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HomeMy WebLinkAbout4422DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -27 BOX 33 IN NY I ,LN T ,. rF � , IN T To � IL 0 ;- . ON - ■ 04422 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WEL1. CCIIYII'EET t)N. POI ;r Well Location S�� Stre t Address: �,�_ wn/Villag : �, Tax Grid # Ma , Block Lot(s) 21 Well Owner: me: Ad ess: Use of Well: 1- primary 2- secondary _ZC Resi ential Public Supply Air c d/hea pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment iL 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 3r ,ft. Diameter 1 " in. Weight per foot _Z�_lb /ft. Materials: � Steel _ Plastic — Other Joints: Welded -7� Threaded _ Other Seal: 4 Cement grout — Bentonite Other Drive shoe: X. Yes _ No Liner: Yes fl)�' No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First x sr, a Yes—No Hours Second Well Yield Test _ Bailed _ Pumped >�/,- Compressed Air Hours Yield 2 gpm 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 analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface L� � r/ ?,a'C� _ . _G n If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type :? � Capacity _^ Depth" Model l/ 5S e Voltage 23 t" HP Tank Type4�v Volume /L/ Y, 7. Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) �1 )7 -c3 iwg-E: tlxact location of well win atstances to at least two permanepI taptamartcs to oe proviaea on a separate(snnreevpian. Well Driller's Name /��N�►� Address: Signature: , Date: G101�- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Farm parr -a7 __ _ IRMA 11 ED gg �(� "A INI CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCFIID CONSTRUCTION PERMIT # PV- Oq - a � Located at 58 L oye(L S L A &)i� Town or Village PU TN A M Vil L t Owner /Applicant Name S-1 E ION EN kyq ST u K y N C. Tax Map Block Lot 2, Formerly Mailing Address 3( L IIJ PSA f LA 6- Subdivision Name L o VC -FF- C K f} c R ES Subd. Lot # 14 UAL Z �AZ. /� y Zip 1 o S 7 l Date Construction Permit Issued b PCHD UL 15 SooS bi� Y i1 yc 1, , �s D S� Separate Sewerage System built by ' Address ' /J Consisting of 1150 Gallon Septic Tank and �- 1I-3 Sq" 611(AVCL eI2e--_/-_/ Other Requirements: -' 15- Wateir�Supply: Public Supply From (3f 2,q 1.4j 6 ro IZP 6sLr r Olt: Private Supply Drilled by /Jrjarvi ti Atitx 2Sof�, /NC, Address 2 1Kf4fZ "rR X7- Address v�dra UKLEFY 'r ' Buil�iirlg ; Has ero .ion - control wbeen!;completed? Number of Bedrooms Fo u f l- Has I certify that the system(s), as listed, serving the built plans (copies of which are attached), in ac plans and the standards, rules and regulatiop Date: /­.31-06 Certified by Design Address V10J4? I WAL,.W 9L 1% rkE6 K XKIL ? /J a ted essentially as shown on the as- Construction Permit and approved' nt of Health. ,�' P.E.1k" R.A. License # (% 2 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: m� Date: eV 06 Whi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT „l ll,Locataon ::: S S Stre t:Address:•'- . ` ' tl gWn/'Viila- - Tax Grid #. ,-;: W - Map ( Block Lot(s) `L Well Owners me: Ad�ess: Use of Well: 1- primary 2- secondary Resi ential Public Supply Air c d/hea pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment YL Rotary . . Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock _ Other Casing Details Total length 4 ft. Length below grade 39 lvft. Diameter /Tin. Weight per foot _IL_lb /ft. Materials: Steel . Plastic _Other Joints: Welded � Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: -.K Yes _No Liner: Yes J No Screen Details Diameter, (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First ix �� o Yes —No Hours Second j Well Yield Test _ Bailed _Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet A Well Log If more detailed information descriptions or sieve. analyses We available; please attach. Depth From Surface )Water Bearing Well Diameter(in) Formation Description ft. - ft. Land Surface 9 o'D G - i If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3,dwirl, Capacity _ Depth 'v Model,22�,� -SrS o> Voltage 23 o HP J Tank Typelu I-Ce) Volume /V Y . 7 i Date Well Completed //,1 1/ 40� Putnam County Certification No. , q Date of Report f. Well Driller (signature) ' :I 14 _42 NOTE: 1 `xact location of well with distances to at least two permanent lar(dmarks to be provided on a separate sheet/pllaan —.-- Well Driller's Name 1����Nw -C Address: Signature: Date: 1 o aG 1012`% i" White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE F— FOLEY. 'Public Health Drreetar' IARETTA MOLINARI RBI., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (9.14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 _ Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: � ��°1'�� � � A) (C 8 o TAX MAP NUMBER: �� Q � '� d a r z E911 ADDRESS: L O VCR X LAAJC TOWN: -r j;'O' VA L �- 4° AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 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 4 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFW ` �ML EN��R IAL.SE�VI�E5 ��� near !jtreet ` Yorktown Heights, N.Y. 10598 ������������������- �}� /��'^���.�� ~ '~�-�' Albert H. Padovani, Director � ' `LAB On 1.600347 CLlENT #: 2663 ~~~~~~~~,~~~.,~~~~~~~~~*~.~.,~ \ AASTUK, STEPHEN 06 LINDSAY LANE �P(JTNAM VALLEY, NY 10579 ` - ' , ��SAMF1ING SITE: 58 LOVERS LANE : COL'D BY: STEVE KASTUK VOTES ... : KITCHEN TAP ~~~~~~~~~~~~M"~~~~~~~~--"~~~~~~~~,~~~~~ DATE FLAG PROCEDURE PUlNAM CNTY PROF[LE 01/17/06 0l/23 X 01/19/0� 0i/18/O6 01/19/06 �1/19 Vl/18 �1/18/06 0L/l8/06 01/23/06 ' MF T. COLIFORM LEAD (INS) NITRATE NITROG NITRITE N[TROG IRON (Fe) MANGANESE (Mn) SODIUM (Na) PH HARDNESSJOTAL ALKALlNlTY (AS TURBIDITY (TUR NON STAT FR[C PAGE: 1 "~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~^~^~~~ DATE/TIME TAKENt DATE/TIME RGC'D: REPORT DATE: PHONEx (845)-528 0/17/06 0300 0l/17/06 01��5 01/26/06 2290 SAMPLE TYPE..: POl.ARLE PRESERVAT}VES: NONIE.: TEMPERATURE.,x < 4C COLlFORM METH: ,,....°.,-,,,.,.,,..,~.,.,"°,,,,,,°,.,,., MF RESULT NORMAL - RANGE METHO0 ABSENT /I 0o <l ppb 1.01 MO/L. <0.U1 MG /L 0.097 MG /I <0.010 NO /11- 9.83 MG /L ?.5 UNITS 178 MG A. 156 MG /L 10 NTU ABSENT 1008 0-15 pph 900-11 0 - 10 9�52 N/A 9162 0-0.3 mg/1 90()2 0-0,3 mg/1 9002 N/A 900W".1 6.5-80 9043 N/A N/A 9001 O-5 NTU - AACT THESE RESULTS INDICATE THAT N(*YT) OF A SATISFACTORY SANITARY QUALITY ACC0[--MI1j NEW YORK STATE EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ` .Pb/Cu LEAD limits for public schoola are set at 15 ppb. / EPA Lead & Copper Rute for Public Gystemm requires that no more ' than 10% of their distribution Points have a LEAD value of more 15 ppb and a COPPER value of 1.3 mo/L, else water treatment must be undertaken to reduce the waters corrosive potential, � Fe/Mn If both iron and manganese are present, their total value Combined shall not exceed 0.5 mg/L. Na No limits for Sodium are pr0scribed. Suggested guidelines state ��. that for people on a sodium restricted diet,the water should � contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, i f 270 _ � , � o.�v ",�m v mg/L or Sodium < ` � YML ENVIRONMENTAL GERV}CES ' 321 Kear Street Yorktown Heights ` Albert H. Padnvani, Director ` �LAB #: 1,60}347 CLIENT #: 263 NON STAT PROC PAGE: 2 ' I..~~~~.~~~~~~~~.~~~~~~~~~~~~~~~.~~~~~~~ ~~~~~~..~~~~._~"~~~~~~~-~~.~~~~~~..~~~.. 00'STUK, STEPHEN DATE/TlME TAKEN: 01/17/06 01iA(` �36 LINDSAY LANE DATE/TIME REC'D, 01/17/06 01,35 - pUTNAM VALLEY, NY 10579 REPORT DATE: 01/26/06 PHDW& (845)-528-3R90 ` MAMPLTNO SITE: 59 LOVERS LANE SAMPLE TYPE.,i POTABLE : PRESERVATlVES, NONE vCOL'D BY: STEVE KA9ll8 TEMPERATURE.,: < 4C � NOTES , KITCHEN TA|� / ^~^ i%]Ll MP '~~~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~°~~~~~~~~~=~.~~~~~~~~~. .-~~~ `� DATF FLA8 PRQCE0]RE RESULT NORMAL - RANGE � THBD is suggested, pH pH SCALE IN WATER RA@BCS FROM 1-14, MEASi8RE]VgNT OF pH lS O THE IMPORTANT AND FREQUENTLY USED TESTS lM WATER CHE |STRY^ WATER WITH A LOW pH 1wil8H~[ BE COB105TVE TO METAL PIPES AND �FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd 'TOTAL HARDNESS lS DEFINED AS THE S{}M OF THE CALCIUM & MAGNESIUM CONCENTRATlON; BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNES HUNDREDS OF MG/Lq DEPENDS ON THE `.��)nu |xEH|MEN| TU WHICH THE WATER HAS BEEN SUBJECTE[>, SO 0-7() MG/L VERY HARD ^L�� | / HARD WATER; 140-306 MOIL. (1 grain/gallon = 170 MG/L) | `. -SUBMITTED RY: Wert Direc�v Padovani, M.l'.(ASCP) r ELAPW l0323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 4AMOK 1 �JC. Owner or Purchaser of Building S I e-fPc/J KAJT%J< I N C. Building Constructed by E_ 8 L % vc12 j CA t*JC Location - Street Building Type eq t Tax Map Block Lot ?0 T7PA in A CCe V TownNillage L0VC -Ptx tgCRe.r Subdivision Name I ly Subdivision Lot I represent that I am wholly and completely responsible for the location; workmanship, material. construction and drainage of the sewage treatment system sen-ing the above - described propem . 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.-, - _....__ -„ - n��- -- .. �_ ....... _.. ,. •..,. a. r __ .._..._.- .._ -�*,. :.ro;: �..._•_. o.:,,... 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. ;General ated: Month d ay 10 Year 2 o o6 Signature: Title:fL.�'.f' 1 GtN'r ontractor (Owner) - Signature OV SI-e-M51i K 1 C. Corporation Name (if corporation) Address: L I MD rA V Zt-) e. Stat IN 1`'�_VA. LL if zip sTvHgtj KqJATQK Ilfc. Corporation Name (if corporation) Address: 3 KIPJDJAV C 1AJV 9 State v (tell 1Q Form GS -97 LETTER OF TRANSMITTAL CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: STEPHEN KASTUK, INC. PCDH PERMI #PV -04 -05 58 LOVERS LANE TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: January 31, 2006 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY VvT•ARE- SENDING YOUattached °..._— .. - ,.......- _,: , ... - -_. ... ........... , ......... ............ . 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) E911 address verification form 6.) $300 certified check for application fee 7.) Well completion report 8.) Water analysis report Please review at your earliest convenience. If there are any questions or if additional information is required please do not hesitate contacting me at the above number. Thank you for your assistance in this matter. Respec ully submitted, Kenneth M. Murphy Design Engineer PUTNAM COUNTY DEPARTMENT OF HEALTII _ D.I.VISION ,0F, ENVIROINMEN.'TA:L X19AT1,11. SERVICES FIELD ACTIVITY REPORT All' Street Town State Zip PERSON IN CHARGE. %� /� - R TNTFR ViFWRn• e e- v1 A - -- r,64 PU1ViP TEST ® FUSE TEST RE Pomp LMED GALLONS C J Q L r =rte m 0 0 m .4I I48.5 A "( r m :1 . - .s. ... .. +. r �• ..... �. • _ • ♦ ..: �.. ... _ . -.. ... .4. .. Ali r .. ..I EL. START EL. STOP IN Q PECTOR ^ TRY Signature and Title RPDA'?pr iDV#"V"=T% DX-"o I acknowledge receipt of this report: SIGNATURE; 02/96 a AA_A.••xiaaJLJa DIVISION OF ENVIRONMENTAL HEALTH SERVICES f (i lc9 e -P FINAL SITE INSPECTION Date. Inspected by: m i- Street Location Owner 1'C& ­S Town. Permit# TM# $4,q• 11 7 Subdivision Lot# 1_Uve 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 ................................. I ................ d. Stone, brush, etc., greater than 15' from STS area....:.:... e. 100' from water course/w:tl ............................ 11. Sewage System a. 4. � _,0_ . Septic tank size - 1,000 ........... 1,250 ......... other ................. b. 'S eptic'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 ....... I ................................... 6. Trenches 1. Length required ' LN q Length installed q 50 2. Distance to watercourse measured Ft.>�7.0-0 - 3. Installed according to plan ......................................... 4. Slope of trench acceptable 1116 - 1/32'.' /foot ............. 5. 10 ft. from property line - 20 ft, foundations.......... 6.. Depth of trench <30 inches from surfice .................. 7. Room allowed for expansion, 100% .......................... &...Size of gravel 3/4 -1' /z' diameter clean ................... 9. Depth of gravel in trench 12" minimum ....... i ........... 10. Pipe ends capped .............. ................................. ....... P UMD, or--DosecY­Svstems "' 1._ Size of pump chamber AJ* ".`IJ 2. Overflow tank ......................................... I .................. 3. Alarm, visual/audio 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................................................... 6. Cycle witnessed by H.D.estimated flow/cycle ........... House/Buildirig A. House located per approved plans, ........................... ....... ,.b. N•mber of bedrooms ........................................................ IV.` Well Well located as per approved plans ...................... k ........... b. Distance from STS area measured I o ft........... c. Casing. IV above grade ................................................ d. 'Surface drainage around well acceptable ....................... V. Overall Worlumanship a. 13oxes, properly grouted .................................................. b. Al pipes partially backfilled ........................................... c. Al pipes flush with inside of box ................................... d. Bzokfill material contains stones <4" diameter .............. e. Culain drain & standpipes installed according to plan.. f Cutain drain outfall protected & dir.to exist watercourse . g. Footing drains h­ --- Surface water protection cion adequate ........ : .......................... i. B.osion control provided ................................................ Rev. 12102 L -Oz 01/10/2006 20:0" 914 ;': 6:3693 CRONIN ENGINEERING 1 fJeWe 511 i I .. � i" ... .- .. .� •` f�.�P. *:.�p- :fir:.. • �.C�.� I PUTNAM COUNTY DEPARTMENT ® HIEALTEI � DMS' 'ION OF ENVIRONMENTAL HEAD H SERVICES ATTENTION. rp GENE )For: � Fill All information must be fully completed prior to any Trenches inspections being made_ k PCHD Construction Permit # t 10 r 0 4 ` a 5, Located- 15'`d Le Vd(Z_ t 1-10 Owner/Applicant Name:.9760fel-' Xasru r _tom -T Formerly,: _...._.._.____— Subdivision Nat ubdi:vision Lot # Is system fill completed? Is system complete? Is system constructed as per plans? Is well drilled? Is well located as per plans? Are erosion control measures in place? i V� ! t Block 1 Lot -Z-2- Date# 1 I certify that the system(s), as listed, at the above premises has been and verified their completion in accordance with the issued I approved :plans: and the:. Standards,, Jules and Regulations of the Health. Date: ? � Certified by: C Q<Yj 11 Address: Comments: Form FM -99 Design Prc rswJ W H L-J41 'Wt- cJb _ PbEKr- onstructed and I hay a inspected "B Construction �ermit and Putnam County De artmaent ,of 160 � `PE �RA asional .1, 01/10/2006 20:03 9147363693 CRONIN ENGINEERING 1 PAGE 02 BY THIS CERTIFICATE OF COMPLIANCE THE BUREAU OF ELECTRIC TY 40 FULTON STREET -- NEW YORK, NY 10038 CERTIFIES THAT ;.; Upon the application of up Do. premises owned by: MOONLIGHT CONTR INC, TEVE KASTUK F.O. BOX 3$9 LOVERS LANE JEFFERSON VALLEY, NY 10535; UTNAM VALLEY, NY10579 Located at 58 LOVERS LANE PUTNAM VALLEY, NY 10579 Application Number: 2084499 Cent icate Number: 20$4499 Section: 001,84,11glogk: 1 Lot:.:. 27.. Building ermit; 2005 -327 : BDC: W106 Described as a Residential 0 -599 square ft. occupancy, wherein th premises electrical system consisting of electrical devices and wiring, described' below, located in /on the premises at: Basement, Outside, A visual inspection .of the premises electrical system, limited to .electrical vices and wiring to the extent detailed herein, was Conducted in ac:c:ordance with the requirements of tie applicable code. and /or standard promulgated by the State' of New York, Department of State Code Enf rcement and AcIrninj.stration, or other authority having jurisdiction, and found to be in compliance therewith on th 5th Day of January, 2006. TY' '.Raf :Rfltj .�,:... Alarm and Emergency Equipment Panel Board 1 septic arm Appliances and Accessories 3 Pump Motor 1 septic F H.P. Wiring and Devices switch 2 float 4ecial seat I or 1 This certificate may not be. altered in anyway and is validated only by the presence of j raised seal at the locatipn indicated. OF P. 2 11/04/2005 13 :1il 91,1 353593 CRONIN ENGINEERING 1 PAGE 01 PUTNAM COUNTY DEPARTIWENT gDIVISION OF IENVIRO"IEN ?AL HEAL ATTENTION ® AAW&t 0 GENE REQLFST FQ L FINAL INSPECTION For: All information must be fully completed prior to any inspections being made. HEALTH I SERVICES F; T PCI� Construction Permit t # ( �t -'p Located: /JAr - _ (f V Owner /Applicant Name: g`'f&?hKZ1 Kt)..t'°rciK JAJC_ Formerly:- - - -.__ r Subdivision Name Subdivision Lot # U Is system fill completed? . AJA _ T Date Is system complete? OiJ Date _ I t t t d 1ans7 ics J' "A! VA LILe� Block Lot �? _ Pec'm �_, r?er_v 14 —.2, oi3 s sys em cons ruc a as pep ___ Is well drilled? Date Is well located as per plans? .Are erosion control measures in place? I I certify that the, system(s), as listed, at the above premises has been onstructed and I ha je inspected and verified ;,heir completion in accordance with the issued CHD Construction IPetmit and t.fl Standards,ules and Regralations:- o.th?tnam;County.De0ariment•of _._. _.... Health. Date: _ -� 8 Certified by' OUR 1 PE _ L— RA 2- ---TdW J WA trf jj JRL-lo Desip Pro ssional i Address:. �?_" ILL / Comments: Form FIR -99 O UTNAM COUNTY DEPARTMENT OF HEALTH' " '' DIVISION OF ENVIRONMENTAL .HEALTH SERVICES�� •P. :+: �}Y' m.._:..a- ... rg....wf ... .. _. N ,.y o . w . w.ryf! • r-. .• ONST�/R/U�/CTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at LOVS95 1. ^N g Town or Village Rv7'WA+M ✓aql'y Subdivision name *A*ubd. Lot # 14 Date Subdivision Approved NovsMQE'k 1141 11996 Owner/ Applicant Name 5�EU K *WVK .. 1 gt, Tax Map M. /1 Block I Lot Renewal Revision Date of Previous Approval Mailing Address 36 4r4AF y LA/V r ArMAN1 1/R&t Ey . �!Y Zip /as .71 Amount of Fee Enclosed .0 Li 00 Building Type S iWiL E Q-*4(L-y Lot Area 3.003 No. of Bedrooms Design Flow GPDY Fill Section Only Depth Q -21911 Volume±' PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 s0 gallon septic tank and g 4 4/ L- F. 6i= 'J" e PV G IN Z 4." 6; Q AV Ec.. T 12LC NG tF Other Requirements: P S)(ST'e To be constructed byT® l6 DergK MI145D Address Water Sp�plv�._ Public Supply From _ Address _ z "or: —J Private Supply Drilled by No RMA4 4N D EIt54N Address IS2 ftae'2 SmQ�Er' P►•rNA�l &LLsy. NY 10." I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate 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 Com .p" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee .wiltbe''`'fu%isl}�`d:the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating pn` ion o aid sewage treatment system during the period of two (2) years tbi immediately followig�date of stance ofrovl of the Certificate of Construction Compliance of the original system or any Signed: o, < Address J 0 *N W E. w .E. R.A. Date LL vim_ License # 061186 �e�� JrYO F ESS1`J�j% APPROVED FOR CONSTRUCTION: °'l rs°Wooval 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 Directoi. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domest' sanitary sewage only. By: Title: Date: d�5 opy - HD File; Yellow copy - Buildin spector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH TiDffVlSffON OF ENVIRONMENTAL ENTAIL. H EAILTIHi SERVICES APPLIICATIION TO CONSTRUCT A WATER WELL lWepn, Qr SYPe :� -� 7 - - P`CHD- -Permit #.. = . Well Location: Street Address: Town/Village Tax Grid # L a VAS t. W& XrNA14 V1* Map fV ! I Block e Lot(s) a?;, WelllOwneir: Name: Address: SZ0069 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- pirimairy Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __(o gpm # People Served 44 Est. of Daily Usage JLo0 gal. Reason ffoir Replace Existing Supply Test/Observation Additional Supply Drilling Y New Supply (new dwelling) Deepen Existing Well Detailed Reason 1q/ & PXY F'o P, N E vV (Z 6.5 r 9 6F N LE ffoir IlDa illing Well Type 1( Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision L 0 bF`— P 9`EY. A (R.F -S Lot No. J4 Water Well Contractor: NoQMhm AN DASH W Address: 1,9-2PftFR S-r Purg4M I/A�tk- M Is Public Water Supply available to site? .................................. ............................... Yes No C,K_ Name of Public Water Supply: �v A Town/Village fy/ Distance to property from nearest water main: /1 Proposed well location & sources of contaminatio rovid d on separate sheet/plan. Date: —13 —C-15- Applicant Signature* P1ERMRT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permi Date of Expiration O Title: Peirmit is lion- Tiransffi •abI White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: Stephen Kastuk Welland SS TS Construction 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) East side of Lovers Lane, approximately 750 ft. south of the intersection with Peekskill Hollow Road 5. PROPOSED ACTION IS: ❑■New ❑Expansion ❑Modification /afteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and a water service connection for the construction of a single family house 7. AMOUNT OF LAND AFFECTED: Initially 3.003 acres Ultimately 3.003 acres 8. WILL PROPOSED ACTION'COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Eyes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑■Residential ❑Industrial ❑Commercial ❑Agricultural ❑Park/Forest/Open space ❑Other Describe: Surrounding lands are zoned single family residential O: J Ji~S C.TIO�1.lNV�i�1l� A.P.ERMIT APP'90 -VAL OR-FUNDING, NdW 0 `UL-•V `( �ROIV1,ANa( OT.IiER GOVI= RNMf3NTAL - -- AGENCY (FEDERAL, STATE OR LOCAL)? Eyes ❑No If yes, list agency(s) name and permit/approvals Town of Putnam Valley — Building Permit, Putnam Co. Health dept — SSTS & Well Permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ONo If yes, list agency(s) name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes jNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor name: �n En/ineee in P.E. P.C. /Patrick M. Bell date: 4 -14 -05 Signature: If the action is in a Coastal Area;-and you are a state agency, complete a. Coastal Assessment Form before proc'eeding with this assessment OVER 1 PART &ENVIRONMENTAL MESSMENT (To be completed by Aaencv) A. DOES ACTION E EED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process use the FULL EAF ❑Yes 4200 B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declarati iy be superseded by another involved agency. ❑Yes "❑1Qo 11 f t N � `: 4Rd'�.. t.. G% ._ .. ... �..< K ...cam et^:r..i a •+c.. .. .^.'°w - hyx>av': moo. 'la.. «.'Qr .F^• 4i^4.. G.i.• ^ M . �<�Cd -.. w n p....M ^t ✓:�d r..w d,'..� �r.:4.e 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 patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? ExpllainJ briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Exp p briefly... C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natur resources? Explain briefly CD C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly:`' C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: O V� D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENT—AL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes , If Yes, explain briefly: E. IS THERE, O S THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑YesYes, explain briefly: Part III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) For each adverse effect identified above, determine wheth..er.ft is. substantial ,.large,_importa_rlt.or otherwise significant. . — hac"ffeet- sMuId-be ass essed-irr connecti on with its (a)-setti ng (i.e. urban or rural);1b) probabiIity of "occurring; (c)-du rat on; (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 Geed directly to the FULL EAF and /or prepare a positive declaration. /k this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: A-"'h Name of Lead Agency Prince Type Name of Responsible Officer in Lead Ager_yy h,, Title of Responsible of Responsible Officer in Lead Agency /,Signature of Preparer (If different from responsible officer) � vs date f J .4 -T6�L p --T7 W � vet V LA CE LLI w �4ddd II Y.�S DD/ Z H12 l�� F.o E ° �• EL % J rl 5u z� jfj 1-1 mao ,em tD LD Q tr. Aft IL (S) , X*. LO "'- m .. CD jo •R � � L i n D i r SHERLITA AMLER, MID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 16, 2005 Patrick Bell Cronin Engineering The Lindy Bldg., Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Dear Mr. Bell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONIDI County Executive u/ Re: Proposed SSTS — Kastuk Lover's Lane, '(T) Putnam Valley TM# 84.11 -1 -27 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 1! Please check with the Town of. Putnam Valley concerning any wetlands that might be associated with the brook. Please either provide a wetlands permit or a letter from the town stating no wetlands exist. Please label the roof leader /footing drain. Equal distribution is required for all dosing systems (primary and expansion). 4. The proposed grading of the 316 contour is unclear. Is the existing 316 contour with grM ,: .pd e ;4A th > t In all sections on the plan where fill is being noted, please note that the fill is to be ROB fill and that it is for grading purposes only. 6"' Please provide a note stating that the proposed SSTS is to be staked by a licensed land surveyor prior to construction. 7/ Please provide basement floor plans for review. 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. JSP:cj Sincerely, Coseph S. Paravati, Jr. Assistant Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 ININ ENGINEERING, P.E., P.C. Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, Ngw York.10566 , '(914)736 =3664 •-Fax: •(9.14)736 =3693' June 21, 2005 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: Stephen Kastuk, Inc. Tax Map #84.11 -1 -27 Lovers Lane Town of Putnam .Valley Dear Mr. Paravati: Please find enclosed the following materials in support of the subsurface sewage treatment system and well permit for the above referenced project. 1.) Three sets of the revised SSTS permit plans 2.) Two sets of basement floor, plans _ 3.) Copy 'of the wetland permik-appiova!- .... „... m... ::.�_ ...:.. :..._ These materials are being submitted in response to comments provided by your office in a letter dated June 16, 2005. Please review the above documents and advise of any additional materials you may need for processing this application. If you have any questions or comments, please contact me at the above number. Respectfully submitted, Kenneth M. Murphy Design Engineer Jun 13 05 10:47a Planning Board (914) 526 -3307 .,i P.3 e. June 6, 1005 STEPHEN KASTU1K, INC. SITE DEVELOPMENT PLAN WETLANDS PERMIT NEGATIVE DECLARATION OF SIGNIFICANCE LOVERS LANE TM: 84.11-1-27 FILE: 84.1114051970 WHEREAS, the applicant is proposing a single-family residence on 3.0 acres of land located on Lovers Lane in the Moderate — Density Residence (R-2) '-Zoning Distric;i; and WHEREAS, in accordance with §165-16 of the Zoning Code, a Site Dcvc;iopment Plan is required; and WHEREAS, construction will take place within a Town regulated buffer area and a Wetlands Pe -emit is required; and WHEREAS, the Code Enforcement Officer has deterininod that a Major Gn'ding Permit is WHEREAS, a Short Environmental AssEssrient Form (EAF), last re\ -ised May 24, 2005, was submitted to the Planning Board; and WHEREAS, the proposed action has been determined to be an Unlisted Aaiun under the State Environmental Quality Review Act (SEQRA); and WHEREAS, the above mentioned application has been reviewed by the Putnam Valley Planning Board, Town Engineer, and Town Planner. NOW THEREFORE BE IT RESOLVED THAT, on motion by Thomas Pat,eison, seconded by Eugene T. Yetter, Jr. and carried, the public hearing for the Site Development Plun and Wetlands Permit is hereby closed; and BE IT FURTHER RESOLVED T.1-1_AT, on motion by Richard Tully, seconded by Eugene '1'. Yetter Jr. and carried, a Negative Declaration of Significance is hereby issued: ad JOHN N1. ZARCONE " ' THC61AS OA rTERSON Chairman PLANNING BOARD Secretary MICHAEL J. RAIMONDI 265 Osxawana Lake Road RICHARD TULLY Vice Chairman Putnam Valley, NY 10579 -2004 EUGENE T. Y):TTER, JR. THF.. CHAZEN COMPANIES JOSEPH C. BECERR;k Town Planner (845)526 -3740; Fax: (845)526 -3307 (Adhoe) INSITE ENGINEERING E -mail LAURA L. LUSSIER Totivn Engineer Clerk June 6, 1005 STEPHEN KASTU1K, INC. SITE DEVELOPMENT PLAN WETLANDS PERMIT NEGATIVE DECLARATION OF SIGNIFICANCE LOVERS LANE TM: 84.11-1-27 FILE: 84.1114051970 WHEREAS, the applicant is proposing a single-family residence on 3.0 acres of land located on Lovers Lane in the Moderate — Density Residence (R-2) '-Zoning Distric;i; and WHEREAS, in accordance with §165-16 of the Zoning Code, a Site Dcvc;iopment Plan is required; and WHEREAS, construction will take place within a Town regulated buffer area and a Wetlands Pe -emit is required; and WHEREAS, the Code Enforcement Officer has deterininod that a Major Gn'ding Permit is WHEREAS, a Short Environmental AssEssrient Form (EAF), last re\ -ised May 24, 2005, was submitted to the Planning Board; and WHEREAS, the proposed action has been determined to be an Unlisted Aaiun under the State Environmental Quality Review Act (SEQRA); and WHEREAS, the above mentioned application has been reviewed by the Putnam Valley Planning Board, Town Engineer, and Town Planner. NOW THEREFORE BE IT RESOLVED THAT, on motion by Thomas Pat,eison, seconded by Eugene T. Yetter, Jr. and carried, the public hearing for the Site Development Plun and Wetlands Permit is hereby closed; and BE IT FURTHER RESOLVED T.1-1_AT, on motion by Richard Tully, seconded by Eugene '1'. Yetter Jr. and carried, a Negative Declaration of Significance is hereby issued: ad Jun 13 05 10:47a Planning Board [914.1 526 -3307 p,4 a 4' BE IT FURTHER RESOLVED THAT, on motion by Thomas Patterson, seconded by Eugene T. Yetter, dr. and carried, the Wetlands Permit and the Site Development Plan prepaied PE., 12, 2005 is.hereby app.r9r,ed2, subject to the below-listed conditions; and BE IT FURTHER RESOLVED THAT, ttheVetlandsPea nitisapproved subject to the signing of the Site Development Plan and shall be valid for a maximum period of three years from the signing of the Site Development Plan; and BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid for a period of 18 months after the Site Development Plan has been signed by the Vice Chairman and may be extended once, at the request of the applicant, by the Planning hoard for a period not to exceed six months; and BE IT FURTHER RESOLVED THAT, all work associated with the Wetland Permit shall be completed within a period of six months following initiation of constl-uctioll, and BE IT FURTHER RESOLVED THAT, the below listed conditions must be completed within 6 months of the date of this resolution. Should th.� below- listoc' conditions not be completed ;within the allotted time frame, this resolution shall become null a--Id %,oid unless an extension is requested by the applicant within said 6 month period and gra ted; and BE IT FURTHER RESOLVED THAT, the Site Development Plan and Wetlands Pcr)uit are subject to the following conditions, which are to be completed prior to the signature of the Site Dewitopment Plan by the Vice Chairman: 1. Submission of all applicable fees and escrow. 2. A construction escrow fund in the aircunt of $1,000 small be. establis..ed wicl> the Planning Board. V. An engineering /inspection fee equal to 5% of the oust of construction, less the cost of the septic and well construction and installation. shall be provieed to the Planning Board in t rm bf,a'certified check. A cost s :�timarE ha' 1�ba�, I :zepare.dtil�y.;the�ahlilic�i�i� u_ud reviewed by the Town Engineer. 4. The comments outlined in a letter from the Town Engineer. dated Jun(. 2, 2005. 5. The Planning Board Vice Chairman shrill sign the Full Environruental A.ses. =ment Form, dated May 10, 2005, 6. Prior to the signing of the Site Det•elopinenr, Pia: by the Vice Chairman., the re•.,is'ed plans shall be reviewad by the Tcwn Engineer and Town Planner and correspondence from both shall be submitted to tha Planning Board indicating that all conditions have been satisfied and the Plans are ready for signature. 7. 5 original copies of the Site Development Plan, sinned by a aiceiised Professional Engineer and the owner of the property, shall se submitted for the Vice Chairman's signature. A, Jun 13 05 10:49a Planning Board (914) 526-3307 r-.5 k 0 am N"alley Planning -n may be required by the Town of Putnam ,,�,.other conditions that m, goard'Buii dirib- epartmeiiik,,-�;,ffighway Consultant, or anv tv other department of the Town of Putnam Valley. ice Michael J. Raimoa SHERLITA AMLEB, MD, MS, PAAP ROBERT J. BUNDI , Commtuioner ofHrnfrh k County&nmunw LURwrrA MUUNAR1, RN, MSN . AaIwi= Cot- duioecr oflloaflh DEPARIVENT 'OF HEALTH. June 16,2005' `• Goauva Read. Nrrwau::, New York 10509 ' Patrick Boll Cronin Engineering The Lindy Bldg., Suitt-, 2011 2 John Walsh Blvd. Peekskill, New York 10i66 Yr PLoposedSSTS — Kastuk LOVOr's Lane, (1') Putnam Valley TMk 54.11 -1 -27 D= Mx, Hell: 'Ibis office has reeelvrd and revieweo Lr, wo6l resent set of plans for the above mentioned project. We would like to offer thr lid lt,winc owunents for your review and considenainn. 1. Plefvsc check with the Town of Pumam Vullcy i:oncarning 9ny wetlands that might be associated with the orovk. Pita >,, niilaa provide a wetlands permit or 9 letter from thu tow,n stating no wodlulW %%tw 2 Please label theruuflvadw tooul:y drool. 3. Equal distribution Ls rcquued for all dosing systems (1117nury told oxpunsioa). 4. The proposed grauiug of th.: i In conmur is unclear. is the existing 316 contour with the upot grade of 317 a to iomam Please clarify. $. In all sections vii the plan whet. fill i6 being noted, please note that tho 1111 is to be ROB fill and that a is for RrudinF ourpw s otdy. 6. Pleaso provide a note stating That hu pw[k)sod SST; is to be staked by a licensed land survayor prior to conk —waimi Plcase ptvvidr basemen: tlrKrr yiuru for n5t'iUW. This uflico will continue its mview upon w:usWcraovu orthe above mentioned comments. Please fool 1Tee to contact meat ext. 115'.1 if auy ti c5giuttt arise. ' Smcertay, Q' \. Osepo $ P:Lruvuti, Jr. 4sistwu Public 4lcalth Engineer ..- _— .....�:•...' ...y � .,..., :....: �. -:.... � .......:... ,......•. ..:....: .... ..,. '.....rtioria,axml�BeulC�..Iatl.S 379.6170. Fac lalV Z "1Ad931 . � •' .. .... ,. .... � ......._ .._. _. - .... ....... _... ..._... ....... —. n... ._... Hu,dlt` &rvlw (995177a.6.i3r WM (945) 279.6679 P-(843)278-6085 i F:MylW-- dad?nawwol(9451279.e014 P.al45)3786649 •• aZIJIWSXVdLL ,LNMI000 JNaDaU ,d0 a9Kd ISHI3 xO sJZflsal3 was saow -,6E,00 aKil Q2isdV IS 8£:TT OZ -NAL' JUVILS T/T S3Jtid £69£9£LVT6T6 : MOM TZ6L- 8LZ -Siv8 nIBJ HlgVHH 3o ZNaKIHVdSG AINfloO WVNJfld • aWVN O 'V:TT NOW SOOZ- OZ -Nnr : ZIVI NOINK I NO3 ONINS .- ''t ,. -.. ��c �!f o.; �t;,,ri 0.r ;:'ao •.::vF= `I�r� -s3 �:.'.. .y �us .ii7 °. R .;:v;,•S�-. _ :'{r -o..:: �u .:Y'1 �•�ki't:'w xr;:v.- .. .:._ _. .. S14ERUTA AMI.ER; IIID, NIS, b'AAP ROBERT d. BONDI COM//tWIO'tW of Nrrdrh « courtly Pp. -one LORETrA MOLINARt. RN, tNSN ArtoUore Commtaioaer of He fth DEPARTMENT OF HEALTH Junto 16, 2005 i i —eva Reaa grow•ilm New fork I05D9 ' Patrick Bell Cronin Eugitrcaring The Lundy Bldg., Suite 200 2 John Walsh Blvd. / Peekskill, Now York 10566 v Proposed SSTS - Kastuk i.oter's Lane, (T) Putnam Valley I NIH 84.11-1-27 Dew Mr. Bell: This offict: has received ante, revtrwed tar nos. n:ccot su of plans for the above, montiond prujucl. Wr. would like to offer The follow,,w etmtmrtw; lin your review and considerntimt. 1. Please check with the 4-1, .,t - ,! ,am alley concerning any wetlands that might be i associated with tie bit-too Ph+aa� airhtr proa'ide a wetlands penult of a letter from the town stAtine, no wedwids exist 2 Plcatse luhnl the roof leader•'fihtntnV. ta-dw. 3. Equal dieiribuuun i, t ctluw,0 to :tit axing systams (printery and expansion). 4. The proposed gtafliny of the '' i,, oontuur u unclear. Is the existing 316 cocoas with the spot grade of 31 %.4 to rumam" Please clarity. 5. In all sections on the phut w•hor,. iii; it ueiag noted, please note that the, fill is to be NOB fill and that its fur grew— puyuscs only. 6. Please provide a note aauog ;km die proposed SSTS is to be staked by u litx:nstxi laud surveyor prior to nnnstructia, 7. Meade provide baeemew tlooi pone rirt rveivw This otlice will continue iw rcvic t upto, ,.ana:nuitm of the above mentioned comracuts. Pleas feel ti'ea to intact me.. si ex i. 215 ' n'wt, ..I,.ririow ;liar, ;wcctely. ... 2 t"naravati, Jr. 44:4i,u lL Public Health Engineer JSP:cj M tm.iretweatW llraetlruh, a �,N- wat! 6)"221wW-7X .11 w Iu Mi >271- r iii� ...�_..... Runtoy &r:ata faun rx•esrr. wtVtx45)2'1a -6671 Fm(845)2711-6015 Ewi7 ldsrv.elkYNratelwlttla5�278.6e14 Ftu(84S)2796W8 _ • • •QS,LtLIWSNV iJ, ,LNMIDOQ SNSOSd do SDVd ZSHId xo : Sszns d WOS : SQOW tt8£.00 : SWIZ QSSdV`1S 89:80 OZ -Nnf : SWIZ JIUVLS T/T : SS9Vd £69£9£Lf7T616 : MOM TZ6L- 8LZ -Sb8 qS,L H17VHH 10 ZNSFLLHVdSa AiNnoO WKNSnd MNN 65:80 NOW SOOZ -OZ -Nor SZKa NOI VEIN03 DOES PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT` '' D i �... NAME OF OWNER: STREETLOCATION: REVIEWED.BY: ' RM, GR, SRDATE: L TAX MAP#: (CONFURSMD) if /N DOCUMENTS C�f/ (�PERIYIIT APPLICATION )WELL PERwr OR PWS LETTER LETTER OF AUTHORIZATION (DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION (���SHORT EAF (Z PLANS -THREE SETS HOUSE FLANS -TWO SETS UUVARIANCE REQUEST SUBDIVISION (� LEGAL SUBDTVTSION ' (�SUBD-rMION APPROVAL CHECKED (PERC RATE L REQUIRED DEPTH - (_)CURTAIN DRAIN REQUIRED GENERAL (� OCATED.IN NYC WATERSHED (! PLANS SUBMITTED TO DEP ELEGATED TO PCHD DEP APPROVAL, IF R + Q'D DEEP TEST HOLES OBSERVED (_ —X _ URCS TO BE WITNESSED AL�SDS�iit3I PT4__ (TOWNIDEC PERMIT REQ ;•15PPZ 1969 NEIGHBOR NOTIFICATION E'TTER BI/ZBA pox . it:: FLOQD,,7�YA'TIOI�i V(?fI Z00' ��jOIL TESTING LOTS >10 YEARS OLD RTOUIRED DETAILS ON PLANS i - . )SEWAGE SYSTEM PLAN (NORTH ARROW) Z.J(_- SSDS HYDRAULIC PROFILE _)(,/ )GRAVITY FLOW �j CONSTRUCTION NOTES 1 -15 ' cj�DESIGN DATA: PERC & DEEP RESULTS -jLJZ'CONTOURS EXISTING & PROPOSED HUSDAjT SOIL TYPE BOUNDARIES L ITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# 7,�DATE OF DRAWING/REVISION ))DATUM REFERENCE /0 LOCATION OF WATERCOURSES, PONDS LAKES,WETLA.NDS WITHIN200' OFP.L. (—)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S WnN 200' OF SSTS PROPERTY METES & .BOUNDS L)L,JEROSION CONTROL FORZOUSE, WELL & SSTS, EROSION CONTROL NOTE Y (REQUIRED DETAILS ON PLANS CONT'D? �HOUSE SEWER -VT FT. 4 "0'; TYPE PIPE.CAST IRON NO BENDS; MAX B 1CU OUT RENEW /!' TE (NO CHANGE) ./ FILL S1 STE (._- )LJ-10' HORIZONTAL; PA CH SLOPES 3:1 TO GRADE SPEC NOTES 1 -5 vk- ( -,_J OME & DIMENSIONS FILL IN EXPANSION AREA S �- FILL GREATER TRtN4f7ffTr S r� 'UU CLAY BARRIER UUFILL•CER ON NOTE , L )L JDE GES (__) . ON PLAN FOR R.O.B., UNCLASSIFIED & MWERVIOUS SEPARATION DISTANCE FROM'TOE OF SLOPE TRENCH*' (✓ . LF TRENCH PROVIDED/ 60FT MAX. L✓�PARALLEL TO CONTOURS (�100% EXPANSION PROVIDED �DETAAIJDUST FREE CRUSHED'STONE OR WASHED GRAVEL GEOTEXTILE COVER. SEPARATION DISTANCES ON PLAN , FROM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. ` TO FOUNDATION WALLS 5v 100' TO WELL, 200' TN DLOD,'150' TQ PITS 100' TO STREAM, WATERCOURSE, LAKE•(iaa c%par.). 50' TO CATCH BASIN, 35l.ST,0RMDRA $ PIPED WATER 50' INTEPSvIITTE1v'T DRAI1�iAGE COURSE �. (PUMP NOTES . DOSE ?5% OF PIPE VOLUME/DOSE VOLUME NOTED ETAIL FOR FORCE'.MAIN, (PIPE TYPE, ETC.) AND D -BOX SHOWN & DETAILED C�Ul DAY STORAGE ABOVE ALARM E2�_J10'HWITO 00'1500 RESERVOI$2, ETC. 150' GALLEY SYSTEMS LEDGE QUTCROP ' SEPTIC TANK ' 10' FROM FOUNDATION; 50' TO WELL . WELL • U/. DIlVIENSIONS TO PROPERTY LINES C----f( LOCATIOK OF SERVICE CONNECTION • MIN 15' TO•PROPERTY LINE • • SLOPE • �` ,• . SLOPE IN SSTS AREA (520 °!0) ���"`' `�"'°'•� +�' U REGRADED TO 15 °! °, IV REQUIRED • •. • DOSE/PUMP SYSTEMS ' (__)L )STANDPIPES, 5' L�L�1S' MAN to CD 20'-4 %, 25' -3 %, 35' -1 %,100 % --<I% (_.)(__.)20' D DLSCHARGE/100' with 182 cons day discharge (__JL__)19''9W to NON - PERFORATED PIPE 'SHEET)09 101/00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES } LETTER OF AUTHORIZATION RE: Property of !j�Ph` -w /f,9S-1-y/( /✓Vc Located at �_ D vEl-izS / T/V 6D]/,4M Tax Map # (Z-q. If Block .-- Lot o? 7 Subdivision,of L,0116--PECK ACRES Subdivision Lot n Filed Map # 2-1 Date Filed MUFOD69 IV, 1581 r Gentlemen: This letter is to authorize .:j';m o C,R o t4 i N a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the cons Wab, of said wastewater treatment and/or water supply systems in conformity with the prov' ton's 6f cl�.� 45 and/or 147 of the Education Law, the Public Health La;� and the -Putnar4 04/p lea :. _,.. - .. , .._... �.:. Very truly yours, Countersigned: 1, 6�29so Signed: P.E., R.A., # `� o r��S�Q (Owner of Property) Mailing Address 2- Jo H N VV A LS H QL VD . Mailing Address: iN DS&V L 04 AE 12e KS K I t✓L , State ;�/ Zip / d s-i(6 Telephone: 14 ) -73L- State N y Zip / o S ? Telephone: (Yys-) - :5Zy — 2 Z go Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ .......v _ _ APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 5TI57 rV K ASTVK /,N C. 2. Name of project: S5" 55%� j' �LFi1% 3. to T�V: ��t�✓►Ri� I�A��E`/ ................. ..... 4. Design Professional: �MO11ty �• «vN /r0 .5. Address: Z —To ffr! Wilt-S hL gul Vi 6. Drainage Basin: /9C"KSKlc-(_ 40U.0w' J2voK,, N i lei 7. Type of Project: _ 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ...................:...... NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N �' 11. Name of Lead Agency N ld 12. Is this project in an area under the control of local planning, zoning, or other �. , officials, ordinances'?` :.......:.:. ...:..::. :...:................. ........... ............................... _ : €5 =...._, _._............ 13. If so, have plans been submitted to such authorities? ............ � 14. Has preliminary approval been granted by such authorities? Date canted: Nl►4 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designatiofi? .................... N Ltq 17. Waters index number (surface) ..... ............................... k 18. Is project located near a public water supply system? ............................. /V 19. If yes, name of water supply /V %A Distance to water supply 20. Is project.site near a public sewage collection or treatment system? : N�� Distance to sewage system 21. Name of sewage system 22. .Date test Boles observed 23. Name of Health Inspector 49i+AA VA_ I 24. Project design'. flow: (g allons paddy) .... :........... ............................... 0`1 25: Is State Pollutant 'Discharge Elimination. System ( SPDES) Permit required ?... rl 26. Has SPDES Application'been submitted to local DEC office? ......................... A) 4 27. Is any portion of this project located within a designated Town or State wetland? A/6 28. Wetlands ID Number........... .... ............................... �....................... Is `VV e- tlands Permit required? ............ ................... .... .......:....................... ..... NO Has application been made to Town or Local DEC office? ............................... �V 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, landfilling, sludge application or industrial activity? .............. ............... Yes/No A/0 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 ao DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... y-E 5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... Nv 35. Are any sewage treatment areas in excess of 15% slope? ............ No 2 36. Tax Map ID Number .......................... ............................... Map 6q It Block I Lot o' � 37. Approved plans are to be returned to ..... Applicant _Y\_ Design Professional NOTE: All applications for review and approyal of a new SSTS xo be laced.withinxhe.NYC Watershed.shall. -be sent #o-the'-Department;-and`rieed-not he senfiri duplicate to the DEY, artE&ai -i 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 inform ion provided on this for h e to the best of my knowledge and belief. False stat eats made herein are• ash a Class A misdemeanor pursuant to Section 2 .45 of nal L ° i h � i ►DIG! A T 7S aft ®FFICUL TITLES, I . � . .. _�, �R`� 5 • . • _. Id Ma ipg Address ...................... o R it!/ A-L S µ ` Aso �\,OrV grg �6C I A, lid \1 / OS 9 �FESS PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.�DESIG [_ A�' rSHEET.- :STJBSURYACE SEWAGE' TREAT- -MENT=SY&TE''M ?.6 L1ry D.5 "9z/ G Owner ST P/ -N s-111K, , l✓V Address Pm /v S; h � 7 Located at (Street) G o v i�-j'Ls LfN�f Tax Map 8411t Block . / . Lot (indicate nearest cross street) Municipality (�T) PVrN,� ✓/ai ` E Drainage Basin ��EKS K I t_ �. !✓� Oki g2 o o K SOIL PERCOLATION TEST DATA Date of Pre - soaking 44 /--�v 1 0 S-- Date of Percolation Test i t A to � Hole No. Run No. Time Start - Stop Ela se Time �illin.) NDe th to Water ro n Ground Surface (Inches) Start Stop Water Level Dro In Inc�es Percolation Rate Min/Inch 0� "° a �/ 7 � Z,o 11 311 9 2 �v1 3 3 3 1 3 y D 30 fa 4 3`'° 410 30 /a 5 PZ 1 2 2P 3 3'° 3sv O 8 4 3sa20 3o �J 5 1 . 2 4- NOTES; 1.. Tests -to be repeated'at same depth until approximately equal percolation rates.are.obtained at each percolation test hole.; (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be u + submitted for reviews -.2:. Depth measurements' to be made from top of hole. - !` Form DD -97 0 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.51 1.01 .2.0 2.51 3.5 4.0 4.50 5.01 5.5' 6.01 6.51 7.0' .0 7.51 8.0' 85 9 0�... 9.51 10.0 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered /-j //I- Deep hole observations made by: !`1 Date Design Professional Name: —rjA4*TtH L.- Cb?owj1j _IT Address: .2 jo*W WM:fSa R1,Vj) Signature Design Professional's Seal 62 OtiOFES PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN_ DATA.SHEET -- SITDSURFACE:SEWAGE "TREATMENT SYSTEM Owner T vk�N K 6 D K I IV C - Address PvTN►,4W 1/4�a IVY /o- r-Y j Located at (Stireet) L0 VETZS �f1,y '... '1 Tax Mapes Block. .1.; Lot (indicate nearest cross street) _ Municipality f7) 2vtWdr4-'VA- Drainage Basin (ft (CS Kl Z H LL ow BRoo K SOIL PERCOLATION TEST DATA Date of Pre - soaking q i -1') 5— Date of Percolation Test y I - r os­ Hole No. Run No. Time Start - Stop Ela se Time t�i Iin.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch l 202 Y° 2-14 11 `' 710 11 ✓ It 2 aq2 3 oq a J. 4 30 NV -,: I o 5 3 310 3J1 30 /0 4 3 v ✓ IV �d 5 3 .. .4 .. 5 1VUTES: 1: Tests:to'be repeated' at same depth until approximately equal percolation -rates are `obtained at each percolatiodn test hole] (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. "r 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' TEST PIT DATA ]DESCRIPTION OF SOILS ENCOUNTERED EX, TEST -H,QLL ZS,, HOLE NO. 1 HOLE NO. * 0 2 HOLE NO. AV e,�+ cossG& 2 ,..v " I 11. ,y Indicate level at which groundwater is encountered I r FR 5r Indicate level at which mottling is observed A(,O D T -rd-1 dI -2 Indicate level to which water level rises after being encountered /�'4591r Deep hole observations made by: CPomi N 6-iV &&, s�� Date �,. Design Professional Name: m oT" 1, CR o Rt r • \ J y Address: j ® ffN g aL vD. O��c 'ACS / �d'� a �,'!�� ' "•�`'� � w Signature: 629$0 U 'JNOFESS��� Design Professional's Seal 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES X;NiTIA1G INDrIViillVilYl ECIAL INSPECTION FORM TJA3:lC SITE SECTION A. GENERAL INFORMATION Name of Project ��- S ~�i� (T)(V) I L)7 n�vn ~lt� -`1 County Site Location . Lov,�.a -S Building construction begun NO Extent Is property within NYC Watershed ? ................. Q Yes �No SECTION B. TOPOGRAPHY (Please check all appropriate Boxes) 1. 0 -Hilly. 0 Rolling ;qsteep-slope a Gentle slope Flat ' .2. Evidence of wetlands Low area subject to flooding Bodies of water . ❑ Drainage ditches Rock qutcrops S 3. Property lines or corners evident ....................... ............................... Yes No t ..... 4. - 'Do water courses exist on or adjoin the.property? .................. . Fi Yes �F7 No 5: Will these affect the design of the sewage system facilities ?............ Yes M 'No 6. Do watershed regulations apply in this development ? ....................... 0 .Yes J12!�7No . 7 Will extensive grading be necessary? ............. . `� Yes No 8. Will extensive fill be necessary for SS`f.S ? ........................... :.Yes : No- -- M ° • " '�' 4: Do filled areas exist within the SSTS area? ..:... .................:......:.:.... Q Yes . No If yes, what is the condition of the fill? . SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: OSand CKGravel Loam 0 Clay Hardpan Mixture 11. Observed. from: 0 Borings Bank cut . �a6khoe excavations 12. Soil borings /excavations observed by ASP, ^ (e�O t�k,k9 on°� 13. Depth "to groundwater on, v 14. Depth to mottling �!'y �j°' on 15. Are test holes representative of primary & reserve areas .....: ............ .................... Yes No 16. _Soil percolation tests made by on f 17. Soil percolation tests witnessed by on SECTION D (on back) . Form ST -1 2 SECTION D. DRkNAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes S�gNo 19. Will groundwater or surface drainage require special consideiation? Yes EJ No 20. Will gullies, ditches, etc.-, be filled and watercourses be relocated? .................... I ...... E-Yes 0 SECTION E. REMARKS 21. If a common water supply upply is proposed; has an inspection been ma�ejpf the existing or proposed source and facilities? .............. * ........... 4­; ............................... 17Yes =No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................................................... Yes -No 23. Additional comments 24. - Site observer /inspector and title J )�J .4 25. Date(s)-of.abservation(s)inspe6tion(s) TEST PIT PROALES -Hole # �_�Lot # Hole # L->4- 'Lot # -Hole # Lot # Depth to water Depth to water ifig-z"mi/l, Depth tomottling Depth to rocklimp. G.L. Depth to rock/imp., 0.5 .0.5 1.0 2.0 3.0* 4.0 2.0 3.0 Depth to water -5 Depth to mottling _ L Depth to rock/imp._ G.L. row" L 1.0 2*.0 3.0 r y 4.0 4.0 5.0 VLN V L0v1v1t > 5.0. 5.0 -6.0 7.0 8.0 9.0 6.0 6.0 7..0 8.0 .0 9.0 9.0 10.0 10.0, 10.0 14J. 0 nti A- ti v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - _.t AFFIDAVIT CORPORATE OWNER APPIKATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for o N St-2v cna N or :5$T5 4rj D W AI&-7Z S. ppc y I, STe PH e N `<CA S Tv K represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 517FPgrN K #tsTvK 1 NG . Having offices at: 3C Giry bsgy & t+N E P"T"Niq," V1# t- G 5_y n/y /dLr7 9 y sI , a_t Vi I. President - Name: STEPHEw Address: .50-me- ,45 i4-3 o vG Vice President -Name: 6, fEr_,I L 'K,+S'ry K Address: S,l-, C &.r R-8o vc Secretary -Name: N 114- Address: ^./#4 Treasurer - Name: Address: .-l/ r and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: _ Sworn to before me this 14 day of AML (month) (year) No - ary u , or No. 4989872 Qualified In Dutchess County Corporate Seal Commission Exoires December 16� Form CA -97 � I E400 I -, URN' 4'- PTRNZ, NO iNbNW�Nd*' 1�i 5 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 91.14-736-3664 Fax 914-736-3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health I Geneva Road Brewster, N.Y. 10509 RE: WELL & SSTS CONSTRUCTION APPLICATIONS STEPHEN KASTUK TAX MAP I. D. #84.11-1-27 LOVERS LANE TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDING YOU attached 1.) Three copies of subsurface sewage treatment system plan Tbtre SSTS construction permit application ' Letter of-authorizati6n� 4.) Application for approval of plans 5.) Soil data sheet 6.) Short environmental assessment form 7.) 2 sets of house plans 8.) Updated survey 9.) $400 for application fee 10.) Application to construct a water well 11.) Corporate Resolution The information is provided based on our March 22, 2005 joint site inspection and ensuing discussions. Please review at your earliest convenience. Thank you for your assistance in this matter. itted, Patrick M. Ben Design Engineer BRUCE R. _EOLEY_. ,.. : •.. t . ... . Public Health Director f - r <.LORE77A= MOLFNARl R:N:;:•M:S:N. a Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REQUEST FOR FIELD TESTING _iCX 'PA1WA1'1 ATTENTION: 9 "G ❑ GENE REED All information below must be fully completed prior to any scheduling. DATE: D ?1 • I 'b� ENGINEER OR FIRM: GV!t*W IWAIRWILMJG PE. P G . PHONE #: q t4-734-5 REASON: DEEPS: / PERCS: ❑ PUNIP TEST: ❑ ROAD /STREET: ji{)uyf► owe TOWN: 'FVTAJAM uP y T. SLAP #: ft.1 - I -Z7 SUBDIVISION: a.EJPe- �f,�5 LOT#: OWNER: 5VG(t)1L . JliG NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ Proposed SSTS within the drainage basin of West- Branchor;Boyds. Corner.. Reservoirs. -µ - ❑ Propoied SSTS wii}iiri SdO feet of a reservoir, reservoir stem or control lake. ❑ , Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: a°� ��� TIME: I l COMMENTS: (FiELDTEST) DISTANCES rO NORW £NOS OF S= D W NO41N END OF 1ST. 7RENOY 111.5' 107.5' NO14TN END Of 2ND. TRENCH 112' f1 NOR 7H END OF MD. 7RENOY/ 112.5' 114' NORTH END OF 47H. 7RENOY 113' Ile NORTH END O' S7N. 7RENOY 1145' f22' DISTANCES TO SOUTH ENDS OF SM C D SOUTH END OF 1ST. TRENCH 42' 72' SOUTH END OF 2ND. TRENCH W 17' SOUTH END SPD. TRENDY ,TD' 22• SOUTH END OF 47HH, 7RENOY 25' 28' o m o t� X17 o � s a \ a a 1 I' nn l� w 0 II m 0 �� s oi0o o \4 t GI WELL LOCH AON I 0-0 EWJ�6' ,p 210' p p o ©Q o t Q Q ll © F �° 0 �Q p V p O , YEn p0 As / fl Q oa* OAS/O l OrArO7W ' • / / / 0-7�-° i 1 DAM 002 OO¢72 / 1 I'n DOS77NG WA M? SMWCF LINE O r` � . . -+•... (c0r7Anav AS•PiR PwaEJ',, , `. ,• . d70 as O o012 0. A� AREA CF 17S CU 7D. LK SAMKRf/N O O AN j l ' \ .GG pp fbP (SHADED EA) aVLY '�� J 0- ::II:JI �+ r 5�i�° m °m parr: 0-4 0— iii d1° <nY+°n0 (\ \� \pme 7000 a4uav cavOPE7E- PUMP OvAMBER Wn/ HYDROVA nC SYIEF5O PUMP t. �. .. Ow nNC DRAINS Amo // y II ELI! LEADERS (7Yp) "/�5!�.� I I a "o 0. li 0- u, °� •' I I at �,72M 1� -�-. I lw" I7W I 0-0 II 0-° ,p °.SPl2 oz ! 5 N.1"ll. '. 0-2 ! ()- e r25 2 ° ° OHO Eaw(WTNBe 410 PW 1 n° 0 risD aAL cave 1, O &P17C 1A) C11 LC24 t __ �� V•11 IO LF. -4 � GST /ROY � I I '� I 4i 1602 II Cr2 Q W7H 21' BEND AS SHONN N {� 11? OLgr (y/M111 1. !E wAra t U � I�u.� � � 11 �p r �D i ° °` Lc° a 0-0 LCl 0 AS MAP i, Oa� BYO .00. T� OI01117W �'• 7 I 450 LX-410 1 (EMUS ARE o- l0 Q ° / P!N LW PRa (nrY 44E JJ O �/ I AS MARKED BY SYalWYOR t �- ASr2 4 01 0 A9 A AUaO AND NS ALARM (COCA n M av BAA SEMENT) 4. : _e. .mot,'. �. : +CONSISM'OF.'j -.., PUMP CNAMBE PIVC PIPE IN 2, i / ! p� SAM S7FPN£N KASn 36 LINDSAY LAA PU7)VAM PALLS! _I-,' 132,309 6. F. Vii''" ?!u 114 r J 003 AO F a 57 W Y� ,. ' ��� h t 1 � ' S 5 t, la e' a F Y � i I31588�sF .\ t 5:04 1 AG u\� M� �� \� ? 1.f,� 'K .�� \: \ ,� ��M �' \ �\ \ � � Vii. s ��• .'- 36p PRO W EIP IL\ ,ak \j POP \\ weu i , 2� Ssp� �TYP. 0 f o \ \ \C) Yl pp - _ G 0 $ f N.ZA °IZ'W. 1 7Z or, $\ X51.75 mo a� 92.39' 8Z 18' 164.45' N.10' Z'40 N ? i• 11 j _ ;- - - _N.q'd8'w -ea.s •� -� na.75 2s1W'I + � 1�'j!j]11� a,: �� �; 1 N.10 12' W. 11.70' � Zt N N N. 21 °47' W 28.29. N IZ'Z(o' W. A9.37 PR+NG ; N.10'3g lti/ Z9 r a N N.3•pg'W. 15.ICo' N.5 2 0' o PARCEL G'., .� 12127�5F O:O'+494Ct ROAD' TO _.'.bE H� 1350 SF. 0.0 FEATURES. DERIVED TOWN OF PUTNAM VALLEY TAX MAP;: IRVEYOR5 FIELD ;WORK SHEET 119 ti 1980, WITH AN A551JMED 6LOGK 3 I } 5' 6E LOW MEAN .5EA= LOTS 32,3.31,3.32,22.11 & 23