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04515
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
0 G
lWell
OL 1
T&M, - �jl e�
Vt, I be v
T d
TEA 41
vf .4
Map Block I Y Lot(s�f 3
Owner:
Name: Address:
0IN 's 4f I., ivt,_
Use of Well:
1-primary
2-secondary
✓Itesidential Public Supply Air cond/h6at pump 'Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
_L/Rotary _ Cable percussion Compressed air percussion Other (specify)
Well Type
Screened t/Open end casing _ Open hole in bedrock Other
Casing Details
Total length __Za_ft.
Length below grade 2, Ift.
Diameter 4w — in.
Weight per foot _70--p lb/ft.
Materials: ✓Steel — Plastic Other
Joints: Welded t.--Threaded Other
Seal: �,�ment grout Bentonite Other
Drive shoe: Yes __LeNo
Liner Yeses ---No
No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed _ Pumped V Compressed Air
Hours
Yield 5--gpm
Depth Data
Measure from land surface-static (specify ft)
20
During yield test(ft)
Depth of completed well in feet
4 oc
Well Log
If more detailed
information
descriptions .or
sieve analyses
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
u- ,r cl e
0
i
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump/Storage Tank Information
Pump Type �*,%,A4Capacity -S–
Depth Model _:Pk�b —A k
Voltage HP /Me
Tank Type Volume
Date Well Completed
Putnam County Certification No.
Date of Report
Well Driller (signature)
I k—It,
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sneetipian.
Well Driller's Name A/rn " n A n d 4-rs 6 n
Signature: Aa(,j AA
Address: ew t
Date: J1 a, 1 J ac, '.
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC-97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DWISION OF _ENNgR- 0. NMENTAL HEALTH.SERVICES
CERTIFICATE OF CONSTRUCTION , MPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT #
Located at 4941 /'S' - Town or illage
Owner /Applicant Name JMy M l 944AP4 Tax Map 15 r Block Lot 5--3
Formerly �dlcAcJ Subdivision Name .1)/liuA
Mailing Address 0-6 S/ v
Date Construction Permit Issued by PCHD
Subd. Lot # 2
Zip
Separate Sewerage System
built by
Address
AX r ? 51V&4,u
Consisting of IZS-o
Gallon Septic Tank and
,(ro-v
Z • 1C c-�
Z t dr WIVC
Other Requirements:
Water Supply:
Public Supply From Address
orz_X_— Private Supply Drilled by Ak4lh✓ Ayvd/LS <J Address /rz PV, 9 ,
ldi�i'' Has erosion control been coni leted?
g
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 accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations
y the Pum County Department of Health.
Date: �Zr Rio 9 Certified by
P.E. X R.A.
/ (Design Professional)
Address ed k ja y7 /���v'ZlkL cz- & -' Z License # 6 � �'�
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modification or change is necessary.
-' Title: Date: to i
- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
NOV -04 -2009 02:28PM FROM - ENVIRONMENTAL HEALTH 845ZT87921 T -975 P.001 /001 F -188
PUT AM COUNTY REPARTMENT OF HEALTH
DWISION OF ENVIRONMENTAL H - -
GUARANTEE OF SUBSURFACE SEWAG ✓ TREATMENT SYSTEM
GLAIIA -1 re-;p
Owner or Purchaser of BWldin
g
OLVE/i5x
Building Constructed by —
�t C
Location - Street LJ
Building Type
Tax Map block Lot
TownlVillage
Subdtvision Name
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, worLmansMp, 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 the which fails to operate for a period of two gears
t xn4ately following the date of approval of the "Certificate of Construction Comnpliance" 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.- _ . ' X` • —_ . _ .. _
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month _ Day Year U
C
General. Contractor ( er) - Signature
�j�v11C {C1vt� � %11,• ?(.\S�Ct L \�:'G lC�(`Q
Corporation Name (if corporation
Address: Ida �?� `� 0
State p 1 ' zip
Signature:`:.
Title: �
Corporation Name (if corporation)
Address: --
State zip —
Form GS -97
FINAL SITE INSPECTION ` 11- 131&1'
Date: ��
Inspected by:
Owner 7pM 0 ?0?�/ y'
P.ermit. #_ .-.PU- 0(-- 0
...... .)Jot # .�
1. Sewage Svstem 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. 1 00' from water course / wetlands ....... ...............................
IL Sewage Svstem
a. Septic tank size - 1,000 ...:.... �5O .othe r..........
b. Septic tank installed level.....
c. 10' minimum from foundation .......... ...............................
d. Distribution Box
1. All outlets at same elevation -water tested .........:.....,.
2. Protected below frost .................. ...............................
3.- Minimum 2 ft.Original soil between box & trenches
e. Junction Box - properly set .......... ...............................
6. Trenches — . 1^
1. Length required -r Length installed C ,
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 3A - 1' /z' diameter clean ...................:
9. Depth cf gravel in trench 12" minimum ....... :...........
10. Pipe ends capped ........................ ...............................
g, Pump or Dosed Svstems
I, -Size of p pshambets;:::.,;.. ::._m_ ........................" `
2. Overflow tank.. .... . .................. ............................... .
3. Alarm, visual/ audio ........:........:.. ...............................
4. Pump easily accessible, manhole to grade .................
5. First box baffied .......................... ...............................
6. Cyycle�witnessed by H.D.estimated flow /cycle...........
III. House/Building
a. Plouse located per approved plans..........
b. Number of bedrooms .......................... �...... ��........�........
IV. Well
Well located as per approved plans . ......:........................ -,r
b. Distance from STS area measure ft5� °.r
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. BackfM material contains stones <4" diameter ..............&iv
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 ............ ...............................
Rev. 12/02
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Fax: Pages-,
Phone: -3 - ?7 Date-
ROGERTi. BONDI
ourr" r -CW
ROBERT MORRIS. PE
Re: lok"
IN r 17
Urgent'. -or Review, = Please Comment = Rie-ase Rapiy Pease Recycie
In the --venr'oF zransmussion/rIeceprion difficulzies. r)ieasl- contact the Environmental Ee ilth_
CLS office at
�--O. Thank vou.
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YML ENVIRONMENTAL SERVICES
!^ 321 Kear Street
Yorktown town Heig ts, N.Y. 10598
~Albert H. Padovani, Director
LAB #: 1.903859 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2
ANDERSON WELL DRILLING DATE /TIME TAKEN: 09/11/09 03:00
152 BARGER ST DATE /TIME-REC'D: 09/11/09 03:20
ATTN: NORMAN, SARAH REPORT DATE: 09/18/09
PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491
SAMPLING SITE: BARGER ST, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE
BROPHY'-. PRESERVATIVES: NONE
COLD -BY:. `- TEMPERATURE. < 4C
NOTES...: COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
PUTNAM CNTY PROFILE
09/11/09 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B
09/18/09 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B
09/11/09 NITRATE NITROG 1.89 MG /L 0 - 10 SM18- 20450ONO3
09/11/09 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2
09/14/09 IRON (Fe) 3.64 MG /L 0 -0.3 mg /1 SM 18 -20 3111B
09/15/09 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B
09/15/09 SODIUM (Na) 4.84 MG /L N/A SM 18 -20 3111B
09/11/09 pH 6.6 UNITS 6.5 -8.5 SM18 -20 4500HB
09/14/09 HARDNESS,TOTAL 72.0 MG /L N/A SM 18 -20 2340C
09./14/09 ALKALINITY (AS ,40.0 MG /L N/A SM 18 -20 2320B
V{'09/14/09 TURBIDITY (TUR 15.0 NTU 0 -5 NTU SM 18 (2130B)
COMMENTS:
MFTC a oliform = This result indicates that-the water
Q�we as) ew (was not) of a satisfactory sanitary quality according to
N York State and EPA federal drinking water standard for
this parameter::--This comment applies to the Total - -Coli -form test
only.
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 hav& 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.
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
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
lbe'rt H Eadovarii , Director'
LAB #: 1.903859 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2
----------- w--------------- ~----- - - - - -- -------------------------------- ~ - - - - --
ANDERSON WELL DRILLING
152 BARGER ST .
ATTN: NORMAN, SARAH
PUTNAM VALLEY, NY, 10579
DATE /TIME TAKEN: .09/11/09 03:00
DATE /TIME RECD: 09/11/09 03.:20
REPORT DATE: 09/18/09
PHONE: (845)- 528 -1491
SAMPLING SITE: BARGER ST, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE
BROPHY PRESERVATIVES: NONE
COL ' D BY: - - _. _ ._ ... _ _ .. _ - TEMPERATURE..-- z 4C
NOTES...: COLIFORM METH: MF
------------------------------ ---------------------------------------
--------------------------------- - - - - --
DATE FLAG PROCEDURE
RESULT NORMAL - RANGE METHOD
moderately restricted diet, a maximum of 270 mg /L of Sodium
is suggested.
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 ,3 00 MG /L
MODERATELY' HA D WATE1Z: 70 -140 MG /L MG /L MILLIGRAM PER L;ITER-
HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L)
THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC,
AND RELATE ONLY TO THESE SAMPLES RECEIVED BY THE LAB
SUBMITTED BY: qlca
Albert Padovani, M.T.(ASCP)
Director
ELAP# 10323
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
� y
Albert H. Padovani,' ^Director
LAB #: 1.904824 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 1
ANDERSON WELL DRILLING DATE /TIME TAKEN: 11/18/09 09:40
152 BARGER ST DATE /TIME RECD: 11/18/09 10:30
ATTN: NORMAN, .SARAH REPORT DATE: 11/23/09
PUI'NAM VALLEY, NY 10579 PHONE: (845)- 528 -1491
SAMPLING SITE: 61 BARGER STREET SAMPLE TYPE..: POTABLE
: OUTSIDE PRESERVATIVES: NONE
COLD BY: BEV TEMPERATURE... :
NOTES...: COLIFORM METH: N/A
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
11/19/09 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 31113
11/20/09 TURBIDITY (TUR 0.4 NTU 0 -5 NTU SM 18 (21308)
COMMENTS:
Fe /Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg /L.
THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC,
AND RELATE NLY T lTH�ESE SAMPLES RECEIVED BY THE LAB
SUBMITTED BY:— °'�
Albert H Padovani, M.T.(ASCP)
Directo
ELAP# 10323
MEMORY TRANSMISSION REPORT
I Vit A2:49PM-`- -":".
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER 714
DATE DEC-04 12:46PM
TO 818455268806
DOCUMENT PAGES 004
START TIME DEC -04 12:46PM
END TIME DEC-04 12:48PM
SENT PAGES : 004
STATUS : OK
FILE NUMBER 714 SUCCESSFUL TX NOT ICE
11D. %,IS- F.-.-P •
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Ft' C:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION.OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # - -
Located at i /z' /Z S ,---'r— Town or Village-
Subdivision name V t1A:�Aj' Subd. Lot # j Tax Mape -S Block Lot
Date Subdivision Approved ; 5wva -!rte 79 wo St
Owner /Applicant Name Z�V§ xofp, 'OR
Renewal Revision
Date of Previous Approval
Mailing Address 117 1?40 MILL 4 � � c.-� 'G!t-N�'i /�'� 1 Zip j0567
Amount of Fee Enclosed • 00
Building Type Lot Area No. of Bedrooms Design Flow GPD �bU
Fill Section Only Depth Volume
PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage S, stem to consist of 4ONP /sue gallon septic tank and ��� /- • �
Other Requirements:
To be constructed by ',� . ii. Address
Water Supply: �. : PubiiG.Supply- From. Address
or: _� Private Supply Drilled by A?4bf Address 06
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatments em described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will 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 o
Signed:
Address
R.A. Date -3 jZy / e �e
License # 0-7 67 5 .3�
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new perp4t. Approved for discharge of domestic sanitary sewage only.
By: Title: Date: I ba I 1C)q
Whi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
NOV-17-2009 01:24PM FROM-ENVIRONMENTAL HEALTH
8452787921 T-093 1`101/002 F-419
E911 ADDRESS VERIFICATION FORM
OWNER'S NAME: H 0 0AA 5
TAX MAP NUMBER: C'-)
E911 ADDRESS: 6-1 A � (,,F V',-- S' —
TOWN:
) �!7 K, fit" �h I/ L're-�"
AUTHORIZED TOWN OFFICIAL-.
(Signature) v
T-E-
_� V6
The- Putnam County Department of Health will not issue a Certificate of ConstrUctioin
Compliance unless the above form is completed, i.e., a legal E911 address is assigned b V an
authorized Town official. This form is to be submitted with the application for a
Certificate of Construction Compliance,
F,911addressverification
SHERLITA AMLER, MD, MS, FAAP
Commissioner of.Henith ,^
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
June 27, 2008
Stephen J. Ferreira
P.O. Box 1047
New Milford, CT 06776
Dear Mr. Ferreira:
DEPARTMENT- OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County, Executive .
ROBERT MORRIS, PE
Director of Environmental Health
Re: Field Inspection — Brophy 46
Barger Street /
(T) Putnam Valley, TM # E� -1 -5.3
The above referenced separate sewage treatment system can be backfilled. The following
comments must be corrected in the field.
1. Silt fence must be erected and maintained below the SSTS area as per the approved plan: , y
2. There appears to be some large stone in SSTS area. Please remove prior to backfilling.
3. Call when ready for well inspection and bedroom count.
4. At time of inspection it was noted that the C.I. pipe from house to septic tank has not
been installed yet.
5. There appears to be a cleanout missing between the tank and the first junction box.
Please clarify.
If you have any further questions, please contact me at (845) 278 -6130, ext. 2155.
JD:kly
Sinc ,
eph Digit
Environmental Engineering Aide
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
06/25/2008 14:38 9147341029
'7_,-. -71)
Mal
PAGE 01/01
MISION OF ENVIRONMENTAL HEALTH SERVICES
ATT.EN71 UON JOSEPH GENE
REQ LM EOR M AL INSPECTION For: Fill
All inforn ation must be fully completed prior to any Trenches
inspe'ctior; being made.
PCH D Ccistruction Pern3it 9 P 0
Located:. Pv mwdft V" M (V) _ &VrA,#PM
37
Owner /Al plicantName- TiXI 1 _ TM .r, B L ot flock I
Fornierly: 1 1 Subdivision Name:
I r
Subdivision Lot # —7
Is � 711 completed? V4
Date.
Is system -.omplete? T/z--7 7w.
- 'r Date:
is qy;t= 1onstructcd as per plans?
Is wAll dr;;Jed? 0- 0 Date.
Is well lo( sted as per. plans?
Are irosic n control measures in place?
i :A
I certify tl. = the system(s), as listed, at the above premises has been constructed and I have inspected
and iierif ,J their completion in accordance with the issued PCHD Construction Ferrait and
appTQVed. ..flans, ayid,,thqAtandards, Rules and:�.egula�ons-of,te,Ntnain,.Count Department of
-4y
.,Deparpm
Date., 1/1,3 1087 Certified by: PE RA
/besign Professional
71-7
Addrdss: 1302C ZV VOL- A04�7141 C7-Lic-
07
Corninent
Forrri'FIR. 99
4z/09
PUTNAM COUNTY DEPARTMENT OF HEALTH
0 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # 'P� - 0b r O�
Located at e S7' Town or Village 41M &6�
Subdivision name &AI vy "r Subd. Lot # Tax Map 6 Block / Lot S3
Date Subdivision Approved . 2 /� Zf q Renewal _, Revision
Owner /Applicant Name *..s "4014 j' Date of Previous Approval
—T
Mailing Address Zip
Amount of Fee Enclosed fob .
Building Type 'MUT
Lot Area 3 Xlt No. of Bedrooms 4" Design Flow GPD RO
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of 12 gallon septic tank and.
Other Requirements:
To be constructed by 7"6-10
Address
_Water Address.- p
or: _ Private Supply Drilled by � ti'✓�� ��' ��''�: Address 9 /
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. % R.A. Date
Address to, 6, 6 � N `1F7 A% W (40 C;;-' 4%_776 License # 6 2& _/ %3
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new p rmit. Approved for dischar a of domestic sanitary sewage only.
By: Title: 0 Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WA�TF�It.�?Vlrr
please print or type PCHD Permit #
Well Location:
Street Address: Town/Village Tax Grid #
Eft V Map bY- Block Lot(s) S7.3
,
Well Owner:
Name:
Address: kv
/aM Fl-
Use of Well:
Residentifil Public Supply Aft /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 J�al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
JL New Supply (new dwelling) Deepen Existing Well
Detailed Reason
v
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision. Yes_J No
Name of subdivision ng,&yi4 VyrK ' Lot No. .3
Water Well Contractor: Anfi0i`✓4,5* *v Gl",C- caves Address: 16r2— 64A6 A/- ST i�'- a
Is Public Water Supply available to site? .................................. ............................... Yes No
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.
Dwe— i i llt Sb.gTTc'ltiire.p
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 Putnam
County.
Date of Issue Permit Issuing Offici
Date of Expiration v Title: -4�2
Permit is Non- Transferrabl
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
Ste.pala�'.& Ferreira; -P "E
P.O. Box 1047
New Milford, Connecticut 06776
Lawrence Werper
Putnam County Health Department
Division of Environmental Services
4 Geneva Road Brewster, New York 10509
Re: SSDS Construction Permit
Sect: 85. Blk: 1 Lot: 5.3
Barger Street
Putnam Valley, NY 10579
Dear Mr. Werper:
Aug. 14, 2006
The following issues have been addressed for the above - mentioned project:
1. A well permit application has been provided.
2. Proposed basement elevations have been added to the plans.
3. Three new sets of modular home plans have been attached showing proposed
room identification.
Please feel free to contact me if there are any fizrtlie 'r questions bi—fn d- riiation required:��-
S' r y Your
e-
Stephen J. Ferreira
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
•x.;, LORET,TA,MOLINARI, RN,�MSN -
Associate Commissioner of Healt�i "
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Stephen J. Ferreira
123 Washington Ridge Road
New Milford, CT 06776
Dear Mr. Ferreira:
ROBERT I BONDI
. County Executive
:ROBERT MORRIS, PE
Director offnvironmental Health
August 9, 2006
Re: Proposed SSTS Renewal — Brophy — PV -06704
Barger Street
(T) Putnam Valley, TM # 85. -1 -5.3
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. A Well Permit Application was not submitted with the renewal.
2. Proposed basement elevation not shown on plans.
3. All rooms must be labeled on house plans.
This office will continue its review upon consideration of the above- mentioned comments.
Please feel free to contact me at est. 2163 if any questions arise.
LCW:kly
Very truly yours,
Lawrence C. Werper
Public Health Engineer
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 =6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
iNDIMtJA-L WATER SUPPLY SL SEPRItI.Cm., r SYSTEks
REVIEW i
FOR CONSTRUCTION PERMIT
NAME OF OWNER:. 0 -STREET LOCATION: 09 re rvL-
REVIEWED.BY: Plvt G SRDATS: TAX MAP#: (CO
NMD) �2—
Y "s DOCUMENT Y N ( REQUIRED DETAILS ON PLAlY5 CONT'D�
ENT-
wmdn APPLICATION )HOUSE SEWER -Y."FT. 4"01.- TYPE PIPE CAST IRON
PC-97 i
LETTER OF AUTHORIZATION
DESIGN DATA SHEET (DDS)
CORPORATE RESOLUTION V4
SHORTW
Lie6
,fL JPLANS-TEME SETS
CZ(__)13OUSE PLANS - TWO SETS
(_)Cj2VARiANcF, REQUEST
SUBDIVISION
LEGAL SUBDIVISION
V )SUBDrMION APPROVAL CHECKED
C Z1--_.J
,DERC RATE
C_)�Z)&LREQUIRED DEPTH
L__)Lt0CURTAJNDRAJNREQU=D
/GENERAL
Ufa POCATEDINNYC
WATERSHED
�PLANS SUBMITTED TO DEP
L:JqELEGATED TO PCHD
EP APPROVAL, IFRFQ'D
, �, j �,
A PEEP TEST HOLES OBSERVED
_WETLANDS (TOWNIDEC PERMU REQ'D?)
DATA ON DDS- PLANS& PERMIT SAME
-J(_!_)'PRE 1969 NEWEIB611 NOTIFICATION
'TT
DC�io6yli FLOOD ELEVATION WIIZO'O',
_J(., SOIL TESTING LOTS>10 YEARS OLD
REQUIRED •DETAILS ON PLANS
SEWAGE SYSTEM PLAX-(NORTH ARROW)
SSDS HYDRAULIC PROFILE
GRAVITY FLOW
CONSTRUCTION NOTES 1-15
V )DESIGN 2' CONTOURS PERC &DEEP RESULTS
'CONTOURS EXISTWG & PROPOSED
DRIVEWAY & SLOPES, CUT
VJMQTINGlGUTTERlCUR±AJN DRAINS
6(-,,---JTITLE BLOCK; 6 OWNERS NAME ADDRESS
TMN, ?ERA; NAME, ADDRESS, PHONE#
'DATE OF DRAWING/REVISION
G
DATUM REFERENCE
.i&(L0XAwmETLANDS CATl0N OF WATERCOURSES, PONDS
. WITE[IN 200'OF P.L.
--)LnOP,OSlD FINISH FLOOR AND -
BA3FZvlEN-T,
IDL Of F SSTS
ROPERTY METES &BOUNDS -
-)�EROSIONCON M-OLF.OR.HOUSX, WELL &
SSTS., EROSION CONTROL NOTE
KAENTS: 6(L' ?L/4A't
inn
L-)l\TO BENDS; MAX ]BENDS 45- W/CLEANOtT
RENEWALS
C(_)SITE NOTE (NO CHANGE)
. FILL SYSTEMS-
C--)L-Jl0'HO=ONTAL; PAS SLOPES 3:1 TO GRADE
C--)CLJ.MISPECS/ OTES 1-5
F
ILL -P & DIMENSIONS
r N
NS
Sl
ro
J"MA ON AREA
FILL GM TEIZZ-94N I FEET
.LJL-) CLAY BARRIER
L-)Lj-*FILl;'CERTIF]� ION NOTE
(_-)DEPTH G-,A&69S
(_)(__)VOL - �05 , PLAN FOP, R.O.B., tNCLASSIFIED & IMPERVIOUS
A,
C--)C��RATION' DISTANCE FP,OM'TOF,OFSLOPE
TRENCH'
�C-JLFTREN`CHpROVID6A--T-lb 60FT MAX
�"(PARALLEVTO CONTOURS
�DETMIMUST 100% EXPAN91ONPROVMED
FREE CRUSHED'STONE OR WASHED GRAVEL
_JGEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN 4 FROM'SSTS
(= 31010' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
201 TO FOUNDATION WALLS
)100' 1001 TO WELL, 200, INDLOD, 150'TQ PITS
TO STREAKWATERCOURSE, LAKE•(inc. expa•.
30' TO CATCH NI -PIP L T 3
WA R
10'TO WATER LINE (pits -20f)
DRAINAGE. COURSE.
200-1500'RESERVOM ETC. 150' GALLEY SYSTEMS
(___)10' MIN TO LEDGE QUTCROP
SEPTIC TANK CIAL10'FROM FOUND*TION-, 50' TO WELL
WELL
,DIMENSIONS TO PROPERTY LINES
LOCATION OF SERVICE CONNECTION
151 TO . PROPERTY LINE
SLOPE
OP.2 IN SSTS AREA. 7h (-,C20%)
Hv-1 14, v T
Ljc.fj,R-zGRA,DED TO 15%, IF REQUIRED
(-)L--)Pube NOTES
L-)(—)DOSE 75% OF P2 OSE VOLUME NOTED
P
CE
(fit )DETAIL
F04" CKMAV, (PIPE TYPE, ETC
PTT 0
L-)C--)Prr V-BOX SRO" & DLTA=
J36
STORAGE ABdVE ALARM
CURTAIN DRAW
L-)(-)S7ANpPlpxS, 5, BO S, DETAIL
LJ(_-)15'X[N to 20'-4%, 25' -3 %, 3T-16/6, 100%-.<l%
DISCHARGEt100'with 182 cons day discharge
to NON-PERFORATED PIPE,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of zMe"_116
Located at OW6
TN Tax Map #
0
Block Lot 573
Subdivision of -D9,,+NA VV ICAO
Subdivision Lot # Filed Map # Date Filed 70() 4-
Gentlemen:
This letter is to authorize , 'S
—te JOJ4 CAJ .7 -� ,44 Of P—A
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 Public Health
Lw. and .the Putnam, 1Qqqpty. Sanitary
Very truly yqW,.,s,
Countersigned: Signed:.
Q # o-76773 (Owner of P-raparty)
Mailing Address
P'0. 60--4- (C)q-7
arm t A11,FCV-0
State e-.T-
7ip
Mailing Address:[Q�
(DG-7-7,6 — State,
Te1ephone:(R&,) �50--_7,41 Telephone: jtic�
Zip
LA-97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_:...., n a__.: -.- t9ww.Lll �AyipmT ®^gtIpT Tp. ■^pY p{,��IY`'1IG'1�' -AW''R =WTI 1<,
please print or type PCHD Permit #
Well Location:
Street Address: Town/Village Tax Grid #
Permit Iss ing Official:
01444 ICA S� AAAr-t &-,* Map es" Block Lots) 57
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 Est. of Daily Usage gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
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
Is well located in a realty subdivision? ... .................................... ............................... Yeses No
Name of subdivision P/4fA)A Lot No. _
Address. /L .S`P"
Water Well Contractor: 4�J.v�,cn! l�t.0 -- D��LG �A,��
Is Public Water Supply available to site? .................................. ........................ ........ Yes Nok-
Name of Public Water Supply: '� Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination t e provided on parate sheet /plan.
'`
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 Putnam
County. n
Date of Issue
��' - °`?
Permit Iss ing Official:
Date of Expiration
.2
Title:
Permit is lion
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
1z
_ SJF Engineering Services
sii�p 'Y' Ferreira, P.s.
103 Perry Drive
New Milford, Connecticut 06776
(860) 350 -2499
Joe Paravati
Putnam County Dept. of Health
Brewster, NY
RE: 5rwjceJ P—aAmvr—iZ
Dear Mr. Pararvati:
7VIZ
P
%Z) 14ccoAA- kf�,9T
pTI"00'r �.
Sin ely Yours,
c
Sx�p#�en d. �� Kira
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
June 9, 2004
Stephen Ferriera, P.E.
SJF Engineering Services
103 Perry Drive
New Milford, CT 06776
Dear Mr. Ferriera:
ROBERT J. BONDI
County Executive
Re: Proposal SSTS — Kantor
Barger Street, (T) Putnam Valley
T.M. # 85 -1 -5.3
This office has received and reviewed the most recent set of plans for the above -
mentloned project,e would 11ke to offer ,the following comments for spur `review
.�.. .__.....�.. �" , -.�. .-�... .
1. The 30 -foot length of SDR -35 needs to be shown to scale in the profile, not just
labeled. Also, show the clean-out locations in the profile.
2. Please coordinate with the owner and engineer for lot #2 concerning the location
of the lot #2 septic and the proposed well for lot #3. There may be separation
concerns between the septic and well.
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
oseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP:cw
r u
T
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845)278-6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
May 3, 2004
Stephen Ferriera, PE
103 Perry Drive
New Milford, Ct. 06776
ROBERT J. BONDI
County Executive
Re: Proposed SSTS — Kantor .
Barger Street, (T) Putnam Valley
TM # 85 -1 -5.3
�j ar Mr. Ferriera:
J� 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.
J 1. Please correct and verify tax map number on documents and plans.
J 2. Please show any 100 -year flood plains within 200 feet of proposed SSTS or provide a note
stating there are none.
- 'Where appears tU ?fie only twe deep,test-holes, -but: a third hole is show- on :the plan.
41 Please show silt fence for house, SSTS, and well. Y
The 30 -foot length of SDR -35 is not shown in the profile view.
3 � 6. Please provide minimuni/maximum label and show cover over septic tank in the septic tank
detail.
7. Please provide water line and location of service connection.
8. Please provide 2 dimensions form the well to the property lines.
9. Please provide a note stating that the proposed SSTS is to be_staked by a licensed land
surveyor before any construction begins.'
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,
oseph S. Paravati, Jr.
Assistant Public Health Engineer
7SP:cj
C..
LORETTA MOLINARI ROBERT J. BONDI
Public Health Director �'� Y�� County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New .York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278-7921
Nursing Services (845)278-65H WIC (845)278-6678 Fax(845)278-6085
Early Intervention/Preschool (845) 278 - 6014. Fax (845) 278 - 6648
May 3, 2004
Stephen Ferriera,'PE
103 Perry Drive
New Milford, Ct. 06776 c'/
Re: Proposed SSTS = Kantor
Barger Street, (T) Putnam Valley
TM # 85 -1 -5.3
Dear Mr. Ferriera:
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. Please correct and. verify tax map number on documents and plans.
2. Please show any 100 -year flood plains within 200 feet of proposed SSTS or provide a note
stating there are none.
..._=� .,:zxeil2oars to'be only two de ?r'testholes; bet=a thirdhol6Js shown :bn•the plan:'
- M v 4. Please show silt fence for house, SSTS, and well.
5. The 30 -foot length of SDR -35 is not shown in the profile view.
6. Please provide minimum/maximum label and show cover over septic tank in the septic tank
detail.
7. Please provide water line and location of service connection.
8. Please provide 2 dimensions form the well to the property lines.
9. Please provide a note stating that the proposed SSTS is to be staked by a licensed land
surveyor before any construction begins.
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,
oseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP:cj
PUTNAI f COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE $F
WA TR +Ta %1" 9TEmrx I
SiIE01T'i OI CONST U�`CTZON PERMIT
NAME OF OWNER: �wr/1� STREET LOCATION: — S --
REVIEWED.BY: RM, GPI SRDATE: o TAX MAP#: (CONFIRIAM ' S
Y N DOCUMENTS Y N UIRED DETAILS O P 'D
PERMIT APPLICATION ( i HOUSE SEWER - W FT. 4 "0'; S
(�(�WELL PERMIT OR PWS LETTER TYPE PIPE. CAST IRON '
NO BENDS; MAX BENDS 45' W /CLE . 7/Tr
�S- (� "
UPC=97
(=::n, LETTER OF AUTHORIZATION (U(__ )S (NO CHANGE) N. /
DESIGN DATA SHEET (DDS) FILL SYSTEMS/
CORPORATE RESOLUTION (- (_)10' HORIZONTAL; PAST T H SLOPES 3:1 TO GRADE
SHORT EAR :.L jL jF]LL SPECS/ .• TES 1 -5
PLANS -THREE SETS (UUFILL P & DIMENSIONS
f _% OUSE PLANS - TWO SETS
U( c/jVARiANCE REQUEST
SUBDIVISION
Cg,-,j (- H
LEGAL SUBDIVISION
SUBDIVISION APJ�_ PT3OVAF�. CHECKED
ERC RATE -- l S b.-
11114. , /1%
(U( L REQUIRED DEPTH
(jURTAIN DRAIN REQUIRED
GENERAL
ACL)PELEGATED OCATED .IN NYC WATERSHED
LANS SUBM n"M TO DEP
TO PCHD
( _). P APPROVAL, IF REQ'D
(___)(DEEP TEST HOLES OBSERVED
( )(_lPERCS TO BE WITNESSED
,TLANDS (TOWNIDEC PERMIT RE4
TA ON DDS- PLA.NS 3c F-EIFMn -S".
E 1969 NEIGHBOR NOTIFICATION
UU IN EXPANSION AREA
FILL GREATS 2 FEET
'(U(.,�_j CLAY BARRIER,
(__)(_JFILL 'CERT7FIC T3 N NOTE
UUDEPTH GA
(- --)L-)VOL. O AN FOR R.O.B., MCLASSIFIED & IMPERVIOUS
(U S TION DISTANCE FROMTOE OF SLOPE
TRENCH
LF TRENCH PROVIDED ' 60FT MAX. -SD r4if7w
(PARALLEL TO CONTOURS
U 100% EXPANSION PROVIDED
DETAdL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL
(_JGEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN : FROM-SSTS
10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
(U(L20' TO FOUNDATION WALLS
100' TO WELL, 2001N DLOD,150' TQ PITS
�-100'TOSTREAM, WATERCOURSE, LAKE (Inc. ezpan).
(50'9C- A?fCHk. S'ST+AIiMDRAI,I'IIk`DV6aT'I2
G 1i7 10'T6 WATER LDM (pits Z lwc�w'
)L�SOILTESTING LOTS>10 Yi'Am5-otu- ° "!' " .. 0 INTERMITTENT D AGE COURSE
REQUIRED DETAILS ON PLANS 200'1500' RESERVOIR, ETC. 150' GALLEY SYSTEMS
+� EWAGE SYSTEM PLAN - (NORTH ARROW) U( --)10' TO LI!YDGE OUTCROP
�SSDS HYDRAULIC PROFILE SEPTIC TANK
GRAVITY FLOW UCU10' FROM FOUNDATION; 50' TO WELL
CONSTRUCTION NOTES 1-15
DESIGN DATA: PERC & DEEP RESULTS S S
LOCATION OF SERVICE CONNECTIO S �w
✓� 2' CONTOURS EXISTING & PROPOSED C_ JMI (15' TOTROPERTY LINE
1DRIVEWAY & SLOPES, CUT SLOPE
FOOTING/GUTTER/CURTAIN DRAINS
�USDA SOIL TYPE BOUNDARIES ( UysLOPE IN SSTS AREA (S20 %)
ITITLE BLOCK; OWNERS NAME ADDRESS (-- -)(-�- /-)REGRADED TO 15 %, IV REQUIRED
/ TM#, PEMA, NAME, ADDRESS, PHONE# DOSE UMP S STEMS
nV )DATE OF DRAWINGMEVISION Ut--)P.uMP NOTES
DATUM REFERENCE UUDOSE 75% OF PIPE VOL OSE VOLUME NOTED
LOCATION OF WATERCOURSES, PONDS UUDETA IL FOR FOR ,(PIPE TYPE, ETC.)
�LAKES,WETLANDS WITHIN 200' OF P.L. U( --)PIT AND D'$`03C�HOWN &DETAILED
IUPROPOSED FINISH FLOOR AND UUI DA RAGE ABOVE ALARM
BASEMENT ELEVATIONS CURTAIN D%�'
WELI,3 & SSDS'S W/iN 20 C— C::::jST�PIPES, 5' BO , DETAIL
PERTY METES & BOUNDS L )C _)15' MIN to CDS= o, 20'-4%,151-3%,35'-1%, 100 % -<I%
C�J EROSION CONTROL FOR HOUSE, WELL -C DISCHARGE1100' with 182 cons day discharge
SSTS EROSION CONTROL NO y to NON - PERFORATED PIPE
)MMNTS: /'�V� Cy r {`w�' w.- &v. 4- ll ,'AC& ' j
'VSRFTr^rinomi inn
air BELUMOeVIELU Boxmloan
Stephen J. Ferreira, P.E
103 Perry Drive
New Milford, Connecticut 06776
(860) 350 -2499
March 22, 2004
Joseph Paravati
Putnam County Health Department
Division of Environmental Services
4 Geneva Road Brewster, New York 10509
Re: Steve Kantor
SSDS Construction Permit
Sect: 85 Blk: 1 Lot: 5.3 (Subdivided lot#3).
Oscawana Lake Road
Putnam Valley, New York
Dear Mr. Paravati:
Please find enclosed:
1. (3) sets of proposed SSDS plans.
2. Two sets of Modular Home plans.
3. Construction permit application.
• 4 Letter of Authorization,-,:.
5. Application for approval of plans.
6. Application to construct a water well.
7. Soil Data Sheet.
8. Short environmental assessment orm.
9. Property Survey.
10. $400.00 Certified Check.''
11. List of property owners notified in accordance with the required neighbor
notification.
The information enclosed is provided based on our field inspections. Please feel free to contact
me if there are any further questions or information required.
Si ely Yours
/Stephen eJ.Ferreira
y
PUTNAM COUNTY DEPARTMENT OF HEALTH
r ON,OF EI N ONi LNT� AL HEALTH SE]W"iCE9'-
LETTER OF AUTHORIZATION
RE: Property of � 'Fy'f AA A/-re%e
Located at 1&11mei2 ST%�
TN jj� 64�kX Tax Map # s Block Lot
Subdivision of 7%�Ae�►9 �y%�4�
Subdivision Lot # Filed Map. # 2-9Y3 Date Filed
Gentlemen:
This letter is to authorize
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 provision s_of Article 145 and/or 147 of the Education Law, the.Puhlc Ha(th.�.._.
Law, `and the Putnaft County "SanitaryCode:
Very truly yours,
Countersigned: Signed: tl`�
P.E., R.A., # -76 7 q01 (Oimer of Property)
Mailing Address 103 ��,C.�y Mailing Address: ! % 1_4omlC_ 4.4,0
State G -r . Zip O%77t,
Telephone: R&D
State /yy Zip l D S
Telephone: (�/m &79— 'wo
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
E.N��ONl�'Ii;NT4I;: I.F�,'F.SE3CE5-
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: 5�E>!F, f �A -AvTz)
2. Name of Project: 'e 3. Location: TN: ���� �v!� �► MALL"
4. Design Professional: 5- e->°d�J J:j 1J ' A 5. Address: A-3 ✓�'�2P -Ui �� ✓ C7-
54, 7 7C
6. Drainage Basin:
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) ? .............. Yes/No AP
Type Status check one Type I Exempt X _
Type II Unlisted k_
9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No iW
10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No
11. Name of Lead Agency
12. Is this project in an area under the control of loca annin ring, or other officials,
- - . _ _ Yes/No . ,�:�_.
13. If so, have plans been submitted to such authorities? .. ............................... Yes/No sV 0
14. Has preliminary approval been granted by such authorities? Y/5- Date granted: ! '
15. Type of sewage treatment system discharge ........................ surface water groundwater
16. If surface water discharge, what is the stream class designation? ..........................
17. Waters index number (surface)
18. Is project located near a public water supply system? . ............................... Yes/No
19. If yes, name of water supply Distance to water supply
20. Is project site near a public sewage collection or treatment system? .......... Yes/No N
21. Name of sewage system Distance to sewage system --
22. Date test holes observed %2 23. Name of Health Inspector 41)Au cST /E yLi��y,
24. Project design flow (gallons per day) ... .............................:.
25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No po
26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No
Rev. 11/02 Form PC -97
Pg. 1 of 2
27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No
t p. v >:'�o. ='b •' �'ii r_ :J -.•S - +... i a. o t <ry - .. j - : wig Pria=f t� fl` -., -p .jq''kP •_}�. im' r<. : :_�,;. �E.a. r a"y -a .c''� rii aa-. .�':'�% ;YY.7:.�.•
28. Wetlands ID number .................................................................. ...............................
29. Is Wetlands Permit required? ............ ............................... Yes/No
Has application been made to Town or Local DEC ........................... Yes/No y�S
30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No NE)
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
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 N�
DESCRIBE:
33.
34.
35.
36.
Is there a local master plan on file with the Town or Village? ................
Are community water and/or sewer facilities planned to be developed within
Yes/No V1'
15 years in or adjacent to project site? .................................. .........................Yes/No
Are any sewage treatment areas in excess of 15% slope? .......
Tax Map ID Number .............. ............................... Map 65-
...................... Yes/No
Block Lot S
h-ro
37. Approved plans are to be returned to ................ Applicant )C Design Professional
. .. a .... -�.. ... h!- i�Cti ,c- :,S'_.1•....�a -,., sf?: .... -f_... ...,....ai,..}ay : s.f. ...... -..s •- .a�:P... �,. .--.o- v - .- .. --... bY- -.yY , ..,^J•• ♦ ...3.�. ,v �. «s r... aa.�a.0 -.�- �...a..w inn. �,
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require
DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious
surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit
those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item 1, the application must be
accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds
for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of
my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor
pursuant to Section 210.45 of the Penal Law.
SIGNATURES & OFFICIAL TITLES: JTl N/L�U 1c:i!7a6(V -A
Mailing Address: ........................... %3 fq---2Ky -p2 -
A1l � AA! &4col -o C r O C 7 76
Form PC -97
,� 6 .........:,:�' °i -.,.. « . "..:c �.. ��. ,,.: �.: a... G .:.c• . K.. , ' , -., . �� . S',:... :�,vl� .. . — °Y »..... �I �FE:.� ^ 11?�(: '.i?` .:�.� 5�: 1aY3� -. .._ .. __ ., � .. _s t�C
RE: Department of Health Review of Proposed
Sewage Treatment System for Property
Name:
Mr. Steve Kantor
Address:
Barger Street
Town:
Putnam Valley
Tax Map #:
85 -1 -5.3
Dear Adjoining property owner:
Please be advised that an application for a Construction Permit relative to the construction of a
sewage system and/or well proposed for the captioned 'property has been made to the Putnam
County Department of Health. Attached please find a copy of the latest site plan.
If you have any questions, concerns or information which may bear the Health Department's
review of this application, you may call the Health Department at (914) 278 -6130, extension
2157.
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Ve Truly Yours,
�v
Stepho Ferreir
N6 TX�1019,i
Nom-' % -
If412 f;
S�>
4- 9
SHERMrrA AMLER, MD, MS, FAAP
Commissioner of Health
. DAFRT MORM PIR _
Director of Environmental Health
Thomas & Nancy Brophy
61 Barger Street
Putnam Valley, NY 10579
Dear Mr. Brophy:
PAUL ELDRIDGE
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Office (845) 808 -1390
Fax (845) 278 -7921 or (845) 808 -1937
February 9, 2011
Re: Addition- A -003 -11
No Increase in Number of Bedrooms
61 Barger Street
(T) Putnam Valley; T.M. #85. -1 -5.3
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp from this Department dated February 9, 2011. The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at four without prior approval by this
Department.
2. The area of the existing sewage disposal system and its expansion area must be
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush
lc: ::toilets,,restrictors for shower heads, and, faucets_ etc. , , ...,
'I-& Deparkmerif recommends you contact your local Building "Departirient to ensure
setbacks and other current codes can be met.
5. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
Any other permits or variances required are the responsibility of the applicant and the
jurisdiction of the Town of Putnam Valley.
If you have any questions, please contact me at (845) 808 -1390, ext. 43261.
Sincerely, 1
Gene D. Reed
Senior Engineering Aide
GDR:cw
cc: BI, (T) Putnam Valley
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Certificate No: 2009 -251 Date of Issue: 12/4/2009
Permit No: 2008 -69
Tax Map No: 85. -1 -5.3
Location: 61 Barger St
Parcel Owner: Brophy Nancy/Brophy Thomas
BROPHY THOMAS
61 Barger Street
Putnam Valley NY 10579
This certificate covers the,construction of:
ONE FAMILY RESIDENCE WITH NO GARAGE;
4 BEDROOMS; 2 -1/2 BATHS; LIVING ROOM;
DINING ROOM, KITCHEN/BREAKFAST NOOK;
DECK (12'X 25'); FRONT PORCH (6'X 45');
AND UNFINISHED BASEMENT.
The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary
ode; tkie Uniformt:ildiri B F p'Code �i nd the Lw-w.8 6Lrb^ -ui- the- T.0W -x 0E-- P_1JTj4A l V L•EY -, . r. K..
Putnam County, NY, having paid the required fee therefore and the undersigned having by personal inspection
ascertained that improvement of the proposed structure is in compliance with the requirements of the laws as
aforementioned; that the said work and materials meet every requirement of the laws as aforementioned; and
that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law.
Now, therefore, the Certificate of Occupancy is hereby issued under the seal of the TOWN OF PUTNAM
VALLEY.
TOWN OF PUTNAM VALLEY
BY
Code Enforcement Officer
1
t
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y
RES check- Software Version 4.0.1
�:;-Oampffanc e :t:
Project Title: ON- 20240 t'�
Report Date: 12119/07
Data filename: M: \\20240.rck C / 17 ' �••'
Energy Code: N Y k t' l/
Location:
Construction Type:
Heating Type:
Glazing Area Percentage:
Heating Degree Days:
- Construction Site:
BARGER STREET
PUTNAM VALLEY, NY
ew or State Energy Conserva on
Construction Code
Putnam County, New York
Detached 1 or 2 Family.
Non- Electric
5750
Owner /Agent:
BROPHY
OAKRIDGE PARKWAY, INC.
PEEKSKILL, NY 10566 -8910
914- 760 -0817
Design er /Contractor:
PROFESSIONAL BUILDING SYSTEMS
72 EAST MARKET STREET
MIDDLEBURG , PA 17842
570 - 837 -1424
Compliance: Passes Maximum UA: 467 Your Home UA: 412 - -> 11.8% Better Than Code UA
Ceiling 1: Flat Ceiling or Scissor Truss: 1697 38.0 0.0 51
Wall 1: Wood Frame, 24" o .c.: 2608 - 19.0 0.0 128
Window 1: Vinyl Frame:Double Pane with Low -E: 356 0.370 132
Door 1: Solid: 38 0.140 5
Door 2: Glass: 40 0.390 16
Floor 1: All -Wood JoistlTruss:Over Unconditioned Space: 1697 19.0 0.0 80
l)Q propgs'ed buildinb surf sented'in this ttocumentis consistent.with the building pKns,.gpecifications and, other,calculations.submittiV,.,
with this permit application. The proposed systems have been 'desigried to meet the fVew`York"State' Energy ;Conseivaiioit Construo46'- "
Code requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of
his/her knowledge, belief, and professional judgment, such plans or specifications are in compliance with this Code.
PROFESSIONAL BUILDING SYSTEMS
Name - Title Signature
Eftlr►tten► Certii1{ttlllm appllis ONLY to FACTQRM W ILT
;pesrtfa►q or ft twllging, CW1 ticolk- doov,4014Pply W 811E
su1PPfisd or Insullsd elmnerea. luva such an, but not
ilirr tihd to; kuhdA t a, sfibptp, 0%,, ►twit b6 dlit tined RY
QTWJM for 440 corod1 ,, ;on "1..110r4dic om
12/19/2007
U to
r ..
ON -20W.. Page 1 of .1
f
D
R � _
r
ELIOT SPITZER
GOVERNOR
Mr. Robert Wilkinson'
Professional Building Systems, Inc.
72 East Market Street
Middleburg, PA 11842
Dear Mr. Wilkinson:
.y
STATE OF NEW YORK
DEPARTMENT OF STATE
41 STATE STREET
ALBANY, NY 12231 -0001
January 22, 2007
RE: M 013 -02 -052 RENEWAL
System approval CONDITIONAL
In reference to your written request received January 22, 2007, your original approval from December
31, 2002 to construct Factory Manufactured Detached One- and Two- Family Dwellings System of Models
designated M 013 -02 -052, is hereby renewed as authorized under 9 NYCRR 1209. This approval will remain in
effect until January 24, 2009 unless sooner revoked, and is subject to renewal thereafter.
Buildings manufactured underthis approval, are limited to irisfatlation on sites meeting the following criteria:
1. The Seismic Design Category as determined -by geographic location and soil site class is limited
to Seismic. D.esign.. Cate gory A,.B, or:C.. .
.2;.-.:_The'basic.;wii�d= ed 1.ocalityis no mp e..thzn' 1:0 inph.,..f'i�e:prc�j
opt
.stte_I&
Exposure, Category A, B, or C within the design wind speed.
3. The ground snow load is not in excess of 85 psf.
Supplemental Conditions of Approval
In addition, the conditions under which system approval is granted are:
1.The manufacturer is to submit to the Division a duplicate of the permit set for each dwelling to be
installed in New York State. Each 'permit set is to be sealed and signed by an architect or engineer
registered in New York State and is to bear that architect or engineer's certification that "the plans and
specifications of the permit set are derived from and .consistent with the plans and specifications
associated with this approval on file with the Division and this conditional approval letter." The
certifying architect or engineer may not be affiliated or associated with the manufacturer's .quality
Assurance agency:: The. following are specific requirements reganling the contents of the permit set.
1:1: Asetof drawings.comprising at a minimum:
- 1::.1:.i Cover, sheet which, contains information on:
Project location
..,,,Design criteria: listing of applicable design loads such as Ground Snow Load,
Seismic Design'Category Wind'Speed, Live Loads;'Dead.Loads; etc.
- Applicable building codes and design specifications
WWW.D'OS.STATE.NY.US • E -MAIL: INFO@ DOS.STATE.NY.US
y
Robert Wilkinson
January 22, 2007
Page 2
.. ..• _ n k
�. • w...a .� . . �« .. ... �,... »: = "�' - ` ,io n c ergy i crrlpc wi i
r&
Conservation Construction Code of New York State, 2002 Edition. Method of
compliance and pertinent documentation shall be provided.
- Occupancy classification
- Construction type classification
- General notes
- Index of drawings
- Manufacturer's title block
- Certification, by design professional, of derivation from approved system set
drawings and this conditional approval letter
1.1.2 Elevations
1. 1.3 Floor plans which convey the information on:
- Required and provided light, ventilation, egress, window and door schedules
- Unambiguous identification of structural members
- Smoke detectors and GFCI Interrupt protection
- Carbon monoxide alarms
- Garage and dwelling unit separations
1.1.4 Foundation plan
1. 1.5 Building cross section with information on:
- Building integration (module. connections) details
- Location of required fire stopping
- Roof truss bracing and structural connections
1. 1.6 Roof system
- Special requirements addressed (such as sliding, drifting.or unbalanced snow load
conditions)
1. 1.7 Non - typical details (such as prow roof, cantilever beams, etc.)
1.2 Summary of references to system for selection of structural members.
1.3 Each page of drawings and calculations should be signed, sealed, and dated by New York
State registered design professional.
2. The manufacturer will submit a weekly report identifying all permit sets with information about project
location, production serial number, and New York State insignia number.
`"; rid �'i•_.r �'r i �
`.° „3 1Tl±P riainufactiirer'ivul pro►3�ptly rsdiifesa;.the.doflciex ci s'vf gubinitthli.7
4. The system conditional approval is subject to termination upon evaluation of compliance with the
provisions of the Uniform Code.
5. The Division will conduct quality control review of permit set submittals to evaluate compliance with
the above conditions and with the provisions ofthe Residential Code ofNew YorkState. Deficiencies will
be reported to Professional Building Systems and are to be promptly addressed.
. The approval is indicated by the New York State Department of State "Stamp of Approval" placed on the
originally submitted set of plans and by this qualifying letter dated January 22, 2007. A copy of the first two
pages of this letter shall accompany each set of plans submitted for a building permit and be deemed a
duplicate original.
Sincerely yours,
Ronald E. Piester, R.A.
Director
Division of Code Enforcement and Administration
cc: PFS Corporation (without attachment)
14 -113.4 (11/%) —Text 12
PROJECT I.D. NUMBER 617.20 SEAR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
. Fsfr- El( �L1� .AE119NS.Qr�X':tt:�= .= �i��M::�:- °ter.. ;:�; � �,. z:
PARI�I �PR6� FifR1fA"TlON1(T'o be completed by Applicant or Project sponsor)
1. APPUC NT /SPONSOR �j
I�- V_14-#"% o'c'
2. PROJECT NAME
.�_1i9 L ! lE
J. PROJECT LOCATION/-} ' /
Municipality /'7/7 N/� -fit (//}�E County
4. PRECISE LOCATION (Street address and road1ntersectiom prominent landmarks, etc., or provide map)
Al R?'� D �'N /1 G/� STl2 i Tt . j� s !— /jl� FG.c� V
5. IS P SED ACTION:
New ❑ Expansion I] Modification /alteration
6. DESCRIBE PROJECT BRIEFLY: N/57 'v� Q v �� �� !CJ
7. AMOUNT OF LAND AFFECTED:
' 2� 39
Initial acres Ultimately " acres
B. WI L PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ❑ No If No. describe briefly
9. W AT IS PRESENT LAND USE IN VICINITY OF PROJECT7
aResidential ❑ industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space 130th.,
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STAT qR LOCAL)?
Yes ❑ No If yes, list agency(s) and permit /approvals - - -
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑ Yes d No If yes, list agency name and permit/approval
12. AS A RESULT O,�bpr PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
13 Yes BNo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE OF MY KNOWLEDGE
�BEST
Date 31Z f
Applicanbsponsor name:
_ T
Signature- ~— ij
G'
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment-
OVER
1
PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION ED ANY TYPE I THRESHOLD IN'6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF.
❑ Yes
. _ B, _1jy?1,C: ACr7�i3f�:RzC�r ,a�fiDi �T� P�`IfEW .' l��- FQ�;' �v' ly��' D# 'G;1;.(��11�$7ED'JCGLfONS''IN ;6 �3yt;.i4R;rp}iFT�6b7�ns :, •-• �i1�Nc ,xan6gatiVe•dactstrdtitl'n`
Yfi3y'De Q1173'edve�d!b� another involved agency.
❑ Yes iCJ�te
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? 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.
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.
D. WILL THE PROJECT. HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑ Yes afN o
E IS THERE, OR IS RE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑ Yes o If Yes, explain briefly
..... -...
PART III — DETERMINATION OF SIGNIFICANCE (ro be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, important or otherwise significant.
Each effect should be assessed In connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed: If
question D of Part 11 was checked yes,.the determination and significance must evaluate the potential Impact of the proposed action
on the environmental characteristics of the CEA.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
ZGbeck this box if you have determined, based on the information and analysls.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:
i7
r_ Name of Lead Agency
D S° h U✓
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c 1(e,,(W 67u 1i
=me of espon le.Otticer in Lead A ency Title of esponsr a UrTicer
Sigrilliture of Responsible Utticer in I ead Apficy. / Signature or Preparer (it different from responsr e o icer)
r Dat
2
PiUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
tl
DESIGN DATA SHEET - SUBSURFACE SEWAGE T EAR 11[ N ���'ATE�YII -...,
Owner V .t.ka Address 7N Qiaz'z &Ua:r !
Located at (Street} &Jgjft�t. 59 � . Tax Map Block 1 Lot. S
(indicate nearest cross street)
Municipality AT)4� YP� tM� Drainage Basin guest -Q (w_ 4
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Date of Percolation Test
Hole No.
Run No.
Time
Start - Stop
E14 6y Time
(pMin.)
De th to Water
rom Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Incises
Percolation
Rate
Min/Inch
f
1
q:
6
3
1.0 : '32 1 i ' o2
,
'21 +' 2 � Y4-
5.. 3/¢-
11
4
30
S
i1't -34. 12�0q
�
2
3
+a/
30
2
j
5
+
1
2
3
4
-
S
NO -I'ES: 1- Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test. hole. (i.e. s l min for 1 -30 min/inch, <_ 2 min for.31-60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
TEST PTT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES
DEPTH HOLE NO. HOLE NO. Z.- HOLE NO.
10.7.51'. JZY' i 1 S& I
1.0'
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered O/A
Deep hole observations made by: Date
Uesign Professional Name:
Address:
Signature:
Design Professional's Seal
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2, PERIMETER RAIL ATTACHED TO SILL WITH 16cl NAILS AT 3' O.C. (4-0'. O.C. MAX. IN AREAS WHERE WIND VELOCITY IS @ OR EXCEEDS 100 MPH)
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TO THE BEST OF NY KNOWLEDGE, BELIEF, AND PROFESSIONAL
JUDGEMENT, THESE PLANS (AND SPECIFACATIONS) ARE IN
COMPLIANCE NTH THE E.C.CC.N.Y.S., 2002 EDITION. COMPLIANCE IS
DETERIMINED BY THE USE OF MECCHECK, COMPUTER SOFTWARE
DEVELOPED BY DOE, AND CUVORMANCE TO THE GENERAL PROVISIONS
OF CHAPTER 5, SECTIONS 500; 607, 604, 505. INDIVIDUAL (DISCRETE)
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4. CONCRETE COMPRESSIVE STRENGTHI 3000 PSI AND SHALL BE LOCATED AS CLOSE TO CORNERS AS POSSIBLE.
5. M OR S.TYPE MORTAR-TO-BE USED 8, NOTES ON THIS PAGE TAKE PRECEDENCE OVER NOTES ON TYPICAL FOUNDATION
THE BEST OF MY KNOWLEDGE, BELIEF, AND PROFESSIONAL
'THE PLANS AND PERMIT SET ARE DERIVED FROM -,AND CONSISTENT WITH THE PLANS
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.9.
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3.HEAT LOSS,�,IAS CALCULATED W/ R -19 INSULATION OR HEATED BSMT7.CLG GIRDER ABOVE DIN /KIT TO BE: (4) 1 1/2' X 9 X1/4' M.L.
10.
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`'1 � 91 ' y Brophy Basement Renovadon
. � r�lir
l' 61 Barger Street, Putnanx "Valley,
NY
CLEANOUT (TYFI.)
SOIL
118-A (Parcel 'D 'w
1238-58' N 61 '50.-.
C. NA THAN
'TIRE SITE
,fal% A
5 'o
solLyff
mm m r
213.64'
) CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS
) ON THE PLAN AND. THAT THE SYSTEM WAS INSPECTED BY ME BEFORE
OVERED OVER.. 1HE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL-"-
RULES AND RE!:;ULATIONS OF -THE. PUTNAM COUNTY DEPARTMENT OF HEALTH
NEW YORKiiSTATE DEPARTMENT OF HEALTH.-
GARBAGE GRINDER WAS INSTALLED
iPHIC SCALE
bd-dATi0N8---'
1
15.5'
601
2
18.5'
541
3
'ut
35'
4
51.5'
37.5'
5
60'
41.51
6
68'
46.5'
7
761
53'
8
921
35'
9
100,
45'
10
107'
531
11
.114'
621
12
121'
701
13
281
831
14
32'
80.5'
15
37-51
791
16
441
791
17
51,
791
It is a viol
for any pe
engineer c
bearing th
C> --I westerly line of lands formerly
of Schroeder, as shown on
`W 1-0 Filed Mop No. 718A
( not to scale
.N 57°55'30 " W
owner
unknown
END CAPS (TYP.)
1250 GALLON
CONC. SEPTIC
TANK. -,
Y4" PER FT.
30' -4" SDR -35
Y4" PER FT. -
CLEANOUT (TYP.)
o:
x
0
h
S SOIL "CO"
ro
v A line as oer Liber 71
lands now or ,
17
J. BOXES (TYP.) 7 `
JEW WELL
p GRAVEL D:
3.6 .....
Q'Q TQ = / A
T .. 0° 1:7'
L`= 1 49.3't
END CAPS (:TYP.) . v •O�, '9� /O 9�0 '1F. �k
1250 GALLON G
CONC. SEP71C
TANK. � \
10'-4* DIP
}'4' PER FT. '
0 J5E 0 6> \
BOXES (TYP.) O..
I existing �• " '> ° �L
we/l
IR t
SOIL BREAK LINES .._�, ,/ J 1 , \
30' -4" SDR -35 a 5 a G,t; Z7 '.(35) :00
0 A" PER FT. 1 b , -
,
a
„ A�
sill CLEANOUT (TYP.) 6
a
'\ N 60 57'30 N. 6.47'
O
1
Q
concrete
� onumF•? t
I ca,ra cer,'sur m
•
�A 173
I ,3U„ yV z pole
sow ' 213 6�, 1y 60° j7 --
ES
�d Mop No. 1.18 -t1 (Parcel 70,00 / 1 — r- o_ "I
r
�^ !.
'VELYN C. NATHAN
Sl TE
ENTIRE .t
•i.. 'rat
' 9a
nmTr V Tu eT TNF SEWAGE DISPOSAL SYSTEM WAS "CONSTRUCTED AS
_ _._ .,Tr+nr rm'Tl RY MT BEFORE
Vi
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