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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -40 BOX 28 03615 IN IN L IN .IN .:� . i .; , m IN �.6 r ,., i �i P IN .6 IN L . NI .1 V NJ oLh 03615 PUTNAM COUNTY DEPARTMENT OF�1 HEyTAL�T7H/^��1 [`) .-� -i .: �...' .' .. i.'�.S►"��JCS:J"�0�`��L:' - r�y'_"'' "Y' �.R V- 1- ♦T'�iis�T�AL H�AL 1 �� AJ i.JR ♦ � \i -•AJ�* ir �� �.;-: �.... ... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE ENT SYSTEM PCHD CONSTRUCTION PERMIT # PV-1J —no = Located at "Q 2ARC ST. Town or Village �vTii/�4�YJ p,//eq L �'� Owner /Applicant Name_, %ya-f.,,-,Ti/L /E Cuomo Tax Map 741,1 Q Block Lot h Formerly S rt. 'Subdivision Name, r Subd. Lot # M Mailing Address Z/ &c&mc f . Pv mr� A/ Pi aln 1/ 4z 4e r- W Zip _ las-7 � Date Construction Permit Issued by PCHD 41 0,0 • Separate Sewerage System built by HEAK C-OM fy 1 ?,.A AAddress 0i4u,v)Ja LU1,4, P-�A_yl'):,�WUI r: Consisting of / 1 Gallon Septic Tank and 900 L /= T/2E�✓�,a Other Requirements:_bOAl 7-ANN , n �" ` /= /G d. Water Suonly: Public Supply From. Address 4 Av: �v ,4M A v-C or: �_�_ Private Supply Drilled by PC LILY- -COWC Address 13e", /X7 QrQ9 Buildirig�ype.4 � F)Z4,ii%jE &L&t Has erosion controi'been completed Number of Bedrooms Has garbage grinder been installed? 4,q q 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 Putn County Department of Health. Date: _j p 1 -, Certified by P.E. _X_ R.A. (Design ,— Proesso Address 79 S45GQW n. -t qj License # ¢ � Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, odif ationa ne is necessary. By: Title: iy I Date: r White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 a ,y t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES W1ELII., CO.MPLE'1('ION. _Po RT-_: :� : Well Location Street Address: 260 Barger Street Town/Village: Putnam Valley Tax Grid # Map 79/013lock / Lot(s)1/0 Well Owner: Name: Address: Kurt & Julie Cuomo, 14 Cindy Lane, Putnam Valley, TW 10579 Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 113 ft. Length below grade 112 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout ^ Bentonite Other Drive shoe: X Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 1L gpm Depth Data Measure from land surface- static (specify ft) 60' During yield test(ft) 220' Depth of completed well in feet 285' 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 85 Drillini in ove burden clay and boulders 85 Hit roc -at.. 85'. .. . 85 11:3 Drillin i 1' n roc " set 6asinq, grouted 113 285 Drillini in roci granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5gpm Depth 240' Model5GS05412 Voltage 230 HP 1/2 Tank Type WX302 Volurne 6 10 Date Well Completed 7/20/01 Putnam County Certification No. 002 Date of Report 9/13/01 Well D le si p al NOTE: Exact location otwell with dtstanc to at I ast two rmanent landmarks to be provtde on a separate sneevptan. Well Driller's Name Pe F. S T Address: 4 Putnam Ave. , Brewster,_ NY 10509 Signature: Date: 9/13/01 Perry Le Beal White copy: HD File; Yellow opy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 1 r BRUCE. R. FOLEY _ r LORETTA. ,. MOLINARI•: R,- N.;. :.�1,5_.•.I`J.-_.::.:.. :�: . �ssoc�ate Public "�altri ��irector Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fait (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (9i4)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: &UR7: 4-Z✓LIE C LJO00 0 TAX MAP NUMBER:. ` %VA.lO E911 ADDRESS: (I 6"Itz'66:1 S77 TOWN: /yAM Uz'I "ise AUTHORIZED TOWN OFFICIAL: " O (Signature) DATE: The Putnam County Departanent. of - Health will not issue a Certificate of Construction Compliance unless the above form is completed,. i.e., a legal E911 address is assigned by an authorized town. official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERRUA) U 1, PUTNAM COUNTY DEPARTMENT ENT OE HEALTH :N?° ENT,41 .. FALT - SE:I YICES ... GUARANTEE GE SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot '� 1L C=ON c VZ i,/ 0—i y Al Building Constructed by- TownNillage A-i fir r Location - Street Subdivision Name L420,0 M/Plie ,tea LlI Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operas properly. is.: caused by the- wiliful.-or negl &ent-act_ofthe occt4p4nt of ±he.huilding utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupan, %e building utilizing the system. Dated: Month in Day J Year #4 0 ( General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip 16 It b Si Title: A �, NB .NORTHEAST LABORATORY OF DANBURY �0 �N ACCO.90 �� �. 203) 748 -7903 - FAX (203) 748 -0652 n NY Cert: 11471 c LABS www.NORTBEAST LABORATORIES. com < _ REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED CBEMISTRY: * Iron LABORATORY REPORT DATE SAMPLE COLLECTED TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB LD. # REPORT DATE: CUOMO, 260 BARGER ST., PUTNAM VALLEY, N.Y. TANK WELL NONE RESULTS 0.154 mg/L METHOD # EPA 236.1 12/12/2001 1:30 P.M. ADAM 12/12/2001 LAB# 11471 PFB -137 12/17/2001 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0.30 mg/L ml= milliliter mg/L--milligrams per Liter ND =none detected MCI-- Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level .... __ ...COMMENTS: _ .. ... .... ... .. _._ ._ ...... .._._ . .._ ... .. .... _ _ . _ -.... ., . ......�.... . _..' ..� . -All holding times (were) met. (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 12/12/2001 fM Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 * OUTSIDE CT: 800 - 654 -1230 I'm LASS REPORT TO: NORTHEAST LABORATORY ®F DAN BURY O0 ,N Acco90 ;- :39 M. -L.?- "-- 3'Irry -r �' _ NjPo.. D A i � F Y;, CT :.:.: 0 69 I G. T tier t'- 1H4 -0j64 �, qy � h 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 0 www.NORTHEAST LABORATORIES.com - P.F. BEAL & SONS DATE SAMPLE COLLECTED: 9/13/2001 4 PUTNAM AVENUE TIME COLLECTED: 12:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: ADAM DATE RECEIVED @ LAB: 9/13/2001 TESTED BY: LAB# 11471 LAB I.D. # PFB -97 REPORT DATE: 9/20/2001 SAMPLE SITE: JULIE CUOMO, 260 BARGER ST., PUTNAM VALLEY, N.Y. SAMPLE POINT: BOILER DRAIN SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: o Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 40 - EPA 110.2 15 • Odor 2- ORGANIC - - 3 Units • pH 7.12 - EPA 150.1 No designated limits • Turbidity 7.4 NTUs EPA 180.1 5 NTUs CHKMSTRY:.. , - ... ......_ ; . o' ` Nitrite Nitrogen • Nitrate Nitrogen • Alkalinity • Hardness • Iron • Manganese o, Sodium o Lead <0.20 mg/L as N EPA 353.3 80.0 mg/L SM 2320B 92.0 mg/L EPA 130.2 1.67 mg/L EPA 236.1 0.113 mg/L EPA 243.1 4.7 mg/L EPA 273.1 0.002 mg/L EPA 239.2 10 mg/L No defined limits No defined limits 0.30 mg/L 0.50 mg/L C:ornbined limit for Trot) plus Manganese = 0.50 mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= milliliter mg/I--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE, or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) ' o RESULTS BASED ON SAMPLES SUBMITTED: 9/13/2001 e Laboratory Director oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 o OUTSIDE CT: 800 - 654 -1230 I 10/01/01 MON 13:17 FAX lih fw 2 Kurt &.Julie Cuomo NORTHEAST LABORATORY OF DANBURY ,N ACCO4 w .. .,: t3 ' it+iii:L fvAYt�7'i t3.�LD'' °�3Y iSf7pci'i_ :""0 '8 1Corl °Pfl- II404:.: 203) 748 -7903 - PAX (203) 7480652 NY Cert: 11471 � LASS C . A . LABORATORY REPORT REPORT TO: P.F. DEAL & SONS DATE SAMPLE COLLECTED: 9/13/2001 4 PUTNAM AVENUE TIME COLLECTED: 12;00 P.M. BREWSTBR, MY, 10509 COLLECTED BY: ADAM DATE RECEIVED @ W: 9/13/2001 TESTED BY: LAB# 11471 LAB I.D. # F'FB -97 REPORT DATE: 912012001 SAMPLE SITE: JULIE CUOMO, 260 BARGER ST., PUTNAM VALLEY, N.Y, SAMPLE POINT: BOILER DRAIN SOURCE: WELL TREATMENT: -NONE r4AXIMM CONTAMINANT TEST PERFORMED . ,SULTS METEOD�# L> VC'1. (MCLI OR STANDARD BACT'ERL4L: • Total Colirorm (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml I_;K_w *fJzwi'3 ml= milliliter. mg/L= milligrams per Litcx ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count "."Notifteation Level **MAction Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or FNOTp07'ABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBNUTTED: 9/13/2001 Laboratory Director •NORTHEAST LABOP ATORY, 129 MILL STREET, BERLIN, CT 06037• (860)9Z, -9787 - FAX (860)829 -1050 TOLL PRE8 WITHIN CT: 800 - 826 -0105 . OUTSIDE CT: 800- 654 -1230 • Color (Apparent) 40 - EPA 110.2 15 • Odor 2- ORGANIC - - 3 Units • pH 7.12 - EPA 1 50.1 No designated limits • Turbidity 7.4 NTUs EPA 180.1 5 NTUs CH ENHSTRY: • • Nitrite Nitrogen <0.005 nzg/L a N s EPA 354.1 , l .0 mAltt _ 10 mg/L _ _ .._...,.._..... _ .. . _ • Alkalinity 80.0 mg/L SM 2320B No defined limits • Iron L67 mg/L _ne EPA 236.1 0.30 mA • Manganese 0.113 mg/L EPA 243.1 0.50 mg/I, • Sodium .7 mg/L EPA 273.1 20,0 mg/L•" • Lead 0.002 mg/L EPA 239,2 0,015 ntd/I.' *s ml= milliliter. mg/L= milligrams per Litcx ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count "."Notifteation Level **MAction Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or FNOTp07'ABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBNUTTED: 9/13/2001 Laboratory Director •NORTHEAST LABOP ATORY, 129 MILL STREET, BERLIN, CT 06037• (860)9Z, -9787 - FAX (860)829 -1050 TOLL PRE8 WITHIN CT: 800 - 826 -0105 . OUTSIDE CT: 800- 654 -1230 _.:_ ... �::- :: __.:... �.......,.. ; . -. ._ • - ENDING NFZRMA _ _ ... _ _ . e _.- ...n. _.: ,v .u.-_ -+: ..o � .. .spua -, - -. r^r—...k. -v =r �..: a . -. .�:p• a.^.. ' _ x,L,. _, ...n.,v �.ur..a:� ,;s �� . - ista . y >=^r.� .. s n:v �-... DATE : DEC-41-2001 TUE 14:58 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96214756 PAGES : 0/1 START TIME : DEC -11 14:57 ELAPSED TIME : 00'001, MODE : ECM RESULTS : NO ANSWER FIRST PAGE OF RECENT DOCUMENT FAILED TO SEND FULLY... 0691%9109 '.W MUM - 6010.91@•006 .y7 N=M %M T(QL af01 '0Lt(090)Xyn•Lilb7LBi0901 -um L7'N110i(•19t01t0 Tpj16Ll'Ai10.LV�ipeV(16V9HLVpH• mlOOrjQ I y� 'Oi• x'�•�� 100TKTl6 :ex_ � ,rmra.�: 6&1A4K D10 Q8SYH CI706'18 •' (GiLVis3'ffi�Vliyldflt1i 6Q0'aU01VJ898D1Affi HLN3Id07diQY80A MeN dQV7.vi411Hd1 irma0ii0171 �.J 11 m i'mrmAm � MADOV (1'B T•m Va•V�M1 t>m•I�RsV.ro I•+s'I v°Ps°OPON•: 0ob�ol sngr•s°y(00.UA1l11 I�T0rs0'o4+aYi+t09i P�•P^®v�i �1!I�Cm06191�+IRm mOMll�•I® «.%Avtl0'0 - T'6tivdd 'i@A two Pon ..7/�O'OL 4'6LL Vera �_ 7Ao1 ®ryos �:. .... t» OSO i'[0L Vdi '1/� 611'0 amtAON'" VmOra 1'myes v*° L9'1 "v0 4wr www �i( eazll.vs '>h� �n1v TOQaI IWV,3 Komsm wa' ®'bAQ1R090'1 V-0-1 Ts. swa. ��?Io1Wal 'ASS iW -r"F IO@IVd$ flux °'L Aa?Wl 4,m "w6m°N l'Otivdi cm 90 soul! t - OWIDW1 lop0 n 1'011 Via M Px001+�0 HERO TT9 T-001-d 0 v� QaTaKv3suo cow Boom Awxmvjmu f 7 fl�' 8NOd1 Tmm -A3ZS4 !Mod NGVQ VIWO 'A:V'11(17vAiVVN MIIOttiU8VE[09t'00movL'1i IM '- [OOTIOyi 7jvpiHpolH L6'em o�g1�L 10119m :A %COL= I WA V6 :9V'l ®U3AQi0H9 z= Frmy 'AeGSLOUTIM twat'A'NY2SanumiB wa oDL1 x5mor=mm 80lQAVP1v:Qf it IOWA 1=71rrmalemam 6m47V80 y a� a�oai�zoe[v = 4m ,t81?>D,.vHOgv'T.T5Y9Hil(G!lw• a 9HV', p wit 303 A.V o804•L 1QOLl xvi - °OiGeliL la°L AT KWEfd !M* 1J 11990 SJ 1 vQry- t7VM Arvu T= Be •0°01 a,t ` aeeleQ d0 V 0aV p 1OVSKINOR s� �tTar 4 L00® IV3 Wel 1('001 T6/10/01 Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 MULIMkf k.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 -7921 Nursing Services (845)278-6558 ' WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 October 24, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Beyer & Associates 73 Secor Road Bryant Pond Plaza Mahopac, New York 10541 Dear Mr. Beyer: L Mme, 0 Re: Application of Certificate of Construction Compliance - Cuomo, 260 Barger Street (T) Putnam Valley, TM# 74.10 -1 -40 This office has determined that the above referenced Certificate of Construction Compliance application, received by the Department on 10 /22 /01is incomplete. Please be advised that the following information is required before the Department may commence. its review. Documents: 1. Original water quality analysis is required, a fax or copy is not acceptable. _.......Plan:.. .�- ..::....... � :...:.. , - .......:...:. _� ..� . _ _._ ...::.: a._...� . _.. .._ .: . ,.,.:...:.. -.. _.. _ : ..:... , .......... _ .._, .:� 1. Please verify survey reference on the as -built plan. This as -built plan is based upon a survey prepared by Robert E..Baxter, NYS Licensed Surveyor 49434 dated August 10, 1993. 2. House should not state "proposed." 3. Well should not be "proposed." This office will continue its review upon receipt of the above mentioned comments. Please feel free to contact this office if any questions arise. Very truly yours, al Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Beyer and A ssocia tes consuitmgapDeers 71 Bryant Pond Plaza, Suite 5 Fax. (914) 628-1905 Mahopac, New York 10541 November 30, 2001 Mr. Adam Stiebeling Assistant Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Cuomo Residence Barger Street, Putnam Valley Tax Map 74.10 Block I Lot 40 Dear Mr. Stiebeling, Please find the enclosed materials for the As Built submittal for the above referenced property. As per your letter dated October 24, 2001 the following information is enclosed: 1. The original Water analysis results are enclosed. 2. The note referring to the As-built survey has been altered to the correct reference. 3. The house is depicted as existing. 4. The well is depicted as existing. 5. Three (3) sets of the revised As-Built Plans are enclosed I-trmt-tha �bsve_.�naterWs av- - adeq"udnejor your -approlylar or the above refie;-encedprqj�ct, However, if you have any questions or require further information concerning this project, please do not hesitate to call me @ 621 -4756. 11 L"U. Yerjyyuly yqlu-rs' Chris Caralyus Project Manager Beyer and Associates T. . 4(21 -4 e191 :756 Bryant Pond. Plaza, Suite 5 Fax. (914) 628 -1905 Mahopac, New York 10541 October 1, 2001 Mr. Robert Morris Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Cuomo Residence Barger Street, Putnam Valley Tax Map 74.10 Block I Lot 40 Dear Mr. Morris, Please find the enclosed materials for the As Built submittal for the above referenced property. This submission includes the following items: 1. Certificate of Construction Compliance 2.. Three copies of Guarantee of Subsurface Sewage Treatment System 3. Well Completion Report 4. Water Analysis Report 5. Three (3) sets of As -Built Plans 6 ._Application fee of $20v 7. E911 Address Verification Form I trust the above materials are adequate for your approval and completely satisfy your previous comments for the above project. However if you have any questions concerning this project, please do not hesitate to call me @ 621- 4756. T Cn��� J C -S Project Manager Kc OT* r • -v BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARl R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services .(845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 601,4 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Michael Beyer, P. E. 78 Secor Road Bryant Pond Plaza Mahopac, NY .10541 Re: Cuomo, Barger Street Theresa Est. Lot #4 Tax Map #74.10 -1 -40 Dear Mr. Beyer: July 17, 2001 _. _.._ This Office has conducted "Fill Pad Inspection" Thursday July 12, 2001; as requested for the above referenced project. I offer the following comments: A. Erosion control measures (silt fence) installed incorrectly. Silt fend "fl. p ":to.be buned. *.... B. Fill Pad "ROB" measured 127'x 80'. C. Side slopes (impervious fill) to be maintained at 3:1. D. Trench plan to be submitted for review and subsequent approval. System (trenches) not to be installed until such time as "trench plan" has been approved. E. Trench plan to reflect "changes" in house placement location and location of "roughed in driveway." F. Plan to also include curtain drain monitoring/observation points - 5'- 0" either side up and down gradient of curtain drain. t'z Details enclosed. 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. Adam B. Stiebeling Assistant Public Health Engineer ABS /jp enc: CD details q" PERFORATED PIPE W/ LAP -EXISTING GROUND 7 a,,, N , - �; — STANDPIPE SHALL BE INSTALLED 5 ON,EACH SIDE OF CURTAIN DRAIN — P, PE T c lJr`a P?6Q i,J G c t-A amt G, WASHED CRUSHED STONE3/4" — 1 -112" M-IN STANDPIPE DETAIL -f 10 PROPO/SED ROOF & FOO ING.DRAIN PROPOSED SEEPAGE PIT \� (SEE DETAIL) PROPOSEQ DRIVEWAY 50 EXpq/VSlc tv, .......... 14 SF SF............ SF STAND PIPES (TYP..) TO MONITOR WATER EXISTING BiTOMBE PAVEMEN REMOVED/ `: -/ •�• ,...yam, •"-.- ..tiZ•.. �,V. .• /�� i n \., 1.`•.t+ `. �..� _ •.�`. .". �_ _ // _1 .mow... •' =fry.- t: ..ti ��\ `� ^� ^>.._ ~`. -,,,may �' *..,..w •�.� 1.....�i �"�,.. �r Cap I •t" Solid or Slutted PVC Pipe K ; Pea Stone Varies - 2' Below or Proposed Bottom of Sharp Sana a System or. 2' Below M ottlins or, 2' Below Anticipated ><tax. Ground water GKOVN D WX -T1!R MON17 -OKING WUH_L .OT 8 SEPTIC Af ��rm% r� A L d S " =30 S A / r° mV 1 GKOUND Whir -IR MOKIYOKING WELL- OMI FAMMgIM N 4' Solid or Sluttea PVC Pipe Pea Stone Varies 2' Below or Proposed Bottom of Sharp a-4 System or. Sano Z' Below Mottling or. 2' Below Anticipated NI ax. Ground Water GKOUND Whir -IR MOKIYOKING WELL- OMI FAMMgIM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Dater 1z o/ - 1, - Street Loca 'or, TMr 1. Sewaee Systeb Area a. STS area located as per approved plans .........................:: b. Fill sect-ion - date of placement 3:1 ba-�rier . Loth. Width Avg.Dpth 3 c. NatursL soil not stripped ................... ............................... d. Stone, gush, etc., greater than 15' from STS area.......... e. 100' from «•ater course/ wetlands ...... ............................... II. Sevkcye Svstern a. eP tic t • size -1,000 .......1,250 .......other ............... b. Septic tank installed level .............. .................. .............. c. 10' ni_ninzum from foundation........ ... .. ........................... d• Distibution Bo 1. ut ts at same elevation -water tested ...:........... 2. Protected below frost ................ ............................... 3, N i' um 2 ft.0rigi nal soil between box & trench e. Ju anon Bo .. ,;.properly set .......... ............................... f. nnc . es- I.-Length required '300 Length installed P c 2. Distance'to watercourse measured Ft......; 3, Installed according to plan ...... .......................... ...... . 4. Slope of trench acceptable'l /16 - 1132 "Ifoot......... S 10-ft. from property line - 20 ft: foundations...... 6 Depth of trench <30 inches from surface ......:....... 'I Room allowed for expansion, 10.0% ..................... 1 Size of gravel 3/4 -1' /2" diameter clean ................ I- Depth of gravel in trench 12" minimum ............... _ ... T. -Pipe ends capped .................................. :............... g. k11MR or Dosed Systems 1. ize ot pump chamber .......... ..............................: . Overflow tank....: .................. ...................... .......... 3 . Alarm, visual / audio .............. ..............:................ 4. Pump easily accessible, manhole to grade....... .... _ -_ -_- S, First box- baffled .:::::::::::�:�.:::::...... __ . _........... - _ .................... 6, Cycle witnessed by H.D.esti nated�flow /cycle... TJ:I, useBuildin .., a house locatdd per approved plans ...:.:.....::.....:........ T(umber of bedrooms.. IN. ell ............. ............................... Well located as per approved plans ................ .... 1 Distance from STS area measured '�ft ... c Casing 18" above grade .......... ............................... i Surface drainage around well acceptable ............... V. 9verall Workmansbin. i Boxes properly grouted .......... ............................... I. All pipes partially artiall backfilled .. ............................... i R L All pipes flush with inside of box ......................... ,. i. Backfill material contains stones <4" diameter.... :. Curtain drain & standpipes installed according to Curtain drain outfall protected & dir.to exist wat, g. Footing drains discharge away from STS area...., i h. Surface water protection adequate ....................... i. Erosion control provided ....... ............................... J33JlJ �.V.bY V'. . 11 A Owner C L07 VK D Subdivision Lot r FILE No.215 09/18 '01 21:41 IMEYER &ASSOCIATES FAX :8456281905 PUTNAM COUNTY DEPARTMENT OF HEALTH H IDMISION OF ENVIRONMENTAL HEM TIHt SERVICES ATTENTION ADAM GENE For: Pill All information must be fully completed prior to any Trenches inspections being made. PAGE 1 PCHD Construe on Permit # L' ` �) - 00 Located: 16,0 l rr/ air r fi (T) M Owner /Applicant Naffie: ,T,1; c „k+.. o TM V O ]dock j Lot y� . Formerly: Subdivision Name: T/A P r06W CSHI -Ps Subdivision Lot # Is system fill completed? "t S Date: Is system complete? VC �I Date: Is system constructed as per plans? Is well drilled? 4VC Date: Is well located as per plans? rZ; S Are erosion control measures in place? � s i certify that the system(s), as listed, at the above premises has been constructed aad I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans a_nd..the Standards, Rules and Regulations of the ]Putnam County Department of Healta.- . Date: 17 l Certified by: " ' PE RA Design Professional Address: �2f— "� p / -- ,; �Vi ote LiG. # 0-2 VM7 Comments: Force FIR-99 NAME: PI ITNAM rni INTY nPPAPTMFNT nF P. 1. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .... CONSTRUCTION PERMIT FOR SEWAGE TREAT PERMIT # ��1 -11-0c) y 4 Located at .60.066, C9 Sj"/y- 66 r Town or Village 1, A LZ Z-,P Subdivision name j/ -E,ECA &'17,4 f Subd. Lot # ` Date Subdivision Approved a /d/ 5t Owner /Applicant Name M.9, - /`ul/'c AME 7— t ut)Alo Tax Map 7 Block �_ Lot d/O Renewal Revision Date of Previous Approval Mailing Address 41 kr� 444 �/4 Ll�r� AIV Zip 1"7% Amount of Fee Enclosed Building Type wp,,n GlL9mr prix Lot Area 4ANo. of Bedrooms Design Flow GPD4?OL,) Fill Section Only Depth Volume Separate Sewerage System to consist of /:�,S'0 gallon septic tank and r Other Requirements: 3 j H /:� G 1A/ i1/ To be constructed by /JZ,KLA Dil,/JfU'IaN Address G //'! r»lj,)iy jZAtt, Water Supply: Public Supply From _ Address or: x . Trivke Supply Drilled by Pf %J AG I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem 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: / P.E. R.A. Address % .x -a o,Q 4)'Q So /a S M &P A,,� License # Date APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and, inspected by'the PCHD and is revocable for cause or may be amended or modified when considered necessary by Public Health Director. Any revision .or alteration of the approved plan requires a new Krrrf i� Approved for`4isoarjA okd�mestic sanitary sewage,lonly. By:( L &�4- _ �` Title: l Date: i. White copy - HD File; Yellow copy - Building Inspector; Pink copy I Owner; Orange copy - Design Pro essi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Mr. and Mrs. Kurt Cuomo Address 4 Kenneth Dr.,PutnamValley, NY 10579 Subdivision Located at (Street) Barger Street Tax Map 74.10 Block 1 • Lot 40 ( indicate nearest cross street ) Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking a� in I . Date of Percolation Test ZL181B1 Hole No. Run No. Time Start — Stop Elapse Time (Min.) Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches ' Percolation Rate Min/Inch. PT -1 1 11:47 -11:55 8 24 27 3 2.7 2 11:57 - 12:05 8 24 27 3 2.7 3 12:09 -12:18 9 24 27 3 3.0 4 5 PT -2 1 2:20 -2:45. 25 24 27 3 8.3 °.24.. _. , ." ..27 3 3:16 -3:41 25 24 27 3 8.3 4 5 1 2 3 ` 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e: <_ 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to.be submitted,for review. 2. Depth measurements to be made from top of hole. �. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 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 Design ]Professional Dame: Beyer and Associates Address: 78 S'ecor ro Signature_ Pond Plaza. Suite 5 Design Professional's Seal A' p' and Associates Consulting Engineers 78 Secor Road, Tel. (84$) 621 -4.156 Bryant P�onYAz'a, Suit'e'5. - FL"'(84bj 0284905 Mahopac, N.Y. 10541 July 25, 2001 Mr. Adam Stiebling Assistant Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Cuomo Residence Barger Street, Putnam Valley, NY Tax Map 74.10 Block I Lot 40 Dear Mr. Stiebling, Please find the enclosed trench plan for the above referenced property. The following is a response to your latest comments as a result of your fill pad inspection : A. The erosion control fence has been repaired B. The Bank Run portion of the pad was measuredprior to the placement of the clay berm and the updatedpad is shown on the enclosed trench plan. Based on field measurements taken off the rear two corners of the house, the bank run pad is 88 feet wide at its narrowestpoint and widens out to 100 feet at the end of the expansion area The pad appears to be of a sufficient size for the proposed SSTS. C. The impervious fill will be maintained at 3 vertical versus I horizontal D. The trench plan is enclosed with the_cnrret fill paa location sh6wri E. The house and driveway locations have been changed on the plan to their proper locations F. The curtain drain observation points have been installed on either side of the curtain drain We are hereby applying for a construction permit for the construction of the SSTS trenches. Enclosed please find a copy of the following items for your review and approval: Construction Permit for Sewage Treatment System Percolation sheets for pert tests in the fill pad Three (3) copies of the trench plan I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me @ 621 -4756. Sinc ,. Chris Caralyus Project Manager ®� - r, BRUCE R. FOLEY Public Health Director DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient . Services Environmental ,Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Michael Beyer, P. E. 78 Secor Road Bryant Pond Plaza Mahopac, NY 10541 Re: Cuomo, Barger Street Theresa Est. Lot #4 Tax Map #74.10 -1 -40 Dear Mr. Beyer: July 17, 2001 Dada "A This Office has conducted "Fill Pad Inspection" Thursday July 12, 2001; as requested for the above referenced project. -I offer the following comments: A. Erosion control measures (silt fence) installed incorrectly. . _.._.. ..- Silt fence'Ttap " -to be-buned. _ .. _ ,_. :. _ _ .. a.... ....... B. Fill Pad "ROB" measured 127'x 80'. C. Side slopes (impervious fill) to be maintained at 3:1. D. Trench plan to be submitted for review and subsequent approval. System (trenches) not to be installed until such time as "trench plan" has been approved. E. Trench plan to reflect "changes" in house placement location and location of "roughed in driveway." F. Plan to also include curtain drain monitoring/observation points - 5'- 0" either side up and down gradient of curtain drain. Details enclosed. 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 yo s, Adam B. Stiebeling Assistant Public Health Engineer ABS /jp enc: CD details 4" PERFORATED PIPE W/. Lap a 1 PROPOSED ROOF & F00 ING . DRAIN PROPOSED SEEPAGE PIT \® (SEE DETAIL) PROPOSED DRIVEWAY �so, Ti Sp °� '0 0 40' _ �� SF -C-31 / SF � . 7 SF SF , d, STAND PIPES (TYP.) TO MONITOR WATER EXISTING BITUMINOUS PAVEMENT TO BE REMOVED FILE No-940 0708 '01 18:39 ,. ID :BEYER&AMIATES FAX:8456281905 PUTNAM COUNTY DEPARTMENT OF HEALTH DI'V'ISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION )(ADAM GENE R-. EQ EST Egg FINAL WP .CTION F t/ For; Fill PAGE 1 All information must be fully completed prior to any Trenches inspections being made. • PCHD Construction Permit # 1� l l -Da Located: t3A R (-Ile 2 !Srl P u Ttl*M V N4:f- ( Owner/ licant Name: C90M O TOV) 4, I Block Lot Owner/Applicant �.r2... _L 4-0 Formerly: APU.SA CSTATc 5 1074 Subdivision Name: - rW02AA c5779T e_5 Subdivision Lot # A Is system fill completed? yCS Date. 24S16f Is system complete? Date: Is system constructed as per pleas? --� Is well drilled? NO Date: Is well located as per plans? �----= Are erosion control measures m place? -Ye: _ I cc* that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. .,.Date: Certified by: /LI %1te yP2 PE �� 1 ` Design Professional Address: Se cot jYa& A I /O PI Comments: hit PIED. JR&a&„wAle AARA140f1 '-'- S/L T &a X (U(2 CRP A)573wI -_e6 60/2 mNSPecLlw -,Arlo/ Form FIR 99 \� PNTNAM COUNTY DEPARTMENT CIF HEALTH 1� MWSRON GIF IENWRO NI MNTAL HEALTH SERVICES CON. STRU CUO" EE E WAGE TREATMENT'SYSTEM PERMIT # 00 - Located at 8 ,4.O&El'L SuEEi Town or Village &7'A64m v&G6k Subdivision name 7 6jei2 6.sA 63TA, 7-eS Subd. Lot # _l Date Subdivision Approved Xz � / CK Owner /Applicant Name AC i- Allf-f jCvtZT c u0wQ Tax Map 7�( O Block / Lot YO Renewal Revision Date of Previous Approval Mailing Address y &&IvCM ji(I 'C , A17AM;M (1,466CK /Vr Zip _.7C7 Amount of Fee Enclosed 1300 Building Type ,S A16.(_C F,4m. h6�11-C Lot Area h 4C. No. of Bedrooms V Design Flow GPD S200 MIR Section Only Depth Volume PCP D NOTIFICATION IS RE UIRED WHEN ]FILL IS COMPLETED Separate Sewerage System to consist of /)._0 gallon septic tank and Qo5-1A1(- 7—,41y& C� GAL DOM Other Requirements: 3 CAF Ell- L QUf/t I°/f-/,04k11 AA1;0 EZ& 'S ap Z 2726`4 To be constructed by 4fVA A- Address AhonetLa_ Water Sui��ld: Public Supply From Address ojr: >(: Private Supply. Drilled by �1, Sin Address 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: P.E. V R.A. Date Address 0 &MA (2D . ytkAtwehe_ License # 0.7 LY0 :7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necess y the Public Health Director. Any revision or alteration of the approved plan requires a new it. ppr a for 'sch a of domestic sanitary sew ge only. By: Title: Date: 4181el;o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profes oval Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL alease nrin or type '' PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # - AfZ6tsg, ST P(jTV4M VAltrr Map 7y 10 Block Lot(s) VO Well Owner: Name: Address: Z/ /C €NIvcrti 0/7. � tmr Cv/1 Gtii7 �tltr,4M Use of Well: L Residential Public Supply Air /Cond/Heat Pump Irrigation rima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm #People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason v 5L V tz- for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision iNEI�'f .4 EST,4TFS Lot No. Water Well Contractor: P'r 3Pc' Address: Qxe-"0aIKQ -- Is Public Water Supply available to site? .................................. ............................... Yes No x Name of Public Water Supply: Town/Village Distance to property from nearest water main: > So Fr• Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: J'2 E� e,D Applicant Signature: L'(-:&� 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 b Putnam County. M � Date of Issue 1� ©� Permit Issuin Official: OL Date of Expiration o Z Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a APPLICATION FOR A.PPROK4 -L OF PLANS. FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: %l�l? �?�, �lc/ .T ��uc�/1//O y IeEiiivE T14 'D 9 i v 2. Name of project: keQs —co ssps 3. Location TN: Pf/1k4& 11,466C N 4. Design Professional: /ZVO-4 5. Address:. , ?9 ScCDiL leyo Sv /%CS 6. Drainage Basin: M#OPC , IVY /(2 S %/ 7. Tyke of Project: ' . y_ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt x Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ?..... ...................... A10 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 ..o -c.ials; -ardi� antes? : ...... ....:..:..........:......:.:..: . :...:.:......:::..: : :::::.:::.:... -.:. :: 'E C 13. If so, have plans been submitted to such authorities? i'rS 14. Has preliminary approval been granted by such authorities? Date granted:L_ 15. Type of Sewage Treatment System Discharge ................. surface water ,/groundwater 16. If surface water discharge, what is the stream class designation? .................... i0 17. Waters index number (surface) ..... ............................... 18. Is project located near a public water supply system? ....... ............................... X).0 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ ')— 21. Name of sewage system Distance to sewage s stem 22. Date test holes observed S"p,,4T,R� a 23. Name of Health Inspector q- 24. Project design flow (gallons per day) ......... ............................... .................... 840 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... _do 26. Has SPDES Application'been submitted to local DEC office? ......................... Form PC -97 27.. Is any portion of this project located within a designated Town or State wetland? „ 28. Wetlands ID Number .................. ............................... .......... ............................... p 29. Is Wetlands Permit required' I ........................... ............. ............................... O Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... AID 31. Is or was project. site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landflling, sludge application or Industrial activity? ............................ Yes/No t7 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No dV 0 DESCRIBE: 33. Is there a local master plan on file with the Town 'or Village? ......................... hf 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ............................................................... _ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map 7Y bBlock / Lot _�Q 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and,approval of a.new.SS.TS to be- located within the NYC Watershed shall. be sent to' thc Departinerit; 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 stormwaterylans 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 pert -ury, that information provided on this form is true to the best of tray knowledge and belief. false statements made hereita are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Pe ]Law. SIGN NATURES & Op'I'ICL4L TITLES.- Mailing Address: ................................... 7 CC S ri ;4 F :, Py'Incl ��.. ®m PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES ..-.....,. �.,.,... �.:__;_. :;.`D�S��]dD-AYAS1tI�ET S1I11ISUl���SE�i' AGE• TR�ATI��vT�SYS `I'E1VI.:...:�;:,�.:�.._ .....: :.... ... _�:. Owner Mr. and Mrs. Kurt Cuomo Address 4 Kenneth Dr.,PutnamValley, NY 10579 Subdivision Located at (Street) Barger Street Tax Map 74.10 Block 1 Lot 40 ( indicate nearest cross street ) Municipality Putnam Valley Drainage Basin Date of Pre - soaking SOIL PERCOLATION TEST DATA Date of Percolation Test Hole No, Run No. Time Start — Stop Elapse Time kmin.) Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate MinAnch PT -1 1 2 3 4 Percolation Rate Used = 31— 45 min/inch and Test Pit Data as per approved plans for Theresa Estates Subdivision approved Tanuary 26--1995- Town of Putnam Valley.— 5 PT -2 1 - 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ( i.e. s 1 min for 1 -30 mindnch, 5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 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' &W 8.5' 9.0' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. I HOLE NO. 2 HOLE NO. TOP SOIL TOP SOIL COMPACTED LOAM WITH SILT COMPACTED LOAM WITH SILT Indicate Revell at which groundwater is encountered No Ground water encountered Indicate Revell at which mottling is observed 3.5 FT Indicate Revell to which eater level irises after being encountered NIA Deep hone observations made by: Date Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant Pond Plaza, Suite S Signature_ Design Professional's Seal r. I4-16r fMS) —TNI 12 PROJECT I.D. NUMBER. $17.20 SEAR �---- State Environmental Quality RevIOw SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only e. e• r —eon IV1%T IfiFnR ATION Re be cemeteted by AnDheant of ProleCt 6DOnSOr) 1. APPLICANT 13PPNSOI'A 01,v L 2. PROJECT NAME 3. PROJECT LOCATION. . Municipality 11 I�GGE/ County a. PRECISE LOCATION (Street address and road Intersections, prominent landmar"; eic., Or provide map) 47 8�1►2G�a 5; ec6r Sv5f l„/E�.r OF THE V- %1Li2/v1C ST, C-_ 19141Zl(6✓,4 b. IS PROPOSED ACTION. uGJ Naw D Expenslon ❑ Modlllt:atlONallerallon' 6. DESCRIBE PROJECT BRIEFLY: CON; Tl?ilcr h/ C9 kf0vsr ./ EGG 7: AMOUNT OF LAND AFFECTED: °L Initially acres Ultimately acres e. WIILxL PROPOSED ACTION COMPLY WITM EXISTING ZONING OR OTHER EXISTING LAND USE RESTF-71ONS7 Lid Yes ❑ No It No. describe briefly. B. WHvAT 15 PRESENT LAND USE IN VICINITY OF PROJECTT nn n - la'esl901181- :' C Incustrl ®I - COmmerclal .. i.0 Aprtculture ParWFweivopen space - . O_ tner . __.._..... _ Deacrloe: f�vSC &or /S I„1iyMlN ./1/v, AlolORajl6t) S✓6)0) / 11'10/✓ Lf)F S11V&(C F.4/r /1-Y MMES 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTMER GOVERNMENTAL AGENCY (FEDERAL. - STATtEE OR LOCAL)? Yes ❑ NO It yes, list aponey(s) and winlWpprorals PU -'/vAM 40C.411-V6 /J �A/�'Ti�F✓T 11. DOES ANY ASPECT OF THE ACTION MAYE A CURREwny VALID PERMIT on APPROVAL? ® Yes O No It yes. 11411 aperlry came and p41nt111tapproIPW , P07"f141 V4"4 -r 10&1k11vl/v(_ 1�0441W 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPMOVAL REQUIRE MODIFICATION?, . Mf ❑ Yes 140o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE aEiT OF MY KNOWi.E:4E ApollunWpmaa nuns' / 1 /t'Wee— UFy°,E%�— ales } Slpnsture: It the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 0 y PART N ®ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A DOES ACTIOWEXCEED ANY TYPE 1 YrtRESHOLD IN 6 NYCRR. PART 617 47 11 gob, coo101nD1e $no 100.00, process ont use one FULL EAR Vol; ONO WILL aC1)On A:CE= V.S :CCOF.D?114AtC0 MEVIEW As PROVIDED FOR UNLISYED ACTIONS IN 6 NVCRP. PART 617.6') to NO D negative oeC1d'D1io• Map be 090010000." DI 8481119' ►nvO1v99 0oen16' — • , r. . Yes NO - 6 COULD ACTION RESu.T IN 610 ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING W-4015 RIDy bt nano rule►. 611061014. = = C1 EnrShng at, gustily. SurfDCO Ot groundwslot owatlty Or qusnitly, note& 600915 0815ting 119111C g0110tnb. D0110 aDSle WDOWC110" 0' 016005a P01011D' lot Oro6101' afainag0 Or 91001n6 prObloms" IEUP10)11 briefly a C3 A0611101K. 09116ulloW o164000108401, 010tiIItS, t: (Whpr aD1ur01 Or 6ullurDf 10gau►606, at 6Ornmently at 1ZOtgnDorho09 6nolociof s Eaploor briefly Q b090101101, of !Dana h6 %. anellASh of pdalife 000clos. D19n1f16Dn1 iWO11015. of owwt0tlo9 Or 00@ongOrOd 0000106? gaptala brteNy C4 6- rafarn9ndy'6 osISting plans Or 00016 05 OfIittally 0000109, Of 0 61`100180 in U06 Of Ifl1011D11y Of 000 Of land Of Othet Miami 1050urces9 gal) toin fit toIIy CS Gomm. 690008uenl 01?v01oRM0111, or 1010109 activities Iitioly 10 bo In ®9609 by Gila p►OpOD1T9 octlon% U91011% brlolly. CE Lon6 IerR, BnOrl 101►+. 69wlulativ0 01 Other 0118C1s 401 tgenlile30 rn tyT CS? Ea ®lain brK311p. c? OIflO' tfi1p0 ".16.t1nglul;m6 eh ®noes in use Of Dither quantity Or type at 0natey1') IEap101n brially. D' WILL THE PROJECT NAVE Ale IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA9 V05 ® NO ••� ., _ . ,��,. ; ' IS-YAERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ... -. hI Y0s n ,. .. Cl N0 : 11 Y(ie. Ospldl�r..rt1t9d1y ... - .,..,....... PART III —DETER MINATiGN OF SIGNIFICANCE (To be completed by Agency) ' INSTRUCTIONS: For each adverse effect identified above, determine twhef f It is substantial, large, Important or otherwise tdignifieont. Each effect should be assessed H connection with Its (a) setting (1.9. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope, and IQ magnitude.� It nocast;ary, add atlachment6 of reference supporting materials. Ensure that 0ugllariations contain Sufficient detail to show that all relevant Adverse Impacts Rae @ been Identified and adequately addressed. It Question 9 of Par! It was chsekad yes, the determination and significance must Gvalulale the potential Impact of the proposed diction on the anvirortmental characteristics of the CEA. A\ ® Cheek this box If you have ,Identifled one or more potentially large at significant adverse impacts which MAY Occur. Then proc'cod directly to the FULL EAI: and/or prepare a positive declaration. ® Clesed< this box If you have delormilmd, tensed on the Information and analysis above and any (supporting documentation, that the proposed action WILL NOT insult In any significant adverse environmental Impacts AND provide on aittechmehts as,necesisary, the reasons supporting this d®termin ®ti ®n; ►141 01 pep Naefe 0r P►pOnEt P KlW rP1 Lee Agen60 1QM19►p 0 e6pOn11 a 1CQ1 Cif L40 AgenCO arm of 1,066 "hcv 6 �� ® aspens Kee Jlt n� grpotmrq 0 lcreloff I t 1 n»peanor e 9 leer :r 1Q i 1 -J f-/A r r Fil4Y� ,V I" PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. • t•<Y �' . ..- ..gar �r �.�.�. - w r ... ... � V .-.. a ". .-.n ..- .e .>.= � ... .a r n- ..bTi. -mu t� ` - •. ♦ � ._ . .. • r. LETTER OF AUTHORIZATION Property of AR, f 62llL k u fff G 0v10 i Located at 4- en�ur h 6Z f PLj f N A bA U A 9.�f Ls !j , TN AvM,01 V,461& Tax Map # 700 /O Block / Lot YO Subdivision of &2S— Aly6 LQAJ 1)11.ErD ( 1' n ?67s�4 Ccz-4 7CT ) Subdivision Lot # Filed Map # YD Date Filed 19� /G f 9S Gentlemen: This letter is to authorize M_ /C ffM E Z �CPC_/G a duly licensed Professional Engineer -x or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the rovisions of Article 145 and/or 147 of the Education -Law,, the Public Health. Law, and the PutnanrCounty Sanitary Code: ` Countersigned. P.E., R.A., # Very truly yours, (Owner of Property) Mailing Address 7F Secva_ Rte, Mailing Address: �Z %C6"671-1 M1,1C MktrjQa�,<_ State — Zip (05'x-( 11 _ I'vTMM yxZ&FF'y ,t N State 4/% Zip Telephone: &Z ( - 4 7 5-(-p . Telephone: Form LA -97 Beyer and Associates T 1 914 621 4756 78 Secor Road, -` Bryant Pond Plaza, Suite 5 'fax. (914) 62y1905 Mahopac, New York 10541 April 19, 2000 Mr.' Robert Morris Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Cuomo Residence . Barger Street, Putnam Valley, NY Tax Map 74.10 Block 1 Lot 40 Dear Mr. Morris, Our client, Mr. and Mrs. Kurt Coumo, proposes to construct a single-family residence at the above address to be serviced by an individual subsurface sewage treatment system and a private drilled well.. We are hereby applying for a construction permit for the construction of the SSTS and drilled well. Enclosed please find a copy of the following items for your review and approval: o Construction Permit for Sewage Treatment System • Application for Approval of Plans for a Wastewater Treatment System. • Application to Construct a Water Well • Design Data Sheet • Short Environmental Assessment Form • Plan and Profile- Separate Sewage Treatment System (3 copies) • Fee — Certified Check in the amount of $300 • House Plans (2 Copies) 1 trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me @ 621 -4756. Froject Manager 9& s N bdE LAND 3, 720 -S-q Ft !' o 2 6-f�A cres' 0 CA. cl C n m 4 ROPO X BDRM HODS 724 = 728.1 i GAR — C 72 .Q P�OR 475 w / � 0000 SJ >.�oa � axo�o_ �'4 1 - Mon. SWING TIES TABLE (FT.) REQUIRED A"' --- m A %Tlrr c 199;n GAL 66 48.5' 2 83 46' 3 136.5' 97 4 140' 107 5 .144' 113 6 146' 118, 7 152.5' 194' 8' 157 131' 9 163 138' 10 167 144 11 171 .149'. 12 176 154.5' 13 181, 161 14 131' 157 15 1259 151 18 119, 145 17 113 139' 18 106.5' 133' .99 -126.5,' 20 93.5' 121' 21 86' 114.5' 22 81' .107' 23 75' 101 WELL 50' 87.5' ITEM REQUIRED PROVIDED --- m A %Tlrr I 43AA VIAT 199;n GAL