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HomeMy WebLinkAbout3665DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.15 -2 -2 BOX 29 ' r� L L7� I - r f I'6 •: 4r�7 I .� r � I � I 03665 r 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