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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 74.10 -1 -5 BOX 28 ,Iry ar � r ■� 1� '' re i 03593 t"// PUTNAM COUNTY DEPARTMENT OF HEALTH OF-ENV-IItONMENTAL .HEALTH. SERVICES..-....:. _ C IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCH STRUCTION PERMIT # Located at d LF_iz -Ly tlli-4 6___ Town or Village PJ, J4nJ Vi / /EZ Owner /Applicant Name &4,W E A W Tax Map : / Block % Lot , Formerly Subdivision Name Pow o Vi ez-j Subd. Lot # 6. Mailing Address 1 LA s � 1r-1 Zip / co Date Construction Permit Issued by PCHD 1 ti' , Separate Sewerage System built by ", 4' of `2J IfTA, Address /ZAp 9JAV-", Consisting of Gallon Septic Tank and �5 y 0 F 01 2 r' Other Requirements: Water Supply: L Public Supply From. rJ cj� i S/ LJr Address. or: t,/ Private Supply Drilled by �f�(rJfiC%t� Address t �" -I ;� / 6� '� B.uildiing-Typs=- - Has erosion control beer.- cornpleted? Number of Bedrooms 3 Has garbage grinder been installed? 1_11 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 thf Pint m .,ounty Department of Health. Date: Certified by `_/l� P.E. L-/ R.A. Address (�L �� l�_ } /(' J �� /�;U /. License #���� 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, modific .i,s necessary. By Title: Cs Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 9. k � e57 WLLL uur1r.LJL11uA r%zruAl Office Use Only DEPARTMENT OF HEALTH Of, Euvironm4t,tal _Hea.j.g#,-. Ser.vices.,. PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: 411. TOWN/ TAX GRID NUMBER: 7 WELL LOCATION WELL OWNER NA ADDRESS: ") fI- ko ee PRIVATE R PUBLIC USE OF WELL 1- primary 2 - secondary 4RESIDENT 0 PUBLIC SUPPLY ❑:AIRICONO.IHEAT WMP ❑ ASANDONED ❑ BUSINESS 0 FARM ❑ TEST/ 0 BSERVATION ❑ OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED =ST. OF DAILY USAGE__ gal. REASON FOR DRILLING. 19 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 7___�ft, STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT -ja ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING -9 OPEN HOLE IN BEDROCK 0 OTHER CASING BETAS TOTAL LENGTH ft- MATERIALS: _':E.STEEL ❑ PLASTIC 0 OTHER LENGTH.BELOW GRADE fL JOINTS: . Q WELDED :.THREADED ❑ OTHER DIAMETER in. SEAL: OCEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT Zle Ib.1ft DRIVE SHOE;9YES ONO LINER: 0 YES/)aNO �SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (11) DEVELOPED? FIRST ...0 YES.. ONO 'wURS SECOND ---- --- GRAVEL-PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH It. BOTTOM DEPTH — It. WELL YIELD TEST If detailed pumping METHOD: b PUMPED i tests were done is in- ;02GOMPRESSED AIR formation attached? - 0 BAILED ❑ OTHER ❑ YES C3 NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water: Bear- ing Well r mete In FORIMATION DESCRIFTION CODE It � It. WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD gpm. d S Launrface - Ar WATE11. ❑ CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? oyEs oNa ANALYSIS ATTACHED? 0 YES 0 No STORAGE TANK TYPE-',,,,_,j CAPACITY GAL. PUMP IXFORMATION TYPE CAPACITY. MAKER . V - DEPTH MODEL . z\,VOLTAGE — HP WELL OR1u0MA%Pg_ OAT AODRES/j �- SIGFIMRE � e57 YML ENVIRONMENTAL SERVICES 321 Kear Street =/ � Yorktown Heights,, ' 10 9R _ _ _ »�x�^ _-~� N Y �� | Albert H. Padovani , Director / LAB #: 32.0025' CLIENT #: 2300 NON STATPROC' PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~�~~~~~ ANNUNZIATA, RICHARD 443 AUSTIN RD MAHOPAC, NY 10541 DATE/TIME TAKEN: 10/31/97 10:30 DATE/TIME REC'D: 10/31/97 01:30 REPORT DATE: 11/04/97 PHONEg (914)-628-6080 SAMPLING SITE: BUTTERFLY LANE, pUTNAM VALLEY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE.^: < 4C NOTES...: . COLIFORM MEM MF --------------- ~ ----------------------- ------------ -------- i --------------- DATE FLAG PROCEDURE PUTNAM CNTY PROFILE RESULT NORMAL - RANGE METHOD 10/31/97 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 10/31/97 LEAD (NMS) <1 ppb 0-15 ppb ` 10/31/97 NITRATE NITROG 1,00 MG/L' 0 - 10 10/31/97 NITRITE NlTROG <0.010 MG/L N/A 10/31/97 IRON (Fe) <0.060'MG/L 0-0�3 mg/l 10/31/97 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 10/31/97 SODIUM (Na) 000 MG/L N/A 10/31/97 pH 01 UNITS '6.5-8.5 10/31/97 HARDNESSJOTAL 24"0 MG/L N/A | 10/3097 ALKALINITY (AS 18.0 MG/L N/A / 10/31/97 TURBIDITY (TUR Q. NTU �-'-� COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING—TD THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ' Pb/Cu LEAD limits for public schools are set at 15 ppb. ' EPA Lead &Copper Rule for Public Systems requires that no more` than 10% of their distribution points have a LEAD value of more ' than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0 5 /L . mg . Na No limits for Sodium that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a j diet, a maximum of 270 mg/L of Sodium %, ^. ila YML ENVIRONMENTAL SERVICES 321 Kear Street - -18598L��� (914\ 245-2800 ` | ' Albert H. Padovani, Director ANNUNZIATA, RICHARD ` DATE/TIME TAKEN: 10/31/97 10:30 443 AUSTIN RD ' DATE/TIME`REC'D: 10/31/97 01:30 MAHOPAC, NY 10541 REPORT DATE: 11/04/97 PHONE: (' 14)-628-6080 . SAMPLING SITE: BOTTERFLY LANE, PUTNAM VALLEY SAMPLE TYPE—': POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL _ RANGE METHOD SUBMITTED BY: ' H1beyt M. Padovani , M.| (ASCP) Director . ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES wv. r - , -a. n- r.t;').n s Miir•,'1 .'f. . ri r 'F': 6^r'e.r -•Qf •'Y' -. f . r GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Al-11-iAi-I 7-� o Owner or Purchaser df Building Tax Map Block Lot i - K(J / —! i A /-] Building Constructed by Town/Village Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a. period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to, operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. ...- .....:_. _ :. ,:_ .:... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam' County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. /-% Dated: Month Day 5 Year __ 9 7 . Corporation Name (if corporation) Address: ,�51fi.1. Z40 Y/ ,44> , )K-, State Zip /Ck* / Title: .. Corporation Name (if corporation) Address: fi1�i,Silr.! o,�D �� 4c State j- 1, �Zip Form GS -97 D Roy Fredericksen PO Boni 950 Mahopac, NY: 10541 Dear k1r. Fredricksen; DEPARTMENT ENT OP BEAL H Division of: Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 -Fax (914) 278 - 7921 BRUCE R. FOLEY Acting Public Health Director Re: Proposed SSDS: Lisa Butterfly Lane (T) Putnam Valley April 24, 1997 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: The revised plans submitted April 22, 1997 for the above regarded lot is approvable by this Department. However, the permit cannot be released until a wetland permit from the Town of Putnam Valley is received. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly, yours, ..... .. _.., _ .._ ._. _ .�. 'b� R OW Robert Morris, P. E. Public Health Engineer RiVUjp cc: Attn: Tom Lisa 3443 Fairview Ct. Yorkrtown Heights, NY 10598 --F .FpY .. Acting Public ,Health Director DEPARTMENT OF HEALTH Division .of . Environmental Health Services F. 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 App 17, . 1997 Roy Fredricksen PO Box 950 Mahopac, NY 10541 Re: Proposed SSDS: Lisa Butterfly Lane (T) Putnam Valley Dear Mr. Fredricksen: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1.of the official compilation of Codes, Rules and Regulations of the State of New York; Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." .: Footing gutter drain discharge has not been shown on the plan. 2. Pump pit dimensions do not appear current for a 1000 gallon pump pit. Please provide side wall dimension outlet elevation, interior dimensions and maximum liquid level or revise to a 1000 gallon tank. 3. D -Box detail has not been provided. 4. A note to be added stating all erosion control measures are to be installed prior to the start of any construction. Upon receipt of a submission, revised to reflect the above, this application will be considered further. RM/JP Ve ly yours, Robert Morris, P. E. Public Health Engineer Ptr7'r � !1 �.m n ti-n m rar �e.T�.,flF::i'{i al F ialr: A { ll:i U1i. yn. d r:•�.1.- ..n....,t i:i.c,.1rt,fi ti.,...4.n. �..,r,�.F+ �. r I @: � .' r•.•.y��.e... ,,,, f ..,fAa, F"e.vd, r a. at;r nlri! � rt m r I►m n�le � � � ti.wt Cul MUU ( il,!U'. PT.il9dirT 170EI MWAM awe= I S Y ffar1 8 el_j -L 'u —AQM4S 65A Ira„ of I ", , w A pyr„, d 1 I. Arc• Clllf `.:.eh ilr* IU�Pt,h YGIMM ti ar�rr w! Nk.•drwnaa I!r.0 �!m f l b F (C1811n Ae,(a i,6= la 4l ..q mibrerA M= M Lu 0®aem883w tie.5= 1e 4� sycd= to =ta d 2i GIn s;9 I an Y arawl i ! . CW a t,er 1 u�ple - V utnY� \,.,P4ui�� F ror� �. N ri . r t� <. �aipgip IU r181k.1 h . IIl ,isy tl.Nn aii[V MMfaRH,t11!v I'' S � �Q 1 roprownt ".that 1 am wholly and compiotoly r©sponsiblo for the dotign and location M the 00pdsoll system($): 1) that the mporoto taw di sal system above dosc►ibod will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu tuns o nam County Doportmcnt of Hmnh, and that on completion thereof a "Cartifieoto of Construction Compliance" eatisfaetory to the Commiaalonm of Hoalthwill b m*mittcd to tOO Ooportmcnt, and a written Ouarantoo will Do furnished the owner. his CuCCOa WS. heirs or assign by the buitdca, that MIS buitdCf will Vxo ict Grid o=oting condition any part of said cawogo dispoml systoln durirog the gm 4 two (8) yowl Imwa diotoly foltowina thodoto of the law ocxo 00 Oho ala(sraval 04 the Certificate of construction Compliance of the y rapah Wpoto; 2) that the drilled well do�ri ai�mvo to000 Do toeote5l as eh=a on M app wdc:9 plan and that acid well will be installed n oo Gri the �a r.0% rubs and rceu na of the putoom County ®cps moat f MmIM. A / Coto Sgncd P.E. ` R A. Address � � License No APOROVEO FOR CONSTRUCTION. -This approval eupiros two years from the data issued Aloss eonstru tlon of the building .teas boon undortatton and is "Notable for cause or may do amondcd or modified when considered nocesee►y by the Commissioner of Hcolth. Any change or alteration of construction r=uiroo a now permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. R2V. 10/88 "o ®y Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 - APPI,ICi�;TITV"'T'EOIys�F%It •> WlFfr.:.4�'ELL PCHD PERMIT # WELL LOCATION S reet Address Town V llage City Tax Grid Number 6- VOT74 , ,b •7/ WELL OWNER ame Mail'ng Address akTp_,yj S ivate O Public USE OF WELL 1 - primary 2- secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE_,gal 10 RE�LACE EXISTING SUPPLY O. TEST/ OBSERVATION U ADDITIONAL SUPPLY EAEW SUPPLY NEW DWELLING1 17 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING 1 11 0sle- WELL TYPE RILLED DRIVEN DDUG �GRAVEI� a OTHER IS WELL SITE SUBJECT.TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 0 111:_:, C eS Lot No. WATER WELL CONTRACTOR: Name D 2)9, 11 4-1'Zk Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �� NO NAME OF PUBLIC WATER SUPPLY: � TOWN /VIL /CITY DI.ST:ANCE"TO-PROPERTY FROM' NEAREST. WATER •MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 4 +� `T SEPARATE SHEET (da e) ign PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: Date of Expiration Permit is Non - Transferrable 3/89 19 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller e I.rO�rNeatt "a1►at I,am �tA01 otooeci os¢crEU®d eyill:tx� ao ci®wky' b0p6Ptmn➢lt of be su0rnitte d to 29m, Des �t9tm Est' ®D�d ®O®ro@irig� O;Itidof -2m—,e eo:'of, Of HOMIL sction? Complianco 09 it mid molt will bo Inatc $lancd� iupkos tebo va from when eon wine_ sos domoatic n ary ®v ition o4.'tho :roipcssd svatwn(ss)l '1) that tha aaparnia song ® disposal a stern ito -dnd in accordance`with tho standords, rulas o!m ropulat ions of a rutnum q of Constiuetion :COmpiionco" 'mtisfoctory, to the Commiaslonor of, Ho®Ethaaill E 4A0 oltlll6p ,his ¢usoossc s, Peolra,or, ossgne by Ova bulk*r, thot mid buildw dill i l l- th'- 07: @euo (8► y®mrs'immadicteIV folloining the date of tho IMM- or st oP any'r • s tllcsroto; ?) .that the drilled well oe=tbed 06Gvo ! i a n A ho r®e, rubs and rGou of Oho putaom P.E. E9.Oa. ka Liconso Poo date issu unloas construction of tho huitdino ihps been undertakon and is i ®y thG' mmism6n,or ,o4 Mca' Ith'. -Any colonoo.or oltcration of construction to.t*rotor oa only. TRIO Data 566 AP MOVED FOR W rw4imaO for, Co. 8 rewires o w Ip Rev. 10/88 'too sction? Complianco 09 it mid molt will bo Inatc $lancd� iupkos tebo va from when eon wine_ sos domoatic n ary ®v ition o4.'tho :roipcssd svatwn(ss)l '1) that tha aaparnia song ® disposal a stern ito -dnd in accordance`with tho standords, rulas o!m ropulat ions of a rutnum q of Constiuetion :COmpiionco" 'mtisfoctory, to the Commiaslonor of, Ho®Ethaaill E 4A0 oltlll6p ,his ¢usoossc s, Peolra,or, ossgne by Ova bulk*r, thot mid buildw dill i l l- th'- 07: @euo (8► y®mrs'immadicteIV folloining the date of tho IMM- or st oP any'r • s tllcsroto; ?) .that the drilled well oe=tbed 06Gvo ! i a n A ho r®e, rubs and rGou of Oho putaom P.E. E9.Oa. ka Liconso Poo date issu unloas construction of tho huitdino ihps been undertakon and is i ®y thG' mmism6n,or ,o4 Mca' Ith'. -Any colonoo.or oltcration of construction to.t*rotor oa only. TRIO DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 AP:P%LICAi'�O I: Q.; GQ1 : H 'F _r�►- in1ATER =WELL ... . . :::r... PCHD PERMIT WELL LOCATION Street Address Town Village City. Tax Grid Number WELL OWNER Natdd Mailing Address! S 344 • /AZT 1&t1 ivate O Public USE OF WELL 1 - primary 2- secondary MX&SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT AT 0 ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. E3 REPLACE EXISTING SUPPLY 13 TEST /OBSERVATION ' Q46 SUPPLY NEW DWELLING O DEEPEN 'E ISTING WELL OF DAILY USAGE gal LZ ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE BILLED DRIVEN ODUG DGRAVEL< 0OTHER IS WELL SITE SUBJECT TO FLOODING? ✓ YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:_ Lot WATER WELL CONTRACTOR: Name Tb 6 c�_ Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L,,"NO NAME OF PUBLIC WATER SUPPLY: &A TOWN /VIL /CITY I^I . , DISTANCE:.TO -PROPERTY-. FROM. NEAREST WATER MAIN:..._..:_:.::..__�1 . LOCATION SKETCH & S URCES OF CONTAMINATION PROVIDED SEPARATE SHEET ' ( at ( ignature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall:. 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dri ling operations be contained on this property and in such a ma ner as not to degrade or of erwise contami to surface or groundwater. Date of Issue: 3116 19 Date of Expiration 19 Permit Issuin ffi aka/ Permit is Non - Transferrable White copy: HD Fil k copy: Owner ' 3/89 Yellow copy: Bldg. tInsp. Orange copy: Well Driller t JOHN KARELL Jr., P.E., M.S. ., ='r'•i .. :@ablic HoAtti Director-; DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Roy Fredricksen 176 West Lake Blvd. Mahopac, iVY 10541 Dear Mr. Fredricksen: February 18, 1994 . . .,> Re: Proposed SSDS: Lisa Butterfly Lane (T) Putnam Valley Renewal PV -5 -84 Review of plans and other supporting documents submitted at this time relative to the above-captioned project has been completed. Comments are offered as follows: The split system shown on the proposed SSDS plan is not permissible under current codes. rovide invert elevations for the septic tank and junction boxes. �! Design details for the well, septic tank and.junction boxes have not been / provided on plan. Standard construction notes have not been provided on plan. 5.e se provide the following items for our files. .. ouse...plans b) dg�si gn data sheet - e,rNlell permit application Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. RM /jp Very truly yours, Robert Morris Public Health Engineer cal, .oN- yi PUTNAM COUNTY DEPARTMENT OF HEALTH - .,.DIVIS.ION OF ENVIRONMENTAL HEALTH. SERVICES Re: Property of Located at Date j`�! c:.i� 3 / 5 y' F - ref (T) %-jig Section , i0 Bl o c k___j Lot Subdivision of C> res Subdv. Lot # 4 Filed Map #_L,316 Date Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate ff to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in ,..connecta_on. with this matter and. to supervise the construction-of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. r Countersigned: P.E., R.A., # C� 'PC,) �- Address Y7)4./ &AC4 �-(' �� CQ 21a - v.3 ')62 Telephone Very truly yours, Signed er of Propkrty Address 24S - 9s -I (4: 2 Telephone 'PUTIVAM COUNTY DEPARTMENT OF HEALTH vPermit a ,�> < D %v/S/on of Environmental Heelth Services, Carmel, N: Y 10512 CONSTRUCTION• PERMIT ,FOR SEWACsE_:DISPOSAL SYSTEMr t Town or olfioge sr -� .. �-• re,- ... ,y. •5: ItiCCif' . t .:. ..t Locatedrat SubdiVifion f + ' * e t I SUM. Lot # Renewal _ � Revision _ [J Owner /Address r d a f Date'Of Previous Approval 4. Buildin9`TYpe fl= xn " ` s'9 ' L''Ot AreaY Z ywl`r Fi1-1, ection.t)nly 0. ' F# - _ •. - _ •. ra P Cv,_H D. Notification Required ,Number of Bedrooms `' Design Flow, c /P /q�s � Separate Sewerage m Syste to consist of Gal SOptic, Tank antl To be constructed by, r� t ` ` p Address f a Water Supply ?utill2 -, Sup01y From 1 - 4 tom'er �U 't t Private supply 'to be drilled by + ' ` `Address ° *= Other' Requirements .' 1 -represent that I' am wholly and completely responsible forthe desigi above,described , will.be constructed as4own onthe,approved,amendr County department of Health, and that on completion thereof a "I be supmitted 5to then Department, and a ;written guarantee -will _be place in - --good operating. condition any part of - -said sewage dispoe ante. -of ;the approval ,of° the Certificate of_ Construction Gompfian wiU�be located'as,shownon-the "approved plan antl,thatssiid wellwillb County Department of Health ;, t—_ : Signet w __ } Address�I APPROVED FOR CONST.,ftUCTION This approval expires- one�,yea w- revocable for cause or. may be ~amended orlbodified'when = eonsldered :requires a new permit .Approved for disposal of domestic sankar z Dater By lieu 9 81 � sand locatwn of "the proposed system(sj; 1),`,that :the separate sewage disposal system rent there to`and_ in accordance with the standards, rulesand o e u nom eeUficaia, of "Construction ConipliancelI "satisfactory to the'Commissioner of Healthwill :furnished the owner -, his,successors, heirs or assigns by the builder, that said builder will a s ad during,``the period of`two (2) ?years immediately followirigthedate of the issu- c4 "of qhe original system or any •repairs thereto; 2) that the drilled well described above e instalio k accordance: 'with the, standards; rules, and..regu a ons .of. the - Putnam rF r 11� %; 6, ; License No r from the date Issued unless construction of. the - building has been undertaken and is necessary by ttie Comrnissrontir mf;,kealth. Any,change`or.alteration:9f construction y Sewage, 'and/or privatg: =water suAPDly'Only.' 'Title FUIN r►n[twrrrYD>DiAlT11�M1;OFDEALTH ;. Q D ai=eiltl Heal1�'Saedee�.'C7nttael. K 11512 MW W to Pwvld� Pratalt /. . V •6tU " ?h a CEL!'1>FI('.A18 OF OOMl1JAHiCB QO N Paaalllalt '� 'q� MW.M IlU =WAGE DWOW SYST®1[ .i.'Tfi2FL�1 w r-1G� aw. Q _ ... � -.. w �e ^.�. �, . ,�, . : � ;a-y x� x• .0 u v +e•... .'� �....�,,. = e -... � �. . ->..s, ax; .r.., .y _f DaDI .. h!e leaf Aaraa_ 4e- . � Yaia�a . timbe` al[ Bash„ r Deaip Flow G P D PCHD Nof16atl6a 1& lYequhed When Fm d d salpe.r s•w•es• srla.:a aowelet aar'Zi0t20 cso9e. s•wk Tatnt To 6:CMWhMdW W"Ill, S "*. BWA.11. Sam Fe;,, Aden Gai Pdlig, Saati b MW by ou.� coo ,� D. 1 rap►aant ;that 1 am 011y, and' comp Ny i sponsiple.f0► t a deign and locution -ol above described will M constructed as shown on the approved amendment there to'ana -County :Wparlment of, keelth, and that on i0m0ati6n;thereof a °Ceitiii, be subrnitted to the Dpi►tmant,'ani -a written guarantee wall bey furnished the o% pate in pod oileratkq condition any Part` of iik1 swaN - ditooial sYiaam,_ dur ante of. the approval of the Certificate of Coitst►uction ;Compliance, of :A M sirNl'bi located is haimn on the app ►Ovid Plan and tsailai i well wv 'b 'instiii n i' County Department of Health. Data , . �i �!j .. Signed Addlress- APPROVED FOR CONSTRUCTION: This apiMOral e*PWei two,' r from tha revocable for cause or- maybe &minded ,or modified whan ton e0 eeesrary by .ti+ ►ep"ires •new permit��Approved for ditpOYl or domistk s f Nw/p�e;�ano[q Rev., Oda. BY -/ 10/88 C in roolied( stem(s). i) that the sepa►ata sew di k( stem )idinoe with the standards, rules a rpu ions or n& ion =Compliancd" satisfactory to the Commissioner of Mealthwlli t Sul C a. how a asigiei by the, bulkier, that said builder will a of 0) Years linmedlately following thedite of the Isau- � , _ an repairs t of 2) that the drilled well.deaa OW al60 a lM' °st hide rules And rpu Wns of the Putnam P.E. License No urt s_ eonst,uc n of the building has been undertaken and Is missiomr of N Ith. Any Change or alteration of construction 9 watN_'su0P1Y �� Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 _... (914). 27.8-013Q., r .. p..r.... •s .. .fir t w.. .y_ .e _G -.r'aa n w..1as..rM'. ...t'r. .. .. .... .- _.b °�..:.y.r[w rb'r .. o.. r. ......• <i. • ..r APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # PV6-- &+ WELL LOCATION S rest Address Town Village ity, 51WTMjq;q 1, 0 Tax Grid Num er -7440-1- WELL OWNER - Name Mailing Ad reams V---L Bate O Public USE OF WELL 1 - primary 2 - secondary r 'SIDENTIAL ® PUBLIC SUPPLY bhR_'/C*'OND/1&AT PUMP ® ABANDONED D BUSINESS . O FARM O TEST /OBSERVATION O OTHER (specify ® INDUSTRIAL 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE 6-- YIELD SOUGHT t� gpm /# PEOPLE SERVED /EST. OF DAILY USAGE,Sal 13 REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 13 ADDITIONAL SUPPLY 0461 SUPPLY NEW DWELLINGI ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS TELL SITE SUBJECT TO FLOODING? YES ---'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: cc Lot No. STATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: r YES ��NO NAHE OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEA%EST WATER "TtiAIN: LOCATION SKETCH & S RCES OF SEPARATE (da e) CONTAMINATION PROVIDED SHEET surnatur PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within third* (30) days of the completion of water well construction, the applicant shall: r 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drill' g perations be contained on this property and in suc a manner as not to degrade or other, ' cont a ate surface or groundwater. Date of Issue: l 1 Date of Expiration -2/A0 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller r 'TOWN OF I'.U:TNAl�4. PERMIT WAIVER ., CHAPTER 63: Freshwater Wetlands, Watereourses.and Waterbodies.Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANT /SPONSOR: PROPERTY LOCATION: May 24, 1997 May 24, 1998 Thomas Lisa 3443 Fairview Ct. Yorktown Heights, NY 10598 Butterfly Lane, Pond View Acres — Lot # G TAX MAP #: 74.10 -1 -5 SIZE OF PARCEL: 2.0 Acres ZONING: not provided PROPOSED ACTION: Construction of 3 Bedroom Rouse, Driveway, Septic tank & well within wetlands buffer area. MATERIALS REVIEWED :... 1. Site Plan, Septic Design for Butterfly Lane, prepared by R. Fredriksen, P.E., dated 05 -84, last revised 04- 22 -97. 2. Site Alteration Permit Application forms, file # WT -222, dated 04- 30 -97. CONDITIONS OF PERMIT: 1. Erosion controls consisting of a silt fence and haybales should be installed as noted in above site plan for construction of the house, septic, well and driveway areas. 2. A natural 30 ft. buffer should be maintained from the wetlands boundary line. This 30 ft, buffer strip should remain naturally vegetated. Conversion to lawn or removal of existing vegetation is prohibited within this area as per Town Code. In addition, this buffer area should be planted with wetland shrubs to provide a permanent buffer between the wetland and the new house. Suggested plantings include red -oiser dogwood, arrowood viburnum, spicebush, summersweet, highbush blueberry and american cranberry bush. Plantings Pwae I d 2 P%limpw o� - should-be .. n, ted.. nor. tRthe. issuau<; o_cexitticareoft?cGU}��nGV �__.- ;,�.•.;; -..., ,_ The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 4. Erosion controls must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 5. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to tirne. 6. The permit shall be prominently displayed at the proiect site during the undertaking of the activities authorized by the permit. 7• An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. 8. Due to the wetland impacts associated with this lot it is highly recommended that the driveway surface remain as gravel. Ill addition, proposed drainage ditches should be stabilized with stone to minimize erosive action over time. Noncompliance with the conditions above will invalidate this ]Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Insnecto_r,(91-4),762,-7288; br the.offrce--of the Inspector (914) 526 -2377. Date Permit Waiver Prepared: cc: Applicant Building Inspector Planning Board Environmental Commission May 26, 1997 Stephen W. Coleman Town Wetlands Inspector pwtdz pvlisa.pw PUTNAM CODNTY DEPARTMENT OF HEALTH . DIvYw d 14sale.s.aata! Ha.11b Sarvloes. Cea�d. N.Y. IPSU Basksaafetsplary We Prt.�lt / 4 as CREWWATS OF ODMIqJANCB CDNS IUMN Pte, PoR lwwAGc DL out SYS om Pet�k # Town a' volfte 401 YA loaded ad, Plus o.:iRb V �6 hS - :Im - -Tax Map , to - �.., ,Block, r • le.wal_B-� Revlde o o.1AW . N. LS Q, Dolled Prevba. Approve Z Towo 71. Date Subdivision Approved Fee' nclosed Amno,nt Type Ic�J�1SFr�7 "� IAt A.ei Fm SefdM.Ot►b Depth vabsme Nob.. d Beie.nia -� De.ip Flow G P D PC® Nodleadon d I<eq.hed Wbe. Fm 6 oSM~ SepeeaM Sewmw sydm a coo" d GeOo. S.pdv Took tied 424 2 eAl T. be e...a..ad by b R 1 �HCd� MkLaor WetW StipplT: L_ F.she_ one S.Dpb D.19ed by OfiarRegsds.ce.al. y� c.isr cc• 1 represent that 1 em wholly and completely re noble for the design and location of the proposed system(s); 1) that the separate sewage dl!glIFga above described will by constructed as shown on the approved amendment then to and in accordance with the standards, rules and regu&ns 7 tne wsnam County D.p.rtnwlt of MeaKh, and that on completion thereof a "Certificate" of Construction Compliance' satisfactory to the Commissioner of HasKhwlll the submitted to the Department, and a written guarantee will be furnished the owner, his'successor% heirs or assigns by the builder, that said builder will place in good..operatMq condition any part of said sawaga disposal . system during the period of two (2) yeas Immediately following thedete of the (sou- once of the approval of the Certificate of Construction Complisnce of orgi sy or any "Wirs thereto; 2) that the drilled well described above well be beated'as shown on the approved plan and that mid well will he Ins 1 in c n with standards, rules and rpu aliions of the Putnam County DepsrSsnaivt of Health. Onto Signed P.E. R.A. Address.— FS � License No APPROVED FOR CONSTRUCTION: This approval expires t" years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Heald. Any change or alteration of construction requires a new permit. Approved for disposal of domestic unitary sewage, and /or private 'water supply only. ReV . 1088 Data By Title wi'e� AW!QQVNTY- DEPARTMENT OF HEALTH Permit # if EnvironMiental Health Services, Carmel, N... Y. '1051Z..'. .XlljSP,OSAL-',SYSTEM JIT 4/n* 4 t C_-. f Block: Tax map S�1_11". Lot Renewal ❑ _ Re.vis ion Date Of Previous Approval YI Ali Fill Section Only El dr, P.C. H. D. Notification Required Design Flow; . . . . . . . . . . . . . . . . ... A, Gal. Septic Tank and We e: slit c r L= of -V! Address m AddrOss -2 iments : itFl am wholly and c d will be constructe4 iW p t- A ' roved -Tn agar L I -j i6ly�,r a _ s r ponsible for the design and location of the proposed system(s); 1) thli?t the separate sewage d Sal ystem own on the approved amendment there to and in accordance with the standards, rules and regulations of at `6n`ci(impletion thereof a "Certiticate of Construction Compliance" satisfactory to the Commissioner of Healthwill e`,vi;rltten guaiantee,will bel.furnished the owner, his successors, heirs or assigns by the builder, that said builder will ;-pairt:,.6f said -siewage --d I isposal system during the period of two (2) years IMniediateIV following the date of the issu- 1,:.of!A Construction Compliance of the original system or any repairs thereto,-;) that-theikirilled well described above e011in4nd.that said weli';w'ill be install !in accordance -w . . ith the,...standards, rules.. and •regulations of the :Putnam Z, t iiried P.E. R.A. License �No. Ws'appr6 it explrmoheyearfrom the' date Issued unless construction of the building has been undertaken and is 8i."-6difleil w�hen;to'ni cibred necessary by the Commissioner of Health. Any change or alteration of construction d I I Sp 0 . Sa I ` domest c'sa sanitary sewage, Ind/or private: W��t qr I only. dii _ supply 15y 'IT it Is o r - T J -. 3 Sr'�za.. -sue c .r Wit : of the proposed, systenl(s);, 1) .that-.the: separa to;and. in accordance with the standards. iuiei a of Construction,;Compliarice 'satisfsctory..tg , the.0 ����.J -� �•- �12jK �Pt 9 J✓ f� rir NAM "COUNTY. DEPARTMENT OF HEALTH ��� ermi . of.Erivironinental :Health "Services, Carmel, .... Y. 10512 E,DISPOSAL SYSTEM rJ .-TaxMap Eloek.J •Lot <;.. t Renewal Revision _Q' - Date Of Previous Approval LOt A!!r__ea//�� -f +^ . ° Fill Section Only ❑ f✓�. P/D L" I O ©�- Gal. Septic Tank P.C. H. D. Notification Re fired 4u. and''` Aad►ess ..Jig µy ' {.;,{ taaee d t � -.• �f�G•.r7,'.��•- .,, / J '- `i� •I_ E •��� dullediliv3jtk'� 6�iT1`lr l._.. f j !•ij �i ._.�1. ' Wit : of the proposed, systenl(s);, 1) .that-.the: separa to;and. in accordance with the standards. iuiei a of Construction,;Compliarice 'satisfsctory..tg , the.0 �f'liealth `SAny.,'cl ipplyl} only ,e sewage'disposal system _ gu a ons of: the u nam . )mmissioner of Healthwill. Ides, that'said builoor will )44iny;the'date of<the issu- .'.t bled welldesaibed ?above -' a oiinsdofr the :_Putnam PE ('' RA � F s;.beenundertaken[ and is sltetation;of construction. Y -. i i_ ,•5 ..Jig • .y �f'liealth `SAny.,'cl ipplyl} only ,e sewage'disposal system _ gu a ons of: the u nam . )mmissioner of Healthwill. Ides, that'said builoor will )44iny;the'date of<the issu- .'.t bled welldesaibed ?above -' a oiinsdofr the :_Putnam PE ('' RA � F s;.beenundertaken[ and is sltetation;of construction. Y -. toi*Tfy DEPARTMENT OF HEALTH:':, Carmel, N. - Y '10512.�. z POSAL-WOS w lo, J T-,�4 4 sr<rtl Town. 9► i Vllag i .Tax. Ma'p Lot "Renewal Revision E3_ Date 01 Previous Approval' Fill-Section ❑ only. D Noti�, tion,.'Required a c; '4` 77 PV j7.1 5, _J� For -�4 hjlcipsign.andv location; of the proposed system(s);:l) that the.. separate . sewage. disposal system wed a n d �6 �nont 'o ntee will De` f ertif furnished uvage d 1 p - y l 0 a tructlon.of ther,bu4ing f -Health. A"y)' change P,P* I y only. it 1,6,aL undertaken is 'tr 4lon, of con n Imo: yh ...pat• v.w�W}•. ,. �i h�' >y......ti�,7 rS .. ..-.. r .-- •c..� \.�. Ax/ tiF `.�st ^^�t•LV �•i \t rx } ^u rxHl:.Ys. !["i1 Ct�.•'rf` ^`n - • • 'P. ,. \ii ^.n,•.a�.rlcT JOHN :<ARELL Jr., P.E., M.S. P_olic Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 11401�3 Re : Gl 7r--);-7 r Dear /iG- /rC� ;IJ%� Your application has been received by this department on The application is considered incomplete and the following items mu be submitted. ( ) Fee should be paid by Certified Check or Money Order only. (•- ): Fee° i s not en61 used ar i ncorrect -amaunt— �_. • , x . Fee due is: ( ew Tax Map designation should be provided. 7d0 /0 ( ) Other: If you have any questions, please contact Robert Morris, ext. 166 or William Hedges, ext. 168 of this office. Thank you for your cooperation. a Ver truly yours, Christine Johnson Intermediate Clerk JOHN KARELL Jr.. P.E., M.S. ... __ ��- - - .. •- -iy ,•. ., •Puulii-�- Fla3ab aDiract�r•`:• � . DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 1, 1993 Roy Fredriksen 176 West Lake Boulevard Mahopac NY_ 10541 RE: Proposed SSDS: Lisa - Butterfield Lane (T) Putnam Valley Dear Mr. Fredriksen: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. 'Comments are offered as follows: 1. The file for the above - captioned Construction Permit could not be located in this Department. If you are the original design engineer, please submit the approved SSDS Construction Plan. Subdivision on map number and approval date has not been.noted. ..., .._ .. a - - . _ ..... - on Engineer'Authorizat�ion ~Form. 3. The current guidelines for Construction Permit Renewals has been enclosed. Revise submission as warranted. 4. Current fill notes - required on fill plan have been enclosed. Upon receipt of, a submission revised to reflect the above comments, this application will be considered further. Very ruly yours, 't", i Robert Morris Assistant Public Health Engineer RM:mk enc. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES....,....___ Date Re: Property of Located at Section t,3 Block -5— Lot 8./ Subdivision of Subdv. Lot Filed Map # Date Gentlemen: This letter is to authorize Wov 4. [;LopwsEt� 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 the 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, constructi.on of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned:(g P E R.A. 7 L4APE 9 L. vo Address I WIA t4 0 4C. C64 q / ,4- & 2-A -0371, Teleph6ne Very trul-, ,y yours, igned Owner of Property d ress Town V �=�fs - �� 4z+� (X1,3-- ��,��� O� Telephone .x .:41!: 4�. ..'NV �t .v -. . ..- a....•..i.:Y..e .n,i � i'^ ... ,kY- ..�, vr.�wt ... XHN <AP.EL L Jr., P.E. N.S. P' one ^sa;th Director DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 914, 278-6130 Re: Dear /Y,� cam./ Your application has been received by this department on The application is considered incomplete and the following items must be`� submitted. ( ) Fee should be paid by Certified Check or Money Order on' /. Fee is not enclosed or incorrect amount. Fee due is: ( C4 elf/ Tax Map designation should be provided. ( ) Other: If you have any questions, please contact Robert Morris, ext. 166 c, William Hedges, ext. 168 of this office. Thank you for your cooperation;. Ver truly yours, ; �J Christine Johnson Intermediate Clerk APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT NAME OF OWNER STREET LOCATION BY DATE � q Y TAX MAP # . DOCUMENTS. M"PERMIT APPLICATION E4WE -1 ELL PERMIT; PWS LETTER ENGINEERS AUTHORIZATION = DESIGN DATA SHEET(DDS) = DEEP HOLE LOG = CONSISTENT PERC RESULTS (3) = PERC HOLE DEPTH = CORPORATE RESOLUTION ,PLANS THREE SETS QUSE PLANS - TWO SETS VARIANCE REQUEST GENERAL EEILEGAL SUBDMSION SUBDMSION APPROVAL CHECKED = PERC RATE C17 FILL REQUIRED CURTAIN DRAIN REQUIRED =STANDPIPES = EX- APPROVAL SSDS ADJ. LOTS = WETLAND (TOtiVN/DEC PERMIT R & D) = DATA ON DDS PLANS & PERMIT SAME PRE- 1969 - NEIGHBOR NOTIFIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION EOUIRED_ DETAILS�ON PLANS �P'SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE = GRAVITY FLOW D/ J BOX = TRENCH/GALLEY = P- PIT DETAILS -LA SEPTIC TANK - SIZE, DETAIL WELL DETAIL, SERVICE LINE IF OVER CONSTRUCTION NOTES (GRINDER RATE) DESIGN DATA: PERC AND DEEP RESULTS I 1J TWO -FOOT CONTOURS EXISTING & PROPOSED AY & SLOPES CUT AIN DRAINS OMMENTS: u_G = DISCHARGE (OK) = PERC & DEEP HOLES LOCATED = RESENTATIVE OF PRIMARY AND EXPANSION XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE En PUMPED PIT & D BOX SHOWN & DETAILED tc i HOUSE - NO. OF BEDROOMS WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4"/FT. 4 "0; TYPE PIPE UJ NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS hAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS DEPTH GAUGES FILL PROFILE & DIMENSIONS =.VOLUME TRENCH =LFTRENCH PROVIDED 3 M60 FT MAX m PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS =-..1.0: TO. P: L: ;- DRIVFWAY.,.EARG�E.J.REES., .TOROF. FIJ ...::.::..: -:.:.. M 20' TO FOUNDATION WALLS = 100 TO WELL, 200' IN D.L.O.D., 150' PITS L-D 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) = 50' TO CATCH BASIN, 35'.STORMDRAIN, PIPED WATER = 10' TO WATERLINE (PITS -201) = 50' INTERMITTENT DRAINAGE COURSE = 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS SEPTIC TANKS =10' FROM FOUNDATION; 50' TO WELL WELLS =15'WELLTOP k . W-4J&bS S C, APPENDIX 3 - J� � 2- PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDI.VIDUAL_.WATER SUPPLY & SUBSURFACE.SEW.AGE DISfQSAL.:5y,,$I'EMS.,. RE IEW` SHEET' for 'CONSTRUCTION P IT STREET LOCATION ,LG�'� NAME OF W R , BY B. HEDGES R.MORRI OTHER DATE L- TAX MAP # - DOCUMENTS. Y,N M PERMIT APPLICATION © PC -1 WELL PERMIT PWS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) T ' 1. CORPORATE RESOLUTION = PLANS THREE SETS HOUSE PLANS - TWO SETS al VARIANCE REQUEST liSUBDIVISION lu(: AL SUBDIVISION L�1 SUBDMSION APPROVAL CHECKED M17 PERC RATE ITJIFILL REQUIRED DEPTH ®CURTAIN DRAIN REQUIRED =STANDPIPES GENERAL fc c IE �TPROVAL SSDS LOTS VEANE (TO, /DEC PERMIT REQ? ) m S PLANS & PERMIT SAME = PRE- 1969 - NEIGHBOR NOTIFIFICATION = LETTER_ BI/ZBA .. L� 100 YR. FLOOD ELEVATION v� g SREQUIRED DETAILS ON PLANS EWAGE SYSTEM PLAN - (NORTH ARROW) P-" CONSTRUCTION HYDRAULIC PROFILE = GRAVITY FLOW P-" .CONSTRUCTION NOTES (GRINDER NOTE) al ESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED ® S ES CUT FOOTIN U CURTAIN DRAINS E SION CONT HQUSE,WELL, SSDS = EAQWN CONTROL N RC & D EEP HOLES LOCATED RESENTAT OF PRIMARY AND EXPANSION 0CATION MAP ,Y EXP. A SHO , TY FLOW, SUFF.SIZE = MPED PIT D BOX WN &DETAILED OUSE - N MS = WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM &ROPERTY METES & BOUNDS F OUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE O BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS rl A YBARRIER (EPTHT HORIZONTAL: SLOPE 3:1 TO GRADE SPECS C= FILL NOTES CERTIFICATION NOTE GAUGES FILL PROFILE & DIMENSIONS VOLUME ILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED �J =60 FT MAX PARALLEL TO CONTOURS ICt(: % -E�` P-,A'i 1SION PROVIDED '* SEPARATION DISTANCES SPECIFIED ON PLAN 1.0' TO P.L., DRIVEWAY, LARGE TREES TOP OP OF FILL 1200 'TO FOUNDATION WALLS W 15' WELL TO P.L 0 TO WELL, 200' IN D.L.O.D., 150' PITS 0 TO STREAM WATERCOURSE LAKE (INC.EXPAN) ' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER ' TO WATER LINE (PITS -20') ' INTERMITTENT DRAINAGE COURSE FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS 'MINTO C.D. S= >5 %,20'- 4 %,25'- 3%,30'- 2 %,35' -I %,100' <1% ' MIN TO C.D. DISHARGE A00' WITH 182 CONS DAY DIS. SEPTIC TAWK =I 0, FROM FOUNDATION; 50' TO WELL COMMENTS: PC -1 PUT NAM COUNTY D E PART M E NT OF H EA LT H "'" APPLICATION FOR APPROVAL '0F 'PLANNS,'FOR`"A WASTEWATER DISPOSAt SYSTEM'-. 1. Name and Address of Applicant: Z� kAi2ui Fug �-- 2. Name of Project: 92 > UiL u1 - LQT_ w 3. Location T /V /C: 4. Project Engineer: � Qgpate,5 lr,( 5. Address: U ba X q.5� License Number: ,� C�S�� Phone: 10c) 017 !o 6. Type Qf Project: L,-*' Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. ��c7• i 9. Has DEIS been completed and found acceptable by Lead Agency ?............ 10. Name of Lead Agency 11. Is: this ,.project--in.an area -under the control of local or other officials, ordinances? ....V............... 12. If so, have plans been submitted to such authorities? 13. Has preliminary approval been granted by such authori 14. Type of Sewage Disposal System Discharge...... planning, zoning,. ..................... . . .� //,�., ties? Date Granted: Surface Water L---/Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. 18. If yes, name of water supply Distance to water supply to 19. Is project site near a public sewage collection or disposal system ?..... kto 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: / IZ �_ 23. Project design flow (gallons per day) ....... ............................... �00 11/93 I 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. a 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... �5. 27. Wetland ID Number ........................ �G L 28. Is Wetland Permit required? ............. ............................... Has application been made to Town or Local DEC Office? .................. S 29. Does project require a DEC Stream Disturbance Permit? ................... 1` 30. 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 or NO 00 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or 06 any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... �S 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15% slope? ' '35. Tax Nap ID Number ........................................ ............... � -/ U -- 36. Approved Plans are to be returned to: Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. % hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A N demean pursuant to Section 210.43 of the Penal Lai✓. SIGNATURES & OFFICIAL TITLES: C 1�AL MAILING ADDRESS: g , 1/\ i CMS PUTNAM COUNTY DEPARTMENT .OF HEALTH Division of Environmental Hea /tti Serwc`es Carmel N:-. Y -10512 CONSTRUCTION PERMIT FOR SEWAGE.` .ar u ,• FO` m- .r: _ ' w :Xrt wrW.v i ©ISPOSr i!L 'SYSTEM.`,C. loLID ck Located •t : B�(. I • E Subd!ylsion ' / (' Subd ?�LOt « - Renewal -;0 .'.. Revision Q �;�Owner /Address ' `•4.. * �` -" 5 Date:Of Previous Approval . h , Buildin 5 Type- I_'ot Area - "• re YP Fill'Se'ction only ❑ 9'. Number Of Bedrooms Design Flow G /P /D` w O 6 ` p C H D Notification Required Separate Sewerage-System ,t coq'si, tv of - ` Gal \Septic Tank. and I" T Z` i YJIU� :./ K'E�.IC.1 I KLS�i: �A ' o� L[aw Q ,0A To be ;constructed by A �. ddiess Water Supply Public Supply, From ° , v :: Pnvate, SuPP1Y. to be drilled by d I + t Address^ Other .Requirements F T o t)�-T141iK. Real : +.: I represent that l:am wholly sail completely responsible for the tles�gn and location of ,.the ',proposed system(s); 1) - that the separate' sewage disposal s stem , Above _described will be constructed as.shown on the approved amendment \there to and `in accordance with the standards; rule 's an regulations o e u nam ' County; Dapactmen -i ' of Ne' It' and that on.compietion` thereof a "Certificate of - C_onstruction'Compliance" satisfactory to the Commiisioner of Fealthwill ;. -'be submitted to the' Department;' and a written, guarantee wlll'be •furnished the ow e► hii, wccessors; heirs or assigns by the builder; that said. builder will place .'in good operating .condition ;any part of.'said sewage disposal system tluringthe. period of two (2) years immediately following the date of the issu- LL Compliance of the originali,system "or any repairs thereto; 2).that.the drilled well described above. ante of.,the approval of ;the'Cerfificate of ,6n - :will';be located as)shawn on the a pproved' plan andahat said well will'be Install i act- anc Ith ;tlie' standards rules and ►egu aTflons of the Putnam q. County: Department of Health Date Z gned , S, P.E;. 'e R A �-.'. �:• `� �: '.. ; .. , -,s i�.� '•f v. '.• ..ter •. r Address Y License No Add vv tJ. APPROVED FOR CON5TROCTION dThis appro al expire3;one'' 'r'fro' the d te` ;su d'unless<co struction of the,�building has-been undertaken and Is .. _. Y • ' „ Y Y Y construction . requciraesl of new perort.— Aberov�e of or 'disposail'o� dourest �c 91 sidny[it ay se s ge, b d /ore" Cwat sioner..opply only.., An change 'or alteration of; c Date r': r - ^� -/ ' e [• "�, - `,, Title Rev 9 -81 _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a Date_.... 20.0..:/.�1 Re: Property of �dJ Located at jii`I'1 �iL�LY !_A.145 PJ 1 44m /eLLcv 14. Y. (T) Subdivision of Section- Block s Lot t> 9-a ?OZ510"-4 t V e j k iZ e.. S Subdvo Lot # C¢ Filed Map # La& Date /11 Gentlemen: �% r This letter is to authorize 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 the 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 ___...._ system -.or- .systAc�a :.z,n - oonformitl:_* i:t!i :ihe' -Iprd'Visiens. -.of 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: PvEe , RaAe , # Very truly yours, Signed Owner of Property Address OF v% s i L,q k/c gLvD. 1-2.D.2-' •1TS°�� Address Town H,4 �o 54 q14- &28- 43gL Telephone Telephone 'S Coo Dep-J . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY 'l- OFFICE�-EUILDING -CARMEL —) Y. – -10512 - .;_,,:.. DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner L_ Address 344.3 F' � Located at (Street Q N ,� p. Sec. Block S Lot 4dicatenearest ross s ree Municipality JOW4 4 ?J j #JArn VALLV atershed d4JT_)SO4 )2;jF_Z_ SOIL PERCOLATION TEST .DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME P PERCOLATION P PERCOLATION Run apse D Depth t to Water a a er ve` No. Time F From Ground Surface i in Inches S Soil Rate Start -Stop Min. S Start S Stop D Drop in M Min. /in drop Inches I Inches I Inches I I /c9 2 21D 12- 2 2 /Z- / / Z 2 �O / / Cg 2 20 Z Z � �5--- 3 3o / /7 30 g ZQ /4 2.4 �3 3 b > 9 Z )' �2 2 /Z 5 . l 2 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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. 2 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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 ENCOUNTERED ITT TESL' HOLES DEPTH ' HOLEY NO _ 1 HOLE 1V0 . HOLE NO . G.L. 611 12" 18" 24" 3011 _ 36" 42" 48" 54" 60" 66" 7211 78 84" @� INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE, LEVEL _T_. WlII H -W TER LFVEZ RISES AFTER BEING ENCOUNTERED - ,..:.... TESTS -IMADE BY ' � iz��i(�j�i .._. ..:µ,.. „......., ....-Date- DESIGN Soil Rate Used "Drop: S.D. Usable Area Proy.. ed— l 4S%0�j No. of Bedrooms OF NEW °` Septic Tank Capacity jCiQC� Ga Absorption Area Pro ded By ZO L. F. x24" 'i�`H'�tier�c Name 0 T l e ", Address LA; S- /_a Wr,- l3Lv r----> SEAL Sc�a�s THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date 1 " ` �1 m �a, : _,_• �- --,:, e -` _711 5cz11E. `...41, 1c, 1a..2O1 . T e zEx+J{�iE F L. ir35i 1:Vo r .'CArilFC ra 7aS �FJeHjiol�5 AS FdRT+(`By ��PT �� tjEAt�ltt• ,1 Mee- 7. c o•tR�5' m Recu t? lE o(y 575 x v m , F •. 9 mo iu>t. //n0 FAY or % FE6�'1?E ,GlJ�TAItJ'Dl{At�,l = t 3 -._, o a 4 At{? �s/u s��� fc7bE� fdF aiFTiAS qr +n m ti + m s6 �c' wf,. il,t o F� DF GJ0 Ati/�§ irJ 4 Qr i� =` e �• - �t�EGj L�riE. F i� , .� -'u on w A , 64 'W �tRAU�7y►'/Oi'syf4A a Er q ro " 1'" 7 /{t 4 7RQ wiS i '1'0' F c':CSF Al ( /�{ZFJ3 o s .. P P a' m F 6 'LAT �!a '!e 49 Stnl G1d MAP`Er �'$ t l± gM� utAE A •ikiRX+oN e: o c� n, ,. D� t?u►�t> v{ bJ:.gLRE3' .Fi Wggi t1E P.a,'ftJIM1.C�`¢teiry C RK� 0FFncC_ 95 MAp 46.. 13'l A „QED .SANU4RY�ra PG74 P. ❑.°-.ems _ P f.ai. 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T 4iT� ' AME��ti� 4b� ;row brp .power IJJE~ q gc mss" FtLE.D •w TNr THE PA.Tn44M .C-4JHT / CUKRK:-K, PPICC— AS MAp sl4. 13 174: Roy A. Fu�rtrKSCH S EPT I C) E-• 1 C. i's \,4zsr LAKE. g'Ft6EE:;�sia�►4�. ¢,..•1GriieER, 1P TOW of PUTNAO;VALLEy 9rp.. � r� d �9z p 3 A - ti � 1 i JiCr SAE -1.iL ID - ter! -V 1f A