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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.75 -1 -46 & 83.75 -1 -47 BOX 32 04183 ' 'r. ! lioN'ij. � �' ,` i _ ' � I �� � .� IN IN IN IN 1 04183 PUTNAM COUNTY DEPARTMENT OF HEALTH ::- :: I ' TO►L� ! : F N TIRONMF N' 'AL, HE A LTH -SERVICE CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # -f 2 ►� — - . f ;i Located at Town or Village Owner /Applicant Name Tax �i�i' Tax Map Block Lot? Formerly Mailing Address Subdivision Name Subd. Lot # Date Construction Permit Issued by PCHD %/'� Separate Sewerage System built by Address 'J O.'V e Zip�'� Consisting of Gallon Septic Tank and ,e' • /=- 0,71-, Other Requirements: Water Supply: Public Supply From Address / or: /1"" Private Supply Drilled by f � ®tt�✓ Address _4P' -�/ B °gilding Type.. - - Has c.osiomco trol been ccmpleted? - - Number of Bedrooms 2� Has garbage grinder been installed? Alo I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Departure th. e Of NewI Date: Certified by s - ;design Professional) Address Any pepon occupying prenuses serV-ecfby the ab a system(s) shall lam' R.A. as may be necessary to secure the correction of any unsanitary conditions resulting from such usag' - t' of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. B Title: Date: ` 0 Whi 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 Well Location Street Address: '- Tow, n/Village: Lake Peekskill Tax Grid # 83.75 -1 -46&47 Map Block Lot(s) Well Owner: Name: Address: Catucci Construction, P. 0. Box 453, Shrub Oak, NY 10588 Use of Well: 1- primary 2- secondary Drilling Equipment Well Type Casing Details EEFC 4R' W 1® 0 Screen Details X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby X Rotary Cable percussion X Compressed air percussion Other (specify) Screened Open end casing X Open hole in bedrock Other Total length 52 ft. Materials: X Steel _ Plastic _ Other Length below grade 5jft. Joints: Welded X Threaded Other Diameter 6 in. Seal: X Cement grout — Bentonite _ Other Weight per foot 19 lb /ft. Drive shoe: X Yes —No Liner Yes X No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Depth Data _ Bailed g Pumped X Compressed Air Measure from land surface- static (specify ft) During yield test(ft) 30' 160' Hours Yield _,_ gpm Depth of completed well in feet 225' Well Log If more detailed information descriptions or yses._' _1 are available, please attach. If yield was tested at different depths during drilling, list: Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 35 Drilling in over_ urden clay and boulders Hit rock at 351 35. 52 Drillin in rock°- routedsiey"na •set-casin 52 225 Drilling in rock grmite Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gW Depth 180, Model 7GS05412 Voltage 230 HP 1/2 Tank Type WX250 Volume 4_alions Date Well Completed 6/2/03 Putnam County Certification No. 001 Date of Report 8/25/03 Well Dr' er (si e) NQ. TE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Na P F. Beal & Sons Inc. Address: 4 Putaratn Aymm, > ber, NY 10509 Signature: Date: 8/25/03 G ri.stopl�.r Beal. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 _,r, d- (;7JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 NELAC, CT and. N, Y- . State .Certified,Envi.ronmental Laboratory 1�� - - - - Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: Client: Catucci Const. Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: CB Address of site: Hewitt St City: Lake Peekskill State: NY Zip: Telephone: Y-3, 7j"- 1—&,6-47) Site: Date Collected: 8/5/03 Date Received: 8/6/03 Preservative: HNO3 Time Collected: 13:30 Time Received: 11:45 Temperature: <4C Lab No.: J035670 Date Analyzed 8/6/03 15:00 8/6/03 8/8/03 8/8/03 8/8/03 8/8/03 8/8/03 8/8/03 8/8/03 _..... - 8/8/03 :.. r 8/8/03 10:00 8/6/03 8/8/03 8/8/03 8/8/03 8/8103 Test Name Result MCL Method Total Coliform Absent Absent SMWW 9222B Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG Color ND 15 Units SMWW 2120 B Odor ND 3 TONs SMWW 2150 B Iron <0.03 mg /L 0.3 mg /L SMWW 3111B Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B Sodium 14.9 mg /L N/A SMWW 3111 B Chloride 51 mg /L 250 mg /L SMWW 4500 CI C Hardness 116 mg /L N/A SMWW 2340 C nag /L. .: ..10- mg /L- ,-...- . .__.__:.,_.G"dIVAAV,4500-NO3E -- ...�...__.:- Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E pH 6.93 S.U. 6.5 -8.5 S. U. SMWW 4500 H B Sulfate 37.6 mg /L 250 mg /L SMWW 4500 SO4F Turbidity 0.01 NTU 5 NTUs SMWW 2130 B Alkalinity 54 mg /L N/A SMWW 2320 B Lead * 22.4 ug /L 15 ug /L SMWW 3113 B Comments: * ABOVE ACTION LEVEL At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. ' �'�`'"`- State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET S STAMFOR •D,"CON.NECTIC,,I�_Tro69o5��_ ._ ......NELq�. C�T,przd ..NY_.State Certi ieAfavironmental,Lobncatory Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845- 279 -2460 Client: Catucci Construction Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: Chris Beal Address of site: Hewitt St City: Lake Peekskill State: NY Zip: Telephone: Sample's Information: Site: Date Collected: 8/10/03 Date Received: 8/12/03 Preservative: HNO3 Time Collected: 8:30 Time Received: 13:00 Temperature:' <4C Lab No.: J035813 Date Analyzed Test Name Result MCL Method 8/13/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B N/A = Not Applicable MCL- Max. Contaminant Level ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com BRUCE R. FOLL'• Y _ ..LORET_TA MOLINARI R.N., M.S.N. Pub` I'd 'Health' "Director Director of' Pae(ertt Services DEPARTMENT OF DEAL `:1 H I Geneva Road Brewster, New York t0509 EuvirunmcMal Health (9 14) 278 - 6130 rax. (914) 278 - 7921 Mirsin; Services (914)278-6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 2-18 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM 0WNE.i S NANIE: TAX N/I. .P N IJ Ni BER: E91 t A1)DIZ.ESS- 'FOWN: A.0- 1`14*01ZIZED 'I'O W N OF (Sigilliture) D AI-1;: I/ i Putualu County Department of health will nut issue a Certificate of C_,ollstructioll (_ ocapliance unless the above (brut is completed, i.e., a legal E91.1 address is assigned ley all authorized town official. This form is to be submitted Nvith the application foi- a Certificate of Construction Compliance. 0',") t i VH1�1R vl) PUTNAM COUNTY DEPARTMENT OF HEALTH .. F , ENVIRONMENTAL NIENT�I HEAIT� SE�_ V ICE� GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by !� Location - Street Building Type 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'�utnam County Department oiHealtlft, 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 IDVA&ng utilxzing the 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 buildlputllltilr,,��e system. Dated: Month o Day ;?e Year 03 Signature: Title: y General Contracto (Owner) - Signature Corporation Name (if corporation) Address: State Zip CorporationName (lf corporat�on� Address-. F i) m Gs -91 08/25/2003 08:05 9149624240 JOSEPH SULLIVAN PAGE 01 r JOSEPWF Ca�u�+aynyG�s 2972 FEANOR[ST DRIVE YORKTOWN HEIGHTS. N.Y. 10996 19141 062•424e r 'Ore -/". X %C�JGr %Aar G✓ 00, gr y Gr /7-0 <y 4g4ok--, �4t CL y r�` to Acting Public Health Director Director of Patient Services May 28, 2003 DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: ROBERT J. BONDI County Executive Re: Field Inspection - Catucci Hewitt Street, (T) Putnam Valley TM# 83.75-1-46 & 47 A site inspection was made for the above referenced project on May 27, 2003. The following comments must be corrected in the field. 1. 2. 3. 4. 5. Total length was measured at approximately 275 feet, 285 feet is required. -Silt feno6heeds to be-repair-4-where-needed Well needs to be drilled, and according to the plan double casing is required. Cast iron pipe needs to be installed and inspected. System can be backfilled, except for any trench ends that are going to be added to achieve the required length. If you have any further questions, please contact me at (845) 278-6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj 2 �:ed l�taes�i+ 4's G j. 4.0 AAW Alp /i. 10'd o c+t /erg t ScP%C ta� 1.3 +� R A"" //1GFr� _.. "This 28 to oerrrify that "_taa ,�ag9 disposal System was ccr_strueto6. a:i on this plan and that the 3y,. ?, ..tea �r32'•3n @pecr?a b;' :" ` -.fors it was Covered Over, T?'° ,-70 m was cc r'. t:,, . _ _ in akcoraanc r:ith allAter,.. _ ruloz and rwp ic:.;7 11 ; h -a'n :a rr.;,r a ;r•. �1i r -, > °salth 'alv'• f9TNAM COUNTY DEPARTMENT OF HEALTH DIVISION Of NVIR(dMENTAL HEALTH SERVICES. /�J ✓r �f SLt! -o?� -o a- APPROVEdNOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE PLITNAM MUNTY HFAI TH nFPARTAAFNT mac.. -. �_�,��:�!''r:• 1.,�.,1� �'`�.� /i zo 33 2 r�- 47 S7 3 4S S2 4 93 4 7 40 42 G 39 37 3 33 ? X6 9z y go 9e !u 8S 19 i� 9s 90 �z 93 90 /3 91 QG i� 33' 3 P 4's G j. 4.0 AAW Alp /i. 10'd o c+t /erg t ScP%C ta� 1.3 +� R A"" //1GFr� _.. "This 28 to oerrrify that "_taa ,�ag9 disposal System was ccr_strueto6. a:i on this plan and that the 3y,. ?, ..tea �r32'•3n @pecr?a b;' :" ` -.fors it was Covered Over, T?'° ,-70 m was cc r'. t:,, . _ _ in akcoraanc r:ith allAter,.. _ ruloz and rwp ic:.;7 11 ; h -a'n :a rr.;,r a ;r•. �1i r -, > °salth 'alv'• f9TNAM COUNTY DEPARTMENT OF HEALTH DIVISION Of NVIR(dMENTAL HEALTH SERVICES. /�J ✓r �f SLt! -o?� -o a- APPROVEdNOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE PLITNAM MUNTY HFAI TH nFPARTAAFNT mac.. -. �_�,��:�!''r:• 1.,�.,1� �'`�.� /i Street Location Town TM # PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date:' Inspected by: *-(P 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .............. d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course /wetla s ...... ............................... H. Sewage System a. Septic tank size - 1,000 .... ..... 1, 250 ......... other ................ b. Septic*tank installed level ............................... ............ .... c. 10' minimum from foundation .......... ............................... d. Distribution Box _--- -- 1 All outlets at s anon -water tested..N:.. 2. Pro e ow frost............ ..... ............................... nimum 2 ft. Original soil between box & trenches e. Junction Box -properly set .......... ............................... 6. 1renc i— eT s —. 1. Length required S Length installed �.) 7 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10 Pi e ends ca ed ig. -Ptitiia or DosodpSystenis " �. 1. Size of pump chamb ............. 2. Overflow to . ........................... ........ . .............. 3. Alarm aUaudio ............:.... ................. 4. p easily accessible, manhole .... to ... g..rade....... ................. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III, House/Buildihe a. house located per approved plans......................... .......... b. Number of bedrooms ................ ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured . ft........... c. Casing 18" above grade ................ ............. ................... d. Surface drainage around well . acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfi fled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to pl�j f. Curtain drain outfall protected & dir.to exist watercb g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... .... ........................ i. Erosion control provided ................. ............................... Rev. 12/02 Permit # Subdivision Lot # Z e 05A 9/2003 09:47 9149624248 JOSEPH SULLIVAN PAGE 01 PMAM COMM DEPAYtTMW OF n"TB DIMION OF ]NVWNA+ TAL XZAMS M :"U ATMNTI®I G For: Fdl All W or ation must be U� comply O prior to Any Try inspections bsiq msde. PCHD Cowuuctioa Permit 0 n w - -o —0 it- r i'fi. �� • wR�►w nor. ».+r OemOApphcaatNMc: 4,21 �'�•fir. -c __ _ 'I'A�i�,x r�8teeic,_I,,,,,;%,ot .,-� T Forqu�rly: i�lwl..r ^. w, _.r._._ _ Svbdivisianl�a�oR: -- h system 5U csmspktad? , �r ..: �, Data: { is complete? DRft• /a 7 IMll�iii>ti IS "an couStmated u per ph= )./e—s Is van drilled? •drr I �.w n _ ' 1�- Due: Is w4l lwwsd as pw plan? Are won' on control mutes in p1mi I Y tilt tiro oama(sl As hta4 At the abow premises ho bm comovaW od I bm kkipsg d and var&ed their compMon in ncccor&m with to wm d PCB CoaMxadu Pme u d approved p1m ad the Stucdards, ltdw ad Ragdation of this hih m CwMy DeputoM of hate: 'JJ + CmMed by: Address, lrli�- S"q Commonds: ria r�u.ur. ■r.en ulw rlu�. +ws �. �. o 1 ■ R��oWi / i• Form FIR 99 I o� I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # "�- // lfla%wn Located at e :�� f�"� �' or Village j n /0 rr1 1K Subdivision name Wd. A' 2 ,3&1 Tax Map *'3.76 °Block / Lot -ov,� Date Subdivision Approved Renewal Revision i/ Owner /Applicant Name hl< 1 � Ae -' -, Date of Previous Approval Mailing Address �a eq�e -1j'3 S���a% l%f,1` Zip Amount of Fee Enclosed Sep Building Type Lot Area No. of Bedrooms Design Flow GPD 4pU Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l eae,, gallon septic tank and Z Other Requirements: To be constructed by r9 t�y- ,,-? e-,"- Address Water Supply: Public Supply From Address _. or Private Supply Drilled`by - �t'i �� ' . Address`` it �i� `1�f 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: Address ;2- %% 7�r�`� ®F NElk, N01:4:0 J Ncis _ R.A. Date ��/ ° License # 27— APPROVES FIR CONSTRUCTION is appro t?v from the date issued unless construction of the sewage treatment system has been completed and inspect}'' ;btu and is revocable for cause or may be amended or modified whe onsidered necessary by the Public Health Direct --eh my revision or alteration of the approved plan requires a new pe t. p or discharge of domestic sanitary sewage only. / By: Title: �lr t, Date: �I5 0 L White y - HD File; Yel w copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PIJTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # a,,l 11114y Map 83, ?& -Block 7 Lot(s) 9 „.,V, Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served 91 Est. of Daily Usage ±f t gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ✓ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No r Is well located in a realty subdivision? ...................................... ............................... Yes ✓ No Name of subdivision G a�% %����f��I %l �eC Lot No. 2S'” 3 G Water Well Contractor: 13 ea/ 16da Address: �3.- �����✓ �Ny Is Public Water Supply available to site? .................................. ............................... Yes No .�-- Name of Public Water Supply: Town/Village —, Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. ]pate: i lo: .:. Applicant Signature: �.0 / -� ✓J� �/. _ , i.. 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 Ovate ell driller certified by Putnam County. _ Date of Issue +� S' 0 2 Permit IssuingQfficial: -Y-4 Date of Expiration —_Ll Title: 1 11)f rk. G r Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 14.1" (2fB7) —T4xr tr _ PRpJEiGT I.ICi. NUMBER SEOR stale Endtr*a wwntal Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For. UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (o be completed by Appl)aant or Project sponsor) 1. APPLICANT /UPGN3UR r I 2. PROJECT NAME PROJECT LOCATION: - MunlclpalnY CCUi11Y j �o'•� _ ___ _ 4 PRECISE LOCATION (Stfoat address and road Intarsactionll, 7 pr" ominarit iondmarks. sac.. o Idom p) -- 6. 1$ PROPOSED ACTION---_----- �------•------._. ._.____._-- --- --__._._..___,..� Expansion ❑ Modification /altersflon 6. DESCRIBE PROJECT BRIEFLY' ��v F ✓ : �� /<. / fin C �9 �/ LL �? yj/� 7. .AMOUNT OF LAND AFFECTED: initially __.._.._.._.._ ePrme' tJlllrntvfely -8. WII.J.. PROPOSED ACTION COMPLY WITH ExivING :LOWNU OR 01HER EXISTING LA14D USE RESTRICTIONS? Aye& No If No, describe brlafly 9. WHAT IS PFlc.5�ElVT LAND USE fN'VICiNITV OF P{ROJECT� usklent;al ❑ Industrlal L � Commarclal [ Agriculture L Psrh /FnrasbQpon space L� Olhsr 10. DOES'AC710N INVOLVE A PERMIT APPROVAL, OR FUNL'4fgG, NOW OR ULTIMATELY F90X ANY OYHER GOVERNMENTAL AGENCY IFF:DERAL., STATE OR LOCALj7�r•-� gvos ` 0 No It yen, Ili1 ePamoy(ID) and pa+1mlUappr0vtl3 l�Cr 5ey 11. DOE6 ANY A����S,P(ECT OF� THE ACTION HAVE A CURRENTLY VALID PEAt/.r1T OR APPROVA' ' Yes Ik'SLNo it yns, flee apm ey name and ptrmWapproval 12 AS A RESULT Or PROPOSED ACTION WILL EXISTING PERMITIAPPAOVAL REQUIRE MODIFICATION' _ —ED Yes - `? Na t CERTIFY THAT THE INFORMATION PROVIE)FD ABOVE IS 'TiffE TO 1HE iW'EVY OF W KNOW LEME Appllcan6'sponaor name' - - -- h the action Is In the erol�s�tmY Area, ar�s3 you x>ttxte eq�tvcgo a~,ocraptato ttao CouRtal Asseummonl berm before proceeding with thdv eslu S IMOnt I PART li - IMPACT `ASSESgMENT (To be combleted by Lead Aaencvl A. DOES ACTION XCEED ANY TYPE-1 THRESHOLD IN 6 NYCRR, PART 617.4? �'.If yes, coordinate the review process and use the FULL EAF. Yes UU No B. WILL ACTIO WREC EIVE COORDINATED REVIEW AS, PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6 ?. If No, a negative' declaration may a superseded by another involved agency. Yes VJ No C. COULD ACTT N RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or- quantity, noise levels, existing"traffic pattern, 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 comnlLirtity or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, or wildlife species, significant habitats, or threatened or endarigered species? Explain briefly: . %shellfish 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 briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed'act'ion? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? .Explain briefly D. WILL THE.PROJECT,.•HAVE AN.IMPACT•OkTHE ENVIRONMENTAL CHARACTERISTICS THAT - CAUSED_ THE -ESTABLISHMENT -OF A CRITICAL ENViRONiENT^ AREA° CEA ? If es; ex lain briefly. Yes o E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS ?. If yes ex 'lain: El Yes No 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. If question d of part i'i was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of theCEA. Check this box if you have identified one ormore potentially large or significant adverse irnpacis which MAY occur. Then proceed directly to the. FULL EAF and /or prepare a positive declaration: Check this box if you have determined, based on the Information and analysis above and any'supporting documentation, that the proposed actin WILL NOT result in an gg4niflcat adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency ��— Date e, sr C- rint or Ty 1b Namp of Responsible Officer in Lead Agen Title of Responsible Officer Sig a ur of Resp Bible Officer in Lead Agency Signature of Preparer (If different from responsible officer) NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems Last Name First M.L Name of Applicant C.c�UC LI i- No�j Street CitylTown State Zp . Address BUX No. Street city/Town Stale Zip Site-Location 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): eparation distance cannot be achieved. `' _ Excessive slope. EJ High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. ;__I Other (explain) ... .......... ...................... :..................................................................................................................................................................... i .................................................................................................:..................................................................................................... ............................... 2. Proposed design or conditions of waiver LAP .................. ........... .........I..................... ........��..............., / N kf%c?. ........... D11 'l...... ... ......................................•-----......................-•----........ .........................._.... ................................................................................................................................................................................................................ ............................... ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ 3. The proposed design may have the following limitations (check appropriate box(es)): r1 Increased risk of well or spring contamination. Increased risk of surface water contamination.- Expected design life of the system will be diminished. i Operation of sewage system is subject to mechanical problems. Other(explain) .................................................................................................................................................... ............................... .. _...... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by t"suing official fora change in conditions for which this waiver was granted. ivE'b'coMi�iissioriEia of HEiuri� " " "' " " " " " " "" ORIGINAL - Local Health Agency Z COPY - Applicant/Design Professional ........................................................... ............................... , BRUCE R FOLEY Public.--.. lalth Director_ .. , -, . , „ _ - LORETTA MOLINARI -R.N., M.S.N. Associate -Public rHealth Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 218 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER /I NAME: ADDRESS SITE LOCATION: DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: o? uae . DOES....THE PROPOSED VARIANCE. REQUEST- POSE, A HEALTH HAZARD :OR A- ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION- REQUEST APPROVAL OR DENIED APPROVED DENIED REASON FOR DENIAL DATE: ( �-- DIRECT R OF P LIC HEALTH (SPECWAIVER) ...- ,�. •.er -� <+*.:�;.r,.a -.- e. �� •. z� 'mss-- �,;a -o:�- �io+I:.':'4': -, �� =.y , .`. �-. -:i•�ae�v: : �. - - - � m`.:'- aw..- :.;e -, ..: aT.�..+ ti+' »;1 a. �� =o :ro'.r � ..i S All, -160 4s N. lynx �f a BRUCE R. FOLEY - : Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA . MOLINARI R.N., M.S.N.._ "{ Associate Public Health' Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Brian Murphy 92 Hewitt Street Lake Peekskill NY 10537 Dear Mr. Murphy: June 7, 2002 Re: Proposed Septic: Catucci Hewitt Street, Lot # 28 -36 (T) Putnam Valley, TM# 83.75 -1 -46, 47 As you are aware, a proposal exists to develop the vacant lot TM# 83.75 -1 -46, 47 owned by Bill Catucci. This Department is concerned that your septic system be located accurately on the plans for this proposal. Enclosed, please find a copy of the latest submission for this project.: Kindly-- contact.me so that -we : - `can discuss your. septic location. If possible, I will meet with you on site to verify the location. I can be reached at (845) 278 -6130 x 2159. Thank you for your help in this matter. SR:tn enc. Sincerely, JAIV Shawn Rogan Public Health Technician ......... . . . . . . . . . J77" 6 4 BRUCE R. F_OLEY 3ireCMr. a -- ,..__ ::,; .:.. • , LORETTA MOLINARI .- • .,..., -., .,.::;• : s'soC,a e !� �alth'•'6irector` " Director of Patient Services DEPARTMENT OF ]HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 March 19, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 2 Fernereist Drive Yorktown Heights, New York 10598 Re: Application to Construct a Subsurface Sewage Treatment System on Hewitt Street (T) Putnam Valley, TM# 83.75 -1 -46, 47 Dear Mr. Sullivan: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on March 18, 2002 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Completed form PC -97 and Short Environmental Assessment Form. • Enclosed please find the check for $350.00 submitted with your application. Please submit a, certified check or money order inlbe correct .amount of $300.00. The review of your application will commence once the Department receives the requested information and determines that the application is complete. Should you have any questions or care to discuss this matter further, please contact me at (845)- 278 -6130 extension 2159. SR:cj Sincerely, Shawn Rogan Public Health Tec cian �o �D PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'APPLICATION FOR APPROVAL OF- PL STOk" A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: 4. Design Professional: .,-f_ _�y//// I-'arJ 6. Drainage Basin: Z "'k- 7. Type of .Project: Private/Residential Apartments Office Building 3. Location TN: %I mod"" 1411lx- y 5. Address: �'��i•�c�?� �r, Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II . Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... iV d 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency _ 42:- Is- this„proiect in an =area under the control of-local _ plannir�g;xognptler.:::: officials, ordinances? ................................................ ............................... c -� 13. If so, have plans been submitted to such authorities? :............. 14. Has preliminary approval been granted by such authorities? Date granted: -- 15. Type of Sewage Treatment System Discharge ................. surface water v/ groundwater 16. If surface water discharge, what is the stream class designation? ..........:......... 17. Waters index number (surface) ................................:.......... ........:...................... 18. Is project located near a public water supply system? ....... ............................... i✓a 19. If yes, name of water supply Distance to water supply ? h e__ 20. Is project site near a public sewage collection or treatment system? ................ /V1; 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) �D .......:......................... ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?. .-. sV'� 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? Wei 28. Wetlands ID Number ...... - .- „ ".'.-:...0 •rte.., .:... ... . 29. Is Wetlands Permit required? /✓� Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfillin sludge application or industrial active Yes/No ✓i��' 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination. Yes/No�`� DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... vt/e 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............................... )VS 35. Are any sewage treatment areas in excess of 1`5% slope? . ............................... ✓✓� 36. Tax Map ID Number .......................... ............................... Map 3•% Block i Lot 44.47 37. Approved plans are to be returned to ..... Applicant k' Design Professional NOTE:.AII pgplie &t ia ci fo %review ai d'approval'ofa riew SSTS-to be located viYHinte�C Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as storrriwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). 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: 0 Cn Mail d e less :.... ............................... ng n asx of CATLJCCI CONSTRUCTION P.O. BOX 453 SHRUB OAK, NY 10588 PAY CHECK NO. TO THE -ORDER OF THE MAHOPAC NATIO MAHOPAC, N.Y. Lu 11400 199411° 1:0219113981: I I DATE I INVOICE I AMOUNT I CATUCCI 0 50-1139 219 -� �_/ 0 1994 YUCTION CORP. %I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO\N,IE\-TAL HEALTH L- OWIDUALWATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEbIS :�,•.., , _.RE,YIEiv.S$EE� F.Q CCQNSLRU.C`IIOt.'�pEi�1IT , 'P a .:: NA M OF ONVER: t STREET LOCATION: - % N / CP'1 S J "c•x!'i REVI"YED BY: R.,%L OR, AS, &ATE: ` D TAX MAP#: I �LN DOCUNME\ ?S zUPER.ti1LT APPLICATioN, ,J ELLPEPUNUT ORPWS LETTER UPC -97 ,oe-)L)LETTER OF AUTHORIZATION UUDESIf,N DATA SHEET (DDS) (OMP,kTE RESOLUTION US80R? E_AF (e!5UPLklS -TMf. SETS (ZJUfiOl$E pLA \S -TWO SETS U(,AVAliLANCE REQUEST SUBDIVISION [y'a �J( LEGLL SUBDIVISION (_.)(__,)SUW VLSION APPROVAL CHECKED UU' pERc RATE U(t=jFM,REQUIRED, DEPTH UL-=)eljjFALti DR.AJN REQUIRED G N-E UI "ATE Zr h D U(�PLiNS TED TO DEP , U(_)D GATED TO. -- DV APPROVAL, IF REQ' C HOLES OBSERVED PEtCS TO BE WTI'\TSSED U�r- �jPr�.PPROVAL SSDS ADJ, LOTS U(-,=)-�rV,TLAt,rDS (IOWN/DECPERbIlT REQ'D ?)- D;TA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION L-X i T7ERBUZEA t.�6` -TLOOD ELEVAATONN W/I -200' UCH MTESTLYG LOTS >10 YEARS OLD gQUTRED DETAILS ON PLANS �,5WAGE SYSTEM PLAN - (NORTH ARROW) ( C____�SDS HYDRAULIC PROFILE ��,,RAvrIY Flow TION NOTES 1 -15 .TA: PERC & DEEP RESULTS COYTOURS.EXLSTJNG & PROPOSED RNEWAY & SLOPES, CUT 00nN, G /GUTTER/CURTAINDRAINS fSDA SOIL TYPE BOUNDARIES TILE BLOCK; OWNERS NAME ADDRESS s u Y IN ( REOUIRED DETAILS Oi (PLANS COi JT'Dl HOUSE SEWER. V," FT. 4 "0'; TYPE PIPE CAST IRON L )N 0 BENDS; NLAX BENDS 45° WICLEANOUT RENEWALS (_-)USFIEQE (NO CHANGE) ( FILL SYSTEMS UL-)10' HORIZO?ITALLIAST TRENCH SLOPES 3:1 TO GRADE UUFILL SPECS N TES +--S aZ ^Y L)L)FILL PROFI �tST�YS LJUFILL L`i E SION AREA FILL GREATER TA9 ` 2 FEET UU CLAY B. R /l1� {4a UUFILL CE FIF ION NOTE ©� �^S� ti-v i (__)(__)DEPTH L )VOL.ON RR O.B.,UNCLASSUUD &IMPERVIOUS -)SEPARA TANCE FROM TOE OF SLOPE TRExfm TRENCH PROVIDED blkg 60FT NL4X. /L�JPAR4LLELTO CONTOURS 100% EXPANSION PROVIDED: UDETAIUDUST FREE CRUSHED STONE OR WASHED GRAVEL �,GEOTEXTILE COVER SEPARATIOi i DIS'TANCES ON PLAN - FROM SSTS (,(__)10' TO P.L. DRNEWAY, LARGE TREES, TOP OF FILL ;(f:5C_)20' TO FOUNDATION WALLS 00 TOLIs 200' 1`I DLOD,150' TO PIT S �0' T TR AlY2, WATERCOURSE, LAKE (mc. e=pan) a0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER .10' TO �IA'T- EP.ZdNE ¢�2A') •..o v.: , r .....� ... K .. ._ ., .. �.. w _ .. _. v L}50' LYTERMITTENT DRAINAGE COURSE •x(__)200' 1500' RESERVOD2, ETC. 150' GALLEY SYSTEMS J,=Z)U10' vMN TO LEDGE OUTCROP SEPTIC TANK X10' FROM FOUNDATION; 50' TO WELL WELL .DULVIENSIONS TO PROPERTY LINES -- ---- CAT ION OF SERVICE CONNECTION ,L5C�)MIN 15' TO PROPERTY LINE SLOPE SLOPE IAN SSTS AREA (520 %) (__)DED TO 15 %, IF REQUIRED DOSEIPU14P SYSTEMS ��------1,, PE/RA; NAb1E, ADDRESS, PHONEr. U(__)PUbIP NOTE �1ATE OF DRAWII`iG/REi�ISiON UUDOSE 75% OF V LUME/DOSE VOLUbIE NOTED -M REFERENCE (__)L,DETAIL FOR F MAIN, (PIPE TYPE, ETC.) __. CKT CATION OF WATERCOURSES, PONDS UUPIT AND D -B SHOWN & DETAILED :AKES,WETLANDS WITHIN 200' OF P.L. UUl DAY STO GE ABOVE ALARM ,_-_ ?ROPOSED FMi lIFLOORAND TATN DRATN BASEbEEN'r ELEVATIONS ( -� �- U(�STANDPIP ;,51B SIDES, DETAIL -= ._ .LLS�8s4SSDS S<WIIl'1209 OF S UU15 MRN to S- /0 014%,251-3%,35'4%, 100 /o-4 % r o 0 0 (PROPERTY hIETES & BOiINDS UU20' MIN to GV100' with 182 cons day discharge �SI� U(_)10' bi11Y to N - PERFORATED PIPE *44 PUTNAM, COUNTY DEPARTMENT OF HEALTH 1 1V ISI '0 ) 'N OF ]EN -VIRONMENTAL HEALTH SERVICES -A)USIGN- ATA SHEET - SUBSUIUACE SEWAGE TREATMENT SYSTEM Owner L ig I-' e Addressv U /'v/ Located at street —TaxMap,�53,Z—Block (indicate nearest Cross street) Municipality /10 0"__v Watershed 80.11, PERCOLATION TEST DATA Date ol"Flre- -soaking Date of Percolation Test v -1 1 ests to be repeated at saine depth until approximately equal percolation rates are obtained at 0011 percolation test hole, -(i.e. s I min for 1-30 minhuh, 5 2 min for 31-60 min/inch) All dAU to be submitted for review. Depth measurements to be made from top of hole, Form DD-97 -77-77. Depth 'to .Ater. Wow r om V rou tip::: T' e Ime Surface (In' Start stop... ro U., Dr 2 3 3v ?w 4 5 /K -5 3/9- 2-Z 3 41- -Ole 4 5 2 co 3 5' v -1 1 ests to be repeated at saine depth until approximately equal percolation rates are obtained at 0011 percolation test hole, -(i.e. s I min for 1-30 minhuh, 5 2 min for 31-60 min/inch) All dAU to be submitted for review. Depth measurements to be made from top of hole, Form DD-97 5.01 .5' i.0 8.01 8.51 9;0' jr ......... .. - go is Which in, r I observ(� d in i claw, D- ------- k J, Date N Addtc gigria �j D csigli ',I OF s0f, 2 Q U f I RhD INTEST HOLES D'L-'Ij T HOLE I'll C V V.1, HOLE NO. G.L. 1.01 - -------- - 2.01 2.51 3.0 4.01 4.51 5.01 .5' i.0 8.01 8.51 9;0' jr ......... .. - go is Which in, r I observ(� d in i claw, D- ------- k J, Date N Addtc gigria �j D csigli 3a(( PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM ONNmer. Address Located at (Street) i ' �° S' Tax Map33, �r Block 1 Lot ; y (indicate nearest cr ss reet) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date, of Pre - soaking -5—A ©°t i �/�� Date of Percolation Test S a�Jt Hole No. Run No. Time Start - Stop Ela se Time (PMin.) De th to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinAnch A .. ..�i7 � a Y4 2 103- 1113 v as -121 yY - I 3 13 -11Y3 Y da -ar3/ 4 5 2 - 3 i�16 --irYG a 0 - za _ 4 5 1 , 2 3 4 5 - NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootamea at eacn percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Indicate level at which groundwater is encountered VIA '� Indicate level at which mottling is observed Indicate level to which water level rises after being encountered N Deep hole observations made by: )twb Date 5��� ZS d, Design Professional Name: Address: Signature: Design Professional's Seal `I acknowledge receip.`t'of this report. SFGNAT -I1RE :•_QZ%96 Title._ Ow ;Shee t f * PUTNAM COUNTY DEPARTMENT OF HEALTH I3IV SIQ1� OF FlM *�'�eIC�3i°r i� - i AE RE T L$I SERVjCES, FIELD ACTIVITY REPORT i PDR•ES Street:. _ _ Town State Zip - PERSON IN CHARGE =Naive avid TWe = - 'TYPE OF FACILITY; - - .. u " FINDINGS.... y .3 M Y Y v r SPRCTORi Sign tune and Title - .al9.F-.`Tl/1T)T 71 "T7 /'�T'.•T <TRTI—D S7.�'. _`_ ,. .. ,. ..,: _ . -. 4 .: .: _.. - -` -; .. ,.:: ;... .: <- `I acknowledge receip.`t'of this report. SFGNAT -I1RE :•_QZ%96 Title._ PU rJfl. Nth. ,, COUNTY DEPARTMENT OF HEALTH IVIS ON OF EN "R.ONMENTAL :HEALTH. 'SE VICES DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM 0wtler _..___y1L19 G4 �� Gc' _ Address Located at (:street) Tax Map y6 _ Block � Lot � 7 (indicate nearest cross street) uciicipality _p '�'i1 � �l s� y T_ Watershed �- `` SOIL PERCOLATION TEST DATA i Date o% l rc, suaking Date of Percolation Test � liercolatiod,test hole, .0.e, s l min for 1 -30 mWinch, s 2 min for 31 -60 min/ineh) ;All dau to be su(�rifitted.for review ...............:._..........._ . ..:.. ,....._. � . [)epth measurements to be made from top of hole, Form DD - +97 Depth to WdtRr*r r ?; From Growth 1����1 olEs flu. iZuu ito..'::':�t U J(il #tot. J1:,la se Time (i11'1in.) Surface (Xncbeo�!`•,' Start tap :r % rt. 2 ?d sr1 vZ- Z 4 �— __�.._..__ 1 •.. is ',�'� : - � 2 - ?� . ' 41 2-3— 4 i s 2 3 4. 'Fgists to be repeated at same depth witil.ar mroxi'mateiu.euual.percolation rates are obtained at..aa liercolatiod,test hole, .0.e, s l min for 1 -30 mWinch, s 2 min for 31 -60 min/ineh) ;All dau to be su(�rifitted.for review ...............:._..........._ . ..:.. ,....._. � . [)epth measurements to be made from top of hole, Form DD - +97 TEST PIT DATA 2 DESCIUP14ON OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. O. HOLE N .(22 HOLENO. 1� G.L. 7— 0.5' 1.01 1.5 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 15 .5' .5' 0", 7.5 8.0 8.5' 9.01 fd.iof Indicate level at which groundwater is encountered Indicate level at which mottling - is observed il'; iicr,lte -level to -which water level rises aft-ei being encountered Deep hole observ'tioils made by: �5rll'111";q Date ,Design Professional Name: 2 _7TC Design 'professional's Seat BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 April 4, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Fernerest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: Proposed SSTS - Catucci, Hewitt Street (T) Putnam Valley, TM# 83.75-1-46,47 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Although the above referenced lot is part of the Lake Peekskill subdivision, approved in 1929, there is no previous documented soil test data (i.e. subdivision field map or approved- cAnstactiori.e��init):: Therefore . +.re soil testing moratoriurri of December 7'- - 2001 affects this lot. You will be contacted by this office once the suspension of soil testing has been lifted at which time we can schedule soil testing as needed. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, g4e, 'f � Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES . LETTER OF AUTHORIZATION RE.: Property of P/V `li eJ w <iu Iii Cc i Located at T/V 41!' aW / e"ll, Tax Map # 83 73 Block / Lot Subdivision of 14A1l� 14e-44sri Subdivision Lot # 2 "'3t� Filed Map # Date Filed S z2 z Gentlemen: This letter is to authorize �3 a duly licensed Professional Engineer _k,-" or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity: with -the provisions of Article 445- and/or -147.. of the c ucation Law the, Public - Law, and the Putnam County Sanitary Code. Countersigned: P.E., lam', # y F9:. Mailing Address; ,• "off State Very truly yours, Signed: (Owner of Property) Mailing Address: /- �• 7�-3 State Zip_L_0 ?y Telephone: % 'rl" Z 1-/ 11 y Telephone: / / � 3 %0-r�) Form LA -97 �\ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAY.a HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREAT PERMIT # Located at Village A7"" 4//, Subdivision name Subd. Lot # ,�.?-Jd Tax MapBj, 75 Block Lot �7 Date Subdivision Approved b y z Renewal Revision Owner /Applicant Name any e of r vious Approval Mailing Address ex 3k5 6 r " ©'/ /Y' Zip ®S ~� Amount of Fee Enclosed / . l Building Type��f i�er� Lo Area No. o o s 2 Design Flow GPD o d Fill Section Separate Sewerage S, stein to consist of -7.,%, Other Requirements: To be constructed by 4 w/� r1011- _ ..._....:. _..Water Supply:. Public Supply - From _ or: Y Private Supply Drilled by I represent that I am wholly and completely separate sewage treatment system described accordance with the standards, rules and re thereof a "Certificate of Construction Co Department, and a written guarantee wil e builder will place in good operating co iti( immediately following the date of the 'ssuanc system or any repairs thereto. Signed: g44e.& Diu Address v /.1' ara�rJ Volume ®� gallon septic tank and 2-67e 4 Oar Address 3 a,077 e Address .�rd Address- / /✓ -e onsible for the design an location of the proposed system(s) and that the ve will be constructed as sho on the approved amendment thereto and in lations of the Putnam County D artment of Health, and that on completion )fiance" satisfactory to the Publi Health Director will be submitted to the furnished the owner, his successors, eirs or assigns by the builder, that said i any part of said sewage treatment s tem during the period of two (2) years of the approval of the Certificate of Co struction Compliance of the original ate, {D R.A. Date 3 4., )w License # APPROVED F ®NSTISiJCTI ®lei: Thi'pprova'l�ex(�t�/tr� Ayers from the date issued unless construction of the v.,,; . -� ,,..d sewage treatment system has been completed and mspectedty,.&: --P—db 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. Approved for discharge of domestic sanitary sewage only. Title: Date: copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT-,,-_ - Well Location Street Address: Town/Village: Lake Peekskill I Tax Grid # 83.75 -1 -46&47 Map .Block Lot(s) Well Owner: Name: Address: Catucci Construction, P. 0. Box 453, Shrub Oak, NY 10588 Use of Well: 1- primary 2- secondary x Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details UKC 4* to 100, Total length 52 ft. Length below grade 5j_ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X 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 g Pumped X Compressed Air Hours _fL_ Yield _ gpm Depth Data Measure from land surface - static (specify ft) 301 During yield test(ft) 1601 Depth of completed well in feet 225' Well Log If more detailed information d escriptions or sieve analyses" are available, please attach. Depth From Surface Well Diameter(in) Formation Description ft. ft. Land Surface 35 in over urden cla and boulders 5Drillin at 35' 35 52 ' 'in rock set casri ou ted 5 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity - Depth 180, Model 70905412 Voltage 230 HP 1/2 Tank Type WX250 Volume 44 Gallons Date Well Completed 6/2/03 Putnam County Certification No. 001 Date of Report 8/25/03 Well D! Per (si e) NOTE: Exact location of well with aistances to at tease two permanent tanttmarxs w or Prvviucu U11 a 5cPa1a10 „1VUL/P.a..- Well Driller's N P F. Beal & Sons Inc. Address: 4 Putnam Av�simi, Buster, NY 10509 Signature: Date: 8/25M Q risb#nr Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fnrm WG97 e ,� 7d q e 0' f•'. Al .57 Lo f 6 D loi p,. S G•C a E3 L 1 a Vi Id PA No fill, )IF 3 F. ' v�e•c ;83 psi. �, . �:.�� 31 r3.t 1 .. C I' {�! G.�'�`'�'/r!"7� .<. �o :►�Ma+' %�,.'► 1M� �'`%•i - � o�,*1q ��+G "i;G PSGo /G o r<. $ed43.7d Se c Sd g,-74 3.'t I J3L 2 � �1., 2 E3L, 2 _ $ a¢ -jig ',•;. W Lot 15�� I.r ♦ve /1.1 eroraii.9, 1 ?ipsc`�4. t OOPS►/ � j � II LANli :ErX/1t ti�g Ss Ts E"tt•r3�i:?� S .S.Ts Awl a s 7"j e ,� 7d q e 0' f•'. Al .57 Lo f 6 D loi p,. S G•C a E3 L 1 a Vi Id PA No fill, )IF 3 F. ' v�e•c ;83 psi. �, . �:.�� 31 r3.t 1 .. C I' {�! G.�'�`'�'/r!"7� .<. �o :►�Ma+' %�,.'► 1M� �'`%•i - � o�,*1q ��+G "i;G w n L .. - tN .. ' coKyR IOOW A +i�0 h_ 7 ./ ...� 1, 6 •' d• .� � -•�;.Y _ 1`.�cntllit r )1;2.,7 iii -fo / s'�Y <"r..r.` �. r -.r a ,w ... *a 4 �, x� x �+ 3 -� .3z.. ,�. yit w ro. ax"`y- •'wtr` "`v sy ss' � � �. , . *. ) ti.;::r � KC7t E�.. .��.'- '.s�.��"�•',t -fafe — ,- ,- t.+... fir. �- ,4., —u�s ,���i� tT a 3�� .a9 ': k x. py,v *::� t�-, :•«. �, a .� '�p"..R :4 Est �r r' �-�4 `'" x "r�"'",5"' '��,�"'�F+* y� �-�+- �'& �'i f9 —acrd �v � UNAUTNORI2ED "ALTERATIONS OR ADOMONS TO THIS DRAWINGS IS A ML—ATtM OF SECTION 7209 (2) OF i%1.Y.5. £nIJCATIDN u+w A l b r r y h4 {�r ss flea a J .� T J p`3 G ` �'�Q -�F• `a ,,(f�9� ��m �04 , - 1E�Q✓". %�4rO b+, ��v y.Ia'N,J�'�A�« �°"�'!"�:z'�/Lq r �c r I �o-x1 _'r► 7110 W R �'EV` n,'< r«. s, _ a 3 : `v` ''. . . 75 -.,,> .� `J #.7 �� �.. 3 �N s 'M � w. ��G•';' CX I �yy l �,�7T l7,`� ,IOM �/ - -" e►'�,Prw��a�•� 35i5 �,,g,.a�c ,y�i'; �.i��,��.v`.�,, �,f5� Cr, C C'1+4rf t-� u► ; / /!- s�a►r. e r ��p F by.,xpe:ed /Ja vrh S3arn?!c iorpiv r ®� 4 ir,C IP/'opa zAy Aaai'I'�� 4f.3 ?9-3d J, CIO-