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HomeMy WebLinkAbout3605DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -24 BOX 28 firm I mll oll"ll or. -,5, 0 IN .I ,L T �ti o' , T I 11r'� T-1 rid rml 03605 a �r v 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 E � m nnGc' : S !ScdiGK 6�C JIA l-y e-c.K 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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S109-Pit(S►P-d PM'M(S")J1A1 UP -lit (S") mW°9 P°)s.MN IZU-94(M)M°d OC19- lit (S7P) V11r+H 14UMUC+M 03 60SOi 3130A -N ` -pia-H 'P °aEi °AOU201 HJ 3b'�3 d0 J NMKj2Pdd'da wgroxd NNnrJ JownO, M7°'H W7q+y )amoa r MGM 14 W ••a•x MVNl '10v+ vu9x01 + r c y ' 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 "W IiMaho #. �r LA F ' a Fu f i 3 0 } L►K jL PL � E Barger Pond ,wit+ s 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 t. a� � .... _ ..�.. -..t. r. C3 ru r- rq IT r_1 ru C3 C3 C3 C3 M IT IT 0 M Cal -0 8_q 117- 117� _r r-3 rA ru C3 C3 It, 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 Inc:70 $ Postage $ 0-34 UNIT !D: 0067 Certified Fee Postage rA Return Receipt Fee rU 1-90 Postmark Return Receipt Fee (Endorsement Required) (Endorsement Required) C3 Here. Restricted Delivery Fee (Endorsement Required) Restricted Delivery Fee M C3 C3 E2. 0 ^Cjf0jjTj'� Total Postage & Fees $ $ Of Mpg ;Please Print ClearW, be MPI V ••... S&"No.; WIPO Bo o. fir' ........................................... 7tiafleo ....... ..... .• ..• .. .• .. ........ •.•.••....•••. Cr fate, ZIP+4 ✓ wt 0ev" PS Forin 3800. July 1999 C3 -See Reverse for Instructions U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; Arlicle Sent To: No Insurance Coverage Provided) PUTNAM VALIF(. Hy j0579 Postage $ 0.55 UNIT ID: 0067 Certified Fee . Return Receipt Fee ..(End q!-=qent Required) 4 44 Restricted Delivery Fee (Endorsement Required) CleMI.LVZ Total Postage & Fees 0 rrl Name (P PfintClearl, o b7eomple;ed by mail 1w 121 )"/Ul Xle N ' 1� , -1 .- ...................................... Ir ­Str_e"e"t,"A'p_t. N '0 PO B Ir a(Tol n tie C3------- 5Z ... A --------------- ........................................................ !717_1,1at" 10-1 - PS Forin 3800. Jui.y 1999 See Reverse for Instructions M rq 1117� :1 Ir Ir Postage $ rl PUTNAM VAII Ir Certified Fee Postage rA Return Receipt Fee rU (Endorsement Required) Return Receipt Fee C3 (Endorsement Required) C3 C3 Restricted Delivery Fee Restricted Delivery Fee (Endorsement Required) C3 C3 C3 Total Postage & Fees C3 Total Postage & Fees $ Name (Please t Cl Er Y) _1 3C M Na P ^^le so nt r1y) ppt . Ir . . . .... ..... ............... free C3 17� 0.34 UNIT ID: 0067 Postmark Herd CIS Kr10zM .... q ----------------------------- C3 Ir rl PUTNAM VAII Ir r%_ Postage Certified Fee Return Receipt Fee rU (Endorsement Required) C3 .3 r Restricted Delivery Fee (Endorsement Required) C3 C3 Total Postage & Fees X M Name (Please t Cl Er Y) _1 3C Ir. C3 SftLA r E V.. .. . M .... r- .... .. Ciix,5tafe. ZIP+4 -D C3 I%- rA IT r%- _r rA rq F'U.- C3 C3 0 0 _r M Ir tr C3 r%- 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. :. w t 3r l A PLA >;M]E . J ova; P A�l�K; Q� V k ' �El��p�j. K { . � X10. MM P :CIL": QA TIM" tN , :� � , E a F,12,, JE e svc• �. TOIIVP�f 1.f� ,:. VALLEY Ys, >{ a�ov nos r;,P�U�"f'NAI IT ;{ F2 W t O 0 O , 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 AV •� � � �n1N�LLING PLAN III PUTHI DIVISI APPR APPL PUZN ("", Gt SURVE SURVE 4 1e'k. N /F WA Li E7'R N W'000 t �: e7 n4i 4. v4� ;t Ypk *.afI V�"i' ].�, �kb�n. d�,r n a DIY 4�'t� s °rw.$°�slt�I'klrl'd ,21 ;� p ,v rJ •v"6P.0 �y� �, a. 'r { {c t o.. •'�6 -M p , ,ri -k. � r r s1 •4 S ",ryE �� y yt yc1c� �2T•�. .t'�• '�ra� .I�a � i /goe � Ilop a - aJege . flop 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