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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -11 BOX 28 I INE I 17- 1; I.- : ' ; I I I , `, 9k I y 116 IN 967 1. 94M n , ,` , it r y� i �I 03537 PUTNAM COUNTY DEPARTMENT OF, HEALTH" DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER, OF'AUTHOffIZ.ATT N ET RW�1 Property,of ? C•R p1 �>� Located at FbRyANT POWO RbAD x_ ' N 00H of 13Ak6EK ST. T/V "?oygAtA VAI -LEY Tax Map # 79 Block . I Lot Subdivision of N/A Subdivision Lot # N /A Filed Map # NIA Date Filed NIA Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water'supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department,.. and -to sign all necessary papers on my- behalf in. connection, with this matter and to supervise the cons truction�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. w �_ Very truly Countersigned: "'` Signed: P.E., R.A., # 047979 (owner of Property) Mailing Address I l BLACK DAM MDHIL�Mailing Address: �D l BRIANT %1�D RoAD State Zip 10�2`�- 'NTNAM VALLEY State Zip 105 79 Telephone: -5S+B Telephone: Sy;S" 222' (pd21 Form LA -97 PUTNAM COUNT" Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :. _ ....... _ .. LETTER OF AUTHORIZATION • p y 0 fici RE: Pro ert of Located at TN vlaauVa �� Subdivision of n Rxat 9. Tax Map # 74 Block 1 Lot I l Subdivision Lot # B1 Filed Map # f? Date Filed Gentlemen: This letter is to authorize l .4 4i k eCorva a ck��%_OA a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and'to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health .Law, and the Putnam County Countersigned: P. E., R. k, # ® '79 Very truly your Signed: a (Owner of Property) Mailing Address I t. 9LAC}<DjAl�to►VJ)C11U- Mailing Address: Gl Blt at1� t'��d State • Y Zip Telephone: ,914- 4 -2,4-- SS4B State 'y T Zip S 7-9 Telephone: Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL.OF. PLANS. FOR A WASTEWATER TREATMENT SYSTEM �1 1. Name and address of applicant: P0- W— rA�'�,lVA! 6A 4 PurN A-µ V AUL-y y 15q q 2. Name of prcject::51k6Zg �AMIIV (ZAe�t-'boqC 3. Location(DV: -PUTNJ&-M V A'LLE 4. Design Professional: 'Q gl Vic'' 9q SmOy.E. 5. Address: 6. Drainage Basin: "SoH I ( BLACK VIAW9 60R)SON NY i 7. Type of Project: LlS2 ,/ 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)? Flo Type Status (check one) ....................... ............................... Type I 0 ? Exempt n a Type II tD Unlisted n a 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 110 10. Has DE IS been completed and found acceptable by Lead Agency? ............... ,P � a 11. Name of Lead Agency, R a 12. Is this project in an area'under the control of local planning, zoning, or other . o€ ftcials,.ordiriartcFC? , ... ........:.:.::........ ..... ..................:...........: ........... _ 13. If so, have-plans been submitted to such authorities? ................. ...... ................ 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water '.X/ 16. If surface water discharge, what is the stream class designation? .................... n a 17. Waters index number (surface) ..... .....: ................................. ............................... �� a 18. Is project located near a public water supply system? :...... ............................... �U 19. If yes, name of water supply Cl ba Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ ho 21. Name of sewage system 01n Distance to sewage system (Itom" 25 0 22. Date test holes observed 10 U 23. Name of Health Inspector s& m 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... (1 26. Has SPDES Application been submitted to local DEC office? ......................... it Form PC -97 27. Is any portion of this project located within a designated Town or State wetlar, 28. Wetlands ID Number ............................................................ ............................... . `29: Is Wetl 'n s Permit required? ........... ............:...............:.. .............................. 30. Has application been made to Town or Local DEC. office? ............................... Does project require a DEC Stream Disturbance Permit?,! �, . ............................... 12 . . 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 VID 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ............... :......... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax bap ID Number .......................... ............................... bap Block ( Lot 37. Approved plans are to be returned to ..... Applicant Design Professional _ NOTE:.AII applications for.reyiew a_nd nproval of a ne;v SSTS-to be located within the.NYC,=Wat rsh c.shall be sent to the Deparf iei t; and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perju y, 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 2)?.45,9f the Pyaal Law. SIGNATURES & OFFICIAL TITLES.- Mailing Address: ................................... PUT -OJ 'W V A' bA Ytl•.N::i. •.•. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES y DE, SIGN .RATA.-:SH'ZFT'.- ..S.L1'BSU?R. FACE: SEVWAG.E':TREATM;ENT.SYSTEM: -. .- .l. Owner P Address(;�� A Located at (Street) --esc' Arm, o�&aof 15 .. Tax Map Block / Lot l / (indicate nearest cross street) . Municipality 07Z' ;tom aMerL Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking (1 %b ?_ �oc� Date of Percolation Test \ \(Q_ Hole No.' Run No. Time Start - Stop Ela se Time aMin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 15.3G- 0Fo 244ri 2�_ ISOw�;� 3 2v/< o� // t �r Cdr`'+`/ V 4 - 5 JS 4 5 1 2 4 NOTES: :'l. Tests to be repeated at same depth until approximately.edual,percolation -rates are obtained at each M; 'perco.latiori`Saest,hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be submitted fot review. ,2. Depth`rieasureinents to be made from top of hole. u.; Form DD -97 ..gin.. -DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' M11 4.0' 4.5' 5.0' 5.5' 6.01 1 6.5' 7.0' 7.5' 8.01 2 'T'ES'T' PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. - HOLE NO.. BOLE I40. _ ©o So\, ` i op �,fi►.►an SonC� �cow�1 S1 t-K� �c�r► Indicate level at which groundwater is encountered n /0_1 Indicate level at which mottling is observed V1 /a, . Indicate level to which water level rises aftg being encountered Deep hole observations made by: Date.ld /2S Design Professional Name: Address: Me'-'911MACK SMITH 9 9 BLACK DIAMOND HILL "T lub24 Signature: Design Professional's Seal z. ORMgC''...�� r� it 0479-1() yq�" A ��edgr� OF dE, ,�eeeo _ McCORMACK SMITH ENQNEERING,. PLLC .. ,_.� ,, :�: . :� 1' BLAC'"K UTAf�Ci�'1'�FtiLL•. ,.. , .. ., ..:.,�...,.. ... ..: ..._ __.. GARRISON, NEw YORK 10524 (845) 424 -3848, Fax: (845) 424 -4067 November 10, 2000 Mr. Adam Stiebeling Putnam County Dept. of Health Division of Environmental Services 1 Geneva Road Brewster, NY 10509 Re: Proposed House Peter Faranda Bryant Pond Rd. -730' North of Barger St., Town of Putnam Valley TM # 74 -1 -11 Dear .Mr. Stiebeling: By copy of this letter I am requesting a permit to construct a sewage disposal system for the subject property. I am attaching for your information and use: Letter of Authorization (LA -97) Three copies of the drawing Postal Money Order in the amount of $300.00 Design Data Sheet (DD -97) - - Construction Permit - :for - Sewage Treatment- System -(CP -97) ._.. -.�_ . .__..._r.�_.- .�....... -- Application to Construct a Water Well (WP -97) Application for Approval of Plans for a Wastewater Treatment System (PC -97) 2 copies of House Plans Short EAF Neighbor Notification for Well Documentation Wetland Determination Request response and Wetland Flagging notification One copy of survey showing Wetland flagging If you have any questions or comments, please do not hesitate to call. Very truly yours, i McCormack Smith, P.E. ,. PMS:deg ENCLOSURES "�r ...�.. .i r ..• i. o .:Z: •..Y )' -'4"f v-'Y. .w. � V. .rti •c i .f H .r �. ... _ r.s - .�: t n n'TwC ~b ��• -.H. ,P';' � .%J tr �t.I '../I 9 a - Dear AV. �Ouo r .l APPENDIX E Date S6-pr, aG, a000 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Dc FAkkv" Address: 1-�=' YAN r Pow 41 7 3o` No or ,BA�6 cre, Town: iU' MAM V,+I -Lt y Tax Map #: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Departmcnt of.l-i a;ltli sAttach,' &01' Fs is :a:c, y.ut'- therla est Fite plan. -�. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Received By: Address: `fax Map #: . Aupst, 1999 Appn&Z Very truly yours, By: Title: INEU C\1 C\1 C\1 A CC cc] CC) ca 111" r M 1!Gkta9p C3 C3 Certified Fee C CO Return Recelp Fee (Endorsement Required) rulCO u C3 r-3 Restricted Delivery Fee C3 C3 (Endorsement Required) C 0 C3 C3 - Total Postage & Fees -0 -111 C3 ROCIP10 C3 r-3 C1 AP - M C3 YOU C3 C3 —j C4 it) �130 U) Z T- O>- UgZ < S 26 MOO og (n fr 2 I> —j Oz nAttach In's (;k1lu — "'- -- - or on the front If space permits. j. Article Addressed to: Lt VM UN I 6'P-y'4^4-rAi09 le" Pct vo mylor77 0 Yes D. is delivery address different from Item 1? [3 No If YES, enter delivery address beloW* 3. s7eice" Certified Mall 0 E),PMW Mall ❑ Registered ❑ Return Receipt for Merchandise ❑ insured Mall 0 C.O.D. XPAI ❑ Yes umber (COPY rn service labeO 72-;�����-7000 6000 C)O Article Domestic Return Receipt PS Form 3811. July 1999 May E, 2000 Peter Fararda 61 Bryant 'Pond Road Putnam Valley, NY 1014779 STEPHEN W COLEMAN' Re: Wetlaands 1QerWt A WT -343 Proposed Building Lot. Bryant Pond Road, Tax Ntip :No. 63 -3 -1 Dear Mr. l»aranda: Environmental Conoulging 3.4spen Comrr Ossining, New Fork 1OS62 Upon review of the application materials of the above referenced property, received on 04- 29 -00, more inforMation is required to rev=iew this application. All wetiandf watercourse areas on the subject parcel require that they be flagged and survey located. In addition, I have the following continents: 1. The delineation of wetland boundaries for a property is beyond the scope of services and initia►. fees norma "ily provided for in the review of a wetlands application. Pursuant to Town Law, foi the Wetlands Inspector to perform this type of service will require you to provide additional furnds to the Town to be deposited into a non - interest bearing escrow account for this project: The fee required to complete this project is estimated to be @7_(,)O 2. As the applicant, you car choose to have this service performed by the T oven's Wetlands Inspector, or you can hire your own independent wetland consultant to perform this work. Please be aware though, that all wetland delineation's performer) by other consult�rts will requ�e on -site field review, and approval from ctland Til -suy for 3. 'Upon notification, and deposit of the escrow, 1 will perform the wetlands Uirneation for ldw above propeITY. 4. A detailed site plan will need to be submitted that shows the approved wetlands and watercourse boundary, the'l00 foot wetlands and 50 foot watercourse setback, location of all structures, house, driveway, septic system, etc., proposed grading and any other details pertinent to the application. The site plan Should be certified by the engineer and surveyor ,for the project. Please contact me if you have any furthcx questions. Sincerely. S�q�, Q., Stephen W. Coleman Town Wetlands Inspector Cc: Buiidinu inspector Phone. (914) 762. Faz: (9146) 762 -5.160 MEMO STEPHEN W. COLEMAN _ ..... _.._ Environmental ConsuDting.. To: Patti Smith, P.E., From: Stephen W. Coleman, Town Wetlands Inspector Date: June 23, 2000 Cc: Building Inspector/Planning Board g %J C, Re: Faranda, Bryant Pond Road - Wetlands Delineation 3 Aver Coat OMWxg, New Yw* 10562 A site inspection of the above referenced property was conducted on 06 -03 -00 for the purpose of delineating the wetlands and watercourse boundaries located on the subject parcel. The wetlands and watercourse boundaries were determined using the criteria outlined in Chapter 144, of the Town Code of the Town of Putnam Valley. The boundary of each wetland and watercourse identified was labeled with sequentially numbered pink flagging ribbon. The individual flag #'s identifying the location of the wetland/watercourse boundaries should be survey located and placed on the proposed site plan. The appropriate wetland/watercourse regulated setback areas should also be shown. The following wetland and watercourse areas have been identified: -1. Wetland A: Flag #'s A -1 — A -11 Please contact me if you have any questions about the location of the wetland areas. .n w . -.. ..- ... -._ -.... �.. v....f.... -.-..- .- ... - .-4 ....� a -u.. --. .. ✓... a .. .+ • ... - .. .. ..... p......�... .«..�0....R ..�........ .. ...� ... �.� -..r. y a...x w . ..... - .. . r .. .. Phone: (914) 762 -7288 Faz: (914) 762 -5260 �AP,A�1�Pt' t�E1v�iP�►2 B�oTiFica�T�o�l (1) _,,- .w -:µms. . -• �� �.. n; �� • � �x. �� , �`. :�� . i' - • ..sat.. -.• a'�VnJh �.s :.a � . } � .. o ... � .>>..w • �. . . I I:I 1��� V •U,6� 0 Print your name and address on the reverse so that we can return the card to you. C. Signature c o Attach this card to the back of the mailpiece, X C3 Agent � ❑ Addressee • or on the front if space permits. I I ` 1. Article Addressed to: ■ , ■ • e4vuoN� L I tIM 2A iq (Domestic Mail Only; No Insurance Coverage Provided) Y/O,r 7 9 3. SS ice Type I]T Certified Mail ❑ Express Mail ca ❑ Registered . ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. .d 4. Restricted Delivery? (Extra fee) ❑ Yes 2. Article Number (Qopy fiord service f ?bg0 0`1 •. ca ice•• RM" VNMP I 10M ® Pow $ o LIMIT ID: 0035 WCORMACK SMITH 0 C' ® Ccnified Foo 1.40 t BLACK DIAMOND HILL footmark GARRISON, IVY 10524 rU RotumRecolptFoo (Endomommari Requlrod) o Hero Q gyS qZ q ' 3t ! (� o ® RsoMated Oollvory Foo Clerk: KUM ® (Endomement Requlnxt) ® Totol Postoeo a Food i 0 $ 11/17/0 . r, C3 Reclplentb (Please Print G (to be completed by/ malleQ �. C3 .. .. dN.y�Jiv� i!R.Y .....:........... °-....... Ap. Y..�r... ? � ...40 ......... .............. 'airy', "srefe, 3iP° Z YM�9 I/* y /OS ,0 I • ® Complete items 1, 2, and 3. Also complete A. Received by (Please Print Clearty) B. Date of Delivery Item 4 if Restricted Delivery is desired. 0 Print your name and address on the reverse so that we can return the card to you. C. Signature c o Attach this card to the back of the mailpiece, X C3 Agent � ❑ Addressee • or on the front if space permits. D. Is delivery ress different from Item 1? ❑ Yes 1. Article Addressed to: If YES, ent delivery address below: ❑ No e4vuoN� L I tIM 2A iq Y/O,r 7 9 3. SS ice Type I]T Certified Mail ❑ Express Mail f ❑ Registered . ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra fee) ❑ Yes 2. Article Number (Qopy fiord service f ?bg0 0`1 ' ¢� (� '6 9 Q Ps Form 381.1, July 1999 Domestic Return Receipt 102595.99 -M -1789 ;v rROACT I.D. NUMBER NEW YORK SIA11 WAXIM(N7,01• INVIROHMINTAIL CONSIKVAIION DIVISION 04 XECULA10KY AIJAWLS •Stile Environmental Quillty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I Projoct l6formallon (To be completed by Applicant or Project sponsor) If the action la In the Coastal Area, and you are a slate agency, complete the Coastal Assessment Form before proceeding with this asseBarriont nifrn 2. r1olto L�r. 3• r1olvia 10(stion: Poo Mvnlclplllty covnry yl Q'It.-M 4• Is p d action: l4t r►pbns;on ❑ Modilki600Wits &lion S. Descilb- ptojtct bukIly; —Z t Map wc-4Qamck- r "M4 t&-W-� loo Ftic;st lo<st;on (toad Wisiections. ptom;ntnt 4ndmaAs, tic, or piov;6,r map) Pow w f2a 5 0. 7 Am7nioll d It Ird. Iniflil y Ultimately At", 4 Will opoltd Action comply with eAit;A& son;^a or other tt;sttnL land wic Ititoki;0nif No• desct;bt briefly No It 1, W'h' i?,ptcacnt land uit;n v;c;n;ly of pictiecil " d ' (41 d in; ❑ P&AIAAdI0ptA4P1CC, ❑ 011191 Dtics;bc: �xI. or fundinl. now or ultim&itly. room any other go-cintnist agency Ift dto&l-.. state or loci Ill 10 0(>Cl action involvc9m4applo ns ❑ Yts 140 11 yt I list sitnty(i) and ptim4loppsovalt 11 Dots any "pt �No he action have a tutiently valid pttmit or approval! ❑ Y" It flat altncy name and ptimli.1appioval type yes• 12 As itisill of poopoir-d action wlll eAsslint plimWapplova) require modification( ❑ Yes No I CERTIFY THAT 7HE INIORNIA11ON PROVIDED ABOVE IS TRUE 10 THE 8131 Of MY KNOWL(DCE eZ+ Applkanijipottiot name: Date: Signature: �' —2 If the action la In the Coastal Area, and you are a slate agency, complete the Coastal Assessment Form before proceeding with this asseBarriont nifrn P U'I NAMI COUNTY DEPARTMENT OIF HEALTH IIDffVff SIION OIF ]ENVERONMIIENTAIL HEALTH S ERVE CES COI STRNtCTIION PERMIT FOR SEWA(al TII89Afr42NT*9f9 Nd PERMIT # PV-49-00 `�; ...... . Located at r rri Rnj 2d. 730 , o a wn or Village Y1aMVQ Lt4 ✓�� -74 I 1 Subdivision name Subd. Lot # Tax Map Block 1 Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name Pofz� I)& Date of Previous Approval Mailing Address day& Qyla a . , P�ftna mw (e H Uy Zip 10 579 Amount of Fee Enclosed a®(f) Building Type �Url Lot Area No. of Bedrooms 4— Design Flow GPD 800 182,&tcQ_. X\CPe lF41 Section Only Depth VORU, ue Separate Sewerage System to consist of 1 .�,' S-5D gallon septic tank and GG-7 LP 24. jTg"cln , Lj��M 14 jj�a Di'4. Oo x -- 94em k D 8 - 14 T rcs (4iA i Mo,a Other Requirements: To be constructed by Water Supald: Public Supply From by Ohl-1�rve 5 °uly;:.Dillea =i' Address SR M y % - �t IA c kA( Address +n.vm v I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sY tem described above will be constructed as shown on the approved amendment thereto and in ac rdance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion the eof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the De artment, 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: P.E. R.A. Date 1 10 — 0--3 Address I l� Gd'�t -t' Wo ri License # i -7 APPROVIEIID YOR CONSTRUC)('IION: 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 rmit. Approveotr discharge of domestic sanitary sew ge only. By: Title: Date: rZ -� White copy - HD F' e; Y to copy - Building Inspector; Pink copy - ner; nge copy - Design Professional Form CP -97 TNAM COUNTY DEPARTMENT OF HEAL ION- OF: EN11RONMENTAL HEALTH SER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATN PCHD CONSTRUCTION PERNIIT # PV-49-00 'yam Located at 6Ry191�T PdND RD.. Town or Village 'POTNRM VALL� Owner /Applicant Name PETE R FA RAN DA Tax Map Block Lot Formerly a Subdivision Name NIA Subd. Lot # A Mailing Address &I BRIANT PC O D k4 ft, Pt9Tn1fA14 VA y:o N I Zip _ I �� % n Date Construction Permit Issued by PCHD 3 q55PRuVY(3R=K ROAcp Separate Sewerage System built by ALLPI O QO)T - j1 C , Address UMANDY MAWR NY 160 Consisting of _ Gallon Septic Tank and G 80 IJ7 �24" 4MAtC k Other Requirements: -to L�,d C Water Supply: Public Supply or: V Private Su ply Drilled by BuilWh g Type � I WA Number of Bedrooms 4)( _Address NORM AhJ RNDERSON INC. Address 15Z 8A?,bFJZ Si go PJT)UAM VALLEY Has* erosior conuol- een ccimplete0 Has garbage grinder been installed? &01 1 V 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: ! ertified by P.E. t/ R.A. Address 116LAtK U MON 6 HILL W91150M Prof 1 105 Z4 License # 017 9 -7 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 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. B Title: C Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 IPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Yell ILoc�tu ®b .- Street Address:' - r'", e! j� u..,., -1 'Tai Grid- #` Map � 'Block Lot(s) Well Owner: m Address: IP I 9R1AMT PDR5 POINAMVALL61 1051.9 Use of Well: I- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment - Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade vf`t. Diameter � in. Weight per foot lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded Other Seal: Cement grout _ Bentonite Other Drive shoe: _Yes No Liner:— Yes >LNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes —No Hours Second Well Yield] Test _ Bailed Pumped ompressed Air Hours Yield7y gpm Depth Data Measure from land surface- static (Specify, ft) During yield test(ft) Depth f completed cell in feet Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameteron) IFora¢umtion Descripti n ft. ft. Land Surface �^ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type zi Capacity. Depth Model 15� q Voltage BP Tank Type Y'" dolume 10 Date Well om I to c: Putnam County Certification No. Date of Report. W 71Driller (signature) NOT7: Ex#t location of well with distances to at least two permanent landtiarKS to ne proviaea on a separate sneevptan. Well Driller's Namey,y, Address: S Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange _p ...-4 - Well driller / Q 5/%C Form WC -97 ..BRUCE ..R.. -FOLEY ' - • `'F�u�blic 'Health `�D'u�cTor - -' -- .' ,. ^T`- . - . ' . � �' - " -- LORETTA._ MOLINARI • R.N. M.S.N. - �' 'Ass3riaie "'Fu61ic "Valtti Dir`ec`tor-F- 7" ' Director of Patient., Services 1 Geneva Road : Brewster;. New York 10.500 Environmental Health (914)278-6130 Fax (914) 279-7921 Nursing Services (914)278-6558 wIC (914)278-6678 . Fax (914) 278-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM • DETER �►9R�1N:D� OWNERS NAME: ....._ .:. _. _ . ... ........: . . � _........._ ,, _ . _..__.. . TAX MAP NUMBER: E911 ADDRESS: ATO - 7 o� TOWN: Ile, !Z AUTHORIZED TOWN OFFICIAL: _aa (Signature) DATE: The .- Putnam, County Department of Health will not, issue a Corti oate _cf 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. (E911VERF'Rlvi) ` YML ENVIRONMENTAL SERVICES 321 Kear Street 8 - - - Albert H. Padovani, Director LAB #: 32.407223 CLIENT #: 57915 NON STAT PROC PAGE: 1 FERANDA, PETER DATE/TIME TAKEN: 10/05/04 05:301-':' 61 BRYANT POND RD DATE/TIME REC'D: 10/06/04 09:50A PUTNAM VALLEY, NY 10579 REPORT DATE: 10/13/04 PHONE: (845)-222-6021 SAMPLING SITE: 87BRYANT POND RD : PUTNAM VALLEY NY COL/D-BY: PETE FARANDO NOTES...: BATHROOM TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY 10/06/04 10/O6/O4 10/06/04 1O/06/O4 10/06/04 10,06/04 10/06/04 10/06/O4 10/06/04 10/06/04 /06 10/04 -` --.-' --, ^' . SAMPLE TYPE..: POTABLE PRESERVATIVESt NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD ' PROFILE MF T. COLIFORM ABSENT /100 ML ABSENT 1008 LEAD (IMS) <1 ppb 0-15 ppb 9101 NITRATE NITROG 0.64 MG/L 0 - 10 9139 NITRITE NITROG <0.01 MG/L N/A 9146 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 MANGANESE (Mn) 0.020 MG/L 0-0.3 mg/l 2037 SODIUM (Na) 3.92 MG/L N/A PH 6.2 UNITS 6.5-8.5 9043 HARDNESS,TOTAL 38.0 MG/L N/A ALKALINITY (AS 30.0 MG/L N/A -''`'l�}RBIDITY -~-���-^'-'----.-'.���--�-'°~_ ' _ ..`�<1` NTU -� '`� - O-5 �.�_'_�����:'����''��_�� COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium that f l n *s a or people o contain no more than ^ moderately restricte is suggested. are proscribed. Suggested guidelines state iumestricted dietvthe water should �'f' " ' / �� �v mo/i)'ofy ovdium. For those on a d diet��a[.maximumyof 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street � - � orkt9w[ ght ' --- '----- - - � ~-'(9i%f/-��5���8��` | Albert H. Padovani, Director LAB #: 32.407223 CLIENT #: 57915 NON STAT PROC PAGE: 2 qqRANDA, PETER DATE/TIME TAKEN: 10/05/04 05:30P 61 BRYANT POND RD ' DATE/TIME REC'D: 10/06/04 09:50A PUTNAM VALLEY, NY 10579 REPORT DATE: 10/13/04 SAMPLING SITE���87 8RYANT POND RD ` ~~PUT|AM VALLEY NY COL/D BY: l» FARANDO NOTES...: BATHROOM TAP ~~~~~~~~~~~~MW~~~~~~~~~~~~=~~~~~~~~~~~~ DATE~ FLAG PROCEDURE PHONE: (045)-222-6021 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TB1PERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD .' .� pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH ALOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L ` .'MODE ELY HARD WATER: 70-140 MG/L ' MG/L'�=�MILLIGRAM_RER''LI�ER ', � '` ''' � � ^ � � ' SUBMITTED BY: Director ELAP# 10323 .A 99 BLACK DIAMOND GILL GARRISON, NEW YORK 10524 (845) 424 -3848 Faz: (845)•424 -4067 December 9, 2004 Mr. Joseph Paravati Putnam County Department of Health Division of Environmental Services 1 Geneva Road Brewster, NY 10509 Re: Request for a Putnam Co. Dept. of Health Certificate of'Construction Compliance Tax Map 74 Block 1 Lot 11 87 Bryant Pond Road, Putnam Valley Dear Mr. Paravati: By copy of this letter I am requesting a Certificate of Construction Compliance for Sewage Treatment System for the referenced property. Enclosed for your information and use are the following: 1. Certificate of Construction Compliance Form 2. Three copies of the Guarantee of Subsurface Sewage Treatment System form with original signatures y 3: Three cooiies As Built�Drawing .. _... _...... .. �.4...-Water Analysis' .... _w_.._� .._ ..............: _:. _ .... _.. . _.,. ..... ... __. - -- --- ,:.�.:..:_ ...____....:„ .zl ✓5. $300 Fee - Bank Money Order 6. Well Completion Report 7. E911 Address Verification Form Thank you. Ve yours, Patti McCormack Smith, P. E. ENCLOSURES PMS /ksm DEC— S-04 T H U 14 : 3 5 1 A as 0A-0L •O A a 0 A a 0 A a 0 A u P. 02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE 5 VVA IE �'R ATM(EN IL SY�STE! Owz;eior: urchaser of Building . >; 'Tax Map.:} , ; -Block, bu:TH FFAC.6. tco,5fR06 ON .Building Constructedby $7 13RYAI�Y FOND 1RDA0 Location - Street E M l ly �� s� t)FMGE� Building Type Town/Village , NIA Subdivision Name N/A Subdivision Lot # �-e y" k represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said.. system constructed by me which fails to operate .for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance ":for the sewage treatment `system, or any repairs MMe"by me to such., system; 'except where the failure to :operate propeiI -'is caused by willful or ne li ent act of the occupant of the- buildin utilizing the Y gg r g system: w , ©elusive the determination of the ?:blic. ealth he,.une_sged: atea es- to accep;_as Director of the Putnam County Department of Health as to whether or not the failure of the system to' operate was caused by the willful or negligent act of the,occupant of thug utilizing the system. bated: �4onth 112- Day A' Year ? General Contractor (Owner) - Signature N/A Corporation Name (if co oration) PETER �ARA9bA Address: Cpl BRIANT POND %)-rNAM VALt.E > State Zlp ILA Si r Title: &e �V X Pcl -i\ Corporation Name (if corporation) Address: slate Form Gs -97 DEC 22,,2Q04 17:55 John Hobby, Jr P +H, Ltd' 914'241 7870 Page 1 I✓ t �.. wa�+.trT r cf -•. h- .n �,I... ..�C• .♦ � .ii ✓. .. .0 4 ♦✓... .. � fin. sy,�.N(I- c..c ♦ ;•� /� -...- � .. • ... ..�. .. ♦ .. . 1 .. .. wf 1. � 1 John`.# -W Jr, P lumbing & llN�tting, Ltd. .Date: To: Fax: From: Re: 76 Kisco Avenue Mt, Kisco, NY.1.O5I9 . (914) 241 =785$ (914) 252 -5675 Fax:. (914) -241- 7870.... FAX TRANSMISSION COVER SHEET 12/22/04 Joe Paravati Putnam County Dept'& Health 845 -278 - 7921.......... - . _. .. .. ._ -- _ -• . _. _... ^- .•.. -- _ -- _ _ _ . . Debby Hobby Specifiations for well pump and cold water storage tank for Peter Ferranda's Rotidence'at 87 Bryant Pond Rd, Putnam Valley, NY. YOU SHOULD RECEIVE ,' PAGE(S), INCLUDI G THI$ COVER SHEET, IF YOU DO NOT RECEIVE ALL OF T�iESE PAGES PLEASE CALL (914) 241 -7$58• DEC -22 -2004 WED 17:43 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 DEC 22,2004 17•:55 John Hobby, Jr P +H,'Ltd 914 241 7870 John Hobby, Jr. Plumbing & Heating, Ltd. 7C5 Kisco :Ave.. Mt. Kloco, NY 10.1549 (914) 2.41 -;7858 December 22, 2004 Mr. Joe F'aravati Putnam County Dept of Health Ke: Peter Ferr•anda 87 E3ryant Fond Rd Putnam Valley, NY 10579 r Pear Mr, f aravati: The opecs on- the well pump and cold water storage tank which we installed at: the Ferranda Re5iderice on Bryant fond Pd: are. a5 followfj: WeifF'ump Gold water storage tank Pnak8: iouldC, Type:' Champion Pneumatic Tank Model no.: 507940 volume.: 119 gal rapacity: 7 galdmin, voltage:L20v hp: t hp depth of well: 380ft. If you have any further questions please do not hositate to Gall me at the number above. Sincert!lq << lam,- c.�.�_• ` �'���`..� ��? John Hubby, Jr. f�resic�c►�t JH.JlFJdgh DEC -22 -2004 WED 17:43 TEL:845- 278 -7921 NAME:PUTNAM COUNTY l7FPARTMFrT nF a a Page 2 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 24, 2004 Patti McCormack Smith, PE 11 Black Diamond Hill Garrison, New York 10524 Re: Field Inspection — Faranda Bryant Pond Road, (T) Putnam Valley l TM# 74 -1 -11 Dear Mrs. Smith: ROBERT J. BONDI County Executive A site inspection was.made for the above referenced project on September 23, 2004. The following comments must be corrected in the field. 1. Trench lengths as installed were not according to the approved plan. Please provide a preliminary as -built plan showing trench layout, lengths, and 100% expansion area. 2. An extra room was added off the breezeway. Since the room has a 6 -foot opening, it is not bedrooan.. Also,'.sinc� the OWarz has a four (4) beClrcmcirri:.syston; converted to a bedroom in the future. If you have any further questions, please contact 'me at (845) 278 -6130 ext. 2157. Sincerely, f Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL ENTAL HEALTH SERVICES h�f CD a4 FINAL SITE INSPECTION Street Location! Town TM# 1. Sewage System Area ,n a. STS area located as per approved plans ...... ..'...'1 ., b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. ............................... d. Stone, brush, etc., greater than 15' from STS area......:.. e. 100' from water course/ wetlands .... ............................... II. Sewage System -4 x S o a. Septic tank size - 1,000 ...:.....1,250 ✓....other ............. b.. Septic'tank installed level .............. ........ ........................ c. 10' minimum from foundation ...... ............................... d. (Distribution Box 1. All outlets at same elevation -water tested .......:....... 2. Protected below frost ........................... I.................. 3... Minimum 2 ft. Original soil between box & trenches e. JuLnctiag Box - properly set ....... ............................... 6 renc es required, Length installed 2. Distance to wa a re Ft.......... 3. Installed according to plan ........ ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot............ 5. 10 ft. from property he - 20 ft.= foundations.......... 6. Depth of trench <30 inches from surface ................. 7. Room allowed for expansion, 100 % ......................:. 8. Size of gravel 3/4 - 11/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... - ... -: Dosed bvsfe--ms 1. Size of pump chamber ................... 2. Overflow tank ... .................. ....................... /....... 3. Alarm, vis udio ...................... ... .......................... .. 4. Pum sly accessible, manhole to grade ............... 5 rst box baffled ...................... ............................... Cycle witnessed by H.D.estimated flow /cycle......... a: -''douse located per approved plans ....................... b. Number of bedrooms ............... ............................... IV. Well Well located as per approved plans .......:....................... b. Distance from STS area measured - -�-� -- ft......... c. Casing IV above grade .............. ............... ................. d. Surface drainage around well acceptable ..................... V. Overall Worlananshin . a. Boxes properly grouted ................ ............................... b. All pipes partially backfilled ........................... ............. c. All pipes flush with inside of box .. ............................... d. Backfill material contains stones <4" diameter ............. e. Curtain drain & standpipes installed according to iii f. Curtain drain outfall protected & dir.to exist watercou g. Footing drains discharge away from STS area ............. h. Surface water protection adequate ........:...........:.......... i. Erosion control provided ............. ............................... Rev. 12/02 Date: Inspected by: ;Ts 7. r Permit # II -Yq -vim Subdivision Lot 4 y { SEP� -24 -04 FR I 4 : S 9 1 Av. 0"'Ll. 0Aa 0Aa 0Aax 0A iOL P _ 0 1 C6,t+f-,;A .. t., -�� _.... 9, 0 Cc► Iw Li. Ir { . ter' • � ; . 1�• � 1 � R." :.. „�. 320 P. ..1. ran. �. r. Al .. . . . . . . . . AA ' SEP -24 -2004 FIJI... 05:18 TEL: 845 -278 -7921 [ ;AM; : RI.ITNAM COUNTY DEPARTMENT OF P. 1 SEP -23 -0 4 T HU 1 3 : S4 _ 1 Ao 0 0Aa 0Acx 0Aa. 0AaL P _ 0 2 ;,Ap .... ......... m L i . •aW.:ti...... bf) !�.�j . / C "3 •_ a -+_..' _'n• .m ... a., .. �� �..' /V ............ .., v ...,..,..... _.._.. ..._.... .... ..._._ _..._._ .. .. 37 ;aJ i rrn r.v �nnn T1 u 1 4A.41 Trl -AS- _ W. S...�7GL. V4- A. b.._.:...:; SEP -23 -04 THU 1 3 :54 1 Ao_ 0A0- 0Aa OA ca OAax OACX P. 01 To". PA�2►�V i FROM: K A T H 1 M 5m t 7 iDATa &5164. No. OF-PACE:S(INCLUD. COVER) . COMMENTS: �e�- �a�v�dGt 8`I5tzZ2.- .[ooZl Nee finis �5 Wlnai' � W .m MCCORMACK SMITH ENGINEERING PLLC 11 BLACK DIAMOND HILL GARRISON, NEW YORK 10524. SEP -22 -04 WED 7 09 _ LAO. 43 inn. OAa OAu OACL OA.0 P. 01 DMS'ION OF ENVIRONMENTAL SEAL Far. pill !111N Trenches PCI-ID Construction Pernoat # A, Located: er /Applicant ame: U o)Mi c"�' '�'1Vt — dock Lot Formerly: - - - - Subdivision dame: T Subdivision Lot 0 Is system fill completed? a hate; �.,.. Is system complete? Date: Is system constructed as per plans? Is well drilled? Date, 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 veined their completion. in accordance with the issued PCHD Construction Permit and I approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health, ertj le y: Design Professional Address: 1,1 !LAC K N_.MIOKb }�iLL Lic. � °�'979 C APW50�J NY 1051 irnmmPnPe- FOR: O ADAM ❑ GENE ❑ .� .. (N) Form M-99 j .. �. _.•r... .. ..... , pev ... ... -..,. a v.:,y,��. �, :^ . ... LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road; Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 = 6648 April 7, 2004 Patti Smith, PE 11 Black Diamond Hill Garrison, New York 10524 Re: Dear Mrs. Smith: ROBERT J. BONDI County Executive V Field Inspection — Faranda Bryant Pond Road, (T) Putnam Valley TM# 74 -1 -11 A site inspection was made for the above referenced project on April 7, 2004. The following comments must be corrected in the field. 1. Curtain drain discharge pipes needs to be solid 4" plastic pipe (non - perforated Loll "itga�Gil- Ii1G�ai;'SCilGUii1: r0 p V'oi'ei�u j. tc lso'; ai a:.:Lial -guard - sho�Il� -3 - - provided at pipe end. If you have, any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, oseph Paravati, Jr. Assistant Public Health Engineer JSP:cj �11 �% it���� �� �1��11��1�il�Yli�1V 11�� ��.�� �L,llll ►J�.�������...._ _ . CONSTRUCTION CTION P]ERMIT TREATMENT SYSTEM PERMIT # Located at Town I� e �' �� ®�• -�� Subdivision name Subd. Lot # a Tax Map Block D Lot Date Subdivision Approved Owner /. Mailing Amount of Fee Enclosed Building Type Other Requirements: ��r&A4 Renewal Revision Date of Previous Approval 8 ®579 Lot Area No. of Bedrooms Design Flow GPD 00 to consist of 8 gallon septic tank and 800 LF'4"'' !P To be constructed by J Nl + V "kA Sc f) sue',, ?®y, — Address smvi . 1?A , ;Ct7Ld44UU ht&"1AU41 Josh Public Supply From. _ Address ✓Private Supply Drilled by AtiAe4`560 - Address mw 5t pofmw VC4 ICY 1®579 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seoara_ to sewage treatment ay stem 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 o Signed: Address A Date 9 �ZS —00 License # 0,479 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 w en considered eces y the Public Health Director. Any revision or alteration of the approved plan requires a new pe i Appro d r ch of domestic sanitary sew le only. By; Title: 1A,,nK-kx_. Date: Z O G White copy - HD File; Yellow copy - Building Inspector; Pink cop - Owner; Orange copy - Design Profe sional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ID please print or type PCHD Permit # Q O Well Location: Street Address: TownNillage Tak Grid # PL[NA-MU4Jey Map Block J Lot(s) 11 Well Owner: game: pem Address: ic' B&rq PO -I 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 5 gpm # People Served --JL Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling :ZNew Supply (new dwelling) Deepen Existing Well Detailed Reason 09Ad for Drilling Well Type V Drilled Driven Gravel Other Is well site subject to flooding? ...........:..................................... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot N R (1 n � Water Well Contractor: 6 a 0) Address: } Is Public Water Supply available to site? ............................. ............................... Yes No Name of Public Water Supply: nIQ _ TownNillage Ill 9 Distance to property from nearest water main: fl a Proposed well location & sources of contamination be provided on separate sheet/plan. � -� - -� . 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 drill ce di by utnan County. Date of Issue 0Z) Permit Issui fficial: - Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 yolug � �- Pr�n LS�. lurk uti taw, Qocaitex � hw.�e "i .. ._..�- _....�_ ._ .._._.._, .... � >_ �. .;- �.;�:s� � .. _... -, p ..... -� - °.�,:.• �_�:.:�a °...=..,..,�.- n ►:: °.,.�.:r;.�.�,� :.rte.,- .- •�;v�: }�;=�� _ . ;::- s w -t�;Y. •r wn.— ..�:�ea..a -+. •� -!.:� <:.N•Tn .ast ., gg ' F a 1 r I t' p �� �1 y ,r A � [}(wry , v w M A R— 2 9— 0 4 M O N 0 3 1 1 ACi 0 Ana 0Au OACL OAax 0Aoa P _ 02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES MUST FQ& FINAL. 0P ."CYi For: Date; fQ — PCHD Constru ' n Permit k V 449 W Located: C(T) Omer /Applicant' a e: ��`d�v�i► y Formerly:, Subdivision Name: Subdivision Lot # Fill Trenches `T Q OW _ Block„! Lot �.. Is system fill completed? „ Date: Is system Complete? RA Date: Is system constructed as per plans? 4 Is well drilled?.' . Date; Is well located as per plans? Are erosioh control measures in' lace? I certify that the system(s), as listed; at khe above premises has been constructed and I have inspected and verified their completion in accordance. with the issued PCHD .Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health, Address: 11 IUAGK DIAMOKb. RtLL Lie, #, _ ?979 GARRiso�1 � to � Comments: MAR -29 -2004 MON.00:50 TEL:8457278 =7921' NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 \ C:ified t�:A TV ' :� . �� l�F� -- �., Design Professional Address: 11 IUAGK DIAMOKb. RtLL Lie, #, _ ?979 GARRiso�1 � to � Comments: MAR -29 -2004 MON.00:50 TEL:8457278 =7921' NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 \ MAR- 30 -0.4 TUE 13 :35 1 A L OACL OAok OArn OAat OA L P _ 02 z td ► „ a w : � rq 93e .ts w r 1 Pr 3 ®S —R—BL 9 a3 -s8%g0 d MAR -30 -2004 TUE 13:55 TEL:845- 278 -7921 e NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 M A R-30-04 TIDE 13:35 1 A Cx 0 A CL OF21CL 0 A ct. 0 A CX 0A CL P.01 pa ox� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVMONNIENTAL HEALTH SERVICES UOMST FOR EINAU 9 For: Date: ^ 2G - PCHD Constrqpton Permit 49CC) Located: 0oA.4-tz �?'j PV ca; Ofter/AppUcaut ajme: TM.- Formerly; Subdivisioh Name:, M Subdivision Lot -# Fill Trenches Block Lot 1R c'9 Is system fig completed? rVq Date: Is system complete? -1 flo Date: Is system constructed as per plans?. Is well drilled? : -Date: Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above. prenui,ses'. has been constructed and I have Inspected and verified their completion in accordance. with the issued PCHD Construction Permit and approved.plans and the Standards, Rules and Rcgulations of the Putnam County Department of Health. 7 er I T�-, P ERA o' Design Professi'n ii Address: 1j5L6C-K t>AWN� ` HILL. Lie. # 041979 Comments: - A4 tt Ag—A %A M&gaA gog 41va -6-kO� 4a&k. IKA C L�;L' �dl� ifw 4u IS IL OVA& �u U - C L11-C Aj*j eat \,A/qA 1 Lt., I bee 4=1 0 It 4,YL4 t FOR: 0 ADAM ❑ GENE MGR_7A -PSfA4 TI F 1 I.- R4 IF i-t1a J1,947. Form PM-99 TP : AW-, 'P7A-7qP1 * WOW:! PUITKIom rn IKITY r1=130DTM=K1T n97 0 1 0 BRUCE R. FOLEY LORETTA MOLINARI RN., M.S.N. Public Health Director - Assoclui • Public. Health Director Director of Patient Services. DEPARTMENT OF BEALTH i 1. Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PROJECT (Owmers Name): COVER SHEIL2d ,� 0/u- STREET: (C l � Gt /�'��a� . ( ,6 A, off/4 Ile &U ICIPALITY: TAX MAP NUMBER: y DESIGN PROFESSIONAL: DATE: Z A 03 - REVISION REQUESTED ADIDITI ®NAL INFORMATION OTHER PEB -12 -03 WED 7 2G - 1Aaa OAoa OAa OAa OACI OAaL P 01 ...- 3 P9 43 MSC RNfA I� Si►+!i I F. !? . .......,s 1'1 BLACK DIAMOND HILL, GARRISON, NEW YORK 10524 (845) 424 -3848, FAX: (845) 424 -4067 �» November 4, 2002 Mr. Joseh S. Paravati, Assistant Public Health Engineer Putnam County Dept. of Health Division of Environmental Services 1 Geneva Road Brewster, N. Y. 10509 Re: Request for a Renewal of Permit to Construct a SSTS Btyant Pond Road, Putnam Valley Tax Map 74 Block 1 Lot 11 Dear Mr. Paravati: By copy of this letter I am requesting a renewal of the permit to construct a sewage disposal system for the subject property. I am attaching for your information and use: Application for Permit to Construct a Septic System (CP97) Three (3) copies of drawing PCDH Fee $300 Post Office Money Order Application to Construct a Water'Weli (WP -97) Letter of Authorization (LA97) Two (2) sets House Plans - Please stamp these 3 bedrooms plans "approved for 4 bedrooms" although the floor plan is for 3 bedrooms since the septic system is being designed .for.:4 bedrooms.:..Mr.. Stiebling had inadvertently stamped 2::bedrooms on th® original apProvai. HOLD C 'q. N5 NOT 'Rui U D W1TIA pff q� F�PAIZ The following documents are not Included, since they are on file at the Putnam County 1)�461;p Department of Health: Short EAF Application for Approval of Plans for SSTS (PC97) Design Data Sheet (DD -97) Neighbor Notification If you have any questions or comments, please do not hesitate to call. Thank you. PMS:ksm ENCLOSURES Ve truly yours, tti McCormack Smith, P. E. 845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P PE]B— 1 2 -03 WED a : 29 _ 1 ACX 0Aa OiAaa [BACX OACL 0ACX P _ 0 1 IS A COUNTY DEPARTMENT y,s HEALTH "- t-7 DIVISION OF ENVIRONMENTAL t 3+ a Y t o SERVICES CONSTRUCTION PERMff Fri SEWAGE TREATMENT SYSTEM P19T 0 P>V m 4 9 - 00 Located at aulr Rnj 2d. , 730, K!« 0� Subdivision narne MIA Subd, Lot # � �+ Date Subdivision Approved 01A Owner /Applicant Name 1••�'1'��' � cav`�.i �C�a"� Hiding Address Town or Village PA en y w;14 � 'T'ax Map —74 Block I Lot 1 ti Renewal y/ Revision Date of Previous Approval Zip 1 Amount of pee Enclosed goo , Building Type '� '�� Lot Area i`�� � No. of Bedrooms 16r Design Plow GPD 600 FiH Section Only ]depth Volume 36aija¢e ftaeraze " to consist of re.nch . L-%rrqx 14 ® gallon septic tank and GG -7 P C4 2421 ff Other Requirements; 1, 0I �., -1A To be construed by � i�►�r1 �° �.�.�� Address fla-,Ok- Ri Private Supply Drilled by _ ,. y1 LM C dress�l II represent that .1 am wholly and completely responsible for the design and location of the proposed system(s) and that the described above will be constructed as shown on the approved amendment thereto and in ace ' apoe with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thcreof,a "Certificate of Construction Compliance" satisfactory to .the Public Health Director will be submitted to the Department,'aitd 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: P.E. R.A. Date Address l� _ -)1� d fl +l l , tC'yg)— __License C24-7-9-79 APkOVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treairnent system has been completed and inspected by the PCl D 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 rArmit, Approa r discharge of domestic sanitary sew re only, By. 4 A�- Title: d Date: - -- —J '• _ •a e• r v,•._e_ _ i1•.•.: nee ��n inc�inna9 WFEB -14 -2003 FRI�06:48 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 h 1.4 IV FEB-14-2003 FRI 06:48 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 ji IV FEB-14-2003 FRI 06:48 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 D McCORMACK SMITH ENGINEERING _ PLLC_ _ 11 "BLACK .DIAMOND- HILL, GARRISON,- NEW ;YORK 0524 (845) 424 -3848, FAX: (845) 424 -4067 November 4, 2002 Mr. Joseh S. Paravati, Assistant Public Health Engineer Putnam County Dept. of Health Division of Environmental Services 1 Geneva Road Brewster, N. Y. 10509 Re: Request for a Renewal of Permit to Construct a SSTS Btyant Pond Road, Putnam Valley Tax Map 74 Block 1 Lot 11 Dear Mr. Paravati: By copy of this letter I am requesting a renewal of the permit to construct a sewage disposal system for the subject property. I am attaching for your information and use: Application for Permit to Construct a Septic System (CP97) Three (3) copies of drawing PCDH Fee $300 Post Office Money Order Application to Construct a Water Well (WP -97) ` Letter of Authorization (LA97) Two (2) sets House Plans - Please stamp these 3 bedrooms plans "approved for 4 bedrooms" although the floor plan is for 3 bedrooms since the septic system is being _.... d?signed for 4.- bedrooms._ .Mr. Stiebling.. had inadvertantLy_- stamped 2 bedrooms -,on the , 'original'approval. The following documents are not included, since they are on file at the Putnam County Department of Health: Short EAF Application for Approval of Plans for SSTS (PC97) Design Data Sheet (DD -97) Neighbor Notification If you have any questions or comments, please do not hesitate to call. Thank you. Ve truly yours, tti McCormack Smith, P. E. PMS:ksm d °ZI "'d 9 _ AON 00 ENCLOSURES S oA S. , y i .: .1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION. REPORT Well.Location, Street Addres- NI TM t,, V GridA ap' Block Lots) I Well Owner: m Address: _ ICI BR11RNt �bNp R�, P�TWA.tA VALLY N 0519 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm. Test/monitoring . Other(specify) Industrial , Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length ft. Length below grade n�`t. Diameter Gr in. Weight per foot lb /ft. Materials: Steel _Plastic Other Joints: _ Welded Threaded _'Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No _ Liner Yes �No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First 'Yes 'No Hours Second Well Yield Test _ Bailed Pumped ompressed Air Hours Yiel gpm Depth Data Measure from land surface- static (speci I ft) r a During yield test(ft) Depth df completed cell in feet Well Log If more detailed information descriptions or sieve analyses ......... _ :..... �; a✓ailaule,...__._. please attach. Depth From Surface Water Bearing Well Diameter in) Formation Descriptl n ft. ft. Land Surface &--1) 1, - - - _ �. • - - -.. n,. .......__ r __ ..- ......... _ . _. , ... _... ...... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type _Cq,�dS Capacity,+ Depth _2S2 Model � qv Voltage .66W I-IP Tank Type " Uume /0 Date Well ompI ted�, l G Putnam County Certification No. Date of Report 2? G W I Driller NO 1 7: rxpt location of well with distances to at least two perman t lanrark§ to be provided on a separate sheet/plan. Well Drillees Name 1 Z J &&N- d� Signature: Date: S_ "'i i`1! •fib 0iiSH ,� N,noJ t4vr,4.1(ld White copy: IID File; Yellow copy - Building Inspector; Pinrop ner; Orange cop - Well driller Vi y. k 13 0 f6 � Form WC -97 / Z3(j / -ii)