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UTNAM COUNTY DEPARTMENT' OF HEAL
VP
VI �O ENVIRON1V ENTA.�.��_�L�.I�_SE
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # W 8 — 91
Located at. 4' Park Drive ..; Town or Village
Owner /Applicant Name Josef Boeschl
Formerly
Same
Putnam Valley
Tax Map 4.10 Block 1 Lot 24
Subdivision Name Laurel Hill Park
Subdivision
Subd. Lot # 15
Mailing Address 33 New Avenue, Yonkers, NY
Date Construction Permit Issued by PCHD 07/02/01
Separate Sewerage System built by
Consisting of 10 0 0
24" Wide/6'—O"-O.C.
Josef Boeschl
Zip 10704
.33 New Avenue
Address Yonkers, NY 10704
Gallon Septic Tank and 30QL, F. Absorption 'Trench
2' -0" R.O.B. Fill Over entire SSTS Area, Clay Berm
Other Requirements: 50% Expansion
Water Supply: X Public Supply From.
or: X Private Supply Drilled by
P.F. Beal & Soiis
Address
Address Brewster, NY
Re s ides t a 1 :. , .. _...:. � e:usio:^. c ntml been ' �or:pleted? - Yes-
as . -... _ _. _....; ... _
Number of Bedrooms 3
Has garbage grinder been installed?
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued CHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam Co J:% Me4tb. ft
Date: 9/10%04
Certified by
Address 113 Smith Avenue, Mount 1�4es;1Oi�,0"� en #
54782
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modification or change is necessary.
By- Title: 4&C Date:
Whi a copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION SPORT
NUDE: Exact location of well with custancestoat lest two permanent lanamarxs to De pro a on a separate sneevptan.
Well Driller's Name P. F Inc. Address: 4 gtnEm Asn., Bna,>#Qr- W 1OM9
Signature: Date: 8/1/202
Perry 91
White copy: HD'. e/; "Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
48 Park Drive
ownlVillage
Putnam Valley
Tax Grid #
Map ;q,trBlock I Lot(s)
Well Owner:
Name: Address:
Rock –All Construction, 1367 Hayes Drive, Yorktown Heights, NY 10598
Use of Well:
I- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm „ Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 32' ft.
Length below grade 31' ft.
Diameter 61, in.
Weight per foot 19 lb /ft.
Materials: X Steel Plastic - Other
Joints: Welded X Threaded Other.
Seal: X Cement grout _ _ n1onite , Other
Drive shoe: X Yes — No
Liner: Yes X No.
11Screen )[Details
Diameter (in)
Slot Size
Length(ft)
Depth to'' Screen. (ft) .
Developed?
First
Yes No
Hours
Second
Well Yield Test
_ Bailed X Pumped X Compressed Air
Hours 6
Yield 15 gpm
Depth Data
Measure from land surface- static (specify ft)
40'
During yield test(ft)
140
Depth of completed well in feet
185'
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameteron)
Formation
Description
A.
ft.
Land Surface
5
Drilling
in over
den clay and boulders
Hit rock
at 5'
in rock,:
set casri° r roared
32
185
Drilling
in rock
ranite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump/Storage Tank Information
Pump Type sub Capacity 7cm
Depth 160' Model 7GS05412
Voltage 230 HP 1/2
Tank Type WTX251 Volume 62 gal.
Date We l Completed
3/16/02
Putnam County Certification No.
002
Date of Report
8/12/02
Well I to
al
NUDE: Exact location of well with custancestoat lest two permanent lanamarxs to De pro a on a separate sneevptan.
Well Driller's Name P. F Inc. Address: 4 gtnEm Asn., Bna,>#Qr- W 1OM9
Signature: Date: 8/1/202
Perry 91
White copy: HD'. e/; "Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
Public Health Director
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH -
1 Geneva Road
Brewster, -New York 10509
Environmental Health (914).278 - 6130 Fax (9.14) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 -6678 Fax (914) 278 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
OWNERS NAME:
TAX MAP NUMBER:
E911 ADDRESS:
TOWN:
AUTHORIZED TOWN OF
(Signature)
DATE:.
4ttz'
The Putnam County Department of Health will not issue a Certificate ;of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is assigned.by an authorized town official. This form into be submitted
with the application for a Certificate of Construction Compliance.
(E911 VERHZK
r--
PIJrm 01 NT'V 1)'9PA ZTMENT OF I EAI.T�
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Josef Boeschl -14,10 1 24
Owner or Purchaser of Building 'Tax Map Block Lot
Park Drive Laurel Hill Park
Building Constructed by Town/Village
Residential 15
Location e Street Subdivision Name
i Building Type ti 5:} :' .. Subdivision Lot # :ao
:.ri4,:teortsenvOii `:I: i4r, lly and completely responsible for thecflocation workmanship rinaterial,
c'6 istmctioti~afld diiihage. of the sewage treatment system sming he aovescibed � property, and
's=hrbeeriatracted as shown on the approved plan or approved:arriendment the`t`b; and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby :guar'antee to the owner, his successors, heirs or assigns, to place in good operating condition
'any part. -of -said 9 stem constructed by me which fails to operate for a period a two years
immediately followingthe 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 b- the willful or negligent act of the occupant of the building utilizing the
',,The undersigned further agrees to accept as conclusive the determination of the Public Health irector 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
(Owner) - Signature
Corporation Name (if corporation)
Address:
State
Signature:
Title:
Corporation Name (if corporation)
Address:
Zip . State
Zip
Form GS -97
KEANE COPPELMAN ENGINEERS, P.C.
113 Smith Avenue
MOUNT KISCO, NEW YORK 10549
(914) 241 -2235
TO' Putnam County Health Department
1 Geneva Road
Route 312
Brewster, New York
WE ARE SENDING YOU:
Attached
r Shop drawings
Copy of Letter
COPIES . ' DATE NO.
C 4
I I
THESE ARE TRANSMITTED as
L7 Under separate cover via
r_,'• Prints ri Plans
r Change order
For approval [; Approved as Approved as
_.
[^-For,your,use :: �,'' j Approved as toted
U, As requested ri Returned for corrections
ri For review and comment
r FORBIDS DUE
REMARKS:
Revised to include swing ties to well
COPY TO:
LET ■TER OTF T �,S TIiTi TTA L
DATE: 2/1/05
JOB NO:
ATTENTION: 5oe aravati;`Jr:
RE: Josef Boeschl
Park Drive
Putnam Valley, New York
17
SSTS As Built
Laurel Hill Subdivision Lot 15
The'following items:
[° Samples ❑ Specifications
r
Resubmit
Copies for approval
Resubmit
Copies-for:approval :..... _ _ ..
17
Resubmit
Copies for approval
PRINTS RETURNED AFTERLOAN TO US
SIGNED:
IC�NE COPPEL IVIA N ENGINEERS, P.C.
113 Smith AvenPu�e
(914) 241 -2235
TO Putnam County Health Department
1 Geneva Road
Route 312
Brewster, New York
WE ARE SENDING YOU:
r'. Attached.
r Shop drawings
Copy of Letter
r Under separate cover via
r Prints r! Plans
rJ Change order
LETiTE Bill F TRANSMITTAL
'� r��'i�: _ 1 �' %3�fl�' -._. . __ ��� tom: •�i., �s -�� ,. _ .. _
ATTENTION: Joe Paravati, Jr.
RE: Josef Boeschl
Park Drive
Putnam Valley, New York
SSTS As Built
Laurel Hill Park Subdivision Lot 15
Samples
COPIES DATE, NO. DESCRIPTION
5 As Built Plan
1 Bacterial Analysis
THESE ARE TRANSMITTED as checked below:
The following items:
Specifications
[r For approval r Approved as Approved as
Resubmit Copies for approval
J For your use ( Approved as noted (`? Resubmit _Copies for approval
As requested Returned for corrections; Resubmit Copies for approval
For review and comment
FOR BIDS DUE C` PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO:
SIGNED:
LORETTA 1vIOLIIVARY ` -
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 . Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
Peter Gregory, PE
Keane Coppelman Engineers, PC
113 Smith Avenue
Mount Kisco, NY 10549
Dear Mr. Gregory:
R-0BEkT— J.�EONIDP �, .
County Executive
September 21, 2004
Re: Construction Compliance — Boeschl
48 Park Drive, (T) Putnam Valley
TM # 74.10 -1 -24
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
The water analysis provided only shows a test for PH. The analysis should show results
for the parameters listed iii `ta.l,ie one on page 18 of Bulletin ST -19. (Section
Since the lateral lengths are unequal, swing ties to all the ends should be provided.
Please provide locations of roof leader /footing drain discharge.
This office will continue its review upon consideration of the above mentioned comments.
Please feel free to contact me at ext. 2157 if any questions arise.
Ve truly yours,
oseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP:km
KEANE COPPELIVIAN ENGINEERS, P.C.
113 Smith Avenue
INIEW YORKA 0549----
(914) 241-2235
TO Putnam County Health Department
1 Geneva Road
Route 312
Brewster, New York
WE ARE SENDING YOU:
,j Attached
r7 Shop drawings
Copy of Letter
Under separate.cover via
rj Prints Plans
r—j Change order
LIEUMN OF UMM3. MMIL
M.
ATTENTION: Joe Paravati, Jr.
RE: Josef Boeschl
Park Drive
Putnam Valley, New York
SSTS As Built
Laurel Hill Park Subdivision Lot 15
The following items:
rf Samples Specifications
r2
COPIES
DATE
NO,
DESCRIPTION
5
As Built Plan
1
Certificate of Compliance
3
Guaranty Form
1
E911 Address Verification
I
Well Completion Report
Bacterial Analysis
Application Fee
I Htjt AHt I HAM MI I I to as cneCKea DeJOW:
Resubmit Copies for approval
r7 For approval r� Approved as Approved as
r--
7 -
E, For your use 1.7' Approved as noted Resubmit Copies for approval.
r
As requested 17 Returned for corrections Resubmit Copies for approval
rs For review and comment
FOR BIDS DUE i PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO: ZZI&Z/
SIGNED:
a
LORETTA MOLINARI R.N., M.S.N.
Public Health Director
DEPARTMENT OF HEALTH
1. Geneva Road, Brewster, New York 10509
Environmental Health (845)278-6130 Fax(845)278-7021
Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085
Early Intervention /Preschool (845)27'8.6014 Fax (845) 278 - 6648 '
FACSIMILE TRANSMITTAL
ROBERT J. BONDI
County Executive
To:.. Fag: /Y !! - C -7 ,y 7
From: �T� ��� 1+0H-i Date:
Re: /0" Qrcve,
ages:
CC:
❑ Urgent For Review ❑ Please Comment ❑ Please Reply
.. pcl�57l��c�t✓1`1 . ,(•E�G�tr�.r� / CJaS'; :G/"..._�o[G��•s►^ � � i"�od'C2�ac�a -mil Fvc{�h`� _ __. .__ ry
Olr/ti�'V� dust; �e -t 1.1 ' /., —e 1 502"C -: c:r
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4" �/uGShahS htvc
1719e
CONFIDENTIALITY STATEMIaNT: The information contained in this facsimile may contain CONFIDENTIAL
and legally protected information intended only. for the use of the individual or entity named above. If the reader of
this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this
telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone'
(845- 278 - 6130) and destroy all documents associated with this facsimile.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ]ENVIRON NT'Ala
ONSTItUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT #
Located at Park Drive Town or Village Putnam valley
Laural Hill Park
Subdivision namesubdivision Subd: Lot # 15 Tax 1Vlap�4 -10 Block 1_ Lot 24
Date, Subdivision Approved Sept. 20, 1950 , NYS -DOH Renewal X Revision
Owner /Applicant Name Josef Boesch 1 Date of Previous Approval 06/26/91
Mailing Address
33 New Avenue, Yonkers, NY
Amount of Fee Enclosed
Zip 10704
Building Type Residential Lot Area 1.0 7ANo. of Bedrooms 3 Design Flow GPD 6 0 0
Fill Section Only X Depth 2 Volume 5 0 0 cy
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
1000
gallon septic tank and 300L. F. Absorption
Trench 24" Wide /7o0" o.c., 2'0" R.O.-B. Fill over entire SSTS Area
Other Requirements: 50% Expansion Area,
To be constructed by Powell Septic Address Bedford, NY
Water Su®®ly: Public Su 1 From Address -_
X `- Private Supply Drilled b3P.. F. Beal Address Brewster, NY
i
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
,Warate sewage treatment u=m described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and'that on.bompletion
thereof a "Certificate of Construction Compliance" satisfactory to the. Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Si s� P.E. X R.A. Date 06/28/01
Address 113 Smith Ave., Mount Kisco, NY 1.0549 License # 54782
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe Approved for discharge of domestic sanitary wage only.
By: Title: iG ak�- Date: Q
White copy - HD Fi e; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
SENDING CONFIRMATION
DATE SEP -10 -2004 FRI 08:44
NAME PUTNAM COUNTY DEPARTMENT OF HEALTH
TEL 845 - 278 -7921 i
PHONE
: 919142416787
PAGES
: 2/2
START TIME
: SEP -10 08:43
ELAPSED TIME
: 0015411
MODE
: ECM
RESULTS
: OK
FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
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9
;Lok i' , MOLINARI k.N., M:S:N: - -' -- V
Acting Public Health Director
Director of Patient Services
May 16, 2003
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Iktervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
Peter Gregory, PE
Keane Coppleman Engineers
113 Smith Avenue
Mount Kisco, New York 10549
Field Inspection
Park Drive, (T) Putnam Valley
TM# 74.10 -1 -24
Dear Mr. Gregory:
ROBERT J. BONDI
Cbunty Executive
A site inspection was made for the above referenced project on May 15, 2003. The following
comments must be corrected in the field.
/1. Silt fence was not installed per our phone conversation on May 16, 2003. Silt fence must
be installed by Monday, May 19, 2003 or a violation will be issued.
CV Fill-for expansi ,in' ".re- was not prov-ided: -
�� 4" ADS corrugated pipe was used for trenches. This pipe may not be acceptable for
trenches.
r6.Footing y barrier is not installed.
rrent side slopes appear to be 1:2, not 1:3 as required.
1. and roof leader drains are not completed. Discharge needs to be away from the
TS area.
7. System cannot be backfilled and re- inspection is required for above items.
If you have aw further questions, lease contact me atX84>55)) 278 -6130 ext. 2157.
�
�Yt5 j. 164 j Two 16V botl Sincerely,
s 6(t Joseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP: cj
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date: � 5115-/13
Inspected by: J-5P
Street Location o� k 0, -. ve
Town _ _. V�Yiarr�. i%a 11-1 . - `Permit
L4urx 1 l ( P�
TM # �7 L! • to - t - � y Subdivision Lot # � �F.
1. Sewage System Area
a. STS area located as per approved plans .......... .. ................
b.. Fill section - date of placement
3:1 barrier Lgth. Width . Avg.Dpth�i
c. Natural soil not stripped ................... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 1 00' from water course / wetlands ...... ...............................
II. Sewage System
a. Septic tank size - 1,000 .......... 1, 250 ......... other ................
b. Septic tank installed level ............................ ..
.......
C. 10' minimum from foundation ............. ........
d. Distribution Box
1. All outlets at a evation -water tested.:.:
2. P elow frost ............ .....:.........................
3... Minimum 2 ft. Original soil between box & trenches
e. Junction Box - properly set .......... ...............................
6. T renc es ��,,�
1. Length required Length installed .3 OJ
2. Distance to watercourse measured
3. Installed according to plan ............................
4. Slope of trench acceptable 1/16 - 1/32" /foot .............
5. 10 ft, from property line - 20 ft.- foundations..........
6. Depth of trench <30 inches from surface ..................
T. Room allowed for expansion, 100 % .........................
8. Size of gravel 3/4 -1'h" diameter clean ...................:
9. Depth of gravel in trench 12" minimum ....... :...........
10. Pipe ends capped..... ................... .
_ ...._ .g Puma -or Dosed , =stean�s- -- - = .: - - _ ....
- 1. Size of pump chamb .......................... ..................
2. OverIlow'tank .. ...................... ... ..................
3. Alarm, .vis audio ...............:.... .......:...:...................
4. Pum sily accessible, manhole to grade .................
5. box baffled ..................:....... ...............................
C�yycle witnessed by H.D.estimated flow /cycle...........
M. ouseBuildbig
a. house located per approved plans ...............
b. Number of bedrooms ....................... .........!,t...................
IV. Well
Well located as per approved plans . ......:........................
b. Distance from STS area measured 4 (o O ft...........
c. Casing. 18" above grade ................ ............. ...................
d. Surface drainage around well acceptable .......................
V. Overall Worlananshiu .
a. Boxes properly grouted ................... ...............................
b. All pipes partially backfilled ........... ...............................
c. All pipes flush with inside of box ... ...............................
d. Backfill material contains stones <4" diameter ..............
e. Curtain drain & standpipes installed according to plan. /�'
�f. Cu ec exis co
t1n �r discharge away from STS are..
h. Surface water protection adequate ........ :...........................
i. Erosion control provided ................. ...............................
Rev. 12/02
ill
WAME
MM
MAM
M
.QW, --
t /�1�Gt��
BRUCE R. FOLEY
LORETTA MOLINARL RN.,
" iissoctitte ' Pu.biic"hMA" Mir eclor
Director. of Patient Services
DEPARTMENT OF HEALTH.
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 -.6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6538 WIC (845) 278 - 6678' Fax (845) 278'- 6085
Early Intervention (845) 278 - 6014 Preschool (945).278-6092 Fax (845) 278 - 6648
]Date:
Fax #: / - 9 A/ - a #/- 6 73 7
No. ]Pages °�
(Including cover sheet) .
From: fr. t ftP4 E
Putnam County ]Department of Health
_..._ _�_ 'or your nf�x><al�t>!oh Please-respond .
. - -
_. For your review ' Attached as requested
As discussed ?lease call
Notes/Messages,
In the event of transmission /reception difficulties, please contact this office at
(845) 278-6130 eat: 2157
V . 'b
:,L-ORE TA'M LINAARI-•1.i. Z�� �F
Acting Public Health Director
Director of Patient Services
May 16, 2003
_. _ .:- ... _ - �----._...: ...1.OI•�ERT`• °J:' °'BUN;)I�..., . •.� �I
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 . Fax (845) 278 - 6085
Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648
Peter Gregory, PE
Keane Coppleman Engineers
113 Smith Avenue
Mount Kisco, New York 10549
Re: Field Inspection — Boeschl
Park Drive, (T) Putnam Valley
TM# 74.10 -1 -24
Dear Mr. Gregory:
A site inspection was made for the above referenced project on May 15, 2003. The following
comments must be corrected in the field.
1. Silt fence was not installed.4 our phone conversation on May 16, 2003, Silt fence must
be installed by Monday, May 19, 2003 or a violation will be issued.
�2 -, Flll °for expansion area wau.not provided
3. 4" ADS corrugated pipe was used for trenches. This pipe may not be acceptable for
trenches.
4. Clay barrier is not installed.
5. Current side slopes appear to be 1:2, not 1:3 as required.
6. Footing and roof leader drains are not completed. Discharge needs to be away from the
SSTS area.
7. System cannot be backfilled and re- inspection is required for above items.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2157.
Sincerely,
/Joseph S. Paravati, Jr.
.Assistant Public Health Engineer
' JSP:cj
Keane Coppelman Eng 9142416797 05115103 01:19am P. 001
PUTNAM COrM DEPARTMENT OF HEALTH
IDMSION OF ENVIRONMENTAL HEALTH SERVICES
AT TENMON )6OSEPH ® GENE
REQUEST FOR FINAL INSPEC'LN For: Fill
All information must be fully completed prior to any Trenches
inspections being made.
PCHD Conmetion Permit *
Located: tW X W l ✓B- (7) (V)
Owner /Applicant Name: :Oscr• ewLir a TM Flock Lot
Formerly. Subdivision Name: 'r
Subdivision Lot: *
Is system fill completed? _P-3 Date:
Is system complete? S Date: .i j2 O-j
Is system construeted as per plans? ,J�E 5
Is well drilled? IKS _ _ Date:
Ys well located as per plans? ,LOL S
Are erosion control mmures in place? _. J;�A ..._
I certify that the system(s), as listed, at the above premises has been constructed and I have.inspected
and verified their completioa in Accordance with' the issued PCHD . ConMetion• Permit and ... .
a�ig��Yi re-ti plans -an&,t is Stard�ds, a ales rind I"�e llasbns aF tlla khlt, a'Caurdi r D part�cnc c .
Health.
Date: 114-1d Certified by: PE '� RA
D i lonat
Address: Lie A
Comments:
Farm FIR -99
��rara� rug A A . �� �TCi . onc_o�o_�oo� �^ ►.iOMG • DI ITAI�M ('111 INTY r1FPARTMFNT f1F P. 1
• Keane Coppelman Eng 9142416787
05/15/09 01:19am P. 002
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Mnv_ 4 c_orar V Tui 1 4 4 -70 7ml . Qag_a7Q_7=31 VAMP: PI ITNAM rn INTY nF-PARTMENT OF P. 2
d, I -P
D 71SION OF ENVIRONMENTAL TAL HEALTH SERVICES
RUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # 7MN-SIT3
°
Located at Park Drive Town or Village P.utnam Valley
Laural Hill Park
Subdivision namesubdivision Subd. Lot # _ 5 Tax Mapu" 10 Block 1_ Lot 24
Date Subdivision Approved Sept. 20, 1950,NYS -DOH Renewal X Revision
Owner /Applicant Name Josef Boe s chl Date of Previous Approval 0 6 / 2 6 / 91
Mailing Address 33 New Avenue, Yonkers, NY Zip 10704
Amount of Fee Enclosed
Building Type Residential Lot Area 1, 0 7 Ablo. of Bedrooms . 3 Design Flow GPD 6 0�
Fill Section Only X Depth 2 Volume 5 0 0 cy
1PCHD NOTIFICATION IS RE UIRED WHEN FM, L IS:COMPLETED
Separate Sewerage System to consist of 1000 gallon septic tank and 3 0 0 L , F . Absorption
Trench 24" Wide /7,0" o.c., 2 °0" R.O.B. Fill over entire SSTS Area
Other Requirements: 50% Expansion Area.
To be constructed by Powell Septic Address Bedford, NY
Water Su ggila: Public Supply From
- soi -x_ Private Supply Drilled b}
Address
Address BrewE teY icy --
I represent that I am wholly and completely. responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Si n P.E. X R.A. Date 06/28/01
Address 113 ;smith Ave . , Mount Kisco, NY 10549. License # 54782
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe . Approved for discharge of domestic sanitary wage only. p
By: Title: IG� � l �C Date: V
White copy - HD Fi e; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
OUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
"ple;se print i i;$e- PCHD'PeTmif: -:.i-
Well Location:
Street Address: To*!Village Tax Grid #
ri 4,L ' Map Block
Lot(s)
Well Owner:
Name:
Address:
ts, P 5oeSCkll
33 NPw Out OV
107oq
Use of Well:
Residential. Public Supply Air /Cond/Heat Pump
Irrigation
1- primary
Business Farm Test/Monitoring
Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 2 0 0 gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
X New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Residential water supply
for Drilling
Well Type
X Drilled Driven Gravel
Other
Is well site subject to flooding? ................................................. ............................... Yes
No X
Is well located in a realty subdivision? ...................................... ............................... Yes
X No
Name of subdivision Laural Hill Park Lot No. 15
Water Well Contractor: :p- F.. Rtnal &Fins Address: greWq mr, NY
Is Public Water Supply available to site? .................................. ............................... Yes
No X
Name of Public Water Supply: N/A Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contami tion to be ro ' ed on separa sheet/pl
Date: 06:,h2- 7101. Applicant Sig nature:
. ... ... ._ _ _ .... .._ .. _ .. .... _ _ .. ..
_ ... .. _ _ ... ._.
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any' and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County. n ,_
Date of Issue % Z oil Permit Issuing ci
Date of Expiration G Title:
Permit is Non
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
I �/
PUTNAM COUNTY DEPARTMENT OF HEALTH
�IVISI ®N OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of Josef Boeschl
Located at Park .Drive - Town of Putnam Valley
T/VPutnam Valley Tax Map # 74.10
Block 1 Lot 24
Subdivision of Laural Hill Park Subdivision
Subdivision Lot # 15 Filed Map # Date Filed
Gentlemen:
This letter is to authorize Keane . Coppelman Engineers, P. C. - Daniel P. Coppelman
a duly licensed Professional Engineer x or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health. Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with.this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the: provisions of -Article -145_ and/or.. 147 of .the Education Law;:.the,Public Health.....: -
a - Law, and the�Putnam County Sanitary Code.' _ _ .. _......:_.
sign
P.E., R.A., # 54782
Mailing Address 113 Smith Avenue
State NY
Telephone:
Mount Kisco, NY 10549
Zip
914 - 241 -2235
10549
Very
Signed:
Josef Boeschl
Mailine Address: 33 New Avenue
State NY
Telephone:
Yonkers, NY 10704
Zip 10704
Cell 403 -6936
Form LA -97
KEANE COPPELMAN ENGINEMS, P.C.
113 Smith Avenue
MOUNT KISCO,.NEW YORK 10549
TO &r&A Ai Cotw f e bri.AhAl' "evrll
WE ARE SENDING YOU Attached ❑ Under separate cover via
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
@[F CD3njH@W0CO3C[f%j
DATE
- '.e— . -•.��
JOB NO.
----- ,- R :a:-- .- •-- r-- ...�_._... T
ATTENTION
S ,f ,1 Al
RE:
C
q
�S �S L /i�✓ L
the following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
q
�S �S L /i�✓ L
C ors ,c ,•.�
1
L^✓Ar �a « PPc.I ?i oAv
I HESE ARE'FRAiNSfvll l'TED as checked below:
For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
r1 I . - _ n N _ — N
REMARKS
COPY TO
SIGNED:
if enclosures are not as noted, kindly notify us at once.
\ PUTNAM COUNTY DEPARTMENT OF HEALTH
t� DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE T STEM
PERMIT # If L-,?_ 9-/ g Z
Located at Park Drive MwnorVillage Putnam Valley
Subdivision nameLaural Hill ParkSubd. Lot # 15 Tax Map74.10 Block 1 Lot 24
Subdivision.
Date Subdivision Approved Sgo-r. � Iq 6-0. Renewal X Revision
o 1
Owner /Applicant Name Robert Boesch 1 Date of Previous Approval 0 6 / 2 6 / 91
Mailing Address 1367 Haves Drive, Yorktown Heights, NY
Amount of Fee Enclosed $4'0-040
Building Type Residential
Zip 10598
Lot Area 1.0 7AIgo. of Bedrooms 3 Design Flow GPD 6 0 0
Fill Section Only X Depth 2 Volume 5 0 0 cy
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
1000
gallon septic tank and 300L. F. Absorption
Trench 24" wide /7,0" o.-c., 210" R.O.B. Fill over entire SSTS area.
Other Requirements: 50% Expansion Area
To be constructed by Powell, Septic Address Bedford, NY
Water Supply: Public Supply From Address
_mac X- Private Supply Drilled by P. F. Beal Address Brewster , NY
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
gparate sewage treatment Ustem described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2 ,years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the oilginal
system or any repairs thereto. FOR
KEANE COPPELMAN
Signed: - X s J&;°b WWI ENGINEERS r AP R•/'.
Address 113 Smith Ave.. Mount Kisco, NY 10549 License # 54782
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be
modified when considered necessary by the Public Health Director. Any revision or alteration of the&v p19rPquires
a new perm' . proved for discharge of domestic sanitary sewage only.
sn,A%
By: Title:. Date: 1 i
White cop - HD F' ; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
I , W
PUTNAM COUNTY DEPARTMENT OF HEALTH
DnqSION OF ENWRONMENTAL HEALTH SIERVE CES -7,f , 1 O _ j " 2- f
APPLICATION TO CONSTRUCT A WATER WELL
please print or type PCHD Permlti # �('
Well Location:
Street Address: Town/Village Tax Grid #
Par k ®ri'Ve_ ®l, L Map Block
Wen Owner:
Name:
't
Address: 4, i0 — (-2-
fla,�wrVr3oe_gh1
s3- - N"v . 4vz.
Use of Well:
X Residential Public Supply Air /Cond/Heat Pump Irrigation
I- primairy
Business Farm Test/Monitoring Other (specify)
2- secopdar°y
Industrial Institutional Standby
Amount of Use
Yield Sought __5— gpm # People Served Est. of Daily Usage ? gal-
Reason for
Replace Existing Supply Test/Obsdrvation Additional Supply
Drining
New Supply (new dwelling) Deepen Existing Well
Detanled Reason
for Drifling
Well Type
Drilled Driven Gravel Other .
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision 1-4y / 141 /luri_ Lot No. +5"
Water Well Contractor: 12 f Aeak Address: 13awsk1- /t/-f
Is Public Water Supply available to site? ....... ... R ...................... ............................... Yes No
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed w 11 location & sources of contami n o provi on se at heet/plan.
TJatPh �.: :. _ .A_nnitratr�t StgriltuTP..;_ ._
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or'modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a wate well driller certified by Putnam
County.
Date of Issue 3 a d Permit J-puing Official:
Date of Expiration Title: k .a
Permit is Non-TransferVaMe
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
r �
. P rte. a � � �•t� •� � -O i
EW YORK STATE DEPARTMENT OF HEALTH Specific Waiver
ureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75 -A, IONYCRR
- - for Individual Household Sewage - Treatment Systems:
Name of Applicant BAesch,l
Address :
I Site Location
1367 Hayes Drive
k Park Drive
Robert
Yorktown Heights;
Putnam Valley,
1. Reason why site does not meet' 10NYCRR Appendix 75 -A (check appropriate box(es)):
Separation distance cannot be achieved.
Excessive slope.
J High groundwater.
{ Inadequate depth to bedrock or impermeable layer.
Soil unsuitable.
Other (explain) .................................. ............................... ... __ ............. _ ...................
.
..................................... :........... ...............
,...
............ _ ..................:.......................:.................. ...............................
2. Proposed design or conditions of waiver:
so
............ ........('���. ..C.!
. ......... ............ ......................
G
_ tics n�o� S
_. W ........................ _. .... .................. __..
NY 10598
NY 10579
:.�........... .............SS /......._....._.
C>
Cl
3. The proposed design may have the following limitations (check appropriate box(es)):
Increased risk of well or spring contamination.
Incre ed risk of surface water contamination. o
Expected design life of the system will be diminished.
Operation of sewage system is subject to mechanical problems.
Other(explain) : .............................. ............... ::..:...................._ .................... ....... .......
..................................... ...............................
i Additional information attached
J
rP
Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with
New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver
may be revoked by the issuing official for a change in conditions for which this waiver was granted.
G
ORIGINAL - Local Health Agency
COPY - Applicant/Design Professional
DOH -1326 (7192) (GEN -152)
c
A V
BRUCE R - FOLEY
}public kealth'Director
11UT
ADDRESS:
SITE LOCATION:
DATE:
SJj�� -off
_ LORETTA M ?LINAR R. N., M—S.N. , . .
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
PUTNAM COUNTY DEPARTMENT OF HEALTH
SPECIFIC WAVIER
�ooL SC Itt
Lr.,
�c y
SPECIFIC WAVIER
REQUEST: ^d as,j �� y, 4. �� Y SOON
DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR
ENVIRONMENTAL CONTANENATION PROBLEM?
'N K
YES NO
WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP?
YES NO
DISCUSSION
� ° 112t -o•,
�12,14 �� l•r�cr,- SST
t-j PL 44,
REQUEST APPROVAL OR DENIED
APPROVED DENIED
F VUBLIC HEALTH
tv 0 f
SLir� -or
14 -16.4 (2187) —Text 12
PROJECT I.D. NUMBER 617./2!1 SEQR
7.
I.. - ^y., ., .w.. xT:� _rem, ': .iGJ�TtX :/ w:..: 'r. -.•�v w�_. • .• .. ,.L
State Environmental buallty Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT /SPONSOR
2. PROJECT NAME
Mr. Robert Boeschl
Boeschl Pro ert
3. PROJECT LOCATION:
Municipality Putnam Valley County Putnam
4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map)
Park Drive
5. IS PROPOSED ACTION:
® New ❑ Expansion ❑ Modificationlalteration
6. DESCRIBE PROJECT BRIEFLY:
Single Family Residence
7. AMOUNT OF LAND AFFECTED:
Initially L-07 acres Ultimately 1.07— acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
❑Yes ®No If No, describe briefly
Variances required from Putnam County Dept of..Heal.th_ ...
50% expansion area provided
9. W` HEAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
e0l u!ta�c - Park'ForesLrCperi s ?aee .
fie�ldaatlal - .. • 0 •IndmSisal.._ 0 commercla! : _' 0, A !
her-'
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
® Yes 0 No If yes, list agency(s) and permlUapprovals
Building Permit, Wetland Permit
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
12 Yes ❑ No If yes, list agency name and permlUapproval
Expired Putnam County Board of Health a pproval: , -
-
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
0 Yes fiNo
I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicantisponsor 0 7�2i �-
Date: °2
name:
Signature:
If the action Is in the Coastal Area, and you are a state agency, complete' the
Coastal Assessment Form before proceeding with this assessment
OVER
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Rgency)
A. DOES ACTlOtj EXCEqP.ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes
.k�;M�1kL•ACv7tQ33 CF�4f:. '�iCsy':�A�C.-f ;rk`1'••�f1( jai i',ROIIDEO FOt3;UNl•ISTF�. ACTIONS tN:�B;I�YCpf%.PAa'�I= 6t7.g7� �,lt�to;�aregative.�aclasatia� -.
may be superseded nother Involved agency.
0 Yes
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, Surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources;. or community or neighborhood character? Explain briefly:
v
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain
C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other effects not identified in CI-CS? Explain briefly.
C7. Other impacts (Including changes in use of either quantity or type of energy)? Explain briefly..
D. IS THERE, OR IS TOE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑ Yes It Yes, explain briefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with Its (a) setting (.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed.
2
�~ PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- --
:A 4D :P PLI. . A TIO FOR APE OV L ,QF P;.L A1�:I r �}
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant
`Robert Boeschl
1367 Hayes Drive
Yorktown Heights,'NY 10598
2.
Name of project:. Boeschl Property
3. Location TN:
Putnam ,Valley
4.
Design Professional: Keane Coppelman En
Address-113
Smith Avenue
6. Drainage Basin: Mount Kisco, NY 10549
7. Type of Project:
X Private/Residential Food Service Commercial .
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status'(check one) .......:........:..::.. ........................ ........ Type I Exempt x
Type II Unlisted
9. Is a Draft Environmental Impact Statement (DEIS.) required? ......................... No
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. , Name of Lead Agency
.12 Is this. project: in an area under the control of local planning,. zoning, or. other.
__ ._....__ __ .._. -.. _
..:...:_. .. ............::................. ............................. Yes
13. If so have plans been submitted to. such authorities? ........ .......................... ......
No
14. Has preliminary approval been granted by,such authorities? Date granted: No
15. Type of Sewage Treatment System Discharge ................. surface water x groundwater
16. If surface water discharge, what is the stream class designation? ....................
17. Waters index number (surface) ........................................... ............................... -
18. Is project located near a public water supply system? ....... ............................... No .
19. If yes, name of water supply - Distance to water supply
20. Is project site near a public sewage collection or treatment system? ................ No
21. Name of sewage system Distance to sewage system -
22. Date test holes observed 03/02/90 23. Name of Health Inspector Bi11 Hedges
24. Project design flow (gallons per day) ....., ........................... ............................... 600
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No
26. Has SPDES Application been submitted to local DEC office? .........................
No
Form PC -97
36. Tax Map ID Number ......................................................... Map 4 ,1OBlock 1 Lot 24
37. Approved plans are to be returned to ..... Applicant A Design Professional
NOTE: All applications for *eview and approval.of a new SSTS to be located within the NYC �Ja«rshcd shall'
t 4)
'be sent to the Departirierit, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the.SSTS prior to final approval by the Department. Projects within the watershed may also.
require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces, and the.project applicant should obtain the.appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of 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 Glass A misdemeanor pursuant to Section 210 of the Penal Law.
SIGNVATURES & OFTIEC'LAL TITLES.-
Mailing Address: ...................................
Robert Boeschi
1367 Hayes Drive
Yorktown Heights, NY .10598
Y 2,
27.
Is any portion of this project located within a designated Town or State wetland?
Yes
28.
J
Wetlands ID Number ........................................................... ............................... ML -4
_ .... 29.
.._...._............._,
I�s W f1 ds Permit' required?. .......................................:...... .........:.....................
Yes....,:....
Has application been made to Town or Local DEC office? ...............................
No
30.
Does project require a DEC Stream Disturbance Permit? .. ...............................
No
31.
Is or was project site used for agricultural activity,involving application of
-
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity .....:..................... Yes/N0
No
32.
Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes/No .
No
DESCRIBE:
33.
Is there a local master plan on file with the Town or Village? .........................
No
34.
Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site ?........... .. ...............
No
35.
Are any sewage treatment areas in excess of 15 %slope? . ..:............................
No
36. Tax Map ID Number ......................................................... Map 4 ,1OBlock 1 Lot 24
37. Approved plans are to be returned to ..... Applicant A Design Professional
NOTE: All applications for *eview and approval.of a new SSTS to be located within the NYC �Ja«rshcd shall'
t 4)
'be sent to the Departirierit, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the.SSTS prior to final approval by the Department. Projects within the watershed may also.
require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces, and the.project applicant should obtain the.appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of 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 Glass A misdemeanor pursuant to Section 210 of the Penal Law.
SIGNVATURES & OFTIEC'LAL TITLES.-
Mailing Address: ...................................
Robert Boeschi
1367 Hayes Drive
Yorktown Heights, NY .10598
k
a
KEANE COPPELMAN ENGINEERS, P.C.
CIVIL & ENVIRONMENTAL CONSULTANTS
113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 .(914) 241 -2235
January 25, 2001
Mr. Adam B. Stiebeling, Asst. Public Health Engineer
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Boeschl, Park Drive
TM# 74.10 -1 -24, (T) Putnam Valley
Dear Mr. Stiebeling:
This letter is to request a waiver of the current 100% expansion requirement for the
above referenced lot.. Due to existing constraints on the lot only a 50% expansion area is
possible.
Attachedds the NYSDOH Gen 1 -52 waiver.form.- ._ _.:._::::__.:.....:.., __ .:._ .__. "_ �� .:.:�•�r
Very truly yours,
a a
\. L
Pete Lind
Attachment
PST NAlVi COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMEN'TAL, HEALTH SERVICES
LETTER OF AVd'HO&tEZA1'LON
RE: Property of Robert Boeschel
Park Drive
Located at
TN Putnam Valley. Tax Map # 74.10 Block
Subdivision of Map of °Lauxal Hill Park
Subdivision Lot # 15 Filed Map # 855
Gentlemen:
1 Lot 24
Date Filed 05/05/1959
This letter is to authorize Daniel P. ,:.`Cappelman
a duly licensed Professional Engineer x or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater treatment and/or water supply systems
in conformity with the provisions of Article.145_.andloz..147 -of the Education Law, the Public Health...
o e ...._.......::,
i,�iw; "and the'Putnam ounty "unitary ICd:
Countersigned:
P.E., R.A.,
ai mg Address
State
Very truly yours,
Signed:
(Owner of Property)
Mailing Address: / 361"' 7� Z r�-
1113 ITH AVENUE �D2 /�Tas -cam Gv h' 9�.f
.OMM KISrn y j
J914) 241 -2235
Zip
Telephone: 914-241-2235
State //, t/ Zip /O s— P J�'
Telephone:
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_.::......:'I�ESkI kTA•S EET,= S BSUR- 'ACE-SE'WAGE TREA`T'MENT °SYSTEM
Owner Robert Boeschl Address 1367, Hayes mr. , Yorktown Heights
NY
Located at (Street) Park Drive Tax Map74.10 Block 1 Lot 24
(indicate nearest cross street)
Municipality Putnam valley - ,Drainage Basin Hudson
SOIL PERCOLATION TEST DATA
Date of Pre- soaking .03-20-90 Date of Percolation Test 03-20-90
Hole No.
.Run No.
Time
Start - Stop
Ela se Time
kiVlin.)
De th to Water
from Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Inches
Percolation
Rate
Min/Inch
1
10:00 10 :12
12.
18 21
3
4
2
10:12 10:24
12
18 21
3
4
3
10:24.10:36
12
18 21
3
4
4
5
1
10:05 10:17
12
18 21
3
4
- -- - •• -. --
- -- .2
10:.17 10:29
- 12-
18 ._.._..•21�._.
3_�.
.......r...4
3
10:29 i0:44
15
18 21
3
5
4
5
1
.
2
3
5
lvUftb: 1. "Tests to be repeated at same depthruntil approximately equal percolation rates are obtained at each
percolation test hole., (i.e. s: l }min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole. �
Form DD -97
2
' TEST PIT DATA
D.ESq* %-&W SOILS ENCOUNTERED IN TEST HOLES
rv- •
gd 59
DEPTH
H%�rl
N(33 AV'
. 2
HOLE NO.'
�E
HOLE NO. 3
G.L.
0.51
OraanLc
ot g a n. i c
Organic
1.01
Dark Brown
Dark Brown
Dark Brown
1.51
Loam
Loam
Loam'
2.0
11
2.51
1 if
10I
if
3.51
it
if
4.01
Sandy Loam
'Sandy Loam
4.5
5.0
Ledge @ 51-0
5.5
6.5
7.01
7.5
8.0
8.51
9..0
9.5
1060,
Indicate level at which groundwater is encountered N..A..
Indicate level at which mottling is observed N. A.
Indicate level to which water level rises after being encountered N. A.
Deep hole observations made by: Keane .--Copp . elman En(jineers Date 03/90&08/00
Design Professional Name: Daniel- -P_,..-_,
Address: 113 Smith Avenue
,Mount Kisco,-:NY 10549
ot5�eiman_
Design Professional's Seal
... FQR
KEANE COPPELMAN
ENGINEERS, P.C.
PROFESSIONAL CORPORATICI
BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N.
Puolir :: ealth- : Director- - -- Ky^• ;- �� � Y O�`� , `;.r ' '- Associate '' Publie' ' Reaith `Director' � w
Director. of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 = 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -,6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
November 8, 2000
Keane Coppelman Engineers, P.C.
113 Smith Avenue
Mount Kisco NY 10549
Re: Boeschl
Park Drive, Lot #15 .
(T) Putnam Valley, TM# 74.10 -1 -24
Dear Mr. Coppelman:
The above regarded application is and cannot be processed. - -
This means the project cannot be forwarded to a Putnam.County Department of Health reviewer for
comments or approval until the following has been received:
1) ❑Standard E911 Address Form.
2) Construction Permit Application.
3) []Certificate of Construction Compliance Application.
4) ®A certified check or money order in the amount of
$300 for a Construction Permit.
® $300 for a renewal of a Construction Permit.
$150 for a revision of an approved Construction Permit.
❑ $200 for a Certificate of Compliance.
El $100 for a Well Permit.
® Other: I am returning your check for $400.00.
,r
If you have any question regarding this matter, please call me at (914) 278 -6130 ext. 2152.
Very truly yours,
Theresa Nemeth
Senior Typist
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KEANE COPPELMAN ENGINEERS, P.C.
CIVIL & ENVIRONMENTAL CONSULTANTS
113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 (914) 241-2235
(Domestic Mail Only,-No
Article Sent To:
Insurance
Coverage Provided)
PUTNAM VAII MY
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Postage
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KEANE COPPELMAN LNGINtERS, P.C.
113 Smith Avenue
MOUNT KISCO, NEW YORK 10549
Q914)z41- 2235
TO QAPQVn (NOVA qQ2YLVA _._:.� . O _...H. e.4. j i .
WE ARE SENDING YOU Attache ® rate cover via _
❑ Shop drawings ❑ Plans
❑ Copy of letter ❑ Change order ❑
LLIMUVIEQ @Ir' U UH @W0CTVL 1
DATE o2-21- ® JOB NO.
AITEN T IOIV
RE: &Oese
❑ Samples
the following items:
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
`.
'c s Well % el cejt5ions
..._- HE- .,� -APE Tw,NoMFi . ED-as- Che:;nCU below-.-
/For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:
if enclosures are not as noted, kindly notify us at
flil e I
KEANE COPPELMAN.ENGINEERS, P.C.
113 Smith Avenue
MOUNT KISCO. NEW YORK 10549
TO
�e�eJg )�vw►6
WE ARE SENDING YOU Attached . ❑ Under separate cover via _
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
[OUTEn @[ IJ ° ° HMO ` 11
DATE O
JOB NO.
q»�... z�seb'e'
RE: �5ch
r k V. tie
�ir4w► ./4I
S �G sy 5, f We
1q,
the following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
S �G sy 5, f We
1q,
It
Lek Le r - So°o F s on -
Z
J 4A S
.TFIESE-ARE TRAN MITTE - - -.
- � _ _.. 4�as chacicgcl Ce��: _.. ... .....__ ... _..._.. __. __.... ...
Y gYFor approval ❑ Approved as submitted ❑ Resubmit copies for approval
`❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED: 1�3
ff enclosures are not as noted, kindly notify us at once.
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
mc
0
LORETTA MOLINARI • R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
ATTENTION: ❑ ADAM STIEBELING ❑ GENE REED ;
All information below must be u lc completed prior to any scheduling. DATE: 10/18/00
ENGINEERORFIRNI: Keane Coppelman Engineers PRONE #• 914 -241 -2235
113 Smith Ave., Mount Kisco, NY
REASON:
DEEPS: AX PERCS: cc PUTHP TEST: ❑
ROAD /STREET:.. Park Drive
TOWN: Putnam Valley TAXMAP #: 63 -7 -3
SUBDIVISION: Laurel Hill Park LOT #: 1.5
OWNER:. Mr.. Robert Boeschel
NYCDEP CRITERIA FOR JOINT REVIEW AND V91NFS4TN OF SOIL TE TIN.
YES- _ NO
❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs.
❑ 6 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.
Y9 ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
❑ IX Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required.
❑ M Proposed SSTS for a Commerical Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Department will determine the NYCDEP project status (Joint or Delegated) based on the
response. If you answered +-es to any of the questions, NYCDEP must witness the soil testing. This -
Depariment will coordinate a mutually suitable time for field testing with the P.CDOH the Design
Professional and NYCDEP.
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility
of the design professional to schedule re- witnessing of the soil testing with NYCDEP.
DATE:
CO,f}f ENE rS:
FOR COUNTY USE ONLY
TME:
NAME OF OWNER:
PUTNAM COUNTY DEPARTMENT OF HEALTH
. DIVISION OF ENVIRONJtENTAL HEALTH
).UAL WER UPPLY & SUBSURFACE SEWAGE TRE4T-MENT SYSTEMS . ..
'.:_ ::.....:..:,
..... AT „1 'SHEET'FOR COiQS�'Rt1CTi�1�13. ,. .. _ _ .. ...> .
S T LOCATION:
REVIEWED BY: RM, RR RDATE: �' �' .TAX MAP#: (CONFIRMED) ?1-110 (�Z
Y DOCUMENTS
ERMTT APPLICATION.
ELL PERMIT OR PWS LETTER
ER OF AUTHORIZATION
:N DATA SHEET (D
ORATE RESOL ON
WT EAF �
lbw
.' ' L
L'ATTL•CT
SUBDIVISION
LL, SUBDIVISION
ITVISION APP VAL CHECKED
:RATE
REQUIRE DEPTH
CAIN DRAIN REQUIRED
GENERAL
TED IN NYC WATERSHED
YS SUBMITTED TO DEP
:GATED TO PCHD
HOUSE SEWER - V." FT. 4 "0'; TYPE PIPE CAST-IRON
�0 BENDS; MAX BENDS 45° W /CLEANOUT
RENEWALS
NOTE (NO CHANGE)
FILL6MTEMS
HORIZONTAL; POT TRENCH SLOPES 3:1 TO GRADE
L SPECS/ FIL OTES 1 -5
(� ONS
(FILL i
CLAY BARRIER
R. O.B., UNCLASSIFIED & IMPERVIOUS
?ARATION DIST ROM TOE OF SLOPE.
TRENCH
TRENCH PROVIDED 60
RALLEL TO CONTOURS ��
% EX vff9ffnT6Tmml 4
rAiuD-umRErcRusmDsToNE OR WASHED GRAVEL
'EOTEXTILE COVER
SERVED . SEPARATION DISTANCES ON PLAN - FROM SSTS
CST E WTTNESSE ' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
APPROVAL- OTS ru ' TO FOUNDATION WALLS
TLANDS (TOWN/DEC PERMIT REQ'D ?) 0' TO WELL, 200' IN . DLOD,150' TO PITS
�ASLYRDS PLANS & PERMIT SAME 100' TO STREAM, WATERCOURSE, LAKE (inc. expan)
.1969 NEIGHBOR NOTE °I— U"50' TO CATCH BASIN 35' STORMDRAIN PIPED WATER
BA1�.- 3�0'TOWATi]5:.�... ?d;'j.
ELEVATION W%I200'.... ,.
SOIL TESTING LOTS >10 YEARS OLD C_JC_ -)`0' INTERMITTENT DRAINAGE COURSE
SOIL TED DETAILS >1 PLANS
YEARS /500 RESERVOIR, ETC. _ 150 GALLEY SYSTEMS
S RAGE SYSTEM PLAN - (NORTH ARROW) U MIN TO LEDGE OUTCROP
� 5
SDS HYDRAULIC PROFILE U10' FROM FOUNDATIO , 50' TO WELL
GRAVITY FLOW
CONSTRUCTION NOTES 1 -15
DESIGN DATA: PERC & DEEP RESULTS
2,CONTOURS EXLSTING &PROPOSED (_JU1.IIIN 15' TO`PROPERTY LINE
RRIVEWAY &'SLOPES, CUT Lg
HOOTING /GUTTER/CURTAIN DRAINS �S PE IN SSTS AREA 2 0 %)
USDA SOIL TYPE BOUNDARIES
MD TO 15 %, IF R QUIRED
TFTLE BLOCK; OWNERS NAME ADDRESS (--)
it#, PE/RA; NAME, ADDRESS, PHONE# DOSE/PUMP SYSTEMS
DATE OF DRAWING/REVISION U(— -)PUMP N
DATUM REFERENCE (_)C�DOSE 75% OF P �(PIP VOLUME NOTED
3,0CATION OF WATER ES, PONDS U(�DETAIL FOR F MAPE, ETC.)
L�1KE$WETLANDS HIN 200' F P.L. (--)C --)PIT AND D X SHOWN & DETAILED
11vIS LOO' UUl DAYS GE ABOVE AL
V�EN NS CU
S & SSDS'S W/IN 20 SSTS i__)USTAND 5' BOT ES, DETAIL
ERTY METES & BOUNDS (x(___)15' MIN to CD o, 20'-4 %, 25'-3%,35'-l%, 100 % - <1%
UU20' MIN to C 00' with 182 cons day discharge
0'. MIN to ON- PERFORATED PIPE
T
CONNECTION
COMIVI.ENTS:
(REVSHEET)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
� ' SI$EET-FIik CO\STRUC'['ION rEk,�Yi f
STREET LOCATION,L NAME OF OWNER -
REVIEWED B� R11, G AS BH DATE TAX NIAP #
Y N 11 Y Y N
IT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS
-1 PERC & DEEP HOLES LOCATED Co ` /
LL PERMIT _ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION
ETTER OF AUTHORIZATION LOCATION MAP
DF,R.GN DATA SHEtT (DDS) EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE G,lz4t ,
TE RESOLUTION IF PUMPED, PIT & D BOX SHOWN & DETAILED
SH02. _ Ila HOUSE - NO.OF BEDROOMS (-� (,c. �'•
S - THREE SETS WELLS & SSDS'S WAN 200' OF PROPOSED SYS.
HOUSE PLANS - TWO SETS' PROPERTY METES & BOUNDS
VARIANCE REQUEST "`� HOUSE SETBACK NECESSARY (TIGHT LOT)
s HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE
SUBDIVISION JNO BENDS; MAX.BENDS 45° W /CLEANOUT
LEGAL SUBDIVISION FILL SYSTEMS
SUBDIVISION APPROVAL CHECKED CLAY BARRIER
PERC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE
FILL REQUIRED DEPTH FILL SPECS FILL NOTES
CURTAIN DRAM REQUIRED FILL CERTIFICATION NOTE
STANDPIPES DEPTH GAUGES
GENERAL
FILL PROFILE & DIMENSIONS
LOCATED N NYC WATERSHED
VOLUME
PLANS SUBMITTED TO DEP
FILL N EXPANSION AREA
DELEGATED TO PCHD
TRENCH
DEP APPROVAL, IF REQ'D
LF TRENCH PROVIDED 60 FT MAX. •..
DEEP TEST HOLES OBSERVED
PARALLEL TO CONTOURS
PPRCS TO BE WITNESSED
100% EXPANSION PROVIDED
EX- APPROVAL SSDS ADJ. LOTS
SEPARATION DISTANCES SPECIFIED
WETLANDS (TOWN/DEC PERMIT REQ'D ?)
O\ PLAN - FROM SSTS
DA.TA_ON, . DDS JPd!Ay1S:& pc.R.1i I SAME- _
-
-
_
:0' TO F:L:, IiRIV .'49'AY, iARGE TREES; 7vi' Di Fill _ .,..._...
PRE 1969 NEIGHBOR NOTIFICATION
20' TO FOUNDATION WALLS _15'WELL TO PL
LETTER BVZBA
100' TO WELL, 200' N DLOD,15V PITS
100 YR. FLOOD ELEVATION
100' TO STREAM WATERCOURSE LAKE (inc. expan)
OTHER REQ'D PER�MIT(S)
50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER
REOUIRED DETAILS ON PLANS
10' TO WATER LINE (pits -20')
SEWAGE SYSTEM PLAN - (NORTH ARROW)
50' INTERMITTENT DRAINAGE COURSE
SSDS HYDRAULIC PROFILE
2007500' RESERVOIR, ETC. —150' GALLEY SYSTEMS
GRAVITY FLOW
CONSTRUCTION NOTES
15'MN to CDS= >5 %,10'- 4 %,251- 3 %,30'- 2 0/o,35' -1 %,100' - <1%
DESIGN DATA: PERC & DEEP RESULTS
20'MN to CD discharge /I00'with 182 cons day discharge
2' CONTOURS EXISTING & PROPOSED
SEPTIC TANK
DRIVEWAY & SLOPES, CUT
W 10' FROM FOUNDATION; 50' TO WELL
FOOTING/GUTTER/CURTAIN DRAINS
WELL
SOIL TYPE BOUNDARIES
DIMENSIONS TO PROPERTY LINE
TITLE BLOCK; OWNERS NAME,ADDRESS
® LOCATION OF SERVICE CONNECTION
TM #,PEIRA; NAME,ADDRESS,PHONE9
OF DRAWNG/REVISION
DATUM REFERENCE
flDATE
LOCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
=PROPOSED FINISH FLOOR AND BASEMENT EL.
COMMENTS:
r i , .
BRUCE -R, FOLEY -
'
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
I.ORETrA. MOLINARI . R.N., M.S.N. :
Associate Public Heat - Director
Director of Patient Services
Environmental Health (845)278-6130 Fax(845)278-7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
February 7, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fak (845) 278 - 6648
Keane Coppleman Engineering
113 Smith Avenue
Mount Kisco, New York 10549
Re: Boeschl, Park Drive
TM # 74.10 -1 -24, Town of Putnam Valley
Dear Mr. Lind:
The above referenced application was discussed at the Departments February 6, 2001 Specific Waiver
meeting.
I offer the following for your review and consideration:
Request for waiver of 100% expansion area reduced to 50% has been granted with the following
conditions:
Well and Separate Sewage Treatment System (SSTS) to be staked by a New York State
Licensed Land Surveyor prior to construction. Please place a note on the plan regarding
condition.
Upon'further review and discussion "of ftie "waiver-meetirig'it has, atso been d'etertninedthat this office
be required to issue a waiver of required 35'0" minimum separation from the SSTS expansion area to pipe
drainage (pipe).
In addition, please also show existing/proposed SSTS to the north, east and west of the subject lot. If there
are no septic systems within 200' of lot, please provide the following note:
"There are no other Separate Sewage Treatment Systems within 200'0" unless shown."
Approval of application will commence upon receipt of the above listed comments.
This office will continue its review upon consideration of the above mentioned comments. Please feel free
to contact us if any questions arise.
Very truly yours,
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
.ate 14 y.
BRUCE R.. FOLEY ......:.,,..: .
Public Health Director
LORETTA ,. MOLWA.R.1 KN4:14S.N:: ;
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York .10509
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 o
December 11, 2000
Mr. Peter J. Gregory, PE
Keane, Coppleman Engineering
113 Smith Avenue
Mount Kisco, New York 10549
Re: Boeschl, Park Drive
TM# 74.10 -1 -24, (T) Putnam Valley
Dear Mr. Gregory:
The Putnam County Department of Health (Department) has determined that the above
referenced application, including fee, and received by this Department is complete. I offer the
I g for your review and consideration.
D uments:
,.�. .u�'ci3G plans skbrn ttcd resiilt =i -r a 4 -(fa j-bG�' 6oriI ilooi=piaii based - ircurrent-POI 3
t� "bedroom" classification.
eral:
1. Pursuant to PCHD Bulletin ST -19, deep test holes and perc test holes must be witnessed
by this office. (� Q
Neighbor notification documentation must be submitted. C
Pla
Finished floor and basement floor elevations must be shown on plan.
�2. •Fill area must be dimensioned.
Well to be dimensioned to property lines. Minimum distance of well to property lines is
15' -0 ".
Show water service connection line to the house.
Please specify size of drain pipe(s).
Junction box detail:
Note: Trench to start T -0" from box, T -0" separation to be solid pipe.
Boeschl
12'11/00
/lease submit a letter of request for waiver of current 100 % expansion requirement for proposed
50% expansion area.
/SO complete required NYSDOH Gen 152, waiver form, attached.
If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2157.
i
Very truly yours,
Ila
Adam B. Stiebeling
Assistant Public Health Engineer . .
ABS:cj
encl. Gen. 152
Env YORK STATE DEPARTMENT OF HEALTH Specific Waiver
-ireau of Community Sanitation and Food Protection from Re uirelnents'of Part 75 and Appendix 75- A,.10NYCRR. _
•fopindlvidt� -4H- use`n idt'Se g ®ir®atn`ia M -8ystginS .. _.
1.. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)):
Separation distance cannot be achieved.
Excessive slope.
High groundwater.
D
Inadequate depth to bedrock or impermeable layer.
Son unsuitable.
Other(explain) ............. .............................................. _ ... _ .......... __-. ....... _.__ .. ................ _............
2. Proposed design or conditions of waiver:
... ......... _ ............... ................ .....,.............,. ...... .......................... ................. ................... ...................... ..... ._....
3. The proposed design may have the following limitations (check appropriate box(es)):
Increased risk of well or spring contamination.
Increased risk of surface water contamination. '
Expected design life of the system will be diminished. - - --
Operation of sewage system is subject to.mechanical problems. - - - - --
Other (explain)............................................................ .. ........ _... ........... __.......... _ .......... ........ _. ....................... ....
.._.
Additional information attached .
Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with
New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver
may be revoked by the issuing official for a change in conditions for which this waiver was granted.
............................... ................................... ...............................
REPRES'cNTATIVE Of COMAAISSIONER OF HEALTH ORIGINAL - Local Health Agency
COPY - Applicant/Design Professional
oar
(GEN -152)
BRUCE R....FOLEY..
Public Health Director
October 4, 1999
y . _, LORE'1T
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New .York 10,509
Environmental Health (914)278-6130 Fax (914) 278-7921
Nursing Services (914)278-6558 Fax(914)278-6085
Early Intervention (914)278-6014 Fax(914)278-6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
Mr. Peter J. Gregory, PE
Keane Coppleman Engineers
113 Smith Avenue
Mount Kisco, New York 10549
Re: Application to Construct a Subsurface Sewage
Treatment System - Boeschl, Park Drive
(T) Putnam Valley
Dear Mr. Gregory:
The Putnam County Department of Health (Department) has determined that the above referenced
application received by the Department on September 13, 1999 is incomplete. Please be advised that
th ollowing information is required before the Department may commence its review.
Permit Application CP -97 (enclosed).
Fee, Certified. Check in the amount of $300.00.: - -'
e . Short Form-EAF- (enclosed). w -
• Plans pursuant to the PCHD Bulletin ST -19 (enclosed).
The proposed design is with use of "flow diffusers ". The following criteria.is required when flow
diffusers are proposed.
• Minimum separation - 24' ° /c.
• Minimum 150' separation distance from well to septic.
• 4.0 sf/lf effective sidewall area credit.
• 12 sf/lf effective sidewall area credit end sections.
Percolation tests at 24" & 36" depth(s).
All of the above addressed in PCHD Bulletin CS -31 "Commercial Design Manual."
A
.:'page 2A :Roeschl:
October 4, 1999 rn-
Additional. requirements:
Provide the source of the survey.
Provide the survey of staked/flagged wetlands.
PCHD notes.
Recommend pre -cast drain basin.
This office reserves its right to further review and comment. .
The review of your application will commence once the Department receives the requested
information and determines that the application is complete. The Department will notify you within
10 days of its receipt of the requested information as to the completeness of your application. Please
be advised that failure to submit information to the Department or to follow procedures is sufficient
grounds to deny approval, pursuant to Putnam County Department of Health regulations.
Should you have any questions or care to discuss this matter, please contact.me at (914) 278 -6130 ext.
2157. .
Very truly yours,
aL
Adam B. •Stiebeling
Assistant F.ubl'ie Health EnLineer
i
°i
PUVU1I CO@f T DElAlO®f! OI+=M=
Dhum d am6s#aMd nsd6 sudom CNNNL X.Y. ICU •� C».AlE hov trump 1
OF
COIgrffUV O[f tO�l 1011 SWAM Dfiloll" Sjs p 0
:P'ar}c Dive
IdeaMd at Tom - a, VlkV
�� Laurel Hill Park ul,&la# 63• 7 JAI 3
Mr. Robert Boeschl
�....� ❑ Defldor k ❑
Data d ttevlapa Aid
flow ow 33 New Avenue Tow■ Yonkers , NY 10704
np
Date Subdivision Annroved Fee Enclosed ❑ Amn,mf•
Residence Aar 1.079 Acres
31111111111111 TW IM Only Dwa 2'-() Ver.. 530 c
Number of _Daalp Plow G P D tin tC®NedItod= k =.gir.a WIvss M la eer�
sgpmm a 2 sb ela. r event d 1000----- S@P* Tmk .., 12 8 L . F . of flow diffusors
T1 beeallowled.bt FrPAbar qpr i r- T,i nrnI nleiale _ Ny
w.a Supply'
on X p+so% Supply Dtld by Real •�--- 8r(�SrJS to r-r NY
paw ampb„�Sao- -21 -0" Run of. Bank Sand & Gravel over SSDS Area
1 rso aant. that 1 am wholly am completely responsible for the dosien and location of the proposed system(y; 1) that the » rat• saw dt »I s stem .
aiseve diecrNled will a constructed as shown on the approved amendment there to and in accordance with the standards. rules a r•2u s o
County Department of Haani% and that on c01r1pletlon.thersof a °Certificate of Construction Compllance" atidactory to the Commissioner of Halthwill
oo submitted to tat Od/MtmerN. No. a written puarentee will be fum~ the owner. his sueaeaers, heirs or assigns by the builder. that said builder will
ptaca in psed .eperal" coadn"". any pert of »M Im ap dispo»I system during th•.period of two (2) years Immediately foltowkb the dote of the khr
8M of the 8WOM of tat CertIlkate of Construction Compliance of the original system or any rep irs thereto; 2) that the WNW well deserlbod above
wed be Named as shoaled M the approval plan and that said well will be installed in o0 k atandafds, ruWF48rRhguS --& the Putnam
edrfrey 6 ~10 - 91� '113 S TH AV K E s�
pear �OPFEL N X
MOUNT C ,
wY.wr � � ■ Wwr Yw
APPROVED FOw'CONSTNt1CTION: Thla approval eapYd� lwd years hum tat date issued unless oonit►uetbri 01 �tN bulgMj has been undertaken and is
revocable for au» or may be amended or modified when considered necessary by the Commissioner of "mHL Any cheap or altersitlen of construction
geererM a w permit... Approved for disposal of domectk serlNer�sw
sep. • private water supply, only.
Rev, Q ��-
��VY Odto f)y Title
i�
DEPARTMENT OF'HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL;,, N.Y. -10512 (914) 225 -3641
APP "Lr CATION'- "TO- :`�OON8TRUCr' -A' -- WATER"VELL . , ..:�.._ :r-
PCHD PERMIT #jfi�_-
WELL LOCATION
Street Address
Park Drive
Town /Village /City Tax
Putnam Valley
Grid Number
63
WELL OWNER
Name Address
R. Boeschl 33 New Avenue, Yonkers, NY
aPrivate
107aPublic
USE OF; WELL
1 primary
2 - secondary
RESIDENTIAL
BUSINESS
❑ INDUSTRIAL
❑ PUBLIC SUPPLY ❑ AIM/ COND /HEAT PUMP
❑ FARM ❑ TEST /OBSERVATION
O INSTITUTIONAL ❑ STAND -BY
❑ ABANDONED
❑ OTHER (specify)
AMOUNT OF USE
YIELD SOUGHT
5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 600 gal
REASON FOR
DRILLING
❑NEW SUPPLY []PROVIDE ADDITIONAL SUPPLY
O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
®TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
1120
°
WELL TYPE
DRILLED
DRIVEN ®DUG ® GRAVEL
® OTHER
IS WELL SITE SUBJECT TO.FLOODING? YES X . NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Laurel Hill Park Lot No. 15
WATER WELL CONTRACTOR: Name. P.F. .Beal & Sons,-Inc. Address: 'Brewster, NY
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __X_NO
NAME OF PUBLIC WATER SUPPLY:
DISTANCE -TO PROPERTY FI�bM'NEARES'P WA`PER MAIN: Miles
TOWN /VIL /CITY
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED FOR
[:]ON REAR OF THIS APPLICATION 0 TE SHEET NE COPFELMAN
(date) (sin t' ROFESSIONAL CORPORATION
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.
Date of Issue:
Date of Exp' tion: 19 ermit Issuing fic'
Permit is Non - Transferrable
M.
. PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
J'
.. :: .APPLICATION FOR APPROVAL, OF PLANS,FOR
A WASTEWATER TREATMENT SYSTEM
L Name and address of applicant: Josef' Bgeschl
IT Avenue '
Yoi�ke`rs, 'N.
2. Name of project: _ P ' Y 3. Location TN. Putnam
Boeschl � Pro ert
4. Design Professional!< :Coppelman Engrs s6, . Address: 1,13 smith Avenue
6. Drainage Basin: Mount, Kisco, NY '10549
7. Type of Project:
X . Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8.
Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ..................:.... .................:..,.......... Type I
Exempt X
Type II
Unlisted
9.
Is a Draft Environmental Impact Statement (DEIS) required? .........................
No
10.
Has DEIS been completed and found acceptable by Lead Agency? ...............
No
11.
Name of Lead Agency Not applicable
12.
Is this project in an area under the control of local planning, zoning, or other
K.......-
°officials; .................................... .... : -yes_ .....:....... .
13.
If 'so, have plans been submitted to such authorities?
No
14.
Has preliminary approval been granted by such authorities? -Date granted:
No
15.
Type of Sewage Treatment System Discharge ................. surface water X groundwater
16:.
If surface water discharge, what is the stream class designation? ....................
17.
Waters index number (surface) ........................................... ...............................
18.
Is project located near a public water supply system? ....... ...............................
19.
If yes, name of water supply Distance to water supply
20.
Is project site near a public sewage collection or treatment system? ................
No.
21.
Name of sewage system --- Distance to sewage
system �-
22.
Date test holes observed .23. Name of Health Inspector Bill Hedges
24.
Project design flow (gallons per day) ................................. ...............................
:,'600
25.
Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?...
No
26.
Has SPDES Application been submitted to local DEC office? .........................
No
Form PC -97
".,
2
27. Is any portion of this project located within a designated Town or State wetland? No
25. Wetlands ID Number .................................. ...............................
u •. .. �� : ..... u ..+.. • -'Y <.�. ..rr^Y. •L" a �� v u.. .. • 1c. .. = r .. ...� •� -- .:- VV.`.•�i. ve.ru �: .. ..�'.\ G'.-.: .., c ....... "..mot.. .1.+.•..a. ..
29 Is Wetlands Permit required? ............................. ............. ...............................
Has application been made to Town or Local DEC, office? ...............................
30. Does project require a DEC Stream Disturbance Permit? .. ...............................
31. Is or was project site used for, agricultural, activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge - application or industrial activity? ......:.....
'32. Is project located withiri:1 ;000 feet of existirig-or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes/No
DESCRIBE:
No
No
33. Is there a local master plan on file with the Town or Village? ... :................ ....... No
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ............................... No
35. Are any sewage treatment areas in excess of 15% slope? ............... No
36. Tax Map ID Number .. Map 6 3 Block Lot !3
37. Approved plans are to be returned to ..... Applicant X Design Professional
NOTE: All.apnlzc t o s-forr- .view oiid.appro�al:of a new S-STS to be- located. within-tlie�IYCzWatershed,shall
be sent .6 the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the Department. Projects within the watershed may.also
require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true
to the best of my knowledge and belief. F stat eats made herein are punishable as
a Class A misdemeanor pursuant to S ction 21 .0�,qf tfre-Pegl Law.
SIGNATURES & ®FFICIAL-T'IT'LES.
Josef Boeschl
Mailing Address' 33 New Avenue
..... ...............................
Yonkers, NY
KEANE COPPELMAN ENGINEERS, P.C.
113 Smith Avenue
MOUNT KISCO, NEW -YORK 10549.
(914)'2'41'-2235
To �f�A. �TMFi�T ..off• . 41.din-1
//o o[ o rZo�T'E S, X �Enrt fE,P
'A Fl iyEw . yo itit
DATE .JOB
06. ,. ?• 9i
NO. -
'ATTENTION
r3 C
DESCRIPTION .
vAz Z.01
S5 05
-�
> WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: '
. i
• Shop drawings ❑ Prints ❑ Plans ❑ 'Samples ❑ Specifications
• Copy of letter 0 Change order ❑
COPIES
DATE
NO.
DESCRIPTION .
S5 05
-�
ea j vir
.4
ArP jeA7 o,4 Tb 6b,Js %Cjt' A •v'ar` lP v%lFliC
THESE ARE TRANSMITTED'as checked below:
I For approval. ❑ Approved as submitted ❑ Resubmit copies for approval
/❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
> ❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED .AFTER LOAN TO US
REMAR
V1 -:5io/\/
COPY TO
SIGNED:
PNOWa 243 ®im, WA am 01471. If .enclosures are not as noted, kindly notify us at once.
Me, ;, i X15 0
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHDR%ZATf ®%1
RE: Property of RO`Jfi� oeSC;dt.�
Located at rl( loriye_
T/V PEE L,44 Tax Map # 63 Block Lot 3
Subdivision of GQLs.r� 1 Hill pall-i
Subdivision Lot # 1,5, Filed Map # . Date Filed
Gentlemen:
This letter is to authorize XeAre &oalavt art 41*,' s P.0 %rep ✓. Aed6oa y,
a duly licensed Professional Engineer X or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulation4 as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater treatment and/or water supply systems
in conformity with the provision _s..of.Article .. 145.and /or 147. of the Education Law; the Public Health
`Law, and the Putnam County Sanitary Code.
Countersigned:
P.E., R.A., # VtX&
Mailing Address //3 SMI%�7
Neaw xa&e
State N Y Zip /G3�1 f
Telephone: �9 /bj) - 2ql - 7 Z 34'
Very
Signe
Mailing Address: 33 //&oL/
fG�. �ElS
State AY Zip 107,41
Telephone:
Form LA -97
. t::..:. PUI'NAM COUNTY DEPARTMENT OF HEALTH .
DIVISION OF ENVIRONME= HEALTH SERVICES
DESIGN DATA • SH=- SUBSUF'ACE. SEWAGE DISPOSAL .SYSTDI :...
Owner Mr. Robert Boeschl
Address 33 New Ave., Yonkers, NY 10704
Located at (Street) Park Drive Sec. 63 Block 7 Lot 3
(indicate nearest cross street)
Municipality Putnam Valley Watershed N.Y.C.'
Date of Pre- Soaking 03-20-90 Date of Percolation Test 03-20-90
HOLE
NUMBER CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Fran Water Level
No. Time Ground Surface In Inches Soil Rate.
Start -Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
1
10:00 -10:12
12
18
21
3
4
5
2
10:12 -10:24
12
18
21
3
4
2
10:17 -10:29
12
18
21
3
4
3
10:24 -10:36
12
18
21
3
4
4
5
1
-.10:05- 10.:17.
12
18_
2
10:17 -10:29
12
18
21
3
4
3
10:29 -10:44
15
18
21
3
5
4
5
1
10:10 -10:28
18
18
21
3
6
2
10:28 -10:46
18
18
21
3
6
3
10:46 -11:04
18
18
21
3
6
4
5
NOTES: 1. Tests to be repeated at same depth until approximately 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.
rev. 9/85
F.
DEPTH
G.L.
1'
, p• 1 YYYI�
APPT,TrATT(-.m
OF SOILS UNTERED IN TEST HOLES
HOLE NO.
HOLE NO.
ORGANIC ORGANIC
2'
3' LOOSE BROWN LOAM
4'
.51
6'
71
81
9' .
10'
12'
13'
14'
I
GRAY SAND
s:
LOOSE LOAM
GRAY SAND
W /COBBLES
INDICATE LEVEL AT WHICH GROUNMATER IS ENCOUNTERED N.A.
HOLE NO
O
ORGANIC
I --
BROWN LOAM
LEDGE @ .5'-.0
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNrIERM N. A.
DEEP HOLE OBSERVATIONS MADE BY: KEANE COPPELMAN ENGINEERS DATE: 03 -02 -90
DESIGN
Soil Rate Used 6 -7 Min /1" Drop: S.D. Usable Area Provided 5_00n �qF
Noe of Bedrooms 3 Septic Tank Capacity 1000 gals. Type CONC.,,
Absorption Area Provided By L.F. x 24" width trench
Other 120 L.F. TRI -GA LERIES. 2 9-0" R.O.B. SAND & GRAVEL, D -BOX
Name Signature
Address M SMITH AVENUE SEAL �C FOR
• E14NE �_',Oe'',PELIV(AN
-._ , na. 10519 ENGINE Z-,5., .P,C.
X914) 2412235 A PROFESSIONAL CORPORATION
THIS SPACE FOR USE BY HEALTH DEPARZMERI ONLY:
Soil Rate Approved sq.ft /gal. Checked by t-P
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Weil',cicatiuin "..`"
Street Address: °'
48 Park Drive
TowniVillage:
Putnam Valley
Tax Grid #
Map 7,(rBlock Lot(s)
Well Owner:
Name: Address.
Rock –All Construction, 1367 Hayes Drive, Yorktown Heights, NY 10598
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air pond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 32' ft.
Length below grade 31' ft.
Diameter 6" in.
Weight per foot 19 lb /ft.
Materials: X Steel Plastic Other
Joints: _Welded X Threaded Other
Seal: X Cement grout — Bentonite Other
Drive shoe: X .Yes No
Liner: Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes—No
Hours
Second
Well Yield Test
_ Bailed . X Pumped X Compressed Air
Hours 6
Yield 15 gpm
Depth Data
Measure from land surface - static (specify ft)
40'
During yield test(ft)
140'
Depth of completed well in feet
185'
Well Log
If more detailed
information
descriptions or
sieve.analyses _ ._._
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
5
Drilling
in over
den clay and boulders
Hit rock
at 5'
.. 5
?_ ..
Drilling .
in rock'
set caasin - route,?
32
185
Drillincr
in rock
hranite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity _7=
Depth 160' Model 7GS05412
Voltage 230 HP 1/2
Tank Type WX251 Volume 62 al.
J9
Date Well Completed
3/16/02
Putnam County Certification No.
002
Date of Report
8/12/02
Well tl to
al
lvvi E: t✓xact location or well win atsmnces to at
Well Drillees Name P. F
Signature:
Perry L
two permanent lanamarxs 10 De p7raea on a separate snceup1an.
D, 8/l/202
White copy: HD Filr Yellow copy -Building Inspector; Pink copy -Owner; Orange copy -Well driller
Form WC -97
SWING TIES
A B C R.
TANK
64' . 17.6'
D1
27' 57.9 —=
02
.32:4' 60.6'. - -- =
D3
38: 4 64:6' =.
D4
44.9' :70' — =� —=-
E1.
53:11.0 ` _-
E2
,28.6,' 89.0' ---- --, --
E3..
84-0! -
E4
37:6' : 98.5 — —
E5
73:0'
46141 - 05.0'
E7
684' 7601,} =
E8
48.8. 101st}'
WELL
43 8
"UNAUTHORIZED A- IONS OR ADDITiONS..1`0`'THIS DfAWLNG IS A VI.OLATION ''
'
4F SECTION 7209 (2)' OF THE NEW YQRKj STATE :EDUCA710N �,AW"
1
t
REVISIONS.
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APPf20X. C0CATION OF
I?OOF ANP FbO -nNG PIMN5
`N/ VIP PPP�Ar P15CHAPGZ _ !.
i' CLP,Y (>E12M _ I :`_ _ _ _ _ _ _ �}.�} rc • • AFI'PDXIMATI; LIMI OF
I2.2.f3, G2AVl;I, FILL
- e 38' vz 38. ' •
300 L.F. OF A135CWTiON TP.t;NC1^
2 1 ' . W/ _IUNC •ION "F-5 < ryp)
000 GALLON
5eP11C TANK
41, PVC 50L It? PIPS
A 1
o .2' 51'OPY .
Q.
z : F- 121V1�
VVELL
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DIVISI
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t
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r s1 •4 S ",ryE �� y
yt yc1c� �2T•�. .t'�• '�ra� .I�a �
i /goe
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croaa cut
/4
3
6j
O
M
O
O
N
O
wolf Y bvn rod
15 cmaa cal _ 16
AREA- 47,014? SOFT.
or 1.079 AC.
_ _...
_S59 *39:00.' 'E i5L7.
PARK DRIVE
�D
W
O
O
N
O
Iron rod
CE2Tf / -/L ° T0:
80,13, 2T a05 xNL SURVEY OF PROPERTY
PREPARED FOR
ROBERT BOESCHL
SITUATE IN THE
TOWN OF PUTNAM VALLEY
PUTNAM COUNTY NEW YORK
SCALE 1 in. _ '5,0 ft. 19 89
1. RICHARD H. GORR the Surveyor who made this map. comfy
that the survey sho wn hereon was complet ed b y m e on
1989 .that this map was completedbyme
on feb. zy, 1989
and that this survey has been prepared in acco /diince with the
existing Code of Practice for Lana Surveys adopted by The New
York State Association of Professional Land Surveyors
focofing wolland, flag& 8 adjoining wolla
May 25, 1990. .
NOTES:
1. All certifications are valid for this map and copies thereof
only if the said map or copies bear the impressed seal of the
surveyor whose signature appears hereon.
2. Alteration of this document, except by a licensed Land
Surveyor, is illegal.
3. This map and copies thereof ar%certified to the above -
named owner and the title company and lending insti-
tution(s) named hereon, and to those parties only.
4. LOT 15,1s shown on mop entitled 'MAP OF LAURAL HILL
PARK" filed in the Putnam County Clerk's office,May 5,1959
as map # 855.
RICHARD H, GORR, P.L.S. N.Y.S. Lic. No. 40513
ROUTE 6 P,O. BOX 918
o MAHOPAC. N.Y. 10541 RICHARD 11. GORR & ASSO(:S.
LAND SURVEYORS ° GEOLOGISTS • ENVIRONMENTAL STUDIES
J08 No. 69- // 7