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HomeMy WebLinkAbout4566DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -62 BOX 34 04566 COUNTY DEPARTMENT OF HEALTH T OF ENVIIZON T A.Is- 1� ICES - = .r.:__ .:.. .�..�n -%i �..k: -`ic .16a.'Cwtit.- .u;»e•t. r-.': ..may. .e4v... - CERTIFI OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CQNSTR CTION PERMIT # -141- 77 nits Located at GA?, a Al F_'•E Town or Village L.11 O /Applicant Ne 5 f Vp/an 1,15 /46.50(,. Lam. Tax Map 9.5',05' Block _�_ Lot Formerly Subdivision Name � . yazm_A;S r "le Mailing Addressa Subd. Lot # Zip 1d,5--7,q Date Construction Permit Issued by PCHD Separate Sewerage System built by Address Consisting of A25-0 Gallon Septic Tank and Y : Orr W i ©S ON Other Requirements: Water Supple: Public Supply From Address rt Bge�rEZ�' or• Private Supply Drilled by fVon1ng1v f��ct►�EQ$z�+� . Sic. Address FV IV/. Zg5:1q �Builciing Type, =r.NC� �A rY7. � Has crow control. bwh caiwx3lefilx€1 ?.__ Number of Bedrooms 4 Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance a iss PCHD Construction Permit and approved plans and the standards, rules and regu he m County D artment of Health. Date: _ Certified by P.E. X R.A. � r , (Design Professional Address iLLG /0o7 C� aiq AAc, License # Oho 7 `/qb GAetirA"_ Ny. /or/Z 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 revocati5prTodificatiou or change is necessary. Q By: Title: ��- Date: 47 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT FWell t'Addfess�" -- '"�oT /Village: => �f. Tax -Grid Map Block Lot(s) Owner: Name Address: Use of Well: 1- primary 2- secondary . _� Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment . Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _ pen hole in bedrock Other Casing Details Total length ft. Length below grade 34a . Diameter &I l in. Weight per foot _lb/ft. Materials: ` Steel _ Plastic _ Other Joints: _ Welded �< Threaded _ Other Seal: :� Cement grout _ Bentonite Other Drive shoe: Yes No Liner:— Yes i4No Screen Details Well Yield Test . Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Hours%` Yield Zrgpm or Second _ Bailed Pumped Compressed Air Depth Data su e- static specify ft) Measure 607ra0 ac During yield test(ft) Depth of completed well in feet Zo ` Well Log If more detailed information descriptions or sieve analyses .- ..,.... are .available,- , please attach. De th From Surface Water Bearing Well Diameteron) Formation Description ft. ft. Land Surface G " A If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3A-vi e.2. Capacity Depth 36o ' Model JoS ✓�- `J /b Voltage a- 30 HP Tank Type Volume Date Well Eomplete= Putnam County Certification No. Date of Report Well Driller (signature) w NOTE: Exact location of well with distances to at least two permanenoanchfiarks to be provided on a separate sheet/plan Well Drillees Name A,&", 9 , Address: %'7' 72 Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 z v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL_ TH SERVICES '( .. - Rt �,: � 5. ..,� t1.: �i ✓- . �.r t �;.:. `.s.w.:.tj .,_.4. ,r_::..'.:�:. :. °..e i'. .,. p'4s 4�bi -00�NSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at e4ozpI N950a R-0 Town or Village -FUT� � Subdivision name$T,THOP0S PUaCsE Subd. Lot # 4 Tax Map %C613lock ( Lot 2 55' CA -T E S Date Subdivision Approved !j 12n I q o Renewal Revision Owner /Applicant Nam6Te b , (.'Z D Date of Previous Approval Mailing Address i0 s-ox 6ee:l %-Dl.[" \/A! � 1\I �j Zip b�Z Amount of Fee Enclosed 30c> Building Type S 1 NEE rArniwl Lot Area << aG No. of Bedrooms Design Flow GPD g00 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 450 l.� �,�w►>� �s��rw�.l ���t-� Other Requirements: 7 L7 iP G N PRAIrl CS7 LF fVMf S*FM (�QpFoYZ f�N To be constructed by —To ijf-- -be-r- Address Water Supply: Public Supply From Address Pa�yat :.Suppl- :Dulled liy` -1�a = _ "f _ _ _ _ :..�icidress 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 an aid sewage treatment system during the period of two (2) years immediately following the date of the is�uance the appro al of the Certificate of Construction Compliance of the original system or any repairs tk�:et� A I Signed: J R.A. Date III 10 AddressPu-rµ,n I eLAz= L02 GLa4r--tpA *W5— License # '06 7 44!a GAI�M'G�U Hy ' 105 12 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 permit. Approved for di _. harge �ddom�estiic sanitary sewage only. By: Title: �d°�� Date: 1 oe., Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PR AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ ! m: ^T' .� - x.0'•.:4": ..a °gib '. ;:I fltYP6•r. ':- .. �9'. ^.. - -•• rCHD -1 eft' Well L c g tion: Street Address: . Town/Village Tax Grid # 6/4'V.Dj eex gD i K►AM.Vb Map85,C67BIock ( Lot(s) Cot Well r: Name: Address: ST. V HOC- LTD I, Pv F--.C>c 6- -7-7 ray 05 7i M 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 My.4 S gpm # People Served ( is.M 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? ...................................... ............................... Yes_ X No Name of subdivision 5T TWAA -5 1 -A 6'STAMSS Lot No. Water Well Contractor: To 1-36 'E)ev'. Address: Is Public Water Supply available to site? .................................. ............................... Yes No - Name of Public Water Supply: Town/Village Distance to property from nearest water main: 64 -poi , � I t4i Proposed well location & sources of contamination to b r' o s arate sheet/ Ian. Date: t ( 110 A li. cant Si nature.. .......Pp_. - g .. 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 Z Permit Issuing Official: Date of Expiration-� e o- %/ 9 Title: :5�e f Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P+ DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATIVIJ N SYaTI E [, . ;_:,._....: 1.9 and'address of applicant: 5T- 'THeN�. SScx- -wres LTD Po C. 7 2. Name ofproject:5:1ftnVN,s Fes. 3. Location T/V: Pqr�p<m Vnu,*s-yl I�o1- L+ 4. Design Professional: ('on c,,,,n toa. (,,racy 4M6,Pwd. Address: 102 C .Zoe'DA P� 6. Drainage Basin: )NN- (05)2 -- 7. Tv pe of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ...................:... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... ice% 1.1. Name of Lead Agency CIA 12. Is this project in an area under the control of local planning zoning or. othera . :. officials., ordinances? _.....,.,..;:e .......:...:.:::: F .........::.: ::.:::.::.:.:. : :.: v. 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class. designation? .................... Nlp' 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... !-Jo 19. If yes, name of water supply Distance to water supply��� 20. Is project site near a public sewage collection or treatment system? ................ 1�fD GC�T�- TNz 21. Name of sewage system Distance to sewage system I M i LAi5. 22. Date test holes observed 11/1319-7 '23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 500 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 1-30 26. Has SPDES Application been submitted to local DEC office? N /441 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .............................................:............. ............................... 29. Is Wetlands Permit, required? y ...:......::...- .. ... .,a..{....- Has. application been made to Town or Local DEC office?....: ...................... 30. Does project require a DEC Stream. Disturbance Permit? .. ............................... t-r0 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 o 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 b DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ....................... ... tjo 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... tO 35. Are any sewage treatment areas in excess of 15% slope? . ............ .................... 36. Tax Map ID Number .......................... ............................... Map B15.oZlock___ Lot � 2- 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval:of.a new SSTS.to.be :located,%ithin theNYGWater slt L '.-:- ' Lj =sentt tie ep :err" and i�eedTiot be serit'iri duplicate to the rP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, underpenalty 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: Mailing Address: ................................... C 1Ju IDSD2- It, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET $ [ J � . �I7R. ����14�G� ..:A,TTV:T--'°i'E14I`�; s:. �`- .Sv- 'C'+�i�,- �ri:,'- ''i+¢�::;�.. � �ti :fL'"ue.::: :. �i,.- aa'•�h n�.�`���,'= ^'., -�f`' Owner St. THOKiAS ASGE>,-- . Lq-0 Address I O F-6 � 6,170 Located at (Street) 4,kRt:)o, l2 Tax Map$Sxf Block �_ Lot 62 (indicate nearest cross street) Municipality Po7a*r, V W=A� Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop E1a s . Time an.) Depth to Water rom Ground Surface (Inches) Start Stop Water. Level Drop In Indies Percolation Rate Min/Inch 1 2 3 i'`'I !,l- A �j AS 4 C 5 2}-62 1 3 4 4 5 1 , 2 3 4 5 NOTES: 1. Tests to -be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2:..'6epth measurements to be made from top of hole. Form DD -97 TESL' ]PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES - `DEPTH" -- ...HOLE NO. . _..:� HOLEYNO. .. HOLE NO.::. G.L. 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Tsrz lm-w• Indicate level at which groundwater is encountered l Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 1,j Deep hole observations made by: V —rte; ,MIL ELH77 Date i /3 Design Professional Name: Pu-n•Gm 6-&imemb Address: [ce _aLAELac oA &,/t= 1 Signature: Design Professional's Seal Q� y � 0 44 14.19.4 (2187) —Text 12 , PROJECT I.D. NUMBER 811.21 SEAR Appendix C CYYAA - Staptto*,Enviro/nwnMgntsl- Q`• g�u�_ gaallic�ty�y�sReview p�r�N /fir} p`� For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicarifor Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME, ST. THOM45 Assoc - - LTD vT-I}IoMos p(�a.c� AS S 3. PROJECT LOCATION: p Municipality f m„ A f A �,6, l�l_ -1 _ County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) �t2Gt�2. �I�T "TLS �A+2ID�'G 2� (S6155 8r--3 Ft A -�,S 5. IS PR POSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 1Zi245)P05t5 0 1 —lll>� l.l. -tnl- �oGa.T�'P_ 0Jls�-I ivG. 7. AMOUNT OF LAND AFFECTED: Initially . I 1 acres Ultimately t acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Lgres ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial 0 Commercial ❑ Agriculture ❑ Park/Fore3VOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? D Yes N0 If yes, list agency(s) and perrnit/approvels 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes );�o If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes No I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TTO' THE BEST OF MY KNOWLEDGE ApplicanUsponsor Date: (� L�G Signature: x 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 _. - _ ..._.....s ..-.d s %, w ue completea oy agency) A. DOES ACTION p( ANY TYPE I THRESHOLD IN 6 NYCRR, PART 817.12? It yes, coordinate the realew process and use the FULL EJaF. ❑ Yes AO .,• B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.0. If No, a negative declaration may be superseded by another Involved agency. ❑ Yes o • -C: -COULD ACTIA RE_SULT.IN; W- ADVEME--�EFF ASSOCiATED1NITH'THE FOLLt)WINd: (Anst era hwy b6 hAnd6ihtten`, If legible) .`01stiri` cair 46a, surface or groundwater quality or quantity, noise levels, ex sting traffic patterns. solid waste production or disposal, g q Y 9 4 tY q 9 P P P 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 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 C1-057 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 biietly:` - �. _ _ �. ;_�, ._ -ti.j -- . •- �•�,'. -�_ ` 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 significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF 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: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in. Lead Agency. Name of Lead Agency Date 2 Title of Responsible Officer • Signature ot Preparer (if different from responsible officer) r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEYTAL HEALTH SEUT -CES t t:C°�_'7. -�`:.. Date j L4 1 T, -7 Re: Property of CjTeV LLGJS9 -t) l Located at �F22p11�iE�R,4(� (T) Section 95-0ej Block ) Lot 67 Subdivision of dJT• rFiVr'A6 pt- � r Subdv. Lot Filed Map 2482 Date 5`1%/19' Gentlemen: This letter is to authorize FUTr,�XH F(,LC a duly licensed professional engineer X_or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rule or regulations as promulagated by the Commissioner of the Putnam Couz Department of Health, and to sign all necessary papers on my behalf. i_ ' '" c'o`nnection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani tar" Coui P.E. 102 C-Lr--Nsi )A A\le Address F- L 42- G 14 - 225- d&o. Telephone Very truly your Signed Z/ Owner of Property 1a MtLLFrr r2�D. Address Town qIY -5c;2� Telephone FROM : PUTNRM ENGINEERING PLLC PHONE NO. : 914 225 2955 Jun. 26 1998 05:19PM P2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. _ �A WX Q - •�a ^-+ v ex+:= '�.; ;� - <.. �,. -w o _. r`rye.'7- �n:s:ty �. �-�r, o "xs _'4 GUARANTEE OF SUBSURFACE StWAGE TREATMENT SYSTEM Christopher & Susan Elmes Owner -or Purchaser of Building St. Thomas Associates, Ltd. Building Constructed by Gardineer Road Location - Street Building Type 85.05 1 62 Tax Map Block Lot Putnam Valley, NY Town/Village 8_r.7��G RAc_5 �5r. Subdivision Name _ 4- 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 ofthe Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The iindersigned further- agrees to * accept as canlusive 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 willfiiI or negligent act of the occupant of the building utilizing the system, Dated:. Month 06 Day 2 9 ar 98 Steven Leardi General Contractor (Owner) - ignature� Lea -Rome, Inc. Corporation Name (if corporation) Address: 21 Peekskill Hollow Road State New York Zip 10579 Signature: IJ,&v Z Title: President Lea -Rome, Inc. Corporation Name (if corporation) Address:21 Peekskill Hollow Road State New 'York Zip 10579 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear: Street Yo_rktownHeig+hhtss^, N�.'�Y�. 10598 28!�V G`4- CJ't Albert H. Padovani,, Director, LAB #: 32.805075. CLIENT #: 8599 NON STAT P'ROC PAGE 1 NNNNNNNNNNNNNNNNN NNNNNNNNNNNNN------- N NNNNNN-------- ---- -- V----N-----NNNN/V--- ST. THOMAS ASSOC. /STEV DATE /TIME TAKEN: 06/10/98 11:35A 21 PEEKSKILL HOLLOW -RD. DATE /TIME RECD: 06 /11/98 i2:0oP PUTNAM VALLEY, NY 10579 REPORT DATE: 06/18/98 PHONE: (914)-528-5448 SAMPLING SITE: LOT #4 ELMES AT ST. THOMAS PLACE SAMPLE TYPE..: POTABLE :.PUTNAM VALLEY, N.Y. PRESERVATIVES: NONE COL'D BY: STEVE LEARDI TEMPERATURE..: < 4C NOTES.....: KITCHEN TAR COLIFORM METH MF NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN / .DATE FLAG PROCEDURE RESULT NORMAL'- RANGE METHOD PUTNAM CNTY PROFILE 06/11/98 MF T. COLIFORM PRESNT /100 ML ABSENT 1008 06/11/98 LEAD (IMS) <i ppb 6 -15 ppb 12345 06/11/98 NITRATE NITROG 0.77 MG /L 0 - 10 .9139 06/11/98 NITRITE NITROG <0.01 MG /L N/A 9146 06/11/98 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l 2037 06/11/98 MANGANESE (Mn) 0.014 MG /L 0 -0.3 mg /1 2037 06/11/98 SODIUM (Na) 11.7 MG /L N/A 06/11/98 pH 8.1 UNITS 6.5 -8.5 9043 06/11/98 HARDNESS, TOTAL 12 ..8 MG /L N/A 06/11/98 ALKALINITY (AS 72.0 MG /L N/A 06/11/98 TURBIDITY (TUR <1 NTU 0 -5 NTU .. .... ::_ 06 / -11. "fF: -FECAL Chit T F: ABSENT.-100 .ML 06/11/98 E. COLI (CONFI ABSENT 100 /ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS) (WA5 NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T RK STATE AND EPA FEDERAL DRINKING WATER STANDARDS,FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for pi EPA Lead & Copper than 10% of their than 15 ppb and a treatment'must tie potential. ablic 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 diet,the water should contain no more' than 20 mg /L of Sodium. For, those on a YML ENVIRONMENTAL SERVICES 321 Kear Street YprktgwnAyyHeightys,._, N.Y., 10598 �rfr _A.:" Ln. C�'_.w ..(, ..P r- _..A�: -O •'.I >.••Z'b(. /i4T.i —��Y O'.I-�u- L'�0��.- in.(.c ifP:•� .yav-V'�, b�0'.�. .. .y. •y ,.. (. . Albert He Padovani, Director_ LAB #: 320805075 CLIENT #: 8599 NON STAT FROC PAGE 2 ~NNNNNNN----- N— NAINNNNNN— NNNNNNN ~NNNNNNN NNNNNNNNNNNNNNNNN ~-- ---- -- NNNNNNN —N ~.NN St. THOMAS ASSOC. /STEV DATE /TIME TAKEN: 06 /10/98 11:35A 21 PEEKSKILL HOLLOW RD. DATE /TIME REC D: 06/11/98 12:OOP PUTNAM VALLEY, NY 105 19 REPORT DATE: 06/18/98 PHONE: (914)-528 -5448 SAMPLING SITE: LOT #4 ELMES AT ST. THOMAS PLACE SAMPLE TYPE.a': POTABLE : PUTNAM VALLEY, N.Y. PRESERVATIVES: NONE` COLD BY: STEVE LEARDI TEMPERATURE...-.< 4C NOTES...;: KITCHEN TAP COLIFOPM METH: MF ~NN NNNNNNN — MICA/~--- ------ m-- -- NNNNNNNNN NNNNNNN NN — ~NNNNNNN N N NNNNNNN NNNNNNN —N —N~ DATE FLAG PROCEDURE RESULT NORMAL'- RANGE METHOD moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. .. 1. . .. :. ... .. ..... .....w ..fin• � \y.6..e .�rw�. .... ..A ..r s. �... s. . ♦ '-: _ ��.... ... .. .._ n..R .��.. +4 .• .1- ....4w� s SUBMITTED BY: Albert o Fadovani, M.T.(ASCF) Director FLAP# 10323 ` . YML ENVIRONMENTAL SERVICES. ` 321 ` N.Y. Yorktown Heightsx '�10598 (�14), ' Albert H. .Padovani, Director` ` ' LAB #: 32.805432 CLIENT #: 8599 ' � �NON STAT PROC ' �PAGE 1 . ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~--~~~~~~~~~~~ ' . . ST. THOMAS ASSOC�/STEV DATE/TIME TAKEN: 06/19/98..12:05r 21PEEKSKILL HOLLOW RD. DATE/TIME REC'D: 06/19/98 12:35P PUTNAM'4ALLEY, NY 10579 REPORT DATE: 06/26/98 , PHONE: (914)-528�5448 SAMPLING SITE: LOT#4 ELMES ' SAMPLE TYPE...: POTABLE ' ST.THOMAS PLACE' ' ' � PRESERVATIVES: NONE, COL'D BY: STEVE,|LEARDI ` TEMPERATURE,.: <.4C NOTEIS ...: KITCHEN TAP ' COLIFORM METH: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~ ~~~-~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~ ' DAT£ FLAG PROC�DURE RESULT _RANGE METHOD 06/19/98 MF T. COLIFORM ABSENT /100 ML ABSENT zoo& ` ` COMMENTS: FAX TO 528-1366 ' Cunncm/o: BACT OF A SATISFACTORY SANITARY �C AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.' ` ` ` SUBMITTED-BY: Albert H. Palicovani, M.T.. (ASCPT', Director ELAP# 10323 A- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Streettocati.on l� A4 TM 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ......... 1, 250 .......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ......................................... d. Distribtuion Box 1. All out le at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set. .................... ............................... Length required Length installed 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 in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g—Pum or Dosed Systems .. T 4S z o pump c am er . ....... .............. - ...... ....................... 2. Overflow tank ............................. ............................... 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. House/Building a. House located per approved plans..; ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade ...................... d. Surface drainage around well acceptable ..................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 Date: _ Inspected b. Permit # `f'�\J —K4 _-:17 Subdivision Lot # x'i'u;1169W " PROM : PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Jun. 01 1998 08:42AM Pi MEMO FROM: PUTNAM ENGINEERING, PLLC DATE: RE: REQUEST FOR SSDS AS BUILT INSPECTION PROJECT TITLE: '5r • 11i"Vwg LOT* STREET ADDRESS:'; - 2 0 TOWN: Fo TAX MAP #: • D `e Z PERMIT #: P �%'- I �7 t 1 _ PLEASE NOTIFY THIS OFFICE AFTER YOUR INSPECTION AT (914)225-3060, IN ORDER FOR US TO.NOTIFY THE CONTRACTOR/OWNER THAT BACKFILLING THE SYSTEM MAY BEGIN. File9801022 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue 41,:-NY �.-Can 914-225-3060 Fax: 914-225-2955 TO: 14DAAA LETTER OF TRANSMITTAL RE: -T-001\011 We are sending you -X- attached under separate cover, the following items: Shop drawings Specifications Plans No. of Conies Prints Copy of letter Other: r)p-wrintinn 45-'3LLiA--T PL-AN3 H -D -:Fcs- Cb;Oy-) Ce/cf-tc-,c' -f-e of Waf ee- 4N A L- YS 'l 5 kA.1 F- L- L- . C-r . & V1 0-/Q f— 0 (z W-) These are transmitted- For approval__.. Approved .as. submitted —`�Fdr-tyou"r' --,Ap"p-r'o'V-e-d' a5s­noted As requested Returned for corrections X For review/comment Resubmit copies for approval — Submit — copies for distribution REMARKS: Copies to: SIGNED: AiL /ICL'4� If enclosures are not as noted, kindly notify this office. P, 6A HOUSE ',TIO PP O -A L E: fa r,", -A5-­--E5ULT MEA SUREMENT5 5. .4' 5t, T. I _7 7 7 Sc LC No Ni LA N�t!,R. r, � .