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Home My WebLink About3769DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83. -1 -8 BOX 29 is !'• f . L„ % , 03769 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health -.F a - ....- 'a:_?n wry ^:et:s •m!+��r �:. -vn :�. ��'..:.:r�.. s n...:q.:.:� ��.:> .'e.. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 24, 2007 ROBERT J. BONDI County Executive -. - - .�.... -., �.�.� = itfC /B�;R'i`I�fOiitltlS;�PE:_;:,: •,:_ , .f_.�, ....�.< � a Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Timothy Cronin Re: Field Inspection — 10 Angela Drive (T) .Putnam Valley, TM # 83.4-8 Dear Mr. Cronin: The above ref6rences separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Please call when construction is completed for a bedroom count. L/2. The 90° elbow must be removed between the s c tanks and use a series of 22° elbows, If you have any further questions, please contact me at (845) 278 -6130, ext. 2155. JD:kly Sincerel r 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 '07 -02 -05 09:23 FROM- Ifm To: Joseph S. Paravati Fam (845) 278 -7821 T -090 P001/003 F -217 THE LINDY BUILDING. SUITE 200 2 JOHN WALSH BOULEVARD, PEEKSKILL NY I 05 (PH) 914 - 73&3864 (FX) 914.736 -3893 From: Patrick M. Bell Pages: 3 (including cover sheet) Phow (845) 278 -6130 Ex. 2157 Date: February 5, 2047 Ruz DeMaio Property, - Angela Drive, Putnam Valley, W [] urgent [] For Review a Please Comment [] Please Reply [] Please Recycle ® Comments: Mr. Paravati, conducted a site visit on February 2, 2007 to inspect the above referenced property for the following changes: Installation of two 45- degree bends in piping between septic tanks. As the included pictures -show;: the changes have been made bo replace the. originally.instai lied_ —deg" bend. ..Please let me know if this change is satisfactory Thanks, Patrick M. Bell If this transmission is not clear please contact our office 7 M r 1 J �t,7 � Frd1 ri rS I r pyc r r t M1e r t { ` •� • � "� ` O fit. � S p t Tire, 5 f y'. I r + {r�A'^ Acia, t M1e r t { ` •� • � "� ` O fit. Iii " {•4 ' T �'tY4�S`t, tip )l ,F„tiy y, f IN gtyA 4 ti r' PeJ\it @ c !Pt +s Stu i t' t K r i. o ) 7s7.,_. ;� s.a�f' - �•-r+ �:•r^rve g..aor; R«ve++ Y i '°`". me9..:�'��`•. . . n ,.3,...M.w�.. �a �r1 'Sr '' G'Ny;`,�.�Mrlr c : `� j � �� *��t- `�M��, "' �'��xr4'�, � "3`'�KQ'`+� •t z , Ae �b � vet i�g,,�Z�t �o ' i� � '. r , fl � S� �: ,, w �u�R�1y� �ppf,�k � �s ;�� ti { r� H, p � rY,... •^i r� a+� �tri tt�' i (�,�� +r� � Y'�rat � .. E�. !j r., ��,•i :t ryt� t.rF.,ftt t V 7, nSt r,(j Y cr OR W. '07 -01 -23 15:52 FROM- T -066 P001/001 F -150 .- -. .. _" -� .. .'.` ^�tt -e .. �. ,. .. .� __,... �.- -. n mot. �F .'. - r.- �.r- �c- ..s+.,. - .r. y. s.. -++. -rt -. _ >ed..' ... '•o %:..- ,..�.�y %a _. .. .. •,- . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION - 91 ._M _ n GfP �jOe- REQUEST FOR FINAL INfi,PRCTION All information must be fully completed prior to any inspections being made. For: Fill Trenches x PCHD Construction ,Permit # A ` Z .q1-06 Located: 10 Av, D H_1 Owner /Applicant Name: ,x. s,, ►k) TM Al Block l Lot Formerly: Subdivision Name: Subdivision. Lot # Is system fill completed? AIJA Date: (V Is system complete? 4.. 5 Date, �r �-' Is system constructed as per plans? e S Is well drilled? w`�-'� -K 4 L� Date: Nz� Is well located as per plans? e- ( t Are erosion control measures in P lace �. �— I certify that the system(s), as listed, at the above premises has and verified their completion in accordance with the isp approyed..plans and t1e. Standards, Rules and Re fat s Date: _ �`� �? ,r _ Certified by: Address: _� '�% �.,� i 1 v d 'Re 1 $ � � t 1/ /0 y ./ a S-Z Comments: Foam FIR 99 I have inspected Lion Permit and Wepartment of MvtZ,_; . ,: -ofessional f 62980, +� i Sl lERLI.'T - AMLER, MD, MS, F'AAP Commissioner of'Healt%' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jennifer Demaio 10 Angela Drive Putnam Valley, NY 10579 Dear Ms Demaio: DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 October 18, 2006 Re: Addition A- 247 -06 ROcBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health Demaio, 10 Angela Dr. Increase in Number of Bedrooms with new SSTS (T)Putnam Valley, TM #83. -1 -8 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this - - 4Yartment eldo is approved- -with the ^following�conditions 1. The total number of bedrooms must remain at four without prior approval by this department. 2. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets, etc.). 3. Approved SSTS must be constructed according to the approved plans certified by Timothy L. Cronin III. Any deviation from the plan requires a revision be submitted to this Department. 4. SSTS must be inspected by this Department before any backfilling. 5. The house must be inspected for bedroom count before compliance is issued. 6. Once SSTS has been inspected and backfilled, a construction compliance package must be submitted for review and approval before operation of the new SSTS and a water test for bacteria must be provided from an approved NYS lab. 7. The approval is for the proposed changes only. This approval does not validate any construction shown as. existing that has not obtained proper approvals. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Far (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. JP:lm cc: BI (T)Putnam Valley Timothy L. Cronin, M., P.E. Very truly yours, (:7osep$h S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH .,.y.: .'4.. CONSTRUCTION P>E IT FOR SEWA�>IJ°T�E�'�1b�iE1�T�° �51'S')i'I�I�iI _ s. P]ERMffT # 6 - 247 -oy Located at �%IX e ,c_. yy�Ve Subdivision name;l\geA Psrje_,S Subd. Lot # Date Subdivision Approved Owner /Applicant Name Town or Tax Map 83 Block d Lot Renewal — Revision Date of Previous Approval A-- 2,--qS Mailing Address Amt &, \jc -11P�j Zip 1 O Amount of Fee Enclosed l9� Building TypeVr2_ Lot Area 33A GA No. of Bedrooms Design Qow GPD c_-�o Fill Section Only )(Depth volume Separate Sewerage System to consist of 2V-"0 sd gallon septic tank and r-A 3 C0e0 L-S S ,A" �r �� '� �, o e n� 2-4' 4 ' 6, ,,eA 7 J cam. Other Requirements: ?rr, Pv� L-f- �# '�� c� ji' � Vlv- r 1Q�tqc_ t., 24, fir Tre eKA1\ To be constructed by 0 Address — Water Supply: Public Supply rom Address ,Supply. .►n:..., .. _... r. _ ._ ..�-. Add 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 C atisfactory to the Public Health Director will be submitted to the Department, and a written guarantee q Be owner, his successors, heirs or assigns by the builder, that said builder will place in good opera i�i ;�; ndinya f sa' sewage treatment system during the period of two (2) years immediately following the afe e i�ancth appFaval . f the Certificate of Construction Compliance of the original system or any repairs t . r Signed: %P. ®iE9Z.�i Date Address 'Z, WcN 5 y?'r - ? f ' Ate; � � License #C6- �i BO ,Ji•Lr.7, J APlPROV ED FOR CONSTRUCTION: This approval expires two years f o6 Co m 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 p it. Approved for discharge of domestic sanitary sewage only. B Title: Date: d It 7 lah. iYcopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 M_ pmmnuf 04 x19N M M2� — — — — — — — — --------- LFOFSIb — — — — — — — — — — --- - - - - - - - uEOOFR t'ulll.liA'%'l COUNT): DEI'ARIWENT OF HEALTil ----- - -------------- ---------------------------- �IOLJSE VIANS Al'PROVED ji-oll Vf ---------- 5. ®R LWA I ALL SUDISEQUENT 11L\;I.q,-ON/AL1-,-'IIA'IICIN.,3 TO THESE HOUSE PLANS MUST 11E SUBMITIA) 'CO THE PCDOft FOU APPRO- IJ9 // -7 /C cOCO ------ ------ ------- SNA'Fi�lzl Ml� TITLE DATE D-EMA10 ADDITION :11 ------------------------ PUTNAM VALLEY. NEW YORK ---------- �if� ------ ------------------- ICOT —ED DAKIN ----------- a.lxm mm Ion ao FOUNDATION PLAN T �ALO , t. I PP iQ RENT cEd 1. Fm I FiWl L—G P-V F--1 T, I LEGEND N. m+siwirna NOTES: I'Ll"l,"lAAl COUNTS OF HEALTIi F HOUSE PLANS APPROVED FOR BEDUCIOM COUNT ONLY, —DRY 06 7"" 05 � -- / - f ALL SUPSET W ENT TO THESE HOUSE PLANS IVIU�i'F 111E SUBMITTED TO T11L PCD011 FOR APPROVAL I o, mim /o/17/ F— P— qj Z AT 1W & TITLE---c— i)-ATF—, r---1 IFA___ ---------------- DEMA10 ADDITION PUTNAM VALLEY. NEW YORK SCOTT FLEE ,R,DAKIN FIRST FLOOR PLAN sw rail a; c A Ni Y 8 LEGEND NOIPS:� t 4£ PImGR 4VY¢ !D NYMY NDkS W 9�i ffi4 1 PUTNAM COUNTY DEPARTMENT 017' HEALTH ROUSE PLANS APPROVED FOI't BEDROOM COUNT ONLY, �! tlraitovn A -- ALL SUBSEQUENT IFEVISIONjALTif:RAT10NS 'yo'i'HEsr HOUSE PLANS NIL1ST BE SUBMITTED TO THE PCDOII FOR APPROVAL ST .NA'CUltl's Z '1'1'fl_:E !)ATE DE MAI O ADDITION PUTNAM VALLEY, NEW YORK SCOTT REED DAKIN .amirzcr SECOND FLOOR PLAN �A1.2 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200,2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736 -3664 • Fax. (914) 736 -3693 September 27, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: SSTS Expansion - Demaio Property Angela Drive, Town of Putnam Valley Dear Mr. Paravati: Per your August 31, 2006 memo for the above mentioned project the following changes have been made to the plan. 1. The orignial perc rate has been added to the plan. 2. The new deep holes were witnessed by the DOH and noted on the plan 3. Length of Expansion areas has been showed with the 2' solids after the J- boxes. 4. Comment addressed. 5. Fill pad has been modified to reflect what was documented on the As -Built plan. Please find enclosed the following information pertaining to the above pferenceqk property: An- additional $IbD .10 complete the App{icatcA fee 2. Four copies of the Subsurface Sewage Treatment System Plan 3. Soils Data Sheet 4. A copy of the previously submitted Application information for your reference. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. Respec Ily submitted, Patrick M. Bell Project Engineer. SHERLITA AMLER; MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Ass&state-Ciymmiss 6n&i t;f fJealtY� ROBERT J. BONDI County Executive _ _ = ROBER7,MORRIS PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 31, 2006 John Cronin Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Proposed SSTS Addition — DeMaio Angela Drive, (T) Putnam Valley TM# 83 -1 -8 Dear Mr. Cronin: 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. Please. "rote -the on inal,. ere rate for =the existin 'SSTS area. g p� g: :.. 2. The new deep hole needs to be witnessed by this Department. 3. Please label the expansion area lengths and show the 2' solid after the J- boxes. 4. The application fee to r a new SSTS or expansion to an existing SSTS is $500.00. tie`~' 5. It appears that the existing SSTS area according to the as -built is smaller than the existing SSTS area shown on the recent plans, specifically the width of the fill pad. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/lcly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address to 5& VIt b,r < t_- Located at (Street) A E,.e 1c, Tax Map Block ( Lot (indic a nearest cross street) WLn W V Watershed Pe z Ls MunicipalityTr << k- SOIL PERCOLATION TEST DATA Date of Pre-soaking ',r� 6106 Date of Percolation Test .;P- 9 A G No.ole Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 1 t u: coo 10,1q Z 17T p 2 t°' z r qG 1- 2 0 3 3 l %j + 0 3 4 ys° 30 1 0 3 0 5 11,46 V,11 ptl 1 2.-o 3 1 2. 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< 1 min for 1 -30 min/inch,, <_ 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. ,y Fomi DD -97 Pe. I ot'Z TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPT1-1:.'.'_': HOLE NO., IHOLE.NO; Q~ 0.5' 1.01 1.5' 2.0' x. Y VA 2.5' 3.0' 3.5' 4.0' NY 4.5' 0 rq C'o 5.0' j '1 5.5' 't 4-q Lo c, vvx 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.01 9.5' 10.01 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises afte Deep hole observations made by: Ke i-1-0 v � sw" Design Professional Name: 6-wifo IZ-Address: 2—JA" Signature: L0 *11 WsikZ YJa&Gional=s Seal j, �J T� o4EW 62 ""?0FES5\0 o6 RONIN ENGINEERING P.E., P.C. The Lindy Building, Suite 200,2 John Walsh Blvd., Peekskill, New York 10566 Tel. (9 14) 736 -3664 • Fax. (914) 736 -3693 August 2, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: SSTS Expansion - Demaio Property Angela Drive, Town of Putnam Valley Dear Mr. Paravati: Please find enclosed the following information to allow for site modifications to the above referenced property: 1. Application fee in the amount of $400 2. Four copies of the Subsurface Sewage Treatment System Plan 3. Four Permit Applications 4. Letter of Authorization 5. Soils Data Sheet 6. Copy of letter from the Town of Putnam Valley Building Inspector re: the existing legal bedroom count 7. Floor plans of the existing and proposed residence The applicant is -proposing to increase the bedroom count from 3 bedrooms. to 4 bedrooms. The.. - - -- -p�oposecfifl f Pireirc�.� the- existing peptic system require the i istaiiaiion- of a-750'i .241IG l se'pbc _. tank to operate in series with the existing 1,000 gallon septic tank, to install 2 new junction boxes and 84 LF of additional 24" gravel trench. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. P ully m�d, 4 ronin, ngineer DEPARTMENT PUTNAM COUNTY DIVISION LETTER OF AUTHORIZATION RE: Property of j 0e, a.: Located at �c,V Tax Map # Block. i _ Lot g Subdivision of C..�� r�" Subdivision Lot # Filed Map #. Date Filed Gentlemen: This letter is to authorize �O, ; ,N �=, �„ �,i r� e�� c �� 1 =l C— � a duly licensed Professional Engineer _/ or ?p _-'-_**�-_'_t 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 r�,�trla,&ioa aid wastewater treatment and/or water supply systems in conformity with the pr si s of 441 i e Y - and/or 147 of the Education LaN�,, the Public Health Law, and the Putnam u an' C Countersigned: - P.E., R.A., # 6 Uj (- �1� 62-080 7_'1 1 �.''KOFESS o . Mailing Address C,rp.,,;,,., �,��,;� {,�;,,`� Mailing Address: c, i0C\ State _ L Zip \®5 c,, State Zip 10 _A9 Telephone: c 14 Telephone: Form LA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .. . LORE"1'TA MOLINAR1, RN,- MSN:.-_ Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. Bi Counry Ezecuti ADDITION APPLICATION RESIDENTIAL ONLY STREET j,r, c e.� c_ TOWN �.+��• �i & AX MAP# NAME r 1CY,Y','t, N, c.; n PHONE SLk S- SZG - k�_1PCHD# IVIAiLING ADDRESS rc�� C)��, !�„�.�,�w, \�CA \P_ _,� 10�— DESCRIPTION OF r ADDITION NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSP * *Any addition \vhich is considered a bedroom requires formal approval of plans (Construction permit` prepared by a Professional Engineer or Reeistered Architect in accordance with applicable sections of t Putnam County Sanitary Code. Please submit this form and the following to Putnam Countv Health Dept., 1 Geneva Bre.wster., NY....1 UW P tone,(845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including 3. Two sets of proposed floor plan (drawn to scale — with name, street and t: *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your kno- Include date of installation if known. Label all wells and septic systems of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Bull( Dept. with legal bedroom count of dwelling. OFFICE USE CON24ENTS Environmental Health (545) 278 -6130 Fax (S-15) 27S - -921 Nursincy Services (845) 275 -6555 WIC (S45) 278 -6678 Fax (5 51 278 -60S5 Earlv InterventionlPreschool (S45'! 2_7S-601-1 Fax (S45) 2 -S -56-15 04LER, MD, MS, FAAP sioner of Health iOLINARI, RN, MSN �mmissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive ADDITION APPLICATION RESIDENTIAL, ONLY ,TREET R A G D ;,,4_ TOWN �� j AX MAP# PHONE aL- �;-5Z(o - `6GkPCHD# 'TAILING nn ,)DRESS 0 -r% yG (!551_� ►ESCRIPTION OF (� .DDITION \,r, c ,r e.L �v"_ J I IVIBER OF EXISTING BEDROOMS -S PROPOSED # OF BEDROOINIS 11� FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) `Any addition which is considered a bedroom requires formal approval of plans (Construction permit) -epared by a Professional Engineer or Registered Architect in accordance with applicable sections of the itnam County Sanitary Code. lease submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, rewster-_N'Y 10509, PhonP:.(845) 278 - 6.13.0. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map r) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. FFICE USE DMti1ENTS Environmental Health (S45) 278 -6130 Fax (345) 27S - 7931 Nursing Services (535) 278 -6558 1VIC (8 35) 278 -6678 Fax (S -:', 2?S -6085 Early Intervention /Preschool (S45) 275 -601 -i Fax (S45) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM J ` R „ I' Address Owner f' s ... . s Located at (Street) Av,c Cis Tax Map $3 Block 1 Lot g (indicate nearest cross street) Municipalia _2A -y. Qc.1 Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking '7 - 2� -y (c, Date of Percolation Test - ? -C)E, Hole No. Run No. Time Start - Stop Ela se Time (Iin.) Depth to Water From Ground Surface (Inches) Start Stop Water level Drop In Inches Percolation Rate itilin/Inch 1 0 i Z-4, I�l 13 I a 1 2 10 s lu ° I .L I ' r 11 +� I 11 i�-► 'zo I 3 Il►s 1`�s 3o I LO i 3 I o 146 1L�3 I 2� I,1 20 I 3 1 I I I I 4 I I, I 5 I 1 2 I I 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 -b0 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, M[ N Associate Commissioner of Health PUTNAM COUNTY DEPT 1 GENEVA ROAD BREWSTER, NY 10509 Q To Whom It May Concern: ROBERT J. R( County Execulp DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 OF HEALTH Re,- �1 �r 1 1�J Residence TAX MAP# (?' 9 > ` � — S TOWN PU'T_A/A� VAC-L (-I According to records maintained by the Town, the above noted dwelling, IS NOT - `I.XN_CDA/JPLIANCE WITH TOWN CODE. IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Building Inspector Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Im Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 F,arly Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 s • "�I HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK ®I�''+GyFFtCIAL CHECK I ®HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK.. Lp CHASE r �� ` - -- - - -- r 160830279 ? 020 ® Date 08/01/2006 New York Remitter Jennifer DeMaio ' c Pay: FOUR HUNDRED DOLLARS AND 00. CENTS I $ * * * * * * * * ** *400.00 * ** O der To The Putnam County Department of Health Drawar: JPMORGAN CHASE BANK, N.A. A�' I-1_�' I------ ------------------- esident ) Issued by Integrate Payment Systems Inc., Englewood, Colorado@ r JPMorgan Chase Bank, N.A., Denver, Colorado t 111 700 100f1' 1: LO 20009 791: 2 SOO 1608 30 2 7990 A. � ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'J DATA- SH7EET - SUBSIJP, -rACE SEWAGE TREATMENT SYSi Eryl Owner Q.�n Y, �e �C� vin e,: o Address -f: ve— Located at (Street) irlc Qi,Qe— Tax Map $� Block 1 Lot g (indicate nearest cross street) Municipalit�T v�•n� �c l Drainage Basin�zks�;� SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test —7 - Z,' -oE, Hole No. Run No. Time Start - Stop Ela se Time (ii Iin.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate IMin/Inch 1 0 7,0 I 3 . 2 117 s 10�`t° I L r 111 210 I ( 1 ba, i1��` �1 Ire zo I 3 I Ci 4 ► l`s ,ys �o I z0 I 3 I O 146 1 L� 3 �� i '"I 13 2 J I I 4 5 I I 1 1 2 I I 3 I i 4 5 iL3: i. tests to t)e repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch. <- 2 min for 31 -b0 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. .... 7-,�,.o- Indicate level at which groundwater is encountered Indicate level at which mottling is observed � A Indicate level to which water level rises after beinc, encountered tA N Deep hole observations made by: Date Design Professional Name: Address: 2 Sianature: j L.. S- \ 11 0:1114 83J3S90 Uj N, I IN . -111- 62- rofessional's Seal I d TEST PIT DATA DESCRIPTION OF SOILS ENCOUXTERED IN TEST HOLES DEPTH HOLE NO.T? k HOLE NO. HOLE NO. G.L. I 0.51 1.01 1.51 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9-.01 9.5' 10.01 Indicate level at which groundwater is encountered Indicate level at which mottling is observed � A Indicate level to which water level rises after beinc, encountered tA N Deep hole observations made by: Date Design Professional Name: Address: 2 Sianature: j L.. S- \ 11 0:1114 83J3S90 Uj N, I IN . -111- 62- rofessional's Seal I d PUTNAM COUNTY DEPARTMENT OF HEALTH.. y DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' - t iftLx t114 bWIDUALitbMMERCIAL SITE INSPECTION FORM SECTION A. GENARAL INFORMATION Name of Project County Site Location- Building construction begun ±? Extent�'�•� Is property within NYC Watershed ? ................. 0 Yes CNo =7J SECTION B. TOPOGRAPHY (Please check all appropriate boxes) rzAj6 � ( 1. Q Hilly- .= Rolling Steep slope Gentle slope Flat ' SS 71 2. Evidence of wetlands F7. Low area subject to flooding 0 Bodies of water. a Drainage ditches a Rock outcrops - 3 . Property lines or corners evident ................. ...... ............................... 'des O�4 4. - 'Do water courses exist on or adjoin the - property? ............................ Yes g�No. 5-- Will these affect the design of the sewage system facilities ?............ Q Yes No 6. Do watershed regulations apply in this development ? ....................... =Yes No 7 Will extensive grading be necessary? ....................... ..................... Yes No 8. Will extensive fill be necessary for Ye.s No = - ---- - 9. Do filled areas exist within the SSTS area ? .......................................... . es . No '�� If is of fill? (3 yes, what the condition the SECTION C. SOIL OBSERVATIONS 10. Appearance of soiia Sand Gravel Loam 0 Clay =Hardpan Mixture 11. Observed from: Borings Bank out Backhoe excavations 12. Soil borings /excavations observed by /�d;, Ke _ 4A - on 13. Depth'to groundwater ! iY on 14. Depth to mottling /V l ( on 15. Are test holes representative of primary & reserve areas ...... ............ .................... EzYes No 16. Soil percolation tests made by -,. V1 on 17. Soil percolation. tests witnessed by on SECTION D (on back) Form ST -1 2 x' SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes L<No 19. Will groundwater or surface drainage require special consideration? ..................... =Yes No 20. Will gullies, ditches, etc:, be filled and watercourses be relocated ? ..................... o Yes No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection bee ade of the existing or proposed source and facilities ? ...................... ......,.:......... = Yes =No Inspection data .s 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Yes No 23. Additional comments 24. - Site observer /inspector and title 25. Date(s)-of o-bservation(s)inspection(s) TEST PIT PROFILES Hole - t Lot # Hole - Lot # Depth to water ,-..Depth to mottling Depth to rock/imp. 1.0 i Depth to water Depth to mottling Depth to 06 -Hole 4 3 Lot # Depth to water - w Depth to mottling Depth to rock/imp... /'� G.L. G.L. 0.5 0.5 1.0 M 1.0 2.0 2.0 f� 3.0 3.0 4.0 4.0 4.4� 5.0 5.0 . 5.0 7.0 ?. 8.0 .0 8.0 9.0 9.0 9.0 10.0. 10.0 10.0 Depth to water Depth to mottling Depth to 06 -Hole 4 3 Lot # Depth to water - w Depth to mottling Depth to rock/imp... /'� G.L. G.L. 0.5 0.5 1.0 M 1.0 2.0 2.0 f� 3.0 3.0 4.0 4.0 4.4� 5.0 5.0 . 5.0 7.0 ?. 8.0 .0 8.0 9.0 9.0 9.0 10.0. 10.0 10.0 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health " LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH ROBERT J. BONDI County Executive 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION STREET TOWN �.� }rc�. N .-��AX MAP# — 1- NAME je--^ PHONE t34� S- SZfo 40G� PCHD# - MAILING {{� ADDRESS 1 DESCRIPTION OF ADDITION `,n e.v a c, % O 51 NUMBER OF EXISTING BEDROOMS :1 PROPOSED # OF BEDROOMS A (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of. the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1. Geneva Rd, :.. . ... -_ Brea ster, l` ' -10509,•Phoh :(845)--2'-8-6430 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line: Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .W.. _LORETTA MOLINARI, RN, MSN` Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET P� Z-\ c- TOWN ��•�cy.� ' -M AX MAP# &S - 0 -,'j PHONE t`i S- &ZXC - ze4o�PCHD# -60 MAILING ADDRESSr�c��c, �rt \JC2 DESCRIPTION OF ADDITION 3 � yi - NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS A (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Br- e-Wsfer; NY.::1.0509, Ph6* -ne (845),2:78- 6 <130._ . ...: �_... �.. �. _._.. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 (345) 275 -664S SHERLITA AMLER, MD, MS, FAAP Commissioner of Health a '- LORETTA MOLINARI;'.RN t►1S1`F'1 r m Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY STREET ,r. ZA C_ ;.rte TOWN �� V A jgAX MAP# IBS — � - NAME ,�_v,,,' Tc r PHONE 6'1 S- 5ZG - 45,A PCHD# —o I -06 MAILING (� ADDRESS Rvr 2\ c_ 1qCA DESCRIPTION OF ADDITION i �. t,r eL�� C ��. 3 o »� NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS A (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: :(845) 278 - 6130 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �$ LORETTA 11%I®LINARI, RN, MSN F Associate Commissioner of Health ROBERT I BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET f� K c` c, D,, TOWN WV�, N McJAX MAP# - c� PHONE &Z.G - 4,-:�4APCHD# - MAILING nn ADDRESS trt, yG1 ®S_lg DESCRIPTION OF ADDITION `,r, �v u d' .� C w h�' 3 )-- AA NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd ..-_:Brewster, ICY IOSnQ P -hone: (845) 278 51?0:- -- - 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 - ?921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 27S -664S SHERLITA AMLER, MD, MS, FAAP Commissioner of Health i.ORETTA- ViOLINtiRI,: RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY STREET oi,�e-` c, TOWN �� }�. y �Ma'..TAX MAP# 1- NAME cJev�r:� PHONE_ $� !!�- 5Z(c - 466�kPCHD# MAILING ADDRESS e_\ c- Or- � v� c 6S-1 g DESCRIPTION OF ADDITION \,r, L,t e,� a �� L7A. C w -1�' 3 i NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS A� (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd'.. __:.....:_� _.:.. Brewster, NY 0509;.Phone:.(845).27.8-61.30- _ 1 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736 -3664 Fax: (914) 736 -3693 - August 2, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: SSTS Expansion - Demaio Property Angela Drive, Town of Putnam Valley Dear Mr. Paravati: Please find enclosed the following information to allow for site modifications to the above referenced property: 1...: .Application fee in the amount of $400 2. Four copies of the Subsurface Sewage Treatment System Plan 3. Four Permit Applications 4. Letter of Authorization 5., Soils Data Sheet 6. Copy of letter from the Town of Putnam Valley Building Inspector re: the existing legal bedroom count 7. Floor plans of the existing and proposed residence Thew licant i;; ro osin -to.increase the bedroom -count frOff315WC56Ms "to 4 `bedroom _ _ ......_ pp P" p g s. The proposed improvements to the existing septic system require the installation of a 750 gallon septic tank to operate in series with the existing 1,000 gallon septic tank, to install 2 new junction boxes and 84 LF of additional 24" gravel trench. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. ec ully mi d, ohn L. Cronin, Project Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER Ot ATT* HO,' RE: Property of Jev� �n �ed- �e�• a,: Located at Zia• r Q A G. \k: (50 vac"' Tax Map # S'_ Block I— Lot g Subdivision of 6%V*6er�_ 4C_Ye5 Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize nee \ -2 L a duly licensed Professional Engineer_ or t to apply for the required wastewater treatment and/or water supply permits) 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 n tr1d0ioe aid wastewater treatment and/or water supply systems in conformity with the pr i & of iA, 1' and/or 147 of the Education Law, the Public Health Law, and the Putnam 'u . .-a C�, * - ',6: r. c U; Very truly y s Countersigned: 62gso . Signed: P.E., R.A., # ® NkOFESS�O�P'" (Owner of Property) Mailing Address Cv�,,,;r ,,,� �,�;, Mailing Address: f4 V% �c„ State NJ Zip 1o5((. State VA)� Zip 10 S-19 Telephone: cj 14- 1'SC,- 3��,ct Telephone: SC+S_�2L -clu�1 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ � � �..-ei ^:....1 .]A '.to .. ... ,. s.- y........; ,. ... �- �..:._..y ;. �. ...�.�Y. _: u �.5'••tf w..- -1 +_wr ^a.4 :..r -u.y -. ';M wf� .i .-. , n N..rl. .. s.. +. .. .r a .e v - O-sa. mow.. �.s.s DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner je_y%vnXk'r_ ye_m c.: o Address v� Located at (Street) v1 ; ge— Tax Map g 3 Block' 1 Lot g (indi ate nearest cross street) Municipalit T Drainaje Basin :, Jbitol-131 Q Woo ` s SOIL PERCOLATION TEST DATA Date of Pre - soaking '1- 20• -o (r., Date of Percolation Test-. 7 Hole No. Run No. Time Start - Stop Ela se Time (1 in.) Depth to Water From Ground Surface (Inches) Start Stop .:Water -Level Dropp� In ` Incles ' Percolation Rate Min/Inch 1 O � � Zvi 1 za - 3 2 } 3 d, 'ZO 4 NAs 5 " vZ "' �—� ; I .10 3 2 3 4 5 1 2 3 4 5 -77 A NUTE6: 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, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.01 1.51 2.01 2.5' 3.0' 3.5' 4.01 4.51 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.01 9.5' 10.01 P. 2 TEST PIT DATA SE-C C-RIP-TION;�GESOM 4N 70UNTER.E. IN �C - �T HOLE No. HOLE NO. HOLE NO, _ 1. Indicate level at which groundwater is encountered s Indicate level at which mottling is observed H Pk Indicate level to which water level rises after being encountered IAN Dee hole observations made by: Date -1 -7 Deep C % Design Professional Name: Address: -Z— Signature: Fofessional's Seal I SHERLITA AMLER, MD, MS, FAAP Commissioner of Health •LORETTA' NROLIN:dRI;'RN; MSN a Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 R Residence TAX MAP# 0 TOWNy To Whom It May Concern: According to records maintained by the Town, the above noted dwelling, IS ✓ IN COMPLIANCE WITH TOWN CODE. IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS _S7_ This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Building Inspector Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 lm 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health `I.' KETTA_MOLINARI, RN, MSN Associate Commissioner of Health R ®BERT 3. BONDI County Executive -> - .. s� .aT. v n. r a -� r_.� _ .. - -5�. s. �f -.! f s �• w- 3ci•. .e.r i. Y.t ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 13, 2006 John Cronin will be borrowing map of proposed sewage disposal for Angela Drive, Putnam Valley. 01, Q ��^d� 7 �� Z- Jose2 ph P avatiC o oh 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 4. PUMAK MUNTYAMPARTMENI! OF HEALTH GPI 6 Dhbkffi gizovkczmwdd Rod& Seivbr. amimet. N.Y. 113b EM, h Sol CERTIFICATE OF QpHgl Pismo MOTION PRUM.POR 119WAGE DISPOSAL SYSTIM 0 Mralm or Vol"@ Black List W-0 Renewal-0—Reirlidest-0 ws AddWom aft OL) g a -5 4 DOW of P"riumme, Town — J;�'q 47-In -n.t-o qiibr1iuiQinn Annrovp-d FAA En r 1 n R P IM Ana FM Sedlems 0* b<j Deptis -!�V.Wmsme 9 1-e jj,gma d aweetOg, _3 Dedge Flow G P D 1i�tHDNodft=d=kR! 9.�ta Whisms . FM Is commspleted SWOON �U—M* sy0ftm fteeendatmit-L-26—'o QMosmSpdr Tack 1O1 To be: 'by Address; wassir SHP*;—PdAe swffly F"n- —Addremme on- —P, supply DiEW by ---Ad&vw Odwr ReRskemmOft i represse Vthst I am Wholly Slid Completely responsible! for the design and location of the proposed system(s); 1) that the separate above-dimiscribmid will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regu erns .1 nam County Department of MM AN and that an completion thereof a "Certificate of construction Compliance satisfactory to the Commissioner at mealthwul be,'umbenitted to the Department and a written guarantee Will be furnished the owner, his SUCCessorm, half$ or assigns by the bulkier, that said bulklmsr will place . in good operat" condition .any port of said sewage disposal system during the period of two knM"iat*IY following thedste Of the inu. ance at the approval of the Certificate of Construction �Compllsnce of the original system or any r tF 2) that the drilled well described above win " located as show" on the approved plan and that sold well will be installed In accordance with t a u s and relu%Mns of the Putnam County Department of Health. Date 'P.E.— ftjlli.,� Address License N,��q :7Y APPROVED FOR CONSTRUCTION: This approval expires two years from the date iss6ed unless n of ilding.has been undertaken and is revocable for cause Or may be amended or modified when considereldnQ4sury by the IssionX f h. nge Of alteration of construction requires a nevi per it. Pproved for disposal of domestic sairil 4,41, 0, mind/ W sou Lev. LO/88 'to— A 14? By -- ----- DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 P►P'F�LTCAfiTON'" O' OOY�S`TRUCT`° A...GIATP:R' "WErap —::PCHD PERMIT # 1 vd5y� WELL LOCATION Street Address Town Village City Tax Grid Number — g` ":&- �/ g5 --/ WELL OWNER Mailing Address �/ /— �/ rivate '144W i �i_ �/� Public USE OF WELL RESIDENTIAL 4BUSINESS ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ® ABANDONED 1 - primary O FARM Q TEST /OBSERVATION ❑ OTHER (specify 2 - secondary ® INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY AMOUNT OF USE YIELD SOUGHT � gpm /# 0 REPLACE EXISTING SUPPLY PEOPLE SERVED 4f- ❑ TEST /OBSERVATION /EST. OF .DAILY USAGE 490 Ral GL ADDITIONAL SUPPLY REASON FOR DRILLING NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG [3 GRAVEL ®OTHER IS WELL SITE SUBJEC� T. TO FLOODING? YES � NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Jj� A22 J'rly �elp? Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: °-R TOWN /VIL /CITY - DISTAP?CE -TO PROPERTY FROM NEARE'ST'-WATER LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (da 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- y'(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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to d egrade or Date of Issue: 19 -I,/- Date of Expiration 0 19 1 Permit is Non - Transferrable White shall take appropriate action to assure that drilling operations be contained on this otherw' a contaminate surface or groundwater. Permit Issuing Official copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PC -1 1. 2. 4. PUT NAM COUNTY D E PARTM E NT OF HEALTH APPLICATION -� F"OR APPROVAL' OF ``PLANS YFO t A WASTEWATER DISPOSAL SYSTEM Name and Address of Applicant: _ Aelctl'Id 1e 21'2& Name of Project: s, S 3. Location T /V /C: Project Engineer: xtz' i��G� 5. Address: License Number: %✓ Phone:_ 6. Type of Project: Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One). Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. All 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency 11..Is this .project in .an..area under the control of 1pcal..pl'anhi.ng; zon -ing, ar-- other offi`ci'als, ordinances? ........ ............................... i G� 12. If so, have plans been submitted to such authorities? .................. V l.J 13. Has preliminary approval been granted by such authorities ? Date Granted: 1 9Z70'1"' 14. Type of Sewage Disposal System Discharge...... Surface Water y Ground Waters 15. If surface water discharge, what is the stream class designation ?........ —' 16. Waters index number (surface) ........... ............................... '` 17. Is project located near a public water supply system? .................. Ale,, 18. If yes, name of water supply Distance to water supply A�—g 19. Is project site near a public sewage collection or disposal system ?..... A/o 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day) ....... ............................... 11/93 2. .._24.. -Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. Vi 25. Has SPDES Application been submitted 1 to local DEC Office? ...... , ..... ...L r- 26. Is any portion of this project located within a designated Town or State wetland? .... .............o.............,... ............................ 27. Wetland ID Number ....................................................... 28. Is Wetland Permit required? .............. ............................... %lam Has application been made to Town or Local DEC Office? 29. Does project require a DEC Stream Disturbance Permit? ................... 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO _y 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site.orU any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... 33. Are community water, sewer facilities planned to be developed within 15 years? 34: --Are any sewage.disposal..areas in.excess of_.15X slope? ........................ 35. Tax Map ID Number ......... ...................... ........... �_.... .r r_.r.. 36. Approved Plans are to be returned to: ................ Applicant ngineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: • 1040N Piz owe 11 D1• IN 6012 1.1 py.1 fob . Is) 03 _ DESXGN,�DA7.l jSU=— SUBSSUUFACF,.. SEWAC —E. DISPOSAL.- ffi- Sy ST _,..:., -- .. _; -,..� > �R _.< <ti.; -- ...,a..�..r. Owner Address �� C� �,g GCi vg1Gw Located at (Street.) Sec. $ ��• Block / Lotg� Undicat4 nearest cross street) Municipality .■ ■ • �1;1�• s M�i;�flw�.�ll�i��v�;�ai Watershed TO BE SUBMI= WITH APPLICATIONS Date of Pre- Soaking 9 Date of Percolation Test HOLE NUMBER CLOCK TTME PERCQLATION 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 4 !�5 4 5 1 2 3 4 5 NOTES: 1. 2. rev. 9/85 Tests to be repeated are obtained at each for review. Depth measurements to at same depth until approximately equal soil rates percolation test hole. All data to-be submitted be made fran top of hole. TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION'OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. HOLE NO. G.L. 2'c 3° 4' 5' 6' 7' 8' 9' 10° 11' 12' 13' 14' ` .INDICATE 12EVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:��t1 DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms -3 Septic Tank Capacity /4 y gals. Type Absorption Area Provided By O L.F. x 24" width trench Other '3 Y> J )� o _C:, 6 •-. -v e,-/ f Ski; ) Name T7 `I D VrW1 Signat OF 0° '42. 1i v� i`� �� '�,�'� Address � SPACE FOR USE BY DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH--SERVICES Date Re: Property of Located at ri ✓e (T )lr,;4d /0//ee'.0/Section_ff_3Block Lot jf Subdivision of Subdv. Lot # 7 Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer 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.ma.tter and to supervise the constructi_on.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, Signed Owner of Property ? y� y Telephone G/"G4-1 () 5 6C Z 44 /—(.e XV Address Town Telephone a " PUTNAM COUNTY DEPARTMENT OF HEALTH 386 Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide P.C.H.D. Permit .CER CATE OF,CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM v/`siJ .Pyli L c? e/e, — ^Located MaWng Address c'', ISeparate Sewerage System built b) Consisting of fJ eyl— 51 Address Tag Map v JBlock Lot e Subdivision Nam e /� Subdv. fat # Date Permit Issued / Y5� Gallon Septic Tank and 16 6�t sy X` ;a Water Supply: Public Supply From Address � or: /� Private Supply Drilled by � i'L ''+�� Address / "s^ ei� 4;,'- / tg ya� ey Building Type A"'- :f;z > eC'�7 Has Erosion Control Been Completed? /� , Number of Bedrooms t; Has Garbage Grinder Been Installed? � °" d Other Requirements I certify that the system(s) as listed serving the above premises were constructed essenti apfslltb6 yo a plans of the completed work ( copies of which are attached), and in accordance with the standards ,,rules andtregulati� in ed plan, and the permit issued by the I -f }3 Putnam County DepartmentOfHealth. s,. y , ,�•� *raw ~ Date yCCertified by *i �' ` P. E. R.A. —�� Address AGam i' F �, c� ? i ' "r' -ic nco No. Any person occupying premises served by the above system(s) shall prom conditions resulting from such usage. Approval of the separate naweii z ✓. available and the approval of the private water supply shall become null subject to mo dicati or change when, in the judgment of the Co Date ` BY jjjjjj`� such °aCtio �la ;�ta, { Curo tho co►roction of any unsanitary I Shall'beco aj' n as a pubs;: sanitary cower becomes °whin a pu" ocomos ovailablo. Such approvals are of aHealth. r , modification or change Is o sorry. �Y Title' ELL LOCATION WELL OWNER USE OF WELL 1 - primary 2 - secondary MOUNT OF US REASON FOR DRILLING DEPTH DATA . DRILLING EQUIPMENT WELL TYPE WELL COMPLETION REPORT DEPARTMENT OF HEALTH vislon..-Of,Environmental Health. Services PUTNAM COUNTY DEPARTMENT OF HEALTH SIR 'T ADDRESS: �df TOWNIVILLAGLICIIY v4 ADDRESS: Office Use — .•.1�.-�.�f TAX GRID NUMBER: l) BIVATE /.. j ❑ PUBLIC I1iESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED • BUSINESS O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) A I' ft. • INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ 'Is ft. JOINTS: ❑ WELDED BEADED ❑ OTHER YIELD SOUGHT_ gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. SEAL: QCMENT GROUT NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL I DRIVE SHOE: ❑ YES 15,60--1 �'C? 'SLOT SIZE WELL DEPTH�b ft. STATIC WATER LEVEL ft. DATE MEASURED VROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG • WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): O. YES • SCREENED 0'OPEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER r. - . . _. ._._ TOTAL LENGTH CASING LENGTH.BELOW GRADE DETAILS DIAMETER WEIGHT PER FOOT SCREEN DIAMETER (in) .., p.j�i 1:5 .:.:.. FIRST SECOND _ ..... GRAVEL PACK ❑ YES GRAVEL ❑ NO SIZE. WELL YIELD TEST ; If detailed pumping METHOD: O PUMPED tests were done is in- W4'0MPRESSEO AIR ; formation attached? O BAILED O OTHER ; ❑ YES O NO WELL DEPTH DURATION DRAWOOWN YIELD ft. hr. min. it. gpm. n I L -I- t7 WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP IHFURMATION TYPE S" i"" FF4 4, CAPACITY MAKER L uM & DEPTH Lk l> MODEL VOLTAGE °2°34' HP IDIAMETER I TOP B01TOht OF PACK in. DEPTH tt DEPTH It. WELL LOG If more detailed formation descriptions or sieve analyses are available. please attach.. DEPTH FROM Water Well SURFACE Bear- Oia- FORMATION DESCRIPTION CODE tt. ft ing In Land f3L'-� "4.1/ Surface. Q R a '44 -A -4 STORAGE TANK: TYPE III ,.-1)15 -b CAPACITY GAL. WELL DRILL NAME ADDRESS 0ir Ih C, of d "z SIGN3fT a /� O OTHER A I' ft. MATERIALS: EEL O PLASTIC 'Is ft. JOINTS: ❑ WELDED BEADED ❑ OTHER —in. SEAL: QCMENT GROUT p BENTONITE OOTHER Ib_ /ft_ I DRIVE SHOE: ❑ YES 15,60--1 LINER: OYES 0 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? O. YES _.0 NO. r. - . . _. ._._ _. .....� . „ .. .... _.... . _...... HOURS .. —1 '_ .. _�, . IDIAMETER I TOP B01TOht OF PACK in. DEPTH tt DEPTH It. WELL LOG If more detailed formation descriptions or sieve analyses are available. please attach.. DEPTH FROM Water Well SURFACE Bear- Oia- FORMATION DESCRIPTION CODE tt. ft ing In Land f3L'-� "4.1/ Surface. Q R a '44 -A -4 STORAGE TANK: TYPE III ,.-1)15 -b CAPACITY GAL. WELL DRILL NAME ADDRESS 0ir Ih C, of d "z SIGN3fT a /� PUTNAM COUNTY DEPARTMENT OF HEALTH ..... - . - P.TV.ISI01 - OF �� . HEALTH SERVICES_ Owner or Purchaser of Building Building Constructed by Loca io` - Street Municipality Building Type ff-3 r 1 Section Block Lot Subdivision Name Subdivision Lot # GUARANI OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 - "Curt €icat of �Con�ti,:onion Compliance" for the sewage disposal .system, or any - repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 this day of > 19%�� Signature �- Title General Contractor (Owner) - Signature 4 ,1,1 , "tn,G 4 � pl v-r Corporation Name (if Corp.) ZIZW , . ess rev. 9/85 mk e;;,- h,-- ✓ Corporation Name (if Corp.) /rte / Address E ff PUTNAM COUNTY DEPARTMENT OF HEALTH ..... - . - P.TV.ISI01 - OF �� . HEALTH SERVICES_ Owner or Purchaser of Building Building Constructed by Loca io` - Street Municipality Building Type ff-3 r 1 Section Block Lot Subdivision Name Subdivision Lot # GUARANI OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 - "Curt €icat of �Con�ti,:onion Compliance" for the sewage disposal .system, or any - repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 this day of > 19%�� Signature �- Title General Contractor (Owner) - Signature 4 ,1,1 , "tn,G 4 � pl v-r Corporation Name (if Corp.) ZIZW , . ess rev. 9/85 mk e;;,- h,-- ✓ Corporation Name (if Corp.) /rte / Address b YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 ( 914) 245 -2800 Albert H. Padovani,. Oire.ctor - LAB # "- 87.302485 CLIENT #: 823 NON STAT PROC PAGE 1 PADILLA, ROLAND 466 OSCAWANA LAKE RD PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN: 08/08/95 10 :45 DATE /TIME RECD: 08/08/95 11:15 REPORT DATE: 08/11/95 PHONE: (.914)-528-2992 SAMPLING SITE :.LOT 7 ANGELA DR WATER.TANK SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COLD BY: ROLAND PADILLA TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE 08/09/95 MF T. COLIFORM ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WA SATISFACTORY SANITARY (QUALITY ACCORDIN AND EPA FEDERAL DRINKING WATER STANDARDS, TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H. Padovani , M .T .( ASCP ) Director /100 ML ABSENT S , ( WAS NOT) OF A THE NEW YORK STATE FOR THE PARAMETERS ELAP# 10323 COUNTY*, DEPARTMENT OF ' "HEALTH Locat-ioia Street Subdivision Name Municipality Subdivision Lot # Building Type GUAFiANM OF SUBSURFACE.SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material,', construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal system, or any bY me:_to,:_sij�h :system, :except: where .- the.rfe?�1 ure to= operate •properl: is_, - -: caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 this 2, day of G General Contra r (Owner); ®%,Signature Corporation Name .(if Corp.) Address rev. 9/85 mk Signature Title e-p-` Corporation Name (if Corp.) 77— _7 Ilk, pp C n, Rt 7- N"' ti r iz Al 4 Xpre of" s a. Dlildfon �of- Envi "y �''JOOnfOTmanQi TAx-0ii3d' -- eT� DODO 6:z