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74.15 -2 -2
BOX 29
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03665
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PITTNAM WUfM DEPAIrIi►lMNr OF HEALTH � �� �� �
Dlvb" d Ohl He" Sanbeo. Gomel. N.Y. les ? w ATE CO
FOR SEWAGE Porn* # s� "
RUMON PZUM DISPOSAL SYS18M �L�
i l/ li 1, f� J d / S own or Merge
in Nees ...
,�. -__.- ,.�...,.. --•r, . - ....,.. ,Ot'iY .. ..._ _.... , 'a .: 4.
toi
Renewal_ ❑ Rebliva ❑
O� /� N�
Date of Previona Approval
S% G� Yom. Town /tJ�d /G C31%LG C.' Zip 'J d S' #J
pate Subdivision Annroved Fee Enclosed 1:1 assn „rat
Type Lot Area / Acre- FM Seeden Only LJ Depth Voilim
Number of Bedro om '� Deaige Flow G P. D PCHD Nodli ailom Is Regabred Wben FIR ho eomWk sd
SepMrAil Sewemw Syd m to ocelot d X 2.5 d raM. Septle Tank seer 4 �L� L � � - C c2/
� X07 G`7 �-
To be oaeslamsted by Address
Water Supply: Pd Me Supply Faoo Address
// Ii.twM Addreas
an / 4 Ds®ed by _�'., -e,l
Otbsr Reambemenb ✓5
1 repreancthat 1 am wholly and completely responsible for the design and location of the proposed system(s). 1) that the separate sewage disposal s stem
above described will be constructed as shown on the approved amendment there to and in accordance wi ndards, rules a regu oral o nam
County Department of Mealth, and that on completion thereof a "Certificate of Construction C story to the Commissioner of Healthwill
be atbmitted to tM Department, and a written guarantee will be furnished the owner. his ja s by the builder, that said builder will
place in good operating condition any art of said sewage disposal system during the per aor s lately following thedate of the lap-
ol of the approval of the Certificate of Construction Compliance of the orgihal syst eairs t hat the drilled well described above
WHO be located as shown on the approved plan and that aid well will M Installed in as oorMn M r and rpu YMns of the Putnam
County Dee /rtlMntt of Health. Health.
Oats �/ �%/ / 6 Signal
License No
Address
APPROVED FOR CONSTRUCTION -This approval expires two years from the date issued
revocable for cause or may be amended or modified when considered necessary b n
requires a w it. se
Approved for disposal of domestic sanitary wage nd /Or pr'
.0/88 Date ��_�i�l'
building .has been undertaken and is
Change or alteration of construction
Title
AA
NAM DEPAI:lbHSM OF HEALTH
Divlelem of ivbesommiall Hevlb SeeAM& Carmel. N.Y. 10512 t DVw V M 0 Peasit 0
CONSRUMON PROM FOR SEWAGE DISPOSAL SYSTMM
LafataA &t v `'d
a CERTIFICATE fF?VML4K
PON* R
To” or VRIW*
Sebdlvm m Name .Lot i Tea Map 'JS Lot Z
{' / ��vi✓if�r ti��J • Ret►ed__7 � Revlde�+mc, ❑
Ow..r /Appilcamt Naas /� �/ / -�
J n Date of Pmvioae Approvd
Mefte Add. �/lc: D: b� /J r� Tuwn �wsLi�arn !�v /�i'21 ZIP / yS' �l
n
Boodblg Type d _1'z Lot Aare& Fm Secdon Only Death Vdmw
Number Of Bedrooas 41: Design Flow G P D !J PCHD Nodfloatloe is Regabed Wbee FM le imuipieeed
Separm/s Sesnrage System o to ougelst d !Z.S U Gal1= Sollode Tw flood S O .>! 2-
To be emme4+artad by Addnas
Water Sttppb': Sloppily From Address
PdvsM Supply D MW by sddnm
an
Otber or= T
1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s). 1) that the separate savage di al stem
above described will be constructed as shown on the approved amendment there to and in accordance wit
rules a regulation, o
County Department of Health, and that on Completion thereof a "Certificate of Construction Corns '; "j -0-
County
to the Commissioner of MMlthwill
be to the Deartment, and a written guarantee will be furnished the owner, his succa pAq
the builder, that aid bulkier will
place in good operating condition any art of aid savage disposal system during the period r re� I
ly following tladate of the I=.
ante of the approval of the Certificate of Construction Compliance of the original system or r its eta,
t he drilled well described above'
WOO be located as shown on the approved plan and that aid well will be installed in accordance w sta ru
rpu a�%ns of the. Putnam
County Deartmeot of Health.
Dates y��� Signed
P.E. R.A. —
Address-..;! /0,7"104-0 cCd tJ /'t`°
icense No Z Fig
APPROVED FOR CONSTRUCTION- This approval expires two y rs from he data iss less C
ilding Ms been under taken and is
►evou0le for caua or ma De amended or modified when considoe by the assigner o th.+b'•
.change or alteration of construction
squires •haw permit. pproved for disposal of domestic snit and/or i w ter supply 'oiliY.
Rev. i
/
n tram Date / ev
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR REATMENT SYSTEM
b
PCHD CONSTRUCTION PERMIT #
Located at S A* s Dn V e_ r� Town or Villag Alm Va AV I/
Owner /Applicant Name C tYq 2st� 15 -� j'. Tax Map 7L Block Lot
Formerly �Pr �� ► �- Subdivision e
Subd. Lot #
Mailing Address 01 �b e`� d� �� i Zip
Date Construction Permit Issued by PCHD to ? *
Separate Sewerage System built by &%krt Nrk 6cu. _-MC Address � ��. S�!'M� ►ik-N�
Consisting of Gallon Septic Tank and �6�' Fr. of 02 FT wI)DIC . -- -
Other Requirements:
Wat r Public Supply From Address
or,; . Private Supply Drilled by. Address PlAri►A4K
Building Type ) LeJeJ- Has erosion control been completed? 1%�S
Number of Bedrooms Has garbage grinder . been installed? C�
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam County Department of Health.
�- ll
Date: e � .�' Certified by P.E. R.A.
y (Desig ofessional
Address 1 t;� � �='�. P
-
11-1 License # Q�6 s;.y _15
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 frgm such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modification or change is necessary.
:By:., Title. Y� /- Date: / 3
T
White copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT � " —,2
Well Location
(<t%
Street Address:
TownNillage:
10abl... (%�1�
Tax Grid #
Map7Lf1,f Block Z Lot(s) Z
Well Owner:
ame: Address:
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
Rotary Cable percussion Compressed air percussion Other (specify)
Well Type
Screened Open end casing >4- Open hole in bedrock Other
Casing Details
Total length e1 ft.
Length below grade
Diameter G tn.
Weight per foot lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: Welded Threaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: Yes No
Liner: Yes L No
Screen Details
Diameter (in)
Slot Size.
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed P,p pe_:. XC. amp ressed_Air
e'. -? gpr� •--
De' th Data -
Measure rwm land surface - static s ec i fy ft )
� G
During yield test ft
Depth of completed well in feet
300
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
0°
p
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type 14vt-t- Capacity S
Depth Model SS'pS
Voltage 2,3 o ilp
Tank Typed)( X ,2-'G Volume /Z 0
Date We I Completed
'27
Putnam County Certification No.
Date of Re ort
� �9- - A/o?
Well Driller (signature)
NOTE:' Exact location of well with distances to at least two permaneo landmarks to be provided on a separate sheet/plan.
Well Driller's Name VL Address:
S�giature:• ...:..:. :. - _ _ .. :Date
- -- ion �9
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
AUG -11 -98 TUE 05:°50 PM CASSIDY ENVIRONMENTAL 9142766403
PUTNAM COUNTY DEPARTIY ENT OF HEALTH
DIVISION OF ]ENVIRONINIENTA:C,,11EALTH SERVICES
LETTER ()P AUTHORIZA110N
rM'vP. 01
RE: Property of ������ W) A �� _��4J �_.._��•��,
Located at hC��,_,.,.. }►� . !I� ,!
T N ._...._.. _... Tax Map it % Hlock _ Lot
Subdivision of
Subdivision T.ot 9 __. ...._.— Filets Map # Vatc Filed
Go.ndomt n:
This letter is to authorize. "' Ass�to _ _ _ _ - _.. t _.....
.. _._... ���tjii ~liGcnsed-�_. �' - -i i�a �C� v.�'yt� �.r�istered�rc itecc'_.. •. =ta app fni�ti�e re
f�iu e�ssio TEngineer Reg A h - pp Y q
wastvmater treatment andior water supply pernut(s) to serve the above- rioted property in accordance
with the standards, rvlcs vr rrgul;gians as promulgated by the Public Healthy Director of the Putpam
Couitty- f- iealth De.patimca, an d- to sign ail ne-cessary papers on my behalf in connection with fibs
matter and to supervise the construction of Wd wastrivater trctment and'or -mater supply systems in
conformity with the provisions of Article 145 and,or ) 4? of the Education Lain, the Public Health
Late, and the Putnam County Sanitary Code.
Cy'
}oanttersipicd:
II Z.. R.A. I N
Mai WS Address $,^,�
Wry truly youpl,
�rf I
tuNrer or Propan� >�
IviailinS Addrt$S:
`CPcm��il� .
State -Ny .._._,_ziF State_ I��� C dip
Telephone; Telephone: ;K Q221.
_ .. Fomi LA -97
IPUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL .HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or P rchaser of Building Tax Map Block Lot
Building Co structed by
Location - S reet °
Building Type
Tow illage
Subdivision Name
Subdivision Lot*
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction_ and drainage of the sewgge,treatr_n and' " =`
-`° ` -'ihat s has oeen'consducte-d 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, .p;.any repairs made by me to.such system, except where the failure to
operate properly is caused by the willful or negligent At 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. .. /" A //—I
1 �
Dated: Month Da Year Signature: A I W^j, 4 0
Title: .
General Contrac or (Owner) - Signature
De
Corporati Name (if corporation) Corporation ame (if corporation)
Address: i;3 OZ `j Address: R) 13 DX o2 0>?•�ri Y� ��, �1 }/
ff 7.1
State . -Y' - ^Zip %L` .. State Zip /�� . _...
Form GS -97
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y; 1059E
(914) 245-2800
Albert H. Padovani, Director
LAB #: 32.806411 CLIENT #: 7686 NON STAT PROC ` PAGE 1
-------- ;� --------------------------- -- ------------ — ---- ~ -------- ~ -------
QUARTERHORSE DEV, INC
PO BOX 402
STORMVILLE, NY 12582
DATE/TIME TAKEN: 07/22/98 01:20P
DATE/TIME REC`D: 07/22/98 04:11P
REPORT DATE: 07/30/98
PHONE: (914)-628-0971
SAMPLING SITE: 3 SHOPIS DR. SAMPLE TYPE.,: POTABLE
: PUTNAM VALLEY PRESERVATIVES: NONE
COL'D 8Y: MICHAEL SPACCARELLI TEMPERATURE..:
NOTES...: KITCHEN TAP COLIFORM METH: MF
DATE FLAG
PROCEDURE
RESULT
NORMAL - RANGE
METHOD
PUTNAM CNTY PROFILE
'
07/22/9
MF T. COLIFORM
ABSENT
/100 ML
ABSENT
1008
07/2Q98''`�
.LEAD-(IMS)
.<1.pp�b'_'..
`'-0-15,ppb�^ '
�'.`12345
07/22/9G
NITRATE hOTROG `
� 042
MG/L
'0^- 10
' -9119
07/22/98
NITRITE NITROG
<0.01
MG/L
N/A
' 9146
07/22/98
IRON (Fe)
<0.060
MG/L
0-0.3 mg/l
2037
07/22/98
MANGANESE (Mn)
<0.010
MG/L
076.3 mg/1-
2087
07/22/98
SODIUM (Na)
27.2
MG/L
N.A
07/22/98
p H
.
� 1
UNITS
6.5-8.5
9043
07/22/98
HARDNESS,TOTAL
104
MG/L
N/A-
.(37/22/92
ALKALINITY (AS
50.0
MG/L
N/A
07/22/98
TURBIDITY (TUN
<1
NTU
0-5 NTU
COMMENTS:.
BACT. THESE RESULTS
INDICATE THAT THE
WAT
AS NOT) OF A
SATISFACTORY SANITARY QUALITY
ACCORDI
E
NEW YORK STATE
AND EPA FEDERAL*DRINKING WATER
STANDARDS, FOR
THE PARAMETERS
'
TESTED, AT THE TIME OF COLLECTION.
Pb /Cu LEAD !!mitt for p
EPA Lead & Copper
than 10% of their
than 1'
o pp b and
treatment must be
potential.
ublic schools are set at 15 ppb.
Rule for Public Systems requires that no more
distribution points have LEAD value of more
COPPER value of 1.3 mg/L, else water
undertaken to reduce the waters corrosive
'
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
Na 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 270 mg/L of Sodium
is suggested.
I
~
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
Albert H. Padovani, Director
LAB #: 32.806411, CLIENT #.-. 71686 NON STAT PROC PAGE 2
QUARTERHORSE DEV, INC DATE/TIME TAKEN: 07/22/98 01:`20P
PO BOX 402 DATE/TIME REC'D: 07/22/98 04:11P
STQRMVILLE, NY 12582' REPORT DATE: 07/30/98
PHONE: (914)-628-0971
SAMPLING SITE: 3 SHOPIS DR. SAMPLE TYPE..: POTABLE
: PUTNAM VALLEY PRESERVATIVES: NONE
COL'D BY: MICHAEL SPACCARELLI TEMPERATURE.-.':
NOTES...: KITCHEN TAP COLIFORM METH: MF '
DATE FLAG PROCEDURE RESULT ' NORMAL _ RANGE METHOD
m
' '
`
'
SUBMITTED
Al b . Padovani, M"T.(ASCP>
' �
uzr r
' _-` .^"+
�
0
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
Mr. Marvin O'Dell
Building Inspector
Town of Putnam Valley
Oscawana Lake Road
Putnam Valley, NY 10579
BRUCE R. FOLEY
Public Health Director
January 23, 1998
Re: Construction Permit PV -28 -93
tree�A Shopi5J)6ve__ _ ...._. _.... _.. _ >.... .
- -- -- (f) Putnam Valley
TM #74.15 -2 -2
Dear Mr. O'Dell:
Please be advised that all individual residential sewage treatment systems within the New York
City Watershed have been delegated to this Department for review and approval as of
January 1, 1998. The above referenced lot is within the New York City Watershed and therefore
delegated to this Department.
The renewed construction permit, approved by this Department on January 21, 1997, is stilllvalid
and NYC Dept. of Environmental Protection approval is not required.
Should you have any questions concerning the above, feel free to contact this office.
MJB /jp
cc: Mike Spacarelli
Very truly yours,
Michael J. Bud 'nski P.
Director of Eng eering
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank Sullivan, P. E.
2972 Ferncrest Drive
Yorktown Heights, NY 10598
Dear Mr. Sullivan:
BRUCE R. FOLEY, R.S.
Acting Public Health Director
January 16, 1997
Re: Proposed SSDS: Spacarelli
Shopis Drive
(T) Putnam Valley
Review of plans and other supporting documents submitted at this time relative to the above -
captioned project has been completed. Comments are offered as follows:
"The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in this regard."
"You are referred to Article 128.1 of the official compilation of Codes, Rules and Regulations of
the State of New York, Title 10, relative to the need for approval of individual sewage disposal
systems by the City of New York. You should contact city Officials in this regard."
1. Well permit application has not been submitted.
2. Current Engineers Authorization better has not been submitted.
3. Cross out or remove fill settling note.
Upon receipt of a submission, revised to reflect the above, this application will be considered
further.
Very truly yours,
Robert Morris, P. E.
Public Health Engineer
RNVjp
V
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET for CONSTRUCTION PERMIT
STREET LOCATION NAME OF OWNER
BY B. HEDGES R.MORRIS OTHER DATE _/_/ TAX MAP # _
DOCUMENTS.
Y
PERMIT APPLICATION
' RM PINS LETTER
S THORIZATION
m DESIGN DATA SHEET(DDS)
m CORPORATE RESOLUTION
m PLANS THREE SETS
m HOUSE PLANS - TWO SETS
M VARIANCE REQUEST
SUBDIVISION
GAL SUBDMSION it AMA
SUBDIVISION APPRO A ECKED
PERC RATE
:.. FYI:i; REQL.it'EIi : rat -
CURTAIN DRAIN REQUIRED m STANDPIPES
-
Y
EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE
IF PUMPED PIT & D BOX SHOWN & DETAILED
HOUSE - NO.OF BEDROOMS
WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
PROPERTY METES & BOUNDS
HOUSE SETBACK NECESSARY (TIGHT LOT)
HOUSE SEWER - 1 /4 "/PT. 4 "0; TYPE PIPE
NO BENDS; MAX. BENDS 450 W /CLEANOUT
FILL SYSTEMS
(CLAYBARRIER
10 FT HORIZONTAL: SLOPE 3:1 TO GRADE
FILL SPECS m FILL NOTES
FILLCERTIFICATI N NOTF��
-.
DEPTH - GAUGES
FILL PROFILE & DIMENSIONS
VOLUME
GENERAL FILL IN EXPANSION AREA
m EX- APPROVAL SSDS ADJ. LOTS
m WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH q�
m DATA ON DDS PLANS & PERMIT SAME LF TRENCH PROVIDED r m60 FT MAX
m PRE- 1969 - NEIGHBOR NOTIFIFICATION
PARALLEL TO CONTOURS
FT-1 LETTER BI/ZBA K-J 100% EXPANSION PROVIDED
M 100 YR. FLOOD ELEVATION
SEPARATION DISTANCES SPECIFIED ON PLAN
REQUIRED DETAILS ON PLANS FIELDS
SEWAGE SYSTEM PLAN - (NORTH ARROW) ® 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL
SSDS HYDRAULIC PROFILE m GRAVITY FLOW 20' TO FOUNDATION WALLS 15' WELL TO P.I
CONSTRUCTION NOTES (GRINDER NOTE) 100 TO WELL, 200' IN D.L.O.D., 150' PITS
DESI TA: PER ND DEEP RESULTS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)
m TW S EXISTING & PROPOSED 1,50'TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
COMM-
DRIVEWAY & SLOPES CUT 1.200 0' TO WATER LINE (PITS -20')
FOOTING /GUTTER/CURTAIN DRAINS 0' INTERMITTENT DRAINAGE COURSE
EROSION CONTROL; HOUSE,WELL, SSDS FT. RESERVOIR, ETC:m 150 FT. GALLEY SYSTEMS
Lzld EROSION CONTROL NOTE 5' MIN TO C.D. S= >5%,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1%
PERC & DEEP HOLES LOCATED 0' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS,
REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK
LOCATION MAP IT 10' FROM FOUNDATION; 50' TO WELL
kAy
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL�,�
PCHD PERMIT #
WELL LOCATION
Street Address Town Village C ty . Tax Grid Number
��4 may; e --e f�dl?9�r�2� 74 •� �� ��
WELL OWNER
Nameiz
!✓ /
Mailing Address Priva te
C�erP��% ��� i� ,�i"%✓Y ..� ��� c 0Public
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
t3 INSTITUTIONAL O STAND -BY
AMOUNT OF USE
gpm /# PEOPLE SERVED! /EST. OF DAILY USAGE �Gi� al
YIELD SOUGHT 4-- _
_
0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12. ADDITIONAL SUPPLY
VNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
PDRILLED
ODRIVEN
ODUG OGRAVEL O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES p,-NO
_'IF':►�iELL':35 rLUCyT� �' i11 A AEt�L�i Y.- .SUBDI�IS70iJ, Nk1 E OF- CUBDIVISICON -
Lot No. r A
WATER WELL CONTRACTOR: Name Address rfe"/
IS PUBLIC WATER SUPPLY AVAILABLE TO.SITE: YES d,-' NO
NAME OF PUBLIC WATER SUPPLY: -- TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
'(date (signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drill' operations be contained on this
property and in suc a manner as not to dew/ grade or oth w' contaminat surface or groundwater.
Date of Issue: �� 19
Date of Expiration 19 Permit Issuing OffYcial
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property o
Located at
Date 141 f
(T) Section 7-/•l,S '-Block Lot P-L
Subdivision of
Subdv. Lot # ,Filed Map # Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer V or registered architect
(Indicate .
�,._�.:,.._—to .apply for:,_a , Construction Permit for a separate sewage system, to
serve the above'noted property in accordance with the standards, rules
or.regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Hetilth Law, and the Putnam County Sani-
tary Code.
Ver truly, .yours ,
Si ne d
Countersigned: OP NEW Owner of Property
W
P.E., R.A., # Address
e
Address Town
1 91� 1� >/ Telephone
,.... Telephone,
r
September 25, 1996
Putnam County Department of Health
4 Geneva Road
Brewster, New York 10509
Gentlemen:
pleh d l i San d' iOjI iif(;i fovi toitlae redewal of 1 e proposed
Sewage Disposal System of Mr. Victor 5pacarelii's tot on Wood Street in the 'Town
of Putnam Valley.
This design was approved by your department in 1993. From a field inspection,
there have been no changes to adversely affect this design.
Very truly yours,
'� C�4z
.Joseph F. Sullivan, P. E
JFSfats
Enclosures
93 -64
APPENDIX 3
- PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY &
SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET for CONSTRUCTIQN PERMI
NAME OF ER STREET LOCATION J 5
BY DATE
�}� TAX MAP
CUMENTS.
Y
W DISCHARGE (OK)
ERMIT APPLICATION
PER &DEEP HOLES LOCATED
PC -1
EPRESENTATIVE OF PRIMARY AND EXPANSION
WELL PERMIT; PWS LETTER
XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
all]
GINEERS AUTHORIZATION
F PUMPED PIT & D BOX SHOWN & DETAILED
DESIGN DATA SHEET(DDS)
- NO. OF BEDROOMS
DEEP HOLE LOG
-HOUSE
f WELLS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM
CONSISTENT PERC RESULTS (3)
ED PROPERTY METES & BOUNDS
31 PERC HOLE DEPTH
Iti HOUSE SETBACK NECESSARY (TIGHT LOT)
CORPORATE RESOLUTION
M HOUSE SEWER - 1/4 "/FT. 4"0; TYPE PIPE
THREE SETS
NO BENDS; MAX. BENDS 45 W /CLEANOUT
HOUSEPLANTS - TWO SETS
FILL SYSTEMS
'4PLANS
VARIANCE REQUEST
YBARRIER
GENERAL
-eEll—EGAL SUBDIVISION
0 FT HORIZONTAL: SLOPE 3:1 TO GRADE
FILL SPECS
DIVISION P �� c
Fffi
DEPTH GAUGES
- -
RATE
- - 8cY1TMENSIZ) -
FILL PROFILE .:- N.,,
ILL REQUIRED
VOLUME
URTAIN DRAIN REQUIRED MSTANDPIPES
TRENCH
X- APPROVAL SSDS ADJ. LOTS
TRENCH PROVIDED
ETLAND (TOWNADEC PERMIT R & D)
JDATA
t60 FT MAX
ON DDS PLANS & PERMIT SAME
RALLEL TO CONTOURS
RE- 1969 -NEIGHBOR NOTIFIFICATION
100% EXPANSION PROVIDED
ETTER BVZBA
SEPARATION DISTANCES SPECIFIED ON PLAN
00 YR. FLOOD ELEVATION
FIELD S
REQUIRED DETAILS ON PLANS
10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL
SEWAGE SYSTEM PLAN - (NORTH ARROW)
20' TO FOUNDATION WALLS
SSDS HYDRAULIC PROFILE m GRAVITY FLOW
100 TO WELL, 200' IN D.L.O.D., 150' PITS
110'TO
D/ J BOX m TRENCH/GALLEY m P- PIT DETAILS
100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)
SEPTIC TANK - SIZE, DETAIL
50' TO CATCH BASIN, 35' STOKMDRAIN, PIPED WATER
WELL DETAIL, SERVICE LINE IF OVER
WATER LINE (PITS -29)
CONSTRUCTION NOTES (GRINDER RATE)
M 50' INTERMITTENT DRAINAGE COURSE
DESIGN DATA: PERC AND DEEP RESULTS
200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS
TWO -FOOT CONTOURS EXISTING & PROPOSED
SEPTIC TANKS
�LJ DRIVEWAY & SLOPES CUT
CD 10' FROM FOUNDATION; 50' TO WELL
CD FOOTING /GUTTER/CURTAIN DRAINS
WELD
CD 15' WELL TO P.L.
COMMENTS-
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property of
Date
Located at
Section Block Lot
Subdivision of
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize
.a duly licensed professional engineer X0
or registered architect
A -c Wto 7
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance.with the standards, rules.
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said-
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,.
Signe
�;CZ6�1 A
Countersigned: Owner of'Property
PI. E. , A. 'SNOPLS. QRks�e
Co e 16 Address
Address ± Town
7? 71
Telephone
Telephone
1.
pUTNAM COUNTY DEPARTMENT O F H EA L TH
APPLICATION FOR APPROVAL OF PLANS /FOR A WASTEWATER DISPOSAL SYSTEM
lI /.C'11V ' 111Z Ge rre-1%.
and Address of Applicant:
es.:;:
2. .:flame of Project:
4.
6.
7.
8.
9.
10.
11.
12.
13.
14.
ect Engineer:
cense Number:
e f Pro ect•
Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision, Other (specify)
this project subject to State Environmental Quality Review (SEAR)? A10
Status ..(Check One) Type I .. Exempt
a Draft Environmental Impact Statement (DEIS) required? ............. �✓�
i DEIS been completed and found acceptable by Lead. Agency? ...........
ie of Lead Agency
this project in an area under the control of local planning, zoning,
otherofficials, ordinances? ......... ................ ................
so, have plans been submitted to such authorities? ..................%'
preliminary approval been granted by such authorities? %a Date Granted:
e of Sewage Disposal System Discharge...... Surface Water P" Ground Waters
15. I surface water discharge, what is the stream class designation ?........
W"
w.
16. 1 -ters index.number (surface) ............................................
17. I project located near a public water supply-system? .................. A&
18. I� yes, name of water .supplyl ,;,_ Distance to water supply IS
fiS
19. I-' project site near a public sewage collection or.disposal system ?..... S✓Q
w•
20. Name of sewage system "' Distance to sewage system
21. to observed: 23. Name of Health.Inspector:
�a .
24: Project design flow (gallons per day): :....:.d.:... °...:.:...
2.
25 ,As State Pollutant Discharge Elimination System (SPDES) Permit required ?.. A16
IRV
26. Has SPDES Application been submitted to local DEC Office? ................ �v
X�.
27 Is any portion of this project located within a designated Town or State �O
wetl and? ................................................................
.
28.111 etland ID Number...... o ......:.......... ...............................
j f.
t
29i, s Wetland Permit required? .............. ............................... �
F
'Has application been made to Town or Local DEC Office? ................
30:Does project require a DEC Stream Disturbance Permit? ........... Ale,
31: -1s or was project site used for agricultural activity involving application
Hof pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ........ YES or NO
32. Is project located within 1,000 feet of existence of abandoned landfill,
:hazardous waste site, salt stockpile, landfill, sludge disposal site or AlG
F'
,'Any other potential known source of contamination? ..............YES or NO
$TPE$CRJBE---
33.'RIs there a local master plan or -file with the Town or Village? .....:..::.
34 -1..re community water, sewer facilities planned to be developed within 15 years?
35. re any sewage disposal areas in excess of 15% slope? ........................ A1v
36. 1Rax Map ID Number ..... ........ ............................... .....
37.1"U. s'
proved Plans are to be returned to: ................ Applicant Engineer
If the application is signed by a person other than the applicant shown in Item 1, the
app..11cation must be accompanied by a Letter of Authorization. Failure to comply with this
prosion 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.
rURES & OFFICIAL TITLES: L/
ADDRESS:.
j
JOSEPH F. SULLIVAN, P.E.
2972 Ferncrest Drive
Yorktown Heights, Now York 10598
(914) 962-4248
September 25, 1996
Putnam County Departmeent of Health
4 Geneva Road
Brewster, New York 10509
Gentlemen:
Wde -W.U. 6f
-tKe pdii&-.
Sewage Disposal System of Mr. Victor Spacarelli's lot on Wood Street in the Town
of Putnam Valley.
This design was approved by your department in 1993. From a field inspection,
there have been no changes to adversely affect this design.
JFS/ats
Enclosures
93-64
Very truly yours,
I f W11101
Joseph F. Sullivan, P. E
1
t
is
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL !z
PCHD PERMIT #"-
WELL LOCATION
Street Address Town/,Village/City '!/
d //i
Tax Grid Number
1�. %S .2 - z
WELL OWNER
a Mail' g Address
/C✓ �' C r��- , 5.4 iS
iJr'C D t%
rivate
❑Public
USE OF WELL
1 - primary
2 - secondary
ARESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT P ❑ ABANDONED
® BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify
® INDUSTRIAL b INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT 6"' gpm /# PEOPLE SERVED -0 /EST. OF DAILY USAGE BOG' gal
REASON FOR
DRILLING
❑ REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION
JKNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
M ADDITIONAL SUPPLY
DETAILED
REASON FOR
DRILLING
WELL TYPE
GPDRILLED
®DRIVEN
®DUG
13
GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES t/ NO
- - - --
... Lot No.
WATER WELL CONTRACTOR: Name J.O/,J e5l*,71' 4--sew Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES d/'NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: lv li`i_,�5
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
/ �� ,�ON SEPARATE SHEET 72�Z4 -1
(date) (signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt;- (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a a ner as not to//�� degrade or other se contaminate surface or groundwater.
Date of Issue: 1917-3
... _ - - ------
1; of" Expiration Z 19 �� Pefm - Issuing Official
Permit is Non- Transferrab e White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
/ •' • � /• •' 1� Y' '1 �1' Mme.
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner (��d •'� %%, Address
Located at (Street) �G° %� riY Sec.% .1.!;- Block a~ Lot �-
(indi czfte. nearest cross street)
Municipality / � 1407, !' a IV-V
Watershed
• / • 51• •• •' Y / ` Y• ' �• /'��• • I �I/ • • • •
Date of Pre - Soaking 3� 9.3 Date of Percolation Test
HOLE
NUMBER CLOCK
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water Fran
Water Level
No.
Time
Ground Surface
In Inches
Soil Rate
Start -Stop
Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
3
4
2
4
5
NOTES.: 1. Tests` to` be repeated'.
are obtained at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to'be submitted
be made fran top of hole.
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
TEST PIT DATA
��4oi l
lei X,
TO BE SUBMITTED WITH APPLICATION
IS ENCOUNTERED IN TEST HOLES
EME, 13. - ; BOLE.. -NO'
..14 -
_r} Y INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: (/ V // � �CGyI DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms 14 Septic Tank Capacity /,5 �1 gals. Type
Absorption Area Provided By -0 °!a L.F. x 24" width trench
Other 1
Ur ne►y Y
Name 4-1-5v Signature y�� I QW �t
Address "iq 72- F'vo C'r'y 4- SERI,
1 o.d 0vi'v" 2
R
THIS SPACE FOR USE BY HEALTH DEPAMMEN2 ONLY: '-
Soil Rate Approved sq.ft /gal. Checked by Date
m
1
•
a
n
V
Wb&
NE,sW*4 E ',
INK
.w.
Yntnam County Department oP HWXfM
3on Y Ennvviironmental Healtb.Ser¢loer
.65" �e � Oted foro�nformance w ti b
�pplioable Rules and Regulations of the
��°utnam.Coonty Real apartment..
3q D of icjA1AL S,'wVEy OY
"aoe•2, Ls., DA7+:C -14Ly ZZ, 199,9
Asa-W61 LAypOj T--)M& ISI OtJS
A a Tar, L d LF,i4rm
SE?Pf- -TA N e
13
17'
'mac Flo
98 fi 49
Z
71 '
10 f '
�50 > .So
s
4'
70'
Sd f.60
4
-77'
710
1 Sn Sa
s
66
7Z'
34 t 34
TOTAL Let-t*H = 4( -6r--
P—E6iD LE,467,1= 444Ft'
AS6L11 LT_
T/./ /5 /5 To 6ER77Fy T447- Nd - SEH/9GE Ais -faSgL SYSTEM
Vg4S eoa1STz J�T Ea AS maolae, -Ax> ew 7Nes ,4NSLNoni4TT'I1�
-S STEM W45 /NS�FLTEo �y.M� 5E)=OaE /,T NAS �yE�Ev
6yE2• 77�e51/6TEM rV46 COMSTZ'JCTE //.L yccr�e�� w�T
ALL rnE- J2�•1 J'S g/ID ZuWI- 4T /oAJS of 7H >� �'I Y
4EA4 fH or- (>- A 4 D 7-11,&- J4y- C>O M
�nwq� cuss /py, ��
Goi.IS�JLTlMC7 E�JG /ti/E6,�
1.105 DA) 5 - -4
4-.A 4-Y
y /Q- Z7 &- 3644
boa' �j
q S&J I LT Z Oc�— S� F NE,
Eocq-�io�1: S/-j O P/
T.....i. 1 .�C OITtiIAf� �.4(/��/ ti0 n...ca9