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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -44 BOX 33 I IN I, :.,q 1AR �, �.. r:� I�, rr r ♦, f. . = �F- I - - ' T ,, 04383 C` PUTNAM COUNTY ' DEPARTMENT OF HEALTH ' "' _ _.... _.. _ .._.: :0 .. T 1 (�I�IMENT , HE T'I - SE-R� E--: � _ .-...:... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV 0 4- 0 4 11-76, Located atWILLIAMS DRIVE Owner /Applicant Name STUART SILVERMAN Formerly N/A Town or Village PUTNAM VALLEY Tax Map 8 4 • Block 2 Subdivision Name N/A Lot 44 Subd. Lot # N. /A Mailing Address -10W WILLIAMS DRIVE, N.Y. Zip 1 05b8 Date Construction Permit Issued by PCHD 5/4/04 Separate Sewerage System built by Correia Contr. Inc. Consisting of 1500 `Other. Requirements: Water Supply: 1135 Williams Drive Address—shrub Oak, N.Y. 10588 Gallon Septic Tank and 560 LF of 24" Wide Trenches Public Supply From Address 152 Barger Street or: xx Private Supply Drilled by Norman Anderson Address Putnam Valley, N.Y. 10579 -� Btrildi g ype -Resi- dente -- - --:Has erosion •control`been.corripleted? - Yes- Number of Bedrooms 5 Has garbage grinder, been installed? No 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 wi the issued PC Construction Permit and approved plans and the standards, rules and regulatigns of the Putna nrounty Departt jnnt of Health. Date: 11/22/06 Certified by �- Ili JJA P.E. R.A. xx 2 Muscoot Road North Aa o esaPro ssY. �>1 0541 1 1 056 Address P Lice se # 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. Title: Date: �- 7 White copy = HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional `w Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 0- .E VIRONMENTAL REi/e���T'.H SE�tYjC, � .� GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM STUART SILVERM.AN Owner or Purchaser -of Building 84. 2 44 Tax Map Block Lot STUART SILV.ERMAN Building Constructed by TownNillage 1176 tollhamS Xr- _ L kJJ Location - Street Subdivision Name fisldo&l: 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 oil - -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 oUapproval 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 th&willful or negligent act of the occupant of the building utilizing 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 building utilizing the system. Dated: Month Day ll Year eneral Contractof (Owner) - Signature Corporation Name (if corporation) Address: State Zip Signature: Title: Corporation Name (if corporation) Address:-/%-3i (,C%iLaf- llS I Y Jwd'a, State , G Zip .LCro Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION-REPORT. _ _.....::..: e c ioll treet ress: Town/Village: Tax Grid # Map 9y Block Z' Lot(s) Yy Well Owner: Name: Address- Use of Well: 1.primary 2- secondary Residential Public Supply Air cond/heat pump I igation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _�C Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length D ft. Length below grade ft. Diameter _in. Weight per foot j lb /ft. Materials: Steel Plastic _ Other Joints: Welded _c Threaded _ Other Seal: f Cement grout _ Bentonite Other Drive shoe: K Yes No _ Liner Yes 7C No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield i ogpm Depth Data Measure from land surface- static (specify ft) © During yield test(ft) Depth of completed well in feet 30 O 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 Z " If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth s Model 7Se Voltage o HP Tank Type 9 e ,,y` Volume I Date Well Completed ... v-G G Putnam County Certification No. Date of Report // Ile l Well Driller (signature) I ajz_� NOTE: Exact location otwell with distances to at least two permanent Yandni�[rKS to be provided on a separate Well Driller's Name �.�ai�Qi^ (`fir �' Address: Signature: Date: _ White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 7 r SHERLITA AMLEP, MD, MS, FAAP Commissioner of Health 6�tA�VIOLINARI, RN, N18N. Associate Commissioner of Health OWNER'S NAME: TAX MAP NUMBER: E911 ADDRESS: Wfl&fjel DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 E911 ADDRESS VERIFICATION FORM AUTHORIZED TOWN OFFICIAL: (Signature) PATFv: ROBERT 1110NDI County Executive The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is. to be submitted with the application for a Certificate. of Construction Compliance. . I E911 addressverification 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 JOEL GREENBERG-& ASSOCIATES 2 MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 TEL. (645) 628-6613 FAX (845)628-2807 EMAIL: JLGARCH@BESTWEB.NET TRANSMITTAL DATE: JANUARY 30, 207 7 TO: ..PUTNAM COUNTY HEALTH DEPARTMENT ATTN: JOSEPH PARAVATI, JR. FROM: JOEL GREENBERG RE: SILVERMAN —1176 WILLIAMS DRIVE ❑ As Requested ❑ For your use ❑ Review ❑ Comments DI—M MR. PAR,k\',k ON YOUlt],]"1'1'1.,"RDA'1'1--"D,JANU,kItY 11, 2007. [F YOU I-lAV1-!,;\NYQUf-,ST1()NS PLI.s: \Sfs DO Z)TH1.,1'S1'1'X1*1.-1' TO CONTACT M171. ; I r UI,Y 'OURS, ,1,NBF'RG Confidential 1 • JOEL GREENBERG & ASSOCIATES 2 MUSCOOT ROAD' NORTH MAHOPAC, NEW YORK 10541 TEL. (845) 628 -6613 FAX (845)628 -2807 EMAIL: JLGARCH @BESTWEB.NET TRANSMITTAL DATE: JANUARY 30, 2007 TO: PUTNAM COUNTY HEALTH DEPARTMENT ATTN: JOSEPH PARAVATI, JR. FROM: JOEL GREENBERG RE: SILVERMAN —1176 WILLIAMS DRIVE ❑ As Requested ❑ For your use DEAR MR. PARAVATI, ❑ Review ❑ Comments ENCI;.OSED PLEASE FIND tU.L.'EHF. NECESSARY CI- IANGES TO SILVERMAN AS RE(XESTED ON YOUR LI ITER DATED, JANUARY 11, 2007. IF YOU HAVE ANY QUESTIONS PLEASE DO HESITATE 1'0 CONTACT ME. iu/—L,Y- OURS, r,'U S 5- AP 11 V /- •e f Confidential 1 SHERLITA AMLER, MD, MS, F'AAP _Commissioner of Health LORETTA MOLINARI, RBI, MSN Associate Commissioner of Health Joel Greenberg, R.A. 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT .I: BONDI County Executive .�,� 'p,,: '�: c:�. -'-�. .c; .z .'ITT- ii- r`S•�a� .-R� -, r.:,- ..��= '?R.:...'�«", -. •.ri w�_ DEPARTMENT OF HEALTH 1, Geneva Road, Brewster, New York 10509 Re January 11, 2007 ROBERT MORRIS, PE Director of Environmental Health Construction Compliance - Silverman 1176 Williams Drive (T) Putnam Valley, TM# 84. -2 -44 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The E -911 is not on the construction compliance form and the wrong address is provided on the well completion report. 2. The construction compliance form and the well application report have not been completed (enclosed). _., .. 3:•. ": Two.more copies :of the guarantee form need to be' provided.`: = 4. There are several as -built dimensions that appear incorrect. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Enc. Very truly yours, tseph . Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845}278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 <; PUTNAM COUNTY DEPARTMENT OF HEALTH i ..DIVISION OF.ENVIRONMENTAL HEALTH. SERVICES .... •� , _ 7ri2#� er`ws.. j: :' �,; :.yo- =. i a i•ei V s. � �.< •,. ..."a1c+ ,' � .. .. .. :,tiro: m - rr• „'.. `._ �,,.w�.i� =•. �.e i .r.' v.+� �.� .... .w� CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV - 0 4 - 0 4 Located atWILLIAMS DRIVE Owner /Applicant Name STUART SILVERMAN Formerly N/A Town or Village .PUTNAM VALLEY Tax Map 8 4• Block 2 Lot 4 4 Subdivision Name N/A Subd. Lot # N/A g ��X '9,, N. Y. Zip 10588 Mailing Address 1195 WILLIAMS DRIVE, � Date Construction Permit Issued by PCHD 5/4/04 SeQarate Sewerage System built by Consisting of Other Requirements: Water Supply: Gallon Septic Tank and . Public Supply From or: xx Private Supply Drilled by Address Address Address Building ;Type , Resid�errce• Has erosion control been completed? - Ye -s _ . _. - Number of Bedrooms 5 Has garbage grinder been installed? No 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 wi t the issued PC Construction Permit and approved plans and the standards, rules and regulati�of the Putna h Lounty Depa nt t of Health. Date: 11/22/06 Certified by Address 2 Muscoot Road North P.E. R.A. xx pac, /N. Y. 10541 Liceise # 11 056 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street ���_����������� �-'--/ Albert H. Padovani, Director | LAB #: 1.604338 CLIENT #: 59545 - NON STAT PROC PAGE: 1 ` ~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~m~~~~~~~~~~~~~~~~~~ SILVEFMAN, ELIZABETH 1195 WILLIAMS DRIVE SHRUB OAK,'NY 10588 SAMPLING SITE: 1176 WILLIAMS DRIVE : PUTNAM VALLEY COL'D BY: ELIZAATH _ NOTES.".: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: O7/20/06 08:00 DATE/TIME REC'D: 07/20/06 11:00 REPORT DATE: 07127/06 PHONE: (914)-528-9138 SAMPLE TYPE..: POTABLE PRESERVATIVES! NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 67120/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/21/06 LEAD ([MS) 6.0 ppb 0-15 ppb 9003 07/26/06 NITRATE NITROG <0.2 MG/L 0 - 10 9052 07/21/06 ' NITRITE'NITROG <0.01 MG/L N/A-- 9162 07/24/06. IRON (Fe) <0.060 MG/L 0-0.3 mg/] 9002 07/27/06 MANGANESE (MnO <0 11 010 MG/L 0-00 mg/l 9002 07/27/06 SODIUM (Na) 6.29 MG/L N/A 9002 07/20/06 pH ' 6.4 UNITS 6.5-8.5 9043 07/26/06 HARDNE8S,TOTAL 106 MG/L N/A 07/26/06 ALKALINITY (AS, 52.0 MG/L N/A 9001 07/27/06 TURBIDITy__[TUR.. '-'<1 NTU.- ^ _- -/}=�5,NTU� | | COMMENTS: ` | BACT THESE RESULTS INDICATE THAT T ^'`~ 'WAS NOT) OF A '' SATISFACTORY SANITARY QUALITY ACCORD E NEW YORK STATE ' '-~-~ | AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS � TESTED, AT THE TIME OF COLLECTION,, ' Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Oe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. 4a No limits for Sodium are proscribed. Suggested guidelines state that for ,people oq e\,sndium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION . Date: 6/o d,6 Inspectedby: E 1G -�ee� Town PQ rrVAjt -1 Permit # PV'- 041 — 444 - TM # $�/ - Z — y Subdivision Lot. # 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 �" 2 c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... IL 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 same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. Irenches .1. Length required SS (o Length installed Jqn 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. Pipe ends ca fe d........ ..... - -g: Pu vrposed ys4ems-- 1. Size of pump chamber ................. ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................................. Pump easily accessible, manhole to grade ................. 5 First box baffled ....................................... :.................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans ....................... : b. Number of bedrooms .......... ............................... ....... IV. Well Well located as per approved plans ....... :....... b. Distance from STS area measured I - ft........... c. Casing. 18" above grade ................ ............. ................... 'd. Surface drainage around well acceptable ....................... V. Overall Workmanshin . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f, Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. x2/02 11 05/08/2006 15:13' 8456282807 JOEL GREENBERG 2 Muscoot Road North ,.-ireenberg 14mYork I Ll I' Associates Tai Att ram now. 0-urgene L3 For view 0 plems Cainnumt L3 Fkass Reply 0 PlemsO ROCYcic PAGE 01 TOTAL NUMBERS OF PAGF- . S INCLUDING THIS TRMSMgTAL SHEET�� IF YOU DON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSIBLE., -- rNN- TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P- i 05/08/2006 15: 1 '3456282807 JOEL GREENBERG PAGE 02 ATTENTION PUTNAM COUNTY DEPARTMENT OF)BEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RIJOSEPH REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. 13 GENE For:' Fill Trenches x 4 4 PCHD Construction Permit# PV-04 Located: Williams Drive,,_,, Putnam Valley Owner/Applicant Name: Stuart Silverman _TM84- - Block 2 Lot _4 _4 Formerly: Subdivision Name, Sabdivis'ton Lot 9 is system fill completed? Yes Date- 4/19/06 Is system complete? Yes Date: 4/19/06 Is system constructed. as per plans?. Ye s. Is well drilled? Yes Date: 4 / 3 / 06 Is Well located as per plans? Yes Are erosion control measures in .: place.? le-s I certify that the system(s), as listed, at the above premises has been and verified their completion in accorda:n approved plans and the standards, Rules and 5/5/2006 Date: Certified by: j� and I haveinspected :ruction Permit and unty Department of PE RA 2 r4uscoot Road -North , maho W C. # ji 056 Address: MAY-8-2006 TEL:845-278-7921 NAME•PI-ITNAM rniNTY n1=P1QPTM1=WT np- P' M i') ! `m S l l/d •.. OF ENVIRONMENTAL d ' A i SERVICES , CONSTRUCTION PERMIT YOR SEWAGE TREATMENT SYSTEM PERMffT # t fl S 0 Located at Williams Drive To utnam Valley Subdivision name N/ A Subd. Lot # Date Subdivision Approved N/A Tax .Map 8 4, Block 2 Lot 4 4 Renewal Revision Owner /Applicant Name Stuart Silverman Date of Previous Approval N/A Mailing Address 1195 Williams Drive, Yorktown Heights, N.Y. Zip 10598 Amount of Fee Enclosed $400.00 Building Type Residence Lot Area 4.169 No. of Bedrooms 5 Design Flow GPD 1000 acre Fail Section Only Depth volanme PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 15 0 0 gallon septic tank and .556 1 _ f - of 2' wide leaching trenches at 6' oece Other Requirements: 2 ft-- hank ri, n f i l l -- L 1 S To be constructed by to be selected Address Water Suggly: Public Supply From Address ®�,: XX Private "Supply Dnlled`by to _hA._Gr�lprt�?c� -- Address_.. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good opera condition any part of said sewage treatment system during the period of two (2) years immediately following the date f e issuance tthe approval of the Certificate of Construction Compliance of the original system or any r�irs thereto. 1 Signed: P.E. R.A. _x Date 1 / 2 7 / 2 o o 4 Address 2 M coot ad North, Ma opac, N.Y. 10541 License# 11056 APPROVE➢ FIR CON" RUCTION: This approval expires two years from the date issued unless construction of the sewage trea t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By: z Title: Date: 1,41 L C Wh' 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 __.. ✓2c.... .M ". xtxaC .. _ ... _.1:.J �' - A J ^ ... �. t J •- ...�./�.�r�,'r ."/�` :�• please print or type PCHD Permit # I V —0 Well Location: Street Address: Town/Village Tax Grid # Williams Drive Putnam Valley Map S4 - Block 2 Lot(s) 44 Well Owner: Name: Address: 1195 Williams Drive., Shrub Oak, Stuart Silverman New York 10588 Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _5_ gpm # People Served 6 Est. of Daily Usage 44 5 +gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _ New Supply (new dwelling) Deepen Existing Well Detailed Reason New Dwelling for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding? ................................................. . ............................... Yes No xX Is well located in a realty subdivision. Yes No xx Name of subdivision N / A Lot No. Water Well Contractor: Nit splP�tP� Address: Is Public Water Supply available to site? .................................. ............................... Yes No xx Name of Public Water Supply: N/A Town/Village Distance to property from nearest water main: N A Proposed well location & sources of contamination to be pro 'ded on sep to sheet/plan. . bliat SDatea .1. / 2.9- �4. " A cignature;a - Qot v PERMIT TO CONSTRUCT A WATER WEL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner, as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 9'1140q Permit Issuing Official: 4�� - le"6ll'exl � Date of Expiration Title: del% mil' Permit is Non- Transfetra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 G R E E N B E R G & ASSOCIATES, A. I. A. GSN CONSTRUCTION 2 MUSCOOT ROAD NORTH (►--� - AHOPAC, NEW YOKK 1064. f; T (845) 628.6613 F. (845) 628.2807:'' _ MEM E -MAIL: JLGARCH @BESTWEB.NET . T A.. N.SMITTAL R.. Gr� con-Aac+ w��jcx.,, hG�� sigh.acc COPIES TO JOEL GREENBERG., ALA. MAHOPAC.. NEW YORK 10541 T- (845) 628-6613 F- (845) 628-28 7- To: PUTNAM COUNTY HEALTH DEPT. From: JOEL GREENBERG, A.I.A. Date: JUNE 239 2004 Re : SILVERMAN-WILLIAMS STREET T.M. # 84.-2-44 PLEASE FIND ENCLOSED REVISED PLANS. ALL THE REQUESTED ISSUES HAVE BEEN ADDRESSED. IN ADDITION, A COPY OF YOUR LETTER DATED MARCH 22, 2004 IS ALSO ENCLOSED. 1Z 1 LORETTA MOLINARI Public Health Director ROBERT J. BONDI' . County Executive. DEPARTMENT OF HEALTH 1,Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -.6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 March 22, 2004 'Joel Greenberg, R.A. 2 Muscoot North, RFD# 2 Mahopac, New York 1,0541 Re: Proposed SSTS — Proposed SSTS — Silverman Williams Street, (T) Putnam Valley - TM# 84. -2 -44 Dear Mr. Greenberg: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. Based on deep holes witnessed by this Department, total depth of the two holes was 7 feet and 6.5 feet. Therefore, only. 0.5 feet of fill is- required. _ ........ -.- : ,- _ If lot was 'created before 1969, neighbor notification is required per Bulletin ST -19, Section 4.11. 3. Please place the tax .map number in the title block. 4. Seepage pit for roof and footing drains needs to be a minimum of 50 feet from the proposed SSTS and well. Please provide first floor and basement elevations. The SSTS profile is not complete, specifically, the end of the profile doesn't show where proposed grade returns to existing grade. 01. The septic tank should be rotated and/or shifted to avoid the bend in the cast iron pipe. Regrading of side slopes and end of system is greater than 1:3. 9` Please make driveway easier to see. Part of driveway is less than 10 feet from the proposed SSTS.. L,1*�. The septic tank detail needs to show minimum/maximum cover. 4-: Please specify what gallon tank is being proposed in septic tank detail. 1-3/ The junction box detail is mislabeled "leaching trench" and the leaching trench detail should be labeled "absorption trench detail." 1XI The words "clay pipe" need to be removed from the junction box detail. �� #7 //3 r, "-�5.� The words "dust free" need to be. added to the crushed stone /washed gravel label in the absorption trench detail. 16 Largest size of washed gravel is l liz„ not l v3„ Please provide back side of Short EAF form. This office will continue its review upon consideration of the above mentioned comments.. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Healu-I Engineer JSP:cj I� PUTNAIVI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE, SEWAGE'TRE'A.TMENT SYSiENu :,•�,•'. .' REV "T FOR CONSTRUCTION PERMIT NAME OF OWNER: ((,/Pif7YLL�� STREET LOCATION- -3 REVIEWED.BY: RM, GR, A . SRDATE: TAX MAP#: (CONFIRMED) Y DOCUMENTS Y (REQUIRED DETAILS ON PLANS CONT'D1 PERMIT APPLICATION (i/ I PIPE. CAST IRON WELL PERMIT OR PWS LETTER (_)NO BENDS; MAX BENDS 45' W /CIS O'UT� -- C PC-97 ,� or e•l�Get /�. f2� LETTER OF AUTHORIZATION SITE NOTE (NO CHANGE) /' (�UESIGN DATA SHEET (DDS) STEMS U(_,CORPORATE RESOLUTION 10' HORIZONTAL; PAST TRENCH SLO S• 3:1 TO GRADE ( ) }SHORT EAF C�FILL SPECS/ FILL NOTES 1 -5 J( _W ) YLANS- 'THREE SETS SETS PROFILE & DMENSIONS (� USE PLANS - TWO SETS (�C�aL IN EXPANSION AREA C__) j VARL4NCE REQbEST FILL G.RF•ATER THAN2 FEET SUBDIVISION }� j CLAY BARRIER UEGAL SUBDIVISIO ` CSC J (()FILL •CERTIFICATION–NOTE � )( )SUBDIVISIO Al, CHECKS t if Nn VD'T nr 11 A TTr.Mic " . L_)L_)XOU; ON PLAN FOR R.O.B., UNCLASSIFIED & IlVIPERVIOUS _-)(� REQUIREDD DEPTH `( SEPARATION DISTANCE FROM'TOE OF SLOPE CURTAIN DRAIN REQUIRED TREK H �. �NEV =I' (� LFTRENCHPROVIDED� 5 :& 60FTMAX ,S& II qui;` -( _JC±0E0CATED.lN NYC WATERSHED (k/ PARALLEL TO CONTOURS __)kczjp LANS SUBMITTED TO DEP 010 OX E�US�TF�) OVIDED LEGATED TO PCHD ( DET CRU SHED'STONE OR WASHED GRAVEL DEP APPROVAL, IF REQ'D ( GEOTEXTILE _COVE_ --- C_)DEEP TEST HOLES OBSERVED Ei~ARA rION DISTANCES ON P wN = FROM-SST ,,rr _j_ERCS TO BE WITNESSED i0' DRIVE ES TOP OF FILL I(3EX- APPROVAL SSDS ADJ, LOTS' G 20' TO FOUNDATION WALLS �___ i'a lass ��. Q D' off, 100' TO WELL, 200' IN DLOD,150' TO PITS ' �� t D TA OODDS PLANS &PERMIT S 100' TO STREAM, WATERCOURSE, LAXE-(inc. ezpam): 969.NEIGHBOR NO c�� ►rff _ (v 50': TO. CATCH BASIL; 35' "§ WPMVW N;$i :D=WA .. _._ _ . LETTER.BUZ$ ,...:: _ :. = :: = WATER LINT, (pits .20') YR FLOOD'ELT;VATIbFI �Vl 200' '� - 50'• INTERMITTENT DRAINAGE COURSE L j SOIL-TESTING LOTS >IO YEARS OLD 2001i500' RESERYOII2, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS : J10' MIN TO LEDGE OUTCROP Lvd USEWAGE SYSTEM PLAN- (NORTH ARRO,.. _ SEPTIC TANK (j SSDS HYDRAULIC PROFILE _ n o ( U�U10' FR011�.F.OUNI)ATION• 50' TO WELL GRAVITY FLOW `WELL`°' �- (_,j/�CONSTI[7CTION NOTES 1 -15 =1�5 SIONS TO PROPERTY LINES ✓CDESIGN DATA: PERC & DEEP RESULTS---- ----� ;.__) 2' CONTOURS EXISTING & PROPOSED ( ' T O PROPERTY LINE EW Y SLOPES, CUT____ • OPE FO TIN(: /G 2/CURTAIN DRAINS ` / �D ARIES __._ �'` ": 5 •o C )S E IN SSTS AREA ` (S20 %) USDA, SOLI. TYPE BOUND ,s•n Fi.+� S • T E BLOCK; OWNERS NAME ADDRESS (-- )C!= y7�*RADED TO 15 %, It REQUIRED M# ; NAME, ADDRESS, PHONE# DOSE/PUMP SY5TEM$`'� i !� Y (_._)C�P.UM[P NOTES . ATE OF /FOEVISi4Nr y� ;,t; && j°�0(_)DOSE 75% OF PIPE•VOLUMEMOSE VOLUME NOTED DATUM REFERENCE . �]ULOCATION OF WATERCOURSES, PONDS UL-- )DETAIL•FORFORCE'.MAIN, (PIPE TYPE, ETC.) (••, J,� TIT AND D -BOX SHOWN & DETAILED 200 OF P.L. 1 DAY STORAGE ABOVE ALARM )(t�PROPOSED FINNH FLOOR AND %��, �� ( CURTAIN D WELLS & SSDS'S W/Il�.200' OF SSTS C— !C_JST�Pg'ES, 5' BO , DETAIL PROPERTY METES & BOUNDS to CD o, 20' -4 %, 15'-3%,35'-l%, 100 °Jo -Q °lo _)EROSION CONTROL FOR.HOUSE, WELL & U(-- J20'�0' D DISCHARGE/1001 with 182 cons day discharge SSTS, EROSION CONTROL NOTE�� to NON - PERFORATED PIPE MMRNTS: V61EET)09(0l/00 PROJECT ID NUMBER SEAR APPP617.20 ENDIENDI X C STATE ENVIRONMENTAL QUALITY REVIEW -.-._._SHORT_ENV1R0NMENTAL ASSESSMENT FORM--: for UNLISTED ACTIONS Only Y PART 'I -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME STUART SILVERMAN STUART SILVERMAN 3.PROJECT LOCATION: PUTNAM VALLEY PUTNAM Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map WILLIAMS DRIVE - SEE LOCATION MAP 5. IS PROPOSED ACTION: � New ❑Expansion ❑Modification /.alteration 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE AND SSTS 7. AMOUNT OF LAND AFFECTED: Initially 4.17 acres Ultimately 4.17 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑ Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) PIResidential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park / Forest / Open Space ❑ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes El No If yes, list agency name and permit / approval: PUTNAM VALLEY PLANNING BOARD AND BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes P] No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTI0 LL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑ Yes ❑ No I CERTIFY TH T HE IN ORMATI N PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S onso Name ST AR SILV RMAN Date: June 23, 2004 Signature % PROJECT ARCHITECT If the action is a ostal Area, and you are a state agency, omplete the Coastal Ass ssment Form before proceeding with this assessment A €c' PART 16 ' IMP �.T',A'SSEtS. IeMT T _, .�;� A ,. � o-tie-corrs feted= `-Lvaiel' ear -�- -':;•: A. DOES ACTIOA4 EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR Yes M' No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration.may b superseded by another involved agency. F-1 Yes 0Jdo C. COULD ACTION 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. C3. C4. 19 AO— Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or \ 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: N0/4e- C5. Growth, subsequent development, or related activities C6. Long term, short term, cumulative, or other effects not C7. Alone_ in use or in C1 -05? action? D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL REA CEA ? If es, ex lain briefly: _ Yes. o -, . •.. -. t r E. IS THERE, OR IS THERE LIKELY TO Yes allo TED TO 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 ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the F EAF and /or prepare a positive declaration. heck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed ai WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting determination. Name of Lead Agency Date C2 �G�, S. ���w�� f; �7"�. f+5 s� s,�� Pv�t; lfh bi /..FTnt or'f ype aN me of esponsibTe Officer in Lead Agency Title of Responsible Officer Signature of Preparer (If different from responsible officer) PIJTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER. OF AUTHOR.IZATffON RE: Property of Stuart Silverman Located at 1195 Williams Drive TN —Putnam valley Tax Map # 84 Subdivision of Subdivision Lot # Gentlemen Block 2 Lot 4 4 Filed Map # Date Filed This letter is to authorize Joel Greenberg a duly licensed Professional Engineer + or Registered Architect xx 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 treatment and/or water supply systems in conformity with the prov' of Article.145 and/or...l47.of the Education Law, the-Public Health Law, and the"lut�zarr Code. _. ..... Countersigne P.E., R.A., # Mailing Addy State N. Y Telephone: Mahopac Zip 0541 845 628 -6613 Very truly yours, Signed: (Owner of Property) Mailing Address: 1195 Williams Drive Yorktown Heights State New York Zip 10598 Telephone: 528-9138 Form LA -97 128107 JOEL GREENBERG PAGE 02 61720 SEQR STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only (To be completed by Applicant or Project Sponsor) 1. APPLICANT i SPONSOR 2. PROJECT NAME STUART SILVERMAN STUART SILVERMAN 3.PROJECT LOCATION: TOWN OF PUTNAM VALLEY PUTNAM Municipality county 4. PRECISE LOCATION; WILLIAMS DRIVE Sbixit Adiess and Road Intersections, Oromnent landmarks ate - or provide map S. IS PROPOSED ACTION: New MFxpansion L] modification/ alteration 6. DESCRIBE PROJECT NEW HOUSE BRIEFLY: T. AMOUNT OF LAND AFFECTED: InItIally 4.169 acres Ultimately 4.169 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑Yes No If no, describe briefly, 280 -.A VARI ANCit C-4F;�AN'4'TECi-'BY�.Zi3A,'8/�—)61�1497 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) WIResidential 1:1 Industrial 1-1 Commercial ❑Agricutture E] Park ) Forest/ Open Space Other (describe) 10.- DOFS ACTION INVOLVE AGENCY State A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL Local) (Federal,- or zYes 11 No If yes, list agency name and pdrMit I approval PUTNAM COUNTY HEALTH DEPT. & PUTNAM VALLEY BUILDING DEPT. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes MV No if yes, W agency name and permit I approval: 12. AS A RESULT OF —jY RjNo es P);NPOS ACTIO WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ERTIFY T H Ali* IS MATION PROVIDED ABOVE IS TRUE TOTHE BEST OF MY KNOWLEDGE AppliC2 I Sponso N T RYILVERMAN Date: January 26, 2004 Sloneture Pr6d.e If the acfi " Is a Costal Area, and you are a state age' ni'cy, 00o /lpletethe Coastal Assessment Form before proceeding with this assessment MAP-9 -PI'AR4 TLIF IP:1711; TFI:R49-P7R-7qP1 NAMF:PIITNAM rniINTY nFPARTMFNT OF P. 2 DA TO AND ASSOCIATES GSN CONSTRUCTION ARCHITECTS — PLANNERS - BUMDERS TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 845-618-6613 - FAX 845-628-2807 F', -MA M! ilearch(Rhostweb.net FROM: RE: JOB# It ti on rlRp� �........ ..... .. . r � T'S:.. - e� -:vo '�:.:�.m <,+•..��`oo -i r5^,^ -. c:. _ .�_�.. � ^:"'�' 'p�.�ii:�^ --i 4 +'v .:.�: _•.�i:r �...Gs I s �a IEET F 4d mow LLIS D 4• m LAKELAND ST. y y ELEANOR A DR. - HUDSONVIEW W cS ALLEYVIEW J _ R STJ 1 IDE C liE — AV FIE D CT. O rn 2 s ZI ol pp`� it it s X11 lr 1; �! I Ai ti on rlRp� �........ ..... .. . r � T'S:.. - e� -:vo '�:.:�.m <,+•..��`oo -i r5^,^ -. c:. _ .�_�.. � ^:"'�' 'p�.�ii:�^ --i 4 +'v .:.�: _•.�i:r �...Gs I s �a IEET F 4d mow LLIS D 4• m LAKELAND ST. y y ELEANOR A DR. - HUDSONVIEW W cS ALLEYVIEW J _ R STJ 1 IDE C liE — AV FIE D CT. O rn 2 s ZI ol pp`� it it vt 01 �,�` RGER ST. PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT . .� � , -.. 1 IVQ.DTH: Exact location of well with distances to at least two permanent lanam�tms to ne provtaea on a separate Well Driller's Name d( r �.hi�oi" Ar 0 � S ignature: r Address: S �., �I L. r Date: �/ �S ). --� l White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 Sireet`P►``dd'res`S. �' "'t ' own/Village: Tax Grid # v Map °I Block Z— Lot(s) �J Well Owner: Name: �� 'A dress, ..�rQ i ><Jse of Well: &- primary 2- secondary 7F� Residential Public Supply Air cond/heat pump I igation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment _ Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Detai ➢s Total length ft. Length below grade Y ft. .Joints: Diameter in. Weight per foot �_lb/ft. Materials: Steel — Plastic _ Other _ Welded Threaded _Other Seal: Cement grout — Bentonite Other Drive shoe: �C Yes No Liner _ Yes 7C No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped .� Compressed Air Hours Yield / ,Ogpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyse, are available, please attach. Depth From Surface Water Bearing Well Diameter(in) . Formation Description ft. ft. Land Surface /, `'., �. u2`� / 'r''' Tj -' -- _ rn c 7rin d If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _ Depth .1 $Z Model 7P '7 " 44— Voltage _12-0 UP i i d- Tank Type f dv\ Volume -_1 � a Date Well Completed Putnam County Certification No. Date of Report / Well Driller (signature) IVQ.DTH: Exact location of well with distances to at least two permanent lanam�tms to ne provtaea on a separate Well Driller's Name d( r �.hi�oi" Ar 0 � S ignature: r Address: S �., �I L. r Date: �/ �S ). --� l White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �LICATON..Ol APPR.4�ZP,I�.OF. PLANS..FQI2 { ~A WASTEWATER TREATMENT SYSTEM 1 1. Name and address of applicant: - tart —s iva rma n 1195 William Drive Yorktown Heights, New York 10598 2. Name of project: Stuart Silverman 3. Location T/Vx Qutnam Val 1 ev 4. Design Professional: Joel Greenberg, R. A.5. Address: Muscoot Road North 6. Drainage Basin: Hudson River Mahopac, New York ".1 0541 7. Tvne of Proiect: x Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building 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 x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? .............. 11. Name of Lead Agency N/A N/A 12. Is this project in an area under the control of local planning, zoning, or other off ...... ...... ............................... -- �- - ... ..:..::.:.- .........:..... -:... - ; - ',Yes. 13. If so, have plans been submitted to such authorities? ....................................... ........................... 14. Has preliminary approval been granted by such authorities? No Date granted: N/A 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A 18. Is project located near a public water supply system? ....... ............................... Yes 19. If yes, name. of water supply Ynrktnwn Distance to water supply 50 0Ft 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system NIA Distance to sewage system N / A 22. Date test holes observed +44-144-9 a343. Name of Health Inspector Adam s t i ebe 1 i ng 24. Project design flow (gallons per day) ...... ............................... ................'...........800 GPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? .......... .. .............. —N/A Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? No I' �28 etlands'ID iitunibe .............................................................. ........................ ............................... : °.......................:. N Au "m 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... RR N/A 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, landfilling, sludge application or industrial activity? ............... Yes/No No 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... No 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number .......................... ............................... Map a 4 _ Block 2 Lot 4 4 37. Approved plans are to be returned to ..... Applicant _� Design Professional _ _ NUTE:.Al1 applic`a`tions for review and approval of a new SSTS to be locatedfw dt n the NYC 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 stormwater 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 & ®F'F'IC4L TITLES.- ,,Ea f.',� — c fi' rt Silverman Mailing Address: 1195 Williams Drive '' Yorktown HpiahtS, N.Y. 10598 PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Stuart Silverman Address 1.195 Williams Drive Located at (Street) Williams Drive Tax Map 84 - Block 2 Lot 44 (indicate nearest cross street) Municipality Putnam Valley Watershed Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 1/12/98 Date of Percolation Test 1/13/98 1.. 1 :01 8:29 28 24" 27" 3" 28/3 =9.33 2 3 :30 8:59 29 24" 27" 3" 9/3 =9.66 3' :00' 9:29 29 24" 27" 3" 129/3=9.66. 4 :30. 9:59 2.9 24" 27" 3" 9/3 =9.66 5 .2_ 1.. :fl3,.. -8' -3.2 2.9 2.3x,;5! 2.5.7 3"' 91J6 2 :33 9.02 29 " " 111 _ 3 :03 9:32 29 23.5" 26.5" 3" 9/3 =9.66 4 5 2 4, t NOTES: ; Tesfs to be at same depth until approximately equal percolation rates are obtained at each ,'repeated ��? " ercolation'test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be su b mitted:foz review. inasirements to be made from top of hole. Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH:,': HOhELNf3 ^� ;;.. -HOS E NO 2. -<;r :. -HOL-E`ND;' G.L. top soil _ top soil 0.5' 1.0 medium brown meci i tam hrnwn _ 1.5' ciancly i nam wi th sandy leafft 2.0' sto nes 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered None Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered N /A Deep hole observations made by:, Adam S t i ebe 1 i ng Date 1/12/98 Design Yrotessional Name: Joel Greenherq Address: 2 M»Gnnnt- RnAa Mnrth /1") Signature 41 6j �("0%,E GO cv ?� -4 �0 Oil 00 O OF N " A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES — — :.....- :- -- RE ATX:SIB IIIYIS I �N SITE IN SPECTION FORM ' ' SECTION A. GENER�L INFORMATION , r Name of Subdivision i� tit r i T) ��-• �lWc.c �c. Count ?" ll . �) Y Site Location . D. J. ©- _ s ,gyp (0JtL'1"A1"Vs iW) Distance to: Public water supply Public sewer system Building construction begun ItA€ t46' Extent , Is property within NYC Watershed ? ................. Yes No SECTION.B. TOPOGRAPHY (Please check all appropriate boxes) 1. illy F7 Rolling Steep.slope Gentle slope F7 Flat 2. Evidence of swampland Low area subject to flooding Bodies of water F7 Drainage ditches Rock outcrops 3. Do water courses exist on or adjoin the property? ......I .......:............. F7 Yes Ey. No 4. Will these affect the design of the sewage treatment facilities? .......... Yes o 5. Do watershed regulations apply in this development ? ....................... F7 Yes No 6. Will extensive grading be necessary? ................. ............................... Yes No 7. Will extensive fill be necessary? ........................ ..............:................ Yes No 8. Do filled areas exist. in the. tract ?.............. ...... Ye : 7o: " ; If yes, what is the condition of the fill? SECTION C. SOIL OBSERV TIONS . ` 9. Appearance of soil: and Gravel Loam �SiltF7 Clay Hardpan Mixture 10. Observed from: .Borings Bank cut a Backhoe excavations 11. Soil borings /excavations observed by JoF,L G- on 2 23 4j& 12. Depth to groundwater on 13. Depth to mottling m nc e on 14. Soil percolation tests made byc„sf --rl 1&nt Z %�, on 15. Soil percolation tests witnessed by f' on SECTION D. DRAINAGE 16. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes ED< 17. Will groundwater or surface drainage require special consideration ? ....................... F__J Yes C��<o 18. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F_� Yes o Form RS -1 SECTION E. REMARKS 19. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... Yes 10 20. Have previous sections of this proposed If yes, describe subdivision been approved? ............ ❑ Yes 21. Will there be additional sections of this subdivision? Yes No 22. Is it probable that the total number of lots will exceed 49? ... ............................... F--] Yes F-1 No 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation (s) /inspection(s) rre 21> 'Z5 (q 9 e 'PEST PIT PROFILES Hole # �_ Lot # ole #_ Lot # _� Hole # Lot # Depth to water N�vg6, Depth to water NoN E, Depth to water got4rz Depth to mottling �� Depth to mottling Depth to mottling Depth.to.rork /inar. _. �, p c _� : r�eth:o rael:/ix�p: .._Depth to: ruciv�ir�ip. G.L. G.L. G.L. 0.5 O «r r( -,--� 0.5 .0 1.0 3.0 VQ �'D 4.0 sm sow Lori 5.0 6.0 5 -p - 7 -0 7.0 z, atjoY 8.0 Ci Am -r, 9.0 10.0 1.0 2.0 3.0 VU 4,p 3P- . 4.0 �>, fly' (r o 5.0 6.0.,. ��(a..... 7.0 HE Lo C'&n 0 NA -C> E?-4 0.5 V 64b 3.0 1.0 5.0 v 2.0 V 64b 3.0 4.0 5.0 v 6.0 Ilio �a1 S 7.0 �}ew 8.0 Ste, - ►��� 9.0 10.0 TEST PIT PROFILES q•7,� Hole # Lot # Hole # Lot # Hole # Lot # 7i Hole # Lot # Hole # .. Lot #, Depth to water V*IPmC Depth -to water _ ., Depth to mottling Depth to mottling Depth to mottling rock/imp. Depth to roc a► p p 4 � � .Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 ( "_ 6 cr S 0.5 0.5 1.0 1.0 1.0 2.0 (91r _ 4', ? Ir 2.0 2.0 3.0 RED � is _ 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole# Lot # Hole # Lot # Hole # Lot # Depth to water Depth to.y!ater ..._ . .. :..:.. .... ._ ..._ Depth to .water . _ Depth to-mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. - _.._ t _._._ __ .G.L.- ..._ :.... ........ 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # sY' TEST SPIT PROFILES Depth to water _ .: -- Depth: to water,` Hole # Lot # Hole # Lot # Hole # Lot # Depth to.water _ Depth to water--, _ .:-Depth -to water Depth to mottling Depth to mottling Depth to mottling ` Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 . 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water _ .: -- Depth: to water,` Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. t G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 N89 *11'35 "E N co N Z VJ- 3 26 Lli Q 15.28 / z 580 *01.55 W JAM �/AL -LEY 58.00 & TOWN LINE _R COUNTY 580.30' 5„ < .'� S81'42; 5� O hy 9' 1° STORY USE FRAME RETWIG WALL PiAv: AREA J3 NOW OR FORMERLY ELIZABETH ra 1= N86'51'06 "E 29.61' 0. 1$ R,5 3.0 4 95.57' 110. !� 0 O$ S 50'50 ".W ON UNE —10 6 0 584'13'45 W.. 578 94.5 53.82' '42'16 S78109 rl S78'09'45 "W W t 106-39 582' 25, W 90.01' /� 9,.W Sg0.488 m ad W&E S80 21 3 ASPHALT 1 59.28 DRIVE ABOVE . ^^'' /n��/ ,� g� q � 912 Or POOL N� V v r N, 6. 1 c �op5'4�,� -`' N� of: MppK1sv -'oFF ASPHALT 7 �I f ��LV GLER DRIVE , O s; REFER GDUN PUTNPtA :ELIZABEI THE FORMERLY O R •.. A ). 1 1 e t7/554 :1� h .05 ' ST: � LOT 80 'SHRUB OAK PARK NUMBER 4877 r� PREPARED B Y. .S 'r ;IGNA TED .�ON THE TAX MAP FOR THE: VALLEY tt < 2 LOT :44 K THAT THE SEWAGE DISPOSAL CONSTROICTED AS INDICATING ON \T I INSPE -CTED THE SYSTEM BEFORE D VER. THE:` SYSTEM WAS _ ACCORDANCE WITH ALL STANDARD .ATIONS OF THE PUTNAM COUNTY I EAL TH. 1 FRAME F USE AS BUILT SSDS SCALE: 1° - 20' 0 10' 20' 40' AS BUILT LOCATIONS im m W, IN AS BUILT LOCATIONS m W, IN mmmmWESPENE/som m VENOM —mm mmmmm. ®® .J.P®rms I ErNo 0 m m MEN EMEN • m m • PEN No MEN m m ml MEN M , J. mmmmMERVE/m, m I NE's NO pzzrz,Pzzrz VON MENERMWEIRVEIN, m m MEN ON, 0/04 .A 0,0000 m PEN I MEN 0 NZE'll ==n.o m.mvzz ,od o P, /FZ,/jdj m m Me rz, 0/4, m m 0, NZE ME 0/0 1 mm mm MEN % /%. ® % %N %%%%, 0 MEN, MEN, ml 240.1 u rn O QQ Zc� �ZQ �J S82'42'16' W 9.37' 34.25' TONE 1 1 ®� N, EN UI rrn U 1 m i m Q w co U O_ in m U) Q LZU Z�m 0 Z¢ LLw to g'- =m® Ul fig5 N� W v " `°. lb � Ln z U ~ W a L ry n W Z M fy rn � JN f II Q a Cpl -.. .. .