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HomeMy WebLinkAbout4372DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -26 BOX 33 I -m :4... r rw 1 I 161 Milo; 1 ON 04372 $ 11TlhlAllt ICOU 'Y DMP"MM OP Mane DNlalB?""°�t Be�Mh Sae•loee. � N.Y.1lSU Ba�Ylarr.to Pewfd• I4•�It �-•� r - _ • :�. amC OF i50A18il�)C N , t FOR UWAM DMOS" nw M ret�+t red.d.e. Foothill, Street. 1^n .aral Tntan �f PI i sr,hab�aia. w., David M. - Schwartz c.ihd.1a 3 T= ME 84 2 , 26 David M. Schwartz .. . R•! a Masai e a Date of Pwyke,.Approvad . 330W ,45th St.' Apt Lobby E Tows . NY ' NY ...10036 4atg Subdivision Approved `7 =6-89 FM _U4 -4 Fee Enclosed Amri;,n:t- $300. . TnM . Rtzsi'elpnt i a T Lot Area .l _ RS AC F®Sectlon Depth Valdes Nokar of i A.­ : De. so Flow .G' P D 800.. YCHD Notlecatim 1.1ta4*ar! -rubes PID Is olmpbuli 1 250 .�.t 444 _LF. of 24'.. wide absorption trench SIIe le s.Vwild. Si.a. b 6Mik et Gtioe. s.ptle reek. . Te bs o.e,4aaa 6s TO Be Determined ;�. witac Stipp¢t Prblic Sepjlb Ptr., ;Adrhas on_ X ptfiiebe - Dt®ed To Re hptar ^^a.. M- �pP�1 hi' Ot`e. Regadaea•a�ta 1:r prat nt tha 1 am; wholly antl,'compNt�ly nsponsiblefor the d•tigga, bution ol. tna p►opoi r! sya.m(U 1) that fn•.separate; sew` •ai ssl a item sbo,ii.daseiibad will.btt eonstruct�d a shown on tM approw0'am•ndmtr,t there to and io aceordinp with tAt standard; rules ana rQuIallons o a County aeowtment o1 tM•RN; Snd that,on Cornpwwn thereof a ,;eojifkata of Cogitruttion Compliinctt".'wtlsfaetory.to M• Commissioner of Mealthwill be submitted to.:thia D partniwet, ihd a wrlttM;,pNrantN will M- fumisMO,tM ownM, his sicassor `h lisoi an,4*s by th %buiah;tlat said builder will f y ` ( ing the data of the Issue anee of the approval of the Cdtifieat• of Construction Compllanc• of lth• o►iyinal ;yit•m or any r•peNf to"o• 2) that, the dNINO "I described -bow suet. aA good. op•ratinj condRlon any' part o/ said alnraa• disporil system aurirq tM pabd of two 2t yMr :Immadletaty follow wN1_ b.l0eat•Otls shown on tM a0prowd plan and that said well will M Installed ;In ccor p h tM staneards, rules and rpu i�of the Putnam County O.aPart!r,snt.ol;Nwlth oat. 4/18/95. S�n� ` . P.E. X RA. _ Aau:,si iBADEY : & WATSON License No 62505 APPROVED FOR CONSTRUCTION This approval_ expires two y m the date IssuM unlasf, eonstrua!on of the buiaino has beer, undertaken and is •s• a . ..,... tevocabl• la us• or y Ooamondod or•modifi o wnareconatl n" ry` by tha ssloner of HMIfA,' Any Chan" Or Alteration of construction repulses a M pw�it - A�ror•d to► difpowl of dom•stk' n -y� ,and�or" w' .► Wpp1Y. Only. J % / / //((� pits 11. ' Title i 0 f \'L PUTNAM COUNTY DEPARTMENT OF HEALTH _ . -� _ _ _. DIVISION_ OE_ENVIRONMENTAL..HEALTH SERVICES _ .- .. :..:A:: =.a , _ "...^F''"� . � . - .. .. '.q. � eJ:. +.r. �i'qi p:9Ye'L� ..'s'.. �. -'_; cy' =i.s .�.= .. : =Y.:7� � _ �:,c; :5.. ri..�+ �. ..r � .9.. �•1 ::..ai: =�. �ni a :tr. ♦�. -.� •�. u... CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PJ �° 9 %-o?a %�' Located at 0 �o o� hF I LL QTR -fr Town or Village Owner /Applicant Name Formerly P, E -W , C:b NSTFa► f�l'iot -� PAN 10 VA, 5u4WArRr2- Tax Map &4 Subdivision Name Block 2 Lot 2"a 5GNWA1%-T?, Subd. Lot # ?j Mailing Address Po 9 oX 4 U F�e lit S Er PArr6R6# H, N i Zip l E GG Date Construction Permit Issued by PCHD Separate Sewerage System built by 21 qQ� AE.w• Address F0 &Y- �& FAMP� JH My 11,q� Consisting of Gallon Septic Tank and +44 L-F AB5 T -si y-,H (,TiP) Other Requirements: Water Supply: Public Supply From, Address or: Private Supply Drilled by M��T °N I-jYTr Address lcl� �j1 ����t'� Building Type Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? N0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 11W 1 Certified by L' 1 �A , ; L�t1) : P.E. "X' R.A. Address 1-0 m l LLT-OwiA Ro f(V B 10401 License # 6 G 11,4- Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to,modification ' or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: Y Title: Date: 717,8 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 �lfLocatn ... c29I:Qet"tl�drf°J9.' r cs cd< m -1;. v. /9 Fa % rQwlf/'V tl(ag�' i ea di l/F.' `abij o- is co< m Map Block Lot(s) 2(p Well Owner: Name: Address: A)'n ara e� Use of Well: I- primary 2-secondary Residential Pub& Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock _ Other Casing Details Total length ��ft. Length below grade ft. Diameter 7 in. Weight per foot J�Ib /ft. Materials: -A Steel _ Plastic _ Other Joints: _ Welded _X Threaded Other Seal: Y Cement grout _ Bentonite Other Drive shoe: —Y 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 _x Compressed Air Hours _ Yield _r gpm Depth Data Measure from land surface - static (ssppeciffy+ ft) During pyield �test(ft) Depth of completed well in feet Z_ 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 ,27 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information a816 Pump Type ull Capacity,—IC.TM Depth W Model Voltage IZO HP 3 Tank Type Volume IT Date Well Completed 1 1- Putnam County Certification No. Date of Report Well Driller (signature) . NO'd'lE V'Exaqf, location of well with distances to at least two permanent Jhn4arks to be provided on a separate eet/plan. Well Driller's Name / %�cay2 Signature: Ott' . U Address: /d/Sr Rte , 31/ Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street ..,. �;��--= •�Y'cy'r�k'•t�wn H��:• ��htsd ' ~��'VY.°��`1�0598'�-r,c� ,.'�s.. ...:_:,;s; -, -... "<:r�;; . _ !. ( 914) 245--2800 Albert H. Padova ni, Director LAB #: 32.903963 CLIENT #: 3692 NON STAT PROC PAGE 1 DEW CON5T. INC. DATE /TIME TAKEN: 07/13/99 01:OOP PO BOX 420 DATE /TIME REC'D: 07/13/99 01:40P PATTERSON, NY 12531 REPORT DATE. 07/21/99 PHONE.' (914)-878-2015 SAMPLING SITE: 10 FOOTHILL ST. PUTNAM VALLEY, NY COL "D BY: WILLIAM FINNEY NOTES...: KIT TAP DATE FLAG PROCEDURE SAMPLE. TYPE..: POTABLE PRESERVATIVES. NONE TEMPERATURE..: < 4C COLIFORM METH: MF RESULT NORMAL. -- RANGE METHOD PUTNAM CNTY PROFILE' 07/13/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/13/99 LEAD (IMS) I <1 ppb 0 -15 ppb 9101. 07/13/99 NITRATE NITROG <0.2 MG /L 0 - 10 9139 07/13/99 NITRITE. NITROG <0.01 MG /L N/A 9146 07/13/99 IRON (Fe) <0.060 IVIG /L 0-0.3 mg/ l 2037 07/13/99 MANGANESE (Mn) <0.01 MG /L 0-0.3 mg /l 2037 07/13/99 SODIUM (Na) 2.51 MG /L N/A 07/13/99 PH 7.8 UNITS 6.5-8.5 9043 07/13/99 HARDNESS,TOTAL 108 MG /L N/A : <..r.., ...._ 07/1 /9 ._: _; -ALf AL IN T•�' =(.FMS - ..:...._ - 146, :NGx/L-- 07/13/99 TURF IDI'l+l' ( fO' <1 NTU 0° 5 N --U COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (W911E WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ='b /Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment:. must- be potential. iblic 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 =e /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. ,la No limits for Sodium are Proscribed. Suggested guidelines state that for people, on •a sod'i6m :.restricted diet,the water should contain no more than 20 mg /L. of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /t_ of sodium is suggested. 0 YML NVVryIi ONM�'�- .',Ff,,t- 'a.... SERVICES j'. 4. .. -. a• w%.J'�.. • � :;i w:w? "�':.�' . ".,. ii tY 1.'PL T", SQL,. T k.. .. , .a.. pj;_:. y:r -'•�n� a."w "v::.3 ...,. .� �.. . +. .�i+; ice•. . Yorktown Heights, N.Y. 10598 ( 914) 245-2800 Albert. H. Paclovani , Director LAB #: 32 .903963 CLIENT #: 3692 DEW CONST. PO BOX 420 PATTERSON, INC . NY 12531 SAMPLING SITE: 10 FOOTHILL ST. PUTNAM VALLEY, NY COLD BY: WILLIAM FINNEY NOTES...: KIT TAP DATE FLAG PROCEDURE NON STAT PROC PAGE 2 DATE /TIME TAKEN: 07/13/99 0:1 :OOP DATE /TIME REC'D: 07/13/99 01 :40P REPORT DATE: 07/21/99 PHONE" (914)--878-2015 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF 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 15 6.5 TO 8.5. 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 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREA'rMENT TO WHICH THE WATER HAS BEEN SUBJECTED. _,5 ��WA� *-R. MODERATELY HARD WATER: 70- -140 MG /L MG /L = MILLIGRAM PER LITER HARE) WATER: 140-300 MG /L (1 grain/gallon = 17.2 MG /L) SUBMITTED BY, Albert , .. P a d o Illdn i , M . T . ( A S C P ) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :.: - GUARANTEE OF•SUB FA SURCE SEWAGE TREATMENT SYSTEM D'E•W . GOHSi(_0C r'1 0►-+, fNL. 84 Owner or Purchaser of Building A � .�, c,o 5�5 -fP-v vile K , I r� t- • . Buildin; Constructed by 10 F-6 crn4 la, Location - Street Tax Map 2 2L Block Lot fUTNOM '4PrL1_.EY TownNillage t�)C, N W AP-T� Subdivision Name 9 Building 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 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: Da . Month J U D Signati Title: General C acto ner) - Signature p E�bJ� C,0�45TF- U,c.TIOH j 1HL" Corporation Name (if corporation) pleow• IH" Corporation Name (if corporation) Address: ��� 42� Ir�la� SY ET Address: PO bflyL State pP� 4 M • I'�- a�j Zip State ?WOLI" N N� Zip 0_56 � p Form GS -97 HARRY W. NICHOLS JR., P.E. July 22, 1999 �� \ " LAURENT ENGINEERING ASSOCIATES, P.C. -.20 Milltown Road 9'reiWiW-New 6ik10509" (914)278-6108 - (FAX) 278-2658 CONSULTING SHE ENGINEERS W Adam Steibeling . Putnam County Health Department I Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance D.E.W. Construction' Foothills Street Putnam Valley Dear Mr. Steibeling: Enclosed are the following: 1. Five (5) prints of Drawing S-3, "As-Built Plan," dated 7-22-99. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 7-22-99. 3. "Guarantee of Subsurface Sewage Disposal System," dated 7-22-.99. 4. Well Completion Report, dated 346-99. 5. Laboratory Report, dated 7-'21-99. A ' io Fee-inthe amount of $200,,00-payable ..to.Put.nam.Co!4nt y...Health...- Piz Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Olt-IJK Harry W. 'Nichols Jr., P.E. HWN:JM:his 99011 BRUCE -R. -FOLEY Public Health Director May 18, 1999 DEPARTMENT OF 1 Geneva Road Brewster, New York. LORETTA. MOLINARI RN., M.S.N. " Asioci'iw- P66lic"'j&Rth Di;ic:&r"'.' Director of Patient Services HEALTH 10509 Environmental Health (914) 278 -6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Harry Nichols Laurent Engineering Millbrook Office Centre Route 22 & Milltown Road Brewster, New York 10509 Re: Foothills Street (PV -6 -95) TM# 84 -2 -26, (T) PV Dear Mr. Nichols: A final inspection of the SSTS and Well was conducted on Friday, May 14, 1999 for the above referenced lot. IaE Prior to issuance of a Certificate of Construction compliance, the following items require attention and a subsequent additional inspection. 1= - Vizell easilig tai cut down fo a reasonable - height- above.grade.(finished). Mimftium ' height is 18 inches. Present height is 5' - 0" +. V.R oof and footing leader drains piping to be continued past area of the SSTS, as shown on approved plans. Additional erosion control measures (silt fence) must be installed below area of the SSTS. In Please contact this office upon completion of the above mentioned to schedule an additional field inspection. ABS:cj Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 1 q "Ihs'p-eCted Ovyner t�u�_ Sfr;�Wjton, OOT- Town Permit # 'Pb -(0 --ef 5- T&1 4 Subdivision Lot 9 - --------------- 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 IS' from STS area.......... e. 100' from water course/wetlands ..................................... II. Sewage System a. Septic tank size -1,000 ...... ....other ................ b. Septic tank installed level ............................................... c. 10' minimum from foundation :m ........................................ d. Distribtuion Box It outlets at same elevation-water tested ................. 2. Protected below frost ................................................. 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ...................... ............................... I . Length required _ _ Length instal _ 2. Distance to watercasured Ft.......... 3. Installed according to an .............. 4. Slope of trench accept�a b el/16-lik" ...... 5. 10 ft. from property line. 20 ft.- foundations .......... 6. Depth of trench <30 inche from surface.................. 7. Room allowed for expansi � n, I % ......... I ...... from .............. 8. Size f­�e 1/4 - I Y2" di e er cleart.....,1Z _p 9. 1 e- p of/kravel Jh trench I ,in p�pc .' _t­ ............. inim 44it0n(#'capped1-.-..� .......... .. ............................. g. PUMD or Dosed Systlems T_Size o Pump _EERFer ........................... 'e ow e.......\....... ...... 2. e 0 tank ...... I ................................... .... 3. Ov Al visual/a4o ..................... N ... ... . 4. Pump asily accessible, ... hoic t gr . 't gr -s 0 5. First bo bafflef., ................. ... 6. Cycle wi6 . e�s by H/D�estNpated w/cyc e .......... III. House/Building 4). a. House located per approved �plans`... ......... .............. b. Number of bedrooms, ........... ................. I ...... ....... . ...... IV. Well a. Well located as per approved plans ............ b.' Distance from STS area measured c. Casing 18" above grade .......................................... I . .... d. Surface drainage around well acceptable ........ V 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 Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .................................. i. Erosion control provided ................................................ C 0 Lil ME N T S 19Y, apm- 190 IIVIWMFWWWI.7w''��� N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - CONStT1lWfION PER 10R SEW JAE'tREATMtNT S°�STEM"` PERMIT # P \j -C -q5 Located at fboTw1 CST Subdivision name 5C4WArfZT-7_ Subd. Lot 3 Date Subdivision Approved 01 0( Owner /Applicant Name IRAN t D M. SGk� Mailing Address 75--�O- \A(e$T Ac;r-� ^�1 Town or Village PuTt� \IAL.I19�? Tax Map - — Block Z Lot 24--, Renewal _ X _ Revision Date of Previous Approval C)15 eis Zip lflU3( Amount of Fee Enclosed „ 00 Building Type gg!2 Cw_--N)nArt_ LotArea_jjqA 1,No. of Bedrooms Design Flow GPD� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I Z5C) gallon septic tank and A44 LF — 24 l6`lg k vac 111- eco{2'n coi\J 'T M9.004� 15P AT- G Q .L Other Requirements: To be constructed by S-rm\ lr I A_r5-r V__ Address PLrrlJ M�A \/&'1•t lri� . Water Sunn1v: Public Supply From Address ,., _....... ...Pit _ h9i: �z: ; A ddr ess -� �i81 -m- ALt,. . prdl I represent that'I ain.wholly and completely responsible for the design and location of the proposed system(s) and that the senar� ate sewage tre atments s em 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 placeiri 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 R.A. Date 0412-1 -ice 1. License # U505 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 p rmit. Approved f discharge of domestic sanitary sewage only. By: d ''C Title: —Dle. Oi PU NAM COUNTY DEPARTMENT OF HEALTH IlDRVESEO Y OF IEN VERONMENTAL HEALTH S]ERVECIES APPLICATION TO CONSTRUCT A WATER WELL _ _ . - ... r• •- piea F print or-typV� 7 Permit # � '- "' �'� 6e r. a r•. WeIR Location: Street Address: Town/Village Tax Grid # R-r �t.L VkXT WAI%i VA1AE~ Map &4 Block `2- Lot(s) 2G WelllOwne>r: Name: ppjrp G�Cktv�tP�LiZ_ Address: e � �I. �5- Si t� Use of WeIlll: � Residential Public Supply Air /Cond/Heat Pump Irrigation I- prinmairy Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 95 gpm # People Served _ Est. of Daily Usage (.ad gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling i New Supply (new dwelling) Deepen Existing Well Detailed Reason SLIP e- t ew r2usi Do,,� for IIDrrilllling Wefll Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ......:........................ Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision pArv' i p K, Lot No. _ Water Well Contractor: NCtt•( AAD`jX�,R- Sz�•D; i t�e-�- Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: N IA- Town/Village to /Ac Distance to property from nearest water main: 7 1 M t tj—:� Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: �...: Applicant Signature::. _ - ..- ,ass. 1- -,--= n . 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 1FOR 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. b Date of Issue Z 1 Permit Issuing Official: Date of Expiration i2 zo 00 Title: !7 c, r. O�- N4� �' E Permit is Non- T>ransffetr>rabR White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 i 1; i. EXCEr "We're Buildi g Our Reputation With Your Home. " Photographs may sbowjenrerior elmatiom and option whieb an nos part of the Series.Sperif cationst. f IJ 2 NOTE. Upgrade to Arserrsen Windows. (See your bstildrr.) i ►�ti r� G�L7 r r r r r C f, `F C rt i O c c z 3 z w yrnu.'T"i couxTy D'"-waliumn OF MLTR tLnUjor, PLANS APPROVED FOR OM COUNT ONLYi EDROOM's 'Asaikble f uppskin the AffanidUe&7in HAMILTON I Fo0"am"Li �m tam= ,..-rgff- "r-mr-w < Cho •amilton I Ist Floor 27648 1.320 Sq. Ft. lam.9, tam P41L Lo CID wM 90 an" r3a cdaw Hamilton I 2nd Roor 27'48 1,320 5g. Ft. O& AP si.� isa Hamilton 11 1st Spur - 2 AA Aru 1.2105q. Ft. Hamilton 11 2nd Floor 2i64A 1,210 Sq. R. "'We're Bu"ng Our Repu'taft'an. Wsth Your Home."' T,,EXCtW 1:10014ts" wa room 1&0 &W appmm . Mae. E.F. 02. Ban 683 0 LkrpoA PA 17045 *Upgrek re Aa*mn high per*wav win4" for a minimal inwimc" 1-900-445-0767 (S" year bmil&rfir &"ib-) tad ............ E .......... i ............ Xi .............. CEr "We're Building Our Reputation *1ith Your Home." Pbot"phs nwy show exterior elevations and options WIA am not part of Aw Series Specifications. NOTE. Upgrade to Andp"en"Wim:&wf. (Seryour build-2j1 if ............ E .......... i ............ Xi .............. CEr "We're Building Our Reputation *1ith Your Home." Pbot"phs nwy show exterior elevations and options WIA am not part of Aw Series Specifications. NOTE. Upgrade to Andp"en"Wim:&wf. (Seryour build-2j1 4f Jim 09 1109 'ZOWN AM WMI SWO PW a#17446W -JA .6s oull B oom PUZ 11 UOIPMH -b-q otrl "gLz XMIJ. 12111 uc*PuTgH PAM VNWI WS2, ma I "ga JWII PUZ 1 UDIIMM14 -m.-bsotvl stga 30013 ul I U01PURTH ✓ Z nIqNO WOO NOO -( Mff 'PAW b/b abed VddLO:g -B&iv-q8Q- !tT;AtpLgq?L? !iw;w;nvNvw-qqnnw Num :AA ivaQ ' � Q -b-q otrl "gLz XMIJ. 12111 uc*PuTgH PAM VNWI WS2, ma I "ga JWII PUZ 1 UDIIMM14 -m.-bsotvl stga 30013 ul I U01PURTH ✓ Z nIqNO WOO NOO -( Mff 'PAW b/b abed VddLO:g -B&iv-q8Q- !tT;AtpLgq?L? !iw;w;nvNvw-qqnnw Num :AA ivaQ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130. _:APPLICATION TO CONSTRUCT A. WATER WELI,. PCHD PERMIT WELL LOCATION Street Address Foothill Street Town/Village/City Tax Grid Number Town of Putnam Valle 84 -2 -26 WELL OWNER Name Mailing Address Private David M. Schwartz 330 W 45th St, Apt. Lobby E NY,NY O Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify M INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 6 /EST. OF DAILY USAGE 6_ 00 gal ❑ REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION. 12-ADDITIONAL SUPPLY taNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING New well to supply proposed four bedroom residence WELL TYPE DRILLED DRIVEN []DUG C] GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO' IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: YPG, navir7 M_ Schwan? Lot No. 3 WATER WELL CONTRACTOR: Name To be determined Address: �.; PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: _ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED j@ON SEPARATE SHEET 4/18/95 (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drillin operations be contained on this property and in suc a manner as not to degrade or oth w con ta ate surface or groundwater. :Je of Issue: 6 19� i Date of Expiration ) 19 Pe it Issuing Official Permit is Non- Transferra le White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PU'.I'NAM COUNTY DEPAIVITI.ENT OF 11EAL;.C11 APPENDIX E DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'Re: Property of Located at David M.-Schwartz Foothill Street Aki•i1- l9� °�I995` (T) Putnam Valley S r. c t i. o n 84 Block 2 Subdivision of David Me Schwartz Subdv. Lot ;/ 3 Gentlemen: Filed bia p# 2422 Lo t 26 ___Da t e 7/16/89 This letter is to authorize John Po Delano, P.E., a duly licensed professional engineer X or registered architect (Indicate) to apply for a Construction Permit for a separaL-e sewage system, -to serve the above noted property in accordance with the standards, rules or regulations as promulaga ted by the Commissioner of' the Putnam County Department of Health, and to sign all ,necessary pal:)er5 on my behalf in connection with this matter and -to supervise the construction of said r__...__ _...__ �i� "stew.:_or en: viii., c0Tfq rmit :aitlz :the.::r.t- s_i.or�s- ui' -.(� ;.1�f / , Education Law, l:he .Public 1lealth Law, and . the Putnam County Sani- ta.ry Code. i 'Countersigned: P . E . , /f 62505 BADEii & WATSON P.C. Address 'Very truly yours, Signed Oimcr of 1'r perty US Route 9 Cold Spring Imo.. - 10 16 _ 914- 265 -9217 Telephone - S'�!J �✓PS i` yS't � Sf Address Tow►i 612 ) L V 3 cls-(-) �- Telephone a �� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES I�: =;y'� ;'r= -: -.... .y_:^i¢r' r• -,-.. . -, __. _ .'�,3. �._;e`: � <,r.::, :. ew�a i;'iG: ^TM "- re• -�.;: � �;. -... la.:.yfi. °.�;Y�_.:�_ '.J. _ .. ,� __ V ��..,,�..� LETTER OF AUTHORIZATION RE: Property of _ DAV t D M. -5Ct- wA-(L 7_ , Located at Foo -r L t 5; -r T/V `RArNAiA VPA_.tO Tax Map # i�4 Block 2 Lot ZC. Subdivision of 1DAy e o M_ SC {-E vet A�f2TZ Subdivision Lot # 3 Filed Map # 2A -M Date Filed d7 cam, V3 Gentlemen: This letter is to authorize ZT040 P. MLA- ao i P. . a duly licensed Professional Engineer _-,< or Registered Architect to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and -to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health %1aw,.and the_Putna -Cbunty. Sanitary .Code. ...-_ Very truly yours, Countersigned: Signed: P.E.,y # (Owner of Property) Mailing Address rZou-rE q COLD 5F State N? Zip 1© C�>i C, Telephone: A t,4 — 2C,5 - q 21 ­7 Mailing Address: 330 W q ;-Po f T -T- t_,o6e*-r State Zip twaf-' Telephone: 212— ?.GS— 15 t�&q Form LA -97 1� BADEY & WAS Surveying and Engineering, P.C. Route 9 CdRd Spring'.'Ny- 10516 (914) 265-9217 739-3577 628-1800 ]FAX (914) 2654428 TO: Putnam County Department of Health 4 Geneva Road Brewster NY 10509 We are sending you: Via: US Mail Attached LETUER GIF TRANSMITTAL Date: May 2, 1995 Job No. 867192- Attention: Mr. Robert Morris, P.E. Re: - David M. Schwartz SSDS Permit Foothill Street Town of Putnam Valley TM# 84-2-26 Copies Date No. Description 1 4/19/95 Construction Permit SSDS Application PC -1 Design Data Sheet 1 4/19/95 Construction Permit Well Plan of Proposed SSDS 1 4/28/95 Ck No. WP4275227 for $300 As Application Fee These are transmitted: For approval Remarks: Copy to: Signed: Kurt Schollmeyer, P.E. me ?(7T.1II i .0 CJN.I'Y ' DEPARTMia- . Or. a P-I TH 1V1:SIoN or 'FNS'lRCi� 4�IlAZ;:`HE�S,Tx "SEl�VICES. . DESIGN DATA Si1F_.EL- •SUBSUFAC.i S ,,'PGE DISOOS,n.L SXS'Md �'n!D•1•. gyp. w- -.. 1. . � •, - .:tiQ:�:: -.. • _+say... -.. a.- .�!•T :gr`r•MI.Y ^-. :.L• •f•.-. •. +r7' . a .n -.. r'�1!+,!• .t. - jS�lwl .-Y^^ •Yl• •.!` •, O',vner David M. Schwartz Addres's,330 W 45th St, Apt E NY, NY 10036 Lorat°d at (Sl'reet) Foothill Street Sec. 84 : Block 2 Jot 26 ( in-Lcate _ nearest cross stzetLat) munici.T--�i'lity T/O Putnam Valley Watershed Peekskill Hollow Creek SOIL PErRODL d7C'N T-I-ST DATA R ?UTRI'D To EE SUaf -rTr£D APPIJCATIONS Date of Pre - Soaking .7/9/87 Date of Percolation Test — 7/10,/87 HOLE NLMBER CL= TL-"E PERCOLA al P RCOLUION Run - - -- - Elapse Depth to Nater ZYcm Water Levc1 No. TirTx� Ground. Surface L . Inches Soil Rate S tart -S top Min . Start Stop Drop • L, . Hin /In Drop inches _ Inches Inches A 1 1:10 - 1:40 30 22 25 3 10 2 1:40 - 2:10 30 22 25 3 10 2:10 - '�:40 30 22 25 3 10 5 2 2:05 - 2:35 30 '22 26T 4 8 3 2:35 - 3:05 30 22 26 4 8 .5 1 3 5 _ - -- - — - -! - -- - - - -- - - -- — -. ISMES: 1.. ralysts to rn at s<::fra depth .i .itil a�;- ryvci-ma-tely equal soi.1 rates are cbtain:�_, .at. e��ch i�?r�' co:i.�.tion te. t hole. .All 'da;ta to•• Ee sukmitte& _Or reVIC- i 2-- j)zpUi <<ia-asure„_•nt_s to Fe m =.?c fr'on •cop of Jule. ROL• No. G. -TDpsoil 8" Silt loam 21 21 31 Sandy loam 51 61 71 8411 31 91 10, 131 aca-,T-;�[Ozq OF so= a\NccXJ-1QTER M. E N, 3A MOTE NO 3B 1-10LE 1170 Topsoil 1 ... .... Silt loam 21 -'31 Sandy loam End 141 n -pQ- Nap-, 1-4 .0. J, D.ZXATE EEv-EG TO M.TO-11 ATER :, I* RISES AlrIER ENCOUNMOD' N/A DFM- HOLE GBSE-Rn-'1'IONS MP,.jDE BY: BADEY & WATSON P.C. 5/15/87 DESIGN So.-;."L Ra'U-Q- Used 8-10 S-- Usable Prea Provided C' . 1,250 gals. Tepyf Rio. o D f .-Drh-ccos 4 Sc: ;.-_ ) t-ic Taxi�.,- Ca- n, �-1 ss yp Qn Absorp-Lion Area Provided By 444 L.F. x 211; ,i;:Lh 'trench OLhe-r ............. Nacre BADEY & WATSONtLP.C. S4 OWW OF NEtv Address US ROUTE 0-v co, !A.V COLD SPRINGS NY uj `J'HZS a P Evu SPACE FQR,'US-C'BY 'HEALTH —''HEALTH DEPAX.MOT'OL Y: IQ V, 1 L/gal., 'lecke-E. by FE Soil Fzt'e Approved sq - ;Pc -1 ]PUTNAL� COUNTY YJEPARTMENT OF HEALTH . APPLICATION FOR APPROVAL OF y�.�.1.L11 T'.-. ..y.. ...2' 0 -. iw- ..� ... ..v. PLANS FOR A WASTEWATER DISPOSAL .r. .. �� •. .itv .l ��.._."•�� -..,., q.. r� L. .s{; C'•�; SYSTEM 1. Name and Address of Applicant: David M. Schwartz 330 W 45th Sty Apt Lobby E NY NY 10036 2. Name of Project: Same as Applicant 3." Location TJC: Putnam Valley 4. Project Engineer: BADEY & WATSON P.C. 5. Address: US Route 9. 6 Cold Spring, NY 10516 License Number: 62505 Phone: 265 -9217 Type of Project: X Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office B(Nlding Realty Subdivision Other (specify) , 7. Is this project subject -to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. No Has DEIS been completed and found acceptable by Lead Agency? N/A 10. Name of Lead Agency Putnam County Dept. of Health °'° 1*P1: Is'this• pr-oject-' -frr an area under the control -of - ioca '.l_.plann.ang,- zoning;.- or other officials, ordinances? .......... ............................... Yes 12. If so, have plans been submitted to such authorities? No 13. Has preliminary approval been granted by such authorities? N/A Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters 15. If surface water discharge, what is the stream class designation? .... 1116 N/A 16. Waters index number (surface) ........... ............................... N/A 17. Is project located near a public water supply system? No 18. If yes, name of water supply N/A Distance to water supply N/A 19. Is project site near a public sewage collection or disposal system ?..... No 20. Name of sewage system N/A Distance to sewage system N/A late observed: May 1987 23. Name of Health Inspector: Michael J..Budzih6ki':PE 24. Project design flow (gallons per day) ...... ............................... 800 2. St-i- e',Pol %t`8rft1'0 i's charge Elimination` System "(SPDES)'*-Permit -•required ?::, No 26. Has SPDES Application been submitted to local DEC Office? ............... N/A 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... No 28. Wetland ID Number ........................ ............................... N/A 29. Is Wetland Permit required? .................. No Has application'been made to Town or Local DEC Office? ....... N/A 30. Does project require a DEC Stream Disturbance Permit? No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, No landfilling, sludge application or industrial activity? ........ YES or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or No any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... Yes 34. Are community water, sewer facilities planned to be developed within 15 years? No u' 3 °`A re an sewa a dis osal areas in excess of 15X slo a ................ des 1 36. Tax Map ID Number ......................... ............................... 84 -2 -26 37. Approved Plans are to be returned to: ................ Applicant X Engineer If the application is signed by a person: other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this, provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 7 Law. SIGNATURES & OFFICIAL TITLES: Engineer for ✓BADEY & WATSON, Surveying & Engineering, P.C. NAILING ADDRESS: U.S.. Route 9, Cold Spring, NY 10516 01MENSIOMI'011 ll'e 41 ,gy. W, A 'N V 6. M-4 -k� V 70 V 0 V All " M- 6gw ht, 1*0 AIM, VIZ � Z 0 ;"54i '4