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Home My WebLink About3937DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.50 -1 -52.2 BOX 30 03937 J AL d I l a �. 03937 J PUTNAM COUNTY DEPARTMENT OF HEALTH -- DIVISION OF ENVIRONMENTAL: HFAI. T_.H SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE" G'E`TRL�. ENT SYSTEM PCHD CONSTRUCTION PERMIT # 0/_J0 - %� " ? 03 y° Located at C/L 66977 own r Village Owner /Applicant Name r-0401 -6—&R Tax Map S"! Block / Lot Formerly Subdivision Name FeI414' ff- Subd. Lot # 'Z Mailing AddressfJ-6 /z' 8 r-'A-t 7— J--4 oy_ P_ 1007� 'vkl Zip Date Construction Permit Issued by PCHD Separate Sewerage S, sy tem built by %��e�.�✓�� Address /f 'a pk Consisting of /c : f b Gallon Septic Tank and 410 4� F 6 r plie't Ate, 1 T /ay� Other Requirements: N V /u P- Water Supply: Public Supply From. Address or: Z.%L Private Supply Drilled by 'Ac /* 41 Address pa'j -+-y fl t"Pd yp `. 1 e' % - .Has erosion control been completed? _G - - -.. Buildirig:T e 1 � �. • � __ Number of Bedrooms -!t Has garbage grinder been installed? NU 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 oDhe Putnam CAunty Department of Health. Date: T -110 0 k Certified by (De ice► Pr Address 1 � k� r-1 4 =t. xy /"C!� P.E.° R.A. final) c A- �_ License # 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 revocatio modi do r an is cessary. By: - Title: Date: -5-1-2,3100 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Weltl �.ocati�>�° °° ` Well Owner: - .. ...... treetcliiress` ` awnlVillage' a`s7-7 Map916' Block Lot(s )ro1,2 Na W: Address: ' Use of Well: 1- primary 2- secondary _ _ Residential Public Supply Air cond/heat pump __jrf igation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing >-'— Open hole in bedrock Other Casing Details Total length F'� ft. Length below grade i �4''ft. Diameter in. Weight per foot 14 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded %'-Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: >G Yes No Liner _ Yes '><No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours I Yield /D gpm Depth Data Measure from land surface -static (specify ft) b During yield test(ft) Depth of completed well in feet goo Well Log If more detailed information descriptions or sieve analyses. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 30 p` _ .. .... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type kcy2" Capacity Depth „, 7f Model Voltage0l) HP Tank Type Dco � Volume Qr YP %C Date Well Completed ' 71qq Putnam County Certification No. Date of Report ell Driller (s'gnature) INILKE: hx ct location of well wrtn distances to at least two permanent lattnrnarKS to be provideu on a separate sneettplan. /a7 79 Well Driller's Name C ` J, Address: I_S - G Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 p^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown - _`- 914), �'' Albert H. Padovani, Director LAB #: 32.002171 CLIENT #: 12043 NON STAT PROC PAGE 1 FOWLER, JENNIFER DATE/TIME TAKEN: 04/19/00 10:30A 15 GILBERT LANE DATE/TIME REC'D: 04/19/00 03:12P PUTNAM VALLEY, NY 10579 REPORT DATE: 04/26/00 PHONE: (914)-528-2271 SAMPLING SITE: 15 GILBERT LANE : PUTNAM VALLEY, NY, 18579 COL'D BY: JENNIFER FOWLER NOTES...: WELL ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~= DATE FLAG PROCEDURE PUTNAM CNTY 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 04/19/00 - , 04/19/00 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE PROFILE MF T. COLIFORM ABSENT LEAD (IMS) <1 NITRATE NITROG 0.51 NITRITE NITROG <0.01 IRON (Fe) 0.128 MANGANESE (Mn) <0.01() SODIUM (Na) 7.89 pH 6"7 HARDNESS,TOTAL 54.0 ALKALINITY (AS 34.0 TURBIDITY ATUR,, - _---_ '�3.1 _-' /10O ML ppb MG /L MG /L MG /L MG /L MG /L UNITS MG /L MG/L NTU _- -- _—,- ,_-- ABSENT 0-15 ppb 0 - 10 N/A 0-0.3 mg/l 0-0.3 mg/l N/A 6.5-8.5 N/A N/A COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a J diet, a maximum of 270 mg/L of Sodium METHOD 1008 9101 9139 9146 2037 2037 9043 -.-_ �.� � YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 - Albert H. Padovani, Director LAB #: 32.002171 CLIENT #: 12043 NON STAT PROC PAGE 2 FOWLER, JENNIFER DATE/TIME TAKEN: 04/19/00 10:30A 15 GILBERT LANE DATE/TIME REC'D: 04/19/00 03:12P PUTNAM VALLEY, NY 10579 REPORT DATE: 04/26/00 PHONE: (914)7528-2271 SAMPLING SITE: 15 GILBERT LANE SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY, 10579 PRESERVATIVES: NONE COL'D BY: JENNIFER FOWLER TEMPERATURE..: < 4C NOTES...: WELL COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 6.5. 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 O 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 WATE�: 140-300 MG/L (1 grain/gallon = 1,.2 MG/L) ` SUBMITTED BY Albert M-Padovani, M.T.(ASCP) Director ELAP# 10323 � . YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 245_2800- Albert H. Fadovani, Director LAG #: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 32.002171 CLIENT #: 12043 NON STAT ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PROC PAGE 2 FOWLER, JENNIFER DA7E/7IME TAKEN: 04/19/00 10:30A DATE/TIME REC'D: 04/10/00 03:12P 15 GILBERT LANE PUTNAM VALLEY, NY 10579 REPORT DATE: 04/26/00 PHONE: (914)-528-2271 SAMPLING SITE: 15 GILBERT LANE : PUTNAM VALLEY, NY, 10579 COL'D BY: JENNIFER FOWLE7. NOTES—: WELL ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHDD 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. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, 107S EXPRESSED AS CAL=UM CARBONATE, IN MG/L. ThE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE 2OURCE ANDTREATMEN7 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 = MILLI8RAM PER LITER +1ARDQATEGt:��0��-�G/L~-�__�'- SUBMITTED BY: Albert Whadovlami.. M.7. (ASCP-- Director ELAP# 10323 . ` � - yML ENVIRONMENTAL SERVICES E21 Kear Street Yorktown Heights, N.Y. 10598 AVert H. Padovani, Director LAB #: 32.00E171 CLIENT #: 12043 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FOWLER, JENNIFER 15 GILBER7 LANE �UTNAM VALLEY' NY 10579 SAMPLIN5 SITE: 15 GILBERT LANE : FUTNAM VALLEY, NY, 10579 COL`D BY: JENNIFER FOWLER NOTES...: WELL ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 04/19/00 10:�0A DATE/TIME REC'D: 04/19/00 03:12P REPORT DATE: 04/26/00 PHONE: (914)-52G-2271 SAMPLE TYPE,: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 47 COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/19/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 04/19/00 LEAD (IMS) <1 ppb 0-15 ppb 9101 04/19/00 NITRATE NITROG 0.51 MG/L 0 - 1O 9139 04/19/00 NITRITE NITROG <0.01 MG/L N/A 9146 04/19/00 ZRON (Fe) 0.12B MG/L 0-0.3 mg/1 2037 04/19/00 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2037 04/19/00 SODIUM (Na) 7.89 MG/L N/� 04/19/00 pH 6.7 UNITS 6.5-8.5 9043 04/19/00 HARDNESS,TOTAL 54.0 MS/L N/A 04/19/00 ALKALINITY (AS 34.0 MG/L NIA ' 04/19/00 TURSIDITY (TUR 3.1 NTU 0-5 N T U -COMME�TS: BACT THESE RESULTS �NDICATE THAT THE WAT AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. 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 va:ue of more than 15 pPb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the wate'rs corrosive potential. %/Mn If both iron and manganese,Are present, their total value combined shall not emcee! 0.5 mg/L. Va No limits for Sodium are oroscribed. Suggested guidelines state that for people on a sodium restricted diet.the water should contain no more than 2O mg/L of Sodium. For those on a moderately restricted diet^ a maximum of 270 mg/L of Sodium is suggested. ' - ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block . Lot &W Building Constructed by J5 Lmg, Location - Street Q,Am.YV� Town/Village Subdivision Name sncAel V0. , J e.� Buil ' g Type 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 ofConstruction -Compliance" for-the -- sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not t ailure o _ . e system to operate was caused by the willful or negligent act of the occup a bu' ing uti the system. (Owned Corporation Name`(.] Address: State ion) ear Zk-- Signatue: Title: Address: Zip State (if corporation) Zi Form G PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWA.GE.Ti,;d #Thf1,NT SYSTEM Owner or Purchaser of Building 'Tax Map Block Lot MAI Building Constructed by G 120ef tee. Location - Street Buil ' g Type P��-ry� TownNillage �;W�ec �� Jti Sic Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for: a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination df Public Health Director of the Putnam County Department of Health as to whether or not ailure o e system to operate was caused by the willful or negligent act of the occup a bu' Ong uti e system. Corporation Name�4f Address: State Zip ear ZI-- Signature: Title: (if corporation) Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - GUARANTEE OF SUBSURFACE SEWAGE TR k. rM9Nt S"YSTi` Owner or Purchaser of Building Tax Map Block Lot Dw IA�N_ Building Constructed by Town/Village Location - Street Subdivision Name "A IRA c.2. Buil ' g Type Subdivision Lot #t 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 approved of the "Certificate of ConsUmlion Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of th Public Health - Director of the Putnam County Department of Health as to whether or not allure o e system to operate was caused by the willful or negligent act of the occup a bu' mg uU e system. ear Z*-- Signature: Title: Corporation Name 'f co oration) Corpo tits o N (if corporation) Address: Address: State Zip State - Zio Form GS-97 DANIEL py E E CONSULTING ENGINEERS 120 Beckenridge Road Mahopac, N.Y. 10541 914 -628 -7576 May 10, 2000 Putnam County Department of Health Geneva Road Brewster, N.Y. 10509 Att: Adam Steibling RE: As Built SSTS Lot #2 Fowler-Subdivision Gilbert Lane TM4 $3.5 -1 -52 Putnam Valley Dear Mr. Steibling: Enclosed please find: 1. Certification of Construction Compliance 2. Well Log and Bacti Results 3. Guarantee and two copies 4. Four copies of the asbuilt plan 5 Fil ng fee of $200.00 - Comments: Your prompt attention would be appreciated. P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES � � h ". • : ^...... .. ...�. -� .' _ .. � 1:_ � i.. ., .: ,.. -� � .-v viVp ��•'. ».rt: _ .....�, Y4�.v.' w R.....4v n,. +. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM . I 'Rir ha U� 9�- &n Fo-ii /ff Owner or Purchaser of Building C1wn�r Building Constructed by Location - Street id S ?C Building Type 2,50 - I -5a d a Tax Map Block Lot R,b-NUA TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction- and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and. in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where.the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the .building utilizing the system. Year SELL Signature: Title: Corporation Name (if corporation) Corporation Name (if corporation). Address: 19 (j-}FS_T&_Q PLACE r 1-,4a Pa LL Address:_ State UK U09K Zip N531 State zip Form GS -97 O � a .. -BRUCE R: FOLE-Y - Public Health Director LORETTA -MOLfNAF!: RN., M.S.N. Associate Public Health Director Director of. Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (9.14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICA.TION FORM owNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: R l c- R b J Ai /N1 GJ �. 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) i N2 41 I 1 8.94 Th 1 -3J.q Rot `5 •1 71PO wi ' 1 •-h n,n ltrw ,.l t. i/ We /� On CC:r 0 (0 T 5 er File M< Mon. W. Line GIL SSTS TIE - INS (MEASURED BY TAPE) _ lec. S UNIT A B ' Shed on t..ne SEPTIC TANK 40 21 -- ` -- J. B•I 40 63 + 2 46 67 u I 30 3 52 72 k 4 58 77 5 64 82 ^1 .2f 6 70. 87 7/1 7 76 92 e 8 82 98 — p � I o END OF TRENCH c o 9 100 90 p 0 10 95 84 c ° I 11 0 2 91 78 (V 12 86 72 �0pE3sI0,yq�.. 13 81 67 �o 2 v 004'1yFyQ � 14 76 60 to � 3t Slot z e G� Z\ t�^ 15 !•72 ,54 (p p p Drai' ,f -- 7j. ^ :u�yusw tu6 .uy vepurAuG 68 Au"v- •�%,c 'lvisio o£ ironmental Health 8eMalp, o ^ of W 0. 480A pY'./ proved ae noted for conformance w ith TFOF NEI plicable Rulea and R gulations of the ° R.O. W. Line -' ?ut Co l` D artmenty C W 11 — o L ne V N 2823 Mon t Z3 00 Iron Pipe fou O.SO•N., 0.16' 2 'S0 "E 100.00' 'R �...�. T. +,`� r-.- cn wa Overheod. Utility Wires Pole i/ _� LA / Y S6 25'50E 11/, _ Macadam 0 Povement �/i BERT` 22.9.2 THIS IS TO CER'T'IFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS DANIEL J. DONAHUE, P.E. INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT CONSULTING ENGINEERS WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL 628-7576 1 STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF MAHOPAC, N.Y. 10541 HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. DATE: MAY 10, 2000 SCALE 1'=30' SURVEY BY: I. HENRY CARPENTER & CO. Wall Along tine , , '" • -- - 1.0- RESERVED STRIP AS S •- ? J SHOWN ON MAP 1655 C Cor. 'kiwi /QJ FN�(! W 0 1.490 Acres (64,920 34.78' - � 143.5'.__ - -- - - - - -- b b �_--- - - - - - -- 1 0 Well 2. ST. FRAME b.w 90 fa DWELLING !-- F, F. 361.3 14.67` C Cov. Por A ASBUILTPLAN 3 3 A S SEWAGE TREATMENT SYSTEM I -)SO G4L < CEP 7!c TAUK ' 'EAR AND RICHARD FOWLER GILBERT LANE TM# 83.6-1 -52.y PUTNAM VALLEY (7) ■ —— .. —� - -- —/6 I ILI /i ■ 3 --------------- 4-1., 5' S6 25'50"E 1 120.50' o o S e---- .. ------- A,1 2 Ang /e /rn G e -- -�— rx v' A "— l — OD l, Angle 6 �• — 0 (0 T 5 er File M< Mon. W. Line GIL SSTS TIE - INS (MEASURED BY TAPE) _ lec. S UNIT A B ' Shed on t..ne SEPTIC TANK 40 21 -- ` -- J. B•I 40 63 + 2 46 67 u I 30 3 52 72 k 4 58 77 5 64 82 ^1 .2f 6 70. 87 7/1 7 76 92 e 8 82 98 — p � I o END OF TRENCH c o 9 100 90 p 0 10 95 84 c ° I 11 0 2 91 78 (V 12 86 72 �0pE3sI0,yq�.. 13 81 67 �o 2 v 004'1yFyQ � 14 76 60 to � 3t Slot z e G� Z\ t�^ 15 !•72 ,54 (p p p Drai' ,f -- 7j. ^ :u�yusw tu6 .uy vepurAuG 68 Au"v- •�%,c 'lvisio o£ ironmental Health 8eMalp, o ^ of W 0. 480A pY'./ proved ae noted for conformance w ith TFOF NEI plicable Rulea and R gulations of the ° R.O. W. Line -' ?ut Co l` D artmenty C W 11 — o L ne V N 2823 Mon t Z3 00 Iron Pipe fou O.SO•N., 0.16' 2 'S0 "E 100.00' 'R �...�. T. +,`� r-.- cn wa Overheod. Utility Wires Pole i/ _� LA / Y S6 25'50E 11/, _ Macadam 0 Povement �/i BERT` 22.9.2 THIS IS TO CER'T'IFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS DANIEL J. DONAHUE, P.E. INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT CONSULTING ENGINEERS WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL 628-7576 1 STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF MAHOPAC, N.Y. 10541 HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. DATE: MAY 10, 2000 SCALE 1'=30' SURVEY BY: I. HENRY CARPENTER & CO. BRUCE R. FOLEY 'z Publio- Health Dii;kvor -: •... LORETTA MOLINARI R.N., M.S.N. = • . Associate • Public ,HBaJth- Director..:. ,::.::..�;:..r.. -.� Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York 10509. Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 May 17, 2000 0 Mr. Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Application of Certificate of Construction Compliance - 15 Gilbert Lane, Fowler Town of Putnam Valley, TM# 83.5 -1 -52.2 Dear Mr. Donahue: This offs e has determined that the above referenced Certificate of Construction Compliance applic 'on, received by the Department on May 15, 2000 is incomplete. Please be advised that the f owing information is required before the Department may commence its review. D um nts: 1 Correct Tax Map Number on Form CC -97 Correct Tax Map # is 83.5 71 -52.2 Complete Form WC -97 a. Tax Map Number is incorrect b. Well Yield c. Pump /storage tank information 1 Label north arrow 2. Correct TM# on plan 3. Show 1250 gallon septic tank proper size. 4. Clarify /clean up trench layout on plan. 5. Label length of trenches. 6. Show representation of 100% expansion. This office will continue its review upon receipt of the above mentioned comments. Please feel free to contact this office if any questions arise. Very truly yours, &Uvi �. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc. Form CC -97 Form WC -97 Marked up plan v% PITTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TItEATl:ENT SYISTEM PE # Located t 11-80-19 % Al F, Town or Village A7,YV�t'� Subdivision name /V Subd. Lot # Tax Map 93,r Block _/ Lot S-2- Date Subdivision Approved A ( J/% Renewal Revision Owner /Applicant Name &1/d ftRi)4' JC'xtvAI F041e-!!tA Date of Previous Approval Mailing Address /� � 2 i �'q ni, /�!� ?�l�i�i d�'�LG ��f Zip 16S' �X f Amount of Fee Enclosed Z) r%(tG Ltd Z `j Building Type yT L-! Lot Area No. of Bedrooms -11L- Design Flow GPD � Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of f -J7J gallon septic tank and -mod �. is ¢ihf - —o eel Other Requirements: /VOAJR To be constructed by Address Water Supply:, Public Supply From orc' .. ' -i &ate Supply Drilled -by Address Address -- f1,10,► I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date Address /� /,6��G'� ��'e�t /.��i�i �.j.�% 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 anew pernnit. Appr ed f d' ch ge of domestic sanitary sewage only. By: Title: / Date: � Z White copy - HD File; Yellow copy - B ' d- g Inspector; Pink copy - Owner; Orange copy - Design Profe sional Form CP -97 PUTNAM COUNTY DEPARTiNIENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH, SERVICES FINAL SITE INSPECTION 'I L �t Ozrer R -_ r L Date: (t jnspec;ed by: Street L ......... - Permit r 2'4 — Zvi — Q� Ti`-1 r� , 1 —"Z Subdivision Lot',-. 1. Sewage S ystem 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. Sewaae System peptic tan. siz 0 :....1,2- ....... ther ................ b. Septic tank in eve ............................................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box &- trenches Junction Box properly set. ......................... 1Zen; required D fJ Leno installed-44 ® 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... .......... ...................... o Q i 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 - 1112." diameter clean .................... 7 9. DepPn of gravel in trench 12" minimum ................... 10. Pipe ends capped. ............ ............................... 9-.-PLUM or-Dosed•S-r,stems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. house located per approved plans .. ..............................: b. Number of bedrooms .......... ..............................� IV. Well a. Well located as per approved plans ............. t.................. b. Distance from STS area measured O ft ........... c. Casing 18" above grade .............. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship 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. drain outfall exist watercourse . Fo 'ns ar e awa ea......... h. u ace water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 EI{ TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - please 10int®ir ripe, , PCHI Pei miY ii Well Location: Street Address: TownNillage Tax Grid # 009,17'MOV44 � Map f- ?Y—Block / Lot(s) J"_ - Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation Primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # ed Est. of Daily Usage allb dal. Reason for =° Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 'ri N674.: /Q �P/ �Of i✓ for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No !/ Name of subdivisions Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? ............. . . a......... ............................... Yes No � Name of Public Water Supply: /V/ 4 TownNillage Distance to property from nearest water main: All Proposed well location & sources of contamination to be ovided 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 a water well driller certified by Putnam County. Date of Issue s Permit Issu' Official: ala' Date of Expiratio B i v Title: g i#ll!;� Permit is Non- Transfers e U White co y - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Lie— L4,4 &I&XVIlyc" 1)'U.TNAM COUNTY DEVAknvr TENT OF HEALTH • — „APPLICATION FOR -APPROVAL`UF PLANS FOR A WASTEWATER- DISPOSAL SYSTEM Name and Address of Applicant: ')49,,1R4 Aojo fAvNIFIVe C'6 w4-Fo? . Name of Project: F4 W4k'& Jt�E'S / %��= �vc.� -' 3. Location <OV/C: ayu�lh . Project Engineer: D&WIVt . J. DoM.a. /u °. 5. Address: tf License Number: Phone:_ e Tvoe of o e t• Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) Is this project subject to State Environmental Quality, Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted_ . Is a Draft Environmental Impact Statement (DEIS) required? ............. A10 Has DEIS been completed and found acceptable by Lead Agency? ........... 1Uf/i� Name of Lead Agency _ PU Is this ' p - roject in an area under the control of local planning, zoning, or other -.ffIc,fa hr -ord s ?..�. . -... :::. -.— .... - .:...... _._...— If so, have plans been submitted to such authorities? .................. �l~r Has preliminary approval been granted by such authorities? A/ O Date Granted: Type of Sewage Disposal System Discharge...... Surface Water —y—Ground Waters If surface water discharge, what is the stream class designation ?........ , A Waters index number (surface) ......................... Is project located near a public water supply system? .................. , At 12t If yes, name of water supply. �( /I�-F Distance to water supply Is project site near a public sewage collection or disposal system ?..... Nle Norte of sewage system . °Distance to sewage system H / Data observed: S/ /� 23. Name of Health Inspector• t4. �YZ,91 ?1,i-'VG P raject design flow (gallons per day) ...... ............................... 4OIDG �� 2. 5. Is State 'Pollutant Discharge Elimination System (SPDES) Permit required?.. NZ) n ti-.,o-n***6'e�e,"""�'-s"-iiiWtt-ifd iZ� I— 6'.° Ta ,§PDS. App oca 7. Is any portion of this project located within a designated Town 'o'r,.,State wet.land?,.,. ........... ............................................ /J 3. Wetland ID Number ....................... ................... Ala 1. Is Wet]"and -Permit required?.. ............................. Has 'apol idtt-46n been -made ,_1.;,to!;,Town dr,166al,'DEC� ice) Doe,0 pr0ect requ i re:-.t :'Stream. Disturbance' Is Or was project sl. e used .4foi, agricultural 16ti.vity'Invoiving 6pplication . of pesti.cides-,to orchard' or ther cropt, solid or hazairdous waste dispoAl Jandfillin§,. sludge 'appl'lcatidn.or industrial activity? ........ YES or s,,. proi ie'c t' 10catied within . .�1,060'ftet of existence. of abandoned landfill, .hazardous Waste site; saft, stockpile, landfill,'sludge disposal site or any.--other pot6nt.ial known- source of contamination? ......... YES,. or�� bESCRIBL: Is there, a-16dal master . plan or file with the.Town or Village? ........... 9151 Are.' co in . mun - i-ty water, sewe r facilities planned to be developed within 15 years? IV4 Are'any sewage dispos.al..areasi in excess of 15% slope? ...................... Tax Map ID _ Number-- ......................... ... 77 Approved Plans are to, be returned to: ................ Applicant Y Engineer the ..a pp1,Jcation is signed by a person other than the applicant shown in Item 1, the ,Iication' must be accompanied by A Letter of Authorization. Failure to comply,with this )vision may be grounds for the rejection of any submission. 1hereby 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 C7.ass;A Misdemeanor pursuant to Section 210 0 the Penal Law. ;NATURES & OFFICIAL TITLES:"-, LING" ADDRESS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES "::' ,i ,, .:.: •: °,I SIOI�T` c i'A'S�iE -:SUBSURFACE SE WAG--E� Y REAT -ME T'►7Y&WFEMl . ' > ..•:.... Owner FD k1 G Ar R Address T L .4 -V E Located at (Street) 6/ L ?ER°T L.;•v.X Tax Map. 4'Slock ---j Lot x%L (indicate nearest cross street) Municipality PO N47-1 41,44 -4 G' WatershedI,.4A-e,. SOIL PERCOLATION .TEST DATA Date of Pre - soaking Date of Percolation Test lEe �o.iun Nv. T�tte Stall * Stm►pMLn.) st W. m DiTl+e . DeFptb to W$teri<tssr rom and _ Gro Surface flnche�} : Start Stap ievei 1<1n es Peccolago�n to Mct, . 2 � 3 1 �4 1I a �1 �� y a� -3 f... 5 3 �' �6 y 4 — JY X70, .5 400. Y " 02 to, ..c, I - , 2 3 ...4„ 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,.,. 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' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0'. 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST 'HOLES HOLE NO. � HOLE NO. HOLE NO. K Indicate level at which groundwater is encountered Y6 AJe Indicate level at which mottling is observed MCi�f Indicate level to which water level rises after being encountered Deep hole observations made by: Z)9Nt &, J, 1iQAj 4 ffv� e4. Irs8u ea,G Date -f Design Professional Name: U j Art E c J L 4- rrc"E. Address: ® Z?,e c tA- r.4, e4 ,o d ,.-. !1 o P Signature• Design Professional's Seal 14.1&4 (2187)—Text 12 817.21 SEAR PROJECT I.D. NUMBER Appendix C State Environmental CUallty Review - - ...�...,. �r�Ndl .�.� :E�LTAL�,.ASSESSMENT�F :.� :. _.:......_ For UNLISTED ACTT � _--n�Y. -� �_...A t,., enntinnnf er Pro(eCt sponsor) PART 1— PROJECT INFORMATION (IO oe Gvrnp►a.ov wy ••rr•• -- -• -- . PLICANT ISPONSO 2. PROJECT NAME 1 1e1-1'6-'W 10 3. PROJECT LOCATION: r� Municipality �' /"" c�7L�� County •. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) T . s. IS PROPOSED ACTION: IV Naw ❑ Expansion ❑ Modificatiordalteralion fi. DESCRIBE PROJECT i V `7 i� N io -0 S J" /V / ,V/4,loarlt 7. AMOUNT OF LAND AFFECTED: Initially 1— acres Ultimately 06 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 4Yes ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? XResleentla! LJ InCUetriat ❑ Commercial ❑ Agriculture • -` ❑ ParklFornt/Cpen space ❑ Other Describe: 1C. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCAL)? _ Yes ❑ No It yes, list agency(s) and permivapprovals 3L dl) ,r 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes g No It yes, list agency name and permltlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 115 TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: G Q "� Dater Signature: rr. It the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11 - ENVIRONMENTAL ASSESSMENT (To be completed by.ggency) 1.A. DOES ACTION - EXCEED ANY TYPE. t -THRESNOLD.IN e- Nt4M!i.,PR 8J7 B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. . ..0-Yes QNb C. =COULD ACTION, RESULT IWANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic. agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3, Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain brief Nod C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. C&. Long term, short term, cumulative, or other effects not identified In CI-057 Explain briefly. r vo C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. 401 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes Bfo Il Yes, explain briefly PART Iii— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or.rural);.(b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if. you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a posltive declaration. ❑ Check this box., if you have determined, based on the information and analysis above and any supporting documentatioh, that.the proposed action WILL NOT result ln,any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or, Type Name of esponsi a Officer in Lead Agency Tftle -OT responsible icer #;natvfe of esponsi e Officer in Lead Agency Sipature of mparer (If dif I erent f rom responsi, e of icer) Dote i. '.� •3. 9k COUNTY ice.. 4 > Kd _ h a LTH OWISION OF ENVIRONMENTAL HEALTH SERVICi� : Property of Located at TN Tax IVfap $'� a S'o Block / Lot Subdivision of Subdivision Lot # .� ? /,I-- Filed Map # Date Filed Gentlest: This letter is to authorize ' ' eL&lz z/ tf r�iD,x� - a duly licatued Professional Eatgineer or Registered Architect — to apply for the required wastewater trcatment and/or waer supply pemit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Put _ County Health Depampent, anti. to-sign all 4 "ssary papers on Iny behalf in connection with this weir aid i g tewafer tretment and/o r.supply .syste i comfortnity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law,-and the Putnam County Sanitary Code, n A Very ft Countersigned: \i ed: (Owner of Property) Mailing ,address G r , Mziling Address: �' 1 � 7~ State Zip telephone: c .2-1--,? r2,,1 State,(` ��-' zip Telephone: Four, LA -97 q a .- 11' x Z o 0 Im CL X -4, x Wa dm 02 co -4 co 4 0 PUTNAM COUNTY DEP4RTMENT OF HEALTH PLANS APPROVED FOR,, BEDROOM COUNT ONLYI BEDROOMS ALL SUBSEQUENT REVISION[ALTERATIONS 'I'CI TITESt HOU4� S PLANS MUST DE SUB24ITTE T THE PCDOH FOR APPROVAL SIGNATURE. & TfrLE I.- u- v. DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 . .. _ . � -. � � . , . - _t. -: � •. - : -. - .... - ro -� - 914 -628 -7576 ' : , July 28, 1999 - Putnam CountyDepartment offlealtfi Geneva Road - Brewster N.Y. 10509 Att: Mr. Adam Steibling. Dear Mr. Steibling: Enclosed herewith please. fiud:the following: 1. Form PC -1 2. SSTS application 3. Well permit application 4. Design data -sheet 5. Letter of authorization. 6. Fee in the amount of $300:00 7...Short.EAF 8. Three copies the construction_ plan -and -one copypfplan- showing -wells located:bysurveWr 9. Two sets of house plans. Sincer Daniel J. Donahue, P.E. Site • Sanitary • Environmental �� ERtlPPOnawanQiflf � ®kty Re3�� This woke is iwuW pursuant of Psut 017 d the implerngnting reguMM porlaining to Article 8 (SWe Environmerw IwbV Rvvivw Act) d Vie fEnvironmantsl Corservaatlon Lear. They Plann ft Dmrd of the Twn of Putnam Valley. ee Lead Agcy, has cleb"nod that the pr®poGOd wbw don iced bdw %will not have+ a3lgni wt Vic¢ en tha owvOwMant end a !haft Enwronmentel 1ftV 4 Stmt VAa FM bo pr0parod. s" DWCHPMVQ W Aaan.- The applicants are ptopwing o w-iot e;ubdivh)ion w m suffxj" PnntW within the R -4 toning OIMCt with individual vmfls and sonp diepoum syutgm, 9110911 LAM Tarr. of Putnam - Valloy..... Count of Esietnanm Rewene SUPPOMR9 Wo Ioter6toini ion: The a>ppliCantaa ar® proposing to Contain all Vw storwvater on site and IcCeft the improvemem so vW ft proindies to the w t vw ould "W be impamd. R!"M ROW that the Planning Word hae hold a prolirainsry pu®11C PIGOAM9 On the subdivision an 7M and ctasssic? wfa sfWr beeping the e®faea ms N Ma laeljhb0M" j r"160"N. OVA y AkE PE E K D I L ><- E TIC N G" 9A t (FILJED 5 28/ 9 A MAF No. 18,90 -, .5 1 q J'7 TO N� F bULLETTE i I N/F AYYOR i N/F.i K D 1� 0 -4 r, -0 i ((-20� :21 r2 2 Cl 1�, (I 72�) Cl�) /F S MB /F ALV OR AV$ App, J).A. c-, Found P—p—ty C., 456,936 S.F.) .t.t. 1— �m l T FE 0 LI F-ILBERT k Col. Fn -N SERVED STRIP AS N0� ON "AP 185E y A —P, W., 1.496 Acres F- (65.175 PR i EL. 3�p.o � F ; O�. LANES 23.42.'