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HomeMy WebLinkAbout3619DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 74.11 -2 -4.2 BOX 29 • 1I J loll 16 r- � I IFF Ve 03619 PUTNAM COUNTY DEPARTMENT OF HEAL ° DIVISION—OF ENVIRON�-rIENTAL HEAL'T'H SERVIC CERTIFICATE OF CONSTRUCTIONrCOMPLIANCE4, FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # RV-03, JI-W Located at W &&PV 4' iltfi Town or Village NUMA,M VA9A.& pp &Nin LL Tax Map °?�, L I Block ®Z- Lot . -Z Owner/Applicant licant Name Formerly Subdivision Name 61,660R Les Subd. Lot # 21 - Mailing Address JA! L-W e-K Chi" S/d"10Wd 10601< J`% Zip 1 40" B Date Construction Permit Issued by PCHD 097 . M • ( L_ Separate Sewerage System built by JC)6 � Address mw ot-9 Consisting of I Gallon Septic Tank and 400 LF 01: -f i "S Other Requirements: 644 + "O 12"-#J Water Supply: Public Supply From. Address or: Private Supply Drilled by NZOV..l AW ANQj::OJAddress L-M 1T :T%�TNAn.t -control been tariioetei d' __ Number of Bedrooms a Has garbage grinder been installed? y0__ I certify that the system(s), as listed, serving the ab iseg co tructed essentially as shown on the as- built plans (copies of which are attached), in th is Construction Permit and approved plans and the standards, rules and regulatio o;l a� -_,ty ent of Health. Date: p% • 3 aA 1 �- Certified by Address ,-, ?0; Any person occupying premises served by the above P.E. V R.A. License # D(�2g g0 �7 promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Ad 10-16 Date: �a z Whit co y - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Pe COMPLETION REPORT Well Location Street Address: / ! 7 W 0j d 'r' Town/Village., hl `, A ° f' �- Tax Map # Map Block Lot(s) GPS Well Owner: Name: %? Address: v t x!► V� P� �i �Q 117-10 v a �S-i Met. 4 a" C a c. IV Use of Well: 1- Primary 2- Secondary _Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Mary _Cable percussion _Compressed air percussion_Other(specify) Well Type Screened pen end casing _ Open hole in bedrock _Other Casing Details Total Length /v,ft. Length below gradelnbft. Diameter i_in. Weight per foot f lb/ft Materials: (,,,Steel Plastic Other Joints: v Welded Threaded Other Seal: ement grout Bentonite Other Drive shoe: Yes _&�No Liner: _Yes No Diameter (in) ISlot Size Length (ft) IDeptto Screen (ft) Developed? Screen Details First Second Well Yield Test _Bailed Depth Date Tea-sure from Well Log If more detailed dinformation descriptions or sieve analyses are available, please attach. If yield was tested at different depths during drilling list: u d Air Hours 1-! lYie During yield test ft 3& )e th From Surface ft. ft. Water Bearing :,,rface S(n 3 0 eet Gallons Per Minute r /_ _Yes No Hours 300 Formation Description Pump /Storage Tank Information Pump Type may,` ', Capacity_4p Depth 74, o Model Voltage ___a a o HPN,o Tank Type WA B 5 Volume � (, NOTE: Exact Location of well with distances tdat least two permanent landmarVs to the provided on a separate sheet /plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -9T Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building .Joe U e fill L.� C Building Constructed by Imo' Woo D 4unn- Location - Street !!!WA C_ 99*tpepa5 Building Type -74,11 aZ d-' Z, Tax Map Block Lot R"AM VAVL!N Town/Viilagu" Subdivision Name v 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 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 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 occupant of the building utilizing the system. Dated: Month Day a Year 1,ol Signature: o Title: W Gener Contra (Owner) - Signature �6L Caere Corporation Name (if corporation) Address: J !�j L.QDtM PAP, �OgK t_W State K zip j, D 9q& Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Of ENVIRONMENTAL, HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by woo 1) 4UL01— Location - Street Building Type _24'[1 ®Z 1 ors Tax Map Block Lot PUT/ yAtLn Town/VrlfagC- t,*& C Subdivision Name 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 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 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 occupant of the building utilizing the system. Dated: Month OA Day o Year 1,ol Signature: p Title: ® f GerVavl Co ctor (Owner) - Signature . ,�n&� Cam le Corporation Name (if corporation) Corporation Name (if corporation) Address: A L- O — lui,4D �V ZAVw�)- W2 Address: State Zip l State _ Zip Form OS -97 PUTNAM COUNTY DEPARTMENT OF .HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 'lob �jllw� Owner or Purchaser of Building Joi G, c Nil u 6 Building Constructed by WOOD 4II &L01- Location - Street Building Type Tax Map Block Lot Town/q l °' G�M1L t' Subdivision Name 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 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 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 occupant of the building utilizing the system. Dated: Month Day a Year Zol Signature: ,� / e Title: W Gener Contra (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: l LDW-)?,- pAQ Address: State N Zip State _ Zip Form GS -97 ALLEN BEALS, M.D., J.D. - .Commissioner of Health ... - ROBERT MORRIS, P.E., MPH Director ofEmironmental Health September 2, 2014 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New' York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Cronin Engineering James W. Teed 39 Arlo Lane Cortlandt Manor, NY 10567 Dear Mr. Teed: MARYELLEN ODELL Re: Construction Compliance — Gentile 199 Wood Street (T) Putnam Valley, T.M. 74.11 -2 -42 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. ® A full Putnam county profile water analysis has not been provided. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 43157 of any questions arise. Very truly yours, Jeph S. Paravati, Jr., P.E. istant Public Health Engineer JSP:cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROESERTi -14ORRIS, P.%., Afffl _ Director ofEnvironmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 4, 2014 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Cronin Engineering Tim Cronin 39 Arlo Lane . Cortlandt Manor, NY 10567 Dear Mr. Cronin: MARYELLEN ODELL County Executive Re: Field Inspection — Joseph Gentile Wood Street (T) Putnam Valley, TM 74.11 -2 -4.2 The above referenced separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time in reference to this Department's open work inspection. If.you have any further. questions, .please contact. me at (845) 808 -1:390 ext. 43261 Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR:cml tA,LLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. .Director ofF,nvironmental Health aK 9� 11ARX1;]LLEN ODF,LL County Execurive DEPARTMENT OF HtALT I Geneva Road, Brewster, New York 10509 Phone # (845)1808 -1390 Fax # (845) 2�I�8 -792.1 OWNIBRS NAME: Gentile TAX MAP NUMBER: .74.11-2-4.2 B911 ADDRESS: TOWN: Putnam . Valley AUTHORIM TOWN SATE: The Puft=. County Department of Health will not issuO a Certificate of construction Compliance unless the above foam is completed, Le., a 1*0 E911 #ress is assigned by are authorized town official. This form is to. be submitted with the application for a Certificate of Construotioo Compliance. (8911 wx&M) YO tSep 05 2014 1:21PM . HP LASERJET FAX p.l YML ENVIRONMENTAL SERVICES ,... r....; „ .:. ;,_,:.�:. ,..•.� ,. : , s : -,:., . - �;„�Q ._:, :. -.2 °aletia�tYilii�1g'riresStreet (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT.** LAB #: 1.401500 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN; 05/08/14 08:45 DATE /TIME RECD: 05/08/14 09:45 REPORT DATE: 09/05/14 PHONE: (645) -528 -1491 SAMPLING SITE: 197 WOOD ST, MMOPAC, NY SAMPLE TYPE..: POTABLE : WATER HOLDING TANK PRESERVATIVES: HNO3 COLD BY: NORMAN ANDERSON TEMP RECEIVED: < 4C NOTES...: COLIFORM METH: MF START DATE /TIMOL END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 05/08/14 0430 05/09/14 0415 MF T. COLIPOR ABSENT /100 ML ABSENT SM 18 -20 9222B 05/23/14 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113E OS/09/14 0240 05/09/14 0315 NITRATE NITRO 1.07 MG /L 0 - 10 HACH 10206 05/09/14 0320 05/09/14 0345 NITRITE NITRO 0.01 MG /L 1.0 MG /L SM18- 20450ONO2 05/21/14 IRON (Fe) 0.35 M© /L 0 -0.3 mg /l SM 18 -20 3111E 05/21/14 MANGANESS (Mn <0.01 M4 /L 0 -0.3 mg /1 SM 18 -20 31118 05/21/14 SODIUM (Na) 3.16 MG /L N/A SM 18 -20 3111E 05/09/14 0308 05/09/14 0310 * pH 7.5 UNITS 6.5 -8 -5 S1418 -20 456OUB 05/09/14 HARDNESS,TOTA 78 MG /L N/A SM 18 -20 2340C 05/19/14 ALKALINITY (A 76 MG /L N/A SM 18- 20'2320B 05/08/14 1000 05/0$/14 1002 TURBIDITY (TU 3.9 NTU 0 -5 NTU SM 18 (21308) COMM,ENTtS ... _. .._... 09f0'S /14,;AMMNDED RF,??ORT;- �rOAi?E4_G`r�RPCTED'I:OI�• I57 WOOD ST: . TO ;197 ,W,fJOD ST, (RP) COMMENTS: MFT'C oliform This result indicates that the water (was), was not) of a satisfactory sanitary quality according to York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 108 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. Sep 05 2014 1:21PM HP LASERJET FAY( p.2. YML ENVIRONMENTAL SERVICES Yorktown Heights, N.Y. .10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.401500 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 05/00/14 08:45 152 BARGER ST DATE /TIME RRC'D: 05/08/14 09:45 ATTN: NORMAN REPORT DATE: 09/05/14 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: 197 WOOD ST, MAHOPAC, NY SAMPLE TYPE..: POTABLE WATER HOLDING TANK PRESERVATIVES: KNO3 COLD BY: NORMAN ANDERSON TEMP RECEIVED: < 4C NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS w NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should _ Contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. • PH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW PH.MIGRT BE CORROSIVE TO METAL PIPES AND FIXTURES. THR. NORMAL RATdGE OF PH IS' 6. 5 TO 0.5.. 4 PH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. PH REPORTED FOR REFERENCE ONLY, Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAmESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L, THE HARDNESS MAY RANGE FROM 0 T0. HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMHNT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER; 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) ALR (ALKA)UINITY REPORTED AT PH 4.5) IMS IMS - IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELAT NLY TO ESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert H Padovani, M.T.(ASCP) ....CRONIN. 39 Arlo Lane. ® ENGINEERING P.E P.C.' CortlandtManor,.NY.10567 Professional Engineering & Consulting T: (91'4) 736 =3664. F: (914) 736 -3693 t w.. �ir- 4,al:..y M•.:.r.e _.S. rt. •i..•,. -r.v .. -..'� ..P" • ".. .- t.:.�_ ... .. ..• •.w ..�:. .e. August 22, 2014 Mr. Joseph Paravati Assistant. Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509. Re: Joseph Gentile : . Certificate of Construction Compliance 199 Wood Street Mahopac, New York 10541 Section: 74.11, Biock: 2, Lot: 4.2 Dear. Mr. Paravati; Enclosed for your review and approval please find the following'items regarding the application for a Certificate of Construction Compliance at the above referenced project: T. One (1)'Certified Check in the amount of $300 made payable to the Putnam County : Health Department. 2:. Three (3) Copies of a two (2). year guarantee signed by the Owner& the Installer 3.` Four %(4), Well Completion Reports signed. by Norman Anderson (The Well Driller) 4., One (1) Cooy_of Satisfactory Results of a WaterAnalysis by a.NYSDOH- Approved. Lab 5. Four (4) Certificates of Construction.Compliance 6.- Four (4) Sets of "As- Built "Plans- signed and sealed by the Design Professional :Please review the above items at your earliest convenience -and. should you have any questions or „require additional information, please'do not hesitate in contacting me afthe'number above. . Respec ully Submitted, jesW. Teed Project Engineer PUTNAM COUNTY DEPARTMENT OF HEEALT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at or Village �IV'�'► �' Subdivision name W71 1,e Subd. Lot # ' 2— Tax Map Block 2- Lot r Date Subdivision Approved Ayi4 VJ 1 (6 f ZZ 1 Owner /Applicant Name �te CENT l L-f, Renewal Revision Date of Previous Approval Mailing Address La Eq, FD, Neox-f" Af B F Ic' 1Z i 1�jj Zip Amount of Fee Enclosed Eo o Building Type 5 loint,�, t. Lot Area No. of Bedrooms L Design Flow GPD 200 Fill Section Only Depth Volume to consist of gallon septic tank and 500 � c T ` OF n. t^ n •I fhtt , ,.. A S�9 Other Requirements: C'un ✓'Ca r1 P inl To be constructed by 7 �@ Address Water ftply: Public Supply From Address or: 5c PrivaWSupply Drilled by 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. R.A. Date Address AI�,� (,ti �llQTL.�in/� �P..i� ��icense # �`}(n'2,�g(� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. B 7,7�= Cu r 1 �i Title: l Date: y hit copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # -'QEF T UfNPPA Map t �f Block Z Lot(s) Well Owner: Name: Address. & (,F, I 14 Lz pffL,4D b E, l� Use of Well: X, Residential Public Supply Air /Cond/Heat Pump I ' gation 1- primary 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 �, -�,d„1 12 ITx P ,rye for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....... Yes ......................................................................... No- Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision 6 6NT I LO Lot No. 2- Water Well Contractor: t Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: k Town/Village Distance to property from nearest water main: N 1A Proposed well location & sources of contamination to be provided on separate sheet/plan. Date; ApPlimit Signature:_ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 2 �i Date of Issue Permit Issuing Official Date of Expiration ey 6 y Title: sis tZ r ►ems Permit is Non- Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 •i 1Z. {: . -'ALT �- ;:.::_ _P TT���.COI�IY DEARTI EN.O�_ .-_ .. DIVISION OF ENVIRONMENTAL HEALTH SERVICES $ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM ✓'i PERMIT # i V, 03 ` I?-- Located at _ sD S (, �� Subdivision name 6 Gr,�i l L[ Srubd. Lot # 2. Date Subdivision Approved A�JGIVST (t f � 1Z Owner /Applicant Name — OE, O (�•�,n TI 1� To or Village )u T!V yv1 Tax Map Block _, Lot 14, Renewal Revision Date of Previous Approval Mailing Address Itj j.4'Q'�l?. R�L7c �gi'�Y�'�,�te(p(- �IG,IL� , AJj Zip !0 Amount of Fee Enclosed I E� b Building Type &okq, f�m . Lot AreaZ2,j7,-J- No. of Bedrooms Design Flow GPD �00 Fill Section Only Depth Volume Orate Sewerage System to consist of 1:5�DQ __ gallon septic tank and q0o Gc <7F Other Requirements: —71 eD-et "In -i r1 P_.liinl To be constructed by �1 Address Water Sunni y: _ Public.Supply From Address �-- :- -"::.k. �Private �Supply Drilled by•... -- -••'Address_�`""�"�`'�_-.: I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the 6eparate 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 gupent6i:v_n -fished the owner, his successors, heirs or assigns by the builder, that said builder will place in good 0l 0r tjng:.Conditiczn� y li�rt of said sewage treatment system during the period of two (2) years immediately following t te; .Rile issuance 6f ea�proval of the Certificate of Construction Compliance of the original system or any repa'r efeto Signed: ' r - = P.E. R.A. Date 'z Address `` b -. icense # - �d APPROVED FOR CONSTRUCTION <Tliffapproval 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 permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Ptn CP -97 PUTN,A►M COUNTY DEPARTMENT OF HEALTH DX.'VISXON ,OF. EN.VMONMENTAL HEALTH SERVICES LETTER OF AUTHORMATWN RE: Property of Josech Gentile Located at wOl" gtreat TN Putnam valley Tax Map -14.11 Block Z Lot 4.2 Subdivision of Joseoh Gentile ' Subdivision Lot # s FHad Map # '3241A Date Filed Auo4►Rt 16 , 2012 Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licemed Pro&seional Engineers or Ploostered4d -Aitset to apply fbr the required wastmtcr trratment.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 Daprtrtment, and: to sip.oll necessary papers on my behalf in connection with this matter and to supervise thegg!;'fr' ctr�o ff.-g�id wastewater tretment and/or water supply systems in contbrmity with the pr siontt of Ar lole �41 ' r1d/or 147 or the Education Law, the Public Health Law, and the Putnam od P.E., I %M 5280 062980 \ ''� - ......_ Mailing Address c""in Rnaineerina 39 Arlo Lane, Cortlandt Manor Stale New York zi P 10567 1 . ery truly. yours - 4- .g (o; ref My) Mailing Address: 14 Loder Road. Yorktown Heiohts State New York Zip 1)598 Telephone: (914) 736-3664 Telephone: 19141 174 -0111 Form LA -97 6 ZO 3!)Vd - ___ 31IIN39 09LOZ96OT6 90:EO TTOZ /L0 /0T P'UTNA►M COUNTY DEPARTMENT OF HEALTH. . DlYWON OF ENVIRONMENTAL HEALTH SER'V'ICES _ LETTER OF AU'!'HORIZATW» RE: Proparty of Joseph Gent, ile Located at w0 °d ArrP ®r. T!V Putnam ya11r_v Tax Map M 14.1,1 Block a Lot 49 2 Subdivision of Joseph Gentile Subdivision Lot 0 3 1~Oad Map M '3141A Date Piled AuouAr, 26. 2012 0entlemen. This letter ie to author!Ze Timothy L. Cronin II I a duly licensed Proficssional Engineer _Y'_ or i atersd- Architeet to apply ibr the required wastewater treatment "or water supply permit(s) to serve the above -noted property in accordance with the standards, ndea or regulations as promulgated by the Public Health Director of the Putnam County Health Dopartment, 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 conibrtt+ity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code, Countersigned: P. %-M # 062980 Very truly yours, ' (o;4 r of ) Mailing Address cro,nin Bnainearina Mailing Address: 39 Arlo Larne, Cortlandt P9anor State Now York zip 10567 Tolephone: (914) 736 -3664 14 Loder Road. Yorktoam Heiohts state New York Z10 10598 Telephone: 19141 714 -elil Pam LA -97 Z0 39dd 31IIN39 b9LOZ96016 5b:60 iIOZ/L0 /01 1 1 2. 4. 6. 7. 8. 9. 10. 11. 12. 13. 14. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR . A WASTEWATER TREATMENT SYSTEM Name and address of applicant: Joseph Gentile 14 Loder Road Yorktown Heights NY 10598 Name of Project: Gentile Property Design Professional: Timothy L. Cronin III Drainage Basin: Hudson River Type of Project: 3. Location: TN: Putnam Valley 5. Address: Wood Street ✓ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) _ Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No Yes Type Status (check one) ...................................:.. ............................... Type I ✓ Exempt_ Type II Unlisted _ Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No No Has DEIS been completed and found acceptable by Lead Agency? Name of Lead Agency Putnam Valley Planning Board . Yes/No NIA Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ............................:... ............................... Yes/No es If so, have plans been submitted to such authorities? .. ............................... Yes/No Yes Has preliminary approval been granted by such authorities? Yes Date granted: 1/23/2012 15. Type of sewage treatment system discharge ........................ 16. If surface water discharge, what is the stream class designation? . 17. Waters index number (surface) ....................... ............................... 18. 19. 20. 21. 22. 24. 25. 26. surface water ✓ groundwater N/A N/A Is project located near a public water supply system? . ............................... Yes/No No If yes, name of water supply Not Applicable Distance to water supply N/A Is project site near a public sewage collection or treatment system? .......... Yes/No None Name of sewage system Not Applicable Distance to sewage system N/A Date test holes observed 10/27/2011 23. Name of Health Inspector Gene Reed Project design flow (gallons per day) 800GPD (4bdrm) Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No No Has SPDES Application been submitted to local DEC office? ......................... Yes/No N/A Rev. 11/02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No No 28. Wetlands ID number . ............................... ................................ ..................a............ N/A 29. Is Wetlands Permit required? ...................................... ............................... Yes/No No Has application been made to Town or Local DEC ........................... Yes/No N/A 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .......................................... .........................Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? .................................................. :............... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No Yes 34. Are community water and /or sewer facilities planned to be developed within 15 years in or adjacent to project site? ........................................ 7 ................... Yes/No No 35. Are any sewage treatment areas in excess of 15% slope? ........................ 36. Tax Map ID Number 4 ...................... Map 74.11 Block 37. Approved plans are to be returned to ................ Applicant Yes/No No 2 Lot 4.2 Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall 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 1, the application must be . accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Timothy L. Cronin III, P.E. Mailing Address: ........................... Cronin Engineering 39 Arlo Lane, Cortlandt Manor, NY 10567 Form PC -97 617.20 Appendix C .. �.. _. . __.. State Environmental Quality Review ISH.ART,.:EN.VI OywEN AL:aASSES.g 'E NT .F.O_^M ,:, -. _. For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Joseph Gentile Gentile 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County , 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 199 Wood Street, Mahopac, NY 5. PROPOSED ACTION IS: [Z] New F] Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of House and Driveway with Subsurface Sewage Treatment System 7. AMOUNT OF LAND AFFECTED: Initially 2.327 acres Ultimately 2.327 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? R Yes E] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential 1:1 Industrial E] Commercial ❑ Agriculture Park/Forest/Open Space Other Describe: Surrounding lands are zoned R -1 (Medium Density Residential) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑� Yes No If Yes, list agency(s) name and permittapprovals: Town of Putnam Valley- Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes No If Yes, list agency(s) name and permittapprovals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes ❑✓ No I CERTIFY T HE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: onin gineer' P.E. C./ James W. Teed, Jr. Date: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11 - IMPACT ASSESSMENT (To be completed by Lead Actencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. E] Yes No .. . = L:? r'I . CT t N. CE � v„ _ i ZYVf DED F0 UJNUS L DD ACTIONS iN 6 NYCR R- F=ART &1, i .0 ?~ Af -No, a negative declaration may be superseded by another involved agency. Yes El 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. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed 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)? r] Yes EJ No If Yes, explain briefly: E: IS THERE; OP, iS THERE LIKEL',TO BE,_CONT Q�'Eh YF2 ZATED.T0 F'Ql'cNTIAI_.,AUVERSE E "VIR.',) !MEr ITAI_ Ir,4pAF^.r,.S ?.. Yes No If Yes, explain briefly. PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (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 impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the EAF and /or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determir Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -9 05erg G� ,wn t,L Address 1 Q ot W OOP 5T , PRAM V/+ y ley, Located..at,(Street) ; I q. UJ60D.W1 Tax Lot 04- f.(indicate neatest cross street) Municipality ik/rm -kvl - Watershed SOIL;PERCOLATION TEST DATA., ,, ,:,. Date of Pre - soaking ,12 A.5 alt ; Date of Percolation Test Z i NoHole Run No. Time Start - .Stop' . Elapse Time fMin.) Depth to Water From Ground + Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 3 , 1 8.0- 9:33 9 mi DD -975 3 x.59 X170,` 9 2 g:3N3 -g.q6 "1� �y�� _ •Z ,. 3 y Zy`` -z�" 3 8Al -9:oz 15 zy`' - 70" 3 5 4 :03 -9:21 119 u - z T, 3 6 b 4 5 S 1 8'.28.- &y o 2 2'f � ,, z 7" 3 y 4 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. Deoth measurements to be made from top of hole. �q" _ Z7,, 3 q Zy`' "Z 4 3 F mi DD -975 3 x.59 7 ,y`` --z:�" 3 `� 9:18- 9:�6 28 Zy`` -z�" 3 6 r TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES %A1 DEPTH HOLE NO. 121 HOLE NO. HOL E NO. Vs G.L. f:r2 0 1.01 1.5' w W ou4u') OWA) W 13 MAJ 66YAJ 2.01 LOAM 2.5'! go 3.0' U(awr MLJI) 5La-4 1W6k1-f;90WA)�UM 561W D1 3.5' IV4� WA-1 .,sw4kr $4AA04 LVA-A -QV,,Mr 4.01 4.5' 5.01 5.5' 6.0' 7.0' 71 -71 1-7 7.5' 8.0' 8.5'- 9.01 .9.5' 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: (aeN xem O-N ST91M094A Date lo • Z7 jj pe-p" / C-fZ4MjAJ GAJ WEMIL% Design Professional Name: L,.,194A))Aj Address: Signature: Design Professional=s Seal C LU Uj -99 "OR ESSIO A CRONIN- 39 Arlo Lane. ENGINEERING RE.,.P.C. Urtlandt Manor, NY 10567. f Professional Engineering & Consulting T. (914) 736-3664 F (914) 736 -3693 - ..... �. . o .. u .t'.. � t u .G W .—.. .. v. A1: ]n. v s. .. t .—. .r y < Teti i. 1 •_ <vm " .... �. v a1. ._ O .sesl.i. s4Y, .+.vci ., r ... ^.O w� August 27, 2012 Mc Joseph S. Paravati, PE. Public.Health Engineer Putnam County Health Department' 1 Geneva Road Brewster, New York 10509 Re: Gentile SSTS 199 Wood Street Mahopac; New York 10541 Town of Putnam_ Valley Section: 74.11, Block. 2, Lot: 4.2 Dear Mr. Paravati, 'Please find enclosed the following regarding an application for approval of sanitary facilities for a proposed single family residence at the above referenced location: 1. One (1) Certified Check in the am unt $500 for the application f q e. 2.. One (1) Letter of Authorization. aM i`.xX, 3. One (1) Applications for Approva'Fof Plans of a Wastewater Treatment System PCDH Form PC -97) 4.: One (1).1VYS. SEQR.Short Envii4Qnmenta� Asr? smi?ht FO,rms (Pa!ta.Only' 5. One (1) Sets of Design. Data Sheets. 6. Four (4) Sets of Applications to Construct a WaterWell, 7. Four (4). Sets of Applications to Construct a Sewage Treatment System. 8. Four (4) Sets of SSTS Construction Plans. 9. Four (4) Sets of House Plains., Please review the above items at your earliest and should -you have any questions or require any additional information, please contact me at the number above. Re ctfully Sub ..fitted, Jam' . Teed, Jr. oject Engineer ca Owner- Joseph Gentile File- Paravati- PCDH - Gentile -199 Wood Street - SSTS- SubmittalJT- 20120827.doc NO TEST PIT DATA I�ESCItIPTION OF SOILS ENGOUNTEItEI) IN TEST BOLES r >a. , 'a ..•. .:.psi' . -.-ri. - .r.. . r - :�.. .. . --• .. .. .vr � ........rc -w s .. -• ... • -..I .I. .s-vs. .... ... .r. +. �. .>.. u .. .. PTH HOLE NO. -- J2.6 — HOLE NO.____p!S- HOLE NO. n (� G.L. 0.5' 1.0' 1.5' V�'ltvw 54 n�D� w :Lt.vul 2Fa�rJ 2.0' LOAM 2.5' o�� r( i► 3.0' LIGFM—Brzow� StLrr1bl�t- RO.Gt,.IJ �,Ic,1w L(6tL -f �(tA�N �ilL 3.5' 54AIDH �!�"� lrm4o-r SAV04 LFrkm , SGIC�ttr►' 5+V01 L-W"( 5144k- 4.0' 4.5' 5.0' KZ WAT21ft 5.5' = s' l 5'' 6.0' 6.5' c 6 7.0' 1 -) ' �•S' 7.5' 8.0' 8.5' 9.0' 9.5' Indicate level at which groundwater is encountered 5 ` Indicate level at which mottling is observed / Indicate level to which water level rises after being encountered y' Deep hole observations made by: C a BEEP / A j jgEki tt Date 10.2-7.11 Design Professional Name: .f0Mony L , C 1,000 OP Address: �iZD�Ut N [:NL� lNt�•l�Li Signature: Design Professional =s Seal `Al Ud I v A2z��sti'�` i i� Z 6290 pROFESSIO�P