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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -38 BOX 28 17--P;- - _ 16t IX 03613 r PUTNAM COUNTY* DEPARTMENT OF HEALTH VIS N-O -E- NVIRQl'4 MENTAL BE -ALTH : CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD COPJSTRUCTION PERMIT # P k/ LS =03 Svc/ Located at ,�� 9 �.: ' = FOR SEWAGE TREATMENT SYSTEM � - 4A Town or Village c zagt2l / 4 & Owner /Applicant Name—e,7-42 Tax Map PV. 16 Block / Lot 31F Formerly Mailing Address /a 9C7 hl:1 ,5e",2 //d, Subdivision Name �rl�rCSq Subd. /Lot # 16Aawn A, 2% !Z Zip o Date Construction Permit Issued by PCHD /G d� Separate Sewerage System built by o yyw ee Address a.$" e Consisting of Gallon Septic Tank and 7a � • e' Other Requirements: Water Supply: Public Supply From. Address or: ?"I Private Supply Drilled by IV �i� ���s�n Address �N �� a/oe)Jl"�Y A� Building 'hype f zWd? Has erosion control been completed? y Number of Bedrooms Has garbage grinder been installed? A10 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 v ' d PCHD Construction Permit and approved plans and the standards, rules and regulations of the P a artment of Health. j �; Date: esig Address License # Any pers occupying premises se ed by the above system sha1F romptly 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: Zi�& Title: Aat!E Date: e copy tHD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 MAY -27 -2004 12:0t9. FROM:PL•TNAM COUITY DEPART 845 - 278 - 792221 r . TO:919149624248*51 P :1 /1 _ .BRUCE" & FOLBX - - ".:.: 1�RF�TI'�•.�MQ�1T+lA1a1! R. :S:N. . Pu lfc ifeafth YYtipeioi " o Aisodate Public Health Dimethr Director of Patient Servrees DEPAt,'fNMNT OF MALTH 1' Geneva Road. Brewster; New Yoik, low. tnvlraptarntal Health (914) 278.6130 Tax (914) 279.7921. ' Nursing Servlcts (914) 278 - 6558 'WIC (914) 278.6678 . Fax (914) 278.6089 F.ariy Intervention (9 14) 278.ON FresehaM (914) 2784082 Fax (914) 278 - 6648 OWNERS NAME: TAX MABXYJMF -R,: E911 ADDRESS: TOWN: AIJ TEEO)? YED TOWN OF (Signature) DATE.: M The �utiaa, County Department of Health will not issue a Certificate of Construction Co�nipli,ance leas •the above foxni fs 'co�uplete , i.e., a lega E� 9' 1 . ' address Is assigned b� an authorize -d town official. Thus form is to.be submitted ivvith the appii6flo a f6r a Certifichte of Co " tiiaction Complia se. ; . (6911i1MFRIA) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT . NT: Yxact'location of welrwith distances to at least two perm ent latidmarks to be provided on i separate sheet/plan. tY,: r� / J n� Well Driller's Name Address: /J' Signature: /,,J Date: //1 /jam / U V White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 S .. etAddr s :.T�,a�/"J'il d Map fF Block Lot(s) Well Owner: . � �.- Address: Use of Well: 1- primary 2- secondary Residential ublic Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable, percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length Length below grade / rPt. Diameter in. Weight per foot Zd, lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: <Cement grout _ Bentonite Other Drive shoe: K Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield D gpm Depth Data Measure from land surface-static-(specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve. analyses '_.. are available, please attach. attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land. Surface 3 ...... - _.... ,.._ .:..........._. _.. ,.. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypV% o7 / 3Capacity _ o Depth ' 9-9D Modellby Voltage �--3 HP T Tank Typpa a1,,Kd Volume/, Date W I Completed Putnam County Certification No. Date of Report o `t jDriller (signature li NT: Yxact'location of welrwith distances to at least two perm ent latidmarks to be provided on i separate sheet/plan. tY,: r� / J n� Well Driller's Name Address: /J' Signature: /,,J Date: //1 /jam / U V White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUT91 Y DEPARTMENT OF HEALTH ., '_..,,R.,. - -. ....,..<,...... ... .. ,.-, ., ••.D�ui�LVr �wit••:�T`�.�L��1'r�i'll�i' i lair =�ETiryVI'''T:' �.. .. - .... .-.... - •._.' ... .,... ..,. Owner or Purchaser of Building Section Block Lot &,�� Z ;, / ,-Q Building Constructed by V/ Locati - .Street /� Z!k� Zd Municipality Building Type Subdivision Name Subdivision Lot # GUARANPI'EE OF SUBSURFACE SEVMGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of. the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a.period -of two years immediately following. the date of_.approval,of the. °iCertificate° ot� Cdristruct ori�'Cbftipliaric(°" for' th6 sewage disji i' systan;- or-- ariy_.,.. repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent. act of the occupant of the building utilizing the system. Dated this day of CC Signatur e Title Generai Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Co J2 Fa l/ b"/,V ti� . Address YML ENVlRONMENTALSERVlCES '321� Kear Street Yorktown Heights, ht 0 �' Albert H. Padovani, Director i-AB #: 32.406964 CLIENT l4: 12591 NQNSTAT PROC PAGE: .1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MJD CONTRACTING CORP. 1992 COMMERCE STREET YORKTOWN, NY 10598 SAMPLING SITE: 252 BARGER ST : PUTNAM VALLEY NY COL/D BY: BEN LOZZI NOTES...: KlTCHENTAP ^ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE' FLAG 1--'ROCED(.JF*kE DATE/T]ME TAKEN:09/24/04 o3:00P DATE/TIME REC'.D: 09/24/04 04:20P REPORT DATE: 10/01/04 PHONE: (9l4)-245-0f,3 .80 SAMPLE TYPE. .: POTABLE ` PRESERVATlVES� NONE . TEMPER/TURE`.: < 41.1 ` COLlFORM METH� MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE ° 09/24/04 Ill" T. COLIFORM ABSENT /l00 ML ABSENT 100B 09/24/O4 LEAD (IMS) <1 ppb 0-15 pph 9l0J. 09/24/04 NITRATE NITROG 1U.(;) MLj/L 0 - }V 9z3Y 09/24/O4 NITRITE NITROG <0.01 MG /L N/A 9146 09/24/04 IRON (Fe) 1.04 MG/L 0-0.3 mg/l 2037 09/24/04 MANGANESE (Mn) 0.048 MG /L 0-O.3 mg/j. 2037 09/24/04 SODIUM (Na) 75.9 MG /L N/A 4 H 7 4 UNITS 6.'5---8.5 9 09/24/0 p , 043 09/24/04 HARDNESS, TOTAL 160 1113 /L N/A 09/24/04 ALKALINITY (AS 106 MG /L N/A 09/24/04 TURBIDITY (TUR 4..8' 1\11 COMMENTS: BACT THESE RESULTS lN OT> OF A SATISFACTORY SNITARY oL�LITY ACCORDI NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS ' TESTED, AT THE TIME OF COLLECTION. | Pb /CU LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and at treatment must be potential. �blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points hZlve a LEAD value of more COPPER ' value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are-present, their total value combined shall not exceed 0.5 mg/L. Na Nu limits for Sodium that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state s-ilium restricted diet,the water should 20 mg/L. of Sodium. For those on a diet, a maximum of 27() mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street y | Albert H Padovani Director LAB #: 32.406964 CLIENT #: 12591 NON STAT |ROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MJD CONTRACTING CORP. 1992 COMMERCE STREET YORKTOWN, NY 10598 SAMPLING SITE: 252 BARGER ST : PUTNAM VALLEY-NY � COL'D BY: BEN LUZZl NOTES...: KITCHEN TAP - ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 09/24/04 03:00P DATE/TIME REC'D: 09/24/04 04:20P REPORT DATE: l0/01/04 PHONE: (914)-245-0880 SAMPLE TYFE..Y POTABLE PRESERVATIVES: NONE NEMPERATURE..: < 4C COLlFORM METH: MA ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER VANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF'pH,IS 6.5 TO G.& Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THQCALClUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM O TOHUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L ` DERATEL HARD ' TER: 70-140'MG/L MG/L = MILLI GRAM PER {-lTER 0 SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 El YML ENVIRONMENTAL SERVICES 321 Kear Street Albert Fl. Paclovani, Director LAB #� 32.407511 CLIENT #.-.12591 NON STAT PROC PAGE: 1 '~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN 10/18/O4 11 45A M3� CONTRACTING CORP. : : 1992 COMMERCE GTRBE. DATE/TIME REC'D: 10/18/04 01:50P -YORKTOWN NY 10598 --- REPORT DATE: � 1O/20/04 ' ' P ` : (914)-245-0880 SAMPLING SITE: 252 BARGER ST SAMPLE TYPE..: POTABLE : PUTNAM VALLEY - PRESERVATIVES: NONE COL/D BY: BEN CO ZI TEMPERATURE..: < 4C' ' NOTES.-. . -' KITCHEN I T AP COLIFORM METH.- 11,11, JDATE FLAG.PROCEDURE RESULT NORMAL - RANGE METHOD .- COMMENTS: Fe/MnIf both iron and manganese are present, _ _ combime �---_~_----__--°_- SUBMITTED BY: their total value m ' YML ENVIRONMENTAL SERVICES 321 Kear Street yorktuwn Hei q^ - h N.Y.'10598 -:'`�����~`-�'�'�"��,���~+~�^�-'''' | Albert H. Padnvani, Director ` MJD�CONTRACTING CORP. DATE/TIME TAKEN: 10/06/04 11:00A 1992 COMMERCE STREET DATE/TIME REC'D: 10/06/04 01:25P YORKTOWN, NY 10598 REPORT DATE: 10/14/04 PHONE: (914)-245-0880 SAMPLING SITE: 252 BARGER ST SAMPLE TYPE..: POTA8LE : PUTNAM VALLEY NY PRESERVATIVES: NONE COL'D BY: BEN COZZl TEMPERATURE.,: < 4C NOTES ... : KITCHEN TAP COLIFORM METH: MF ' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL _ RANGE METHOD 10/06/04 � � IRON (Fe) 0.691 MG/L 0-0.3 mg/1 2037 10/06/04 NITRATE NITROG 2.85 MG/L 0 - 10 9139 COMMENTS: Fe/Mn If both iron and a t t m nganese are present, their e r t l value o a combihed shall not exceed 0.5 mg/L. ` SUBMITTED BY: Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7 311*11 Inspected by 5 P - Street Location A4 --j-D own _V 4e44 P6rMit-# ',0 V-iS-03 5,W -a3-P3 TM # Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ............ * ................. b. Fill section - date of placement. 3:1 barrier Lgth. Width .'Avg.Ppth c. Natural soil not stripped ............................. . ...... I ............ a. Stone, brush, etc., greater than 15' from STS area ............ e. 100' from water course/wetlands ............. ....... It Sewage System a. Septic tank size - 1,000 .......... 1,250.J... ... other ................ b. * S eptic'tank installed level ................................................. c. 10' minimum from foundation.. ..... I ........ d. Distribution Box 4:44'44ki"d VWA7 PL,-4 1. All outlets at same elevation -water tested ................... 1. 2. Protected below frost ............. ........ . . -4 ........................... .3. .. Minimum 2 ft.Original soil between box & trenche e, Junction Box properly set ................................. N 0 6. trenches 1. Length required 6.1p 60 Length instaU &70 *ed — 2. Distance to watercourse measured Ft.. : �? 3. Installed according to plan .................... .................. 4., Slope of trench acceptable 1/16 - 1/32"/f`o.ot 5. 10 ft. from property he -.20 ft.- foundations.......... U 6.. Depth of trench <30 inches from surEce .................... 7. Room allowed for expansion, 100 %...' ...:.... ...... 8. Size of gravel 3/4 - 11/2" diameter clean ............. 11 ....... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................................................ g_.*Purnv. o. -Dosed capped 1. Size of pump chamber .................... 2. Overflow tank ........................ ......... 3. Alarm, visual/audio ....................................................... 4. Pump easily accessible, manhole to grade .................. 5. First box baffled ...................................................... 6. Cycle witnessed by H.D.estimated flow/cycle ........... Ell. House/Building a* House located per approved plans ................................... b.. Number of bedrooms ................................................ .. IV. Well Well loc - ated as per approved plans ........ * ......................... b.., Distance from STS area measured ft............ c. Casing. 18" above grade ................................................ d '' Surface drainage around wellacceptable ...:....... ............. V. Overall Workmanship . 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 i6 plan.. f. Curtain drain outfall -protected & dinto exist watercourse' g. Footing drains discharge away from 'STS area ............... h. Surface water protection adequate..'.'.. . ............................. i. Erosion control ovided ...................... *..., .......................... Rev. F2r/02 XrIMO . XT^ . e4 r%%: X-% A-"'%Trr111 R6^NWL&WA mm. IM-17 PON MMR A' Or, r7AXWERW 09/23/2004. 11:31 9149624248 JOSEPH SULLIVAN PAGE 01 jE. BY THIS CERT!FI£'ATE,. C)F . br)Mt- LI.A NEW YORK BOARD OF FIRE UNDERWRITERS jBUREAU OF ELECTRICITY 40 (FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon.,the application..of. BRENISH, GEORGE 23 TINKER HILL ROAD PUTNAM VALLEY, NY. 10579 -1537, upon premises owned by BEN COZZI 1290 WILSON ROAD YORKTOWN, NY 10598 Located at 252 BARGER STREET PUTNAM VALLEY, NY 10579 Application Number: 2012542 Certificate Number: 2012542 Section: 74.1 block: 1 Lot: 38 Building Permit:836.04 BDC: W106 Described as a Residential 3000 -4000 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below; located in /on the premises at: basement, First Floor, Second Floor, Attached Garage, Outside, j A - visual inspection of the premises electrical system, limited to electrical devises and wiring to the extent detailed Herein, was conducted in accordance with the , requirements of the applicable code and /or standard M promulgated by the State of New York, Department of State Code Enforcement and Administration, or other _ a authority having jurisdiction, and found to be in compliance therewith on the nrh. pay of igr 7004;_..._ Rate _. Ratine Circuit _Seltterr lyge Outlet 174 0 Fixture 39 0 110 Incandescent Receptacle 60 0 1 1 U General Purpose Receptacle 6 0 110 GFCI Receptacle 1 0 110 Laundry 9 Switch 50 0 110 General Purpose Outlet 6 0 TeJephone a Outlet 5 0 CATV Nj Paddle Fan 2 0 110 Receptucle 1 U 110 Appliance a Service I Phase 3 W Service ,Rating 200 Amperes .3 Service Disconnect: 1 200 CEO Meters: I seal 2 ti This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 09/23/2004 .11:31 9149624248 ■ JOSEPH SULLIVAN' PAGE 02 _ ..... . _ BY THIS• CERTIFICATE.:.C7.�.-COMPLIANCE .THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK,. NY 10038 CERTIFIES THAT Upon the application, of _. ,upon premises owned by BRENISH, GEORGE BEN COZZI 23-,TINKER HILL ROAD: 1290 WILSON ROAD PUTNAM VALLEY, N.`': 10579 -1537, YORKTOWN, NY 10598 Located of 252 BARGER STREET PUTNAM. VALLEY. NY 10579 Application Number: 2012542 Certificate Number: 2012542 Section: 74.1 Block: 1 Lot: 38 Building Permit:836 -04 BDC: W106 Described as a Residential 3000 -4000 square fl. occupancy, wherein the premises electrical system consisting of electrical devices end wiring, described below, located ih /on the premises at: Basement, First Floor, Second Floor, Attached Garage, Outside, A visual inspection of, the premises electrical, system, limited; tc eiectr'ical devices and wiring to the extent detailed herein, was conducted in accordance 'with' the requii'empnts of the applicable code and/or standard promulgated by the State of New York, Department Of State Code. Enforcement and Administration, or other -authority.having jurisdiction,- anclJound.to be in cornpliance.ther.ewrth..on the 'nth Ray of September,2004,.._. Nan -. - Miscellaneous SEPTIC PUMP AND ALARM. Alarm and Emergency Equipment Sensor I' 7 0' 110 Smoke Sensor 1 0. 110 Carbon Monoxide Appliances and Accessories Clothes Dryer 1 0 4.5 KW Dish Washer l 0 1:5 . IOW Pump Motor 1 0 Air Conditioner 2 0 42000 BTU. Exhaust Fan 1 0 110 F.H.P. Water Heater 1 0 4.5 , K W Hydro Massage'fub (Therapeutic 1 0 Microwave 1 0 20 Amps Bell Transformer 1 '0 Range -I 0 8 KW Furnace 1 0 Oil seal Wiring and Devices Continued on Now Pose I of 2 '1117 7y-1 This certificate may not A in an" y way and is- validated only by a present of a raised seat at the location indicated. SEP -23 -2004 THU 13:06 TEL:845- 278 -7921 HAME:PUTNAM CnIINTY nFPAPTMFNT nF P P 07/26/2004 .12:34 9149624248. JOSEPH SULLIVAN 1' 00 ,r PAGE 01 i d M Tor. m 1 Wf%=ation mut be tY #Ay •� ' M`eYM'YDtmc" / al* 0.. r.�T1 I YCJ oR. "_ d �i gyOWOw+y* 77- �1 m.r. `ly" ewe." pfr ? ...>::........ 4 WA toc ud u * i ? WO&M Coal* u rep Pbm approved pkw'md ftw �MMd ,.. !',�, tf'. Haft:. ,r PAGE 01 i d M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # .. Located at z !z Town or Village Subdivision name 2 Subd. Lot # -2 Tax Map T4, / Block _ j Lot J ,�F Date Subdivision Approved _ /,/�,,,Z95 Renewal Revision Owner /Applicant Name Date of Previous Approval Mailing Address 1-2 t) IV'� `..S &10 mad o / +Yn Al Zip /01 y57 Amount of Fee Enclosed 3lJD Building Type &,,%',e ne. e.. Lot Area 2, 9 *�No. of Bedrooms of Design Flow GPD X" Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED to consist of Other Requirements: gallon: septic tank and 2 j7 14 To be constructed by to e-l—I Address -!� .el Water Suo"ly: Public Supply From Address _ 4 or: - r- Private Supply Drilled by x'�' V Did O� ^ Ad&ess 23a 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. Signed: a P.E. Address A--'- - R.A. Date 111.2 a, License # Z Y F3 - i APPROVED FOR CONSTRUCTION: This approval expires .. to ears from the date issued unless construction of the sewage treatment system has been completed and inspected by the P HD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Approved r discharge of domestic sanitary saage onl y. By: ` Title: Date: White copy - HD F' e; Yell copy - Building Inspector; Pink copy - er; Or n e copy - Design Professional Form CP -97 LORETTA MOLINARI R.N.; M.S.N. Public Health Director DEPARTMENT ®F. 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 October 9, 2003 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: V / ROBERT J. BONDI County Executive Waiver Determination — N'I J D Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -38, R.S. Lot # 2 The Putnam County Health Department reviewed the waiver request for the above regarded project on 10/8/03. The following determination has been made: X. The Waiver request was approved.. 7.1 ❑ - "The VvaiwTre'quesrwas c-onditi -rially approved;'However; the revisibri0g) noted beiow must be completed prior to the issuance of a permit. • The Waiver request was denied. An explanation,has been noted below. • The Waiver request was not voted on. Explanation noted below. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, seph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj -W YORK STATE DEPARTMENT OF HEALTH :;o "�f:l�f I Lam f�i z3�::`t:r 141.ot Gammagit�! ���?.ltti� r P C I `' i_ an.a id =roc�i . ro .not cn; f ron: Flequin�.mentd of l?ah 75.��nc! �;,;ajW Fr;cil r, r'!i ., -r; ' It .•�,: for Individual Household Sewtcrp�; fa1RB� LCII! '116:'l.Uk!C11i16;,`,5.IT9MIME S:�i l'd!lslBS lame of Applicant kdd ress 'Dite'Location • / p� ./ ru 1 1. Reason why sit.a does• not meet I ONYCFIR Appendix.75 -A (check appropriate box(es)): Separation distance cannot be achieved. CAW3iV® slope. %. High groundwater: Inadequate depth to bedrock or impermeable layer. Soil unsultable. Other(explain) ...... ......................... .. ................. I ,... .........I..................... ,.......,.........,... ............................... - - -.... 3� l ................................ ..................................................... . ................................ . ...................... .,........................... .....,.......... ..._....... .. - ............ .. ... ................................................. .................................... :...................................................................................................... .............. ..... ............................... .......... Proposed design or conditions of waiver: ,f' r �s.,.... �1' 1Frn....< ...'.�........?.....1. °........ LAY %`....? .................... . . ........ ..............................� .... .. .................... ......................... ............................................... ....,......... .............. ............................... 3. The proposed design may have the following limitations (check appropriate box(es)),. { increased risk of weil. or spring contamination. M Increased risk of surface water contamination,• Expected design Ilfe of the system will be diminished. Operation of sewage system Is subject to mechanical problems. Other (explain) .............. ................., :. ..........r .............. ....... ................... ....................................................................... ......................... 3.. i Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or sWronmert4r New York State Department of Health Acminlstrative Rules and Regulations, Part 75.6 (b), a waive., ;;s he cloy maybe revoked by Ike issuing:cffloial for a change in conditions for which this waiver wens granted. IN ittfN ... ............................... ORIGNAL - Lac:zl HuH' fir 0 3....... C©PY - ^ A ....PART 11.- IMPACT ASSES.SMENT.CT ©.be com le+ed;b,v. VI DOES ACTION EXCEED ANY TYPE -1 THRESHOLD IN 6 NYCRR, PART 617 'S c,J —a 3 -a3 .4? If yes, coordinate the review process and use the FULL EAF• Yes o . B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN-6 NYCRR, PART 617.6? • If No, a negative declaration may be upe.rseded by another involved agency. Yes 1 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.pattern, solid waste'.production or disposal.- potential for erosion, drainage or flooding problems? Explain briefly: Dom_ C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or comnWhity or neighborhood character? Explain briefly:' - 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 briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed 'ettiorr? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: V ` C7. Other impacts (including changes in use of either quantity or type of energy? .Explain briefly • ' ' D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? If es; ex lain briery aYes No ERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex 'lain: E. IS THERE, OeNo. El Yes 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 (i.e. urban or rural); (b) probability of occurring: (c) duratioh; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explahatiohs contain sufficient detail to show that all relevant adverse impacts have been identified,and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impactof the proposed action on the environmental characteristics of theCEA. Check this box if you have Identified one or more potentially large or signi)cant adverse it ipac(s which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. &,-16heck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide; on attachments as necessary, the reasons supporting thi determination. Nnr co Name Of Lead Agency Date i see Print or ype Name of Resd t corlh Lebt[Ad641icy — Title of Responsible Offi r —7 f' PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM .. _ .. ..:.- • : ':.for UNLISTEfk ACTIONS C1rlya� ..:." .,;; .r,. •. °,:: � .:..::.. ^ ... . PARt -P OJECT INFORMATION __ -- be completed by Applicant or Project Sponsor) /r�T 1. APPLICANT / SPPO;NSORR ' 2. PROJECT NAME 3.PROJECT LOCATION: /104 / isf/�fj Municipality County yy7 4.-PRECISE LOCATION: Street ' Addess an Road Intersections. P °minent landmarks✓ etc y- or provide m6,-.1 ` 1`,:SO o � o � �/'J �/� �G%�io /J d / �i� �iJT / D .✓l � � � • • . T 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: el, 7. AMOUNT OF LAND AFFECT D: =' , Initially 4169 acres Ultimately acres 8. WILL 4ROPOSED ACTIOd COMPLY WITH EXISTIN6 ZONING OR OTHER RESTRICZIOt`l8 ?. XYes • a No If no, describe briefly:. 9. WHAT IS PRESENT LAND USE IN VICINITY OF. PROJECT? .(Choose as many.•as apply.) Residential Industrial a Commercial []Agriculture a Park / Forest / Open Space Q Other (describe) .. . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY .OTHER .GOVERNMENTAL AGENCY. (Federal,.. State or Local) Yes No If yes, list agency name and permit I approval: ,Gd��`�!•.(��! �• "���% "d ��� `,f 11. DOES ANY ASPECT OF THE ACTION HAVE 'A CURRENTLY. VALID .PERMIT OR „APRRO L?....... Yes No -If yes, list agency name and permit / approval: 12. AS A ME ULT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? []Yes No I. CERTIFY THAT THE, INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Name Date: Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before•proceeding with this assessment J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location: Street Address:: Town/Village Tax Grid # �r-0' 11-1127 Ae- g pT Map .V / Block Lot(s) Z Well Owner: Name: Al; p e!O14 Address: 141,-/ a � A'y . Use of Well: l/kesidential 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 Z± & al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling eNew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ✓' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No v Is well located in a realty subdivision? ...................................... ............................... Yes "" No Name of subdivision e'rrJ 0 Lot No. 2 Water Well Contractor: M Address: �� dr �� f''✓� Is Public Water Supply available to site? .................................: ............................... Yes No t-- Name of Public Water Supply: — Town/Village Distance to property from nearest water main:''i.'��_ 5 Proposed well location & sources of contamination to be provided on separate sheet/plan. Date:. Applicant. Signature:..___.y% 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. Date of Issue 'o Date of Expiration Permit is Non - Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; copy - Well driller Form WP -97 LORETTA MOIII�AT -R.N:, N1V: T`': Public Health Director DEPARTMENT OF HEALTH i 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845).278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 4, 2003 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: County Executive Re: Waiver Determination — MJD Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -38, R.S.Lot # 2 The Putnam County Health Department reviewed the waiver request for the above regarded project on September 3, 2003. The following determination has been made: O The Waiver request was approved ❑ The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. % The Waiver request was not voted on. Explanation noted below. The following comments need to be addressed: 1. Any house downslope and.in direct line of drainage of an SSTS needs to be a minimum of 50 feet away. 2. Trench lengths should be shortened and length added downhill towards the house to obtain 1:3 side slopes. 3. A two (2) foot clay barrier needs to be provided between the house foundation and the system. This barrier is in addition to the two (2) foot clay barrier being provided for the septic fill. Please be advised that once comments are addressed, the project must return to a future waiver meeting. ' If'ther'e ate any gtiestioris regarding this natter,' p'lea'se cdfitact me - -at (84.5) 278 -b i 30, ext: 2157. "I JSP:cj Very truly yours, Joseph S. Paravati, Jr..... Assistant Public Health Engineer C it iii � ... ._. I _ "03 r -A4 TD _� h_ 6,P/r S7 J C /` dii� -vim VG .j 713 �I �Ii �'�'✓!w CDrn �y, /eSJ cyi� S Si �cft PLASTIC PIPE: MINIM GPM OPH• a s ,ed, 3A IN Ft. Lbs. Ft. Lbs. Ft. Lbs. Ft. Lbs. Ft. - _ Us, �Ft. � _- Lbo. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 2 120 . 15.13 6.58 4.83 2.10 1.21 526 .38. .164 .111 _ .. F1`L.... 3 180 31-.97 13.9 9.96 4.33 2.51 1.09 .77 .336 _ .2'1- .._.... _ .0110 10 043 4 240 54.97 23.9 17.07 7.42 4.21 1.83 1.30 .665 AS _..150 .16 1.___W .071 5 300 84.41 36.7 25:76 11.2 6.33 2.75 1.92 .635 .5.1 ------- _ .223 , .24 .104 6 360 36.34 15.8 8.83 3.84 2.69 1.11 .7.1 + _ .309 j .33 .145 8 480 63.71 .. 27.7 15.18. 6.60 4.56 1.99 1 1.19 r .5 -!, 8 .";5 .241 10 600 97.5 '' 42.4 25.98 11.27. 6.88 :. 2.:� 1. "111.. ... J74 _ .83 .._ _ -.361 15 900 49.68 21.6 14.63 6.36 3.75 1.6 � 1.74 .._ .755 20 1,200 86.94 31.8 25.07 10.9' 6.39 2.78 _- .7.9.4 1.28 25 1,500 38.41 16.7 9.7I� ..i!2 4.44 i 1.93 30 1,800 ---- 13.62 5.922 13.213 • 2.72• 35 2,100 '18.1;' <<' Villa - l3. 17•�,64 40 2,400 2;700. .23.5.1. 29.4412.80 •� 10..24.... ,- 10.701 - 4.65... -13.48 ; 5.85 50 3,000 6.45 Iw 7:15 60 3,600 - J 23.48 90.21 1 2 0, . �M a s ,ed, 1 2 0, . �t OF NEW �t LORETTA MOL'INARI R.N.; M.S.N. Acting Public Health Director Director of Patient Services August 7, 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 Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: Proposed SSTS — MJD Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -38, R. S. Lot # 2 ROBERT J. ~ BONDI County Executive 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. 6- ✓I0. C"d Actual perc test results should be included on the plan along with the design perc being used. All lateral lengths should be 67 feet. Provide curtain drain discharge elevation. Add the words `dust free' to absorption trench detail for stone /gravel label. .Add .erosion control. just downgrade of the :SSTs construction area.. Provide sedond-diinensiori fo property line for well location. Elevation chart for pump design needs to be corrected. Pump tank detail should read 1250 gallons. It appears storage will not be adequate when corrected elevations are made. The length and elevation values being used in the head and friction loss calculations appear to be in error. Proposed SSTS is being shown on slopes approximately 18 %. Current code requires a slope of 15% or less. Therefore, the application is denied: However, a waiver request can be made. Please be advised that all comments above need to be addressed before any waiver request is discussed. 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. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj Acting 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 /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 August 7, 2003 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Proposed SSTS — MJD Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -38, R. S. Lot # 2 Dear Mr. Sullivan: ROBERT J. BONDI County Executive 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. 1. Actual perc test results should be included on the plan along with the design perc being used. 2. All lateral lengths should be 67 feet. 3. Provide curtain drain discharge elevation. 4. Add the words `dust free' to absorption trench detail for stone /gravel label. :.5 . -Add erosion control just downgrade of the SSTS construction area.- - 6: Provide second dimension to property line for well location. 7. Elevation chart for pump design needs to be corrected. 8. Pump tank detail should read 1250 gallons. 9. It appears storage will not be adequate when corrected elevations are made. 10. The length and elevation values being used in the head and friction loss calculations appear to be in error. 11. Proposed SSTS is being shown on slopes approximately 18 %. Current code requires a slope of 15% or less. Therefore, the application is denied. However, a waiver request can be made. Please be advised that all comments above need to be addressed before any waiver request is discussed. 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. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM* COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SVTEKS..,' : . . .:........ . , .. . ` _--- :�. <---- •�.:;^,::. , .. , ., . ;.:.- ,. -: REVIEW, SHETTFOR °CtDh`STi2iTCTIONTERIV�I"lr y NAME OF OWNER: // `c� Co.� i�'�`� STREET LOCATION: _ l�`c r-yr./ S '� '4 L 3 REVIEWED BY: M GR, SRDATE: D ' MAP #: (CONFIRIviED) Y /N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'DI ( ✓,y.JPERMIT APPLICATION (tom (OUSE SEWER - V411 FT. 4 "0'; TYPE PIPE. CAST IRON (✓� WELL PERMIT OR PWS LETTER (__)UNO BENDS; MAX BENDS 45' W /CLEANOUT (,/�PC -97 - EFtFALS Aillt- TIER OF AUTHORIZATION (�r �(��j.S�EN E (NO CHANGE) (✓J(JPE5IGN DATA SHEET (DDS) FII.L SYSTEMS C ✓CORPORATE RESOLUTION (__)( _)10' HORIZONTAL; PAST TREK :1 TO GRADE SHORT EAF : (___ CLJFIILL SPECS/ 1 -5 (��PLANS -THREE SETS ((� ILE & DIMENSIONS ' �(___)9OUSE PLANS - TWO SETS (� ILL IN EXPANSION AREA ((�_��VVARIANCE REQUEST FILL GREATER TH"LAEET SUBDIVISION 'UU CLAY BARRIER LEGAL SUBDIVISION U(�FmL'CERTmC NOTE CHECKED (�UDEPTH GES ((�PERC RATE �t// FILL REQUIRED 3 . S DEPTH (-- )�-- -) • ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS 5 i S SEPARATION DISTANCE FROMTOE OF SLOPE �(�CURTAIN DRAIN REQUIRED s� e.0 w�'� TRENCH GENERAL �,o�e��; ��`"� TRENCH PROVIDED —-7 60FT MAX. (� ZCATED.IN NYC WATERSHED arP�' 'ih r. U ARALLEL TO CONTOURS -7-647 (_ PLANS SUBMITTED TO DEP C o �`" 100% EXP ROVIDED ELEGATED TO PCHD DETA ST CRUSHED'STONE OR WASHED GRAVEL (�(�DEP APPROVAL, IF REQ'D (�GEOTE COVER ��� DEEP TEST' HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM'SSTS (�(___) ERCS TO BE WITNESSED 10 TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__) O' TO FOU t Z NDATION WALLS WEWETLANDS ('TOWNIDEC PERMIT REQ'D ?) (ILL )100' TO WELL, 200' IN DLOD,150' TQ PITS D TA ON DDS PLANS &PERMIT SAME (� —' 100' TO STREAM, WATERCOURSE, LANK(inc. ezpan) , (� E 19 69 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, -35': STORMDRA�t; PIPES BVATER ' y' TTER BI/ZBA - _ ._.. _ . __ . .,....., 1®'-TO WATEWL3NE- (pits' - 20') UU`0 -MFR. FLOOD ELEVATION W/Y 2U050' iNTERNIITTENT DRAINAGE COURSE OIL TESTING LOTS>10 YEARS OLD 00'i500' RESERy0Ii2, ETC. ' 150' GALLEY SYSTEMS REQUIRED - DETAILS ON PLAINS ; Ci,O� L• -L�) SEWAGE SYSTEM PLAN -(NORTH ARROW) (- -�( --)1 MIN TO LEDGE QUPTIC J JIJ S HYDRAULIC PROFILE / SEPTIC TANK (�RAVTTY FLOW UU10' FROM FOUNDATION; 50' TO WELL CONSTRUCTION NOTES 1 -15 ,� r :, ,-- ��.��y1,f �(It+�•c s•'a� -� TO PROPERTY LINES (Z.(_)DESIGN DATA: PERC &DEEP RESULTS i • 1� F'SERVICE CONNECTION ss// V CONTOURS EXISTING & PROPOSED —7" U— MM 15' TO PROPERTY LINE (,DRIVEWAY & SLOPES, CUT SLOPE FOOTING/GUITER/CURTAIN DRAINS U ?USDA SOII. TYPE BOUNDARIES UUSLOPE IN SSTS AREA ��20 %) (}(__)TITLE BLOCK; OWNERS NAME ADDRESS (�(—J( TO 15 %, Ili' REQUIRED TM# PE/RA• NAME ADDRESS PHONE# / DOSE/PUMP SYSTEMS ( �/ DATE OF DRAWING/REVISION (�7►�DATUM REFERENCE . (,_}ULOCATION OF WATERCOURSES, PONDS LAICES,WEIZANDS WITHIN 200' OF P.L. ( (__)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ��---�WELLS & SSDS'S W/W 200' OF SSTS �1 ROPERTY METES & BOUNDS ' - �EROSION CONTROL FOXHOUSE, WELL & SSTS, EROSION CONTROL NOTE OP NOTES . E 75% OF PIPE VOLUMEMOSE VOLUME NOTED AIL FOR FORCKMAIN, (PIPE TYPE, ETC.) MD-BOX SHOWN & DETAILED Y UUSTANDPIPES, T BOTH SIDES, DETAIL (_JC—JIT MIN to CDS=>S %, 20'4%, 15'-3%,35'-l6/6, 100%-<l% (___ L--)20' MIN to CD DISCHARGE/100' with 182 cons day discharge (__,_)(,_)10' MIN to NON - PERFORATED PIPE 64 Ow riii LfvG� f. r- Sv 511. Qf/Y�•/� 1/7„ -�, (r r 3 ,f .2 j � iw t• loo d EVSHM)09 /oVoo PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION, OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION "�'i' w a"", Located at /_5a.1,4 ,K�of� -e/,/-/— T/V Tax Map # Block �_ Lot Subdivision of Subdivision Lot # �- Gentlemen: This letter is to authorize Filed Map # 2G40 Date Filed 3�Wq� a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in eonformity.with :the provisions.of.Article 145 and/.or.147 of the Education- Law,`the Pub.-lip Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # Z y�ss� Mailing Address State Zip Telephone: Very truly yours, Signed: (Owner of Property) Mailing Address: /�?d State Zip /off ✓�� Telephone: Form LA -97° PUTNAM COUNTY -DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A� Y LOCI- ►iON °FOi Ali PicO"v"A; OF Pi;A1�1S E0 :,:::.....:....:.:..:: A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: ..17 2. Name of project: 3. Location TN: /o-l�v& 4. Design Professional: 5 6. Drainage Basin: e/ 7. TvDe.of .Pro ect: I/Ifrivate/Residential Apartments Office Building Address:,,5j yL y Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify). 8. Is this project subject to State Environmental Quality Review (SEQR)? �t/o Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Dra$ Environmental Impact Statement (DEIS) required ?. ......................... A41 10. Has DEISbeen completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. " Is this _roiect in an area under.the control pf h cal_:planning;�cc��tng;:nr-o6er officials, ordinances? ..:...:.................................................. ............................... ilt;4- 13. If so, have plans been submitted to such authorities? 14. Has preliminary approval been granted by such authorities Date granted: 15. Type of Sewage Treatment-System Discharge ................. surface water v--'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? ....... ............................... .y'a 19. If yes, name of water supply — Distance to water supply /` 20. Is project site near a public sewage collection or treatment system? ................ 4/ 21. Name of sewage system Distance to sewage system /y/ W:_4 22. Date test holes observed 3 23. Name.of Health InspectorXr /o %17 VIP 11' 24. Project design flow (gallons per day) ................................. ............................... 00 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.:. 41 y 26. Has SPDES Application been submitted to local DEC office? ......................... — Form PC -97 . 2 27. Is any portion of this project located within a designated Town or State wetland? A10 28. Wetlands ID Number ......................... ................................ . ............ ................... � Y Is- 'ctlands Permit _i64 66 ...: .... ............... ..... ............................... 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? ............................ Yes/No Alla 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any Al J other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or i/illage? ......................... A/O 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 'o 35. Are any sewage treatment areas in excess of 1'5% slope? . ...................... .......... Ale 36. Tax Map ID Number .......................... .........................:..... Map ?L Block_ Lot . 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE:.All applications for review and approval of a new SSTS'to be located waiY� the 'YC atershcd shall D- epa�s,�e11i, -and need nbt be serf 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 Class A misdemeanor pursuant to Section 210.45 of the Renal Law. SIGNATURES & OF'F'ICL4L TITLES: A Ya s Nnr, co Mailing Address t - 1115 � l -I 11 ]i 1.s:1. Nno r d lfld, , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner . P717 45te 17-4 G Address /Vy Located at (Street) 1-30 r Tax Map 7././ Block Lot (indicate nearest cross street) Municipality )16'11eu Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking __'1311 v3 Date of Percolation Test e-3 .2 .3 4 .5 2 3 4 5 1 2 3 ........< . ..... ........... ....... .. tart tu QW .4 -3,6 ado d _3el 3 e) JZ 52— NOTES:`1 I 'T esu to b6 repeated at. same depth until approximately equal percolation rates are obtained at each ion test hole. (i.e. s I min for 1-30 min/inch, s 2-min for 31-60 min/inch) All data to be -,,A4#oifted f6i,review. 2. _Opth"inpkguirements to be made from top of hole. Form DD-97 TEST PIT DATA IDESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES 2 �. <r - P . _, :I�IE�' "�'�. -, r - . -• :< Y- iCDf;E�I�(�:- - v- _ � :�: . �, .. :H(�LE'ri0::..:_ - ...�:. s.... ; -�I-i'c�1✓1✓�I�T�: �_ . _ .. :. ., - . ,... . G.L. o �,: .1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7:5'- 8.01. 8.5' .. .wt 9.S'`. -. ...n -._.. _. .. `.v6 .r... r... .r.� �w� ...._.ub...— .+.....ate. .wt .P..a r. ...w ... .. ..... .. .. .. .. s -_- r... ....� ��.. •..�ww 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date o Design Professional Name: �5 h u (1 1` v Address: 9 7 Z r r n 6 v e� r✓ e -v I� u, , Signature: Design Professional's Seal �oF 40 /- rlz� 'PUT - NAM. COUNTY DEPARTMENT OF HEALTH -DIVISION OF ENVIRONMENTAL HEALTH SERVICE'S' JNIT A ; I IV I,LA:> /CO IERCIAL SATE �iiy PEA IOI�° 'I`l li%t SECTION A. GENERAL INFORMATION L10, 1� . Name of .Project . (T)(V) County. Site Location Building construction :begun Extent Is property within NYC Watershed ? ........:::.: `:. Yes No SECTION.B. TOPOGRAPHY (Please check all appropriate boxes) 1. 0 Billy. _-.0 Rolling E Steep slope Gentle slope 0 Flat 2. Evidence .of wetlands Low: area subject to flooding Bodies of water ' a Drainage ditches Rock,qutcrops-',, _ 3.. Pro a lines or. corners. evident .::....:.............. ;.............................. Yes' Na 4. Do water courses exist on or adjoin the property? ...........:....:.......:..: Yes dNo.. 5. Will these affect the. design of the sewage system facilities ?............ es No 6. Do watershed regulations apply in this development ? .................. ...... 0 Yes No 7 Will extensive grading be necessary? ................. . ........................... ... a Yes_ No.� 8. Will extensive fill be necessary. for SSt S? ......... ......... ....................:.. Yes. :,No' - �:o When- areas`exisf within the SSTS area? ................... ..... ........ 0- Yes �a No < If yes, what is the condition of the fill? ' SECTION C. SOIL OBSERVATIONS ' 10. Appearance of goi : d Gravel Loam . Clay *.. - ` Hardpan Mixture 11. Observed from: Q Borings 71 Bank cut Z70ackhoe excavations. 12. Soil borings/excavations observed by �7�P- B e-4 joa z% °fw on a;3 a3 13. Depth to groundwater o4es44.)�► 4� V3s on 14. Depth to mottling on -• 15. Are test•holes representative of primary .& reserve areas ..... ...........................:... Yes Q No i. 16. Soil percolation tests made b on 17. Soil percolation-te'sts witnessed by b w.' skvi on SECTION D (on back) Form ST -1 t 2 ���r�YVL{ LJ• ��BYi J.-.11 \LSV� ' .. ' .. r r 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes • No 19. Will groundwater or surface drainage require special consideration? ....::.:.:.....:..:.. 'F-]'-Yes LZINo 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a Yes o -SECT-ION E. REK9. 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ...:.............:............. ............................... Yes Inspection data 22. Do adjacent wells and /or sewage systems exist ? ...................... ....................... No - 23. Additional comments CW 24. Site. observer /jnspector: and title 1p,; cP. f 25. Date(s)- of observation(s)inspection(s) 3 'TEST PIT PROFI[L]ES Hole # .. Lot #. Hole '# . t Lot # . -Hole # Lot #, Depth to water Depth to water r Depth to water. Depth to -Mottling ivy 13pt -to zse±rT,�.g� Depth to mottling . . `Depth to rock/imp. epth to rock/imp. Depth to rockhmp.- G.L.�� ! G.L. - G.L. 0.5 .0.5 0.5 1.0 1.0 '1.0 2.0 t� '" L JAhvV-- (n X10 _ 2.0 3.Or Gw.vt L,"wa'"• 3.0 3.0 4.0 4.0 4.0 5.0 5.0 • 5.0 6.0 6.0 7.0 7.0 8.0 = 8.0 9.0 9.0- 10.0 10.0 10.0 i ^v7 a'' a y1 J,te { K F f. r vc K�, v . �" .. �{ i `!� her *•' n � } i t .r f 3e a F F Lk f� Y t; 1 r c i r a `3 Vi '�• .� x � � f � Y7 .'+e.�y�d r• a ` FL _ � f • f A • ,Ry PL DI `46 H AF AF - -- Vi '�• .� x � � f � Y7 .'+e.�y�d r• a •r rdwy r ' a "' b • t 'F' SY4 y � Fr�,�.•,f ir' r 6 S • � to a :x Yw4s x 4 i tt t� d 7 i h } N', `i i•S Z i F K, \j, q l v tib y v "1 • r, Y• i Tt r s 1� � Z � ) , z G a i}akt �Jcig �G. �4ri; Mui "� r t k r t g4lo ns�" p K.rk pce d ? Yv fa fi r ``sR�is�. r. x ' 6 4 % v l4rtr�r i "k yx. e �c huh f §• y • S y'1. - 3. �-1t �Ff5h �L 4 4 J I�IY ift"iyY .Y�'f r T •14YZ T J t \ NAYM,COUNTY`DEPARTMENT OF HEALTH $ION OFi g✓ / MENTAI-HEALTH SERVICES r f. ry as �3 RO VED AS,N�3TED Fi)R CONFORMANCE WFFH L'I CAB LE RULES AND REGULATIONS OF THE NAM COUNTY,HEALTH DEPARTMENT }�y /Cpj !i/7s �+ ✓sc `jp rr v2 AT E TL Ae� -.,z wv ' t F y U' II` .'+e.�y�d r• a •r rdwy `46 H 1qVI %,wr• h� Y r 6 S • � to a :x Yw4s x 4 i tt t� d 7 i h } N', `i i•S Z i F K, \j, q l v tib y v "1 • r, Y• i Tt r s 1� � Z � ) , z G a i}akt �Jcig �G. �4ri; Mui "� r t k r t g4lo ns�" p K.rk pce d ? Yv fa fi r ``sR�is�. r. x ' 6 4 % v l4rtr�r i "k yx. e �c huh f §• y • S y'1. - 3. �-1t �Ff5h �L 4 4 J I�IY ift"iyY .Y�'f r T •14YZ T J t \ NAYM,COUNTY`DEPARTMENT OF HEALTH $ION OFi g✓ / MENTAI-HEALTH SERVICES r f. ry as �3 RO VED AS,N�3TED Fi)R CONFORMANCE WFFH L'I CAB LE RULES AND REGULATIONS OF THE NAM COUNTY,HEALTH DEPARTMENT }�y /Cpj !i/7s �+ ✓sc `jp rr v2 AT E TL Ae� -.,z wv ' t F y U' II`