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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -2 BOX 28 03590 Tri r7. I I, r . A 03590 7/7 '.4 h ` . H SI*ERLiTA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 O ADDITION APPLICATION RESIDENTIAL ONLY STREET .j6 S Inarm rock Ar TOWN c„1 - ;'�e _TAX MAP# • /0 -J- I NAMEA04t1S? 4 n-monl a PHONE I SIS_ G2 /- Od y PCHD# MAILING g L ADDRESS 6& 5kam noel Dr Philhv", lk &L, /J� /0$'7i DESCRIPTION OF ADDITION' er9j,&e j C 4 1j;rjAJ4 Af NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS 3 (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, Phone: - (845). 278- 6130:: _ . Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 ester- Supply3S"on JS43) -'i .23= 51,86•- Fax�,845)423 --3445 -- --w- -- 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 SHERLITA AMLEIZ, MD, MS, FAAP - t o riKissioner��f 'lea dth LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count ROBERT J. BONDI Re: (::� A7T d e A(I a tl 5 z (Owner's Name) Tax Map #: :7f./O—/—/. Address: 5e, 5�.a,4" 6-0 e% Town: j?yit,c• tom- Vj,,(�,I . A.1 Year Built: / V 2 According to records maintained by the Town, the above noted dwelling, is ✓ in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: E ao© ZS-A Other: Building Inspector Date I ax 78-7921 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 `a OWNER'S NAND SITE LOCATION ` MAILING ADDRESS PERSON, INTMM V;W� PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR 7 7~ PHONE TO 7Y 16 PCHD Complaint/# itionship (i.e, owner,tenant, etc.) TYPE FACILITY PROPOSE Y IISSTM PHONE Z6 91- 14-7 REGISTRATION # (nr 9° i'- l Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered, architect. Proposal approved � s Siqnature & /--9 Date Proposal approved with -the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed camponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diaia. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNUM �� ►. TITLE ((,V r DATE 9 \ME: V&te MD); YeUcw (Tam ED; Pink Vq2iauit) w _RP 07 y. . PUTNAM COUNTY DEPARTAMIM, F HEALTH ; j' Rev. 3/86 Division of Environmental Health Services Carmel N Y 10512 s u` 4 Engineer Mast Provide , v C,/'Oj C6S • P C H.D Permit CERTIFICATE OF NSTRUGTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �G/ ]�/r/G !� �/ O >: 1 e • � ' Td" brit e ^located aE,^� � l�G� �: �! tf G • Taa Map Bock Lot ` Ownei /wppllcaat Name �- C� �� }' Formerly Sabdivieloa Name Sabdv: Lot q r`d ,osg h Miu,n- Aaaa Date Pemit eaed , ej '41 y� • Separate Sewerage;;Syetem.ballt by' •' Address Consisting of �' P � �+ Gallon Septic Taak end Water Sapplys Pdbllc Sapply. From :: Address >_ or Private Sapply I)rWed by- O Address Ballg:T*Pe n mple :Has Eroelo Conhol Been.Co ted7 Nambei oPBedroome Has Garbage Grinder Been InstalledY Otbei Regairemente I ceiiify that the systeials) as listed serving the `above pi ises� were consrtructed essentially "e shown on.the pldns'of the comeleted woik ( copies of'which are attached) gnd in accordance with the`etandai3s rules and requlationsi, in'accordance with the; filed. plan', and e p t Putnam Count +Depaitment.,of Eiealth. - - '�. 1 Date LC�S• ` � ` / �� Certifisd`by� r � ( P.E. R.A. Address %d /� <G /A ✓�' �_ � ! LIcen" No Person, occupying Dfemises served by the above system(f) shall promptly taki0sUCh actionlai; may 0e necesYry't0 sacuri the correction of any unsanitary kioni resulting, from . such usage Approval of; the separ�ta sewerage,syftim shaiviiecome null Ind void ae loon a1. a pub t!: sanitary qwer becomes stile and theapproval -of the2private water supply shall tisicome null'snd ,void when,a public'vvatar •wpply`.b'ecoma "evallibli. Ssieh••approvala are r ct'to rriodifiratlon oi_ cMn4e -when Ire the; Jud9menY of the Commifsioosr oY N"it- :•,inch revoertbn, ;modification, or change. is - necessary, t y BY T1r� I WELL COMPLETION REPORT Office Use Only / DEPARTMENT OF HEALTH Division Of Environmental Health Services " PUTNAMi COUNTY DEPARTMENT- OlF "HEALTH _,.......:.._ .,_: _ STREET ADDRESS: IMNivttsAWLIGHT TAX GRID Numea WELL LOCATION Shamrock Drive Put a alle NY A NAME: ADDRESS: ❑ PBIVATE WELL OWNER H.S.F. Construction C6.,Krystal Dr.,Som.�rs,NY ❑ PUBLIC USE OF WELL IEI RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary p INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR :K1 NEW SUPPLY O' PROVIDE ADDITIONAL SUPPLY p TEST /OBSERVATION DRILLING 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 280 ft. STATIC WATER LEVEL —_.ft. DATE MEASURED 7/18/86 DRILLING B ROTARY IM COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT 0 WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE 10 SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH CASING LENGTH.BELOW GRADE DETAILS DIAMETER WEIGHT PER FOOT SCREEN DIAMETER (in) DETAILS FIRST SECOND GRAVEL PACK O YES GRAVEL O NO SIZE WELL YIELD TEST ; If detailed pumping METHOD: WUMPED t tests were done is in- 0 COMPRESSED AIR ; formation attached? O BAILED ❑ OTHER ; 0 YES 0 NO WELL DEPTH DURATION DRAWOOWN YIELD It. hr. min. ft. gpm. 280 6 1260 1 10 WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES O NO PUMP INFORMATION TYPE submersible CAPACITY 7 g MAKER C n» 1 d DEPTH 240 MODEL 7E 05 412 VOLTAGE 2 30 HP 1 Z 82 ft MATERIALS: 91 STEEL O PLASTIC O OTHER 81 f, JOINTS: O WELDED ® THREADED ❑ OTHER 6 in. SEAL: [CEMENT GROUT O BENTONITE OOTHER 19 Ib. /ft DRIVE SHOE: ®.YES ONO LIN ER: 0 YES ® NO 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? O YES ONO HOURS DIAMETER 70P BOTTOM OF PACK 1n. OEPTH iL I DEPTH 11. WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM Water Well SURFACE gear- Oia- FORMATION DESCRIPTION cooE ft. I ft ing meter In Land Surface 1 7o nir i 1 1 I ncr i n nvarhrnrrlan t-1 av A. rlr,a ck at 70' U Old 111 n In rocis set casin routed 82i2801 ill'ng in rock granite. STORAGE TANK: TYPE Well Xtrol 250 CAPACITY 44 GAY.. 13.6 ®30/50 WELL DRILLER NAME P . F o Beal- & Sons , nc DATE PO Box B ADDRESS Brewster,NY 105 �, PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT T0: Commissioner of Health In the matter of application for: I, Charles W. Hatcher represent that I am an officer or employee of the corporation and am authorized to act for H.S.F. Construction Corp. (Name of Corporation) having offices at 3 Krystal Drive Somers, N.Y. 10589 Whose officers are: President: Thomas Flood. III Lovell Street, Lincolndale, N.Y. 10540 Vice - President: (Name and Address) (Name and Address) Secretary: Charles W. Hatcher, 32 Eastview Drive, Valhalla, N.Y. 10595 ;. (Name:. and A.ddress):_...._.._... .. ... . Treasurer: (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 17 day of JU2.y 19 85 Notary Public Sys j=Nwr Ybilt In WtDuM+wa erch 310 Cgn1�d��i 6� Ins Cmaa ► ..aV \8/84 1 - Corporate Seal i w lQ►�OfI. TTTT T /"1Aw.mT TTTnfiT nnnnnm ..e �'I$r Y4`M WL' LL %/VP1C Lr/11V1V 1tL- r V1 \1 DEPARTMENT OF. HEALTH D�v;;ion Of Env ironmental-•fea_li? Services PUTNAM COUNTY DEPARTMENT OF HEALTH - Office Use Only / - IWE LL LOCATION STREET ADDRESS: WN /VI 1 Y TAX 6R10 NUh1BER: - Shamrock Drive Putna alle NY WELL OWNER NAME: ADDRESS:. -Too H.S,F. Construction Co,,Krystal Dr. ,Somers ,NY .. P61VATE PUBLIC USE OF WELL 1 - primary 2 - secondary :E1 RESIDENTIAL O PUBLIC SUPPLY O AIRICOND./HEAT PUMP 0 ABANDONED ❑ BUSINESS 0. FARM 0 TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING :I NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TESTIOBSERVATION ❑ REPLACE. EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 280 fL STATIC WATER LEVEL 35 ft..DATE- MEASURED 7/18/86 DRILLING EQUIPMENT 13 ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT .0 CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED. O OPEN END CASING. .'® OPEN HOLE IN BEDROCK O OTHER . TOTAL LENGTH 82 tL MATERIALS: EI STEEL ❑ PLASTIC O OTHER CASING DETAILS LENGTH.BELOW GRADE 81 ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER in.. SEAL: 12CEMENT GROUT O BENTONITE . O OTHER WEIGHT PER FOOT 19 1b./ft. . DRIVE SHOE ® YES ONO LINER: OYES ONO SCREEN ,...DETAILS , DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST _ ..... ❑ YES ,T ❑ NO ...: HOURS' a ._ GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK In. TOP DEPTH ft. BOTTOM DEPTH N. WELL YIELD TEST 'If detailed pumping METHOD: BUMPED 1 tests were done.is in- • COMPRESSED AIR , formation attached? • BAILED ❑ OTHER 0 YES O NO WELL LOG 11 more detailed formation descriptions,or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Dia- peter FORMATION OESCRIPnON voce tt.. ft. WELL DEPTH It. DURATION hr, min. DRAWOOWN ft. YIELD gpm. Surface 0 1' ` • ""' i verburden clay & bldrs, Hit r ck at 70' 280 6 260 10 .0 .82 D illkna in rock set casin routed 82 280 D ill'ng in rock. granite. O CLEAR TEMP., ❑CLOUDY HARDNESS O COLORED .ANALYZED? OYES ONO NALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE' Well, 250 CAPACITY 44 GAL. 13.6 030/50 WELLDRILLERNAME P.F. Beal- & Sons Inc' DATE ADDRESS Brewster,NY 105 � PO Box B ' 1 E;�47 INFORMATION submersible 7 g c�PacITY C a �1 d DEPTH L [MAKEFR� EH05412 2 0 7 VOLTAGE �_ HP _1L2 t;.. 5i^5r:�� 4 �ra� � .,i�7u��i�. . '?� •Hiq <' n, �� � ewe J4�4'��+ � � �, '- �=,.� � �.� �.rrr� > �' . te;'.. rS;f z',r. h 'w• i ��' .:�' , ry Cl �. u azr�li�?.:�oPS: v ;L+`F;• ` ,�+�, - r`w {�' n. �r. ��"� i .;S �•h 1�. � a c. i{ c,.a- ``r�`'� � � .v r a. 1�c : ,. � `}.. i 4vt . )':r ti�Y •, o '�,t�, � �.sR ?s + ry .t r.�,� ��t c f5 q-^5 „+ v 7. e t - ti i t•� a ,,3�: "L ,�, t 7 a ' _� s� ` ..„' ^f* ''�� l��'a. _,,.1yaG ,y< k +f s�'.:i. 5!� ° i i,�.ry;�' to fi,. f �` ar' 7r.,;� -.r + �' '+1�ia.�"Gh..S*�S^tS�•v..y$ �Y -'� ie. FL�.y'.;LN. X'N; r•.? x + .�'i"1�F'i�.. �GiuL�ii BREWSTER •-LABQRATQRIES. (914) 225 -2U72 WATER ANALYSIS REPORT -- SAMPLE NO. 6344 SOURCE, HSF ,C.onstruction hose bibb - well . Shamrock,Rd.` Putnam.Val,iey COLLECTED: October. 14'0 1986 BY. P.F.Be'al & Sons, Inc. BACTERIOLOGICAL EXAMINATION .Co;iform. Count, MF Method 0 per 100 ml. y C) 1985 - C � This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 16, 1986 •Bickwit P.E. Director PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EOVIROWDUAL HEALTH SERVICES Owner or Purchaser of Building �✓ S. � �D.-J s��c �a� Building Constructed by Location = Street Subdivision Dame Munich- pa�li�ty Subdivision Lot # Building Type GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal system, or any repairs made key. me to.. such ;system,....except where she failure t o o ©er.ate_ droner y. -. :sh =. eauseu -by "tne will fuI o`r `negl igent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirental. Health Services 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/htilizing the system. Dated this % day f uFi 19 �P 7 General Cyontrac or°( er) - ignature F2 � 19Gt .Ir (.n n-, GAJI-a Corporation Name (if Corp.) Address l0��� rev. 9/85: mk 1715;4 57 Signa Ti f4 e- ` Ae f Corporation Name (if Corp.) )_9UV,-C 4.:4COI-"d4je AN ess p S -(,ID Section Block Lot �✓ S. � �D.-J s��c �a� Building Constructed by Location = Street Subdivision Dame Munich- pa�li�ty Subdivision Lot # Building Type GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal system, or any repairs made key. me to.. such ;system,....except where she failure t o o ©er.ate_ droner y. -. :sh =. eauseu -by "tne will fuI o`r `negl igent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environirental. Health Services 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/htilizing the system. Dated this % day f uFi 19 �P 7 General Cyontrac or°( er) - ignature F2 � 19Gt .Ir (.n n-, GAJI-a Corporation Name (if Corp.) Address l0��� rev. 9/85: mk 1715;4 57 Signa Ti f4 e- ` Ae f Corporation Name (if Corp.) )_9UV,-C 4.:4COI-"d4je AN ess p S -(,ID ;;CATION -W a. SDS area b. F' sec :1 barn APPENDIX C FINAL SIT`E /INSPECTION Date - "' CWN " � �p�t Jy - _ - -- �. .� .• . -, � ,4 - �OR SUBDIVISION.. . (,,, ...., � ..: „ . - ,,.. ... ... t as per approved plans ate of placement , LGTH WID`T'H AVG . DPTH c. turd soii not stripped - d. Stone, brush, etc., qreater than 15' fran SDS area. e. 100 ft. fran water c wetlands. II. SEtnua. GCE DISPOSAL SYSTEM a Septic tank size 1,000 1,250 b. 'Septic tank ins ed 1EViel c. 10' minimum from fc ion d. No 90° bends, cle= r_cut within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and t f. JUNCTION BOX - -properly set g. TRENCHES 1. Length reru7red - A6bl Length install 2. Distance to wata+Tcourse measured. ft. -'3. Installed according to plan 4. Distance center to center 5. Slore of trench acceptable 1/16 - 1/32 " /foot 6. 10 feet free prcc*--- "y line - 20 feet - four_da 7. Depth of trench < 30 inches from surface S. Roan allcwe3 for excansion, 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum 11;..Pipe, ends caorei n. PUMP OR DC75E, o m b ir-mb 1. Size of pump chaamber 2. Overflew tank - 3. Alarm, visual /audio 4. Pump easily acces =sible manhole to Sr; 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle IV. HOUSE a. House located per approved plan : b. Number of bedrooms V. WELL a. Well located as per approved pl b. Distance fram SDS area measured c. Casing 18" above grade. d. Surface drainage around well ac VI. OVERALL WORIMSHIP a. Boxes properly grouted b. All pipes partially backfilled ns 4M -L ft. eptable. n MW c. All pipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercours g. Footing drains discharge away fircm SDS area h. Surface water protection adea ate i. Errosion control provided o _n sl e ✓f 1 I • .5 %. "'IX' I 'I r,..6 (18MIll 0 i �iiri Number,of... 00 -Other, R*64uirt Depat CdiirifyibiOar- 0 \ , Ti --PERMIT s PUTNAM COUNTY DEPARTMENT 01P. HEALTH ........ ... _ DIVISION OF ENVIRONMENTAL HEALTH - SERVICES ` Date / // R&: Property:.. °f 4ZU F_ Located at Section Block Lot. Subdivision ' of [cc a . Subdv. Lo t- # � � Filed Map #,� �G �� .�' Date . � �!�V L71 Gentlemen: This letter ,��Ls to authorize • �% � � /, :��; �" u duly 1.ic;uuaucl, Prof U1111 i.cuui i (ingi.110011 � er -rogia Lorod upchitue' L' (lndica te. to apply for ..a Construction Permit for a separate s.ewa -ge' systed, to serve the above noted property in accordance witir the standards,, rules or regulat ions 4s" promulag•ated by. the Commissioner of the Putnam' County Department. of Reilth, and to silgn,:all 'necessary papers ,on my '.behalf in _onnec.tion�wil-h thi,smatti_er--and, to,:sup .se._ the. c.oFist -4ction f.. aaEd" :... M.. si!�O;tem or systems in conformity with the .provisions of .Articl.e 145 or 147, Educption• Law, the Public Health Law,.:-and -the Putnam County Sani- tary Code'. r Very- truly yours, Signed Countersig ed: Owner of Property P.E. , R.A. , 59 ��- Address Address t Town _ Telephone - .�+<r� :! +.+- s-%cmK �*::':.•.; rt. -srn:r .'-!r!r.. ^•.b:'•. - =. i' r !''•+z••'�"tx!cna:..- ci�a.'..� �.�ati.ii!rna- :.e... _ _ — ;•r.L.7.'r- .i..�,r.•.: o .c PUMAM COUNTY DEPARTMENT OF HEALTH - .DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS "FIEM INSPEICTION, R REPORT - / DATE. -S vl d � �Oc' /��,o,, INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO CS Wetlands on /or proximate to property .............. Property lines or corners found...... ...... >. . Can estimate house location ........................ Will-driveway need cut......... .. ............. Must trees be removed - note these................. Deep holes representative of entire SDS area...... Additional deep holes needed ......... ...... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... , Adjacent wells /septics ............. . ... Access to.nronosed well location for drillina..... D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9� ft. 12 ft D.H. 2 Lot Depth to G.W. Depth to rock Soil Descriptia 3 ft. 0' % V -- �/'7 6 ft. - - LL9 eft. 12 ft. - DATE: _ FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan ............. Length.of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches. ............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded...... .. .................. 10 ft. maintained fran property line and 20 ft. from house :.< ......................... <. Distance well to SSDS (ft.) .................. .o.< Number of bedroans checks... ....... o ............. Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench..........,. ..... 15 ft. of peripheral soil horizontally frantrench— ...... ....... Boxes properly 000lo Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS. FTAmT. r_annMr_ OR RTTP Acr.F PTART F _ _ _ _ _ _ _ _ . . _ . D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Descri YES NO CUIENI'S 0 ft. 3 ft. 6 ft. 12 ft. Soil Descri YES NO CUIENI'S z ;2Y t i n1 '+t 4 ' d t � � fir` a ��i AiYe DAVID D. BRUEN. �'4 / �+ ;' JOHN SIMMONS: M.D. County Executive �w YO� Deputy ,Corn missioner DEPARTMENT ':OF HEALTH Division Of Environmental Health. Services August 7, 1986 Anthony S. Pisarri, P.E. Consulting Engineer 190 Locust Aveune Peekskill, .NY 10566 RE:' HSF SDS Fill Section Shamrock Drive TM 68 -6 71 .(T)..-Putnam Valley : Dear Mr. Pisarri: A field inspection of the fill area for the sewage disposal system on the above mentioned lot was made on August 5, 1986: e 11 ing. comments are offered: 1 The depth of fill did not appear adequate. 2. The clay barrier and two and one slope has not been installed. 1 �' 3. The-natural soil appears to have been ,stripped from the SSDS • area ' ...... . The curtain drain has not been.installed. - _._... Surface drainage in the area of the SSDS must be controlled. 6�. The septic tank and pump chamber has been installed behind the house.and not in accordance with original plans. If a pump and pump chamber are to be used, their design must be approved and acceptable to this Department. If you have any questions concerning this matter, please contact me at your earliest convenience. Very truly yours, William Hedges, Jr. Public Health Sanitarian WH:mk TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641- DAVID D.' MEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services September 17, 1985 :JOAN SIMMONS. M.D. Deputy 'Commissioner rA Mr. Anthony Pisarri 190 Locust Avenue Peekskill, New York 10566. Re: H.S.F. SDS Permit Application Shamrock Drive, Putnam Valley TM P „V. 68 -6 -1 Dear Mr. Pisan: As discussed during our telephone conversation of September 16, 1985, the following details on the above referenced submission should be addressed: R4 rL q -Z6-u Evidence of issuance of D.E.C. permit for construction: of well, sewage disposal system (SDS) and house in adjacent area to a State regulated wetland designated as ML -4. eairtain drain depth should be specified as seven feet:as on _ previous:. ;submi.ssi can.;_.: 0.irtain &ain._discharge -.should;be _conveyed... below grade to a point below SDS. VDistribution box detail should be specified showing frost protection. Note 4 on plans should be modified to reflect absence of trenches on plan. Clean fill must have a percolation rate that is no greater than indigenous soil. Note 5 appears to require modification to reflect actual amount of Run of Bank gravel fill proposed. The location.of its placement should be. clearly "defined to.,assure. foundation .fill ,is not..placed / on SDS. 7. Due to the great depth of fill, note 11 should state that proposed fill section.shall stabilize for six months prior to installation of proposed SDS. Upon receipt of three copies of revised plans,.one of which shows proposed trench layout, review of this application will continue. - continued- TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 Mr. Antony Pisan.. -2- September 17,1985 Enclosed, per your request, is a copy of the plans submitted September 9th, 1985. Very truly yours, James S. Hodgen Assistant Environmental Health Engineer JSH /JP Enc. cc: Chuck Hatcher Mr. Priano,,Putnam Valley C.A.C. Chairman - James S. Hodgens File 0 I ------------ �i 11 , OK I Date: "�70 Insp. by : IlIT7AL SIT ISP:'TIOrI Yes No Connnents Property lirius or corneM found . . . . . . . Can estimate house location . . . . . . . . : Nater service line location DrY;M- 21T(TS �( MAIP Top slope, bottom slope of fill i 'rouse plans .0. K. Will driveway nec :d cut . . . . . . . . . }•just trees be removed -hote these ./ DasiCn_ data sheet Peres presoaked? , Kin.. 3V pert test depth or- 1 Is deep hol.c representative of entire SM area D. Hole log O.K. t Additional deep holcs needed. . . . . . . . . Sufficient SW area available considering driveway 'cut,houze location, separation . . . Authorization for engineer Ietter � from l -later Supply if' appiicable distances, etc. . . . . . . . . . . . If variance requested -such noted on plans & apps. Property boundaries. (metes and bounds- clearly o-- LeGgr; �%aoro;slo�, ✓ LOG -Art Q ... - —..... _ ✓ Wei cau6 (nor_/ A�RM;rc ti DEEP HOLE T11T TO Depth: - - — ldater el.evat --- �-. -- -- - Rock elevation:_ Soils dcscrd,..)t i on: Date: _ FIX^L S.I.TE Tit3PP.CT10, Ln :% bY: — _.._. —r }louse Locateq where shown on approved plan - - SDS located orhare approved . . . . . . . . . Jr..n,g,th of trench m3as,L; red Width of treroch aver r Slope of till line and trenctr.accoptable . . . Room allowed--,for expansion trenches . . . . . Over 50 ft. from swamp,iratercour•se . . _.- }•:atural soil. not "stripped or S]13 area wulecessarly graded 10 Ft. maintained from prop.line and 20 ft. froio house —_ -- SeJxtration of trench from house', well etc. fol.low.s plan . . . _. hiuuber of bedrooms checks . . Stone:,, brush, stumps, rubble., etc. greater than 15 ft.;.. from nearest trench . . 15 FL. -of periplrcral soil horizontally -from trench . . . ... . . Junci.ion box&i properly set - CoiO.d surface` run off from driveway, roads, ground su1'llcc, etc. channel near SDS , urea. . : 1 . . . . . . . . . . . Dac:: lot draii:j-1P-e anr0:u• O.K. J.n area of SRS FIlML GRADIP}C•OF SITE ACCEPTABLE A DaTAILS �r}eets : + eyes r : Nater service line location DrY;M- 21T(TS �( MAIP Top slope, bottom slope of fill i 'rouse plans .0. K. Percolation tests and deep test pit ocation ./ DasiCn_ data sheet Peres presoaked? , Kin.. 3V pert test depth or- Cont..rresults for 3 runs ✓ D. Hole log O.K. Corporate Affidavit i'or other than individual Authorization for engineer Ietter � from l -later Supply if' appiicable ; If variance requested -such noted on plans & apps. Property boundaries. (metes and bounds- clearly DaTAILS . rILL bepYN P;iER• ;HC�.`n•� <•y) NMEPLn" ro r3c- rpov.yeb, Existjrig contours shown (show new contours) Slopes:rfor driveway cuts, etc. shown Nater service line location Footing- drain, etc. location Top slope, bottom slope of fill i Percolation tests and deep test pit ocation r Seotic tank size and conformance to std. 3 T3. R. house minimum House setback shown Distribution box ftg. below frost All Mater within 5Q9 T't. of. PL shown .• 4lfilL_•C&S1M(G ii" gpove GeADCC Plan`and profile SDS All other wells and SDS closer 200' ; shown or reference made Property boundaries. (metes and bounds- clearly o-- LeGgr; �%aoro;slo�, ✓ LOG -Art Q ... - —..... _ ✓ Wei cau6 (nor_/ A�RM;rc ti SPECIFIED ON PLIM X10' to PAL. ,20'• to Finlndation walls c- i o� to n7oarest well � J' to siream, irarch, lake, etc. incl:expansion �5' to Cgrtain drain O' to water lino (pits -20 5' to storm drain to ltir, trees 10' from h'oundation Lo s t:anl: 5' to pupe from lc�adcr drain &.1'00EDIC, 41'a.ill '25 To CATCU IZASIw� IS' WECL TO TL _ =0' �E(yT:C. TANK TG • w0e r. EMEwl)T ` Pre f- L lr,3 ES �C3 �s P2rrsS /N� T'O M+✓f�� TD itAu. 5bCAl-. 70 _ Vl F�G-w tlol 1 c4c o ?J9 BS pe -7 -t& r M X IM Ci Mo New York State Department of Environmental Conservation , - 21 'South Putt Corners Road ~ ^n l Foel New Paltz, NY 12561 -1696 Proavc ( 914) 255 -5453 Henry G. Williams Centennial Commissioner November 4, 1985 HSF Construction Corporation R.D. #1, 3 Krystal Drive. Somers, NY 10589' Attention: C.W: Hatches-`"e•- Re: HSF Construction Corporation Location: T /Putnam Valley, Putnam County UPA No.: 3085 -0619 Dear Mr. Hatches: Enclosed is the above referenced Freshwater Wetlands permit. Please note however, that permit condition #19 requires you .to seek -a variance from the Town of Putnam.Valley's 60 foot set back requirement from the turnaround to allow the house to be relocated at least 20 feet closer to the front of the lot. The Department believes that such a. variance approval will significantly improve the project by minimizing impacts to the, 'his - approval Would - :leave a- se-t ,'-b'ack--of �as' much -as 40 feet around the.cul -de -sac to satisfy the future needs of the Town of Putnam Valley and.provide a.reasonable rear yard as well. Please provide us with a copy of the Town's decision on this matter'. If approval is granted, please submit a revised drawing showing the new.house location with the Town's approval. -If you have any questions regarding your permit, please contact me. - - ----= _� — -- Sincerely, I Alec F. Ciesluk Alternate Regional Permit Admin Region 3 AFC /)b cc::, Putnam Valley.Planning Board r.. ... r . 0. "... .. .t .. q..v.�c�w . to �.>. .• -'-it �ir .. : :'y ..' u ,I (3k LOP h 1 V qlL " tcL Lor,> p� , R — _ �Pt S �C - NT Y ZD'E PART MENT:OF 'HEALTH � NDivision ,V� thVM 5nM on dt ; Mflth. IS& VieesI-C4 'k-IQ ' kJMOT W M fjmj.T�_.f� SEWAGE DISPOSAL REM, Town or U9, lol� 2. 7 B, W, _Lot Y Subdivision lot Rev -e' V-s4w- 1"" ne I t e t5 Builtlmg A r _4L i inn ipa fa. 1- m oiijG/P/ .3 k4q 5- ys Sepa ate Sewerage System_ _Wt �, � To be constructed by k, 1Nater Supply Public Supply From ti O,ther�Requirementsr��° (,.represent that I,am wholly and 7— !n,pi q4'yArisgi nii- i6h' - & fhaf. fi, comptg ate f A 64 l�Yr S. .4' 2'c A 71 at, tph i ate�, VVaj lSpOS#_iSY_# 60! n4rfdjdc'i6dri _of ,',,t fiej Or,00 !)-."t Ar V., "V616 an ;r u lons',o _� ,the �Putnam ��mept it"tel,tq�j n, �, in- accordance ;with ."ithe standiI4�JfO16 I-,per,Ufj!;atS, Uat ionldiiiiip'l ij nce- %sit i f �'Conitr' ifadory 4&th a:," iisid-ner of Heilfh,will' 0, q - - I - - - - -, 'h _.- - - - N11 qVe'- fs the _ , '?, ,�iiiWne�� � K�� that,N!kf. ;h 16'4cbssou;�_e r�, 'a!TqM"� _"pqqr-buildiii . ir� !Wd t(2,) 49, s;ImLMidiAtif�'"fdildwiri,9,4K-e4*4t6-,dt ithe, nu- 4 k�Awlr; i a -0 drill lbed' above Ide IQ;Cp" f slist well,desct rnsfa_iT A n L- a idance wdh c a * I �esp. ' ,an i earrf►om t e? date . e n 'l of of onitruet �su $ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROATMEPITAL HALTH SERVICES ._.. _ :u ....., COt' NTY,: OF' FIf�E; .BUTT_DZl`IG....CA?�I'�IE.T,,.• � �Y. ..].4��.2 _ :: ...,.. _ .., .... ....., DESIGN DATA SHEET- SEPARATE SD4AGE DISPOSAL SYSTEM;,'., FILE'NO., M' OwnerAli P. �� da47to�t1 Address ,3 <!�� j37 .DRtyl�r �';Se 9EE► S a N•Y. Located at ( Street .Si�wM1eDek. 'ate• sec. 68 Block 6 Lot Indicate neares cross street) .ti Municipality A►9711199Y! ..1, 4tieey Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 3 /Z.t oo /Z .035' 35 tk i, t �V Hole /3.:� In," Number CLOCK vIME . } ♦ .rya PERCOLATION , �"`" ` 'PERCOLATION Run 'eve 'No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Stasrt$ �St'�p `� . Dr,6PAA Min. /in drop Inches Inches Inches .1:9•x,- . q:38 33. .:- /S':.. .�_:f8. :.3 : y,o 2 9.40 /0:/s 35 /3 .. /8 3 11.7 ho '18 3 /Z.t oo /Z .035' 35 5' Notes: 1) ,Tests to be'repeated at same depth until anoroximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted " for review. 2) Depth measurements to be made from top of hole. tk i, t �V /3.:� 2 i 1 r / Y Gi l7 / n i •S e l .ci Y . } ♦ .rya 5' Notes: 1) ,Tests to be'repeated at same depth until anoroximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted " for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS EIv'COUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 4 611 � clam o 1 4�0 ... `.Y k : Fv}• ,. -.. :I Ip� • ...� VS /t/1 /l_ ii, � T,: '!F L1v X .fi. .�."'.s'V.4 ^I •a1 ? 1811 2411, 36 4 If 8 All AAA a� • 5411 9ca &P IV alf 60.11 . ; . - .... .. • 7211 7811. 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE IEVEL TO WHICH WATER RISES =AFTER BEING ;QENCOUNTERED ;• t. TESTS MADE BY ,��� Yaa -0 _�, 49-e. W Date ZC���'��� - - _ DESIGN Soil Rater sed Min T'Drop: S %D. Usable ^Area ,f, ided ...� - No. of Bedrooms 4 Septic Tank Capacity IZ50 -Gals. Absorption Area Provided By L.F.x24" [ Name Anthony S. PlPe, F,'= igna ure consulting Address 9i- �.�c��� `�►v�n�► SEAL , , 4� w Mx. 10M THIS .SPACE FOR USE BY HEALTH DEPARTPE111T ONLY: Soil Rate Approved Sq. Ft /Cal.. Checked by Date PERMIT NO. NEW"YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3085 -06.19 o . t 'PERMIT:. ` i -' ...,•.. wr.r:T •'+f �+ .. ..q,. t .• ... ........ .: . .- •��.1 .�...j. •-'T .}1^"i �..".• �V ....... .. �r ... " UNDER THE ENVIRONMENTAL CONSERVATION LAW " j' ARTICLE 15, (Protection of Water) r ; . •8 ARTICLE 25, (Tidal Wetlands) r. t• •ARTICLE'24; (Freshwater Wetlands) ARTICLE 36, (Construction in Flood Hazard Areas) PERMIT ISSUED TO i i;,r I i it .i t "; ..:.•'rN't + ?; :; .:`•. }; HSF Construction "Corp. ,... T .�i`til Permit Administrator, a. notice of. intention ,to commence work, at least 48 hours in advance of the time of commencement and ",also notify him : or-injury to the structure or work herein authorized which may be caused'by or ADDRESS OF PERMITTEE . 3 Krystal D'r'ive, 'Som`e`rs. NY`,10589" A{t`in C "'. W` Hatche'r`, r' LOCATION OF PROJECT (Section of stream, tidal wetland, dam, building) 1n the a jacen area, 0 f freshwater we an d ML-4 on Lot #21 just east of'Shamrock Drive in Glocamoria Acres. representative of the Department of Environmental Conservation who may DESCRIPTION OF PROJECT" .r,•.: , ..: • ": -si : „'�; ,,•,: � • : i .. • ; •, ' . , ; .i. Constructs sin 1.e- family ;disposal.” in a .r „es,idence,,,wellTarid.s.' nntary „system. accordance with "�rr. tt.. i.+ `+ _ ;t • a drawl ng prepa`r"e'd:,by_� Anthony. Pi sarri "; P.E. ;; enti "t:l'ed :.'.'Lot 21, 'Gl ocamori a Acres" - dated September 3; 1985 `except as noted herein. cepted expressly, 6y.the "execution of the application, the full,legal respon - COMMUNITY NAME (City, Town, Village) ; TOWN r ever suffered, arising out of the project described herein and has agreed to" Putnam Val l ey indemnify and save” harmless .the. State from suits; actions;.'damal;es "and ^'- .- . %asts of every -name and�e tiptio; resultingf om*Aesuid pmj-ect. "r'.�•- =..":« _.. 11. ; I€. granted" under - Art.lcles.- 24- or. - Department reserves•- the- 'rig:ht. COUNTY TI FIA COMMUNITY NO DAM NO. PERMIT, EXPIRATION DATE Putnam '' modification of the wetland, hereby authorized has not been completed, the cause injury to,navigable channels or to the banks of the waterway. December 31, 1986. GENERAL CONDITIONS 1. The •permittee..shall file in ithe off ice :of ,the'appropriate'Regional i 1" ,& ThatIthe State of New York shall in 'no case be'liable for any damage Permit Administrator, a. notice of. intention ,to commence work, at least 48 hours in advance of the time of commencement and ",also notify him : or-injury to the structure or work herein authorized which may be caused'by or ,shall promptly in writing of the com_pletio_n-of _ " result, .from future operations undertaken by the State for the conservation or improvement of navigation,' or for other purposes, and no claim or right to 2.: The permitted work shall be subject to inspection by an authorized compensation shall accrue from any such damage. representative of the Department of Environmental Conservation who may 9. That if the display of lights and signals on any work hereby authorized order the work suspended if the public interest so requires. ' is not otherwise provided for by law, such lights and signals'as may be pre-' 3.' As a condition of the issuance of this permit, the applicant has ac- scribed by the United States ,Coast Guard shall be installed and maintained cepted expressly, 6y.the "execution of the application, the full,legal respon - by and at,the expense of the " owner .. sibility for all damages, "direct or indirect,.of whatever nature, and by whom -. r; 10.; All work carried out under this' permit shall be performed in actor- ever suffered, arising out of the project described herein and has agreed to" .. „, dapce• with established engineering practice and in a workmanlike manner. indemnify and save” harmless .the. State from suits; actions;.'damal;es "and ^'- .- . %asts of every -name and�e tiptio; resultingf om*Aesuid pmj-ect. "r'.�•- =..":« _.. 11. ; I€. granted" under - Art.lcles.- 24- or. - Department reserves•- the- 'rig:ht. ;.; 4. Any material dredged' in the prosecution of the work fiereln' permitted. :.:to jeconsider this approval, at anytime and after, due notice and hearing to ""'' continue, rescind or modify this permit in such a manner' as may be found to shall be removed evenly, without leaving large refuse piles, ridges across the be just and equitable. If upon the expiration or revocation of this permit, the bed of the waterway or flood plain or deep holes that may have a tendency to modification of the wetland, hereby authorized has not been completed, the cause injury to,navigable channels or to the banks of the waterway. applicant shall, without expense to the State, and to such extent and- In such 5. Any material to be deposited or dumped under this permit, either in time and manner as the Department of Environmental Conservation may require,:° 'any the waterway or on shore above high -water mark, shall be deposited or dumped remove all or portion of the uncompleted structure or fill and restore the at the locality shown on the drawing hereto attached, and, if so prescribed site to its former condition. No claim shall be made against the State of New ` thereon, within or behind a good and substantial bulkhead or bulkheads, such York on account of any such removal or alteration. as will prevent escape of the material into the waterway. 12. This permit shall not be construed as conveying to the" applicant any ' 6. There shall be' no unreasonable interference with navigation. by the right to trespass upon the lands or interfere with the riparian rights of- others .4 herein authorized. to perform the permitted work or as authorizing the impairment of any rights, r },work title or interest in real or personal property held or vested in a person "not a +• 7. That if future operations by the State of New York require an alteration party to the permit. in the position of the structure or work herein authorized, or if,,in the opinion !. of the Department of Environmental Conservation it shall cause unreasonable 13. The permittee is responsible for obtaining any other permits, ap-, obstruction to the free navigation of said waters or flood.flows or endanger provals, lands, easements and rights -of -way which may be required for this•. project. the health, safety or welfare of the people of the State, or loss or destruction of the natural resources of the State, the owner may be ordered by the Depart - ment to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State; and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners shall, without expense to the State, and to such extent and in such time "and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to Its former tpnditlon the navlgable and flood capacity of the watercourse. No claim shall €be made against the State of New York on account of any such removal or alteration, 14: If granted under Article 36, this permit is granted solely on the basis' of the requirements of Article 36 of the Environmental Conservation Law and Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards Building Permits) and in 'no way signifies that the project will be free from flooding. 15. By acceptance of Is contingent upon strict faVtir9R pills. 95.20 " " -4 (9/75) (SEE REVERSE SIDE) this permit the peimittee agrees that the permit compliance with the special conditions on the SPECIAL CONDITIONS_!_':------ r ? Y 16. To satisfy the requirement of.General Condition No. 1, the permittee.or a representative shall contact, by :telephone, the Division of.Law Enforcement, in New Paltz (914/255 -5453) 48 hours prior to the commencement of any, portion of the pro '-ect- 'culthor i zeo herein. ; 17. The permittee .shaTl'requ'ire'that''any contractor, project'engineer, or other person responsible�:,for the overall supervision' of this project roads and understands this permit and,all special conditions. 18. The permittee shall not commence construction of,the; house until he has ;complied.with.Condition 419*.. All other ..filling•and.constructi,on may "commence immediately. �.e r a" 19. The permi ttee. shal 1.. request from the Town of Putnam- Val 1 ey. a ..variance 3from' the 60 foot temporary easement for the`turnaroun'd in order to relocate,,the,.;:' ' house on Lot #21,: at. 1 east, 20feet. cl oser. to Shamrock 'Dri ve. Vco.pyi, of,+ the , Town's decision- "shall be'submitted.to'this office prior to construction of the house. ,. r 20. All necessary precautions ,shall'be taken to prevent contamination of`the waters of the freshwater wetland by'silt, sediment, fuels, solvents,' lubricants, epoxy coatings, concrete leachate, or any other pollutant associated.with'construction. and construction. procedures. 21. All areas of soil disturbance resulting from this project` shalI be seeded.."*:.. with an appropriate perenniall grass seed and mulched with, hay or straw. .within one week of'final'grading,' Mulch shall be maintained until :.a suitable vegetative.cover is.established. SEQR NOTE: ,K Under the State Environmental' "Quality Review,Act,(SEQR), the project associated r with this - permit is'classifiedras an Unlisted-Action and the Department of Environmental Conservation (DECY has determined.that it -will not -have a �v. -sign ifi-cant---effectT!.on -the environment., Other invorved agencies may reach an:� . independent`;_determination of.- environmental significance for_this project, K: 'DISTRIBUTION .. .. trv; t44. Yy.} {'"�..`:>•A b +91t Y..t't tti� rtT`Y }T"{�lij ik.- Y J..,7 i v{ t Ft, y �F Y i. -. Z X t �• ,� Po °: Kel.l Law Enforcement' t Steel eY." _! t - - x -f,, { ' { Y .d 4 t a r. . pis rt"wS•,. ,et ;�5a'�S y+ ` e a 'rt. tqi stiff s �.., r s.K kn. t ,.. �'l\ {a �a �• 1,,r "'�?f:}a5 I� J ti:n 8! t .s � �r't� t y � .t• 717 X31 {p ,., ,'C .. Yro,^ t 4 % f 3 { - J �;I -� "f' 7 t r { •i., r i2 i .�.\ � -t r , ry j.. t < t - y }I. Lt. +s, gIY. •., #.''a Li,�. z�:..ju ..s pr,.' ..?"a'" t. I Y .� f • t !. t ',, 5% ; ,�: = ` " t 1 'If 1 t !jLq 1 , V�J r PERMIT ISSUE,DATE PERMIT ADMINISTRATOR ADDRESS 21 South Putt Corners Road. New Paltz, NY 12561 -1696 U . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re Property : Property of I`7• S• F co- ovare"CrIvAl Located at (T )AM/IM yALL6�l . Section 68 Block 6 Lot / Subdivision of Subdv. Lot # Z/ Filed /Z Z Z. Map # iZZ7 -A Date Gentlemen: This letter is to authorize T/1o0V -d jg4e, a duly licensed professional engineer ✓ or registered architect (Indicate to apply for a Construction Permit for a. separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations.as promulagated by tke Commissioner of the Putnam County Department.of Health, and to'sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said -- sys-temY or-systems ..in conformity ritii `thc,, provisioArs o '.:.Art1c1P—.1-45 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code..' Very truly yours, Signed Countersigned: Owner of Property - P.E. , R.A. , # AddiVe ss 1190 Xoewor o*veAjue � Y Address Town '�EE�•SIr�l.G fl40 16.�SO Telephone Telephone ' PETER C. ALEXANDERSON r County. Executive DEPARTMENT OF HEALTH Division Of Environmental Health. Services January 30, 1987 Mr. Frank G. Fowler, III, P.E. 386 Main Street Ridgefield, Conn. 06877 Re: HSF Sewage Disposal System Shamrock .Drive TM 68 -6 -1 (T) Putnam Valley Dear.Mr. Fowler: JOHN SIMMONS, M.D. _ Deputy, Commissioner A final inspection of the sewage disposal system on the above captioned lot was made on .January 16, 1987. The following comments are offered:. 1. A swale should be constructed along the south west portion of the property to protect the.system from surface water drainage. 2. A 2 on 1 grade for the fill.section has not been installed. 3. The audio /visual alarm for the pump has not been installed. If you have any. questions. concerning .this matter please. contact one at - __.. - _. Very truly yours, A�rinemarie Brady-, Environmental Health Techru.cian i AB /JP 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 In PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT CORPORATE -OWNER 'APPLICATION- FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: Construction permit for sewage disposal system at lot #21 Gloram6rra Acres Putnam Valley ey I$ Charles W. Hatcher represent that I am an officer or employee of the corporation and am authorized to act for H.S.F. Construction Corp* (Name of Corporation) having offices at 3 Krystal Drive Somers, N.Y. 10589 Whose officers are: President: Thomas Flood, III Lovell Street, Lincolndale, N.Y. 10540 (Name and Address) Vice-President: (Name and Address) Secretary: Charles W. Hatcher, _32.-Eastview Drive, Valhalla. ---(Name -and-Addre-s-s-)� Treasurer:, (Name and Address) and that I am and will be individually responsible for any and all acts of the 'corporation with-respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 17 day Signed; of JU.1y 19 85 Title: Notary P u b I i c L PECARINA riftw:q ftne 9f NOW York 4U*= GUBMI" In outchm C /0-7 Cr$r* fift,gres March A i9Z/ 8/84 Corporate Seal .-�-'r-` ` -~-----'`-�-�------~-----`--'---- ' . ` _ .......... _--'--- Abxv ---�-�--�~~----`=^� --\'---- ���--l�'�--=-- � v u | ---- --- ---��----------------�--� '--�---- | / / N ew York State , Department of Environmental Conservation N 01, TI..I C E . a . _ The Department of Environmental . Conservatio'n (DEC) has pursuant t permit(s) o the Environmental. Conservation issued Law for work being conducted on this site. For further informa tion regarding .the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below, Please refer to the permit number shown when contacting the DEC., Regional Permit Administrator Regional Permit Administrator �O Department of Environmental Conseatio'Permit N o. I Region 3 New. Paltz, New York 1 2561 -1 696 ^' ! Telephone (9141 255 -5453 Expiration Date ]� 95.20 -1 (11M2) NOTE: This notice .is --not a permit �._ s /o,z J'8. =' 7 /C X "N vd CYRTAI _j7 tr Ou q; \A 7---v %A F-XISTIUC. C11- A '0 PTIC TANK PUMP CHAMBER rur LI County Ueparz"Jaz Qr,.tLeauza; .01v1s1on of Environmental Reanim serviceri ipproved as noted for conformance with OPlicable Efules and RegulatIMS: of. the Putnam County Health Department.. Ile -IBUIL 'T SEPTIC LOCATIOU 14 LP1LJ MW OF LOT� C: 7-2 3,