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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.14 -1 -8 BOX 34 �A %. .tip I ! .. 11 IN . ' lNir% -0 L ,- - ' �� { r 'J i LL UL 04435 PUTNAM COUNTY DEPARTMENT OF HEALTH QN 0RI --NN- T1R CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # P V-17 T q Located at -7 �4t4 r-- FOR SEW NT SYSTEM Town or Village r-v'' V All'L I Owner /Applicant Name i lQ :; �LL..l� Tax Map S `f' � i Block Lot Formerly °� 'T Subdivision Name G-t"ti`4.GasdCi' Mailing Address 0 Date Construction Permit Issued by PCHD Separate Sewerage System built by Consisting of / `2'S'D Gallon S Subd. Lot # 5 Zip Other Requirements: % Water Supply: Public Supply From Address / or: i./ Private Supply Drilled by �,D c=,� o rJ Address ,�c%r �' . lJf��,J g ype Has eto'siori contra been compieted? Number of Bedrooms z 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 accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations o e P Co un Department of Health. Date i 4 � Certified by P.E. "� R.A. i Profess'on Address /License #�� Any person occupying premises served by the above systerri(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. 1 By: - Y Title: PEt Date: oZ b C) White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 !Gear Street Heights;-.- N'Y r 1059ar- (914) 245-2800' Albert H. Padova - hig, Director LAB #: 32.106537 CLIENT #.- 54729 . NON STAT PROC PAGE ------------ ------- M_ --------- -PIGNATELLIv THOMAS JR DATE/TIME TAKEN: 09/15/01 12:45 .64 SHERWOOD RD DATE /TIME RECD: 09/15/01 01:10 CORTLANDT MANOR, . NY 10567, REPORT DATE: 09/26/01.. PHONE: (914)-528-1033 -SAMPLING.SITE: 7 CINDY LANE, PUTNAM,VALLEY- NY* SAMPLE-TYPE..: POTABLE GARDEN HOSE- FROM TANK PRESERVATIVES: NONE COLD BY THOMAS PIGNATELLI TEMPERATURE..: < 4C NOTES....: COLIFOR11 METH: MF NNN ---------------- NNM ------ AND EPA -FEDER,AL.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/L5 else water treatment must be undertaken to reduce the waters corrosive. potential. Fe/Mn If both iron and manganese are pre'sento their total-value combined shall not exceed 0.5 mg/L. Na No'limits-for Sodium 'are proscribed. Suggested guidelines state that for people on a.siodium restricted diet.the water should' contain no more than 20 mg/L of Sodium. For-�lthose on a moderately restricted diet, a maximum of 270 mg/L of Sodium DATE FLAG PROCEDURE RESULT NORMAL RANGE METHOD PUTNAM:.CNTY PROFILE:' 09t15/01 MF T. - COL.IFORM ABSENT:/190 ML 1008-.-- `...LEAD.'-:(j.MSY.'.'. 0--15-:_.pp4 9101. _09/11-5101- 'NITRATE NITROG. <0-2 MG/L -9139 09 /1 .401. TR 1 TE 'N'i Tkdtj G/L N/A* 9146 0911-5/01 IRON . (Fe), 0.6239 MG:. -0. 3 9/1 09/�5/01 MANdANitk_�Mh) 0 1 M� .02 /L 0.. 02 1. M /L 0-0, 3, mg./1 .037 .2037 09/15/01 SOD.IUM - . a) (N 41 MG /L 09 4-15JOI 7.4 ..UNITS '9043 '09/-15/01': HARDNESSJOTAL' 130-MG/L 09/15/01. ALKALINITY (AS .1-13. MG /L, N/A 4'9' z, -41 DA.j7 M�.. tA.A. .-bACT THESE RESULTS, INDICATE THAT THE WATER. (WAS.NDT) 'OF --- - ----- �v - -_ SATISFACTORY SANITARY QUALITY ACCORD, IN HE NEW YORK -STATE AND EPA -FEDER,AL.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/L5 else water treatment must be undertaken to reduce the waters corrosive. potential. Fe/Mn If both iron and manganese are pre'sento their total-value combined shall not exceed 0.5 mg/L. Na No'limits-for Sodium 'are proscribed. Suggested guidelines state that for people on a.siodium restricted diet.the water should' contain no more than 20 mg/L of Sodium. For-�lthose on a moderately restricted diet, a maximum of 270 mg/L of Sodium BRUCE R- FOLEY Public Health Director - ---v �S-.: ^-y:- .'�'::... �.�p,o. a _' +:vi,,�..t;i`..�:'�YiM .`. Q- - -ti..— . ��i'-• � LORETTA MOLINARI 1ZN., M.S.N. .associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Eaviroamental Health (914)278-6130 Fax (9.14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 —6678 Fax (0 14) 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) i Ho 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 address is assigned.by an authorized town official. This form is to be submitted NYith the application for a Certificate of Construction Compliance. (E911 VER1RhO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W@iILocation ` S'' "t Address: - _ �i..� —; To W 'i ag "Tax ,� ' Grid # ap H, Block Lot(s) Well Owner: Nerrff e: Addr sss: ' x- r , Use of Well: 1- primary 2- secondary < Resi ential Pu is Supply Air cond/he t pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment <: Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ZD ft. Length below grade / y -ft. Diameter G" in. Weight per foot /G lb /ft. Materials: Steel Plastic Other Joints: _ Welded ,L Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours Yield /d gpm Depth Data Measure from land surface- static ( specify ft) ,?o ( During yield test(ft) _ Depth of completed well in feet a;2 `%d / Well Log If more detailed information descriptions or Steve analyse,:.:. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ,}- ,�r�Gr��d -sue If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3 Capacity /o Depth Z o Model /oS;Y- 5 Voltage -�' :70 HP Tank TypeALI 3v Volume / 7- `' Date Well Completed '7//-? Id l Putnam County Certification No. Date of Report �l sd/ Well Driller (signature) NOTF,: Ex�tt location of well with distances to at least two permanent Yandniarks to be provided on a separate sheet/plan. Well Drillees Name',o' Signature: - Address: /S Date: i i l / White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. -; " -a - v" r, .'S {,'.:' ': ":s �:.�s ._.'tip -oa v`*..4'� V +.. ."iris.- -.- a-� - :::^n •:,�_..x.�,i,...Y ^:_...d es'. 'mss. ""'4 "'�i:'.yS GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM P t(iNA nat. i ) `Lomas Jr. 00k Owner or Purchaser of Building Tax Map Block Lot 01i'Vei ra LUh5�l layr PVAVA K Wj& Building Constructed by Town/Village 'Jl Gin Ld KA-1 Sbu,V Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the ystc 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 - / Da Year o f ature: Title: _ General Contractor ( wner) - Signature Corporation Name (if corporation) Address: % � 51e1'W06d 1?&A Corporation Name (if corporation) Address: State (lova? ndf i/Pv'"or- N � Zip l U'7 State Zip Form GS -97 tZ f j }s � rr d 'l 4 q . F � sx t t3y "f - ° _,• -- 'rv.. e " _. �° � � > . ^i. � s •= '`7'�� a 4a .. iv' • vt t' 4'+M1'k � � �•. . a Il i 2 ;$ y .; � Sl...^,�'� s"y *�'� .rF• 'R �� �'V*r � k L F .�j �,. mss; '} _ � -e a c 1 � ' x Y° zt IM _t # YL' y �•'� f sue.` �S tip l ,gyp '- : i i xk T zf '"r j Vii. 4- 'i� • t 3 L' t.$ iL }s � rr d 'l 4 q . F � sx t t3y "f i YML ENVIRONMENTAL SERVICES 321 Bear Street Yorktown Heights, N -. -Y. - .a42i27) Albert H. Padovani, Director .AB #. 32.106537 CLIENT #: 54729 INNN NNNKN MNNAINKKNNN NN NNNNNNNNNNNNNNKNNN `IGNATELLI,- THOMAS :4 SHERWOOD RD ;ORTLANDT- MANOR "NY JR 10567 iAMPLING SITE-. 7 CINDY LANE, PUTNAM. GARDEN HOSE -; FROM TANK 'OL' D BY. THOHAS "PIGNATELLI NON STAT PROC PAGE 2 NN NNNKN KNNNNKNN KNKNNNNNNNNNNIVNNMN NNNKMN DATE /TIME: TAKEN.- 09/15/01.1 _12: 45 - DATE /TIME REC'.D. 09/15/(]i 01.10. .: REPORT' DATE: 09/26/01 PHONE: (914)-528-1033 VALLEY, NY ,. SAMPLE TYPE. w POi'F1I3LE... IOTES IVNNNNKIVNKNNNNIVwiNNNNNNN NN NN NN- IVNNNIVMIVNN DATE oFLAG PROCEDURE PFxESLRVATIVES. NQNE TEMPERATURE..'. of 4C COLIFORM METH-.* [IF N MNNM NNKKNM NN KKN NIV NIVN N,N NNNNNN NNlVNIVNNN NI.I RESULT NORMAL ---" RANGE _ METHOD,--_:.. TTED BY. Albert 44. Padovani, M.T. (ASCP) Director ELAP# 10383 YML ENVIRONMENTAL SERVICES 321 Kear Street hwt��� (914� 245-2800 Albert H. Padovani, Director LAB #: 32.308493 CLIENT #: 54729 ' NON STAT PROC ' PAGE 1 PIGNATELLI-9 THOMAS JR- `-'^' 'DATE/TIME TAKEN: 1{)/16703 06�30�� ' 64SHERWOQD`RD� - '' -� ' DATE/TIME RECD.- 10/1'/ -09.00 ' CORTLANDT`MHNDR, NY 10567 REPORT DATE: 10/24/03 PHONE: (914)-528-1033 - - `$AMPL,TNG�`E@-TlE,-:�J7 `[}IWDY'LANE,��PUTNA-MLVALLEY,-:1\1Y�' GAMPLE'TYPE.��x/,P8TABiE`��~��' TSHEN'TAP-� -'�-'---- -' -' ' PRESERVATIVES�-NONE^`'~ `^ COL'D' BY: VALERIE PIGNATELLI TEMPERATURE..: NOTES...:' _- - `,�`' � _ COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~�~~ ~~~~�~~~~~�"~~~~~~~~~~~°~~=~~~~~~~~~~~~ DATE ,FLAG RESULT- NORMAL /^ - RANGE METHOD^�� dMMENTS SUBMITTED BY: Director ELAP* 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N..y. 1059$ (914T Albert H. Padovahi, Director LAB #: 32.106537 CLIENT #: 54729 NON STAT PROC PAGE I ------------------------ --------- ------------------------- PIGNATELLI, THOMAS JR DATE/TIME TAKEN: 09/15/01 12:45 64 SHERWOOD RD DATE/TIKE REC'D: 09/15/01 01:10 CORTLANDT MANOR, NY 10567 REPORT DATE: 09/26/01 PHONE: (914)-528-1033 SAMPLING SITE: 7 CINDY LANE, PUTNAM VALLEY, NY SAMPLE TYPE..: P014ABLE GARDEN HOSE FROM TANK PRESERVATIVES: NONE COLD BY.: THOMAS PIGNATELLI TEMPERATURE..: < 4C NOTES-6: COLIFORM METH: MF ----------- - ------ ---------- ~ ------ M-111.1 ---- DATE FLAB PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/15/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 09/15/01 LEAD (IMS) <1 ppb 0-15 ppb 9101 09/15/01 NITRATE NITROG <0.2 MG/L 0 - 10 9189 09/13/01 NITRITE NITROG N/A 9146 09/15/01 IRON (Fe) �.6 a 9m iG7 �t�:- 0-0.3 mg/1 8037 09/15/01 MANGANESE (Mn) 0.021 MG/L 0-0.3 mg/1 2037 09/15/01 SODIUM (Na) 1.41 MG/L N/A 09/15/01 pH 7.4 UNITS 6.5-8.5 9043 09/15/01 HARDNESS,TOTAL 130 MG/L NIA 09/15/01 ALKALINITY (AS 113 MG/L N/A 09/15/01 TURBIDITY (TUR <1 NTU 075.NTU_., COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF'A SATISFACTORY SANITARY QUALITY ACCORDINrHE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment, must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water . undertaken to reduce the waters corrosive. 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 proscribed. Suggested guidelines state that for people on a sodium restricted dietthe 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown. Heights, N.Y_ . 10598 Albert H. Padovani, Director LAB #: 32.106537 CLIENT 54729 NON STAT PROC PAGE 2 ------------- ------ PIGNATELLIp THOMAS JR 64 SHERWOOD RD CORTLANDT MANOR., NY 10567 DATE/TIME TAKEN: 09/15/01 12:45 DATE/TIME REC'D: 09/15/01 01:10 REPORT DATE: . 09/26/01 PHONE: (914)-528-1033 SAMPLING SITE: 7 CINDY LANE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE GARDEN HOSE FROM TANK PRESERVATIVES: NONE COLD BY: THOMAS PIGNATELLI TEMPERATURE..g < 4C NOTES ... COL IFORM METH: [IF' N- NNNNNNNNNN ---------- ------ NNN,VMN NNNNNIVNNNNNN N/VNNi1I i--- ---- -1 - ------- DATE FLAB PROCEDURE is suggested. RESULT NORMAL - RANGE pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES.* THE NORMAL RANGE OF pH 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,JIG/L WATER-. -70"'140'i4G-/'L'"- MGYL'= MIL1:*I'GkA'ff' PER- _L I TER" HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Albert-fq. Padovani, M.T.(ASCF) Director METHOD- ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street yo kt Heights, Y 105 ''��' � ''� ,.�������h^�-"'-11^ll w�'��-����'�'� ' Albert H. Padovani, Director LAB Q 32.308493 CLIENT #1 54729 NON STAT PROC PAGE I PIGNATELLI, THOMAS JR DATE/TIME TAKEN: 10/16/03 06:30 64 SHERWOOD RD DATE/TIME REC'D: 10/17/03 09:00 CORTLANDT MANOR, NY 10567 REPORT DATE: 10/24/03 PHONE: (914)-528-1033 SAMPLING SITE: 7 CINDY LANE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: VALERIE PIGNATELLI TEMPERATURE,.: NOTES...: T COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ` DATE FLAG PROCEDURE RESULT NORMAL ~ RANGE METHOD 10/17/03 IRON (Fe) <0.060 MG/L 0-0.3 Mg/1 2037 10/17/03 MANGANESE (Mn) 0.011 MG/L 0-0.3 mg/1 2037 .. COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBM,ITTED,By: Director ELAP# 10323 ` ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BT =!NG, DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE-NO.- - CO�ITRACT VENOE'ES; . TNOMA9.P�G►.1AtEt.�. \�..3R. Address -64. SHERw000 RoAO, PEEKSK'tt.l., 1L%1. to566 � Located at (Street �Indicqte C440-IS t i-AI> E Sec . 1 t q Block 4 Lot 5 cross s reef j A[ ttoTERSi'cG•c�ow� w�•tH PEE KSKtI� NOt.�OW ROAO Municipality. TowV otc PuT>JA►:� Watershed PEEK's t<%% _ Ho%.t,ow $RooK _ VA%_L.Ey SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 1,oT No, S CF ��GE `1 ERS f3ERG� "Ore, o w►zE it c-v PRoP6RY4 x- PttESE1�T tS A-aR. JoKlJ 1�RoF.N� Hole .. Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water a e- ve - No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min./in in dro P Inches Inches Inches i 1 o:eo :. 10:58 ' Sg .Iq Zo t 5g I 2 9- se. 5q iy 20 I S9 1 3 It- oo -12.59 59 tq 20 1 59 5 2 1 10;02- tt:ot 59 IaVa. 20Ve ( 59 cr Z" 3 I2 •. 03- t: 0 z S 9 19 '/Z 5 _ 3 1 10; 03 t0:48 45 1 S Z 1 3 ! 15 3 2 'to-. so;- i►_ 35 45 t 8 Pa 3 t 5 3 3 It; �� = Ii: ZZ 4.5 t g Z1 3' ►� 3 4 IZtZ4'- t_oq. 5 Notes: 1) Tests to be repeated at same depth until approximatelyy rates are obtained at each percolation test hole. All data to be for review. equREaii EIVED submitted 2) Depth measurements to be made from top of hole. JUL 2 01984 PUTNAM COUNTY:' DEPT. OF HEALTH 4211 4811 54 6011 66" 7 2 if 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED N o C-V R o u M p %1Z r-_ T"t .-TTiDI0QATB' ' -.T 14MI CH. NAT-ER 10WEL RISESAFTER BEEING ENCOUNTERED �4 TESTS MADE" BY j o ll a g. ag-ueKo P. E. Date M A-1 2-1 19S4. %-T4zp W! 43usow Alai 0 t�3 Pr,-rt bsep, -ree-c vA-rA cauakA DESIGN Soil Rate Used GO. Min/1"brop: S.D. Usable Area Provided S,Z25 No. of Bedrooms 12 Septic Tank Capacity Gals. Type PRECAST r-vszCRZTX- Absorption Area -T—r—ov-1—ded ByE� -10 L. F. x24 5b" width trench. Other e:,EmLk-t-zz .Foovi%Dt- 01tAMIS 4 C-43LMA%la WkAoa WEC4ut%te,0;. BA%.Vo %A%j CSTAXED) Rzdo Fox emcs�cm Cv*a-%RoL; t As-%- F%t.'t- M 0050vSM- Aptio . L 'SKAI-A. Name dc"sj R. 1BFku5K0-, FNE% Signature Yl.—? - PF GRAVEL V Address TRAVuwae RoA0 SEAL OF N t-AK-- 414 -52nd -209A cad lLn THIS TEST PIT DATA REQUIRED.TO BE SUBMITTEDWITH APPLICATION ONLY: DESCRIPTION OF SOTT-Z ENCOUNTERED IN.TEST HOLES. Sq. Ft/Gal. Checked by DEPTH HOLE NO. ► HOLE NO. Z HOLE NO. G.L. SO GAIL, SE.P"V%C- o PS v -rope 6 ti C %o- M 6 XM' c-1-Ati %-oP%1A Lo AM. 1211 4211 4811 54 6011 66" 7 2 if 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED N o C-V R o u M p %1Z r-_ T"t .-TTiDI0QATB' ' -.T 14MI CH. NAT-ER 10WEL RISESAFTER BEEING ENCOUNTERED �4 TESTS MADE" BY j o ll a g. ag-ueKo P. E. Date M A-1 2-1 19S4. %-T4zp W! 43usow Alai 0 t�3 Pr,-rt bsep, -ree-c vA-rA cauakA DESIGN Soil Rate Used GO. Min/1"brop: S.D. Usable Area Provided S,Z25 No. of Bedrooms 12 Septic Tank Capacity Gals. Type PRECAST r-vszCRZTX- Absorption Area -T—r—ov-1—ded ByE� -10 L. F. x24 5b" width trench. Other e:,EmLk-t-zz .Foovi%Dt- 01tAMIS 4 C-43LMA%la WkAoa WEC4ut%te,0;. BA%.Vo %A%j CSTAXED) Rzdo Fox emcs�cm Cv*a-%RoL; t As-%- F%t.'t- M 0050vSM- Aptio . L 'SKAI-A. Name dc"sj R. 1BFku5K0-, FNE% Signature Yl.—? - PF GRAVEL V Address TRAVuwae RoA0 SEAL OF N t-AK-- 414 -52nd -209A cad lLn THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by C -r 1z 057436 fssioo %-k k5 15 AN --I t- L- l- T Is IV e M 11 (-rw�o -C&VzK�' 4Q m of SO GAIL, SE.P"V%C- I PUTNAM CO.UNTY DEPARTMENT OF HEALTH .. _ .s. DIVISION OF ENVIRONMENTAL HEALTH SERVICES'T j Date eluL r /,s, 11704- C'on�racf Vev/deeS.:.T»Q.M,/fs P /GNA.TE[[> �` YALER /E _,a >�,Vi�T Re: Property of elvvA' KRz c-HL Located -at E/NDYS Li9NE� - az✓VAM Y'i9LGFY� Section 119 Block Lot S" BE /N6 L oT BYO, 5 O.0 �GEYEiPS BE�E'G " Gentlemen: This letter is to authorize John R. Brusko. P.E. — a duly licensed professional. engineer X or registered architect to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the pro- visions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly Cou,�� i ocd -. __- .: 5igne frte John R. Brusko, P.E. P.E. C �- P. . , SM , # 57436 Address: Traverse Road Lake Peekskil Telephone: ` 914- 528 -2099 051436 urs, 7'HoMAS PlGNArEt� >, JR. YA[ -.0 le P/G A/A TCL G / cvn �rtt c r- (g i� Sf4MAXboA a. , QCEA:SK /C_L, /V, V 105616 Address 9/4 - S28 — 2099 Telephone RECE11%ED `''UL 2 01984 DEP'OF COUNTY HEALTH m JOHN R. BRUSKO, P.E. TRAVERSE ROAD ROAD LAKE. PEEKSKILL, N. Y. 10537 Tuesday, July 17, 1984 Putnam County Department of Health Putnam County Office Building Route 52 Carmel, New York 10512 Att'n.: Mr. Robert Tutoni Environmental Health Services Reference: Sewage Disposal System and Private Water Supply to Serve the Proposed Residence of Mr. & Mrs. Thomas Pignatell.i (Making Application as Contract Vendees) My Project No. 84 -6 Subject: Permit to Construct Gentlemen: ��. ... W >. r - ul-. -. .. .. .4.... .�.. ..... •.. �.. .. - -..._ ...c. r. �- A . -m - w ..r ... -... •6• .Or - SJ£�n.. ^q!e ": .._.. .s.. .._. w... -�� e. _. __.�.. ...s. .r.r s.. - _... Enclosed please find the following material constituting a contract vendee application for the subject Permit to Con - struct the.above referenced sewage disposal system and pri- vate water supply: 1. Completed Construction Permit Application'(PCHD Form) 2. Letter of Authorization (PCHD Form) 3. Design Data Sheet (PCHD Form) . 4. Construction Drawings (including Location Plan) (3 sets) 5. Subdivision Plat in Place of Survey 6. Plans of the. Proposed Residence (2 sets) It is my understanding that this material completes the requirements for filing. It is Mr. Pignatelli's intent to install the sewage dis- posal system himself. As an operating engineer with many years experience in excavation and other heavy construction,.Mr. Pignatelli is certainly qualified to do this work'and I will. be available to assist in system layout. If you have any questions with regard to this matter, please contact me. (2) I-It r John R. Brusko, P.E. Consulting Engineer and Designer cc: Thomas and Valerie Pignatelli File No. 84-6 PUTNAM COUNTY-DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE RiSPECTION Date: Sfre�i`T.dciit'io Owner 101 as 4-rcc, — - Town �( �l_ Permit 0 TM 4. F4, i _ 1 _ Subdivision Lot n c GV Yfiv- 1. SeNvage Systetla 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. SeAge System a. Septic tank size -1,000 ... .1,250. ...other....!. n� b. Septic tank installed level ................. ............ 1 .. C. 10' minimum from foundation.......................................... �. d. Distribution Box 1. Ail outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches k e. Junction Box - properly set ........... ............................... W f. Trenches Length required 7 Length installed (a67+ 2. Distance'to watercourse measured Ft...:...... 3. Installed according to plan ......... ............................... .4. Slope of trench acceptable 1/16 -1/32" /foot .....:....... 5. 10 ft. from property line - 20 ft.- foundations...:...... 6. Depth of trench <30 inches from surface ...........:...... 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1%" diameter clean ..........:..:...... 9. Depth of gravel;Antrerach 12" minimum ..:.:...:.....::.:.. ; 10:` Pipe ends capped. ...........:......:.... ..........:.................... g. umn or Dosed Systems tems 1. Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... u 3. Alarm, visual / audio ............................:. 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............................... .........::.........:. .... .. 6. Cycle witnessed by H.D.estimated flow /cycle......,.... III. HouseBuildin .a. House located per approved plans ............................ b. Number of bedrooms .................. ............................... . IV. Well a. Virell located as per approved plans . ............................... b. Distance from STS area measured *k-,1'2? ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ................ I...... V. Overall Workmanship. a. Boxes properly grouted ....:.............. ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ...................... . .... ..... i. Erosion control provided ................. ............................... INUEN INSIMESEN imam IMES Icy C� �4 A. Y AUG -29 -01 WED 8-.4.7 WILLIAM-SESHARAT P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTALHEALTH SERVICES ATTENTION XADAM[ ❑ GENE MUST FOR E LON For Fill All information must be fully completed prior to any Trenches A inspectigns being made. PCHD Construction Permit # ?V- 1.77 q Located: I QUID)( LAbft iT) Owner/Applicant Name: IBM&& BeAIATAILI TM Block �_ Lot .,0 Formerly: Subdivision Name: G Subdivision. Lot # Is system fill completed? t l .6 Date: Is system complete? Y r. s._ - Date: Is system constructed as per plans? YPIS Is well drilled? i� Date: Is well located as per plans? fa Are erosion control measures in place? I certify that the system(s), as list4 at the above premises, has been constructed and I love inspected aAd verified their completion in accordance with the issued PCHD Construction,Perut and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Date: O Certified b . r F PE fat y ZPA Design Professional MINIME V44 Mw Comments: Form FIR 99 BRUCE.- R.- FOLE '. =Public Healin Directory LORETTA MOLIN ARI _R.N. •M.S.N.� r Associate 'Public _ Hia'Ith `Director "µ Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing .Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 July 12, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 p ° Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Pignatelli, Cindy Lane TM# 84.14 -1 -8, PCHD #PV -17 -99 Town of Putnam Valley Dear Mr. Fredriksen: An inspection of the above referenced lot has been conducted by this office. This notice is to advise you that the required erosion control measures have not been installed or are installed incorrectly, as shown on the approved plan dated August 19, 1999. Effective immediately, a notice of non - compliance will be issued for a violation of the Putnam County Sanitary Code, Article III, Section 2, Paragraph C, and a stop -work order shall be -:..• . ._ requested from the Town Building Departrpent_as, required :by.Article_II_,I,..Section 2, ParagraPh_Da .. _. -, •'Y'IY . -,. .a. _ w,w.. .. �.�... .en R >i t _� s.__. .. �..._.. ... -.t' fv-.. _. -. --•-.. a. ..... .+ -�... -- �r�. -a+ .. .. � - .�T'.,._ This matter is to be corrected immediately. 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 cc: Applicant Pignatelli (T) Putnam Valley Building Inspector PUTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVICES C ST RUCTION PERMIT FOR SEWAGE. TREATMENT SYSTEM PE T#1 - Located at L Ili-o y Town or Village . Y(% Al Am I/ az Subdivision Le 4eyEr -e, g ff G Subd. Lot # Tax Map Block 1 Lot Date Subdivision Approved G, — 2 G - 7 :5, Renewal Revision Owner /Applicant Name !o M F/ 6 NA T ELL 1 Date of Previous Approval Mailing Address Amount of Fee S' � W00 ziP�a( Enclosed kSOCI Building Type Q,�SJ I�Eh6G� Lot Area f� No. of Bedrooms Design Flow GPD 00(2 Fill Section Only Depth Volume FCHD NOTIFICATION IS REQUIRED WHEN F L IS COMPLETED (o SLgparate Sewerage. System to consist of )z S-0 gallon septic tank and L , F - Other Requirements: , 1 I f O CVOL -rA1 /J ,gA ) N To be constructed by © (j N F, Address Water Supply: Public. Supply From Address - r% "Private Supply grilled by - Ll iii` 7 6'&= = fj : Address U Tf/� ' : JPrGL �� /✓ y I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ggpate sewage treatment Ustem 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 tion Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a i 96al�p * ' 1 be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place ' M- on any part of said sewage treatment system during the period of two (2) years immediately foll i of the approval of the Certificate of Construction Compliance of the original system or any r r L '� Signed: Address so P.E. ✓ R.A. Date 4— 9 9 License # -9- SSt� APPROVE D-F 0 R LO ON: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. A oved or is a of domestic sanitary sewag only. By: Title: Date: S1 i White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELIJ_.__. please r type CH Permit # print o Well Location: Street Address: Town/Village Tax Grid # C /ND Y LA Map , It/Block Lot(s) CS Well Owner: Name: Address: Use of Well: Residential Public Supply. Air /Cond/Heat Pump Irrigation 1- primary , Business Farm Test/Monitoring Other (specify) 2- secondary Industrial. Institutional Standby Amount of Use Yield Sought gpm # People Served 4 Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason k-J U0 (15 6 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No C Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision Lot No. S Water Well Contractor: AAv 12,6R_5 Address: 1QU7' 11AU-cY Iu �e Is Public Water Supply available to site? .................................. ............................... Yes No x Name of Public Water Supply: Town/Village Distance to property from nearest water main: — Proposed well location & sources of contamination to be rovided on separate sheet/plan. Date: Applicant Signature:) 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 19 `l Permit Issuing cial: Date of Expiration s Title: v Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - __:_�_.:. "- ^- = : ti "^i.. -yam. �- «a;- o,.7_ -� - -�.� -= . .... s;:..:.:' -�j: -. - -. : -, _ "- _-= �___„_ ._. _ , ,;.�, �;_o,,,r•�_ .;.• =..:. .... - APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 1�Erl� s V-1 LL A/ Z Q 4 2. Name of project: e 16 61 NTT LO 5 57 < 3. Location TN: pU7'ZA,0 \1At rLr 4. Design Professional: e6 �Eggr lK-s &gip 5. Address: t j . Mee RLV .ice 6. Type of Project: _ Private/Residential Apartments Office Building Food Service Institutional Realty Subidvision :,p� Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... t111-6 9. Has DEIS been completed and found acceptable by Lead Agency? ............... „L/ p _..:.10.._ Name, of Lead Agency.._ -- -�-'"_ 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ..............................S 12. If so, have plans been submitted to such authorities? ........ ............................... ^1110 13. Has preliminary approval been granted by such authorities? Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water,�groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ---- 17. Is project located near a public water supply system? ....... ............................... 1%l0 18. If yes, name of water supply —' Distance.to .water supply -- 19. Is project site near a public sewage collection or treatment system? ...::....:..:::. A) d 20. Name of sewage system Distance to sewage system 21. Date test holes observed o,1 99 22. Name of Health Inspector AVA- /0 Form PC -97 t 2 23. Project design flow_(gallonser.day) .f. ................................................. . _ 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Alko 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? b 27. Wetlands ID Number .......:................................................... ............................... — 28. Is Wetlands Permit required? .............................................. ............................... A " Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? ............. t') 30. 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 AJ b 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No DESCRIBE: A,10 32. Is there a local master plan on file with the Town or Village? ......................... A" 33. Are community water and/or sewer facilities planned to be developed within 15 -years in or- adjacent .to project, site? -..... ... _ 34. Are any sewage treatment areas in excess of 15% slope? . .................. .............. A-J P. 35. Tax Map ID Number .......................... .......... ...................... Maps .N Block 1 Lot 8 36. Approved plans are to be returned to ..... Applicant Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my know a and belief. False statements made herein are punishable as a Class A misd t to Section 2 0.45, of he Penal Law. �V N. If R ED.* . SIGNATURES.I l CO Mailing Addres %\...'�IO �- 13 -i6-4 W87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR IJ l Appendix C -State Environmental duaiity Review SHORT ENVIRONMENTAL ASSESSMENT FORM.. For UNLISTED ACTIONS Only. - PART 1- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) i. APPLICANT /SPONSOR 2. PROJECT. NAME 3. PROJECT LOCATION: �� ��� }. LA: Municipality . P V 7-k4 County •t. PRECISE LOCATION (Sue =t address and road Intersections, prominent landmarks, etc., or provide map) • s 5. IS PROPOSED ACTION: Nrx 0 Expanslon ❑ Mcdification/alteration 8. DESCRIBE PROJECT BRIEFLY: _ /'i F t.-/ H v it-S E 7. AMOU47 OF LAND AFFECTED: Initially 0 ? acres Ultimately 0 . acres' 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? yes n No it No, describe briefly 9. W AT IS PRESENT LAND USE IN VICINITY OF PROJECT? esidentia! Ll.Industflal 0 Comm, ercia,' C� wYricultuic - ")?gr„1FpreaJOpaaapacc _ _- 024er - c.ibe. 1C. DOES ACTION' INVOLVE A PERMIT APPROVAL, OR FUNDING, NOVI OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? ❑Yes KNO Ii yes, list agency(s) and permitlapprovals, it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes. RNo 1f yes, list agency name and permiVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes C40 I CERTIFY THAT THE INFORMATION PROVIDED•ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE t Applicantlsponscr name: �- Date: Signature: rr•• If the action is in the Coastal Area, and you are a state agency, complete1he Coastal Assessment Form before proceeding with this assessment (1VER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? It yes, coordinate the review process and use the FULL EAF.' ❑Yes .❑ No _ - -- - 8:_i IL ?A fSi 1 RECE1V C66_ h 6 lkNf ED'REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration maybe superseded by another Involved agency.. ❑ Yes - 13N0 , No 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 quantlly, noise levels,• existing traffic patterns, solid waste production, or'disposal, potential for erosion, drainage or flooding problems? Explain brlefiy, C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood.eharacle.? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain 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 natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C5. Long term, short term, cumulative, or other effects not identified In Ct•C5? Explain briefly.: C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its.(a) setting (i.e. urban or.rural);.(b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or'signlficant adverse impacts which MAY occur. Then proceed directly to the FULL E.4F.and /or prepare a'positive declaration. ❑ Check this .box If you have determined, based on the information and analysis above and any supporting documentation, that the _proposed action_ WILL NOT result in any significant adverse environmental impacts AND'provide on attachments. as necessary, the reasons supporting this determination: Name of Lead Agency. Print or Type Name of Responsible Officer in lead Agency Title of Responsible Officer Signature of Responsible Office( in Lead Agency Signature of Preparer (Ir different from responsible o icer) Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM t nsb�, Owner ��.p S /a,V A r Uj . Address &4 5 0 Ep woo.0 P -D Located at (Street) eig LA A EK-S k.i flu bJ'ax Mapd#j Block �_ Lot 8 (indicate nearest cross street) Municipality FLI -W A M yA L L 1✓ y Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking C, 9 - 9 9 Date of Percolation Test r 1 r0: 10 f0:25 1 �" ate 23 3 2 : 2' % ) S �" 21 ti - 4 5 2 If °� '70 3 3 4. f 3 j 4 5 r ll:a° 11,22 S �� °f 2t9 2? 3 1 2 3 . .5 NOTES: .1. Tests fo be repeated at same 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 submitted for review. 2. . Depth measurements to be made from top of hole. Form DD -97 TEST FIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES .. DEP1`H'y T�OLE_NOf . �_ . HO1EfitU. Z HOLE NO:lY.. .. ;. ; .. G.L. �-- 0.5 - S 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 4111 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' Isi ITO] In 9 Indicate level at which groundwater is encountered' 4c LE A 3 6 o Li' Indicate level at which mottling is observed e15" p o LE #f n1 Indicate level to which water level rises after being encountered Deep hole observations made by: Al2 A M Date & —i Design Professional Name: y2 C� �' Q F_ 9 1kS_ Address: p Si_._v�2 OF Re�$i 4A C% // Z sv/o„�'L Signature: Design Professional's Seal V XIA 61 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE S INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM T T SECTIO\ A. ERAL 11N L) NA'T'ION Name of Project .(6,- A-fVLLA (T)(V) County Site Location C tMAbq �.14 . f 4eez�L f- , Building construction begun l` O Is property «ithin \TYC Watershed ? ................. F_� Yes Extent SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 4 LA 1. F__J Hilly a Rolling 0 Steep slope Gentle slope a Flat 2. F� Evidence of- wetlands F_� Low area subject to flooding Bodies of water Drainage ditches Rock outcrops 3. Property lines or corners evident ..................:.... .............:................. � Yes o 4. Do water courses exist on or adjoin the property? Yes 1:0__ 5. Will these affect the design of the sewage system facilities ?............ a Yes E Rio 6. Do watershed regulations apply in this development ? ................... ..... � Yes No 7 Will extensive grading be necessary? .................. ............................... Yes No N 8. Will extensive fill be necessary for SSTS ? ........................................ 0 Yes o exist N�Zthin tl^e §ST$ :grea? 4 ,...e_:�.::.. .Yes.. _,�io Y: If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: 1,qzarid �aveFam .F--J Clay D Hardpan ixture 11. Observed from: ❑`. Borings Bank cut ackhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater - —0 on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas. .................................... es El No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 SECTIO?�' D. DRAINAGE i 8: -W 11i proposed grading matenally alter the naturafdrainage in this or adjacent areas? F_l Yes No 19. Will groundwater or surface drainage require special consideration? ..................... F-I Yes o 20. Will gullies, ditches, etc.; be filled and watercourses be relocated ? ......................... Yes o SECTION' E..RENUR.KS 21. If a common water supply is.proposed, has an inspection been made of the existing or proposed source and facilities?.- Yes ............. o Inspection data._ 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... (� Y�,e�Q No 23. Additional comments `� _24. - Site observer /inspector and title Ile 2.5. Date(s) of obse:rvation(s)inspection(s) ` TEST PIT PROFILES Hole Lot n Hole r Z Lot = j Hole r .Lot r Depth to water Depth to water Depth to water Depth to mottling _ Depth to mottling Depth to mottling j _ De; the o toclJirnp._ neY h o -oc'N rnp - Depth to rockiimp.'.... G.L. G.L. G.L. �_I 0.5 0.5 6 i3 0.5 Ts 1.0 1.0 1.0 2.0 2.0 2.0 i 3.0 4.0 5.0 6.0 7.0 � 8.0 l 10.0 5.1 C.1 7.1 �. 8.0 9.0 5 vac, 10.0 t/(, 3.0 yo 4.0 5.0 6.0 7.0 8.0 Y / Le(D&-g all 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . t.� ^.,Ti1: •. ..l �.ak/ .l "..i �� .r. .. [tu .,. i.. a .-..• �. : ` � v .�[' � �,.��.'.. .al ..vy •V' .1. .. .�.. m. rf.C� .. .. �.. .. .a ` , LETTER OF AUTHORIZATION RE: Property of nOMA S P I Ca M A 7E LL) Located at �,,W D j°[ L-A TN lflU r VA. Tax Map # Block _� Lot Subdivision of E Yee S f3 Cry G Subdivision Lot # Filed Map # lS'� Date Filed 7 Gentlemen: This letter is to authorize ZD i Oq IP�OCQ%21 KS CA] P£ a duly licensed Professional Engineer _ X 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 con of said wastewater tretment and/or water supply systems in ormity with the pr S. and/ _or..147 of the Education Law, the.Publc Health. Law,'arid'the P utnam -C _ _ .. _ ..,_.:......- 7 &c Countersigned: I P.E., R.A., # _ j" 5 Mailing Address State LIZ Z Zip /p 5 / Telephone: g)1/ - 6, 4,9 ,, c13 70- Vey truly yours, Signed: (Owner of Property) Mailing Address: 6 � 6< ,Yq gg S) 0 c3' —D Y -S k-1GL State AJ Zip /Q 5� , (' Telephone: S 2.8 / O 3 3 Form LA -97 e � BRUCE R. FOLEY Public —Reali . D rnr: or August 10, 1999 LORETTA MOLINARI R.N., M.S.N. =i' tt= ibGiCle'$ ^Pdblic- 41cafih Der —ectur° Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Pignatelli, Cindy Lane TM# 84.14 -1 -8, Lot #5 Town of Putnam Valley Dear Mr. Fredriksen: N' This office has received and reviewed the most recent set of plans for the above mentioned proje t. We would like to offer the following comments for your consideration. The well is shown 10' from property line, minimum separation is 15'. '2. House plan submitted results in a 5 bedroom house, design is for a 4 bedroom. Please clarify. 3. Design perc of record from the subdivision result is 28 min/inch perc rate. System must be designed at 21. - 30 min/inch . design range 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENNIRONNIE\TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATINfENT SYSTEMS M - (. .RE .. I I - .. . -, C!?ISTRULTI'J nE'..aPLS STREET LOCATION i `'l IV NAME OF OWNER (0` N Alr9 AA REVIEWED BY RNI, GR, AS, NIB, BH D ATE TAX 1yIAP # Y DOCUMENTS Y N% LOCATED IN NYC WATERSHED NS SUBMITTED TO DEP EGATED TO PCHD EP APPROVAL, IF REQD DE T HOLES OBSERVED C TO BE WITNESSED E PPROVAL SSDS ADJ. LOTS ANDS (TOWN/DEC PERMIT REQ'D ?) 7. A.ON.DDS- LAMS & PERMIT SAME _. i I >69NiiGiiBGRNOTiFICA11.ON LE R BI/ZBA 00 . FLOOD ELEVATION ER REQ'D PERMITS) jEQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE VITY FLOW ONSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED R/CURTAN DRAINS 30IL TYPE BO TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWNG/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS CAKES AND WETLANDS WITHIN 200 F PROPOSED FNISH FLOOR AND B El C01IM S 'kCOSION CONTROL:HOUSE,WELL, SSDS PERMIT APPLICATION jF,PRESENTATIVE OF PRIMARY & EXPANSION PC -I . .00t1TION zX AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE WELL PERMIT _ P WS LETTER LETTER OF AUTHORIZATION ;LOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/N 200' OF PROPOSED SYS. SIGN DATA SHEET (DDS) HOUSE SETBACK NECESSARY (TIGHT LOT) CORPORATE RESOLUTION X10 BENDS; MAX.BENDS 451 W /CLEANOUT SHORT EAF AY BARRIER PLANS - THREE SETS FILL SP FILL NOTES USE PLANS -TWO SETS DEPTH GES VARIANCE REQUEST M LUME IN EXPANSION AREA FEE ,SUBDIVISION LEGAL SUBDIVISION &UBDMSIONi APPROVAL CHECKED P RATE ILL REQUIRED DEPTH CURTAIN DRAIN, REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED NS SUBMITTED TO DEP EGATED TO PCHD EP APPROVAL, IF REQD DE T HOLES OBSERVED C TO BE WITNESSED E PPROVAL SSDS ADJ. LOTS ANDS (TOWN/DEC PERMIT REQ'D ?) 7. A.ON.DDS- LAMS & PERMIT SAME _. i I >69NiiGiiBGRNOTiFICA11.ON LE R BI/ZBA 00 . FLOOD ELEVATION ER REQ'D PERMITS) jEQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE VITY FLOW ONSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED R/CURTAN DRAINS 30IL TYPE BO TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWNG/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS CAKES AND WETLANDS WITHIN 200 F PROPOSED FNISH FLOOR AND B El C01IM S 'kCOSION CONTROL:HOUSE,WELL, SSDS "hRC & DEEP HOLES LOCATED jF,PRESENTATIVE OF PRIMARY & EXPANSION MAP .00t1TION zX AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE F PUMPED, PIT & D BOX SHOWN & DETAILED ;LOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/N 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSES EWER -1/4" FT. 4 "0; TYPE PIPE X10 BENDS; MAX.BENDS 451 W /CLEANOUT FILL SYSTEMS AY BARRIER 10- HORIZONTAL PE 3:1 TO GRADE FILL SP FILL NOTES FILL CER' TION NOTE DEPTH GES FIL OFILE & DID ONS M LUME IN EXPANSION AREA .FILL TRENCHS2' 'LF TRENCH PROVIDED 60 FT MAX. 'PARALLEL TO CONTOURS 100% EXPANSION PROVIDED S ON PLAN - FROM SSTS 10' TO P.I. DR- VEWAY.•LARGE TiiPES, T 0 F- OF FILL - �0' TO FOUWATIbN WALLSIYWELL TO PL 100' TO WELL, 200' N DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LNE (pits -20) 50' INTERMITTENT DRAINAGE COURSE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS /x 15'MN to CDS=> 5°/ ql0'- 4%, 25 '- 31/,30' - 2°/0,35' -1° /,100' - <1% m20'MN to CD discharge /100'with 182 cons day discharge SEPTIC TANK' 10' FROM FOUNDATION; 50' TO WELL WELL IMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION v Im C*t-s