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HomeMy WebLinkAbout3614DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -39 BOX 28 111 , e o ° TNAM COUNTY DEPARTMENT OF HEALTH o DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE T TMENT SYSTEM PCHD CONSTRUCTION PERMIT # = W '�°� p�/ /?- G 3� Located e/L Town or Village Owner /Applicant Name Tax Map 7 Block / Lot 3,V Formerly Subdivision Name /�� ,i �j� Mailing Address 12f" J*✓' %N­' 157e e d 0 Subd. Lot # --:? Date Construction Permit Issued by PCHD J,9 / 0 % "_> Separate Sewerage System built by _ D py,oq e r Address Consisting of �� s'� Gallon Septic Tank and 4.1_% Other Requirements: ""o m Water Supply: Public Supply From. Address Zip A or: �� Private Supply Drilled by Address Building Type ��5� � GC Has erosion control been completed?� Number of Bedrooms Has garbage grinder been installed? a I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Cour1goOffas ent of Health. Date: %Zi a '' Certified by Address ;? Z P.E. 1.-4 R.A. # 1 �� j � �► �i' . v • a46 Any perso occup mg premises served by the abovesystem(s) s such action as may be necessary to secure the correction of any unsanitary conditions resulting fro e. 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 revocati , modification or change is necessary. ..F ... .. s S.. ._ .. f.. By: e Title: Date: l© J P copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY D EPARTMEN- OIF1MAL.TH DIVISION OF ENVIIRONMENTAL.' HIEALTH SERVICES WELL COMPLETION REPORT Well ]Location Styeet Address; - : w Ir illa e:. � . ,? Tax Grid # Map Block / Lot(s) � Well Owner: Name: Address: Use of Well: I- primary 2-secondary ->,e (/Residential, Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment K. Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _2L Open hole in bedrock Other Casing Details Total length eft. Length below grade `'' �''ft. Diameter .>n in. Weight per foot )�L7_lb/ft. Materials: �j! Steel Plastic _ Other Joints: _ Welded _x.. Threaded — Other Seal: ,�L Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second .e` Lffl.Yield TiKA.- . _ _ �atied.'....._ r�rlin�js; d'� 'Cbm)5re sea Air - IIDepth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completedfwell in feet TIC 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 I If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type city -5- Depth ;P,- V Model 5S U 7 - Voltage Z-.3 O HP f� Tank Type( !L :mod Volume; Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) NOTE: Ex�t location of well with distances to at least two permanent lanamarKS to De proviaea on a separate sneeup►an. Well Driller's Nat e /'�� Address: _ - _ Signature ate: / Y %G! i White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 i :12:('13 F ROM: PUTNAM COUNTY DEPART 845-278-7921 TO: .-;I S449G24c -.S*51 BRUCE R. L ORETTA MOUISIAM NLN, N. D)2PAR.TWNr OF FiBALTH' I • Geneva Road Brewster;. New Yoik 2Q509, Environtuentmi MOM (14)2784130 Fax (914) 278 - 7921. NurAng Serylea (914) 278.65813 VVIC 014) 2.79. 578 . Fu (91 K) 371, • 6083 Hp.sly Intervention (914) 270.6014 Fret.-Mal (914) 373.6081 Fm (914) 178 - 66419 OWNERS MANX: TAX mik.114.;IUBER: rou Amllci3s.. 6_1�_. 7AA11410A TOWN: 2W AIMICXR� ZED TOWN. OFFICIAL:- ,rt►e. iltit uun Qvunty Department of Health mall not i1s.4"Ve''a cev'Kii'nl.'� of 0 e comp Owl, Lie d a i. a Pik l v f or ii is addressIs u1 sipped by ail aith6iize'd i4n, 04fict's-l" Tlds form►. fiR to-lise,,i,tit)llr.u".�ti-.E'I 0 FI: PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building �/ Building Constructed by Locatti- - Street /P0 �7a) Municipality Building Type 7-1-1 / 3� Section Block, Lot Subdivision Name 3 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for- the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails tc operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made 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 Aev -19- Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if rp.) . Address rev. 9/85 mk YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB & 32.403434 CLIENT & 12591 MJD CONTRACTING CORP. _ /B--�-- 1992 COMMERCE STREET �^ YORKTOWN, NY 10598 NON STAT PROC PAGE: 1 ' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ V DATE/TIME TAKEN: 05719/04 10:00A DATE/TIME REC'D: 05/19/04 10:55A REPORT DATE: 05/26/04 PHONE: (914)-245-0880 SAMPLING SITE: 256 BARGER ST ' : YORKTOWN NY ' COL'D BY: BEN COZZI NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SAMPLE TYPE,.: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE _ 05/19/04 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 ^.jppo'^ 05/19/04 NITRATE NITROG 1.72 MG/L 0 - 10 9139 05/19/04 NITRITE NITROG <0.01 MG/L N/A 9146 05/19/04 IRON (Fe) 0.194 MG/L 0-0.3 mg/l 2037 ' 05/19/04 MANGANESE (Mn) 0.15 MG/L 0-0.3 mg/l 2037 05/19/04 SODIUM (Na) 15.7 MG/L N/A 05/19/04 pH 6.7 UNITS 6.5-8.5 9043 05/19/04 HARDNESS,TOTAL 120 MG/L N/A 05/19/04 ALKALINITY (AS 98.0 MG/L N/A 05/19/04 'TURBIDITY (TUR <1 NTU 0-5 NTU COMMENT0 BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDh:!;�THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR-THE PARAMETERS | TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted.ddetothe water should contdih no more than 2O mg/L~`��!``'u`� ���� those on a moderately restricted die maximum of27O mg/L of Sodium ' ~� ~-,'.��'�.- 1 7 Fax to: Joe Paravotti Fax from: Bern Cozzi Y 103 Attached is the New York Board of Underwriters Ger9cate for 256 Barger Street. Berl Cozzi Td WH9T :170 t7WZ $T •hleW 0Sb6Z96bT6: 'ON XUJ IZZ00 N08: WOdJ lit16(. -fdcil i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLH SERVICES F ELD ACTIVITY REPORT Street . Town PERSON IN CHARGE nR TNT .RVTRWRn; 0 6�1 L it 5w'- -) � —o3 ) (/V- l2 -a,3 State Zip iw,rY.✓ �'ld"A Con�T�atP� h��c��`�`� PUMP TEST 0. DOSE TEST REQUIRED GALLONS �• x' yr S y J` �I oZQ 1 l ai I- ►-e- EL. START A j EL. STOP INSPF,rTQR - TRT Signature and Title Drnnn r ii rr irx mr% nxr. I acknowledge receipt of this report: SIGNATURE: 02/96 Title: PUTNAM COUNT`.' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7 Inspected by: DTs ?O Street Location A .S hf Owner TD Town 1157 ZIM. 'x Permit # 6,v --2Y -vim' TM #— y, i ,- / - 31 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.Dpth c. Natural soil not stripped ............................. I..................... d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course /wetlands....... ..................... II. Sewaze System a. Septic tank size - 1,000 .......... 1, 250 ...:.....other ................ b. 'S eptic'tank installed level ................ .......... :.................... c. 10' minimum from foundation ...... ............................... d. (Distribution Box 1. All outlets at same elevation -water tested....::...: 2. Protected below frost .............. ............................... Y 3... Minimum 2 ft. Original soil between box & trenches e. .function Box - properly set .......... ..............................: 6. Trenches 1. Length required Length installed ..&:p 2': Distance to watercourse measured ; Ft.. 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 .................. 7. Room allowed for expansion, 100 % ......................:.. 8. Size of gravel 3/4 - 11/2" diameter clean ...........:.......: 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends cap ed ............ . .............. ............................ . g. Puma or (Dosed Systems 1. Size of pump chamber ... ............................... 2. Overflow tank ............................. ............................... J . Alarm, visual/ audio ........:........:.: ............................... �„G% . Pump easily accessible, manhole to grade ................. ' , . First box baffied........ . Cycle witnessed by H.D.estimated flow /cycle........... I➢I. se/Buildin' a. House located per approved plans ........................ b. Number of bedrooms ........... ............................... - .......... � IV. Well � Well located as per approved plans . ......:.............I.......... b. Distance from STS area measured ft ........... c. Casing. 18” above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... 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_to 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 provided ................. ............................... Rev. 12/02 i�►� -. ,i ,. ,,, q ��' J .FYI - J �J °l J 05/05/2004 08:23 9149624248 JOSEPH SULLIVAN PAGE 01 r AmNTT CIADAN— 13 a= UQ= yak EN For: lu ,; •, ,,.._.:�: ;'_w., All iwb=dom m* be My domed poor to any T=Nkm PCHD Coast�r/u'J�tiaa Patmit�. "'.0704a. &Iafllllo-j c wadAppct Nom: Ooo1 ^ .:: '�'I�t .. L� (k�r.G�.�F.+{�_ L IS "m n Y "m c i' An madon ooatrd attp is plic.0 W ver3Sed� , �ttia� d ri��gst�, �1`iniM�;t�r1� �wrs i�r+trt�d dad approval plow imd the ids, Its Bpd. . dE11�1h r 1 ► ` of He" rte: � � y_, �. c ay:. ,r� ✓'u�.,..,.,. 4F-9�% MAY -5 -2004 WED 09:55 TEL:845- 278 -7921 r NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 r NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 LORETTA MOLINARI R.N., M.S.N. Public Health• Director October 9, 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 r <___-- ROBERT J. BONDI County Executive Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re:. Waiver Determination —1@'JD Contracting Bf ger Street;' (T )' Pu i arii Val e3 TM# 74.10 -1 -38, R.S. Lot # 3 Dear Mr. Sullivan: 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. ❑ 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. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Ve truly yours, a0seph S. Paravati, Jr. . Assistant Public Health Engineer JSP: cJ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM p "S--M PERMIT # I V Rc Located at ��s� 4 '� C own or Village U! V a Subdivision name e4-%--J,? Subd. Lot # 3 Tax Map 7 / Block �_ Lot 3 9 Date Subdivision Approved Owner /Applicant Name /0712 Mailing Address Amount of Fee Enclosed 3 V ,4C- Building Type,, 4!rrr� �' t'. Lot Area 3.6 z No. Renewal Revision Date of Previous Zip /� " 'g,F of Bedrooms 4 Design Flow GPD �aU Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / ?- S �U gallon septic tank and 6 j / / Other Requirements: To be constructed by D W 17 e ?— Address Water Supply: Public Supply From Address or: V"- Private Supply Drilled by Address goy',2 V✓ 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. Address rte' R.A. . Date v 2 U License # Z 9 %sue APPROVEWFOR CONSTOTION-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 it. Approved for discharge of domestic sanrtary 'sew By: r Title: Date: P%' v White copy - HD F le; 410� copy - Building Inspector; Pink copy - Owner; O ge c - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT OIF HEALTH DRVISRON OF ENWRONMENTAL HEALTH SIEI18\VIIECIES Al?? LIiCATffON TO CONSTRUCT WATER WELL please print or type PCHD Permit # P v w - 0 3 Wen Location: Street Address: Town/Village Tax Grid # / - �4r Y� ��rtiT u�lcb ��r Map .W- / Block Lot(s)3 Well Owner: Nam : / �J2 Address: Use of Wen: eResidential Public Supply Air /Cond/Heat Pump Irrigation I- pirinmaq Business Faun Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �� gpm # People Served __..A Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply ➢DrillIling New Supply (new dwelling) Deepen Existing Well IIDeta led Reason for IIDAHing Wen Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No A.- Is well located in a realty subdivision? ........ .................... .. Yes No .............................. Nance of sutdiwi3iurr ... �.. i�Cj �i'LC= ::: -Lot No: :.;3..._ �� _ Water Well Contractor: A/ eh iZei%°a .7 Address: Is Public Water Supply available to site? .................................. ...........:................... Yes No Name of Public Water Supply: -- Town/Village Distance to property from nearest water main: /!i AJ Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: S ?-9 Applicant Signature: PERT 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 ell driller certified by Putnam County. , i I - /L1 Date of Issue Permit Iss g Off i : Date of Expiration Title: P'6rm' l IS Ncn- Iln9ana' ><° �ilmle q White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WP -97 BRUCE R. FOLEY Public Health Director NAME: ADDRESS: -)Ly LORETTA MOLINARI 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 (845)279-6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -'6085 Early Intervention (845) 278.6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER SITE LOCATION: ki 1 q,� iiy; 15.0 �t�( yam - k1VW;1 � -�s �u �� c a 5`c� DATE: 3 /c,3 Ts P STAFF PRESENT: ., Rob M.. Mike B., ., Gene R., Shawn R.. SPECIFIC WAVIER REQUEST: t fir" �97, 7�, �s1 DOES. THE PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? DISCUSSION. REQUEST APPROVAL OR DENIED . APPRO RPON DENIAL DF AL'f�H (SPECWAIVER) .DENIED DATE:... ly YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION. REQUEST APPROVAL OR DENIED . APPRO RPON DENIAL DF AL'f�H (SPECWAIVER) .DENIED DATE:... ly r ' PROJECT 10 NUMBER 617'20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM 'for UNLISTED ACTIONS pasty;, „_- PART 1 - PROJECT INFORMATION ( To be, completed by Applicant or Project Sponsor) I. APPLICANT /SPONSOR // /yof f% Aae 1- /'r� 2. PROJECT NAME �1 3.PROJECT LOCATION``: ``_� All r r� .5rA_ iri ff Municipality v'd /�Yr County 1101 TO 4: PRECISE LOCATION: Street A dess and Road Intersections. Promine landmarks etc - or provide map :: I /nt, 2 0 ej � . /� act o T �h / /'1 eGT9 5. IS PROPOSED ACTION: /I New Expansion Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: well f' _J CS /J . Gl ✓ QG /./� /�d�� `�./ ' 7. AMOUNT OF LAND AFFECTED: % Initially acres Ultimately acres 8. WILL PRO OSED ACTION COMPLY: WITH EXIS ING ZONING OR OTHER RESTRICZIbfVS?.. • : ` Yes • a No If. no, describe briefly:. ,'-`•' 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many.•as,apply.) Residential Industrial Commercial aAgriculture Park! Forest / Open''Space a Other (describe) ., s 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY;OTHER .GOVERNMENTAL AGENCY. (Federal, State or Local) Yes a No If yes, list agency name and permit I approval: % .�l%. C e_ �i 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY, VALID .PERMIT OR.. APPROVAL?.... •,. Yes No -If yes, list agency name and permit I approvak 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? ❑`fes o. I CERTIFY THAT THE; INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY'KNVOWLEDGE 7' Il Applicant /.Sponsor Nam�Al-L�r? 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 N �Jl N ° �-. - q y=w - PART II -• IMPACT ASSESSMENT.(To be completed by -Lead Agency >> r DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 612.4? If yes, coordinate the review process and use the FULL EAF. Yes 'No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN-6 NYCRR, PART.617.6 ?.' If No, a negative declaration may a superseded by another involved agency. - Yes No 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: C2. ,esthetic, agricultural, archaeological, historic, or other natural or cultural resources; or commtiriity or neighborhood character? ExDlain brieflv: C3. Vegetation or fauna, fish, shellfish or wi C4. A community's existing plans or goals as C5. Growth, subsequent development, or related activities or threatened or endangered species? Explain briefly: or a change in use or intensity of.use of land or other natural rely to be induced by the proposed action? Explain briefly C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: 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 yes, explain briefly: _ © - - - E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Yes JNo t t 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) 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. 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 significant adverse impact's which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ✓Check this box if you have determined, based on the information and analysis above and ' a ' hy'qupporting documentation, that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on atachments as necessary, the reasons supporting thi determination. // Name fl y S- Nnr o— /Date Print or Type Name Re Ibie f iedr In%1Le1jd cY Title of Responsible Officer Signature f Resot n le Officer in Lead Agency ignatu a of Preparer (If different from responsible, officer) . :_W YORK STATE DEPARTMENT OF HEALTH 11 0 f ireau of Community Sanitation and F d--Pro Part for Individual Household Sewt,� ; ,:jTr�vli ttr. Last Nwne 14 lame of Applicant JO 4ea e- /V ............ No. Street ;i,,r,.wn sw kddress'. 2 No. Street Q11 frown 'Lo 3itecation 1. Reason why site does. not meet I ONYCRR. Appe hdIx 75.A (check appropriate box(es))*. Separation distance cannot be achieved. Excessive.slope' iJ High groundwater: Inadequate depth to bedrock or Impermeable layer. SOII Unsuitable. Othe,, (explain) ...: ......... ...................... ......................................................................................................................... •. . ........ ....... ......... .. . .... ....... ....... ..................................... ..................... ; .................. ...... ............................................................................................................................................... 2. osed design or conditions of waiver-, ez, Jow 9(.,v q/7L .. .................. ........ . ..... ........ .... .... afih ....................................................................... .......... .................................... ..... ........... ................................................................................................. ...................... ............. .... .. ... .. ..... ... . .... ... ............. . ..... .. ................ . . . ...................... ............. .................. . ................. ............................ ........... .............. . . . ............... . ....... . . ..... . ....... ............................ . ..... ....... ....... 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. ot'hor (explain) .... ............................... .......................... ............. .................. .... ................................. ........ ............................. ................. ........................................... ......................................................................... ...... .............. Additional Information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental pr,. iif In New York State Department of Health Acministrative Rules and Regulations, Part 75.6 (b), a waiver Is hi::oby may be revoked by the Issuing official fora change in conditions for which this waiver was granted. 'i fiEPHENTAfiIVF OF . to ......•.... ...... COPY Aipl lc<irJ[ 1:,[! 05/13/2004 12:4.6 9149624248 JOSEPH SULLIVAN PAGE 01 PUTNAM COUNTY DEPARTMENT OF.��Y TO IDIVISMON OF .EN MONMI�NTAL SAS SERVICES ATTENTION ADAM 0 GENE RwIdISUM ALIN REM ON N IFor Fillo��...._ - -- . All in Fonnflon must be fully completed. praor to any 'lien ;bes inspe :tiers beta;§ matte. � /-ura�� �� .�' • ,. i . _. PCH) Conr=01011 - Pelmit # ww 7- y I.,oce:ed:..r... ,w: ��g — . , •�. - . (`I'j _ ►: d e � _ /��' .. Ou ®.r /A )phcatit Naa,,s- Forme ray Subclvision Nurse: Is system fill co.thpl.ei:ed? _ Date: Is System compCete. >..._:.. bate: M Is system const7ucted- as per plaa.s? .... _ Is wt. -H deed? k]ate .:...: �.. _ .._...::._. .�....._ . _.. _ ,_,... . __.. Is w.-!U located M pv.plaw? Are erosi.on control..mum mes.ia place?..: I testify that thg.:syste ®(s), as premises has l)een'cODstnnctei'�td and verified their c:o:mpietioa in awordance;with.the. -mied $ ,.IC®�ien `ra;.�r,r', ;�a al±pa'otile plate €and the • Standards, pules and IteStilati�ns of the Put ire ►, tr . rlt;I_ I�f: .. _.... Date: /. ,:_ ®� Certified by. Desip;Professiowl Ad •cress:., . IA A,,-:' z Lie Form lFIR 99 MAY- 1.3 —PM4 THI 1 14: 1 R TPI a R4S— ?7R -74 ?1 MQM;:! PI 1ThIDM- rn1 IAITV ncc)nDTMCAIT nC- D JO IN3WIdUd30 AiNnoo WUNind:3WUN r: NOW 700 • 1f 1?'fc'n_R LT.: c- {2'c)(?�R;' " Tai^. ( L_� -- 'rHIS CERTIFICATE OF COMPLIANCE THE ::...:.: ..:.....; - ►, � S ;, � �I=. IR UNDERWRITERS �....:...: BUREAU, OF ELECTRICITY 40 FUL,TON STREET -' NEW YORK,' IVY 10038 CERTIFIES THAT Upon the application of upon-premises owned by BRENISH, GEORGE BEN COZZI 23 TINKER 'HILL ROAD, 256'BARGER-ST PUTNAM VALLEY, N.Y. 10579 -1537; PUTNAM VALLEY, TN +, NY 10579 . Located at 266 BARGER ST PUTNAM VALLEY, TN +, NY 10579 'll Car ilcate•NVMbere ppli�dtion. Number:. .1196514 � .. .... ,• Section: 74.10 Block: 1 Lot:- 39' Building Permit: BDC: W106 170 -04 `a Described as a I Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Basement, Fixst Floor, Second Floor, Attached Garage, Outside, 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 applic'able.. code and/or. 'standard promulgated by the State of New York, Department of State Code Enforcement and Administration,'.or 'other authority having jurisdiction, .and found to be in compliance therewith on the &h -.Day of' May, 2004. Name M Rato agtng CIquAt Lg. ..i�l'iiSCPllall _ , ...... .., _, .. _.....�. ..., SEPnC'1PUMP AND ALARM. .. ...... �, _.:�... :.. _ __ ..:.�.. _ .. ROUGH 1111/04 Alarm and Emergency Equipment Sensor 8 0 110 Smoke Sensor 1 0 110 Carbon Monoxide Appliances and A,Cces$aries.. r ,... j Hydto Manage TubF Residential • ' 1. 0 .Micro-wave 1 0 20 A Air Conditioner 2.1 0 . ;. 42000 BTU 5 Furnace 1 p Clothes Dryer 1.. 0.. ,A.5 KW Dish Washer . I , U' 1:5 1CW ` Water 1kater 1 0 4.5 KW' r, - Exhaust Favl 3 0 110. F :H P: `- 'n Panels - I� 1 , 200 40 seal Wiring and Devices - - Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the locatlon indleated. Zd WULT : b0 b00Z ST 'hpW 0Sb6Z96bT6: 'ON Xd_A IZZ00 NjS : W02ld L..:`.. _ - . PUTNAM COUNTY DEPARTMENT Of MALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT. Well -Loeattoen ' S get Addre, �-' - i/c / e: Tax Grid # Map lock 1 Lot(s) .3 Well Owner: Name: Address: �n- Use of Well: I- primary 2- secondary � esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) . Industrial Institutional Standby 1Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify)' Well Type Screened Open end casing >e� Open hole in bedrock Other Casing Details Total length /Z--f ft. Length below grade ),ft. Diameter , _in. Weight per foot jL_lb /ft. Materials: Steel _ Plastic Other Joints: Welded _ Threaded Other Seal: eL Cement grout _ Bentonite Other Drive shoe: Jg Yes _ No Liner: Yes LC, 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 gpm Depth Data Measure from iana su ace -sta9c specify ft) 30 During yield test(ft) Depth of completed well in feet T Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface : Lc p z �i If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typ city Depth Model ST 7 Voltage O HP ff Tank Typej(2,5�c) Volume $41/, Date Well Com leted Putnam County Certification No. Date o Report -4- Well Dnl er signature NOTE: XX11t location of well with distances to at least two permane)n tanamarxs to be provtaea on a separate sneevptan. Well Driller's Name Address: Signature: Date: y d c, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 1 .. b SHERLITA AMLER, MD, MS, FAAP Commissioner.of Health . _ ... ... LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Bonomo 256 Barger Street Putnam Valley, NY 10579 Dear Mr. Bonomo: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health March 23, 2010 Re: Addition- A- 030 -10 No Increase in Number of Bedrooms 256 Barger Street (T) Putnam Valley, T.M. # 74.10 -1 -39 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated March 22, 2010. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3:, ,. All plumbing fixtures must be updated with water saving devices,.i.e., new low flush . toilets, restrictors for showerheads`and•faiicet "s etc: "" " "' ` -"' - ""�' " """ ° --"--- "--•"- ° "•• °" - 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITAAMR LER, lid, MS, ItAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BON DI County Executive ROBERT MORRIS, PE Director of Environmental Health ADDITION APPLICATION RESflDENTIAL ONLY S� \ `� � STREET �� `o �� a�� � e.�, � ®max �,. �a� g�e..�A� MAP NAIL o�o��® PHONE 1\ PCH —Q :L)o "' I MAILING ADDRESS�`o0.�ge.c DESCRIPTI N OF ADDITION v.��c oo � � � � �..1t� ���o. � ec� NUMMER Off' EMSTIN G BEDROOMS �PROPOSEIlD # OF BEDROOMS Q (]FROM CERT. OE OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer.or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. . Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. Certified check or money order for $100.00. -2;,_ Skeit Ahe of existing floor plan (drawnAo scale,-a Llivine area inclu€ ing basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) - * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA-:1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS 5. ]Environmental health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278-6026 Nursing Horne Care Fax (845) 278 -6085 WIC (845) 278 -6678 ]Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 b SHERLITA ANTLER, MD; MS, FAAP .Commissioner.of Health ..... ...r - .....arm. -� -. �..�,RJ.. ?• -.c.. -.U... .,, :._, ....,. +.._••w- ,� -..... LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Town Legal Bedroom Count & Proposed Addition Status ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: BONOMO Tax Map # 74,10-1-39 Address: 256 'Barger Street (Owner's Name) Town: ptteftaffl Valley Year Built:. 2064 According to records maintained by the Town, the above noted dwelling, is . XX in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: 4 -This, information hats been.obtained from:', Certificate of .Occupancy: c n j 2 n n 4 -1 1 4 *a t: tact e d) Other: The plans for the proposed addition are considered: New Construction xx Addition to existing house only Teardown and/or re -build allowed under Town Regulations 1.6-; 10 Assi.st..Building Inspector..,,,..John .W.... Allen ... ._Date.. 6. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Pax (845) 225 -5418 Nursing.Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 76085 WIC (845) 278 -6678 Early Intervention /Preschool (845) 228 -2847 Fax (845) 225 -1580 3 Public Health Director 'i ,SW-Q3-0-3 Associate Public. Health Director Director of Patient Services 1 - Geneva Road Brewster, New York. 10509 Environmental Health (845),278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 219 - 6558 WIC (845) 278 - 6678 Fax (845) 278 .6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (945) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: AJ9 IDSW. SITE LOCATION: J DATE: STAFF PRESENT: Bruce F. Rob M. Mike B. AdawS., Gene R. Shawn R. Bill H. SPECIFIC WAVIER REQUEST: 2.1 AoI3 4 '-60-ff-f PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? +s + YES NO DISCUSSION. REQUEST APPROVAL OR DENIED PROVED DENIED (SPECWAIVER) V�11 "1 11; - i F. � W'; A TV, A 0 7d ,..,LFJ• R�:r.TA;::MQJ, SIN. �' �3: �i:.N.;..M:S.k..: :�.«.- .-�,:- ;,.,r ` 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 FA (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: J�B NDI County Executive Re: Waiver Determination — MJD Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -39, R. S. Lot # 3 The Putnam County Health Department reviewed the waiver request for the above regarded project on September 3, 2003. The following determination has been made: U.- lne Waiver request was:approveo. ❑ 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. X 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. . f iiiere re'any qt s�ibris`r�garding Lhis ita.tter; please "cOriiaet -:n& aY JSP: cj 0 Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer n r< el J ate / Fnc Jon .S . -� .�.,>. «_. .T. x- �t _ u. � �.� � � .... .ij` .S _i .- ..V .i1'F..n� �1'N - .... �i•.b tR ...._'f. �,...a .� :..q•. .� • : 1. =. PLASTIC PIPE: ii1 1�I GPM GPN• 3 /8rr 1/2 rr 9/4 n 1 n - 11/4: . 1 �� n Ft. Lbs. Ft. Lbs. Ft. Lbs, Ft. Lbs. - - -- Ft. Lbs. Ft. lbs. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 Y 2 120 15.13 6.58 4.83 2.10 1.21 .526 .38 .164 10 -11-4-4 �^ 3 180 31.97 13.9 9.96 4.33 2.51 1.09 .77 .336 ..21 090 10 .043 4 240 54.97 23.9 17.07 7.42 4.21 1.83 1.30 .565 -..35 AN �.16 I .071 5 300 84.41 36.7 25:76 11.2 6.33 2.75 1 1.92 .835 1 .51 .223 1y .104 6 360 36.34 15.8 8.83 3.84 169 1.17 7.1 309 3 .145 8 480 63.71. 27.7 15.18 6.60 4.58 1.99 1.141 u. 518 241 10 600 97.52." .: 42.4 25.98 11.27. 6.88 2.99 1.78 - .774 �.83 - .361 15 900 49.68 21.6 14.63 6.36 3.75 1.63 134 :755 20 1,200 86.94 37.8 25.07. 10.9' 6.39. 2.78 2.94' 1.28 25 1,500 38.41 16.7 9.71 4.22 4..,,!.-A 1.93 30 1,800 13.62 5.92' 6.26 2.72 35 2,100 18,1.7- 7.10 8.37 $.64 40 2,400 _ . 23.;5_...1.0.24• ..:.]0.711:.....4..65,,. -.. 45 _ _ 12,700 - _ 29.44 W12.80 13.46 5.85 50 3,000 '16.45 7.15 60 3,600 23.18 10.21 k / -,"o e /`'%r , w ) ' ) . ZO-W T � ioa / 17 �v 2.9� �-- z� �•o �� /�. ?/• 9 �� � Ala a&/ 3 dam of NEW Y yQ�QpNCfS A W N O • 4 1 .... - .�...')'✓01tETTA 1vI0L11VARI R.N',~M.S.N. , . ' - . Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI� County Executive 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 f Frank Sullivan, PE 2972 Femcrest Drive Yorktown Heights, New York 10598 Re:. Proposed SSTS — MJD Contracting Barger Street, (T) Putnam Valley TM# 74.10 -1 -39, R.S. Lot # 3 Dear Mr. Sullivan: 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. 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. -4. Add the words `dust free' to absorption trench detail for stone /gravel label. __......!add - erosion control just down . ade of the SSTS construction area: = -_.... g! = - Provide second dimension to property line for well location. The profile needs to show 3' -6" cover over the force main. Also, provide 3'6" minimum / label. `B. Pump tank detail should read 1250 gallons. One day storage has not been provided in the pump chamber. The length and elevation values being used in the head and friction loss calculations appear to be in error. 1. Provide further separation distance between wells on Lots 2 and 3 to avoid aquifer interference. �2. 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 �(o ,3 to contact me at ext. 2157 if any questions arise. ✓"t/` y"1 w� yzfi h--� Very truly yours, 7 L,,e t I 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.SYSTEMS . ,r . - - REVIEW S=, , T FOR CONSTRUCTION PERMIT NAME OF OWNER: ,M TA loin�-rc� �h STREETLOCATION: REVIEWED.BY: RM, GR, Bar, SRDATE: 3 T:4X MAK (CONFIRMED) 7 3 9 Y / N DOCUMENTS Y N (REOMED DETAILS ON PLANS CONT'D� ��� 'V• �-'� ' ✓( • )PERMIT APPLICATION (C HOUSE SEWER -'/.�' FT. 4 "0'; TYPE PIPE.CAST IRON ✓( )k )WELL PERMIT OR PWS LETTER U(i/)NO BENDS; MAX BENDS 45' W /CLEANOUT ✓( )(_ )PC 97 RENEWALS } / LU ETTER OF AUTHORIZATION LU )SITE 1�LQ'rF nvn�x,� p) ---" > ) (ZLU)DDESIGN DATA SHEET (DDS) FILL SYSTEMS L _)C SCORPORATE RESOLUTION U(�10' HORIZONTAL; P,AS H SLOPES TO GRADE ( dLJSHORT EAF .: U_)UJFILL SPECS / L NOTES 1 -5 L�UPLANS -THREE SETS CUC. ILE & DIl�'IENSIONS -PLANS,-TX SETS 6i-,�' - IN EXPANSION AREA VARIANCE REQUES .- "� co �� FILL GREATER TAALIF2'FEET� 'TSION 7 C- U)L-) CLAY BARRIER vt.i*�r cc U�GAL SUBDIVISION U�(_- _)FILL CERTIFIGES NOTE � / � CUUSUBDIVISION APPROVAL CHECKED CU(UDaGAJI, E�.S PERC RATE Yoa_%,lei�. SSY3sw✓{� VPLAN FOR RO.B., UNCLASSIFIED &IMPERVIOUS U FILL REQUIRED <_ DEPTH AWAx too' C) TIO DISTANCE FROM•TOE OF SLOPE (..DL. DRAIN REQUIRED vl ti.. i( 6vK+ TRENCH" / GENERAL P''F""`6'�'� '� LF TRENCH PROVIDED �� 60FT MAX. UU.�L 1CATED.IN NYC WATERSHED sky PARALLEL TO CONTOUR (p (v? 9* LU LANS SUBI4 =D TO DEP 0100% EXP 6A�PROVIDED LUD LEGATED TO PCHD ✓ U )DET UST FRE CRUSHED'STONE OR WAS GRAVEL (� EP APPROVAL, IF REQ'D (� (�GEOTEXI'M OVE� L ) EEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN. FROM U(.�fj-PERCS TO BE WITNESSED � 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (-U APPROVAL SSDS ADJ, LOTS �U ZO , TO FOUNDATION WALLS WETLANDS (TOWN/DEC PERMIT REQ'D ?) 100' TO WELL, 200' IN DLOD,150' TO PITS ERMTT SAME S�co:v 100' TO STREAM, WATERCOURSE, LARK(inc. ezpan). UUUP 1969 NEIGHBOR NOTIFICATION (/'�^� 50'. TO. CATCH BASIN, 35' STORMDRAYN, PIPED -WATER; ..... C U ER BI/�BA .. k, #.,� �s U 10 Tug WAiEIIIm ' fs• `20 .... . (_).. 0-Y rZOUD ELEVXTION W/I�200' - .. ... .... (:U i - _.....,_.. .._. . U j 50 NTERM ENT DRAINAGE COURSE (__) SOIL TESTING LOTS>10 YEARS OLD 200'/500' RESERVOIO, ETC. _ 150' GALLEY SYSTEMS RF.OUIRED DETAILS ON PLANS (� . 10' MIN TO LEDGE OUTCROP (__ _) SEWAGE SYSTEM PLA.14 (NORTH ARROW) SEPTIC TANK �SSDS HYDRAULIC PROFILE LU 10' FR`OM'FOifiNi?A�A • 50' TO WELL (___)��GRAVTTY FLOW ' JCONSTRtJCTION NOTES 1 -15 (,� DESIGN DATA: PERC &DEEP RESULTS D.IIVIENSIO S TO PROPERTY LINES f' � �'°'y`''t •°�,"��' � 2' CONTOURS EXISTING & PROPOSED C—. CATION OF SERVICE CO CTION DRIVEWAY & SLOPES, CUT C--) MIN 15' TO_ PROPERTY LINE FOOTING /GUTTER/CURTAIN DRAINS 77]N SSTS ARC " y SSLOP 520 /o USDA SOIL TYPE BOUNDARIES �--� C•UTTTLE BLOCK; OWNERS NAME ADDRESS �UREGRAD. 5 %, IF REQUIRED DOSE/PUMP SYSTEMS 4TM #, PE/RA; NAME, ADDRESS, PHONE# � PUMP NOTES. -UDATE OF DRAWING/REVISION DOSE' 75% OF PIPE VOLUMMOSE VOLUME NOTED DATUM REFERENCE . PL-1 H(LOCATION OF WATERCOURSES, PONDS DETAIL FOR FORCKMAIN, (PIPE TYPE, ETC.) ;IAEES,WETLANDS WITHIN 200' OF P.L. D-BOX.SHO-MU DETAILED (�UPROPOSED FINISH FLOOR AND 1 DAYS RAGE ABOVE Scfvr�C• 'nnc[cgb+: BASEMENT ELEVATIONS CURTAIN DRAIN ( ✓U- )WELLS & SSDS'S W/TN 200' OF SSTS I J STANDPIPES, T BOTH SIDES, DETAIL R SION CONTROL FORHOU §K MML16 &-�'' 20' MIN to CD DISCHARGE/100' with 182 cons day discharge STS EROSI L` 0TE (�[ ew;i =—i lO�MIN to NON - PERFORATED PIPE !Omnvmms: wit . C-� j� C (ul -114 41-16- (- -.- tEVSMET)09 /0 V00 O.F E. NV IRONMENTAL HEALTH SERVICES ......,,. :.r r .. aeo.>,... , . ;u:-. .: 'ui .• r . -... �.w..:< -.-: .w.wwt .. . — .r eao-:-..—.:rt . r.�- ......_. ..� .._ .: s •. - .- ....W.,• RE: Property of LETTER OF AUTHORIZATION Located at ji`y-x-�e�� T/V </� Tax Map # Block / Lot9 Subdivision of vpkzve? . le5,1' /r�1 Subdivision Lot # Gentlemen: Filed Map # This letter is to authorize Date Filed 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 conformity with-the provisions of..Article. j45- and/or-.147 of the E ducation :-Law,.the- PublictHealth Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # Mailing Address z97� Very truly yours, Signed: (Owner of Property) tv Mailing Address: %Z% A;llha,717 9�1��� State V Zip /OZ'S State 217 Zy Zip Telephone: � Z Telephone: 41'd 3 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL; OF PLANS FOR 4.. AST9WATEI� TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: �a 4. Design Professional: f�i do's 6. Drainage Basin:ar�r� 7. Type of Project: Private/Residential Apartments Office Building 3. Location TN: ;aq .a 5. Address: Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Al'G 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 _ -. nffic�als;.�rsit��ances ?..a. ............. :..............:.......... _ :... _ _ 13. If so, have plans been submitted to such authorities? ........ ............................... 0-14 14. Has preliminary approval been granted by such authorities?/ granted: 15. Type of Sewage Treatment System Discharge ................. surface water ✓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? 40 19. If yes, name of water supply Distance to water supply 1%0';1S$ 20. Is project site near a public sewage collection or treatment system? ................ 11ld 21. Name of sewage system Distance to sewage system 22. Date test holes observed s,-�v— 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... ey"e 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? —' ..................... Form PC -97 8/99 . 2 27. Is any portion of this project located within a designated Town or State wetland? A ej �Wetlands.ID.. tarnber 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... A/0 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 Nd 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? ..................... I ........... Yes/No� DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... A',a 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... /V o 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Aio 36. Tax Map ID Number .......................... ............................... Map7.si/ Block_ Lot 37. Approved plans are to be returned to ..... Applicant 1,-- Design Professional -tvDiE:.Ali applicaiiGns'i6r review ana approvai-of a newSSTS is belbddfed`withiri tlid NYC Watershei §half' be sent to 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 I .,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. Il hereby affirm, under penalty of perjury, that information provided on this form is tree to the best of my knowledge and belief. False statements made herein are punishable as a Class Al misdemeanor pursuant to Section 210.45 of the Renal Law. SIGNA71 URES & OFFICIAL T'IT'LES. 00 =Z Wd 9- Nnr Co Marl ai# AEi ......................... +. Y r�,.lf1 7_� 2-1472— ✓��rz��Y. . 111.0-1-17 A4'eo' 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -SUBSURFACE SEWAGE TREATMENT SYSTEM Owner '-A,T-p Address /-'t �;e, A? 12- /Y IV V. Located it (Street).-- Tax Map7-2t-/ Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test .percolation test hole. (i.e. i5 I min for 1-30 min/inch, -.q 2 min fbr3l= 60,minhnch) All data to be submitted forfeview. 2. Deoth,meAsurenients to be made from top of hole. Form DD-97 ...... .. ... ... ep 14:i...-Yal .............. S ..... "M veU DO.... .. ... ... .... S `,14 2 -3o 3 2- Z 4 5 2 3,o ag 'Al .3 27" 3 14 4 5 2 3 4 NOTES: L! Tests•6 bit"repeated at same depth until approximately equal percolation rates are obtained at each .percolation test hole. (i.e. i5 I min for 1-30 min/inch, -.q 2 min fbr3l= 60,minhnch) All data to be submitted forfeview. 2. Deoth,meAsurenients to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -74 bi�TH G.L. 0.51' 1.0' 1.51 2.01 2.5' 3.01 3.51 err — i�� I / 4 4.0 e4 _ 'y 4.5 Aww n- ItAj M 6.01. 6.5' .5 7.01 7.51 8.01 8.51 9.51 10.01 Indicate level at which groundwater is encountered A16 e Indicate level at which mottling is observed -3 Indicate level to which water level rises after being encountered Deep hole observations made by: Date 2 5 Design Professional Name: Address: 7 Z 1-11-1 AN3 11 nd t4 n o 4 Design Professional's Seal 'PUTNAM-COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,..... � . INITIA:L,INl M. TU..ALfCOMIY�ERCL #,,, -SITE II�SFECT IOlyl FI��IVI .......... SECTION A. GENERAL INFORMATION - Name of Project (T)(V) �� y County l Site Location' Building construction :begun Extent Is property within NYC Watershed ?... .. .......:..... F7 Yes a No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. I-iilly- a Rolling `Steep slope Gentle slope F7. Flat 2. $vidence.of wetlands Low- area subject to flooding Bodies of water - Drainage ditches F_71 Rock outcrops 3:. Property lines or. corners. evident .......:............................................... Yes No 4. Do water courses exist on'or adjoin the property?............ .. ................ Yes a No .. 5.1 Will these affect the design of the sewage system facilities ?............ Yes No 6.. Do watershed regulations apply in this development?.*... .................... Yes �' No 7 Will extensive grading be necessary? ................: .:.....................:....:.. Q Yes - No 8. Will extensive fill be necessary. for SSTS? ......... ......... ...........:........... ( Yes .. No y: Do.Med- areas'exist within the SSTS area? ........ ............................... Yes No If yes, what is the condition of the fill? SECTION C., SOIL OBSERVATIONS 10. Appearance of soil:aSand a Gravel oam . a Clay `0 Hardpan a Mixture 11. Observed from: 0 Borings Q . Bank cut . ' ackhoe excavations . �, ��z, X02 3 12. Soil borings /excavations observed by �s� _ on 13. Depth to groundwater See vC�s� r.,� � `� : on 14. Depth to mottling on 15. Are test,holes representative of primary & reserve areas ...... ............................... -Yes Q No 16. Soil percolation tests made by :w Su. f- on 17. Soil percolafionldsts witnessed by % : on SECTION D (on back) Form ST -1 M 2 SECTION gGI� >D. 1 D AG E 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes 'No 19. Will groundwater or surface drainage require special consideration? ....................... Yes o 20. Will gullies, ditches,*etc., be filled and watercourses be relocated ? ......................... Yes o SECTION E. O&° ' S, 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ....... ........ ............................ ..:.....:...:......... a Yes �-�Io Inspection data 22. Do adjacent wells- and /or sewage systems " exist? ..................... ..................... .I......... Yes a .Na 23. Additional comments , - v� .24. Site observer /inspector.and title 25. Date(s)-ofobservation(s)inspect: 'DES T' PIT' PROFILES Hole # _JLot # Hole # c .Lot # .. Hole # Lot # Depth to water Depth to water /V Mr r Depth to water Depth to mottling Deppth t raottling - Depta zo ruotuin Depth to rock/imp. Ilk Depth to rock/imp. % ` Depth to rock/imp. G.L. Q - .. G.L. G.L. 0.5 .0.5 c '.. 0.5 4 1.0 1.0 1.0 2.0 ` . ✓ C0- . 2.0 5' 2.0 3.0r �t� .�'` 3.0 d 3.0 4.0 Cutu�Ac� 4.0 4.0 5.0� r 3 5.0 " 5.0 6.0 .0 g.0 6.0 6.0 7.0 7.0 g.0 . g.0 9.0 9.0 .9.0- 10.0 10.0 10.0 11 �.. ..�V.t 'b ^S'ic�'kt ^l t.. �.� ViL. .-w�: b`• .. Rya. '.`�. "_S "'/'iM:�jR'/�'I��Yi ✓!.. .r .�C1�•V.�... l�f.��S��tt...r wtn .� ..V M.. i-v.w �b "♦ ...r.�.� •11.�.��.IErW � I �� ' �, �_s�c- svbw`.: s � .�,.z^6� --� �� c.� �H.m.�... ✓,��> •�. pc0 (� b �; __�' /'��� �_ . Il �o t'�^ y►OS -�e—l� /� s S ^ GtJ �'vc.r /��ly�S Z!C — -- f S I1 S K owf/t - 43 ' CtE� II i 1 �_:_._�l'� K.�c 5 v �� �n � t ern �f ®..� ,�✓► -� ye o..s c�Lf'1.�5 ��c.�(.�� 11 .I� ii {i e �.. _. r. �.A ..e_._ ._.... ..�:.r ,w .. r • ....__.r ...a. ....r ..,•n. _. .��...r� .u. r. w. .....w w. o � ...... �A' - !r ... r.. �.. .. •- ..... -�.. r.• �.... .. �� _� � � � ! a �w •. ..��. 1 �I cze Lr V1 'a gv- 00., .7 � -, X. 'C V pl nk 11 7- .;, , q t Ac. to dyvn 7as Idl Sep c +-or,, )k is rx p izso vw�» + zwt�i. 7 -Lem. tie e. Or 13 A' 05, T 7 40 AL is 4-am rlso > ------ "AIN S�CTJON OF MAP NR FS rISION BRA A 1222-A stiflO go 0. c' 'LOCA M-P :1 19 ged JLJIY 21 1222—A No, r .;� T bO Filed mc, .0 cs Q III, lands shown nor, 264, 00 POO d" �i5 �—i deed or D;uolo 05 Mm N.-Y. S.D.E.C. ii FRESHWATER WETLANDS i LI S 5107'45" E I ik ?d, os noted and ArOted below, only to: ✓IEL J. BONOMO "i -MIER ABSTRACT, Un ( r/t/e No. PAL-20275 IYERS 77 7LE INSURANCE CORPORA 77ON 9 SA 14NGS BANK isE mANHA rrAN sAlvk N 522022" W fNT STREAM Y. S D. E. C. WETLANDS BOUNDARY SAM 'A LOT 2 well *F7LANDS cavn?a LINE LOT 3 624J ACRES i q7 875 SO. FT 0 690.46' yuy come Tmonument bf - OY —7- Poe w/ . ............. Pom stone 87�1 61 ............. . concrete monument On,— t T. asphalt dffmwoy aj, n T z! SURVEY OF PRO