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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -33 BOX 29 oom -1.-. No L ' . i� ml i '■aF' ' OPT 03700 TNAM COUNTY DEPARTMENT OF HEALTH ION. :OF: ENVIRONMENTAL;UFAKTH SERV-IC�S ... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #� q'6 Z Located a ftg-yw/06 � lid own Village Owner /Applicant Name J_ cS' Wei Tax Map % 7 Block _ Z Lot 3� Formerly S.& Subdivision�aYneh1� P� /ail Q`,�'s�c y -1" Subd. Lot # Mailing Address J-f- 004 /rr ;..c �a - �L�✓i�i�i�ry yGl� `l� �f, Zip Date Construction Permit Issued by PCHD - d Z Separate Sewerage System built by �irr/��J /l y�`�yc�irk�77>�ddress Consisting of /a !t�A-el/ 4,V J Other Requirements: Water Supply: Gallon Septic Tank and 60t) Public Supply From, Address or: Private Supply Drilled by /Y 11nW -,Ry, e 11 Address : _:...Building .T�'p6 S r1I= -o 1 Has erosion- c©ritrol =been completed? .: ,::. ":_ . Number of Bedrooms Has garbage grinder been installed? 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 Putnam C unty Department of Health. z Date: 1° y �� Certified by P.E. v R.A. esign Professional) Address / �'c!2 ��i a�,� /P�� �l�f �ry����`'��dJ�SjLicense # e Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: / 3 10 6 copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF ]HEALTH �EN RONME TA `HEAL -TH CESM ;�:_::�::.- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 47q,1 7 Owner or Purchaser of Building Tax Map Block Lot �.YVlllP1�Y1 eX.CaUc(.�'on G Bing Constructed by �� . Town/Village Y d �d1 R_X.�Q� �r Location - Street Subdivision Name ..6 Re h Qai� -4 loft 4L t 3_:�). Building Type 6 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 ca�usedby the willful or negligent act of the occnt of the-building�utilizing the vim. v....... .a v.�. 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 2p� 't , ��)n to (fc6ral tontractor (Owner - Signature Corporation Name (if corporation) Address:. V L41 State Zi. . Corporation Name (if corporation) lr ( r Address -a Palf cr State Zip `� Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES � n. -�•.. ~ ¢ ^•^ Meier - �.:: � :^ -.s .. ... � v -- . .. i . - .. - -.. �_ ^t .r.+, 2 .. ,.- r- 1 +.t ^ . b mg wjl�i .x..x .a .. .A&: ... ... .... WELL COMPLETION REPORT Well Location Street Address: Town/Village: + / p V'4I rC' Tax Map # Map Block Lot(s) GP3� ., µ�.� Well Owner: Name: Address: Pit 0 6't - e r cc �r�`� Za f vtAI)e Use of Well: 1- Primary 2- Secondary esidential _Public Supply Air cond /hea pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment otary _Cable,percussion Compressed air percussion — Other(specify) Well Type _Screened _Open end casing _ Open hole in bedrock _Other Casing Details Total Length Length below grade'f!,�t. Diameter in. Weight per foot _lb/ft Materials: c--Steel Plastic Other Joints: Welded L,-Threaded Other Seal: _Cement grout Bentonite Other Drive shoe: Yes t,-114-o Liner: _Yes _No C/ Screen Details Diameter in Slot Size Length ft Dept to Screen ft Develo ped? First I _Yes —No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours ` 4-- Yield 5 gpm _ Depth Date Measure from land surface-static spec ft 30 During yield test 13 Depth of completed well in ft. I Soo 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. Landsurface o.3 . 3w. r Gov r X71 i �-- If yield was tested at different depths during drilling list: Per Minute Pump Type.�u (3;ble Capacity 0 Depth Q8 o Model - 1=4 Voltage �9.-�C2 HP L 2 Tank Type W O ( 1,4 +dasa(olume I NOTE: Exact Location of well with distances to at least two permanent. landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 n BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 279 - 6130 Fax (94S) 278 - 7921 Nuning Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (945) 278 - 6095 Early Intervention/Preschool (945) 278.6014 Fax (945) 279 - 6649 E911 ADDRESS VERIFICATION FOR OWNERS NAME: EEO n � �e ( fcL �CL- TAX MAP NUMBER: � Lf i -1 - � - -33 E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL:�4:�k -/-, DATE: -Z-Ocn� The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verfrm) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 .... ,- ..... _.. - . .. , ... .(9 14 ) 2 4 5. _ 2 g.0.0.,:.- Albert H. Padovani, Director LAB #: 1.606549 CLIENT ##: 59769 STAT PROC PAGE: 1 ESTRADE, JENNIFER DATE /TIME TAKEN: 10/19/06 02:00 24 PARTRIDGE LANE DATE /TIME REC'D: 10/19/06 04:453 PUTNAM VALLEY, NY 10579 REPORT DATE: 10/21/06 PHONE: SAMPLING SITE: SAME SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES-:'NONE COLD BY: SAME TEMPERATURE..: < 4C NOTES...: I COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 10/20/06 LEAD (IMS) <1 ppb 0 -15 ppb 9003 10/20/06 NITRATE NITROG 0.65 MG /L 0 - 10 9052 10/20/06 NITRITE NITROG <0.01 MG /L. N/A 9162 10/20/06 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l 9002 10/20/06 MANGANESE (Mn) 0.087 MG /L 0 -0.3 mg /l 9002 10/20/06 SODIUM (Na) 7.26 MG /L N /A" 9002 10/19/06 pH 7.4 UNITS 6.5 -8.5 9043 10/20/06 HARDNESS,TOTAL 128 MG /L N/A 10/20/06 ALKALINITY (AS 92.0 MG /L N/A 9001 10/20/06 TURBIDITY (TUR <1 NTU 0 -5 NTU COMMENTS: Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than .l5 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted 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 MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, _.._N_ Y. _105981 •new a. ,. .••`. .�t .: .,. . —.ors ... _. .�.. _ .. --.... Albert H. Padovani, Director LAB #: 1.606549 CLIENT #: 59769 STAT PROC PAGE: 2 ESTRADE, JENNIFER. DATE /TIME TAKEN: 10/19/06 02:00 24.PARTRIDGE LANE DATE /TIME RECD: 10/19/06 04:453 PUTNAM VALLEY, NY 10579 REPORT DATE: 10/21/06 PHONE: SAMPLING SITE: SAME SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES'-. NONE` COLD BY: SAME TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ---------------------------------- - -w, -- --------------------------------- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT 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) SUBMITTED BY: Albert H. fadovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 -(9114) •245 =2800 Albert H. Padovani, Director LAB #: 1.606572 CLIENT #: 59769 NON STAT PROC PAGE: 1 ESTRADA; JENNIFER DATE /TIME TAKEN: 10/21/06.09:00 24 PARTRIDGE LANE DATE /TIME REC'D: 10/21/06 10:35 PUTNAM VALLEY, NY 10579 REPORT DATE: 10/24/06 PHONE: SAMPLING SITE: SAME SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COLD BY: JENNIFER TEMPERATURE..: < 4C NOTES...: KITCHEN TAP COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 10/21/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT „(WAS), WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: (14i W Albert H. adovani, M.T. (ASCP) EL,pp# 10323 Director I Cagy- �- I- �- +- /- •'- r�- f- c..r- l- r- f -.f -y. r- i- .- i- �- r.- f- �- �- r -rrr -� �`l� —� -� p�rtr± qMC y ( PA-V ° Q 9$�pROaH K6S�06N�1� � 0.93 �9 11 �\ W 6w�ppe7 7 1 1 1 V � Q \ I s M j 6EP I 1' \ �o R I oR' I r SSTS TIE - INS (MEASURED "BY TAPE) UNIT A B C LENGTH OF TRENCH SEPTIC TANK 18 19 PUMP PIT 16 32 ALL TRENCHES DIST. BOX 99 74 1 98 75 2 94 68 3 89 62 4 85 57 5 142 68 6 149 73 7 154 78 8 156 84 9 97 77 10 91 71 11, 8.8- . .. 66 12 82 60 13 63 122 14 70 122 15 76 122 16 82 128 ASBUILT PLAN SEWAGE TREATMENT SYSTEM Property of ESTRADA ;'" a DANIEL Jo DONAHUE, P.E. CONSiJLTENG ENGINEERS 120 Breckeniidge-Road` Mahopac, N.Y 10541 845 -628 -7576 f November 2, 2006 Putnam County Department of Health 1 Geneva Road Brewster N.Y. 10509 Att: Mr. Joseph Paravatti Dear Mr. Paravatti: Enclosed please find: 1. Certification of Construction Compliance 2. Well Log and Bacti Results 3. Guarantee and two copies 4. Three copies of the as built plan 5. Filing fee of $300.00 6. E911 Verification Letter 7. Underwriters Certificate Your prompt attention would be appreciated. Regard Damel J. Donahue, P.E. Site o Sanitary 0 Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System „ . a. Septic tank size - 1,000 ...: 50 .....1, 2.. ?......other ................ b. 'S eptic tank installed level . ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. 'trenches 1. Length required _� Length installed�� 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1' /2' diameter clean ..................... 9. Depth of gravel in trench 12" minimum ....... :........... -- - 10. Pipe ends . ca ed ......... .............................. ... .... ... . ........... Puetp or�IIes� stems � _ .......... _.. 1. Size of pump chamber ................. ............................... 2. Overflow tank ......................... .... ... ..... ...... ... .... I .... I *... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House /uildiii a. House located per approved plans .......................... b. Number of bedrooms ............. ............................... IV. Well Well located as per approved plans .......:........... b. Distance from STS area measured A ft........... C. Casing. 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanshia . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box .... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. ?2/02 Permit # — 2� • Subdivision Lot # *b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. QF'E- NVIRONMENTA:LUEATLFi•-SERVICES' FIELD ACTIVITY REPORT NAME: -Ii7� _ 0 P vfi A V) Q V /Y. Street PERSON IN CHARGE. OP TNTFR VT UMr). 0 Town State $1r S'?U - 2!r% PUMP TEST 0. DOSE TEST �f lI RE Q UIRED GALLONS Zip 06 CIAM4p FOR— CFC0RD'-7F-rT- 4- DEED X y.36 SignalLrcAfid iitld R_EPOR.11 ECETV D RY- I acknowledge receipt of this report: SIGNATURE: 02/96 Title: .mom LL- Zip 06 CIAM4p FOR— CFC0RD'-7F-rT- 4- DEED X y.36 SignalLrcAfid iitld R_EPOR.11 ECETV D RY- I acknowledge receipt of this report: SIGNATURE: 02/96 Title: n R'UTRAM COUNTY Gir MALTZ Dry,MM M OF IC MMAM 'AL IM ALTH URVICES ATTENMN JOSEPH 130M For Fill Alit be Willy completied prior to my T � �• v ja7 P OWIW/Ap one. "I Lot Formerly: NINwe: . -- Subdiriiiid Lot Is sysgm Mill aim~ Date: Is system complebt~? Daft: Is syMm consWuctad as pa ph4m@?, Is well did? Dde: Is well loctod a per pion? Are erosion control uwwms in place? I certify that** ap*"(4 u lint 4 atthe abovepmmian )w beenoohed and I have inspected and verified emir compledon , in rdance with :#w iatt W PCHD Conduction Permit and approved plan; and the Standards, .RWes and Regula6= of the Putnam County Dcparmoftnt of Date: Cedifiod by: PE RA Address: Lic. # Comments: Forms 111`1_99 /�'S�� 021 q1, .01" a NEW YORK BOARD OF POE L04DERWRITERS BUREAU OF LeL,EC I ITY 40 FULTON STRELrT — NEW YORK, NY 10038 CERTiIMS THAT Upon the application of upon premises owned by JOWN STAB ELEC CONTR."; JENNIFER ESTRADA P.O.86}X 715 24 PARTRIDGE PUTPIA10 VALLEY, NY 10679, PUTNAM VALLEY, NY 10579 L ocaiad at 7Ttl 6 FV ...►AA: V . L(;.. IVY 10579 Y .:....... ::. -.. . Application Number: 2100M C artMitate Number: 2100898 Section: 00/74.111ock: 1 Lot: 33 Building,Permit: 20004 -552 BDC: W108 Described as a iltasideatial0-599 square ft occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described'belbw, located In /on'the premises at: Basement, Outside, A visual inspection of the premises electrical: system, limited .to.. electrical devices and wiring to the extent detailed herein, was conducted in accordance" with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other -authority having jurisdiction; and.fqund:te_be :i0'0oMPllance therewith on.the. Sth ..Day-of. -,June 2006.. saw go BAM clink. TYM Miseelmneaos 644-06 Alarm and Emergeaey Bgoipmsnl . Signaling Device ,.A 0 So* ' Alarm sensor 1 0 SeodC . Alarm This certificate may not be alter in any way and Is validated only by the fence of a raised seal at the location indicated- SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 15, 2006 Daniel Donahue, P.E. 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Estrada Partridge Lane, (T) Putnam Valley TM # 74.17 -1 -33 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Silt fence down in numerous spots — please correct. 2. Remove large stories prior to backfilling SSTS. 3. Once copy of the underwriters certificate is provided, a pump test needs to be witnessed by a representative of this Department. Ir you have any fiuther questions, please contact meat (8�5) "278 =6130, ext: 255:" JD:kly Sincere Jo ph Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTMAM COUNTY OF ZxALTH DWISM OF MMONNNWAL MALTH SERVICES ArrVf N JOSEPH ❑ GFw REQUEST FM .FLAIAL MMECION For: FiU _ _ AN inbrawdw mum be ihtly completed prior to my Trenchesa �� � inspectiooe bed male. j v clicr, PCHD CAeNbutilosi Permit # Located: Ow=/ApplicW Name. Formaly: V.61—mil 'A Z- 3®bdivieion Nw®e• �•�'*� f�Jlrai �f,�, �, 9ubdiviaao Lat #� _ � -- Is cyst" fill oempisad? ,�_� Date: Is syom cao ? ,Z Data: �• !'.� Is systm amebuated as pwr plans —4:0— Is wou drm"? Dente: Is well locood w« per plm? Ara eiwosion a nkol m its place I certify OW sysim(s). w listad, stdwarbovepmeimbaboa conattunted and I h*ve i"wted and vmIftd tjoir congg d m in acoordanoe with the Wood PCHD Construction Permit and awowd plan wd the 8twttdwrds, Rules end RgpJa ions of the Putman County Depubnent of �� `BRA Date: �� Cerdf d by: ,.. Proibssional Address: "Z Lie. it Comments: Form FIR -99 TIIN -12 -2006 MIN 1x:36 TEL:945 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 LORETTA MOLINARI. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 5, 2004 Dan Donahue; PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive , Re: Waiver Determination — Estrada Partridge Lane, (T) Putnam Valley TM# 74.17 -1 -33 The Putnam County Health Department reviewed the waiver request for the above regarded project on October 5, 2004. The following determination has been made: X The Waiver request was approved. ❑ The Waiver request was conditionally approved. However, the revisions) noted below _ must -_he complf fed:prior,torzthe.ssuarice•of a -pe rmit: ❑ The Waiver request was denied. An explanation has been noted below. ❑ The Waiver request was not voted on. Explanation noted below. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj E. UTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVICF.y. `.... CO NSTRUCTION'PERIVIIT*FOR'SEWAGE TREATMENT SYSTEM PERMIT # a '— OD, � Located at t A '� I" Alnn ,* Se-Cg Subdivision name C6<Subd. Lot # Date Subdivision Approved` / J 1-7,,-, Owner /Applicant Name XZ2.t' ti Mailing Address Amount of Fee Enclosed or Village t^ Tax Map lock � Lot m Renewal _ Revision -- Date of Previous Approval 0 Building Type`. - f'—_Qm t � Lot Area I , RN . of Bedrooms Design Flow GPD Zip Z� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ) ,1t,Z� gallon septic tank and ic2 4i in Other Requirements: 2, milt'- T j" To be constructed by % 8 %�) Address Water Supply: Public Supply From Address riled.by - Address _ Private SuuY Dpl 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 th e 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 I B Address Qc •r 60ik .*e 40 V ► C A2 [`' A hewi'kn(Y P) �4 License # 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 ermit. Approv for discharge of domestic sanitary se age only. By: Title: Date: � /o White copy - HD ile; ello copy - Building Inspector; Pink copy - wner; range copy - Design Professional Form CP -97 PUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A.W ,T,E1 :WEI.I,:; \ J _ please print or type V PCHD Permit # l �i GL - Well Location: Street Address: o illage Tax Grid # M urle- '?U \Je4R f&ap 7Y.1 Block I Lot(s)--�3 Well Owner: Name: Address: ,4 ,in (,i 1 '31 S-eev g spar A vre /VJ tavo Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ T- gpm # Pe e erveq--"' Est. of Daily Usage Z]��gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason z Ue-c� ; for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_I,,-'No Name of subdivision Via, t��, �� 5 (2L /3 J 2k*/',,-v,--Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /J Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to a provided on separate sheet/plan. Date: Applicant - .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 4wa r we ll driller certified by Putnam County. Date of Issue Mk� Permit Is ing Off ' Date of Expiration O Title: Permit is Non- Transf rr le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENT_ AL HEALTH _SERVICES ..- ., ..-\.. - -._ ... - ♦ ....r �-.- .n t4 - a r :h +: ♦'r 4.. .._ n. a r- _. w.w.. .. _. .a M.. ... .y -. RE: Property of Located at LETTER OF AUTHORIZATION (DTV �,^A Tax Map # Subdivision of O"-ir_ Block �_ Lot �� ur /l� � f�7 c7 • Subdivision Lot # Filed Map # I S6 Date Filed qa %e) Gentlemen: This letter is to authorize 7onci ht a duly licensed Professional Engineer .Z or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or .14.7_.of the :Education. Law, the Public Health__....: __.".'taw, a d-i -thy Putnam'County Sanitary Code. --.....Very truly yours, Countersigned: Signed: P.E., R.A., # L_T64yt Mailing Address yAn-0 State Zip T Telephone: (Own f Prope ) 1. Mailing Address: 3 ;�T(j; -�� State VJ Zip `J Telephone: Form LA -97 iW YORK STATE 08PAATMgNY OF HEALTH Sop009110 Waiver 1roaV of Co"Wunity sanhatlon and Food Protectlon Qrmrn tioguMadtenta e! Pall 751�fN1 AppeaeNK 7tW1� iONYt tR for Ind6ldua) Heuaeheld Sewage TtaatM*rd Systefne 1 r , Yarns of Applftflt 4o`. O--Ir 4 t. Flsnsen why Qlte does not meet ioNyonR Awondtx n-A (d',&Vk epproprt, tabox( ®alj_ t3apsfation dlilAnoe cannot be aehloved.:..:.. , ., ..; .. J . � ' • - EXcM14:e16po: i High grour>Idwater/ � � .. � • i11nageauste dWh to bedrock or kv par"*e teyor. Sail un:uitoblsl , r�Gthor(axplpJn) .....,,,., .....,...I,,.,r..• wl..a.lar ... «_... » ......;. «« w..J.. «.._..«..�.. __.. «..«. . ..wwWUwm.r6_.....J »»y ••r....00...»r.ww..x +» «.»..r .. «.... «........wr_... ...... ...J.» » ... .r....._galw..r..r...�....»ary» ... .............. a.,llll.. «�......�.. ..« .. .. ..............r. , w .. »...•�.... r..xr.w•_ ..r.wH»w_. «..r .rs. • •.w • - .. »J.rw u.•W�..w» «.t••rwwr. «�4.or- J..I.u_..n• war». Frwu ••.r�ru»w�M1N1VM11•lr��•µ° »M.W �.MNIWM'•" 21'tgrr��rlbddin -or'60 _ tic!ts�gFf wslver.^-_ ,... ...__ ( 74� At� .. .fl i%......:! .R ..il...r�...I:. •-l\... .. d. �. .N;'�II,,:� .�',�`�., �7- .r�.�.w..�. � ..«YIx Iw.M.. 7 1'fte propasad dratgn msy have ih.9onowlnp limit dons (otwok appropriate box(es))! w r [� Invean d risk of web or spring aontamtaatlofl>_ C'j Imeaeod flak of suttees wttteraoruamindon. Expected detilgn IN* of She e/etem. will bs giminisned. 0"ralon of sewage system is subject t0 mechanical problarra, Gthiertoxptaln) ..,, .. ...... :...... .................. .... . ................. ... r .............................. ..•fr ..- 1�y •,...Iwxlr M•..,y+... ✓•.....w.rx6.im1..Y. Canstrutwon pursuant to this walvsr w"O'ehould not posa any foreeaoable koatth fir envkonmantd prod ms. In accordance Mh Neer YoAt State. QopartOwnt of Health, ArlmSNatrapve Autos, wW Regulations, Part 76.6 (b), a waiver Is hsroby gas ted,'rhle waiver faY be rswked b the lauing ottldat t � chaive in oanditivas lot wtgoh thM w4wr was granted. ORIGINAL - Looai :Heakh Agency COPY - AMbant0oslgn PtofesslorW 2,2.'d 91 51.R Sr1.l, t?F./ - RJR -Cbq 1>iH.471 k l knr l) I.&W i r1a ! LnM j yaw : AG T111 - DQ_ :)MM4 r.=n ma -mc TCI 1.snmr'. I-r11T1. inm !^ns IR iT— nrnnnTAArLm nr- n BRUCE..R. TOLE Y 'Public Health Director - 'UO.RETT K 'MO LIP R.N., M.S.N.' Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road $rewster, New ' York. 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845)219-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845)228-6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: SITE LOCATION: DATE: Y `� ✓/ � 1G��Z C.wh �• � �V / � � �Z. i7—f � �� �2N�Z` �v�('•oN r0 d f/ sB STAFF PRESENT: _ ` -� .one ShemTri SPECIFIC WAVIE06` REQUEST: 35 .AKA Sa re, �� �'" � SS'15. DC7ES . THE PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? ++ +-- -+ YES NO DISCUSSION- REQUEST APPROVAL OR DENIED FOR t.' DIRECTOR (SPECWANER) ��� DATE: 10 . _ ,50� ULTING ''ENGINEERS T anict � 1% UP. 20LI Breckenridge Road Mahopac, N.Y. 10541 914.628-7576 TO _�_2 -- -Co ILL WE ARE SENDING YOU C Attached Undey meparste cover via --the following Items: r-j Shop drawimp Cj Prints . . 0 Mons 0 Samples 0 Specifications L3 copy of letter 0 Change Order THESE ARE TRANSMITTED as chocked below., -:3 For approv*1 [J ' Approved as submitted C Resubmit -copies for approval [7,; For your use C Approved as mod ."j Submit ----copias for distribution C As requested C Returned for corrections C; Return--correew Prints 0 For review and comment C.6 0 FOR BIDS DUE El PRINTS RETURNED AFMR LOAM TO US REMARKS,___.____. _ _ _. _ . � .. COPY SIGNED. TO 18452787921 P.01 10i01/2004 17 :25 FROM D Baker Coin Changer:; _ _` Al Sep 26 OAF 10.53a HUI4E;fNG BFPT l 9l 4'S2T6t/F3`8,C6 � ���y p -� CHAZEN ENGINEERING . _LAND SURVEYN.(" Co., P.C. Clew", Dinner opce 21 Fox Sheet FOU04wMe. New }'ark 1e601 NaiACa eay Phasic i.:8)Mj845a Phone: (84S) 45449180 tax-' (845j+FS4 -4016 Phont (Jf8)812-0Si1 G' mil. P9-V4 RRSlC@-ClraaaercorRponWeonc [Ayrrgr Ccunry 'Wee Wet; w�.u,cl7rerce anies cait+ Ptlme ;845)587 -103 September 28, 2004 114emberg of the .Putnam Valley Zoning 3oard 'Town of Putnam Valley Plarmmg Hearn 265 06cawans Lake Road Putnam galley, ,;'V'ew York I057.4 •�: F.,strA�-Dev�loprl�nt�pprvvsl Plr�:o Tax I.D. 74.17-1 -13 Jab # 1004,16 Dear AMerabers of the Putnam Malley Zoning Board' 1 ~ SETY r ZONING BOARD OF APPW The Planning Board has received your na•emorandti:m dated: September 22, 2004 in . -reference to the proposed a nglwfani ily dwelling for Federico and Jennifer Estrada. The Pkauxi ng Beard is in agmsment that the proposed dwelling should be locat6d on the wetland buffer boundary ling and that a front yard variamo will not _._ be r upred front your Boa r .However, Bat fy._ •�1E: ,onrerrs, of Am P,la�rz� ^ e:.. Board and the Wetlands Inspeetoi:,: the applicant Kill likely need to mitigati.ori,mdaFUree to reduce impacts to the wetland buffer. . S:rcerely, vc� Sumn Biickstein' A?CP: PP Planning Board VYtiiiam A. ZuEtt, Egq: Steve Coleman, Wetlands iftsp' eaor Iry Sevelowlt2, Building lilepeCtoT Zoning Board of Appeals ApplieFtat Jan K. Johanneasen PlaixnL -r V421P !TK10M rnj IKETV 1"1L=P�pTMCA1T flC O 4 I S LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention[Preschool (845) 278 - 6014 Fax (845) 278 - 6648 FACSIMILE TRANSMITTAL To: Fax: N - 7�4 From: Vow � ✓� fi . )OWC Date: /e Re: Pages: 3 . CC: ❑ Urgent 4C- For Review ❑ . Please Comment ❑ Please Reply ROBERT J. BONDI County Executive CONFIDENTIALITY STATEMIaNT: The information contained in this facsimile may contain CONFIDIiNTIAL and legally protected information intended only. for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845 - 278 -6130) and destroy all documents associated with this facsimile. LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 8, 2004 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive Re: Waiver Determination — Estrada Partridge Lane, (T) Putnam Valley TM# 74.17 -1 -33 The Putnam County Health Department reviewed the waiver request for the above regarded project on September 7, 2004. The following determination has been made: :: . ,The. Waiver requestas:anp_r_oved...__ _ .. ❑ The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. X The Waiver request was not voted on. Explanation noted below. 1. The waiver committee has concerns with the design and construction of the proposed clay barrier. Based on the detail provided, the trench needs to be 14 feet deep in order to have the clay at the elevation of the footing drains. In order to obtain 2 feet of clay 14 feet below grade, the top of the trench will have to be somewhere between 10 to 15 feet wide depending on the soil conditions. Therefore, the following options are offered. a. Provide a detailed method of construction and provide comprehensive detail of the clay barrier on the plans. b. Apply and obtain a zoning variance for the property line adjacent to the paper road so that the house can be shifted down closer to the road and closer to the side property line to obtain the 50 -foot separation from the SSTS. ,r c. Reduce the size of the house to better fit the lot and relocate it so it is 50 feet away from the SSTS.. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj IAItMA MOL[NAM R.N., M.G.N. ROHPA'I' t, 80t4Ot P7rb(ic NeaaF Oirmear _ Cumay E.—Ii. DEPARTNMNT OF HEAL•THE 1, Geneva Road, Brouster, New York 10509 EnciceanuulW Ileuldl (845)276.6130 F.(845)278.7921 Nanla8 6erv1w (845)278.6518 WIC (845)278.6678 F.(945)218.6085 Early tuzo v deafttschoel (90) 2118 - 6014 Pax(845)278 .6648 ' FACSIMILE TRANSMITTAL To: �_ �.nnt / �5•{'✓Wlx Fa:: From: Zoe. /AYdr✓a ,(7 #W _Ante: . Re: Pages:. CC: ❑ Urgent ?9C For ReSiew ' 7 ' Please Comment O 'Phoase Reply • CO"WXNTU.LM 3TATEMLNT: 4ha infomadan con5atn<d inthia ILceim)le mqy cootaia CONFID11C2TAL , and legally p atemed a ty for the use of the iudtvlddal ar amity named about If the reader of this omsaegu is nor il5e haaedeA Tut(piwt you me hereby notified that ®y di8a5mdaq diatnbWioa, or copying nt thin eoloeapy is Aridly ptah)h(ted. If you have received this telecopyin c=r, pleme t ly wify us by telephone ( 8412166130) ead desimy all dodumnb usociated with this faalmQe. - • • •QHZ1IWSNFRis ZNMifIOW INHOU aO 219Kd J SHI q NO : ssznsHx £� : HaOW ,CS ,TO : HWIS QHSdvlm 8T:ZT ST -dHS : HWIS luviS C/C sHOVd OZZTT9LVT6T6 .: HNOHd TZ6L- 8LZ -SV8 'IHZ HZ'XHH aO ZNaKIdVdHQ 7.ZNII00 WKNZIId MMN TZ:ZT QHM b00Z- ST -dH9 HZKQ NOIRMNOO ONIGES LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 . Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 8, 2004 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive Re: Waiver Determination — Estrada Partridge Lane, (T) Putnam Valley TM# 74.17 -1 -: 3 The Putnam County Health Department reviewed the waiver request for the above regarded project on September 7, 2004. The following determination has been made: The' Waiver request was approved. ❑ The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. X The Waiver request was not voted on. Explanation noted below. 1. The waiver committee has concerns with the design and construction of the proposed clay barrier. Based on the detail provided, the trench needs to be 14 feet deep in order to have the clay at the elevation of the)footing drains. In order to obtain 2 feet of clay 14 feet below grade, the top of the trench will have to be somewhere between 10 to 15 feet wide depending on the soil conditions. Therefore, the following options are offered. a.. Provide a detailed method of construction and provide comprehensive detail of the clay barrier on the plans. b. Apply and obtain a zoning variance for the property line adjacent to the paper road so that the house can be shifted down closer to the road and closer to the side property line to obtain the 50 -foot separation from the SSTS. c. Reduce the size of the house to better fit the lot and relocate it so it is 50 feet away from the SSTS.. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Sincerely, _ Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj Y LORETTA MOLINARI Public Health Director ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Daniel Donahue, PE 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue: August 3, 2004 Re: Waiver Determination — Estrada Partridge Lane, (T) Putnam Valley TM# 74.17 -1 -33 The Putnam County Health Department reviewed the waiver request for the above regarded project on August 3, 2004. The following determination has been made: ❑ The Waiver request was approved. ❑.. - The.Waiver request was. conditionally approved..However, the revision(s) noted below must be. coinpleted'prior to the 'issuance of a permit:--- 11 The Waiver request was denied. An explanation has been noted below. 0 The Waiver request was not voted on. Explanation noted below. 1. Instead of running trenches parallel with the existing contours, provide R.O.B. fill for regarding and straighten out the trenches, thereby providing increased separation between the trenches and the house (approximately 30 feet). 2. Please provide a clay barrier running the entire length of the house to a depth equal to the footing drain depth. Show on plan and provide a detail. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Sincerely, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:km CON - UMING-ENGINEERS _ dEEIrTEM ®F YMARZKOTTk(L U Daniel ).Don4hue, P,E. - 200 Breckenridge Road oAT[ Joe no Mahopac. N.Y. 14541 •tfQN O _ /� 914-628-7576 !.r oil G WE ARE SENDING YOU Z.11 Attached C1 Under separate cover vial —the following items: CI Shop drawings 0 Prints ❑ Plans ❑ Samples ❑ Specifications O Copy of letter C Change order ❑ 4_ THESEARE TRANSMITTED as checked below. for approval ❑ Approved as submitted ❑ Resubmit-cepla Resubmit—c for approval �❑ For your use ❑ Approved as noted ❑ Submit copies for distribution As requested ❑ Returned for corrections 0 Return connected prints ❑ For review and comment 0 .._ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US RIC sa Aker e SIGNED: . O SENDING CONFIRMATION DATE JUL -21 -2004 WED 08:49 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96287576 PAGES : 2/2 START TIME I : JUL -21 08:47 ELAPSED TIME : 01'05" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... •a0a9�3 em W. pa"POM W p p TIB coup Pal iafiTm"W •. =ogdala) Aq pa ipoa Aaoe<Pasan(meaTQ •roam m .( plgl Panmz` a,seq ape R WIPORa+d RG(ru n .tdaaaipi . +}RIP 9al&dW Jo VopngmpTp bo)pptinW Lhp v%pappoe Xq" an wX 1mldPu F'P— a* — pt Qft—W sM P xv- aq dL —v p— Ana; ro vnpm o) mu ad — am +af 4- PaP-m ' --MR m—ow Al(tsal Pap I 1VL1, T.>;,)t> �p. Tp�pTaivoa ,�pTToRoq�NPaal4��v�oP(aaL1 :rpanrriYSS.[SPIVLtNi078HOJ - -- 0a . / alrr,�- .. :aiuQ_ _•.7- 1DU„b` �.•n'�^e � ?�` :mo�� • 7GSL - SZ°� y .iB$ .�(+ ian',eviy� VN'� 'ay . ' IMP '1„LIWSI�i�I,L_('3(rIINIIS�'�� . 9Y99"YLZ(S4Y)M3 f109"BCZ(S49) laa4aa�mp.uolpl pmg glop "pLL(St9) -it 909"YLL(St9) mm 96a9"BLL (SYL) aaW9 i pN. =L•9LL(m) -a oclo - la (m) omm ImmmpWppy 60901 VDA — X'3m9ievg 'PpogpndcoD T HsivaH dO. a,N3Jvrxvaaa +'�l>tiap+? punw,) +piaMO YUaaH all9pd IQNoe 'I THYNCIOP) V.1im07 t �F y n LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 27$ - 6014 Fax (845) 278 - 6648 FACSIMILE TRANSMITTAL To: 0"t 't Qo�u �e , c - From: Jr, e Fax: 75 7, Date• Re: �/.3e� <�'� (,iJ�; . t� `7S Pages: ROBERT J. BONDI County Executive CC: ❑ Urgent ❑. For Review ❑ Please Comment ❑ Please Reply CONFIDENTIALITY STATEMIGNT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only_ for the use of the individual or entity named above. If the reader, of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845 -278 -6130) and destroy all documents associated with this facsimile. VEW YORK STATE DEPARTMENT.OF.HEALTh{_ SpeC�f. c Waiver 3ureau of Community Sanitatiori'arid Food Protection from Requlrements of Part 75 and Appendix 75 -A, IONYCRR for Individual Household Sewage Treatment Systems 1. Reason why site does: not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. i High groundwater: Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ... .......... ...................... :................................ ...................................................................................................... ..... ... _...................... ................. . ...................................................... ............................... ......... ............................... i » ..........................................................................................................................................................................»:................... ............................... »........ ».................: 2. Proposed design or conditions of waiver'. .. ............................................................................................................................ ............................... ' ................................... _ ................................................................... ..................................................................................... :......... .............. ...... ....... ....... s __ ...................... » ......... ......................._ ............................... ..........»...............................»................. ........................ ........ ...............»........»....... .. »........................ ». ». i 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination.. Expected design life of the system will be diminished. E Operation of sewage system is subject to mechanical problems, i; I Other (explain) , ....... ............................................ ............................... ......»......................................... ..:........................ »... ......_........... . . . ... . . .. . .. . . . . . . . . .. .. . . . . . . . .. .. .. . . . . .. . .. .. . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » ........................ . . . . . . . . . . . . . . . . . . . . . . . Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiver was granted. fiEPfiESENTi1TIVE:'CF COMM15SIONE.R do HEALTH .................................. ORIGINAL - Local Health Agency COPY - Applicant/Design Professional ................................................................ ............................... onrE C�SN.'INNGIN EE RS_.... Daniel J: Donahue, P:E 200 Breckenridge Road Mahopsc, N.Y. 10541 A} }[N♦ �J 914.629.7576 TO _ , �%r / ..... OAK f/ N Rt O Approved as submitted 0 Resubmit,, copies for approval O For your use WE ARE SENDING YOU Attached O Under separate cover via ,the following items: ❑ Shop drawings 0 Prints El Plans G Samples O Specifications ❑ Copy of letter ❑ Change order D THESE ARE TRANSMITTED as Checked below: Cl( For approval O Approved as submitted 0 Resubmit,, copies for approval O For your use CJ Approved as noted O Submit copies for distribution 0 As requested ❑ Returned for corrections ❑ Return corrected prints O For review and comment 0 .._ O FOR BIDS DUE 19 0 PRINTS R NEO AFTER LOAN TO US COPY TO SIGNED: ._• �� w�� h".0. M0 4 A* 0116 . P P C IV J 'IN .; iV NE_ERS (OF �T�G�1�SGAI�`�'i��LL U Daniel ] Donahue, P.E. 200 Breckenridge Road Mahopac, N.Y. 10541 914.628.7576 TO 1, 94 , WE ARE SENDING YOU C Attached ❑ Under separate covar via ,the fbllowinR items: ❑ Shop drawings Cl Prints O Plans O Samples ❑ Speciflestions ❑ Copy of letter ❑ Chanty order . G THESE-ARE TRANSMITTE.O -as checked below: ❑ For approval D Approved as submitted O Resubmit copies for approval 0 For your use ❑ Approved as noted O Submit copies for distribution C As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment 0 r-I Mo Rine 'ne)IF 19 n PRINTS RETURN911 AFTER LOAN TO US COPY TO - SIGNEO: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE AGE TREATMENT SYSTEM PERMIT # Located at /D!e .� � /) C; 1_ Village %ozlr ?V4�y A6r��y T- Subdivision name &-Ro 4, Subd. Lot #_ Tax Map Block l Lot Date SubdivisionApprovedl 4L2 Owner /Applicant Name V : Fsj�-4c/,k Renewal Revision Date of Previous Approval Mailing Address 3/ S 7-Pxpr, .cad wit l" h r Zip �C% Amount of Fee Enclosed `ebb Building Type S'hf6 ,1'-f r-OW y Lot Area of Bedrooms -f- Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /07-j -P gallon septic tank and 92yk rf df d5 114 Other Requirements: ri--A-/J ff To be constructed by Address Water Supply: Public Supply From Address or, ' Pnvafe Supply Drilred`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 r 2-..j Address AEA CL /`'l /"'t C- A�5 License # 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 modi ed when considered necessary by the Public Health Director. Any revision or alteration of the.approved plan requires a ne permit. Appro d for discharge of domestic sanitary sew ge only. �.� By: Title: Date. ` White copy - HD ile, Yel ow copy - Building Inspector; Pink copy - caner; ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES e.. APPF; 1< C! �'I'Ifi�,'I'Q'i<'R�J_AA`II'EI.WEL (� please print or type PCHD Permit # T y Well Location: Street Address: o illage Tax Grid # 00,1W' Jed' z7hv,A ho �ftrlj�,,+�► Map 7 lock / Lot(s) Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm mvbd Est. of Daily Usage 3 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _4Aiew Supply (new dwelling) Deepen Existing Well Detailed Reason ,PrniA—V If for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes L--,ONo Name of subdivision hNgwqoo A 017 6FCO-f -8 P4'A14Pt fi"A-p Lot No. Water Well Contractor: �,� Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /V //2" Town/Village Distance to property from nearest water main: At ' A Proposed well location & sources of contamination to be pro vi on separate eet/plan. Applicant . 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. � � AI Date of Issue Date of Expira i00 Permit is lion_Transferrnble Perm Title: White copy - HD file; Yellow copy - Building Inspector; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION t r ' RE: Property ofe.� Located at or� /17 Ov P-1- ��ax Map # Block Lot Subdivision of c Fed gll llig7c) Subdivision Lot.# Filed Map "# Date Filed Gentlemen: This letter is to authorize --D O Y10 h vf' - a duly licensed Professional Engineer i/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 . of the Education_Law, the Public Health Law, and- the- Putnani County-Sanitary,Code: _ ,..... �. . _.._.. Countersigned: PE RA# 1.11rY!'� Very truly yours, Mailing ddress al'l% 19/*5w.�lJe/�ogl,r/Or Mailing Address: 3/ cs����r�sdn � - - t V_1_1q1/ 8 da /e State % Zip ��y�.. State d-&4) VC0, Zip 4) Telephone: % y'. -W 3s-61,V, Telephone: Form LA -97 11 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION` OF ENVIRONMENTAL HEALTH SERVICES DEgICN-VA.tk -SHEET --,-SUBSUR�FACE SEW -AGE TREATMEN-T-SYSTEM-.. --n,,�'. Owner J E4,j 1 eg—;-f? lxld #+,Df Address -2/97F4/9-mr&X 440.J-F4 HAMKP" 6�2 Located at (Street) Tax Map �JW BI ock l Lot (i0dicate nearest cross street) J'Vj��4�1 kl, Wate rshed Municipality SOIL PERCOLATION TEST DATA Date of Pre-soaking 1 -z_ Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each per ,cq0$i9,# :5 test hole. (i.e. 1 min for 1-30 min/inch, f. 2 min for 31-60 min/inch) All data to be V - sub�M'"' e l f6r review. 2. Depth measurements to be made from top of hole. Form DD-97 . ...... . .... ... ... De `th to Vl+ater M' relun 1: latex P. Us 94 1 ... .... . ....... ... ... .. .... .. trait, .6 ok ate I :cc at rt3 2 a1r 3 4 .2 3 3,-Z) 4 '3 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each per ,cq0$i9,# :5 test hole. (i.e. 1 min for 1-30 min/inch, f. 2 min for 31-60 min/inch) All data to be V - sub�M'"' e l f6r review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCrION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH. HO�,ENQ. t1j. HOLE N0,_ ;L G.L. 0.51 .0 2.5 3.0' 4.0 4.51 5.01 5.51 .6.01 7.01 Indicate Jevel at."_ic 9rou n-dwater is encountered h &- Indicate 1pyel, #t w c .,mott ling is observed &A.dpj, Ifidlicite; -level tow "ch Water level rises, after being encountered Deep hole observa ons made by erd. P-e/w, Pill Date'.' Design Professions Name: Noyce t- -w/ D.0 Ajof6tjs Address: Signature Design Professional's Seal tss 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SIERVICES APPLICATION FOR APP!t AL-.OF..FLANS FOR _ _ . _.. ---� -� A''' ASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: `� { Rc h-4 414-4 -,I 1 2. Name of project: slyAg e f'x ,v., r c r 3. Locati4r:.. 4:: Design l'rofessioual: Mq 5. Address: /.10 rs.yw.tf o 6. Orainageaasin. 7. Type' Project: _ PrivateJR�csidential Food Service Commerci,al Apartments Institutional — .'Mobile Dame Park . Office Building Realty Subdivision Other (spdcify) 8. Is this project subject to State Environmental Quality Review (SEAR)? Type tatus (check check one ) ........:.............. ........................:...... Type I i Exempt Type II Unlisted _y_ 9. Is a Draft Environmental Impact Statement (DEIS) required? ....................p.... A114L 10. Has DEIS been completed and found acceptable by Lead Agency? :............. All if 11. Name of Lead Agency Zz T 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .. . .. .......... .......... - 13:. If so, have plans been submitted to such authorities? ................................... Al o 14. Has preliminary approval been granted by such authorities? Date grs4ed: AT_'_ 15. Type of Sewage Treatment System Discharge ..... :..:......... -surface wat groundwater 16. If surface water discharge, what is'the stream class designation? :.:...:..�.... ,1// 17. Waters index number (surface) .....:..:.................. ............................... .....• .... _ � 18. Is project located near a public water supply system? ...... ............................... /I! 19. If yes, name of water supply Distance to 4ater supply 20. Is project site near a public sewage collection or treatment system? ............... A/d 21. Name of sewage system - ", , Distance to sewage system 22. Date test holes observed /y �/, z-- 23. Name of Health Inspector'' ±d 24. Project design flow (gallons per day) ............... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit requiredt... A/o 26. Has SPDES Application been submitted to local DEC office? Form PC -97 5 7. 3. lD J. . I+ 2. . Is State Pollutant ischarge,Elimina.tion System (SPDES)..Per6it required ? `NL6 Has SPDES Applicant n been submitted to local DEC Office? Is any portion of t ;is project located within a designated Town or, -State wetland ? ........... ........................... :.:.:';......., ..• Wetland ID Plumber • , . • !I • O • • • • • • • ��Z.• • • • • • 0 •'. • • • • . • • 0 Y • • D Is Wetland Permit r4uired? .......... .......................•...,.., Has application beeHl made to Town or Local DEC Office? ....... Does project requireh a DEC Stream Disturbance Permit? ..................... -- /V �a '. Is or was project si a use d for agricultural activity involving application of pesticides to orc rds or other.crops, solid or hazardous waste Wspos A , landfilling, sludge plication or industrial activity? ........ YES or, p ?. Is project located wl�hln 1,000 feet of existence of abandoned landfill, hazardous waste site', salt stockpile, landfill, sludge disposal site,or any other potential �Ct own source of contamination? ..............YESio O _ DESCRIBE: - I� - - - - - - -- — - - -- Is there a local mas>dlr'plan or file with the Town or Village? ........... Are community water,Espwer, facilities planned to be developed within 15 years? IV 1� Are any sewage disposia9 areas in .excess- of 15% slope? ,, ........ f Tax -.Map_ _I D. Number ... 1.1 .............. _ ^ ...... ii i Approved Plans are tb'be returned to: r Applicant, Engineer the application is signed by a person other than the applicant shown in-Item. 1, the lication must be accomp led by a,tetter of Authorization. Failure to compl with this vision may be grounds for the rejection,of any submission. " ! I { I hereby affirm, undor penalty of perjury, that information provided on this form is true to . the Est of my knowledge and belief. Fa Ise statements made herein are punishable 0s a Class A Misdemeanor p uant to Section 210.45 of the Penal Law: ATURcS & OFFICIAL TITL'E*: ING ADDRESS: ? `ICY 14.18•; (N7) —Text 12 PROJECT I.D. NUMBER 617.21 EAR .. .. ..vim._ - - - -,• .-. ....,.. q -- .. r ., ... .... %APperrdlx'�' State Environmental Ouallty, Review SHORT ENVIRONMENTAL ASSESSMENY FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Protect sponsor) 1. APP ICANT ISFONSOR 2. PROJECT'NAME �. PROJECT LOCATION: Municipality County�^i�', 7 I 4. PRECISE LOCATION (Street addmss and road Intersections, prominent landmarks, etc., or provide map) S. IS PROPOSED ACTION: Icu New ❑ Ex;,analon ❑ ModifieationJsfteration S. DESCRIBE PROJECT BRIEFLY: r'/ if U G ?!ON Q/C /} iy SS Tr I 7, AMOUNT OF LAND AFFECTED: Initially 0, Ir acres Ultimately r acres S. WIL PROPOSEO?-ACTION COMPLY WITH EXISTING ZONING OKOTH ;R EXISTING LAND USE RESTRICTIONS? IYes C No If No, describe briefly h ° 9• WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? n WV Residential 0 Industrial. ❑ Commercial CJ Agriculture ❑ ParklFotatropan . speee © Other _ ..._ 1C. DOES ACTION INVOLVE A PERM IT'APPROYAL„OR..F.UN6ING,.NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE R LOCAL►? ti j� Yes ❑ No It yes;'dlst sgenff• cy(s),and permlt/approvais it. DOES ANY ASPECT OF THEil1CTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? C1 LJ Yes No It yes. Nat agency name and pormlNapprovai 12. AS A RESULT PROPOSED ACTION WILL EXIS71wo PEF(MCM— PPS OVAL REOUIRE MODIFICATION? aO�yFF, C1 Yes rj No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLE E Datel Applicantlsponsor name: j Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this'essessment OVER 1 OAFIT 11 —ENV,'RON MENTAL A$SESSMENT (To be completed by Agency) A. DOES ACTION: EXCEED ANY, TY I THRESHOLD IN 6 NYCRF4 PART 617.12? if yes. coordinate the review process and use the FULL EAF., !is we'Mycaft.. PAM yes :.MN6 C, COULD ACTION RESULT IN ANYJADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Aniwofs may be handZion. If legible) C1. Existino sit 4uality; slurfac4 or groundwater quality or quantity, noise levels. existing traffic patterns. solid "at* production or disposal, potential for erosion, draln4e or flooding problems? Explain bfI*fIj u a 111itorld. or other natural or cultural resoulus; or community or neighboftod characts.r? Explain briefly. C3. Vtcetatl6rl or fauna, fish, siilellli3h or wildlife species, significani habitats, of threatened oroildangeted species? Explain briefly: C5. Growth, subseq�ont develo mart, or related activities fikely, to be induced �y the proposed action? Explain bf loll C6. 1.6n;, term� Short term, curnblaiive.or other effects not Identified In' CI-CS? Explain briefly. C7.: other impacts (Inciudiniciisjnges In use of ollhor quantity or typo of energy)? Explain briefly. 13 �es ONO it Yes !explain �lidefly PART 1 111_1� DETERMINATION Of. SIGNIFICANCE (To be completed by Agency) INSTAUCTIONS: For each adverse . effect Identlfi*d above, deterrinine whether It Is substantial, large, Imporiantorotherwise significant. Eacli jeffect should be ssset�ed in connection with Its (*) setting (i.e. urban of rur&Q; (b) probability of occurri'm (c) duriatlon.,(d) explanations contain sufficli fit deiall to show that all relevant adverse Irn acts have 'been Identified and adequately addressed. 0 Check this box if you[, have, Identified one or more potentially large or significant adveraiia Impacts Which MAY lo r. Then proceed 41rectik to the.FULL EAF And/or prepare S'P031tive declar'stion. documentation, that the proposed iction"WILL NOT re'sult''In any significant adverse thvironmental Irnpo;ts' AND pr6V,i0e on attachments as, necessary, the teasons supporting this determination: Name of Lead Agency rfrtof yope'Na, of Agenc IS of bleV11*40f Ei It atuto=so TPUt—cei in Lead Agency Signature of Frieparer (it different tmkn - Date ' � CONSULTIlo1 ENGINEERS ❑ Daniel 1. Donahue, P.E. .s . ,,: ,-- _•....:: �:._.- ;-- -� -- -- ' ... -•200 8reckcruidge Road : - .. Mahopac, N.Y. 10541 914 -628 -7576 TO G4�9 n rra�nn n[,�� n rym� m- LETTLSW, ®(F UWUUIf E9 U T11L OATE ,�,' JOS ATTENTION - -, RE Ali A �. ,. WE ARE SENDING YOU CJ Attached ❑ Under separate cover via —the. following items: ❑ Shop drawings ❑ Prints L -1 Plans E3 Samples ❑Specifications ❑ Copy of letter ❑ Change order ❑ THESE ARE TRANSMiT'fED as cKiclied'_below: _., _ ...._ ....,..._.., �61or approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted 0 Submit topies for distribution �~ C As. requested ❑ Returned for corrections ❑ Return 46rrected prints ❑ For review and comment ❑ _ 0 FOR BIDS DUE �19 ❑ PRINTS RETURNED AFTER. LOAN TO US REMARKS COPY .. a SIGNED: If enriosurss aro not es nettle, Artndly notify us at ones. �NO. DESCRIPTION - ,. � r THESE ARE TRANSMiT'fED as cKiclied'_below: _., _ ...._ ....,..._.., �61or approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted 0 Submit topies for distribution �~ C As. requested ❑ Returned for corrections ❑ Return 46rrected prints ❑ For review and comment ❑ _ 0 FOR BIDS DUE �19 ❑ PRINTS RETURNED AFTER. LOAN TO US REMARKS COPY .. a SIGNED: If enriosurss aro not es nettle, Artndly notify us at ones. � 20� .a 0 10 U.S. GPM 1 35 1 25 U 20 Q 4 15 O 10 0-1wo Intl 0t i i .. �__._ :_.L.. p 10 20 30 40 50 60 74 0 9p 100 110 120 U.S. GPM 0 — -- ----�— 10 20 30 M3 /h CAPACITY Etise ive July, 1993 SPECIFICATKMS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED W U. .A. CbNSVETING-ENG-04—EERS P.E. 200 Breckenridge Road" Mahopsi% N.Y. 16541 914.628-7576 ro ^�i /� WE ARE SENDING YOU ❑ Attached C Under separate cover via 0 Shop drawings C3 Copy of letter L I d LZ771M (ELF gT(R6U18PJG77,za. the following Items. ❑ Prints 0 Plans 0 Samples 0 Specifications ❑ Change order THESE ARE TRANSMITTED as ilikkki-Ww" ❑ For approval [3 Approved as submitted C, ResubmIt-oopies for approval C] For your use ^ Approved as noted ❑ Submit copies for distribution 0 As requested Returned for corrections 0 Return -corrected prints U For review and comment 01 ❑ FOR BIDS DUE 19- 0 PRINTS RETURNED AFTER LOAN TO US C71, REMARKS COPY TO SIGNED: . I-- --##fw as of on". P% WM-11 VA '%tow r rr rrr rrrrrrrr THESE ARE TRANSMITTED as ilikkki-Ww" ❑ For approval [3 Approved as submitted C, ResubmIt-oopies for approval C] For your use ^ Approved as noted ❑ Submit copies for distribution 0 As requested Returned for corrections 0 Return -corrected prints U For review and comment 01 ❑ FOR BIDS DUE 19- 0 PRINTS RETURNED AFTER LOAN TO US C71, REMARKS COPY TO SIGNED: . I-- --##fw as of on". CONS TINGINGN —EER8 - acs u a - ❑' Daniel J. Donahue,'P.E. 200 Breckenridge Road ,Viahopac, N.Y. 10541 _... ......_ ...-- ............. 914- 628 -7576 TO R � JOp NO. cL+'� RE I qL' / WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: REMARKS ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ — ❑ FOR BIDS DUE 19 ❑ Resubmit copies for approval ❑ Submit,_____.copies for distribution ' ❑ Return corrected prints . ❑ PRINTS RETURNED AFTER LOAN TO US -- 90 t 11 WV Q d3S Z0 _. rh R -1'+, -fit �• *• '�t 1 1 hM"1 COPY TO _ _-- ---- -- SIGNED: r z PUTNAM COUNTY DEPARTMENT OF HEALTH ]DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1bgSIC;N-IYATA'SI4EET 'SUBSUR- 'ACE;,SEWAGE TREATMENT- SYST1EM - --- =. _ Owner J Ft4 *j i ron =r *,D Address ?/ L7XA6p 4 &,1 ,qVF ',r O~ Located at (Street) PAo?,T C't DG,Ex / V At Tax Map /° Block f Lot GL? ,p (in" dicate nearest cross street) Municipality 0 !17/P7 y�`� -S y Watershed 17�',�1� -� SOIL PERCOLATION 'PEST DATA Date of Pre - soaking 7 /_13/6 Z, Date of Percolation Test 7 A, f1-d 2. A ) 4. "' / / a 2 3 5 "M Wal 2 a _ _ 3 5 goo Ao :.� c� 3 3`0 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test.hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT IDATAZ p: DESCRIPTION OF SOILS ENCOUNTERED. IN TEST HOLES DEPTH HOLE NO.. _._... HOLE NO. _ HOLE NO. G.L. 0.5 pq 1.5 ' /lm` Z:O�_.. 2.5 ' S S 3.0' 4.0' . 5:0' 5.5' 6.0' 65 C3 7.0 ° 7.5' • Indicate; level at which' groundwater is encountered J&4 y Indicate'level at which mottling is observed Indicate level to which water level rises after being encountered bLvd Deep Bole observations made by4 `.ec` 104M D, J a 0 Date W/ ViL- Design Professional Name: Qd #4 %t. vo mo ftj& Address: Suture: Design Professional's Seal �oFES�,roNq Q ,• , G p O�y. F W Q Z m ; 0. 4848' OF N E`N _ � `C�NSUL't'ING TO ENGINEERS QL'�'C. Daniel J. Donahue, -i':E: - 200 Breckenridge Road Mahopac, N.Y. 10541 914 -628 -7576 WE ARE SENDING YOU, ❑ Attached 0 Under .separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans C Samples O Specifications • Copy of letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted 0 Resubmit copies for approval C. For your use 0 Approved as noted O Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return - corrected prints ❑ For review and comment ❑ -- ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: —#.A kiweBv nntifv us at once. i /I BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 1, 2002 Dan Donahue, PE % 120 Breckenridge Road Mahopac, New York 10541 Re: Proposed SSTS/Estrada Partridge Lane, (T) Putnam Valley TM# 74.17 -1 -33 Dear Mr. Donahue: 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 , _ .: _............:.. _. ✓SSTS Roof leader and footing drain discharges need to be shown on the plan. Property metes and bounds need to be. shown on all property lines. c The road to the southeast needs to be shown on the plan. /4. On the property to the 'southeast (the other side of the road), a direct line of drainage keyhole needs to be added for the existing well. Locations of existing SSTS's for the southeast and northwest properties need to be shown. The distance between the trenches and the channel needs to be dimensioned and labeled "100 foot minimum." . , 7. The pipe between the tank and the pump pit needs to be labeled, "4 inch PVC - SDR 35 @ 1% minimum." l/ 8. Based on the topographic information, there is a possibility that the middle portion of the system will be too deep. ROB fill for grading should be specified to level off the SSTS area. Please show regrading in the plan and profile. �9. There appear to be errors in the SSTS profile, specifically, the location of the pipes and their respective inverts. Please check and make any corrections. d' PUMP �1. �3. ,L)4. 8. A detail for the force main trench needs to be provided. A distribution box detail needs to be provided. One day storage (800 gallons) above the alarm needs to be provided. Bedding material needs to be shown under the pump tank and the type of material needs to be specified. A dimension for the minimum and maximum cover over the pump tank needs to be included in the pump detail. A means for pump removal for maintenance needs to be provided. Calculations showing head loss due to friction and elevation needs to be provided to determine whether the proposed pump is adequate. . The pump operating range needs to be indicated on the pump curve. The invert entering the pump chamber appears to be incorrect (276.5 feet). This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cj Very truly yours, SIJ. `�zUUVLo�S /Joseph S. Paravati, Jr. Assistant Public Health Engineer V, k BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services . DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 2.78 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Date: GI /3a i 0 P, To: 19,,7 Doo xAuel P F. Re: A-r r;jge L.IOC fP✓4-17�- + Va11ej 7M. tr 7q-17-/-33 Dear Mn OonN -hae- 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. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj formletter is �I ��5sY5_ if �rLa_�►� - 1oo-'',rnq�,.�n S_c. eS - -n -u ��e shown ova h� —�, �_P_�P _Me�es �v►d _bavna�s _;�ee� Abe (R,vn ova atl �O�zP�r}� -- %�►�5� ; -- 3 1_1111 ®/1 A��o/a�0Zr77� fl _ 2_S- t?J��i►_P.ccST ( ►e o ju -- ;i ine - -- 5'I &C -AOns e-Y-js i✓15 5:s j_5 'S e Soc•_ /hC�aiST t!%cai f2_o±'T!T_GVeSf 14 —I i�S -.! 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SYSTEMS- = -' /REVIEW SHEET OR CONSTRUCTION PERMIT NAME OF OWNER: �`SG` ` STREET LOCATION: �G�r +Y REVIEWED BY: RM, GR, 00, RDATE: �y o TAX MAP #: (CONFIRMED) 7�{ / -7 3 7 Y N DOCUMENTS Y N ( REOUIRED DETAILS ON PLANS CONT'Dl (�(�PERMTT APPLICATION HOUSE SEWER - K" FT. 4 "0'; TYPE PIPE CAST IRON 9 G (—)WELL PERMIT OR PWS LETTER _;NO BENDS; MAX BENDS 45' W /CLEANOUT )PC -97 ��S ,,�k RENEWALS /j LETTER OF AUTHORIZATION (_-)USITE NOTE (NO CHANGE) 1�I� E_5IGN DAT" � ET (DDS); /,;�J °r��F"^ FILL SYSTEMS C--)L-)][Ol HOW NTA AST TRENCH SLOPES.3t1 TO GRADE SHORT EAF L)LJF LL SPEC 1�L NOTES 1 -5 L� PLANS -THREE SETS UUFILL P ILE &DIMENSIONS ( HOUSE PLANS -TWO SETS e i1� (�UFIL EXPANSION AREA FILL GREATER TH4N2 FEET , / SUBDII rISION p�jvq A i,, eS C�U) CLAY B R V( 1L 1LEGAL SUBDIVISION l�u' �)LJFILL CER ICATION.NOTE �(�/ (SUBDIVISION APPROVAL CHECKE L, Ij�?/ ERC RATE /Vo $' r Cod (_- --)L -)DEPTH GAUG CLASSIFIED &IMPERVIOUS (�U L REQUII2E� D DEPTH yb �C_JVOL. ON P F R.O.B., (�(�URTAIN DRAIN REQUIRED (U�U)SEP ON DISTAN E FROM TOE OF SLOPE GENERAL TRENCH Art Wtz („—)( ✓LOCATED IN NYC WATERSHED A�PARALLEL TO TO . 60FT MAX. �T L,(_11)PLANS SUBMITTED TO DEP r' 100% EXPANSION PROVIDED L,(�DELEGATED TO PCHD IV /a (�(_,DETAIL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL C__)C__)DEP APPROVAL, IF REQ'D f (�UGEOTEXTILE COVER .(�(� EEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM 'SSTS LjERCS TO BE WITNESSED (, ✓ (�10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL L ) W- APPROVAL SSDS ADJ, LOTS � 20' TO FOUNDATION WALLS L� TOWN/DEC PERMIT REQ'D ?) 100' TO WELL, 200' IN DLOD,150' TO PITS DATA..ON DDS PLANS - &PE _ SAME: (� 100' TO STREAM, WATERCOURSE LAKE inc. eg a PRE 1969 NEIGHBOR NOTIFICATION ( P • 50' TO.•CATCH BASIN, 35' STORMDR,AIN,PIPEp WATER: _ : , • °• - �---) # _. _.. 10°• TO WATER 'LINE (pits - 20') jyYGO YR. FLOOD ELERATION W1I 200' (__)50' INTERNIITTENT DRAINAGE COURSE C_)CL SOIL TESTING LOTS >10 YEARS OLD 0200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (ZL,SEWAGE SYSTEM PLAN - (NORTH ARROW) U� --�10 MIN TO LEDGE OUTCROP SEPTIC TANK (�U.SSDS HYDRAULIC PROFILE 0010' FROM FOUNDATION; 50' TO WELL LJ(�/ GRAVITY FLOW WELL i/_�CONSTRUCTION NOTES 1 -15 DIlVIENSIONS TO PROPERTY LINES ✓DESIGN DATA: PERC &DEEP RESULTS (LOCATION OF SERVICE CONNECTION L,2' CONTOURS EXISTING &PROPOSED (� 15' TO PROPERTY LINE (��DRIVEWAY &SLOPES, CUT - ' ' � • SLOPE 0vj ` OOT1Nf : /GiJTTER/CTJRT�lI1�TRATbh.(�C__) LOPE IN SSTS AREA 5��520 %) (_,TITLE BLOCK; OWNERS NAME ADDRESS (--) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS TM#, PE/RA; NAME, ADDRESS, PHONE# ✓L,PUMP NOTES ( �/ L)DATE OF DRAWING/REVISION DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED]" t rL,/ (DATUM REFERENCE r UU LOCATION- FVk -ER -RzSES, PQ�FDS Syr (—� t ✓MAKESWETLATDS-wTH]a�F 20oRP (PROPOSED FINISH FLOOR AND 'y1 DAYS RAGE. ABOVE ALRR�4I ' J,v�P^9 BASEMENT ELEVATIONS CURTAIN D WELLS & SSDS'S W/IN 200' OF SSTS UUSTANDPIPE , 'BOTH , DETAIL O ^MEN BdS a �ri�y'�'9 L�� L -JL�15' MIN to CDS= o, '-4 %, 25' -3 %, 35' -1 %,100 % ION CONTROL FOR HOUSE, WELD L &mss` —,0201 MIN to ISCHAR ' with 182 cons day discharge SSTS, EROSION CONTROL NOTE eboiYA UU10' to NON - PERFORATED P �OMMMNTS: REVSHERT109 101/00 y PPDANIEL J. DONAHUE, P.E. . CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541. 845- 628 -7576 August 20, 2002 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Shawn Rogan. RE: SSTS Permit & Well Permit Property of Estrada Partridge Lane Putnam Valley Dear Mr. Rogan: Enclosed herewith please find the following: 1. Form PC -1 2. SSTS application 3. Well permit application 4. Design data sheet S. Letter of authorization 6. Fee in the amount of $300.00 V/ 7. Short EAF 8. Three copies of construction plans 9. Two sets of house plans 10. Pump Curve By: Daniel J. Donahue, P.E. Site . Sanitary Environmental 00 _ �TM� o DIN. RM. MONNG RIA C � Iiix12� lN. M. t ' ' FAM, RM, 18ftY m IAlIYt20 FOYER 1st Floor sdatoa. t t� .. p11904 LYON HOMES 111C. Old Trail.Raad, Selinsgrove Pa. 17870 c Tel6l t ore (717) 743-0111 DIN. Rh I IIi x 1210 C. I.N. 1921 1-1 L1...... O KITCHEN MCWNG RM. "lots 1210 III xl20 1.. FAM. RM. . 1A8x12n FOYER i �► .- PuNN Wom HOMES INC. taro, ...... Old Trail Road, Selinsgrove Pa. 17370 i Telephone (717) 743 -0111 -711 e ^�� 7 Go TEST PIT PROFILES Hole # !�_ Lot # Hole # _ Lot # Hole # 3 Lot # De p thlo wafer � M th to water ' iV o Ai,6` Depth to mottling 1,jdhlh Depth to mottling. A-J l,,T Depth to mottling NfoAld-E Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 7�y, 0.5 _ 0.5 1.0 y e, /o G✓ � , 1.0 1.0 Xell, . 2.0 ��h �° �✓" et W � oat Yy y 2.0 ...2.0 r 3.0 3.0 3.0 4.0 v R 4.0 4.0 d 5.0 G 5.0 5.0. 6.0 6.0 6.0 5 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 110.0 Hole # _ Lot # Hole # Lot # Hole # Lot # - - _Depth -to wat- / l :p Depth to water Depth to water Depth'to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 � �� 0.5 0.5 1.0 . //r 05x, 1.0 1.0. 2.0 y' . Ida 2.0 2.0 3.0 10 3.0 4.0 / /o� b j' , 4.0 4.0 5.0 5.0 5.0 6.0 MeA 5nw 4c �6.0 6.0 7.0 7.0 7.0 8.0 7 �� 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 g; /_® by Q�P rrows 6624 •.... •.. '3 *x.73 ,',. "-.. 0 2�0. 15 t.52 i5 2l 20'✓ � j V. � 'fi.`S�o /'S�69 �57��' , -.�,. 0.6 4��GS M` 3 -GCti s2 �lys 46 � x.66,333 / / _ .._. _ -... O _.J.•�B —�� / to 6 "F1Lk. _ R:3r ' - E OORR' N R:30 L : 50.79 ? .. pRA/NJ cn !`i 41.92 2 0 y 124.8 3F3 ?' :2 '75... _ - -- •— - — ..�o� ;� � N - ' �.i.48 L 99 - NO PROVE ERRIP- RAp AT ENP CU_V .ASHOUTS- ' / F ,'4.4.955 S' r PUTNAM COUNTY DEPARTMENT OF HEALTH N DIVISION OF ENVIRONMENTAL HEALTH SERVICES- INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project F�vTi't/ i 4e?? aj�- 1% ounty t� itJil�ig Site Location Building construction begun Ale? Extent _ Is property within NYC Watershed ? ................. yes F--� No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Billy F1 Rolling 0 Steep slope F--] Gentle slope E:] Flat 2. 0 Evidence of wetlands a Low area subject to flooding Bodies of water F-lbrainage ditches F7 Rock outcrops 3. Property lines or corners evident ....................... ............................... a Yes E] No 4. Do water courses exist on or adjoin the property? ............................ 0 Yes 0 No 5. Will these affect the design of the sewage system facilities ?............ [7 Yes 0 No 6. Do watershed regulations apply in this development ? ................ ........ 0 Yes F--] No 7 Will extensive grading be necessary ? ................................................ F--] Yes F-� No - - .: 8: _ Will-eXtensivd.f fill- necessar for SSTS ? - ........................... - _ :: _ ,�' U Yes' No . 9. Do filled areas exist within the SSTS area? ........ ............................... Yes- No = If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: =Sand F� Gravel =Loam =Clay =Hardpan =Mixture 11. Observed from: Borings Bank cut Backhoe excavations 12. Soil borings /excavations observed by 13. Depth to groundwater 14. Depth to mottling 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on on on on Yes F--] No Form ST -1 0 I -K eT L F I " Smte -Wailaa 9 P w Sfl" IeSBrvetiO� e mz .t • D E F G H Goulds Submersible Sewage . PUmp , 3886, y t E �i .�• A e y� 7 ' ' o» F! * F rt rp V f r •.e,` -t B #a •.�7i#r " t �A ,i ¢ yEh j s t j }r S. f3' l 1< i Y K pl +] „ �i' • Yy� K ?,I P 3. �` yam. MMI� k 1 �i ';'_ 't pppp�� y►p _ N�y _��" „r w Z� aa n i . iP �.:f � + �V'{�y�]y},�,�� y� fi� h�R•i �..� S 't .. �• Y, � +. �, TjLL 3�' 1 _ ^ ^�..'SLT'pk � y`i '' .'Cc 'F ? 1 sift WNW �E Se j smi ; WWI h M. � {W�3���}y• ryy�{,pj��1 A., '� T N S. S1 tj, w 6y a n y t" � � i'1i ��, •:, "3. �.1 fie. i. i .5 n 4 pIJAI -* Y_ ,,(. -i .• � � � y uy H'iC �r �.. �„ M'y' •[ y 'x , Mwr Tot'. clew it M .f 9 io-. � ` � � jb ;; �� • � r =1 1•, Ib X t '� ` . k,.Tµ® 07A/Yr i wi .s ems` a - S ' ,. ° rf. .? • t r p, ' '�' ♦Y � IA f. j u E rp , - Y 42Z i j fi i T k r I ffi.._ • ' **5 •� , ", ' N ,M = h _ sd• 4; : 1 r f�(a -;, tt4i: �i1i � T � I.r. 10 '� �aM ?. � i -' � A +i!•.d+�iMlGyy�• "fit ]yam ,y - � 3' ::,r ^t, � R V. All Effe TiQi•iil �T' 1! ( i 9 '1�7F M .. �.w r BRUCE K FOLEY Public Health Director d e - • ..r .z-. W - -. � . �t.i 'Y.'.rOtr.r.CrF �=+•. tr. w ._ __. xt ♦ e+ • -.: LOREITA MOLWAM.RN., KS,N. Amoetate Public Health Director Dimdar of Potent Services , DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York .10509 REQUEST F ATTENTION: o ADAM STIEBELING GENE REED Ail information below must be fully completed prior to any scheduling. DATE: ENGINEER OR>r'IRM: Y/ DLL PHONE #: lf ^ 7J 7 REA50N: _. DEEPS: PERCS: a PUiM]? TEST: Q ROAD/STREET:. TOWN: SUBDIVISION:..._ OWNER: TAX MAP#: LOT #. ►r rsa y: f� ; � ; r �r : �ldil � : ►l� yy�l , , i► � • r M .yM ►T 711,17 _.. YES - N Propose�SS'iS "within'tbe drsinegelSasidof West'Branch o Eoy"h w R¢servolrs. ° v 0 0'o' Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 2,' Proposed SSTS within 200 feet of a watercourse or a DEC *etland. C) Proposed SSTS design flow greater than 1000 gallonslday or SPDES Pem* required., o Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answeredXa to any of the questions, NYCDEP must witness the sod testing. This - This will coordinate a mutually, suitable time for .field testing with the pCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibilfRy of the design professional to schedule re- witnessing of the soil testing with NYCDZP. - , M �, 1