Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
4597
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07-2-3 & 85.07 -2 -4 BOX 35 No Wn :;';' 04597 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LUREYTA MOCINARI 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 I 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 4 (T) Putnam Valley, T.M. # 85.7 -2 -3.4 The comment letter dated September 27, 2007 has been satisfactorily addressed and there are no further concerns at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2155. Sincer Joseph Digit Environmental Engineering Aide JD:ens 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 poi!.... .�. .:.a -1���. 4q :, :` -ti «. c ,`-- .';7.oe,'.IL :_.�,'% _. 1'• _:".... LORETI'A MOLINARI, RN, MSN Associate Commissioner of Health September 27, 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 _Connty.£xecutive e... = .a.. • -,.YC :.. ra:.•a .. ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection – Anakin Wood Glenn Drive (T) Putnam Valley, T.M. # 85.7- 2 -3.4, Lot 4 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 0Z Large rocks are to be removed from the SSTS area prior to backfillin _.... The ilt fQ -C .s.missina - ' a_ori -" the �iive.1 -:ride=af -S&T -S areal he silt fence must b6 __ ..._... -. -, _ y installed and maintained as per approved plan. 3. The cast iron pipe is to be inspected by this Department prior to backfilling. V5. A " .. Please call for an inspection when the force main and the distribution box from the pump tank is installed. well inspection and bedroom count is to be done once the well s been installed and the house is completed. ''-- ; SEP-26-2007 01:41 AM WILLIE 18456286520 P.01 ;jL: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 9/JOSEPH 0 G ENE, REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # Located: [ 0 or-, r-> 6216M- D(,,Vc— (T) (V) �6 I/C y Owner/Applicant Name: n A r;-n J7 i-I C' TM85- 7, Bjocic Z. Lot Formerly: Subdivision Name: ' -71z I I I C L kA 5 Subdivision Lot # 6 4 Is system fill completed? Is system complete? co k—r4-I 0141 Is system constructed as per plans? - Is well drilled? Is well located as per plans? Are erosion control measures in place? Date: Date: 25 5 ?7 7 Date: I certify that the system(s), as listed, at the above premises has been constructed and I haveinspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulatiop-of the Putnain'CoT g D� ar , ty p Date: Certified by: r4 P,4 CA PE ;D ign Professional Address: ecqQ- ZLC 5 tic- # cis Comments: Form FIR-99 !r/ OF JENWROMMENTAL HEALTH BERM( . , CONSTRUCTION P ERMffT FOR SEWAGE TREATMENT SYSTEM ]PERMIT # �y /g. Located at oo � (� Ail y �-- Town or Village e-t . \i9 P e Subdivision name e--' l L�l ubd. Lot # 4-^ Date Subdivision Approved 14 to 3 Owner /Applicant Name Kda LAC, Mailing Address I L Tax Map Block 2- Lot-3 Renewal Revision Date of Previous Approval 14. V V Amount of Fee Enclosed 4-30 Building Type Lot Area No. of Bedrooms .3 Zip / 0 Design Flow GPD Lo 6 Fill Section Only Depth VoRume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /060 gallon septic tank and Other Requirements: To be constructed by 1-&D Address Watenr Suggly Public, Supply From _. _ - - Address.. _.._,. . ®r.-- Private Supply Drilled by � ..1�54� v _ - •, M - ~- M �`-Address��r 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 s° sv tem 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 6114,Lo License # SnSCk;- APPROVED 1FOR CONSTRUCTIION: 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: Date: copy - HD File; Yellow copy - Building 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 �� -'.s.. _'�.;:,...... _..a,:. ;•,:.? ,- „�.picase;pr�ntb.��Y��•''y ..r .- .,1: -> _ .•�� .�.�:� .,- �-< PC' I��D- �Perrriitytf '".c�V %.'a��''O- :J�:�...`.+ >.. Well Location: Street Address - Town/Village Tax Grid # GI /M D We--, tv . ��`}��e Map e,'�- Block 2 Lot(s),3..¢ Well Owner: Name, Address: A% 1 14 r"l �' . / O r � lu,1 #c, . �, 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 _,5—_ 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 eto Woo :5F- Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ....................... ............................... Yes L---' No �...... Name of subdivision 112/61 Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No y' Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be Wvided Date: 6 140,6- A licant Si nature: o separate sheet/plan. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issuing Offici (�/, cc� Date of Expiration / Title: ;s . - ”- i An,r Permit is Non- Transferra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAk COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVLOUAL WATER SUPPLY & SUBSURFACE SEWA.C`i}ETN'^§'TF�u1:� - • a? = ``` " " PERMIT NAME OF OWNER: ��nk STREET LOCATION: U'l: 6,,J REVIEWED.BY: 'RIv1, GR, JSl',� SRDATE: ,- 0 TAX MAP#: (CONFIR!rW, t5 �� '3— L� Y DOCUMENTS PERMIT APPLICATION ��)k___)WELL PERMIT OR PWS LETTER a3'T.II TION ��,� 1 SHEET (DOSE` 1't��' RESOLUTION CE6(,_JSHORT EAF _ LAI+IS -THREE SETS • • HOUSE PLtiNS - TWTSErs� • . UUvARIANCE REQl�5'�"` ' SUBDIVISION ti LEGAL SUBDIVISION ' "SUBDIVISION APPROVAL CHECKED RC RATE? - (_-)(yJ REQUIRED DEPTH U =CURTAIN DRAIN REQUIRED -- GENE _• i� �} f CATED .IN NYC WATER_S.HKQ (__) S SUBMITTED TO DEP LEGATED TO PCB3) y n U EP APPROVAL, IF REQ'D `` P1EP_ ERVED ,(�(___ZPERCS TO BE WITNESSED 0% cU(U -APPRO SSDS ADJ, LOTS ' (�WETLANDS (TOWN/DEC PERMIT REQ'D ?) L,-ff(•JDATA ON DDS PLANS & PERMIT SAME (--J RE 1969 NEIGHBOR NOTIFICATION • C=AS OIFR: FLOOD ELEVATION WlI 200" (,� SOIL TESTING LOTS >IO YEARS OLD REOUIItED MAILS ON PLAINS (,, . SEWAGE SYSTEM PLAN-(NORTH ARROW) Y�SSDS HYDRAULIC PROFILE ��GRAVITY FLAW } CONSTRiM IION NOTES 1 -15 C 9In EXISTING & PROPOSED ;-; R IVE�NAY &SLOPES, OOTING/GUTTERICURTAIN DRAINS ; J USDA SOIL TYPE BOUNDARIES *TITLE BLACK; OWNERS NAME ADDRESS TM#, PE/RA; .NAME, ADDRESS, PHONE# �JDATE OF DRAWING/REVISION' < 6 DATUM REFERENCE AC--)LOCATION OF WATERCOURSES, PONDS /LAKES wETLANDs QVITHYN 200' OF P.L. - Jt�PROPOSED FINISH FLOOR AN D - �..BBAASyEMENT ELEVATIONS TY METES &.BOUNDS -)( JF,RASION CONTROL FOXHOUSE, WELL & SSTS, EROSION CONTROL NOTE ISMT)0910voo b►E SEWER �/�' 4 "0'; TYKE PIPE. CAST IRON' UUNO BENDS; MAX Bg. SN 4�TCLEANOU. . RENEWALS UU*� (NO CHANGE) FILL SYSTEMS �` 7/ j 6 U(-)10' HORIZONTAL; PAST THE L'O ESP 3:1 TO GRADE L-)L jFILL SPECS / CLU J LJFILP & D DENSIO NS Ek NSION AREA FILL GREATER THAN 2) CUCU CLAY BARRIER (___)Lj-*FD:rCERTIFICA OTE , C--)C---)DEPTH G 'O,1WPLAN FOR R.O.B., I7NCLASS =D & IMPERVIOUS EPARATION DISTANCE FROM'TOE OF SLOPE TRENCH F TRENCH PROVIDED .505 60FT MAX. ��a �� `•'/ ARALLEL TO CONTOURS IO% MAINSI09MOVIDED 'STONE OR WASHED GRAVEL / SEPARATION DISTANCES ON PLAN : FROM-SSTS e10' TO P.L. DRIVEWAY., LARGE TREES, TOP OF FILL. // 20' TO FOUNDATION WALLS . t, W,100'TO 100' TO WELL, 200' IN DLOD,150TO PITS S.TREAM,WATERCOURSE, LAEE�(Inc. ezparC). SO' TO CATCLE BASIN; 35?' S^TOIt7iRAL ..PIP%J W. TtR..= . N/Hm'-INTEILMITTENTZDRAINAGE COURSE (� . 200'/500' RESERVOM ETC. 150' GALLEY SYSTEMS (10' Mild TO LEDGE QUTCROP / SEPTIC TANK X10' FROM FOUNDATION; 50' TO WELL (� ':/ DIMENSIONS TO PROPERTY —' I- LOCATION OF SERVICE CONNECTION MIN 15' TO•PROPERTY LINE SLOPE SS PE IN SSTS AREA (S20 %) U(�REGRADED TO 15 %cc, IF REQUIRED '�07 ►� STE QK G' � 'W. G'.an 5' n" lc-j (_ }PUMP NOTES . A, S t� �[ c�t f- . S' /4 a y OSE 75% OF PIPE VOLUME/DOSE VOLUMENOTED /I- A TPJ (• .) ]ET I�EL R43 :� e��, rP�' _TYPE, ETC.) r 11 DAY STORAGE ABI)VE � �c h�� " CURTAIN DRAIN L-) __)S'TANDPIPES, 5' BOTH SIDES, C-JL-)20' MIN to CHARGE1100' with 102 cons day discharge C- J(__)10' to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .: :f -.•r: %-i"+,. .�' -� ... ... �, o`( ;... o .. .. _..�•. :U, r,. cs.i�r<i+n`r:iia'.: �::.t :ey,,.i. .. .. ., r -, -o �: �. ';�,., .. a• ,. Y ^�... �1►.• :'.. AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 77- 1c, 1./ I represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: f /</!I Tr./-C., Having offices at: /0 Whose Officers Are: President - Name: Address: /0 Vice President - Name: Address: Secretary -Name: .L 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. to before me this day of __�montl#2� (ri (year) otary JOAN ROBBINS NOTARY PUBLIC, State of New York No. 60- 4725810 Qualified in Westchester Count ,nmmission Fx6res November 30, 20� La Form CA -97 Signed: Title: Corporate Seal � �O'rPor4� 2 f k' Yor}< ILU NAM COUNTY DEPARTMENT OF HEALTH IIDIIVIiMON OF ENVIRONMENTAL HEALTH SERVICES � �... -" <R..: ut�z r n.Yt i% - �:... -o .: •.-�. :..y,:- ,P - r .,... ,, - :•.w.. ... _.. �' F .. �1 .. ,. <e1r. . v_.: F't , c�.l R. .�. -n .r .. -}• �,.+... .. .. +, . -::K -i -~ ei RE: Property of LETTER OF AUTHORIZATION A Vl(,,J Located at W ©oo &Lc4j T/V ' V �1e Tax Map # 5• Block _ Lot -3e _ Subdivision of iEi6 Lid 5'"-. 7; Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize R"'I rz�fz,<SeN a duly licensed Professional Engineer ✓r Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article .145 and/or 147 of the Education Law,. the Public Ieath-:.a _ `Law, and the�Putnam County �Saiiitafy Code. - r �, -.- Very truly yours, Countersigned. � Signed. P.E., R.A., # (Owner of Prope Mailing Address PO LQX &1-0 Mailing Address: / c7 tom) ,/2,4 /L State t4l zip /D(!41 Telephone: - �9/ � V4 - 2 / S6. 1AA /492 d State Zip /fir Telephone: Form LA -97 ff,KGYTREDRIKSEN; ff Consulting Engineer . Design Planning Construction Phone 518-784-2086 P.O. BOX 950 Fax 845-628-6520 Mahopac, NY 106541 71 e 06, January 19, 2006 Re: Triglia subdivision. MR. Robert Morris, PE Putnam County Health Dept. Geneva Ave. Brewster, NY 10509 Dear sir; We are currently in, the process.. of. rectifying. the, situation with. the well location djl 4 ...... .1 ot 4 of Trig ia T li Suibdivision on oo treet m e own of Putnam Valley, NY. The location of the well will be changed and moved away from the proposed septic system for Lot 41 of Hery Wirtz Subdivision to create sufficient (direct line of drainage) separation distance. The revised drawing will be filled at the Putnam County Clerks Office as an amendment to the filed subdivision map #2942. Also copies will be filled with the Putnam County Health Department'. If you have any questions, please don't hesitate to call. OF &O's 06 Yours Tr'uly Roy Fredriksen, PE flange BF or BHF , units: Optional 3 ". NPT threaded companion flange "BF". or' "BHF" units; must order (A1 -3) companion flange separately. Mechanical Seal: Carbon rotary ceramic stationary, 300 series . stainless steel metal parts, BUNA -N elastomers. Temperature: 160 °F (71 °C) maximum. Fasteners: 300 series stainless steel. Capable of running dry without damage to components. ©1985 Goulds Pumps, Inc. 2" Companion Flange. Bearings: Upper and lower heavy duty ball bearings construction. Power Cable: Severe duty . rated, oil and water resistant. Epoxy seal on motor -end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. have O -Ring: Assures positive sealing against contaminants and oil leakage. Effective January 15. 19,95 Irlflotor. D .:APPLICATIONS -- - - ' Si ngle Phase: 115V or FEATURES . f. d 230V, 60 Hz, 1750 RPM; /a 1 HP. 230V, 60 Hz, 1750 RPM;) HP, Impeller Cast iron —semi , Farms ,. 230V, 60 Hz, 3500 RPM. Built In -open,. non -clog with pump -out , Trailer courts - 9 _ flange BF or BHF , units: Optional 3 ". NPT threaded companion flange "BF". or' "BHF" units; must order (A1 -3) companion flange separately. Mechanical Seal: Carbon rotary ceramic stationary, 300 series . stainless steel metal parts, BUNA -N elastomers. Temperature: 160 °F (71 °C) maximum. Fasteners: 300 series stainless steel. Capable of running dry without damage to components. ©1985 Goulds Pumps, Inc. 2" Companion Flange. Bearings: Upper and lower heavy duty ball bearings construction. Power Cable: Severe duty . rated, oil and water resistant. Epoxy seal on motor -end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. have O -Ring: Assures positive sealing against contaminants and oil leakage. Effective January 15. 19,95 Irlflotor. .:APPLICATIONS -- - - ' Si ngle Phase: 115V or FEATURES . f. For Homes 230V, 60 Hz, 1750 RPM; /a 1 HP. 230V, 60 Hz, 1750 RPM;) HP, Impeller Cast iron —semi , Farms ,. 230V, 60 Hz, 3500 RPM. Built In -open,. non -clog with pump -out , Trailer courts - overload with automatic reset Vanes for mechanical seal pro- Motels ; ' '. Three Phase:' /z -1 HP 208/230-. tection. Balanced for smooth operation. Schools 460V, 60 Hz, 1750 RPM;1 HP .: Casing: Cast iron volute type Sewage systems,. 208/230 -460V, 60 Hz, 3500 RPM. ' for maximum eff iciency. 2 NPT }�F,....' Hospitals Overload protection must be in starter unit. provided . -;;,` discharge adaptable for slide rail .,, ,, , ` Indust Shaft Threaded 400 series systems. ., F " Dewatering +' i stainless steel. Mechanical Seal: Ceramic vs anywhere waste or drainage `must` Bearings: Ball bearings — uppgr carbon sealing faces, stainless , steel metal parts, Buna N . ' be'disposed of quickly, quietly and and lower. elastomers. �. efficiently: Power Cord: 15' standard (opHo, gal ° iengtns availabie): Shaft: Corrosion resistant ,stainless steel. Threaded design...*. SPECIFICATIONS..: �� _ Single Phase: 1/3-1/2 HP, 16/3 t , Locknut on three phase models to .: ;., I; W 10 with three prong plug; 3/ and guard against component damage Pump 1 HP, 14/3 STO with bare leads. on accidental reverse rotation. T Solids "Handling Capabilities; Three Phase: /z -1 HP 14/4 STO ' `_{rotor. Fully submerged in 2 '.imaximum with bare leads. high grade turbine oil for Capacities: Up to 180 GPM ;`: On CSA listed models: 20' length lubrication and efficient heat - ,, Total. Heads: Up to 49 feet TDH . . '. SJTW or STW are standard. • transfer. Discharge types available:'_ ; ' Designed for continous operation. 2 ":.NPT threaded casing:, .`, ; ;...:: ' ` All ratings are within the working . 2';,,NPT threaded companion limits of the motor. flange BF or BHF , units: Optional 3 ". NPT threaded companion flange "BF". or' "BHF" units; must order (A1 -3) companion flange separately. Mechanical Seal: Carbon rotary ceramic stationary, 300 series . stainless steel metal parts, BUNA -N elastomers. Temperature: 160 °F (71 °C) maximum. Fasteners: 300 series stainless steel. Capable of running dry without damage to components. ©1985 Goulds Pumps, Inc. 2" Companion Flange. Bearings: Upper and lower heavy duty ball bearings construction. Power Cable: Severe duty . rated, oil and water resistant. Epoxy seal on motor -end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. have O -Ring: Assures positive sealing against contaminants and oil leakage. Effective January 15. 19,95 Goulds Submergible a ti.. , 6 Pumps 1 7 ' "BF" and i =_ _ — "BHF" •r Models 2 q .r 3 ` j,L•' "B" Models 3887 4 � g Rr 771 9 FEATURES........ _... 1 All Iron Construction 5 Epoxy Sealed Cable .': 8 Elector Vanes 2 All Ball Bearing 6 High Grade Turbine Oil 9 Multi -Vane Non -Clog Heavy Duty Design 7 Electrocoat Paint . Cast Iron Impeller 3 Stainless Steel Shaft Outside & Inside 4 Mechanical Seal MODELS Max. Series HP Molts Phase Amps RPM Solids Wt.. W 03118�BF �, 115 8 �..-. r�'�..• ... � st'vx....�,r :.�- 9�o"�t�u zvi.L,Y�,xsd • . . r.�. WS05118,Bf WS051213,81F 230 X6.5 WS05328,BF. , '/: 208/230.._ ..,`' ': 3.3_::., 65 ..:w5�0,f1F 3 i ice_; 750 WS07128.8F ._..'.. 230 1_.�_ .__6.Q_s.. 2" . WS0732B,8F. • ,; •, '/� 208/230...,. ,.' 3 . ' 3.6 _ WS07348,8F ....... . 460 1.:::..:... 1.8.... WS10129,BF ....::... 230,.,.. `• ,WS1032B.BF_.•.• 208/230 85 3 WS1012BH,B4 , 1 :230 0;.", WS1032BH,BHF_', i08/23'0` 3500 WS10348H,BHF 460 3.5 SIMPLEX &'DUPLEX. SYSTEMS_ Simplex Elector Systems: are used where drain facilities are below existing sewer lines. Also can be used for septic tank applications where effluent must be ' pumped away from tank for disposal. Duplex Elector Systems: offer the necessary safety required by institutions which cannot afford an interruption in their sewage disposal systems. . PERFORMANCE RATINGS In Gallons Per Minute S05118,BF Series WS051280 WS0712B,BF WS10128,BF WS1012BH,BHF No. WS0311B,BF WS05328,Bf WS07328,BF WS1032B,BF WS1032BH,BHF ► WS0312B•BF WS0534B.Bf WS0734B.BF WS1034B.BF WS1034BH,BHF HP ► '/, '/1 y4 1 1 _ RPM 0. 1750 3500 _ 5 108 150. 170 _ 10 82 126 150 170 168 15 30 94 125 150 150 s 20 56 90 121 128 ' 25 17 49 81 107 +r 30. 14 40 s 35 10. &1 ' 40 _ r 4't _ 45 I .. 24 DIMENSIONS (IN INCHES) 1i Rotation 53/4" �`� { r� R i'A.,; Kick -Back A' — All models are 17'/." except :144 HP 10 and 1 HP 10 = 20'/." -Dimensions are approximate. Do not use for construction purposes. Available Certifications: sp• Canadian Standards Association. Pennsylvania Bureau of Mines for non -face applications — ROTE 91. �� SENECA FALLS NEW YORK 13148 ATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. Pedormance Curve "Z METERS FEET PM 0 10 20 30 40 M3/hr CAPACITY GOULDS PUMPS W. SBECA FALLS WW'YM 0148 f7b MP 15�70A 745, a Hj- E A 0 FrZICITtam NEC, FOAP �OT- 0J5-rALLbD 'U�T)LL EXPANSIoN IS N E60 EC) 01985 Goulds Pumps, Inc. Inw; 16- 14- 12- w lo- 8- 0 6- 4- 2- 0- PM 0 10 20 30 40 M3/hr CAPACITY GOULDS PUMPS W. SBECA FALLS WW'YM 0148 f7b MP 15�70A 745, a Hj- E A 0 FrZICITtam NEC, FOAP �OT- 0J5-rALLbD 'U�T)LL EXPANSIoN IS N E60 EC) 01985 Goulds Pumps, Inc. Inw; \iri 41 PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 �'} ". '• a sate""' '+9^t 0, - - 1NelislPtem� #:!,s?�+r..0 ^.. Srtiv lilil{I.xw�v �, WELL COMPLETION REPORT Well Location Address: ToownNillage�:� Tax Map # GPS '' ,iS''t'+reet W oc d C � ,o W-y / 4VIV, Q+n Vi Me Map Block Lot(s) Well Owner: Name: Address: ''%� A n ct fl'�ip p -eoV / r ti, Use of Well: Resideritial _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 Open end casing _ Open hole in bedrock _Other Total Length awl. ft- Materials: teel Plastic Other Joints: Welded VThreaded Other Casing Details Length below gradPlt. Seal: Cement grout Bentonite Other Diameter in. Weight per foot lb /ft Drive shoe: Yes _ No Liner: _Yes il4o Diameter in Slot Size Length ft Dept to Screen ft Develo ped? Screen Details First I _Yes _No Hours Second Well Yield Test _Bailed _Pumped _ Compressed Air Hours "74- Yield gpm Depth Date Measure from land surface-static specs ft j a During yield test (ft) Depth of complet;d well in ft. It 9d-1- Well Log Depth From Surface Well Diameter ft. ft. If more detailed Water Bearing in Formation Descri tion information d- esdMption's• or-"' Ond Surface.. a t?p v ve ,! t.�rc�P r✓ _ . _ . �. .._ .._ _ ... _ ... _.. - ", .. S L "h - .._ ... _.._ .. _ sieve analyses are available, please attach. 1 � \ If yield was tested Feet i ;te Pump /Storage Tank Information at different depths '' Pump Type Stt ;yt„ K► 1e Capacity ,,, during drilling list: Depth v Model - 7 �-!$' Voltag� `� � 4 3d HP 31q , Type Volume .S ]Tank Date Well`Completed Xn h �y 1N211 Driller upstallec PC Certificate# e9y -p ANY State # ,�^ J , YIA *�..: 1 C Certificate #;%` NY Stae # ��a °� ;�.nI Well riller Name & Address I p,�+„� - !•'�'"�x._.; +: � ►Ylw� � t� � l V '�S �� i ,2 � fl. a�/a��� ,,', .. ...' � /•[ x : ,x:. '/fx $ -;=. r.I�V �'� We110 rller (sign re)yy��1�. l 1 I VM�9 d4'2 n�;'! I I t� A�1 +Ii�YI,II i a �I 1. rl� C,r � � l �d� ��I, Pu Installer , Name Address >.� y� 3 .� � �, y,3� »�.�w,., :&.r � :Q�v t �Ak.Y;x `S� ' gumInstaller(" ature�� NOTE: Exact Location of well with distances to at lelast two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -9T Rev. 3/06 cotc, 31 stn -bash - LEY Z VNI S 86'050'34" E A 92.08, p o Calvert curb t1. t Mt N No a ""M NV ufl. W51 k g S" . . ..... 2 remoras 7771 Of i N Z, wire '.I jy,o, ............ bag A�M Ax - navy! ""M 200j- 6'U ufl. W51 k g S" .......... j�Id::�a Wh of jy,o, ............ bag Er I I "Y Too %w 1 YA, -J4 �0- -mo Pi� JAS 5,' 110 e", ky Q.- 1, MN, Pe Mp ' A X, M................... ........... TAX - s. 41 Z. aRME, ufl. W51 0 �i S" of M20 way bag . . . . . . . . . . . % W � J, L I ..... ....... N I CE! . . . . . . . . . . . . . F. a AMR nag Mp ' A X, M................... ........... TAX - s. 41 Z. aRME, W51 0 �i S" of M20 way bag Mp ' A X, M................... ........... TAX - s. 41 Z. aRME, W51 0 �i S" of M20 way 1 P V CIS ivy Y Q M:' I'M".0120-51 l 111100, w I a IsI I I ARN I yJ 1 I 111 CERTIFICATE OF CONSTRUCTION L11AAR1�ClE FOR SEWAGE TR EA'B'IYI EN PCHD CONSTRUCTION PERMIT # � —Q Located at � (J o o p Lr--Kt Dry. VC- Town or Village Owner /Applicant Name '4 hl A k Iel -Tj4'- Tax Map 86'.-7- Block Lot 34 T Formerly Subdivision Name .�-iQ l G LI A Subd. Lot # Mailing Address 10 f � OX TRUE I'M Ho l" Date Construction Permit Issued by PCHD ca Zip Selpairste Seweirs eg_ftstem built by C4 L om L Cogs Address E f6 61-1, M A FIOpl- - -'k- Consisting of 1000 Gallon Septic Tank and � :5Cp i-r o 4 2"r Lip., 7 c"�IcAe g .;<- Other Requirements: /000 G Water Su��Dv: -J njo ;t h k- ,- D --13oX s f �0-r'ce M a I � r- Ful-b re- Eta Public Supply From, Address or: ✓ Private Supply Drilled by � t401rSU iI Address EdOP-GF --4Z ��T PU'I V141ky 3ui$di Tv e.�` _ � �c' .l..�l'Z. -:. Has eTnsiar ontAol been comnleed? Number of Bedrooms Has garbage grinder been installed? O 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 regulation of the Putnam County Department of Health. Date: .31 0 Certified by l.� P. E. ✓ R. A. esign Professional) Address ao>( '95(3, 1�'J NO �Y�C : , �/ > ().�'�}� License # 46-0S"O,S 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 odification or change when, in the judgment of the Public Health Director, such modification,of change is necessary White copy - HD Fife; Y Title: - Building Inspector; F Date: 4 - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown - Heights, N.Y. 10598 (914) 245 -2800 . ^G...,; ..�_. 1�!• `P :�a��-t.: �: uc ova - D rect'U'r... '- �...RS -Q� .. rvwGr .. .. r+r .t ..�•1 LAB #: 9.800457 CLIENT #: 13399 NON STAT PROC PAGE: 2 of 2 ANAKIN INC. DATE /TIME TAKEN: 04/11/08 11:.00 10 FOX TRAIL DATE /TIME RECD: 04/11/08 11:18 MAHOPAC, NY 10541 REPORT DATE: 04/23/08 PHONE: (845) -621 -1824 SAMPLING SITE: LOT 4, WOOD GLEN DR, PUTNAM VALLEY SAMPLE TYPE..: POTABLE : WATER TANK PRESERVATIVES: NONE COLD BY: ROY KING TEMPERATURE..: < 4C NOTES...: COLIPbRM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER A,�'_E'8 . "i4 Q: r ,�.0_ a G;/L: _-_.._... _. (:? R- -gr im ga�1 l R- SUBMITTED BY: W—K Albert H. adovan', M.T. (ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245- 280.0. Paauvani, L rector' LAB #: 9.800457 CLIENT #: 13399 NON STAT PROC PAGE: 1 of 2 ANAKIN INC. DATE /TIME TAKEN: 04/11/08 11:00 10 FOX TRAIL DATE /TIME RECD: 04/11/08 11:18 MAHOPAC, NY 10541 REPORT DATE: 04/23/08 PHONE: (845)- 621 -1824 SAMPLING SITE: LOT 4, WOOD GLEN DR, PUTNAM VALLEY. SAMPLE TYPE..: POTABLE : WATER TANK PRESERVATIVES: NONE COLD BY: ROY KING - TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF' DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/11/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 04/16/09 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B 04/11/08 NITRATE NITROG 1.46 MG /L 0 - 10 SM18- 204500NO3 04/11/08 NITRITE NITROG <0.1 MG /L 1.0 MG /L SM18- 204500NO2 04/17/08 IRON (Fe) 01064 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/17/08 MANGANESE (Mn) 0.047 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/17/08 SODIUM (Na) 7.59 MG /L N/A SM 18 -20 3111B 04/11/08 pH 6.9 UNITS 6.5 -8.5 SM18 -20 4500HB 04/17/08 HARDNESS,TOTAL 158 MG /L N/A SM 18 -20 2340C 04/15/08 ALKALINITY (AS 84.0 MG /L N/A SM 18 -20 2320B 04/14/08 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 ACCORDI HE 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. iblic 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 moderately restricted diet, a maximum of 270 mg /L of Sodium SHERLITA ANILER, MD, NIS, FAAP Commissioner of Health Associate Commissioner of Health Roy Fredriksen, P.E. P.O. Box 950 Mahopac, NY 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 'IRUbE1tT.'MOkkiS, PE Director of Environmental Hea /th March 26, 2008 Re: Construction Compliance for A.nakin, Inc. Lot # 4 — Triglia Subdivision (T) Putnam Valley, TM # 85.7 -2 -3.4 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. t,/I. The well water quality analysis results were not submitted with your compliance application.submital... _ I. t -' ,. ,� ✓ 2. The submitted construction compliance application is not complete. Please refer to the marked asterisk ( *). Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Respectfully, Michael J. Budonsk, PP Director of En ineer' 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 qa .. � �..i�i � . i • �. w�...•ir� .. Y.- ,:r,,- .. .. b . :. .. _.� .♦ ;q•_ a � .wi j n . w..�H ... CERTIFICATE OF CONS'T'RUCTION LIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # 'Q o3 Located at �.� 0o D C`a 1�1 Sri �� Town or Village -PJ Owner /Applicant Name h4 A K l fl -Z-N L Tax Map 85'.-7 Block 2 Lot 3.4 Formerly Subdivision Name ' rg I (i L/A Subd. Lot # Mailing Address 0 F::'Oi HOPAC. fJ. Zip I OS4f Date Construction Permit Issued by PCHD I 0 tg2 Separate Sewerage System built by G L O&i L. atIS Address (r,> t , M A KOQ /4-e 4- Consisting of Gallon Septic Tank and -- .K Other Requirements: Wa>rer San ®nDYv:?" Public Supply From Address ®r: ✓ Private Supply Drilled by N01ef.S0 i J Address 5OZ6 F-aZ Vu 'r V&41k-r -TxPC" -4e, Number of Bedrooms Has garbage grinder been installed? N 0 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 regulation of the Putnam County Department of Health. Date: _ 1/3110 Certified by l.+ P.E. ✓ R.A. esign Professional) Address ?( aox 96°P, MA NO-PAC, [4. y / 0,—I/ License # �QS'QS Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: 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_k!EALTH- SERVICES - - 'ie.: - .1 :`•:q..ly.. ;1 a. " . lL - . s . n .. –=i :ciao ' : ''�•.. 4 .:a: o : ;., 'c-a er- 1.:e�?.._ . Vv .. dd.: ' •�w: WELL COMPLETION REPORT Well Location ,iStreet Address: Town/Villagef:, A40 t at V Ile Tax Map # Map Block Lot(s) Well Owner: Name: Address: Te-,q A n.ct kih %V oy to � .` Use of Well: 1- Primary ' 2- Secondary Reside tial _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring _Other(specify) Industrial Institutional Standby Drilling Equipment _ otary _Cable percussion _Compressed air percussion Other(specify) Well Type _Screened ✓Open end casing _ Open hole in bedrock _Other Casing Details Total Length olA ft. Length below grade -It. Diameter in. Weight per foot �S lb/ft Materials: teel Plastic Other Joints: Welded VThreaded Other Seal: ement rout Bentonite Other Drive shoe: Yes _ No Liner: _Yes �ilVo Screen Details Diameter in Slot Size Len 9th ft Dept to Screen ft Develo ed? First _Yes No Hours Second Well Yield Test = Bailed _Pumped _ Compressed Air Hours _7a- Yield � gpm Depth Date Measure from an surface-static spec During yield r:st Depth o completed we n . Well Log If more detailed information • - descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Lalio Surfaces ,a !?ti - -•: If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type �_jrto -mF , Capacity ., Depth Y 1O Model sSv 7 -19' Voltage Ild Hp 3 Tank Typel!! X Volume .S D to eIl,CorylRleled�W CrA.l57 ^` ;�.'up(1(allerePG �� fi IeG �V:h:'n'5' .R -1. R �ertlfic/q�te/$�•{� a`: -P h i� 9VN t.'ggCC•.•...:� I.IYt'% ,::K1!' R Y- �'r:.t.. 3;:::! .: .§. Cblt�' �j :"I�Zk'.t��"��¢PK.i'.l'.W'dtk: l"qi•: "hrtifi�ate�# Q/3 -P `Y State #ri l add # �"ll ile.��l�l' .�iy,, I. ,,. I:.. 3� AID \ ,{pit „� M• d��� :K {iy�. y �.a A� �l. k� 11�y.. fit::. ;..� j".R:N" _/k 'kx 3� °i �". !•�.. x : .. ::I3'. Ql i,ii.�4 Sia r�}1 C :,., it�.l.•ll ll'•'Uitl j1�� : `: ��4e '"p,trf'IB fa:.. •I.0 �k bR. }.:� r"r.K' N: �tF:t 13N;p:'t�.�•gt ?P�. :.. :V .: Ik�iKIM '� FPk �i .. °hy 3,y.rF. �' :. Y r :'• .. ..F - .M�.,. I' ..���' "4 fF N�v✓!JM!: �'.: •.T '.. }�....a^��.rt 7,.ahu ui lc�: > 7.y' ' �K,`t b �!;v'9Z s, fniy , ..! i�.h �. SCI � RAC'• ya: 'Li% !? !� :`T'i �:� J �i' . •tw .. , 1L:M �' §'�:: iv' �' '�'l �/J. K:i Jli '.£ '.k Fx�` '. yR ii^ �,i - t^�I� 1 Z�1. 1 5 P ..:p .. •`� '.: ip� ' i G � \ `�'.1, '�, nSl dr ,1,.I,;. , a' : ; ,Y. r u Irk Ile r at re ! �,,p+Q'yir.• ,lC,Y+'k'18`.YD.': � 4��: .R" ,�! 1.31 Al �,. •.� pp p �.�� J yRn''�y�! "x!' li�•'I � l��y ll.��j �. .f��'��Y 5 OTEc Exact Location of well with distances to atl st two permanent landmarks to be rov' ed on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -9T Rev. 3/06 1,3-r- Ll SHERLITA AMLEP, MD, MS, FAAP Commissioner of Health P TA MO-LINARI, RN, MSN IT Associate Commissioner of ealth OWNER'S NAME: TAX MAP NUMBER:* DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York ork 10509- E911 ADDRESS VERIFICATION FORM E911 ADDRESS: 'J-� idltval TOWN: AUTHORIZED TOWN OFFICUL: (Signature) ROBERT IBONDI County Executive -".:D AX .F.— W, 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 ENVIRONMENT kL HEALTH.. SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Town/Village tdaz>d . :��e — �Iz 6� Z,/"",O- Location - Street Subdivision Name /a,V,6i Building Type Subdivis on 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 s,, stem. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Da �Z Years J Signature: Title: General Contracto caner) - Signature LLB. Corporation Name (if corporation) Corporation Name (if corporation) Address: i6i;,k % /,l y /ma Address: State f� Zip State Zip Form GS -97 'Ell O.. '. . s. \ �_ ♦ '1 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by 1zlez>d Location - Street Building Type S/S-1 7 C�? 1 3, , / Tax Map Block Lot — &r, /" / Town/Village Z" Subdivision Name 4-1 Subdivis on 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 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 *S) Year Signature: Title: General Contracto wner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: /(.) %�,c., Address: State , Zip State ����c �- Zip /65V/ Form GS -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health _LORETTA AbLINARI, RN, MSN Associate Commissioner of Health Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Dear Mr. Fredriksen: ROBERT I BONDI County Executive -Z . ...... . a , .....: M.; DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 21, 2006 Re: Proposed SSTS — Anakin, Inc. Wood Glen Drive, (T) Putnam Valley TM# 85.07 -2 -3.4 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 2 3. 4. 5. 6. 7. Based on the subdivision plat, fill is not required for the SSTS area, yet fill is still being proposed. Please remove the fill from the SSTS area or provide a reason as to why fill is needed. The proposed SSTS area for tax map number 85.07 -2 -1 is still not being shown in the right location. When shown properly, the proposed well will be within the 200 foot setback requirements. The sewer line and the plastic pipe between the tank and the first junction box are to be labeled.in the plan: view like,theprofilesview. Please show the pump and the force main in the profile of the expansion area. - YT Friction/head loss calculations for the pump selection have still not been provided. Please label the property line between subdivision lot # 5 and tax map lot 85.07 -2 -1. This Department has two different sets of house plans on file for this lot. Please advise as to which plans are to be used. 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, 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 SHE)EYI. TA AM LER, MD, MS, ]FAAP Commissioner of Health ]LORE'II TA Ii OLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBEIB'I.I E®NIDI County Execut {ye _ 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 -3.4 Dear Mr. Fredriksen: This office has received and reviewed the most recent set of plans for the above mentioned project. We ,9 1,(, would like to offer the following comments for your review and consideration. . Soil test results are to be noted on the design data sheet. If the design professional accepts the subdivision data, the design professional is to affix a stamp. 2. Run of bank fill for grading to 15% is not necessary. The average slope over the SSTS area is approximately 11 %. /k o r C3.) The proposed SSTS area for tax map number 85.7 -2 -1 is not shown in the right location. When shown properly, the proposed well is within the 200' setback requirement. Basement elevation is to be rioted in the plan view. . 5 WThe regrading in the grading easement is to be shown and the proposed SSTS needs to be 25 feetftom the.top of the.bank.,- The s6Wef "line aid the plastic` pipe between the tank and the first junction box should be labeled in the plan view the same way as the profile. I/ What is the purpose of the dry well detail? V The distribution box only has 8 outlets. J9' The dose level provided is too high. CQ? All pump calculations (friction/head loss) and future pump selection should be provided. nLl� The expansion profile should include the distribution box and its inlet elevation. Tj The revised house plans still have 4 bedrooms and abasement plan was not provided. 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. Sincerely, (Joseph S. Paravati, Jr. JSP:cj 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 Nome Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 .�. .:c= �..- ,= 7.-,dw f :.t�.:;, ^'%+"..'.�'s^+ai"�,:�'.sr .'',. •m.- � .': r:. o,= .. .:: •^....a., ._. :.r:::= 7,- ;ro °i•.:C�.....': ..�, .r�trai�ae =w,a^ �.n.+ ,. .•�.�: ��r:., e�: .. -..C� neon Commtr:ton<r ofxtw /tA DEPARTMENT 'OF HEALTH I Geneva Road, Brcwety. New Yolk 10509 1,r,— ir'Ir.'z. . �; ees5. Ray rredrikson, PF'. .. . PO Box 950 ✓' Mahopao, New York 10541 Re: Proposed SSTS- Anakin Inc. Wood Gim Mvo. (7) Putnam Valley ... '1'htft 85.0'/•2.3.4 SHE LORE .4o RU AMLEI4, MD, aft, FAAY Commh4lorrer ajxmlrA • TA ROBERT J. WNUI County Crutuu,v Dear Mr, Prodriksen: This uftloc has received and roviuwed the most rem, sec of plans for the above oetttionud project. Wr. would like to offer the following commads for youf ric4ow and consideration. I . Soil lest results are to be nulud wi mo d%*4u data 9hoet. If the design profussiunal a ccpts doe subdivision date, the design prollmioaal is to affix a stamp. i Run of bank fill for grading to I $% iS not neoeasary. The avetflge slope over the SSTS aria i, approximately II%. J. Thu proposed SSTS area lbr tax nap number 85.7.2.1 is not shown [n the right location. When Shown properly, the proposed well is within the 200' setback roquitemonl, 4. Basemunt elevation is to be notod in die plat vlow. . i S. The regrading in the grading cascmmar is to Iw shown and the proposed SSTS goods u, ho ^i foci from the top of the (rank. 6. The sown line and the plau[c pipe between the uud: and the first junction box should bu labulud in tie plan view the same way as the pn,l itc. 7. What is the purpose of oho dry well detail? V. 'rho distribution box only has 8 outlets. 9, The dose love[ pruvllkd Is too high. 10. All pump uadeulati6ns (frlctiomthead loss) and fmtuu pump seloullon should he prnvided. 11. 'rhe expansion profile would Include the distribution box and Its Inlet uluvstlon. 17.. 11. rovised house plans Still have 4 bedrooms and u basement plan was not provided. This office will o,wittinuo its review upon cunsidcatkni of da, abcv. aontiohed comments PNaro feel lieu to contact meat exec. 2157 Very questions arise. ' Sinctrely. �y,�oieph S. Paravati, ir•. 1SP:cj Assistant Public i[wdth Gnginecr gn.araaoaoaa HUlm (a4s117 &615U Pnx (Xn5i 278.79J1 '1 , . .... nm,rs,pyryt�:ca(a4s)z7sstes exxta!:.)zis•wrs . .. . e _.,•. ... ..-. .. _...�. ... N;r.!acr- ^•'ttett,'14,S�F7R�r91 P: *;ens)xrau:e w�rie45)xye•e67,p.;,: ^.�,.. .......- - ...- _:`......... ...._.___ ...».. ..... .� p' Nuraim RMa f • pax (945) 378.6085 Endybaavcz1*WP'nrh"J(845) -7"14 Pax(845):78.tiW8 " *C1zj. K9NV*d1 1't M10Oa ZN802U A0 a9vd IsHia NO w� 6Z:60 %Z -NVP OZ99BZ96 s,z'ICnssu NOW :1411 aBSdFPIH �s 1EVIS Mf)Vd BNOHd !:'6'.- W -9tF8 Z8Z HI''MH dO ZNaf 1dVdSQ X1NfI0;) WVNSnd �7N 0£:60 Ef11 900Z-•bZ -NKr BZKQ NOIRMN00 DOES MOWNARI, RN. MBN SHE LORE .4o RU AMLEI4, MD, aft, FAAY Commh4lorrer ajxmlrA • TA ROBERT J. WNUI County Crutuu,v Dear Mr, Prodriksen: This uftloc has received and roviuwed the most rem, sec of plans for the above oetttionud project. Wr. would like to offer the following commads for youf ric4ow and consideration. I . Soil lest results are to be nulud wi mo d%*4u data 9hoet. If the design profussiunal a ccpts doe subdivision date, the design prollmioaal is to affix a stamp. i Run of bank fill for grading to I $% iS not neoeasary. The avetflge slope over the SSTS aria i, approximately II%. J. Thu proposed SSTS area lbr tax nap number 85.7.2.1 is not shown [n the right location. When Shown properly, the proposed well is within the 200' setback roquitemonl, 4. Basemunt elevation is to be notod in die plat vlow. . i S. The regrading in the grading cascmmar is to Iw shown and the proposed SSTS goods u, ho ^i foci from the top of the (rank. 6. The sown line and the plau[c pipe between the uud: and the first junction box should bu labulud in tie plan view the same way as the pn,l itc. 7. What is the purpose of oho dry well detail? V. 'rho distribution box only has 8 outlets. 9, The dose love[ pruvllkd Is too high. 10. All pump uadeulati6ns (frlctiomthead loss) and fmtuu pump seloullon should he prnvided. 11. 'rhe expansion profile would Include the distribution box and Its Inlet uluvstlon. 17.. 11. rovised house plans Still have 4 bedrooms and u basement plan was not provided. This office will o,wittinuo its review upon cunsidcatkni of da, abcv. aontiohed comments PNaro feel lieu to contact meat exec. 2157 Very questions arise. ' Sinctrely. �y,�oieph S. Paravati, ir•. 1SP:cj Assistant Public i[wdth Gnginecr gn.araaoaoaa HUlm (a4s117 &615U Pnx (Xn5i 278.79J1 '1 , . .... nm,rs,pyryt�:ca(a4s)z7sstes exxta!:.)zis•wrs . .. . e _.,•. ... ..-. .. _...�. ... N;r.!acr- ^•'ttett,'14,S�F7R�r91 P: *;ens)xrau:e w�rie45)xye•e67,p.;,: ^.�,.. .......- - ...- _:`......... ...._.___ ...».. ..... .� p' Nuraim RMa f • pax (945) 378.6085 Endybaavcz1*WP'nrh"J(845) -7"14 Pax(845):78.tiW8 " *C1zj. K9NV*d1 1't M10Oa ZN802U A0 a9vd IsHia NO w� 6Z:60 %Z -NVP OZ99BZ96 s,z'ICnssu NOW :1411 aBSdFPIH �s 1EVIS Mf)Vd BNOHd !:'6'.- W -9tF8 Z8Z HI''MH dO ZNaf 1dVdSQ X1NfI0;) WVNSnd �7N 0£:60 Ef11 900Z-•bZ -NKr BZKQ NOIRMN00 DOES Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Dear Mr. Fredriksen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 13, 2005 = E;i.��hLL''... *,n.� Via•.. - County Executive Re: Proposed SSTS - Anakin Trigiia Subdivision, Lot # 4 Wood Glen Drive, (T) Putnam Valley TM# 85.07 -2 -3.4 This Department has discovered an error with the plat for the above referenced subdivision. The approved well location for Lot # 4 is within 200 feet of an uphill SSTS area that was approved on the Wirtz Subdivision plat (approved April 24, 1987, Lot # 1). A letter has been forwarded to the design professional noted on the subdivision plat requiring that an amended map be .filed. =t IJlitii arr arriendecl sabdivlsiorr-iiiap is filed tliac provides a weH location -for Lot t# 4 i:hai meets ail. required separation distances from existing and approved proposed SSTS areas, this Department is not comfortable proceeding with the review of Lot # 4. Please contact this Department if any questions arise. JSP:cj Sincerely, Joseph S. Paravati, Jr.. Assistant 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 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Ralph Mastromonaco, PE 13 Dove Court Croton -on- Hudson, New York 10520 Dear Mr. Mastromonaco: October 13, 2005 ROBERT J.. BONpI _ . Re: Triglia Subdivision Town of Putnam Valley TM# 85.07 -2 -3 This Department has discovered an error with the above referenced subdivision plat. The approved well location for Lot # 4 is within 200 feet of an uphill SSTS area that was approved on the Wirtz subdivision plat (approved April 24, 1987, Lot # 1). This Department strongly advises that an amended subdivision map be filed showing a well location for Lot # 4 that meets all required separation distances from existing and approved proposed SSTS areas. Please contact: this:Departm6nt if any questions arise.. JSP:cj Truly yours, � oseph S. Paravati, Jr. Assistant 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 .r S-PUE Ri LITA: 1 A. ER,. - U.,. L;.� F A.tI F , z .A . Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Dear Mr. Fredriksen: .•r'if�iR°'�w. +'.a "�••e:.r . sa, �p°l'f ��wrTJ���'�� ��W /1 -V AouP %' ..a. .tee.. f- -. .�= , - + County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 20, 2005 Re: Proposed SSTS — Anakin Inc. Wood Glen Drive, (T) Putnam Valley TM# 85.07 -2 -3.4 This office has received and reviewed the most recent set of Mans for the above mentioned project. We would like to offer the following continents for your review and consideration. 1. Soil test results are to be noted on the design data sheet. If the design professional accepts the subdivision data, the design professional is to affix a stamp. 2. Run of bank fill for grading to 15% is not necessary. The average slope over the SSTS area is approximately 11 %. 3. All regrading for the house and driveway is to be shown. 4. _? pr- pos' �� T�F eaR o tar . -.r ap �- 1a:r.b6r• X35 �i -� :.� roti sl�6w' : i.hat1�b-, rig' ht, -. location. When shown properly, the proposed well is within the 200' setback requirement. 5. Basement elevation is to be noted in the plan view. 6. The regrading in the grading easement is to be shown and the proposed SSTS needs to be 25 feet from the top of the bank. 7. The sewer line should be cast iron pipe. Please note in the plan and profile. 8. The sewer line and the plastic pipe between the tank axed the first junction box should , be labeled in the plan view the same way as the profile. 9. The words `dust free' need to be added to the crushed stone /washed gravel label in the absorption trench detail. 10. What is the purpose of the dry well detail? 11. The distribution box only has 8 outlets. 12. Dimensions from the well to two property lines are required. 13. Pump detail is to note the on/off, alarm, and one day storage measurements. 14. Please provide pump chamber dimension between the bottom of tank and inlet invert from the septic tank. 15. • All pump calculations (friction/head loss) and future pump selection should be provided. 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 N Tna arl_d1St<lhlltl.on - ":.�...� are to be installed at the time of construction. 17. Please provide a note stating that the proposed SSTS, well, and house are to be staked by a licensed land surveyor prior to construction. 18. Two soil types were noted for this lot on the subdivision plat. Please show both soil types and descriptions on the plan. 19. Please provide a profile of the expansion area. 20. House plans submitted have 4 bedrooms. 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, Q Joseph S. Paravati, Jr. Assistant Public Health Engineer :.t:SI�lE?tlsl'� A)1,91LE .1 $D S I'AAP.- "t <�''_•.. _ Commissioner of Health L ORE'TTA MOL.INARI, RN, MSN . Associate Commissioner of Health Roy Fredrilcsen, PE PO Box 950 Mahopac, New York 10541 Dear Mr. Fredrilcsen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 19, 2005 County Executive Re: Application to Construct a Subsurface Sewage Treatment System on Wood Glen Drive (T) Putnam Valley, TM# 85.07 -2 -3.4 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. o Two sets of floor plans. Please make sure all floors are provided, including the basement. - .Y- o a: +.. , ' . ' _ .. _ ` _. ,. y . ., F - - -- _ . n, ..• .._ _n ._ _.. � _. . � � „� .. .. _ : _ -. .. . , y' . _y .. _ .-., -.ire. _ .. _ _ 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 •ompleteness of your application. Should you have any questions or care to discuss this matter further, please contact me at 845- 278 -6130, ext. 2157. Sincerely, JSP:cj Joseph S. Paravati, Jr. Assistant 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 ALLEN BEALS, M.D., J.D. Commissioner of Health Director ofEmirownewd Health DEPARTMENT QF HEALTH 1 Geneva Road,. Brewster,-New York 10509 October 24, 2013 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Ryan Brady 23 Wood Glenn Drive Putnam Valley, NY 10579 MARYELLEN ODEI:L County &ecutive Re: Addition - A- 126 -13 No Increase in Number of Bedrooms 23 Wood Glenn Drive (I) Putnam Valley, T.M. 85.7 -2 -3.4 Dear Mr. Brady: This Department. has received and reviewed_ the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated October 24, 2013. The addition is approved with the following conditions: 1. Due to the recent change in design flow (150 gpd per bedroom), the current 3- bedroom SSTS is now large enough to accommodate four potential bedrooms. 2. The total number of bedrooms must remain at four without prior approval by this Department. .3. The area of the existing sewage disposal system.and its expansion area•must be maintained. 4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc .. . 5. The approval, is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 6. This approval is valid for two (2) years and expires on October 24, .2015. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, Gene D. Reed Principal Engineering Aide -GDR:cw cc: BI (T) Putnam Valley ^AIdltIS ADEL'S1LS7 LVP.,P.J.D. . G'onamrssionp' OfH'eRh.4 --� 1 •s . _ ROBERT MORRIS, P.E. !Director of Environmental Health 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 -•' ?. s: b •H.�I.AQx- .B- }T�F?'si3i'.��.4i� County Eucuttve ADDITION - APPLICATION RIESIIDRNTIAL ONLY �3 STREET 1-- TOWN V TAX I4 AP # '63 5 % NAME ILY60 U 'Q T PHONE 9) 4 _336 — zl Pte# Lb ^:' MAULING ADDRESS 23 W66QD 4 LE�J I rXL � 19U711AM VA La? C Y A1Y !(DESCRIPTION OF ADDITION l JI'SH 2t�L/C A ft Y6 AdZ AC1 E *NUMBER OF EXISTING BEDROOMS -3 NUMBER OF PROPOSED NEW BEDROOMS * (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by . a Professional Engineer or Registered Architect in accordance with applicable sectiows of tb-, Putnam County : ...... - 5ailitary Cade. Please submit this form and the following to Putnam County Health Dept., l Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. 1. Certified check or money order for $100.00. t 2. Sketches of existing floor plan (drawn to scale, all laving area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c -of Bulletin HA -1) 3, Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office1with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the $uilding Department with legal bedroom count of dwelling, OFFICE USE COMMENTS. 4. ALLEN BEALS, KA, J_ .D. f4;pZ'6f17dG�1�� ROBERT MORRIS, P.E. Director ofEnvlronmentalHealth DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: R Yp N 8;e &D— (Owner's Name) Tax Map # S 2 — 3 I - ` �. ' , Town ° tj A A4 V AJ.Lff-Y I County irmu' ive Year Built: -Z o f O ' According to ecords maintained by the Town, the above noted dwelling, is in compliance with Town Code. J t . .-in o- m�:_ianoe µqtro N Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: M 2:f �3 Other: The plans for the proposed addition are considered: Addition to existing house only Teardown and/or re -build allowed under Town Regulations Building Inspector Date. MAHOPAC SEPTIC 485 Kennicut Hill Rd. I/1 V00Ce, Mahopac, New York 10541 Date Invoice #. 845 62� -4-526 NY�DEC' 3A 57.2 _ - ^ www.mahopacseptic.com 8/10/12 51643 ,*10 .. BILL TO Mr. Ryan Brady 23 Wood Glen Drive Mahopac, NY 10541 JOB NAME/LOCATION 23 Wood Glen Drive Mahopac, NY 10541 PO # Rep TERMS WS Due on receipt Description Qty Rate Amount Services rendered August 10; 2012: Charge for digging and labor Tax All work complete. Thank You for your business, Joe ii ®W Due A $25.00 fee will be charged for all unpaid returned checks. Reg #PC41 / WC- 13679 -H ®3 We now offer portable toilets 325.00 325.00 35.00 35.00 $30.15 $39®.15 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR _ ;I /� jJ -� .yy107T-I T r�z TT'1df; 1* . -*. ." .:: �::tiriaw +: •-.. ....... .... A �C Al i'�.''•'l.:T� T �'t��Y>,"fl Y ��iA'•1'1C'T."�.']. i�i'Y Cil 111 1. Name and address of applicant: ki t-4 •%O I flj� �i2f� � �. , 2. Name of project: /6L1,4 6B.V. A- Z IA- 3. Location TN: (e•. 4. Design Professional: (?zy 5. Address: P. rt'�oX 6. Drainage Basin: - ? � 21\1&i/ _ J� C, Y__/ J 7. Type of ro'ect: 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... t- 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 officials, ordinances? . .. ...... , ... 13. If so, have plans been submitted to such authorities? ........ ............................... eS. 14. Has preliminary approval been granted by such authorities ? ? 4L Date granted: Zoo 3 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? ...... ............................... 19. If yes, name'of water supply �' Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ �- 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 60'a 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... f•P 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? PP 28,, 29. �A�etlands.Il?. Number ..............:.._ Is Wetlands Permit required? ................ .......................... ......................... ....... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 3.1. 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 . DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .......................... 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? . ............................... I--[D 36. Tax Map ID Number .......................... ............................... Map Block Z Lot SA 37. Approved plans are to be returned to ..... Applicant Design Professional ... NOT rov a -nPw c ST9-to-bo located vvi+&' n the 'i YC v 1atcrs1kd' shali7 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. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.0 of th Penal Law. SIGNATURES & OFFICIAL T'IT'LES. e8 e.%, Mailing Address: .... MA10 W 4 y_ fZ54- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ~,w, '' � Q - 4 �ti ,•<h' 'a. -.. .:;.�� ra ,e - � ��� � tiTC7.. "pl'.; ,. , +�:: DESIGN DADA SHLI✓ i'- �iii�u " "tiAt;r, �r'AvL ii2;�,h:Ti.li,i� �. S�1E ; -.. Owner ,I L1 A P— 1✓1, '17,4C. Address l c7 � x wli, J��%,gl{� 1•� Located at (Street) LA) OU ip C I?j DnV e-- Tax Map Block Lot 3 (indicate nearest cross street) Municipality Watershed ,.5 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test D_eppth to Water Water From Ground "'Level Percolation ':Time:.: .:El se Time Surface (I ches) Drop In Rate. Hole No... Run No.. Start - .Stop... �Vlin.) Start Inches Miu/inch I 3 4 5 3 4 5 1 2 3 4 1. Tests to be repeated 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _ DPTI OfF NO: _ -i I�I� HOLE NQ; H - . a •iS-,. _ -tea:. eewA.'r++ES: .i:�p,n - c _.�. vri.w _ _. t . r .•m r.M7rii+... G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0 I 5.5' 6.0'�; 6.5' F 7.0' 7.5' i 8.0.. 8.5' 9.0' 10.0' i Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name: Address: iq:) i Signature: Design Pr'ofessional's Seal r Date PROJECT ID NUMBER 617'20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM _ .fb r.I N'1.!5J1:F!?:hG !n�15,. : " - ;:; x.',: i:.-:-:,•..:: r�i•$a %�..:_ w's .'fMCbR'S'W.�.x'e;' -'=. �:,; :�1:' . .: .:,yw�'. .::r;�7�a•i �......,. ,_ -, ... .. �(:+e .� ... PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1.. APPLICANT /SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: Municipality County E4n 4. PRECISE LOCATION: Street Addess an /R d Intersections, Prominent landmarks etc -or p ovide map (1 Dri ve., Fri.Z 5. IS PROPOSED ACTION : New Expansion Modification /alter' ation 6. DESCRIBE PROJECT BRIEFLY: C s-pp d udP-l/ 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately (� acres `° :0,0. j 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?--: " LuTyes • No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ,(Choose as many. as apply.) esidential Industrial ❑Commercial Agriculture Park /Forest / Open 'Space a Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY.OTHER .GOVERNMENTAL AGENCY (Federal, State or Local) Die rs M. No If yes, list agency name and permit approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRE.. LY VALId.P ERMIT OR El Yes .FZK -If yes, list agency name and permit / approvak 12. AS A RES OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? [—]Yes No I CERTIFY THAT THE; INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature 1 � If the acts n is a'Costal Area, and you are a state agency, complete the Coastal Assessment Form before *proceeding with this assessment f Q-0 :.,,. .. I �Ar ifr �nr S°,, SN—G w .. ♦ •ryi' ; F Y:- C�,y,y s:-: L w� �, �'�r'f.'t: {.',4`� :J y .: z: t�. -. •S�fd4'� K 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 No B. WILL ACTION REC IVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6? .' If No; a negative" declaration may be/superseded by another involved agency. 0 Yes 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: A'�i. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: " C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of.use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed'action? Explain briefly: C6. Long term, term, cumulative, or other effects not identified in C1 -05? Explain briefly: )lshort 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 CRITICAL ctiVIRON��ENTr'�P.E. <, ,CAI? (if yes explain briefly Yes o .. E. IS THERE, 0 THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain. Yes �,Q � No 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 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 ahy supporting documentation, that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachme is as necessary, the reasons supporting thi determination. n Name of Lead Agency D to P t or Ty��me�espo Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in L gency Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES STEW-.: Owner A, —Address 10 toX JgA'j L AIA an- Located at (Street) 6LEd -1721VE Whop _5j:_ Tax Map85,j Block 2 Lot (indicate nearest cross street) Municipality p j)j:tj1XM VhLLEY Watershed _D< o h Q Lo-r 4,4 SOIL PERCOLATION TEST DATA Date of Pre-soaking 1 0))6 12a"tPj Date of Percolation Test 16 116, 120 01 Form DD-97 ... .. .... ... ... .. . .. . .. . I . ............... ...... . . .. ............ t p W . .... ... . .. . . ................. ..... . ' " F r o : Ground el. . ........ Hole : No r fape (XpcheS) . Start Stop NCO In DC . . . . ...... It to 4 1 12. 1101 11,131 30 122- 30 2 'a l 0 2 22 3v 3 1 131 3o .7 'I. 4 5 j 2.,0_2 2,3 30. Z. 1. 22 2 j 102 12132. 30 21 zz .3 pa 30 eL j 4 5 2 3 4 5o -T11J6_E)A7_A Wks TAV-90 E .5 $0 RADIVI$1W F k7lo 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, i; 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES «:•-•:e..R�`i�t_'`l �l•rl� �'` -�." •t111L1✓'1��.` ��.,oen ,.4. . =� °1Ll� i�i��'i �" � �•'"����.:.. . ;m.: - . -. :,t.�^ ...,. G.L. 0.5' 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' 9.0' 10.0' Indicate level at which groundwater is encountered of / Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by:Aohm QG440 . T _Date to 0 0 Design Professional Name: aF1��11G Address: p.. to # ip x 1 To Signature g� Co- 2 oe r t Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION a IZA12107 . Date: / Inspected by: Street Location Wool �✓/� .Omer :�'� i� Lai -. - =:......e Permit # PV — .D�r�OS TM # 25, :7 2 3 I Subdivision Lot # 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................... ............................... .d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... IL Sewage System a. Septic tank size - 1,000 .......... 1,250. /other .............. b. "Septic'tank installed level ........... ............................... .. c. 10' minimum from foundation .............. d. Distribution Bog 04 1. All outlets at same elevation -water tested ........OP- 2. Protected below frost .................. ............................... 3. .. Nlinimum 2 ft. Original soil between box & trenches e. Junction Bog - properly set .......... ............................... 6. renc ies If 1. Length required 5"9 7J Length installed r 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 he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1'/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ............. ............. ... ... P"!.r p, or DoRe �' _ 1. Size of pump chamber ...... I4Sv.. 600 ........... 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` /cycles- ......... III House/Buildin2 a.. house located _per approved pl osb. Number of bedrrooms ..... ...................::....:.... '� .... IV. Well Well located as per approved plans...... :' b. Distance from STS area measure 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ............................... i. Erosion control provided ............... ............................... Rev. 12/02 ARA Ilbl �I bkw •I •t•I;i` FAA, •, 9�JIN1 :. IIVA ma�■rr. FAA_ . �. . < NMI MJ - /l 'LOA AMI ' 1�1 Irm Offa Ar ` ' 1 ' &AVAA ARA Ilbl �I bkw .c a- "'�ti .ti'• .v se S:r �,.'a.:: .. .. .. ..__.: �:.,. � �....... _ =.cyy .. «e'• ... `..�:3:u =i "ter ,. �w. `:i: - .::���4,•q� +._ �''� �` '� � _ _ �,ii °� I:N'�lt��C:'d'1 ®1�•.F ®RL B'E�D Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Required Length_ Fill Pad Width Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed , Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable