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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07-2-3.2 BOX 35 04595 all :' T ' I , -Il i I I IF 'T 04595 TNAM COUNTY DEPARTMENT OF HEALTH *YT ION OF..ENVIRONMENTAI, . HEAI�T�CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENM-� PCHD CONSTRUCTION PERMIT # PV 0 C, 6 55 Located at 2-4"02 [y 1J QV_4 yF_ Town or Village FaLt4n, Vnary Owner /Applicant Name A as Ko . 4:�4 t, Tax Map L96-'7 Block Z Lot 3•Z. Formerly Subdivision Name 'M O [ / A 6069- Subd. Lot # 2 Mailing Address % D ro)( 7'2, L 414012 AC t 0. Zip / Date Construction Permit Issued by PCHD q-5-6a Separate Sewerage System built by 6L-0f:S IL- C<A► T (O. Address 6'"-61 PT 6N4,# 04c,, g' y Consisting of /50 0 Gallon Septic Tank and 800 F1" Q[ 2f'r0+ xt - Folat4des- � 15"do M12 2v-1 N Other Requirements: _ 7F' CJ @.FAl u 'Q(Z J/ 9 Z Frgw E3 rt l I Water Supply: Public Supply From Address or: Private Supply Drilled by 1-1 Ayt Z's 0 Q Address l52 &W2_C P- V41ky Building Type- % d:9�� --_ �� Has erosion control been completed? Number of Bedrooms 4 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 the Putnam County Department of Health. Date: .Certified b G. f-jj" P.E. i/ R.A. �O � 1 n-S_6, ( i n Professional) ��� Address +-Vx y Y1)lVbQ� , 1`�•�/ / 0_<' g% 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, modificat' n o hange is necessary. Cicopy `'` Title: / I7-�G Date: /16/07 �-HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 .(914)...245._2800 - s - Albert H. Padovani , Director LAB #: 9.701503 CLIENT #: 13399 NON STAT PROC PAGE: 1 of 2 ANAKIN INC. DATE /TIME TAKEN: 10/02/07 02:30 10 FOX TRAIL DATE /TIME RECD: 10/03/07 11:15 MAHOPAC, NY 10541 REPORT DATE: 10/.10/07 PHONE: (845)- 621 -1824 SAMPLING SITE: LOT 2 WOOD GLEN DR PUTNAM VALLEY COLD BY: RAY KING NOTES...: WATER TANK SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: <20 >40C COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 10/03/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 10/10/07 LEAD (IMS) <1 ppb 0: -,15 ppb SM 18 -19 3113B 10/0.8/07 NITRATE NITROG -1 3.2,. MG/1 : 0..- ..10 ;, SM18- 20450ONO3 10/05-/07 NITRITE.NITROG•. <0.O1:MG /L ;. 1. .0 MG. /L: :. SM18- 204500NO2 10/08/07 IRON (Fe) <0.060 MG /L :1 0 -0.3 m4 /1 SM 18 -20 3111B 10/08/07 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 10/05/07 SODIUM (Na) 5.93 MG /L ..N /A SM 18 -20 3111B 10/03/07 pH 7.0 UNITS 6.5 -8.5 SM18 -20 4500HB 10/02/07 HARDNESS,TOTAL 174 MG /L N/A SM 18 -20 2340C 10/08/07 ALKALINITY (AS 90.0 MG /L N/A SM 18 -20 2320B 10/05/07 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p- EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. 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.Sodum.are proscribed. Suggested .guidelines state . ;that for=peopl;e on>.a-1 sodium restricted diet, the water should contain no more than 2.0 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 _... _. -._(914)_245.728Q0.--..- _. . LAB #: 9.701503 CLIENT #: 13399 NON STAT PROC PAGE: 2 of 2 ANAKIN INC. DATE /TIME TAKEN: 10/02/07 02:30 10 FOX TRAIL DATE /TIME RECD: 10/03/07 11:15 MAHOPAC, NY 10541 REPORT DATE: 10/10/07 PHONE: (845)- 621 -1824 SAMPLING SITE: LOT 2 WOOD GLEN DR : . PUTNAM VALLEY COLD BY: RAY KING NOTES...: WATER TANK DATE FLAG PROCEDURE is suggested. SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..': <20 >40C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER.: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140, . =...M.ILLIGRAM DER,, LITER �_l..-grain�gallon� SUBMITTED BY: Ap Albert . Padovani, M. .(ASCP) Director ELAP# 10323 Gam- �;k SHERLITA AMLER, MID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 E911 ADDRESS VERIFICATION FORM . R ®BERT J. BONIDI County Executive OWNER'S NAME: TAX MAP NUMBER: E911 ADDRESS:T TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is. to be submitted with the application for a Certificate of Construction Compliance. E911 addressverification 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES '.r,� - .-7..:�dr;` A '%*: - •k:�•C °ic... >:. i[-•i^�"��- is.::`.► C��.'.Nn .+s- •..c.:.. •,..,�, ':� GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building 114 /1& �1,w / A Building Constructed by ems) y d 4� Location - Street Building Type Tax Map Block Lot 42�,— TownNillage lei CO2,:g Subdivision Name R Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the L.. < ..t.. system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year o?3o General Co or (Owner) - Signature Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: /C) A7,< �i�i�s G. %%�/�, / a� Address: ,5V 10, State 121, Zip State 1714 Zip /mss "e// Form GS -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health November 15, 2007 Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERTA H®NDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Construction Compliance — Anakin, Inc. 24 Wood Glen Drive, (T) Putnam Valley TM # 85.07 -2 -3.2 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. The guarantee form is not complete. A date is to be provided and the full E -911 street address is to be noted on the `location- street' line. 2. Three guarantee forms are to be provided. Only one was submitted. T its office will �cont nue its review upon consideration' of I.Ye afiove men�onea c "o "mments. - Please feel free to contact me at ext. 2157 if any questions arise. JSP:ens Very truly yours, C/J'Oseph S. Paravati, Jr. Assistant 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN,,MSN Associate Commissioner of Health October 17, 2007 Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: 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 — Anakin Wood Glen Drive, Lot 2 (T) Putnam Valley, T.M. # 85.7 -2 -3.2 The results of today's pump test were satisfactory, and all comments of our letter of September 18, 2007 were addressed. There are no further concerns at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2155. JD:ens Sincerely, 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 PUTNAM COUNTY DEPARTMENT OF HEALTH ex— I?:I�VSION OI E�v'VItONIE1T�l FIELD ACTIVITY REPORT NAME.' /or ,Street Town State Zip PERSON IN CHARGE 6-d .. [!(PUfvff TEST 0, DOSE TEST 0l►b I� ! REQUIRED GALLONS 009-f 3 I acknowledge receipl'of this report: SIGNATURE; 02/96 Title; BY THIS CERTIFICATE OF COMPLIANCE THE _NEW YORK ELECTRICAL INSPECTION SERVICES 150 White Plains Road, Suite 104, Tarrytown, NY 10591 CERTIFIES THAT Upon the application of: Douglas Bunyea - Douglas Bunyea POB 343 Mahopac Falls, NY 10542 Located at: Lot #2 Woodglen Dr, Putnam Valley, NY Application Number: 10065913 Section: Block: Lot: �ig Upon premises owned by: Anakin Builders - Lot #2 Woodglen Dr Mahopac, NY Certificate Number: 10065913 BDC: 106 Permit Number: A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Lot #2 Woodglen Dr, Putnam Valley, NY Outside. was inspected in accordance with the NYS and NFPA 70 -99 and the detail of the installation, as set forth below, was founded to be in compliance therewith on the 03 Day of October 2007. Name Date Quantity Rating Circuit Type Motor. 1 7 1/2 Hp . Three pole Septic Pump Station - ....r -., -c. ....r. >.. ..... a. .. -. ........ :..... ,,.. -_ :......� ... ....,r ..... s ..... •�.- ..:..,. •o.. _ ,.. ..o. ..;� ^., . _o_....o -.. ... ..•-. .. .......e ...... „ �.. .�, ...... ,y .... a .... -. Switch 1 2 Pole Officer: Nick Morabito This certificate may not be altered in any way and Is validated only by the presence of a raised seal at the location indicated. This certificate is valid for work preformed before date of Inspection only. jmccue 16 Friday, October 05, 2007 Page I of 1 OCT -04 -2007 01:47 AM WILLIE 18456286520 P.01 PUTNAM COUNTY (DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION O'JOSEPH 1J .GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # ;� Located: W ! t v-L (T) (V) Put ri 4W., v 4 �I e Owner /Applicant Name:. C • i TMgr.Z B1ock Z Lot-.J,_2 Formerly:' Subdivision Name: ThQ11ct Co !1 st' 9; s* Subdivision Lot # Is system fill completed? Date: Is system complete? 4 e Date: 14� Is system constructed as per plans ?' lei Is well drilled? Date: � 1e l, "7 Is well located as per plans? Are erosion control measures in place? 10-1-01 I certify that the system(s), as listed, at the above premises has been constructed and I have.inspected and verified their completion in accordance with the issued PCHD Construction Permit and E? }I-s a {{�( u ion.- o f ham: �%•- t n. J .s I�.�.}. nwo .. -.- _.". -• ....." appr�7bVF!/ 1• l" L•'iiJ- at':d- •.�e'- 't3ndaF'..5, .'�l.I,.J ULLi� J� \egWltliJ�li! "Ua t�lL J- �.i�ll.�ll Cl/�Ly D:iW-ti.11�:,nt o Health. Date: b Certified 'by: PE ✓ RA D sign Professional Address: Vd e-OA % %� �1D� 12 �,,�/A� Comments: 1 AJ S-FC IV o n! 6ZffM 9D P09 EW A I P- Z" AAI 0 Form FIR- 9 re C01 $ Iq _._..__- NEW YORK ELECTRICAL NSPECTIiON SERVICES r- ---- -- 54 North Central Avenue, Elmsford, NY 10523 0 914.347-43go First beyond Gotta —First Fl, Second Fl,.— ThN Fl, Muld Fl, Basement, Outside, Garage Remarks—L Qt- OCT -01 -2007 10:58 PM WILLIE 18456286520 P.01 ; •� .' -. fl. ^•.r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 'RJOSEPH D GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # P V" Q� D / Located: �� f L v'-� (T) (V) pGa ✓i u V � w" (/C Owner /Applicant Name: 1 .':z7oa TM 95.1 Block Z Lot 3, 2 Formerly: Subdivision Name: 1.1 Subdivision Lot # Is system fill completed? Date: Is system complete? Date: -� �� u Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? r�S Are erosion control measures in place? _ Y f 0 1 0 1 I certify that the system(s), as listed, at the above premises has been constructed and I have.inspected. and verified their completion in accordance with the issued PCHD Construction Permit and ,approved plans_ and - the�Standards,. Rules and Regulations of the Pufnam.County Department of _ Health. • - -- •., - -* . .... ..._. �:,. �..._.......___._. , .. _,.._ ...._._. Date: � •� b Certified by: PE RA D sign/ Professional Address: �� �� �,' % fiL�,d2,1 ,, /4`!.0 /DALC. # 9ns � Comments: _ !.&j we -c-r/ onl A/aeo BQ Pre pon'c � mss; AA(Q G -0 /N � 0 „I Form FIR -99 Vv �� %%/ 6% , SHERL.ITA AML.ER, MD, MS, FAAP Commissioner of Health L ORET I'A MOLINARI, RN, MSN Associate Commissioner of Health September 18, 2007 Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROB3ERT J. B30NDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Wood Glenn Drive (T) Putnam Valley T.M. # 85.7 -2 -3.2 Sub. Div. Lot #2 The above referenced separate sewage treatment system can be backfilled. The following com ents must be corrected in the field. V 1. Leave distribution box open for pump test. Pump test must be performed when pump is installed. Call for appointment when ..0�1 b �.� __ ... ��: uiydervvrite�scertfi; afe '•is-rcceiv�;i....__.��.,:._. ,�,�....� ,..� � .,�y.._, .� - ...:.:._:..�.- , ....� 3. Curtain drain above expansion area has not been installed. Call for inspection when curtain drain is ready. If you have any further questions, please contact me at (845) 278 -6130 ext. 2155. JD:ens Sincerely, oseph 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FVIfeIIPe�mtt#Y(r'd�! "ar Iwe";j1 WELL COMPLETION REPORT Well Location Street Address: 1 r +'v Town/Village: y'_ ,Inn_ �r. t� Tax Map # r Map Block Lot(s) Well Owner: Name: Address: Rio 4 Ki"46 )t & . L .1 6k 0f Use of Well: Residen ial _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _ otary _Cable percussion _Compressed air percussion _Other(specify) Well Type _Screened !/Oblpen end casing _ Open hole in bedrock _Other Total Length i�ft., Materials: Steel Plastic Other . Casing Details Length below grade' =ft Joints: Welded Threaded Other Diameter (v •n. In. Seal: -- Cement grout Bentonite Other Weight per foot Drive shoe: Yes o Liner: _Yes L-W Diameter in Slot Size Length ft Dept to Screen ft Develo ed? Screen Details First _Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours"? r. Yield / D gpm Depth Date Measure from land surface-static (specify ft) 3� During yield test ft Depth of completed well in ft. 3bv Well Log Depth From Surface Well Diameter If more detailed Water Bearing Ci n Formation Description ft. ft. lnforrnatigp..... -..-- Land.Surface •., --.. _. !/. descriptioris�or" �• r _ _ _ _ ,_ -.._ _ . �izx sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type SG h * .ei. i 41C Capacity D during drilling Depth Model 0 -S 6 7 -/L list: Voltage QUO HP 3/_hL Tank Type jLJX 8 �% Volume 0 Date Well; ompie ea Ht X � I M Wei. Driller PC Certificate# ©pC�.,p , � NY�Siate #�n a`PPj b d i w... xi 1 Y ,y e h C ,. C y w.: H k k` £ ,"d � 1 'I .. £ ,'x. �.1^ 1,' Purnp Installer PC Certificate # Date�of'Re orti`I ^� �1�r` P;, � ;i;; • �� 1 IM. 1 hl�" ^f I,Ir r 4 'i I W Diller Name�8�`A "ddress t :I s a ,t fi - .n. I, �" t .: r F Ir-• ' sPvl r., r i . ,t ^r. ,C�`, , �k l€ Well DIlert(Sl9at )¢, ;1 3 ` _r 4wi . '�! N u 7 l5 �I' I! i'� .!� R a. n 1 4 „ '` €� rt ..a £R"`�'Ix tt1e:r Pu p lnstall;er Name 8 =Address^ ;" NII9 u Installer si n ature';I;m 1 1 I ,l'1.. Iw.Jll::'FI',. NU t t: txact t_ocation or well witn aistances to at least two permanent ianamarKS to be provfaea on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 SEP =11 -2007 10:30 PM WILLIE 18456286520 P.01 1PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ' -JOSEPH ® GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # E y Q / Located: �� i l eh (v' �, (T) N) - t ��--}} "' i G" (41(C y Owner /Applicant Name: TM ,95-77 Block 2 Lot _.3, 2. Formerly: Subdivision Name: 1 !� Co li s F Subdivision Lot # Is system fill completed? Is system complete? .jC3S Is system constructed as per plans? 2S Is well drilled? Y�5 Is well located as per plans? ?��S Are erosion control measures in place? Date: _ Date: Date: 9 I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and .appro ; dtpl ' an � 1 -.Stwdarcis, _12ules and Reg ;late ns ufJhe Putnarm Health. Date: 1010 Certified by: P,4 PE ✓ RA D si gn Professional Address: Comments: Form FIR -99 �I L. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ° 06 -06 Located at Woo R t ya, Town or Village Ptip-in,ro le- Subdivision name 7iil (�L1q- 6>4s JL Subd. Lot # Z Tax Map 65, Block Z Lot :3.2 Date Subdivision Approved Renewal Revision Owner /Applicant Name K! 1±4 L - Date of Previous Approval O (o Mailing Address to R)( 1 172A <<. , ry1A HWaf., 0.5.4 Zip Amount of Fee Enclosed 2 -5(7 Building Type P695> , Lot Area No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of =0 gallon septic tank and fZ�b 13-JmO `)rz(n!� « 4 loo FT of- TPFplc�z Other Requirements: 2 Fr l olocA kB F11 Q r G o no S t To be constructed by I-5 L). Address Water Supply: Public Supply From Address 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 ay stem 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: Address R.A. Date al.; ?Z O eo License # 5po 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 discharge of domestic sanitary sewage only. B ��` Title: / t Date: 41(5 Lao - HD File; Yellow copy - Building nspector; Pink copy - Owner; Orange Xvl - Design Professional Fo CP -97 ed 6-a i' 11 F07 PUT NAM COUNTY DEPARTMENT ®J' HEALTH v IDWRMON OF ENVIRONMENTAL 1 MENTAL 1C1 EAL 11 H SER �Y. �CES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV -0 - a Located at (A)00 6k, ✓j �il y� Town or Village` f�e. Subdivision name / G Lr . Subd. Lot # Tax Map Block 7, Lot Q-7— Date Subdivision Approved 4 4O3 Owner /Applicant Name 4n r,.}}t <_10 :F- CG Mailing Address to Epp `� iL Amount of Fee Enclosed Renewal Revision Date of Previous Approval Zip Building Type Lot Area 1m3 6No. of Bedrooms-4 Design Flow GPD aQ Dill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of C> gallon septic tank and 600 F�r di 2 'rrW t Dr;P— - k_&kG e s Other Requirements: �— 7�r ar at-ti L al-W 1 Z To be constructed by Address Water SUDIDDRv:. _Public Supply,From _ Address ~ or: ✓� Private Supply Drilled by %��� Address 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: Address R.A. Date Co I os License # O,(; 7 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 discharge of domestic sanitary sewage only. By: Title: AvOef Date: / G Whi opy - HD File; Yellow copy - Buildmg Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL f,, .,Y_ ._ i •. . H,e`o° «:;ice =e:.. . ;� -r..., phase pr "mtror ty "xje �.. ,. . _ .m•_ _._ _ •. -... _ � C-r-1D Pe�itiit -# 0G, �� [ -1 o -., . Well Location: Street Address: TownNnillage1 Tax Grid # / W OCR ivy 1' . Y ��e� Map �g, 7 Block Z Lot(s)3. Well Owner: N e: Address: (4 A- 4i-. �O �OX'�2A L !�G t- Use of Well: esidential 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 ✓ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling �4s ' Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ....................... ........(L........ Yes 1,--► No ............... ,.............. Name of subdivision 1 i 10 Litt CL-05F. Lot No. 2-- Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village --' Distance to property from nearest water main: t -' Proposed well location & sources of contamination to b provided on separate sheet/plan. Date: !o IC? Applicant Signature:_ « J . ..0 w .. , n ... « r -..• �. ....r, .. . D ...„ e, � -1. , a . ... n �H — . w ^r.. ...�.� 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 D Permit Issuing Official-J!'" Date of Expiration jSID Title: qio Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 k-S � ; �J�s�� a �, � LIA ins j . .�-�$ Lod �. z. .��v�a 61,e 5,�� P4,1 {���ss fie. PPS -.�,.r 8� � red �,� �'145j �5a{' tie �, c ��� �- �ysflcc �Ja f�`""�� �� �p�es � ��el� e f �e S.S� k-e- 40a Planning BoarCl its -rte, .7G0 -JJV r the..application was referred to the Putnam County Department of Planning �" 'Gerieirai'M ii. 1= v 4iid: Vag;apprdvea.`4s - sii r nittied` 6n. :May4 -1 WHEREAS, the applicant has submitted Parts 1, 2 and 3 of the Full Environmental Assessment Form (EAF), last revised June 9, 2006; and WHEREAS, the proposed action has been determined to be an Unlisted Action under the State Environmental Quality Review Act (SEQRA); and WHEREAS, the Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c) and determined that the proposed action will not have a significant adverse impact on the environment; and WHEREAS, the Planning Board has considered all reasonably related long-term, short - term, direct, indirect, and cumulative environmental effects associated with the proposed action including other simultaneous or subsequent actions. NOW THEREFORE. BE IT RESOLVED THAT, the public hearing for the Site Development Plan, Wetlands Permit, and Major Grading Permit is hereby closed; and BE IT FURTHER RESOLVED THAT, the attached Negative Declaration of Significance is hereby issued; and BE IT FURTHER RESOLVED THAT, the Site Development Plan for lots 1, 2, 4, and 5 (Sheets 1 through 3) titled "Site Development Approval Plan Prepared for Anakin, Inc.," prepared by Ralph G. Mastromonaco, P.E., P.C., revised September 8, 2006, is hereby approved subject to the below-listed conditions; and BE IT,FURTHER- HER, Site Development Plan is valid for a period of 18 .,.........., ..,.. _ .... _ . _ r. months after the Site 13e`velopment`Plan has been; sigried,by-=tne Chairman�and.'ma •be `' `'':' °': extended once, at the request of the applicant, by the Planning Board fora period not to exceed six months; and BS IT FURTHER RESOLVED THAT, the Wetlands Permit for lot 2 is hereby approved subject to the below-listed conditions and the signing of the Site Development Plan and shall be valid for a period of three years from the signing of the Site Development Plan. All work associated with the Wetlands Permit shall be conducted in strict compliance with the approved Site Development Plan and shall be completed within six months following -the initiation of construction; and BE IT FURTHER RESOLVED THAT, in accordance with Chapter 144, the Planning Board, Wetlands Inspector and Code Enforcement Officer shall have the right to inspect the project from time to time; and Page 3 of 6 SHERLITA AMLER, MD, MS, I'AAP Commissioner of Health ]LORE ll'TA MOLINARI, RN, MSN _.._ Associate Commissioner of Health Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 R®HERT J. BONDI County Executive t ROBERT MORRIS, PE - - Director of Environmental Health October 18, 2006 Re: Proposed SSTS Revision — Anakin, Inc. Wood Glen Drive (T) Putnam Valley, TM# 85.07 -2 -3.2 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 .provide a valid. wetlands permit from the Towm of Putnam Valley_ or letter, _ -_ - -franc the- T-own v &&miffs Inspector stating'rion'e is`required." .._ This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, f Joseph S. Paravati, Jr. Assistant 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 0 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LZ TTA MOLINARI,�RN, IVMSN •.��, `��� Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 23, 2006 Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Proposed SSTS — Anakin, Inc. Wood Glen Drive, (T) Putnam Valley TM# 85.07 -2 -3.2 Dear Mr.. Fredriksen: 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.. Based on the soil testing for this subdivision, it is unclear as to why 2 feet of fill and curtain drains are being proposed. However, since they are shown on the approved. subdivision plat, the fill and the curtain drains should be provided. If the fill for the primary is for grading only, please make sure that the fill is at 2 feet 1 or less and note that the fill is for grading only. If the fill is being provided- for another reason, please clarify what it is for. The curtain drain for the primary system needs to be a minimum of 50 feet from the - - last.expansion trench. Please provide_a minimum- dirnensionjabel _ It appears that there is enough elevation difference to provide a dosing siphon instead of a pump for the primary system. If the pump is to remain, please provide all pump calculations for the primary system and the expansion area (selection of pump from ' Ckx1vA- p pump curve, friction and static head loss, etc.).. Please provide all applicable � manufacturer's cut sheets. I �! There are some errors in the dosing calculation section on the plan and the dose of 343 gallons is too low. Please provide a stamped and signed design data sheet with either the subdivision soil / data or your own test data. lql The dimension between the bottom of the pump chamber and the inlet from the septic tank should be provided on the pump detail. G� Please provide invert elevations along the curtain drain and the discharge location at 1 the catch basin. �� lease note that the curtain drain discharge is to be solid PVC pipe.. joL�. `'Q � �ccording to the subdivision plat, there are two soil types. Please show all soil types and provide all respective descriptions. Please add the words "dust free" to the washed stone 'label in the absorption trench detail. 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 v tT n gar _........ P eawe ca�p�.�et i fy . exactly what area is to be op e , below on the 4ec�ari d,;�,ga4_ f the q...na. s+�n£L a -•T+ n ^: w.-:+, - q...n� .�. �. En.. t.' o _ �'• house plans. 1 ease provide basement -floor plans for review. Please provide a note stating that the proposed SSTS, house, well, and wetland buffer are to be staked by a licensed land surveyor prior to construction. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cj Sincerely, seph S. Paravati, Jr. Assistant Public Health Engineer .- SHERLITA AMLER,SMD� MS, �AAP. _ Commissioner of Health " LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: �� -4 � ;.• � { .r �Q$F�F�,T J BnN41.f. ;> � -• � , �. �.<:�.•;.. >. County Executive DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 20, 2005 RE: Application to Construct a Subsurface Sewage Treatment System Anakin, Inc Wood Glen Drive, Lot 2 (T) Putnam Valley, TM # 85.7 -2 -3.2 The Putnam County Department of Health (Department) has determined. that the above referenced. application, received by the Department on July 11, 2005 is incomplete. Please be advised that the following information is required before the Department may commence its review. • House plans have not been submitted. _•.:" Qil:tcGt:i sillts:aye to-behote:3 on-the-dcA gri'datA'�hect. Iitlie:d "esigri °1?irofessi�inal ' accepts the subdivision data, the design professional is to affix a stamp. •. Curtain drain discharge pipe is not shown on the plan. • All proposed construction is to be labeled as such. • The proposed well is to be dimensioned from two property lines. The review of your application will commence once the Department receives - the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:kly V ry ly /yo U Robert Morris, P. E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY &+[ SUBSURFACE TSEWAGE TREATMENT SYSTEMS Ir.I.O.:' � -. y':vq h•:.yC... y. :Q....+iF ���i.u.' .. .V �y_''�C 7�J�, � 'r��u�u'l.- '�'fd71`i'CJCI� \W$iY �J if 7tYT.t%"1`T'���- PJPlfi`'Kr' - '1•- ��.:T— r- .�.':• -. ..j. _. • v w -.. 1n .�• NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: Y N DOCUMENTS (PERMIT APPLICATION ,C�J(_JWELLPERMIT ORPWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT RAF 'PLANS -THREE SETS (HOUSE PLANS - TWO SETS L-) VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION ( �USUBDIVISION APPROVAL CHECKED UUPERC RATE (_)C__)FILL REQUIRED DEPTH Cam( )CURTAIN DRAIN REQUIRED GENERAL _(�) wlu •CATED IN NYC WATERSHED U NS SUBMITTED TO DEP (� DELEGATED TO PCHD (� DE APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION � .)LETTE t BUZRA .:... )i60 Yk FLOOD ELEVATINN W /Y200' L )SOIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) 'HYDRAULIC PROFILE VITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES C_) TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION . (DATUM REFERENCE U LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. *PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (� WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS (EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 TAX MAP #: (CONFIRMED) Y . (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER - Y." FT. 4 "0'; TYPE PIPE CAST IRON 7L—)SITE NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( )FILL SPECS/ FILL NOTES 1 -5 L�FILL PROFILE & DIMENSIONS (__) F LL IN EXPANSION AREA FILL GREATER THAN 2 FEET CLAY BARRIER (� FILL CERTIFICATION NOTE DEPTH GAUGES VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (� SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH F TRENCH PROVIDED 60FT MAX. ARALLEL TO CONTOURS #DIETAIUDUST 0% EXPANSION PROVIDED FREE CRUSHED STONE OR WASHED GRAVEL U GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS P10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS (,:::)100- TO WELL, 200' IN DLOD,150' TO PITS '00' TO STREAM, WATERCOURSE, LAKE (inc. eepan) (� 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER �10 TO,W�iTERLIN`E (pits -.20')..- *C—) 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS L_)10' MIN TO LEDGE OUTCROP SEPTIC TANK C-610' FROM FOUNDATION; 50' TO WELL WELL IMENSIONS TO PROPERTY LINES (� LOCATION OF SERVICE CONNECTION' 15' TO PROPERTY LINE SLOPE (_)L _)SLOPE IN SSTS AREA (S20 %) L_)UREGRADED TO '15 %, IF REQUIRED DOSE/PUMP SYSTEMS UL—)PUMP NOTES UL_)DOSE'75% OF PIPE VOLUME/DOSE VOLUME NOTED L_)L_)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) L_)L_)PIT AND D -BOX SHOWN & DETAILED L_)L_)1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN L_)( _)STANDPIPES, 5' BOTH SIDES, DETAIL L_)(_)15' MIN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %;100 % - <1% C_)(�20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_)L__)10' MIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH f DIVISION OF ENVIRONMENTAL HEALTH SERVICES.: AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: c f/2 / - Lr_�Z represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: Whose Officers Are: President - Name: Address: Vice President - Name: Address: Secretary -Name: 7—/4 O FO �C liz,4/ 7 �. _ <.. - - Andress:.. r _ . _: - - :.. �:::_ =: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before Mf this day of (mo� (year) Nott/public jGnN ROBBINS NOTARY PUBLIC, State of New York No. 60. 4725810 Qualified in Westchester County, Commission Expires November 30, 2 y_)(,a_ Form CA -97 Signed: Title: Corporate Seal N, I�IgB �p w Y��k �,• 4 � � {I �� 4k t ( ��/� � 4_y { �g 5,r ", 4 d„ ��4 �•�i � ` & � � I 1,1 � � � � �1 � � � y I H V ESION OF ENVIRONMENTAL J.L AID HEAIL'�_ H SERVICES _ c ........_ __._ . •X.. � .P.i =..a. %�er�+•'.G .. �. �,J.L �(::.� _ w •.f^fnl..a.l'z -. p.. _.h., ^4. • -- :R'..a 4:'. !' ^...P .�= ii�'•,.i�:. �• t...kU t•�U� .o .. Yr lv♦•6 to � } -Q .. �. i. ♦'h I� .. �r LETTER OF AUTHORIZATION RE: Property of Located at 'P T/V Subdivision of Subdivision Lot # 2 A • V I Tax Map # '��• Block Ll 2 Lot Z Filed Map # 240 Date Filed 1Z -��� Gentlemen: This letter is to authorize���� /�_ a duly licensed Professional Engineer � 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.14.7_of.the Education Laws the_Public 3ealrh._.,,.. - ~Law, and the Putnam County Sanitary Codeµ v ♦ .. Countersigned: VieW P.E., R.A., # 505Q_'5 Mailing Address Fo �O�C 95-0 State _Zip c64.1 Telephone: S- 7A 0l 6 Very truly yours, (Owner of Property Signed: Mailing Address: L State Zip1Q!�4L Telephone: Form LA -97 PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM "for"UNLIS7'ED'ACTIONS-'Only'-'-'I PART 1 - PROJECT INFORMATION To be completed pleted by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR 2. PROJECT NAME 6A6164, Zlc�, /4&4 4L5T2_ 3.PROJECT LOCATION: Municipality IM /1 County 4. PRECISE LOCATION: Addes/ nd Road Intersections, Prominent landmarks etc - or. Plovide map, Try? ks- 7 5. IS PROPOSED ACTION: W Expansion ❑ Modification alteration L J 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially /.27 acres Ultimately acres &WILL P59POAD ACTION COMPLY WITH EXISTING ZONIAG OR OTHER RESTRIC-TI�6 N:$'?., gles - D No If no, describe briefly:. 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as mapy. a - s apply.) - ' Residential Industrial Commercial 7Agriculture' F Forest El Other (describe) Park F Opqn!Spa 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY.OTHER GOVERNMENTAL AGENC X. (Federal, State or Local) es No If yes, list agency name and permit approval: I OLA>ej 13/J5, 11. DOES ANY ASt�QT OF THE ACTION HAVE A CURRENTLY Y�,L[D.P.�RMIT:OR..APPR.OVALZ....' Yes r7W -If yes, list agency name and permit approval, 12. AS A RLESU ;;F-OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑yes No I CERTIFY THAT THE, INFORMATION PROVIDED ABOVE IS TRUE TO THE BE . $T OF MY KNOWLEDGE Applicant / Sponsor Name Date: A� 6/14 /0.S Signature--------------- - - - - -- If the action is a Costal Area, ifid you are a state agency, complete the Coastal Assessment Form before *proceeding with this assessment I •r'AR i li `IViPPA6'T N�SEaaMEiq i i-rb be corribleted by L'eaa Aaencvl, A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. Yes o B. WILL ACTICK RE EIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN-6 NYCRR, PART 617.6 ?. - If No, a negative declaration may b superseded by another involved agency. Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality.or quantity, noise levels, existing* traffic pattern, solid waste: production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: t�y1'L- C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or comrrlUhi.ty or neighborhood character? Explain briefly: - C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: rte./ 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 a ct'iore? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: Alo� 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:CRtTIC L•• �GNVIRflNf�tCNTF' �EA.(GEA) ^.. ,If es, _ 0 Yes No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex lain: 0 Yes INJINO 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. If question d of part ii was checked yes, the determination of significance must evaluate the potential impactof the proposed action on the environmental characteristics of theCEA. Check this box if you have identified one or more potentially large or significant adverse impact's which MAY occur. Then proceed directly to the FU EAF and/or prepare a positive declaration. /Check this box if you have determined, based on the information and analysis above and airy supporting documentation, that the proposed acti ,,,,,,'Check NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting tl determination. IS Nate of Lead Agency Date Print or Type Nam, e of R,�qonsible Officer in Lead Agency Title of Responsible Officer Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..-DESIGN DATA SHEET -SUBSURFACE SEWAGE TREATMENT SYSTEM Owner A tq� kJ. Address 10 4js, TRA I L AIA 40PAC Located at (Street) CaLEd VRIVE Wopp -51: Tax Map85,-j Block 2 Lot (indicate nearest cross street) Municipality nTdPAM VjkLLEY Watershed R0_D.SQW &AR SOIL PERCOLATION WfN I Lb I DATA A Ur Date of Form DD-97 X depth to Water "s:t:e From Ground Level x T ........ Tarnv .Eta se C Surface * % . . .....RA.. tI e . ..h....... Ilole No Run No. .. . .... .. .. Start .... ... .... C . . . fi.k. --a A 2 vy 3 3! 5-D -21 4 7. 1 2V 16 4 L 2. ' . 7! VS- 7 3 3-0 22 4 5 2 3 4 SOIL DATA WALS 5 5Q RVI V1.4 W F L) Vr NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 1,0-r 2- A TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH y HOLE NO. 'A HOLE NO. ' 116L E NO." G.L. 0.5' �S S 1.0' 1.5' 2.0' 2.5' i3 62z W id (-JtJ 3.0' 3.5' h 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 9.5' � 10.0 Indicate level at which groundwater is encountered ] 6 d4 0 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 4114 4 Deep hole observations made by:poht4 Qe44jMA!Wg17 lQWA4 196 Date 10 ®1 Design Professional Name: &Y f &r) KSFA p , Address: P,0 ao X Signature: -y^ny . Design Professional's Seal . Lo-F ,� 2- .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner A NA Address 10 TRA I L MA 40W. Located at (Street) CaLE-d A JA16op ST Tax Map J1jh,j Block 2 Lot 3, (indicate nearest cross street) Municipality n:TdpM VNLLsy Watershed Rtjf)< I - - 4 L_0T 213 LXLjee_ Ar-9A SOIL PERCOLATION TEST DATA Date of Pre-soaking 10) 1 & Zod I 'Date of Percolation Test 16 2, 0 0 Form DD-97 Depth to :e r oun .. .. .. Eta 0 ur ac "S, x ... oc St n: Start t .. ... . .... Indies Min/Inch 2 .3 MI 3! 1 50 -3 .4 215'L. e 21) z 2 3122 3:32 01 s I T/y 3 3S2 ZZ 30 Z 1 4 5 2 3 4. E�A,7 A WA 5 's U av I V 1_!5 6 yvar NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTI ®N OF SOILS ENCOUNTERED IN TEST MOLES 'lltPTH - G.L. 0.5' $ S 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' J 7.5' 8.0' 8.5' 9.0' 10.0' 1 Indicate level at which groundwater is encountered Indicate level at which mottling is observed S Indicate level to which water level rises after being encountered Co I Deep hole observations made by:AlDAt4 pe, 44f) �M I A!Tgpm4wA4o 96 Date Design Professional Name: ROY f9602A 96LAW-a PE Address: X q AWA Signature: d 01 83J 90 4 -' .777=7 r - Disgg ;- Profcssionaal's Seal ,� F PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- APPLICATION. FOR APPROVAL .OF PLANS FOR. _. . .p `A WASTEWATER TREATMENT SYSTEM - + 1. Name and address of applicant: %� 0 A Ki f t , -� Hc. 2. Name of project: J- &1 U4 &sue Sua- r 23. 4. Design Professional: Roq :: 2Zapgzj F,i,_ 5. 6. Drainage Basin: 9 0 D -5o r�4 P', rler'' 7. Tvne of Proiect: Location T/V:�_�%��_ Address: PO SOX 56-0 'IA X._ t/rrivate/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)? T check one Type-Status ( ) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ....................... ... hka 10: Has DEIS been completed and found acceptable by Lead Agency? .... .......:.... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other ......:....:.:..:............. ....:...............:..: ....... . 13. If so, have plans been submitted to such authorities? ........ ............................... es 14. Has preliminary approval been granted by such authorities? Date granted: Zoo3 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? ............ j—b .......................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ U_- 21. Name of sewage system 22. Date test holes observed Distance to sewage system 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 6 00 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... FIC> 26. Has SPDES Application been submitted to local DEC office? ......................... 0'0' Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? �L .... ........................:..................................... ............... _� .. ... . 29. Is Wetlands Permit required? .............................................. ............................... t-J'=- Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 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 � o DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Le- Is 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ................. ............... ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................ .... f—�o 36. Tax Ma ID Number .......................... ............................... Ma Block 2 Lot • 2 P p�5� 3 37. Approved plans are to be returned to ..... Applicant Design Professional . N ` �N0TE:'Al1 applications for review and approval of a new SSTS t- o 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 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. 11 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 21Y45 of the IPenal kaw. SIGNATURES & OFFIML T'IT'LES: Mailing Address:.:.....': :'.: .`::::.:..:. :..k,;: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner I-r V1 .1.r -f C . Address 1 O e �e I _2A-/ L Located at (Street) l0 D6 0 6 tevi Dn y c_.� Tax Map S. Block 2 Lot 3.Z' .Z (indicate nearest cross street) Municipality Pu7r. VqlieV Watershed 4,Qds9Ii ue,j/' SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test De th to Water ::.: ...W ater From Ground Level Percolation :< Time . Ela�s_e Time Surface nches) Drop In Rate .> . Hole No..- Run No.. Start: Sto (tvlin. Start' Sto Inches Minllnch P ) P 1 2 3 4 5 2 3 4 5 r .. I 5. NOTES: 1. Tests to be at same depth until approximately equal percolation rates are obtained at percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA 2 IDESCRIPTI ®N OF SOILS ENCOUNTERED IN TEST DOLES ...:.: DEpT% 140L NC3: ,........:; :� ,�: L)✓ i+i GLE ND .,.e.. Arrf •`-• D O: II } 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' f 7.5' 8.0' f 8.5' j 9.0' l 10.0' f , Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered i Deep hole observations made by: Date Design Professional Name: 'r' ° i 14,5le Address: V90 Signature Design Professional's Seal COUNTY OF P Tl • AM STA TE OF NT YORK SCALE.• 1 " = 30' DATE' "� APRIL 13, 2005 PROPOSED HOAt ADDED: MARCH 20, 2006 0 - TO SHOW EXISTING FOUNDA TION: MAY 21, 2007 r s. ,f hereon. being lands. designated as Lot 2 on a map I PLAT PREPARED ,FOR 7R/GLIA CONSTRUCTION, INC. e Putnam County Clerk's Office on December 5, X42. signature and any cerfifcofion appearing hereon best of his knowledge and belief, this survey was ice with the minimum stand&ds for land State Code of Pr6ctice adopted by the New York sslonal Land Surveyt?rs, Inc. un only to the person for whom this survey was s behalf, to the title 'company lending institu #ion pency listed: hereon -said eort/pcotions are not in- iditional title` compdties lending irisbtutions, sub ilture contract venders J O �7 O; :tone Ird/ generdly on tine Al LOT 2 EX /STING POURED CONCRE7C FOUNDATION i11, /f' S/Nr J } � q 1A"b!� '91 L 1 y/ • li woi� • 3,9' .�s LOT � a 1 i co . ftie on ino/ of this serve mop marked with both this Only Pres of. 9 Y - s 'sus �e O / e u.. `% otp Ao /I % povem en[ t't 36.1' ir. bb` R = 66.00' L')� = 74, °56'35" L = 86.33' R = 30.00' p = 48 °10'57" L = 25.23' 38.44' -N 87 °50' 10 " W upright B p.c N O y // 0® ill LENporem li elntD .,.iii ii = concrete curb. <: 6 , 9 ff'NSm JOD t7 IFMAP DS By 07 AS S SURti'/£D AND NA�7ED 8Y OINERS t 11 ' J 1 1 , 1 1 . 1 1 t j :tone Ird/ generdly on tine Al LOT 2 EX /STING POURED CONCRE7C FOUNDATION i11, /f' S/Nr J } � q 1A"b!� '91 L 1 y/ • li woi� • 3,9' .�s LOT � a 1 i co . ftie on ino/ of this serve mop marked with both this Only Pres of. 9 Y - s 'sus �e O / e u.. `% otp Ao /I % povem en[ t't 36.1' ir. bb` R = 66.00' L')� = 74, °56'35" L = 86.33' R = 30.00' p = 48 °10'57" L = 25.23' 38.44' -N 87 °50' 10 " W upright B p.c N O y // 0® ill LENporem li elntD .,.iii ii = concrete curb. <: