes are to be provided from the latest version of Bulletin ST -19, Appendix C. This office will continue its review upon consideration of the above- mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP /kly V truly your Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186. Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ONME RIM 91 273 Starr. Ridge. Road Tel. (845) 278 -6212 Brewster, NY 10509 Fax. (845) 278 -0403. May 8, 2008 Mr. Joe Paravati Putnam County Department of Health. 4 Geneva Road Brewster, New. York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Map' 74 Block I Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, .Our client would like to renew the SSTS Construction Permit due to run -out on 6 -9 -08. Enclosed please find a copy of the following items for your review and approval for the renewal of the Permit: • Construction Permit for Sewage Treatment System • Application to Construct a Water Well • NYSDOT Specific Waiver Application • Letter of Authorization • Plan and Profile- Separate Sewage Treatment System -Fill Pad.Layout last revised 518108 (4 copies) • Plan and Profile= Separate Sewage Treatment System - Trench Layout last revised 518108 (4 copies) • House Plans by Westchester Modular dated 201 our copies) • Fee — Certified Check in the amount. of $500 • Copy of Previous Permits dated 619106 1 trust the above materials. are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me. Very truly yours, Michae eye , E Project Manager 273 Starr Ridge Road Brewster, NY 10509 Mr. Joe Paravati Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Man 74 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, TeL (845) 278 -6212 Fax. (845) 278 -0403 May 19, 2006 The enclosed plans have been revised as per your comment letter dated May 15, 2006: 1. We have shifted the SSTS area and fill pad to the right away from the driveway area. Enclosed please find a copy of the following items for your review and approval. o Plan and Profile- Separate Sewage Treatment System —Fill Pad Layout (4 copies) o Plan and Profile- Separate Sewage Treatment System — Trench Layout (4 copies) I trust the above materials are adequate for your approval and complete the submission for the above 'project, However if you have any questions concerning this project, please do not hesitate to call me. k� Ve?y truly. yours, . - ; _. ichael Beyer, P.E. Project Manager SHERLITA AMLER, MD, MS, FAAP Commissioner of Health _ ... ...:.M.. -� .:. in;:. Y�i�i- �.:=i' �i- �w: .:::v:w�s:.�•.'i�.r�":+i�if�%i LORETTA MOLINARI, RN, -MSN Associate Commissioner of Health Michael Beyer, PE Beyer & Associates 273 Starr Ridge Road Brewster, NY 10509 Dear Mr. Beyer: ROBERT J. BONDI _ ... CQunt _&.ccutive �� ►�,::'.:.= �r=- ic:.i:► is J- �t�' r' i►: y.:-: r' r:. �:+ � .�r.:�:1..�::.'.L: "�'i�G =:�"� � ":.w DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT MORRIS, PE Director of Environmental Health ..May 15, 2006 Waiver Committee Determination — Jumper 14 North Meadow Lane (T) Putnam Valley The Putnam County Health Department reviewed the waiver request for the above regarded project on May 12, 2006. The following determination has been made: ❑ The Waiver request was approved. o The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. The Waiver request wad net; wted_Qu, ExplanAtion,ndted below:::- . . 1. Please shift the fill pad and SSTS area to the right away from the driveway and the driveway retaining wall. . If there are any questions regarding this matter, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Very truly yours, oseph S. Paravati, Jr. /Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 273 Starr Ridge Road Tel., .(845) 278 -6212 Brewster, NY 10509 Fax. (845) 278. -0403 March 31, 2005 Mr. Joe Paravati Putnam County Department of Health 4 Geneva Road Brewster; New York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Map 74 Block 1 Lot .9.17 Jumper Prperties Subdivision Lot 7 Dear Mr. Paravati, . The enclosed plans have been revised as per your comment letter dated March 27, 2006: 1. We do request that the 2 :1 slope be added to the. waivers requested. 2. A retaining wall detail has been added to the fill plan. 3. The SSTS data section . has been revised. 4. Two complete copies of the proposed house plans are enclosed. Enclosed please find a copy of the following items for your review and approval. o. Plan and Profile- Separate Sewage Treatment System Fill Pad Layout (4 copies) o Plan and Profile -. Separate Sewage Treatment System = Trench Layout (4 copies) o House Plans (three Dwgs) (2 copies) "" ` "- " "" �'T trust "the above materials 'are ad equate .for your approval and 'comple ~te the submission for the above project, However if you have. any questions concerning this project, please do not hesitate to call me. WE request that the project be placed on the next available waiver committee meeting agenda. Very truly yours, Michael Beyer, P.E. Project Manager .01-15 _ _ _ 273 Starr. Ridge Road . TeL (845) 278 -6212 Brewster, NY 10509 Fax.. (845) 278 -0403 i March 8, 2005 Mr. Joe Paravati Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Map 74 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, The enclosed plans have been revised as per your comment letter dated February 2, 2006: 1. The system'has been located as per the approved filed subdivision :map #2617B as approved by the Putnam County Department of Health. Thus, we are. hereby .requesting a waiver from the current code for the proposed SSTS to be located'on a slope greater than 15% 2. The actual test results have been submitted on new design data sheets. 3. A maximum of a 2 ft high retaining wall will be placed at the property line as shown on the plans. 4. The wall height has been noted. Since the wall is a . maximum of two feet high, a detail has not been included. 5. The length and width have been included on the fill pad. 6 Dimensions have been provided from the well to the property line. 7 The basement plain has been revised to eliminate the potential for an additional bedroom. ... _ - iiN� a vpy c*'i6aejLo: ttowiitg ttens Jar your review ad'pproaT. _ ... ' ` --. ::En* please J • Design Data Sheet (4 copies) Plan and Profile- Separate Sewage Treatment System —Fill Pad Layout (4 copies) • . Plan and Profile - Separate Sewage Treatment System — Trench Layout (4 copies) Basement Plan Dwg 4 of 9 (2 copies) I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions. concerning this project; please do not hesitate to call me. WE request that the project be placed on the next available waiver committee meeting agenda. Very truly yours, M chael Beyer, P. Project Manager PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF .ENVIROMENTAL HEALTH SERVICES- ..- ,rr..:`�;ai ... �.;.;;-.....- �_,:-- �, ;�.i'N::�'j.1a- t�..T..... —.,. DESIGN DATA SHEET — SUBSURFACE SEWA :VA; TREATMENT SYSTEM ' Owner JIM JUMPER Address 10 ARMAND PLACE, VALHALLA Located at(Street) '14. NORTH MEADOW LANE Tax Map 74 Block 1 Lot 9.17 (Indicate nearest cross street) -Subdivision Lot Municipality. TOWN OF PUTNAM VALLEY, NY Drainage. Basin . HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pie - soaking 1/1/93. Date. of Percolation Test 1/1/99 Hole: No. Non S Time Start— Stop Elapse Time Depth to Water From'Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch 1 1 1:02 -1:32. 30 24.25" - 25:58'.' 1.33. 22.6 2 1:33 -2:03 30 24.2511- 25.58" 1.33 22.6 3 - 2:04 -2:34 30 24.25'.' - 25.58" 1.33 22.6 4 2:_35 -3:05 30 24.25"' - 25.58" 1.3.3 22.6 5 2.' 1 1:04-1:34' 30 23.751.1- 25.08" 1:33 22.6 2., 1:35 -2:05 30•: 23.75 "25:00" 125 .24 3 2:06 -2 :36 30 23.7511- 25.00" 125 24 4 2:37 -3:07 30 23.75 " - 25.00" 1.25 24 1 PERCOLATION RATE . 21 -30 MIN/INCH AS PER FILED SUBDIVISION MAP #2617B 2 3.. 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are - obtained ate ch percolation test hole. ( i.e. S 1 min ford -30 min/inch, 5 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 TEST PIT DATA. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES r.�$e a :rw a a..: n..r -.ISM -w t di:::b..- i.s+Fs,y ' st ....n,..•r*,:�.'.".C'.:.::.1: ; a - ... _ aD::i: .�. r -.:._ .. �- :'....,..,e+Y�.a ...r....+v.s�e., . -w.s s,r,,. :.,verso - r;>d 1+i; "{,�Y-';lt+:.,a•.+wv ..S: ..':.C..'.q:�^�_..re Indicate level at which groundwater is encounatered Indicate level at which mottling is observed Indicate ievei.t® which water level rises after being encountered Deep in®ie observations made by: Date Design Professional Name: H A= and Aysociatec Address: 271 Starr Rid= Raad Signature: r besign Professional's Beall �.r; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET = SUBSURFACE SEWAGE TREATMENT SYSTEM Owner JIM JUMPER Address : 10 ARMAND PLACE, VALHALLA . Located at (Street) . 14 NORTH MEADOW. LANE Tax Map 74 Block 1 Lot 9.17 (Indicate. nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY Drainage. Basin HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pre- soaking 1/1'/93 Date of Percolation Test 1/1/93 Bole No.: Run No. Time Start —Stop Elapse Time Depth to Water. From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch 1 i 1:02 -1:32 30 24.25" - 25.58" 1.33. 22.6 . 2 1:33 -2:03 30 24.25" - 25.58" 1.33 22.6 3 2:04 -2:34 30 24.25" - 25.58" 1.33 22.6 4 2:35 -3:05 .30 2425" - 25.58" 1.33 22.6 5. 2 '-.1 1:04 -1:34 30 23.75" - 25.08" 1.33 22.6 .1.;35 -2:05 . 30,. -- • 23.75 " - 25.0(! ° , 1.25,J_ 24. 3 2:06 -2:36 30 23.75:' - 25.00" 1..25 24 4 2:37 -3:07 30 23.75 " - 25.00" 1.25 24 5 1 PERCOLATION RATE 21 -30 MIN/INCH AS PER FILED SUBDIVISION MAP #2617B 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. 5 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST. HOLES Indicate level at Which groundwater is encountered Indicate level at which mottling is observed Indicate level to which Water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Bgy+ x I and Al sso ckd .s Address: 2 7? Slarr. Rid= Enact signnaturI( S'- Co PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner JIM JUMPER... Address 10 ARMAND PLACE, VALHALLA Located at (Street) 14 NORTH MEADOW_ LANE Tax Map 74 Block -1 Lot . 9.17 (Indicate nearest cross street) Subdivision Lot Municipality TOWN OF PUTNAM VALLEY, NY . Drainage Basin HUDSON RIVER WATERSHED . 'SOIL PERCOLATION TEST DATA Date of Pre- soaking 1/1/93 Date of Percolation Test 1/1/93 Hole No. Non t Time Start— Stop Elapse Time Depth. to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate 1VIin/lnch 1 1 '.1:02-1-32 30-. 24.25" - 25.58" 1.33. 22.6 2 1:33 -2:03 30 24.25" - 25.58" 1.33'' 22.6- 3 2:04 -2:34 .30 24:25" - 25.58" 1.33 22.6 4 2 35 -3:05 30 24.2511- 25.58" 1.331. 22.6 5 2 1 1:04 -1:34 30 23.75" - 25.08" 1.33 22.6 ?.. 1:35 2 :05 _.A_.�::_ _23,Z5'.'25f 0Q:' . j. _1 025 _ ...Y_.:24..�: 3 2 006 -2:36 30 23.75 " - 25.00" 1.25 24 4 2:37-3:07' 30. 23.75 " - 25.00" 1.25 24 5 , 1 PERCOLATION RATE 21 -30 .MIN/INCH AST ER, FILED SUBDIVISION , MAP #2617B 2 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal�percolation ratesare;obtained,at each percolation test hole. ( i.e. <_ 1 min for 1 -30 min/inch, S 2 nun 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST. HOLES indicate Ievell.at which grou ndwater is encountered, Indicate level at which mottling is observed) Indicate level to which water level rises after being encountered Deem h®llc observations 'made by: Date IIDesign Professional Name: B=r and Aysncia&s Address:* 73 Varr RidZe Road Signature: ?Q# NIV 01 L V W 90 Design Professionnal's Seal 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE'TREATMENT SYSTEM Owner JIM JUMPER Address .10 ARMAND PLACE; VALHALLA Located at (Street) 14 NORTH MEADOW LANE Tax Map. : 74. Block 1, Lot 9.17 (Indicate nearest cross street) Subdivision Lot Municipality. TOWN OF PUTNAM VALLEY, NY Drainage Basin .. HUDSON RIVER WATERSHED SOIL PERCOLATION TEST DATA Date of Pre - soaking 1/1 /93. Date of Percolation Test 1/1/93 Hole No. u Time Start— Stop Elapse Time Depth to Water From Ground Surface (inches) Start Stop . Water Level Drop in Inches Percolation Rate Min/Inch 1 1 1;02 -1:32 30 24.25" - 25.58"t 1.33. 22.6 1:33 -2:03 30 24.25" - 25.58" 1.33 22.6 3 2:04 -2 :34 30-- 24.25" - 25.58" 1.33 22.6 4 2;35 -3:05 30 24.2511- 25.58: 1.33 22.6 5 2 1 1:04 -1 :34 30 23.75"- 25.08" .1:33 22.6 _ . 2 ..: :35- 2.05.: �:. 30 - �_ 23.75 " - 25.00" 1.25 :24 3 2:06 -2:36 30 23.75 " - 25.00" 1:25 24 4 2:37 -3 :07 30 23.7511- 25.00" 1.25 24 5 1. PERCOLATION RATE 21 -30 MINANCH AS PER FILED SUBDIVISION MAP #2617B 2 3. 4 5 Nu i is: i. i ests to. oe repeateu at same ciepth until approximately equal percolation rates are obtain_ ed.at each percolation test hole. ( i.e. S 1 min for 1 730 min/inch, 5 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 'TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO HOLE NO. _ G.L. 0.5� 1.0' . 1.5' 2.0' 2.5' 3.5' 4.5' 5.0, 5.5' 7:0' 7.5' 8.0' 8.5' 9.0' 10.0' . Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep IlioIle observations made by: Date Design I?roffessional Name: B r and Associates Brey 1 i Signature: 5 �01 I I V 01 M 90 Design Professional's Beall - a SHERLI•TA AMLER, MD, MS, FAAP Commtssioner ofHed1tn' ' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 FACSIMILE TRANSMITTAL To: 106- Fax: 2 7;� ROBERT J. BONDI :C:odhiy'Lecutive From: =;0e'. •,Tr: 401+C Date: 2q r Re: �� /c�.�%�rLS, /�Uw! Pages: CC: ❑ Urgent . :For Review . ❑ Please Comment ❑ Please Reply CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that.any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845- 278 -6130) and destroy all documents associated with this facsimile. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax (845) 278 -6648 0 / 06 4 PU11W4 CM117 DEPAIZ11,11UIr OF HEA11111 SECTION LOT - DIVIS100 OF EWHU1*N1AL HEAU111 SERVICES IG, 7 FILE .M. .P_q�C_�..9EWAGE DISEDSAL. SYSTF #jWner JAMES JUMPER Mdress 29 BARGER STREET, PUTNAM_VALL9Yf. NEW YORK 10579 UxaLed at (Street)_ BARGER STREET Sec. 74. Block 1 Lot 9 (Indicate nearest cross street), Mdhibipality TOWN OF PUTNAM VALLEY Watershed HUDSON RIVER SO-11, PERWIM10H TFS-r M1!A REX)U11tfD ID BE SUM11TED Willi APPIACUIONS bAd bf Pre-Soaking 1 1 9 3 1.25 Date of Percolation Test 1 1 / 9 3 30 23.75 25 1.25 30/1.25=24 HOLE NLNBER CUIZ Tjl•IE PERCX)WICN FERODIATION RLM Elapse Depth to Water From Water Level w0a Time Ground Surface In Inches Soil Pate Min. Start Stop Drop In Min/in Drop Incises Indies Indies SECT, II LOT.- 7 1:02-1:32 30 24.25 25.58 1.33 30/1.33=22.6 PTH 1:33-2:03 30 24.25 25.58 .1.33 30/1';F33=22.6 3.2:04-2:34 30. 24.25 25.58 1.33 30/1,33=22.6 4,2:35-3:05 30. . 24.25 25.58 1.33 30/1.33=22.6 I. PTH . 2, 1 ^.04 -1.34 . 30 23.75 25.08 1.33 30/1.-33=22.6 2 1:35-2:05 30 23.75 25 p 1.25 30/1.25= 24 3 2:.06-2:36 30 23.75 25 1.25 30/1.25=24 2:31-3:07 30 23.75 25 1.25 30/1.25=24 2' 3 Tests to be repeated at sane depth until approximately te's egmi soil sates are VbLained at each percolation test hole.. All data to b--;. subvd ttb4 for review. 2. Depth measureinents to be node fran top of hole. rev, 9/85 SIIKIU.ri'A AMLEA, MD, MS, FAAP C:nwuaissionei fNaalrA LORETTA MOLINARI. RN, MSN .Ir,ucfum Cummirsiduur of /fanfrh A t DEPARTMENT OF HEALTH I (;eneva Road, Grewster, New York 10509 F'ACSIMYLF TR4NSMITTAL RUDERI' S. ItUN01 County F—or oy °3 Tt1: �1� u�... Cull.,• !'� - -- -- F�: __ �' .,_ 7tl � _ From: J, Atr'f c Lure: � -- ? 17/1, Re: -- 3•-�. l.vi ° iK r �:;.Rr$r /inha:%" Pugc, CC: ...................................................................................... ............................... fl UI'genl ;Kbm kavieK L. Plr. :,ve Cnttnn:hl ❑ Pirtle Reply CON17DftN'I'IAL,I'1'T 5'1'a CEMENT: Ti­ul'w um,iwi r.;mumed in this 18uaimilc muy etmwin t70NF7U &*1TInL and Icgully protected inlinnualor. bnenict owy for ihu u;c of lhu imlividuw of entity named above. It thu Nader of i dds message is rol the intended r,aiplont, you uce hereby nutifiud shot any dissclwioq di vlbdrlou, 01 co;ving of :hi: telecopy is smnly prohibited if you how ncaivrd a& t —copy In aau,, ptcase immodimely noufy, es by (u:cplwn� (545 -375. 6150,1 and dcstr..y till dc"Mm asaoaiatod Willi this faniudlc. I7ovlromawul 11a t6 (645, ?716130 Ru iaUl! /8.7921 Fume - Sarvleas(84d) 278•ri55e Fu (845)_)a1a126 WIC (1145) 278.6678 NurAaa Hera•Cun F.c (14151278.6085 Fart) 1mervralleWPrylool(R1512'ra /4114 1ut645)178.6648 • • •QHZ1.IWSNKHS ZNHWID a ZNa08H 30 ZOVd ,LS*dI d NO W08 „Sig ,00 TS:9T LO -HVW Z/Z £OV08LZ6 siznsau HQOW semis IUVILs SHOVC1 BNOHd . T7,6L- 8LZ -Sb8 I= HZ'I aH 30 ZNHWZHVdBQ A LNn00 WVN.Lnd HKVN ZS:9T SflL. 90OZ -L -EVW • SIVG :w�p u.,4,..t•. ... �, ,.�.7. _.!'!P.,O!.STa .,> .• -e..: r s....,, ,. :.,a . •.aL �M vw:.:a:..— . _ -. ... _ ._ .. •� N0I1WEdN00 ONIGMS .. SHERLITA AM LER, MD, MS, iF'AAP Commissioner of Health 1LORETTA MOLINARI, RN, MSN ^ ... Associate Commissioner of Health Mike Beyer, PE Beyer & Associates 273 Stan Ridge Road Brewster, New York 10509 Dear Mr. Beyer: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 2, 2006 ROBERT J. E®NDI County Executive Re: Proposed SSTS — Jumper 14 North Meadow Lane (T) Putnam Valley, TM# 74. -1 -9.17 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. 1. The following does not meet current code: o SSTS proposed on a slope greater than 15 %. Based on the above, the application is denied. However, it is the right of the applicant to request a waiver from the current code. 2. The subdivision data should be provided on the design data sheet (actual test results). 3. The retaining wall should be relocated so that it is closer to the property line, as far away from the SSTS as possible. The wall should be a minimum of 10 feet from the property line. . 4. Please provide a retaining wall detail and note the maximum wall height. 5. Please provide the length and width of the fill pad on sheet 1 of 2. 6. Please provide dimensions from the well to the property lines. 7. Floor plans provided contain a minimum of 5 potential bedrooms. 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. Sincerely, Joseph S. Paravati, Jr. JSP:cj Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 273 Starr Ridge Road Brewster, NY 10509 Mr. Joe Paravali Putnam County Department of Health 4. Geneva Road Brewster, New York 10509 Tel. (845) 278-6212 Fax. (845) 278-0403 December 19, 2005 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY Tax Map 74 Block I Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, The enclosed plans have been revised as per your comment letter dated September 21, 2005: 1. The system has been redesigned for a 21-30 minlinch percolation rate. Additional design data sheet has been enclosed. 2. We have located the retaining wall as per PCDOH regulations.- The. retaining wall is required due to the fact. that we cannot meet the 3 on I slope back to grade within the property line limits. 'We.investigated a 2 on I slope. and alsofound that we could not return to grade within the property line'limits. 3. We have included 3 copies of the fill plan and trench plan. The redesign of the new system required us to relocate the fill pad as shown. This reduced the overall depth of the fill pad but increased the footprint of the fill pad. items E?�,ql�y,�4 pleas nd, a qpp j�jf fb�l?!�ing. i ms fo or yo our review and qpp royal. Design Data Sheet • Plan and Profile- Separate Sewage Treatment System —Fill Pad Layout (3 copies) • Plan and Profile- Separate Sewage Treatment System —Trench Layout (3 copies) I trust the above materials are adequate for your approval and. complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me.- Very truly yours, Wchael Beyer, P.E. Project Manager Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mike Beyer, PE Beyer & Associates 273 Starr Ridge Road Brewster, New York 10509 Dear Mr. Beyer: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 21, 2005 ROBERT J.. BONIDI o iity "Eireciiave v Re: Proposed SSTS - Jumper 14 North Meadow Lane, (T) Putnam Valley TM# 74 -1 -9.17 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. 1. Although it was first thought and agreed upon in the field that new perc test results that were better than the original subdivision perc testing would be acceptable if enough tests were done in the proposed SSTS area, the subdivision plat which is a legal document can't be changed. Therefore, the original perc test result of 21 - 30 min/inch must be used to design the SSTS. _-2. Reiaining walls -cawi' be -aced to side-slopes.. All_fill- pads. must return to the natural theoretical grade based on the amount of fill at the last trench. Only at this point can a retaining wall be used. It is further recommended that the side slopes continue without a wall for as far as possible. If the regrading cannot return to natural grade before the property line, than a retaining wall could be used. 3. Fill plans submitted are showing the trench design. A minimum of 3 copies of fill design only needs to be submitted. Only one copy of the trench plan is required, but more may be submitted. 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 Sincerely, oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Brewster, NY 10509 Fax. (845) 278 -0403 August 15, 2005 Mr. Joe Paravati Putnam County Department of Health 4 Geneva Road . Brewster,. New York 10509 Re: Jumper Residence 14 North Meadow Lane, Putnam Valley NY . Tax Map 74 Block 1 Lot 917 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, Our client, James Jumper, proposes to construct a single-family residence at the above address to be serviced by an individual subsurface sewage treatment system and a private drilled well. Enclosed please find a copy of the following items for your review and approval: Construction Permit for Sewage Treatment System • Application for Approval of Plans for a Wastewater Treatment System. • Application to Construct a Water Well • Design Data Sheets • Letter of Authorization Short Environmental Assessment Form • Plan and Profile- Separate Sewage Treatment S (4. copies) • Fee - Certified Check in the amount of $400 .:Douse Piriri T oui, (:�. l ►ptes) �. _". ... _._, . _..,... : � .. - I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me. Very truly yours, Mi , l Beyer, P.E. Project Manager w : G-. .. - _ • . .. . d r•d �l •• P' -�f -iii= C, a .. _ y ?+�� :r � . BRUCE R. FOLLY Public Health DOector - _ ♦,1. .. . ^: ��+.!r a ~�.6 KYU 4 /vs};..4~CI.. r, y(l �: Y .. ..� -"�� LORD:TTA MOLINARI R.N., M.S.N. Aa roctade l uNic Health Direcdar Dimcwr of Pad ent &wvfcear DEPARTMENT ALT I Geneva Road Brewster, New York. 10509 �. REQUES ATTENTM: 0 ADAM STIESELING; ❑ GZWE MID All information below merit be fuft completed prior tw..y `scheduhg. ENGINEER OR FI RM: PHONE #: Z7 8 -6 21 � I�E.ASON: DEEPS: PERCS: a F11W TZST: n I ®. /SZ'Tt E'Y': 4 � Any r& 4/7e— TOWN: Somvisrom ,iv\PP,(L. ]LOT#: OWNER: a_uVV1P �(L Pr oposed S S TS inter - - R usage lbasin ®ff Yost iranr� or mydsr� ®roar Reservoirs. 11 Proposed SM �. k" $00 feet ;of a reservoir, reservoir stm or control lakv,. 0 Proposed SSTS within 200 feet of a watercourse or. a DEC wetland. 0 Proposed SSTS. design flbiv greeter than 1000 gaOldns /diay or SP DES Permit required. o 'Proposed. SSTS for a Cdaimeriea,# Project It is the rewnsibility of the design professional to provide the above information prior to soil testing. This Department will ., determine the NYCDEP °projec$ status (Joint or Delegated) based on the response; _if,you amweredy—es g®; any of the questions; NY DEP -must.e kness the soil testing. This Department will coordinate a mutually suitable time for field testing with the IPCDOH, the Design Professional and NVCIDEP. If a projcct his been detennined to be.' Delegated based on the above ressponse and *en subsequent infformation iodicates NYCDEP is required, to. witness the sol testing, it. Will be _the sole responsibility of the design professional to schedule re-witnessing of the soak testing rft IYCDEP. MAR -22- 2005 -.TUE 16:11 TEL:.e45 -27877921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 'PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L/C 'SlIERT-T SM .1 U TMU IVIT 1;;� DONNIE _Lkiffi SECTION A. GENERAL INFORMATION Name of Project — ( J Site Location- county Building construction begun A/b, Extent Is property within NYC Watershed? ................. f7 Yes �NO' SECTION B. TOPOGRAPHY (Please check all appropriate doges) 1. � -hilly -� Rolling F7 Steep slope F7 Gentle slope Flat 2. 0 Rvidenc-6 of wetlands a Low area subject to flooding a- Bodies of water. f7 Drainage ditches F7 Rock. outcrops 3. Property lines or comers evident ............... * ..................................... Yes No 4. Do water courses exist on or adjoin the-property? .............................. 'F.7*Yes No 5 Will these affect the design of the sewage system facilities ?.......,.... Yes 6. Do watershed regulations apply in this development? ....................... F7 Yes No 7 Will extensive grading be necessary? ............................... ................ Yes 9. Will extensive fill be necessary for SSTS? ............................ Yes 9. no filled areas exist within the SSTS area? ....................................... Yes If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS MWAR No 10 Appearance of Boil: and Gmv e eL/�Kj Loam Clay Hardpan []Mixtur. 11. Observed-from: Borings Bank cut Backhoeexcivations -7/,-7 12. Soil borings/excavations observed by on 13. Depth'to groundwater on, .14. Depth to mottling A// on 15. Are. test holes representative of primary & reserve areas...,........... Yes No 15. Soil percolation tests made by.' 'le -7 /1" on 17. Soil percolation tests witnessed by �% on SECTION D (on back) Form ST -1 P) gEttrom-bRAINAGE 18. Will Proposed grading materially alter the natural drainage in this or adjacent areas?[:] Yes 0 19. Will groundwater or surface drainage require special consideiation? ...................... . es 20. Will gullies, ditches, etc.; be filled and watercourses be relocated! ............ � -Yes 0 SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of4e 2•.0 existing or proposed source and facilities ?.........., 3.0 4.0 Inspection data ......... . ... . ....... F-1 Yes No 6.0 22. 23. Do adjacent wells aiid/or sewage systems exist? . .......... es: F7-No Additional comments (ea ce'llu s 24. Site observerAiispector and title 25. Date(s)- of PbservationWinspe6tion(s) - �� ;- TEST PIT PROFILES .Hole # ----L-Lot # Hole # 'Lot # Depth to water Depth to water Dh mottli D ppt, to .mottling to rock/imp.:J+4/ Depth to rock/imp. + G.L. > G.L. 0.5 .0.5 1.0 1.0................... ( ... .. .......................... 2.0 2.0 3.0. 3.Q ---------------- 4.0 4.0 ----------------- 5.0 5.0 .6..0 6.0 7.0 ----------------- 7.0 8.0 8.0 9..0 9.0 10. -111 Hole #' 3 Lot # Depth to water Depth fo motfl--- Depth to rock/imp---2-,ii G.L. - - 73 lox-, 1.0 2•.0 3.0 4.0 5.0 6.0 ��W7 9.0 0.0 f q coo Scarr Rid'g'e lioa°d r' °' " - Tel. (845) 278 -6212 Brewster, NY 10509 Fax. (845) 278 -0403 June 2, 2005 Joe Paravati Putnam County Department-of Health 4 Geneva Road Brewster, New York 10509 Re: Jumper Residence Meadow Lane, Town of Putnam Valley Tax Map 74.1 Block 1 Lot 9.17 Jumper Properties Subdivision Lot 7 Dear Mr. Paravati, Enclosed please find a copy of the following items for your review: Preliminary Site Layout dated 612105 We have plotted the adjacent wells and septic as per a file search of the PCDOH records. We' have located the well to be within the regulations regardless on the activity to the rear of the lot. (we could not obtain any information to the rear of the lot). The existing slope in the ssts. area as per the filed subdivision map is 18.8 01o. After field testing we will look to shift the system uphill, away from the slope. I trust the above materials are adequate to schedule a field test date for the above project, However if you have any questions concerning this project, please do not hesitate to call me. Very truly yours Mic Z Beyer, P. . Project Manager . 273 Starr Ridge Road Brewster, NY 10509 Tel. (845) 278 -6212 Fax. (845) 278 -0403 March 30, 2005 Joe Paravati Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re Jumper Residence Meadow Lane, Town of Putnam Valley Tax Map 74.1 Block I Lot 9.17 Jumper Properties. Subdivision Lot 7 Dear Mr. Paravati, Enclosed please find a copy of the following items for your review: a . Preliminary" Site Layout © Jumper Properties Subdivision Map I trust the above materials are adequate . to schedule afield test date for the above project, However if you have any questions concerning this project, please do not hesitate to call me. Very truly yours, Michael Beyer, P.E. Project Manager PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES fir_ v F Hf'- {i.•A'v t"^•Y�.t•t<.. .11� r,'- F..f:'�"e• > -�.az .F. i..h.Y :-1.: yv "V.:.e'ri'rt WellxP.eirmtt #r.�:� ,.Gx: tlt WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # ;'' 41 °22'30.7N 14 North Meadow Lane Putnam Valley Map Block Lot(s) 073048'41.3W Well Owner: Name: Address: Matt Jumper, 10 Armand Place, Valhalla,'NY 10595 Use of Well: X Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment XRotary _Cable percussion XCompressed air percussion Other(specify) Well Type _Screened ^Open end casing X Open hole in bedrock _Other Total Length 42 ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Casing Details Length below grade4l ft. Seal: X Cement grout Bentonite Other Diameter 6 in. Drive shoe: X Yes _ No Liner: Yes -X No Weight per foot 19 lb/ft Diameter in Slot Size Length (ft ) Dept to Screen ft Develo ped? Screen Details First I _Yes No Hours Second Ll Well Yield Test _Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Date Measure from land surface - static specify ft) During yield test ft ) DeptT of compete we n . 60' 520' 610' Well Log Depth From Surface Well Diameter ft. ft. If more detailed Water Bearing in Formation Description information ::Gos; riptibiis : r Land surface 8 Drilling in . ov rburden . clay 4 - l o • c -... _ - _ -..._ _Hi "t rock_ .at__g. _ _ .. 8 42 DrillinR in ro k set casina, grouted sieve analyses 42 1. 610 Drilling in rock granite are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Y7" , 7' u1� ` r Pump Type sub Capacity 5o pm during drilling Depth 540' Model 5GS15412 ji -( �` list: Voltage 230 Hp 1.5 1 Tank Type WX251 Volume 62 gallons Date Well C0. mpleted ' 5/13/09 WeII DFiller PC Certificate # ;0 NY State # , k , ,K `� NtYR 1 1 5 pumpinstaller PC,Certifcate. #' 024 NY State # ,rD =0 0 eo epo r r:: i Dat f R rt r6/12/09``� Welf Driller Name &Address c-­1 4 rPutnam.Ave. ' _Brewster, ;: NY x- 1:050.9 ;:: .,.� Well nature) lit Chr.is.to her.'Bearl'wt" .:.� .sine Pump Installer Name &Address k ^0 P F Beal &Sons, Inc 4 Putnam Ave ,Brewster, NY 10509 . ,t ..... „....,, _:,,..r.:. P taller signature) jj }4�Rrr�'�`1rta lf, L^ kl r,,y. Xg. G hristo her:Beal a..a ,M.,ra. NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. (W:hite co=yH D Fi le; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller . Form WC -97 Rev. 3/06 '1 ,1 nos ie 9r� \ .k •�k LOT 7 AREA = 3.0122 ACRES 131,212 SO. FT. rotohh way L E D G E r e v 0 Water Line dr/ve way Omoh Well �y1 .1 oYvh ''cam erg e •� C �s O` —�e/ay �.�°�.9�, O o ° O ' � O r u s ti � o f y 1 r .ry , �OV.1 N f5e02'00" E utwty 26.56' n cmcrote monument found r7M F ;1 v i k Cr. ogve/ ore° t i 2— S7Z34Y fRAVj- Hotl . k FMOING AND ROQF DRAINS BO' • so �� EXPANSION ,1 tEA N 74°58'00" 1P` ,tz 104.0f' Zo � Septic Tank , 1 , Pump Tank Distribution Box O 96 96' 1W DS = 672 .LF) PRIMARY AREA (7 - 96 LF REIDS = 672 LF) Concrete rotehh R = 200.00' .mv 4, 380`5�,�3 p a and of A B c D 99.5 107.5 r .I..�__..1.7 1 29.4 13.7 2 30.2 22.1 3 54.6 54.3 4 63.6 64.5 5 66.3 70.3 6 69.5 74.2 7 74.1 79.7 8 77.3 83.7 9 82.3 89.5 10' 86.1 93.8 11 157.5 153.1 12 158.1 154.4 13 158.2 155.2 14 160.4 158.1 15 161.6 159.8 !6- _ w. 164.7 183.5. -- 166.9 166.4 i I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION F ENURONNjENT� EALTH SERVICES. JCS APPROVE AS NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE UTNA C TY HEALTH GEPARTMENT. <o ~ I ATURE & Ti L TE ALLEN BEALS, M.D., J.D. Commissioner of Health r Z''Li:iYil lilop%i(iD,F:�;.� r •:�:' Director of Environmental Health April 17, 2014 MARYELLEN ODELL County Ezecuttve �... _ sir •,n .h: . DEPARTMENT OF ]HEALTH, 1 Geneva Road,. Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Matthew Jumper 14 North Meadow Lane Putnam Valley, NY 10579 Re: Addition — A- 043 -14 No Increase in Number of Bedrooms 14 North Meadow Lane ,(T) Putnam Valley, T.M. 74. -1 -9.17 Dear Mr. Jumper: This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. 'The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated April 17, 2014. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be 3. All .plumbing fixtures must be updated with water saving devices, -i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 4. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 5. This approval is valid for two (2) years and expires on April 17, 2016. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, Gene D. Reed Principal Engineering Aide GDR:cw cc: BI (T) Putnam Valley AELEN BEALS, M.D., J.D. Commissioner ojHealth I ROBERT MORRIS, P.E. - ': ' Tits °lee of tivirbninerital tfe #ltfi' O MARY-ELLEN O]DELL County Executive •''�'.�S ^.. �- ... -, '�' .'v�.<`.,,�r�p {,ry ^a %..gib l�:: , DEPARTMENT OF HEALTH 1 Genpa Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 AIDDITION APPLICATION RESIDENTLA. ONLY 1�1 -1 -9.n STREET W ftdaJ TOWN . Vkl�TAX MAP # NAMEk W f �� 1;Pff PHONE U'1. 41" 1 PCHD "(� = 15 =� y MAILING ADDRESS IDESCRIPTIO OF A.DIDITI ®N firi,� *NUMBER OF EXISTING BEDROOMS NUMBER OF PROPOSED NEW BEDROOMS *.(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING..INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, -- Brewster. -NY . 10509, Pb.. ne• -(845) 808-T3,90, _ ...—..� M: -� .. -. ✓. .,e. :....a � ..r ... � . .._ _. - ....... ... ..., �: ..,.�. pr, ...w+ar'..�— .•.K. —�•'� al.. i.: '[ • .y. r .. .r. y 1. Certified check or money order for $100:00. 2. Sketches of existing floor plan (drawn to scale, all Hiving area including basement, to be shown and dimensioned and use of each room specified).. (See Section 3.c of Bulletin HA -1) 3. Two sets'of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedrdom count of dwelling. OFFICE USE COMMENTS 4. ALLEN ' BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. to MARYELLEN ODELL County Executive DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Phone # (845) 808-1390 Fax # (845) 278-7921 Town Legal Bedroom Count & Proposed Addition Status Re: (Owner's Name) Tax map # 711, Address: A/ AVa,,i-A 1ki. 0 Town: ViP7 0 yYi ✓& Year Built: According to records maintained by the Town, the above noted dwelling, is k//" in compliance with Town, Code. Is not in compliance with Town Code. The LeWat Bedroom Co6a-i This information has been obtained from: Certificate of Occupancy: Other: VI-11" The plans for the proposed addition are considered: Addition to existing house only Teardown and/or re-build allowed under Town Regulations wilding Inspector Date 5. I certify: that the system(s), as listed, serving the above ;premises were constructed essentially as shown on the .as= built plan .(copies ofwluch are attached), in accordance with the issued`PCHD Construction Permit and .approved plans and the standards, rules and regulations of the Putnam County Department of Health Date Certified:by P.E. � R.A. (Design Profession Address 5lil`li!? I�0e-�' I L,c..1Sr'' ,;_ License #. ✓'. X3`9. Any person occupying. premises served by the above.. system(s)'shall promptly take such action, as may <be necessary to.•secure the correction of.anyunsanitary 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 oraphange ,1%i,�i the judgment of the Public Health Director such revocation; modification or change is necessary. By: �� m . Title: r Date. �.� I0�7 64opy - HD File; Yellow copy - uilding.Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 iEr /trildTOFHEAITH PLRfJS�APP :iOVCt GR BLDRg6ht COUNT ONLY { _ -- - i ' ' ' i • t t �' b ^• - { -I- - +�E� �ODP:1S • B f ! { 1 I I I 1 I -1, 11LI SU M ST S. U V7. REVI310t1r'TL.(FiRA7�ONB H USE TDiE$E - 4- r -1 r -r - - -- - ..` . I __ i m FiLAN6 E SUBf 91j(EC� TO'( L i CDOH FOR &RL�VAL' i -' _! _ I ' _' I _ ' _ _ t_ -�_ ` - }- !_ -i__ i I ; i— T�Ir -j 1_:._ ' (1� {�t��' -1 :-!�• i I (:_�+ _:I {r-•--_I--- tlr. -�i^- _ -_i -� -'' _-°`{- '� �'- ;".'�.- F 11��i -,,i —} -t- f_ -�- - - _ .F _ _) 1 ti _' I - - i IVl1T4 }RF RT17! i I � I. ( ! i� �- --�- }---;1 I . ! 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' 1 -,,.� � —'j -- i --1.- _ I i ^ Gn• �V __ _ —I -_ � _} � -_j_ _f � "—I 1 r� _.��' _j__.�._ '}._ _i ^ Y- -j.� .�L �- ;1 ; -� } _,j� . }.,- I � � I �_ � j __., -_- I I — i SD�ISLSI h F�ct5T1�1(� - - ,; i. i ! — —� -- --, t —i° ! C •I ,: 'r T. I i i� 1 - I' i —'- TZ19Q ___� i_ -. i - -rte - i _ o__.K�rIAtN uN��NI:SHEl? -_._. r -' -- } - -! - -- , - -' -; -! - I• -) -- { —I -i -- i -_!_- __r_.. _ — �� �_ �- { - -- -- - j -j' � �� -4 I _ p` 1- rr _ pp�� - - - I 1 i �• I ! -I t:. j 4•. e .t J oa n" Um ME rc L 1 } K Ll .a i! 1` 1 d� ■� 1 eANQJZED GARAGE /•i 1 � 1 ;r nr` v+ :a (i d. i J — - 1 '6 �i _INN®,�,�� J oa n" Jlw Ii 1 9 ° —Q" sat FLOOR CEILING �poposC� GNADIC�S — SOLID 9 40TH DOORS (6— PANEL) =UPGRADE TRIMS — "ENERGY STAR — :Y rr 2. J� �•i Um ME Ll — - a _INN®,�,�� 0 Mome � �aa�{n" r•�s Jlw Ii 1 9 ° —Q" sat FLOOR CEILING �poposC� GNADIC�S — SOLID 9 40TH DOORS (6— PANEL) =UPGRADE TRIMS — "ENERGY STAR — :Y rr 2. J� �•i is I IC D DF ?L m �,,, — . r/y• t 5 6 r t� °A'v+oDgy 7 r a 9 10 i; '• 11 12 l 13 1 9g 14 15 ( 16 � LOT r AREA = 3.0122 ACRES t ( 131,212 SO. FT. ) roAvh et°�e fete A,h 0 we LEDGE tr v% day D r o V,/ ❑ AmA Oro, a yr'eQvo; Water Line 8� s dr /vorroy � E ra?y 0 C Tank'-: r um p Tgn'k . . IT"Gr F �• :� Dtstrlb ution Box O fCD7wo AND _ - .. ... O RD F DRAINS 96' 96' At rnd of w// O ? '06 y EXPANSON AREA ( FlELDS = 672 Ll) ?MMARY ® & q { AREA (7 — 96 Lf Flans = 672 U) :s 1 r 1 I I PUT(` DIME APPF APPL RUM r Doi � O�ara� ❑ oleo 4q 30.2 22.1 �IYa s a 3 5 2 SgWy / 54.3 ARE„D 4 6 63.6 6 64.5 - MANSION AREA ( FIELDS = 67 2 LF� ®® b b PRAlARY AREA (7 - 96 (F F1E1pS .672 J : T • • i,s 2 3 30.2 22.1 3 5 54.6 5 54.3 4 6 63.6 6 64.5 - - 5 6 66.9 7 70.3 y y' .6 6 69.5 7 74:2' ' ' t. 7 7 7 74.1. 7 79.7 a a; 8 7 77.3 8 83.7 9 8 82.3 8 89.5 y yG 10 8 86.1 9 93.8. 11 1 157.5 1 153.1 t t` 12 1 158.1 1 154.4 r r. 13 1 158.2 1 155.2 .+ 1 14 1 180.4 1 158.1 ' 1 15 1 161.6 1 159.8 w 1 18 1 164.7 1 163.5 G; 1 17 1 166.9 1 166.4 c g ! i PUTNAM COUNTY. DEPARTMENT OF HEALTH i D DIMSIDN 0 ENV}�O ENT L HEAL -TH,S RVICES. a A APPROV D S NOTED -FO I CONF MANCEWITH APPLICABLE'RULES AND REGULATIONS OF THE '�} �' U UTNAM CO TY HEALTH DEPARTMENT. d d' � R r ��� ,� • � RE DATE ty � • •` c i.• � ��g- DlatHbutfon Box E • � i 0 96'/ �J ........... - - _� I a and of *a A s 1 C iY .e 4 IP -t0 1 W -1 3 e V -i S 4' r O IA • i BDRM 3 g on 13• -0° x 14' e ��•e _ s ®e ®o n ows BBD_ • i° �� ! ` 1T -5 3/4° x 12' -7° t f } u 4 lS ;X �,tM1 U T �Sr 7; .0 r 4 .e 4 IP -t0 1 W -1 3 e V -i S 4' r O IA • i BDRM 3 g on 13• -0° x 14' e ��•e _ s ®e ®o n ows BBD_ • i° �� ! ` 1T -5 3/4° x 12' -7° t f } u • aroHDl Mrr aar •- aammoom many►• a DINING 9 - -0" 131 F1908-CEILING - SOLID SMOOTH DOORS (6- PANEL) - - UPGRADE TRIMS ENERGY STAR i t j• 1 a fi is ov FUMMIM WML W5901 fLp#x omm cmtmd 1p UA)P,,YAP AIT 7 Ila, I. I'M C-69 4