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HomeMy WebLinkAbout4432DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -1 BOX 34 IN %% . ' _ i: f E. - ��'N. �, IN y �l I IN-ir4 ,` 1 ;� ' 04432 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYPEM e PCHD CONSTRUCTION PERMIT # PV 9--c =' 1 Located at q 5 y g `a .#w elr e � er c Town or Village � Z v' 4,7 k✓ a lAf Owner /Applicant Name S//4 -, �e Tax Map 1`��. /4/ Block 1 Lot j Formerly _ Subdivision Name Subd. Lot # Mailing Address -3 d �r�� > c� of </ %��' . Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by "A" e A^ Address 30-�e .,.: Consisting of _J: u. Gallon,Septic Tank.and rC rjC%� Other Requirements: Water Supply: Public Supply From, Address or: Private Supply Drilled by /1�` /�� /Sr�� Address Building Type %� i �� C -f' Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? 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 accordanc with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations o s County Department of Health. Date: A 0 ©� Certified by Address 2 `? % i P.E. 4" R.A. License # ;;,, J/ Any persA occupying premises served by e `. `� shall promptly take such action as may be necessary to secure the correction of any unsanitary on itrtns resu'�ting 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 Diretetor, such rev t* n, modification r change is necessary. a .. � ..,. B Y: Title: - 'Date: CP "' Z— White copy - HD le; Yel opy - Building Inspector; Pink copy - Own Oran opy - Design Professiornal IForm CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLE'T'ION REPORT ,, Well Location Stre ddress: g - ° Grid # ap F Block / Lot(s)00/ Well Owner: Name:- Address: Use of Well: 1- primary 2- secondary a Residential Business Industrial. Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing 2L Open hole in bedrock _ Other Casing Details Total length ft. Length below grade ft. Diameter L it in. Weight per foot /G lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _K Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: 'Yes No Liner:_ Yes �( No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes—No Hours Second Well Yield Test "_ Bailed _ Pumped . Compressed Air' . ' ': " ; . _ . tipitrs: Depth Data Measure from land surface - static (specify ft) (-- S During yield test(ft) Depth of completid well in feet •3 ©0 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 3 64 If yield was tested. at different depths during drilling, list: Date Well Completed Feet Gallons Per Minute Pump /Storage Tank Informatio Pump Type', Capacity Depth �..$'p Model.' 13 Voltage 1=10 HP I Tank Typdb�io Volu e ? L Putnam County Certification No. Date of Report Well Driller (signature) NOTE: EAact location of well wttn instances to at least two permanent ianamarxs w oe prUviuou Wu a bupai=V, „lvlvuF.a. =• l Well.Driller's.NameL4tsr.! Qi�ti� - -Ac(dress:/�S 7- _Afu Signature: , Date. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ij . YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Fadovani, Director LAB #: 32.203607 CLIENT #: 2663 , NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~ —mm ~~~~~~~~~~~~~~~~~~~ KASTUK, STEPHEN DATE/TIME TAKEN: 05/20/02 09:00A 36 LINDSAY LANE DATE/TIME REC'D: 05/21/02 09:11A PUTNAM VALLEY, NY 10579 REPORT DATEr 05/24/02 ^ **�e����� PHONE: (845)-528-2290 SAMPLING SITE: LOT #3 SYCAMORE LANE SAMPLE TYPE..: POTABLE : ��«� o�^�,�^� -~��.� ^�ur� PRESERVATIVES: NONE COL'D BY: STEVEN -- - TEMPERATURE..: < 4C NOTES...: KITCHEN TAP COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 05/21/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 '-- - '''-T/;;�.]�� —--�� � -9I0]�— '�7 -� � 05/21/02 NITRATE NITROG <0.2 MG/L 0 - 10 9139 05/21/02 NITRITE NITROG <0.01 MG/L N/A 9146 05/21/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 05/21/02 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 05/21/02 SODIUM (Na) 4.31 MG/L N/A 05/21/02 pH 7.6 UNITS 6.5-8.5 9043 05/21/02 HARDNESS,TOTAL 158 MG/L N/A 05/21/02 ALKALINITY (AS 126 MG/L N/A 05/21/02 TURBIDITY (TUR <1 NTU 0-5 NT-) COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI'3~�B-°jE 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. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. �z� Na No limits for Sodium are proscribed. 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, a maximum of 270 mg/L of Sodium ~is/-suggestedI o�~��,�' YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-28O0 Albert H. Padovaniv Director LAD #; 32.203607 CLIENT Q 2663 NON STAT PROC PAGE 36 LINDSAY LANE DATE/TIME REC'D: 05/21/02 09:11A PUTNAM VALLEY, NY 10579 REPORT DATE: 05/24/02 PHONE: (845)-528-2290 SAMPLING SITE: LOT #3 SYCAMORE LANE SAMPLE TYPE..: POTA8LE : PRESERVATIVES: NONE COL'D BY: STEVEN TEMPERATURE..: ! *C NOTES...: KITCHEN TAP COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~,~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATERJANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF D-T ATER.f�HE kTEF�'��|T�'-^^ -'-�H�MI' '�' -- O`�OS~^ ^`'[' ' TA[-FiIPES AND ' wo ^ A LOW p u�/ �� � x �v� /u nc FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON-THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: ' � � ' «: a � • � -�+ �� ^fs. i ,,`f..r -, : e.{,' a ��. °-, .. •-• _ •+a- eK The. { New York Board of Fire Underwriters is in the process of issuing a certificate of compliance for the electrical installation as covered in an application noted below. The certificate will providVOIJ all 9f the items inspected -on AO ;L and certified to be in compliance with the National Electrical Code as of that date. (Application Number) Q f C4 m v ky4—� s Location) {1 LL i c1 - (inspector) ISD (Rev. 01/96) _.. . Public Health Director .... . L-ORETTA MOLINARI _ R21., 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 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: li l 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 Fvith the application for a Certificate of Construction Compliance. (E911 VERMK PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Off' ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building; Tax Map Block Lot Building Constructed by Location - Street Building Type TownNillage Subdivision Nairne Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the. failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the :.:.._:.._- system:.._ The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month 5' Da � Year d � Si ature: _ Y � <So Title. General Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: Address: 3Z State Zi p State �'Gip Form GS -97 . 2. PUTNAM COUNTY DEPARTMENYOF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location Z4L4Naz y,¢N Town Pc Z2Ve 2 I//41_1_gX TM € a -y, Date:_2- 02 Ynspected by: c Owner Permit # PV— a 9 -- ©z Sc 1. Sewage Systein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil-not stripped ................................................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands.. II. Sewage System a. Septic t ,, size - 1,000 ..:... :.1,250.. .....other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box . L' A ou�I —'Tits at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box &trenches e. Junction Box - properly set ........... ............................... f. Trenches T. Length required �6jB Length installed 577,9 2. Distance to watercourse measured-+- / 9,:�2Ft.......... 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 - 1'/2" diameter clean .................... R. Depth of gravel in trench 10. Pipe ends capped .................................. :.................... g. PUmD or Dosed Systems I. tze ot pump c am er ................ ............................... 2. Overflow tank ......:...................... ............................... 3. Alarm, visual / audio .................... ............................... . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........... ..............................* ................. 6.- Cycle vritnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. House located per approved plans...: ................... b. Number of bedrooms ......................r.... .................. . IV. Well a. Well .located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. .................... ............ d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercours( g. Footing drains discharge away from STS area............ .... h. Surface water protection adequate .. .............. ....... ............ i Frncinn rnntrnl nrnvitlPft PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OT' ENVIRONMENTAL•IIEATL -I SERVICES FIELD ACTIVITY REPORT At)T)RFRC: 6Y6,4i1?niZa LA. 7t17 -,VA1W VoQ -1,C V Street Town State Zip PERSON IN CHARGE L; PUMP TEST I.q)- DOSE TEST REQUIRED GALLONS 2 q '5�- x- sop EL. START. EL. STOP Signature and Title REPORT RFrF-TVET) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: ve„ v v I > ®o (D (D m ' lz` I.q)- DOSE TEST REQUIRED GALLONS 2 q '5�- x- sop EL. START. EL. STOP Signature and Title REPORT RFrF-TVET) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: ve„ 05/24/2002 09:38 9149624248 JOSEPH SULLIVAN PUTNAM COUNTY DEPARTMENT OF EWALTH DMSION OF EN'VMONMENTAJL MITE SERVICES ATTMION 0 ADAM ew GENE RFL ST FORFINALINUE= ON For: Fill Al information must be fully completed prior to any Trenches ✓ inspections being made. PAGE 01 map ��N..,.�— _. .. .t. .. ,. •. —. PCHD Construction Permit # ^,29—VI f=ated: r (T) M �� �yi sa2 Oemer /Appli t Name: ,9 . s Aw A' df• Of Block t Lot Formerly: Subdivision Name: XA r.5 a� Subdivision Lot # _-S Is system fill completed? Date: h system complete? ) 40,_0 Date: Is system constructed as per plans? r-.e r;��� 'f Q z Is well drilled? Xrf . Date: Is well located as per plans? ,Y 01f Are erosion control measures in place? I ceniify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCM Construction Permit and approved .plans end --rho _Staodords,:litules and Eegt�tatians of thc,Put�naar Countyy0ep ent of Health. .... - - - -_- .... -. _.._ _..._ .. G Date: Certified by:�� �—" PE � RA Design Professional Address: Lie'. 3' cgs Comments; Form FIR-99 •2S'�Z f'",srrG; Public Health Director May 28, 2002 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 I:OliEtTA MOLINARI R rv:; ,'9N Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax(W)278-7921 Nursing Services (845) 278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax(845)278-6648 Preschool (845)228-5912 Fax(845)228-6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Field Inspection - Kastuk Sycamore Lane, (T) Putgam Valley Lot # 3, TM# 84.4 -1 -1 Dear Mr. Sullivan: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. No comments. - -T Ifyou have any furkh :261er giiestions,'please` confact me al'(845y278 =5130 ext'2 Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide SENDING. CONFIRMATION DATE : MAY -28 -2002 TUE 21:02 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919149624248 *51 PAGES : 1/1 START TIME : MAY -28 21:02 ELAPSED TIME : 0012811 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED- - a BIUXB R FOLBY LORSITA MOLINABI ILK. r4.B.N. af, I q( Pmler m,ry DEPARTMENT OF HEALTH I Geneva Road Brewster, Now Yak 10509 mwmnml Bmla (943)Yt1.6130 r- (945)278.5921 Mmdq 9.rvlee• (M5)276.65l6 WW (845)271-6678 N90M)376.6015 K.eW I.W.mb. (245)278.6911 9- (945)276 -66Q Rained (945)226.5912 h*(945)226 -6113 May 28, 2002 Rene. Sullivan, PE: 2972 Fetncreet Drive Yorktown Heights, New York 10598 Re: Field Inspection - Kastuk Syeatnore LaaF (T) Valley Lot # 3, TM# 84.41 -I Dear W. Sullivan: The above refaced aeparato sewage tteshn®t system can be backfillcd. The following comments mast be connoted in the field. No commcuts. If you have any Author qucations, please contact the at (845) 278-6130 cxL 2261. Sincerely, Gcno D. Reed GDR:cj Environmental Health Engincan3g Aide a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL _ CONSTRUCTION PERMIT FOR. SEWAGE PERMIT # ?01� Located at -- Subdivision name / _ Subd. Lot # 2 Date Subdivision Approved Ow ner /Applicant Name Jrl t'iY SGf� HEALTH SERVICES TREATMENT SYSTE ^M �- own or Village Tax Map,?4, 4 Block 1 Lot B v. Renewal Revision — Date of Previous Approval Mailing Address 3 �� /�dsa -y e Amount of Fee Enclosed�lU Building Typ Lot Area/,*,S- No. of Bedrooms 4 Design Flow GPD o0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1,2 gallon septic tank and Other Requirements: To be constructed by Address S o' Water Supply: Public Supply From Address or: Pnvafe Supply Drilled'byrsnorr� ,�• -�,C- s�� Acldress�o r °r�f�� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. Address of msN9� l o ° .a � !q APPROVE FOR NSTRUCT t)iQ: This a royal expires issued unless construction of the sewage treatment system has been completed and inspected by the P e le for cause or may be amended or modified when considered necess by the Public Health Director. An teration of the approved plan requires a new pe sch ge of domestic sanitary sewa a only. By: 0 Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy! Owner; Orange copy - Design Pro ssio al �orrn CP -97 PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES . A A��92ATION TO CONST UCT .A WATER ?'`�' - -- - -- _._ . ". ..:._ .. . -.. .. ` please print or twe PCHD Permit # %� Well Location: Street Address: Town/Village Tax Grid # S 00 tr? 0 e, Mapfa/. Block J Lots) ele Well Owner: N e: � - )a'l10W Address: f 1_�� s' CL EGG 'elwel A2 �1`� 1�' Use of Well: r/�esidential Public Supply /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage Zoo, gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 1/' New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No !i Is well located in a realty subdivision? ...................................... ............................... Yes A.,f No Name of subdivision Lot No. ! Water Well Contractor: 6V n, � z Address: 0ep.0-5 +cam , s ,P> k-! Is Public Water Supply available to site? .................................. ............................... Yes No A' Name of Public Water Supply: --• Town/Village -- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. L _ �.S"� c./ :.. ,. Applict Signatuire:.._ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED) FOR CONSTRUCTION: This approval expires two years from the date issued unless . construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by utnam County. � Date of Issue to -L'1101t Permit Issuing ffic><al: &L Date of Expiration 00 3 Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 'I, I - T"I'N".kM COUNTY DEPARTMENT OF HEALTH a. D.1` ISION• O E NVIRONINIENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Nanit and address of applicant'. _�Gr& 11 L7y /Aa,11 j - j - - J - I - 2. Nana: of,project: 4. Desi.,..!,n Pri.-.)1:essional: n. Tv C of Pl-oiect: 3. Location TN: 5, Address: 2c?72- Food Service Commercial Apartments Institutional _Mobile Home Park Office building Realty Subldvision Other (specify) 7. Is this pr 0 'ect subject to State Environmental Quality Review (SEQR) 2 1 Type Stalus, (check one) ...................................................... Type 1 Exempt Type II Unlisted fl ....... Ale 8. Is a I)i It . I nvironmental Impact Statement (DEIS) required? .................. 9. Has J.)EIS been completed and found acceptable by Lead Agency? ............... 10, Name of Leiad Agency fidefiti�control -of locat-plaru�'ig zoning, , 0 fficials, ordinances? ........... ................. ....................... 12. If so, have plans been submitted to such authorities? ................... ................. 13. Has prtfiaiiaary approval been granted by such authorities ? / -1 Date granted: -14. Type cif' Sewage Treatment System -Discharge .... surface water _Kgroundwater 15.. If surfiaQ• water discharge, what is the stream class designation? ... ........ 16. Waters index nuinber. (surface) .................. ............... ............................. 17. Is project located near a public water supply system? ...................................... 4. 18. 'If ye,, name of water supply Distance to water supply —111 cQ 19. Is projoct site near a Public sewage collection or treatment system? ................ Al- 0 .20. -No.mt of sewage system Distance to sewage syslem, 21. Date hest holes observed 22. Name of Health Inspector Form PC•91 2 3.. Project dqsgq) (Ic»/ 4. Is State Pullurl-int Dischargc.1-311mination Sys[eiii (SPDES) Permit required ?... A10 5. Has SP.D.E.S Application been su.brnitted to local DEC ol ice? ................. 6. Is. any portion of this project located within a designated 'Town Or State wetland? A/° 7. Wetlands I.DNI-Im.bor ..... I ....... I ................... ................................ I .... ... I ... I ........... 8. Is Wedmids P(-,rrnl[ required? . ................................. ........................ Has application been made to Town of 1-ocal DEC office'? .................. ............. 9. Does project require a DEC Strearn Disturbance Perlllll'r ............... I ............ . 0. Is or was pvo3ccL site used for agriCUltUral activity involving applicdtiorl,of pesticides to ouchards or other crops, solid or hazardous waste disposal, land f 111 ifig, sludge appheation Or 111CILIStrial LICIlVity? ............................ YeS/N 1. Is project located withill 1,000 feet eet of existing or abandoned landfill, hazar(JOLV; N-vaste site, salt stockpile, landfill, sludge CkSpOSA Site Or any other poLeolUi[ known source of contamination? .................................. Yes/No DESCRIA),F- 2. Is there; a foutal master plan oti. 1:11e with the 'Fmvn or Village? ................. I ....... Al -v 3. Are C0111011.11.11ty Water alld/or Sewer facilities planried to be developed within IS yea" In Or adjacent to project site? ................................................................. Ale -'4:---A!--6T-41r!y se\vagt treatment areas in excess of.l. 5% slope'? ................................ 5. Tax.Mup ID Number .... ...... I ......... ........................ Map4F!f.4 Block Lot 61d' .6. Approved plans 'are to be returned to ..... Applicant 1Z. Design Professional f the application is ;;igricd by a person Other thull the applicaill Shown ill Item I.,tlle application ML18t e accompml,�d by :a Letter of Authorization (Form LA-97), Failure to comply with this provision lay be groujids liar the rQ, Jection of any SUbmissioil• Iherebj, affirm, underpenaky oJ'Peijwy, that hijbi-nmilioll provided on this form is trite 10 the bast qftn ' p knowledge and belief. False stalements trade herein . are punishable as a C1as,,,-,`-1 misdemeanorpursuant fo Section 210.45 of Penal La ;J). (CYNATORI -S' & OFFICIAL TITLES: a i I I n g A d, d r uss: ................ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of J�-Ive- 11a, Located at 5V" — p 0 T/VI Tax Map # Block f Lot &d / Subdivision of Subdivision Lot # a3 Filed Map #ham Date Filed Gentlemen: This letter is to authorize ou a3 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 construction of said wastewater tretment and/or water supply systems in conformity with:the provisions of Article 145 and /or 147 of the.Education. Law,.the.Publio Health. Law,'and the Putnam County "Sanitary "Code: Vf,;ry truly yours, UI Countersigned: Signed: P.E., "., # 2- tf .�iq (Owner of Properly) - pF PIE Mailing Addres ���� Mailing Address: .3� �%� 7l CL LU 24895 State s State Zip / Telephone: �� �/.� Telephone: S F 1%2, e: Q y Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner_ &jAl�� Address _361;' O�e Located at (Street) e Tax Map;FV- -4- Block Lot 06'1 (4ndi ate nearest cross street) le? ;e Municipality z-w Watershed 40��l SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test w: -No*..J*: ...... RIM G, top:.::, E] Time 4P Depth to Water:-.::- From Ground Surface -face (Tnches) 'Start Stop'.' V t. er, Level e j).rop In. ..AK. es e 0. Rik 2 3 30 2o 2Z 2__ 4 5 3 2 3e 3 4 5 I 2 3 1 . I I . I I 4 1 1 1 1. 1 -1 1 . 1 .1 - I --- '_ -J 1. Tests to be reneated nt urne denth nntif nnproximFif ely ential percolation rates are obtained at each percolation test hole. (i.e. s I min for IJ6 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole, Form DD-97 0.51 1.01 1.5' 2.0' 2, Y 3.0' 33 4.0` 4.5' 5,0' 5.5' 6.0' 65 7.0' 7.5` 8.0: 8.5' 9. 10.01 '1±S`I'PIT DATA. DESWPAPTION OF SOILS ENCOUNI ERUD IN TEST HOLES "" a 0 N 0. HOLE NO HOLE NO. 2 Indica!u Icv(.-.I at which ground,,-Yatcr is encou'litered at which mottling is observed Inchuato1mc-i to -which water level rises after being encountered Dec,l) h o S erwIl on s macle by: Date f0a Wo 1.11 Name: 0 4—V SQI�I I CIT11.11 7 2 Design Professioual's Seal LI N ,P- . -. BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public .Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 October 23, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 r A Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Al Jay Cottages Sycamore Lane, (T) Putnam Valley Lot # 3, TM# 84.4 -1 -1 Dear Mr. Sullivan: 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. Documents: 1. Pump design specifications /design calculations and performance characteristics are.required. Plan: 1. Complete property tax map lot number in the title block. - Provide dimensions to-locate.the-well from, -the pump-.ehamber:.- _ 3. Pump chamber detail: — Force main outlet to exit through the side wall of the property line.- - Force main noted as 1 %2" - this differs from the plan of 2" 0 force main. — Pump chamber requires riser to grade with manhole. 4. Provide note on plan stating "There are. no other wells or septic systems within 200' -0" unless shown. 5. Remove /clarify pump notes pursuant to PCHD memo dated August 10, 2001 (enclosed). 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, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj KWCE.. R... FOI..EY. Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 W •MO""INMU R.N 'M:S.N. ze , Associate Public Health Director Director of Patient Services IF Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845) 278 - 6553 NVIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (345) 278 - 6014 Fax (835) 278 - 6648 MJIMk M AWN . Preschool (845) 228 - 5912 Fax (845) 228 - 6113 a a To: Design Professionals Submitting Plans to Putnam County Health Department From: Bruce Foley, Public Health Directo Date: August 10, 2001 &partment Subject: Revisions to Putnam County Health Bulletins ST -19 and CS -31 As a result of a recent meeting held with the Putnam County Electrical Board, the following items were agreed upon with respect to the design and construction of wastewater pump chambers: 1. An all weather junction box with an outlet and screwed cover will be provided at or above grade at the pump chamber to allow for a plug -in connection.for the pump(s). 2. Prior to conducting a final inspection on the pulrlp'chamber, 'an electrical `Underwriter's Certificate for the pump chamber must be provided to the Putnam County Health Department. The Putnam County Health Department will not schedule a final inspection of the pump chamber until an electrical Underwriter's Certificate is provided. 3. The Putnam County Health Department will only inspect th_e pump pit construction, pump dose and alarm operation. - 4.. The note "All pump power and control wiring shall be made directly to the control panel without any outside splices," is to be deleted from Bulletin ST -19, Section 4.A.7.r and from Bulletin CS -31, Section 4.C. 15.h. 5. The following note from Bulletin ST -19, Section 4.A.7.r and Bulletin CS -31, Section 4.C.15.h has been revised and shall now read as, "The pump control panel and alarms shall be located inside-the house or building" The following revised sheets from the above referenced Putnam County Health Department Bulletins are included for inclusion into your existing Bulletin documents: - Page 12 - Bulletin ST -19 - Page 13 - Bulletin CS -31 Should you have any questions concerning the above, please contact this office. Cc: William Picarella, Electrical Board i „a;.,, .�" ".1 i "iiNts _ __ c)�'�Irii�. rl , _ .:,..:r4ri !�T'.r•,� � . _•:,: ` ^'' %!tl)i'l. ;:►!I ;r; :.rl!:�. {ic'i? i;ot(tinut�ir�iSr . I,, ' 'i,. �1•j' ":'.i fi; i',:.• �` 1.71'. V: {, 3I \ r.• a(�!l (: ilil: i;ii ti, Ui!� 4''a''i ;�!'i ^1 i'ij.': a Seari;ws; t.iF ow— and i r,Ji: �.iillri.' i•':. 7:i(HNI• 'tt�: ,..i'il i!•F'lr' vcr:R:(, l'Jw`;r li:!i!'Ij/ duty ball bearbig' . . B 11r :iEl; ;'. 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PV V-A P Tr-s . 3zo (V-P llmre3 lr-yeOc This 10 to oertif7 4"'nr't the b7stu Oonatruo,ted as 1-ni! id- :n -'-1:'-5 Plan and that the si, 9 'C !Jao COQLersd over. ,70tem wM a orzitnzoted in Fkoeordanoe with all eta: rulaa and reg-O. ationc of she Putnam County Depar'—, -,Imftlth and the 1-9,,r of of NEW df Wf e X,,i AV7 (S. Y4 Sys /0/: Javision a Environmental Health Servi eb AP-01-0 --"&A, e- Ipproved as noted for conformance with ipplicable gales and Regulations of th B wv, County. th Department. 45 J27 /1 4. d /-07 7 6 94 9 90 7H 3 2. 13 A 9,3 I rd 131 124 -65 za 20 /09 21 //v - /01 YJL I /e9 - F6 e ?4, *,- 12!ro. S a I Is VI PV IV I A-> ► 25'o 3 - '0 16 VI 'I -, "Y. -/, ? 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