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Home My WebLink About4611DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -28 BOX 35 'kilr .. '� .. IN Is cilia r 04611 KL PUTNAM COUNTY DEPARTMENT OF HEALTH 0(4 J�JG. -.•�. w{. +-.�.w:�•.A O ti- � � � VZ' `r`�il ��I N L SJ i`V H SER:J%x q...wvVIRVNBE CERTIFICATE �iY- .y+i•erw- OF CONSTRUCTION COMPLIANCE F �/ \\ EATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PI/ �J /'°�6 °�V 1 f �''�l✓C -fir Located at ��0ew e,wo.ir �' Town Village &i NJ'.A Y Owner /ApplicantName Tax Map ��% Block —k L Lot Formerly -L:) A7t Le Subdivision Name 111 .4 d Subd. Lot # Mailing Address Ip �-ti i�j7'°'%�'ic.': -� =gfz. >�'- , �r A!7, Zip Y Date Construction Permit Issued by PCHD Separate Sewerage System built by 0U e A v,, .P.Z. �'�� f �� Address Consisting of ID Gallon Septic Tank and /* � 7 X Other Requirements: Water Supply: Public Supply From Address or: Y Private Supply Drilled by /V A cz'�t, I`<<�l Address •BuildingType iH� -`%'' j ' ` ' ' ` �1 8 erosion Toiiti•ol bden-completed? Number of Bedrooms Has garbage grinder been installed? Mr I certify that the system(s), as listed, serving the above premises were constructed essentially as s9own =9n -the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Perm' erna fi'and.ap-roved plans and the standards, rules and regulations of th tnam County Department of Flealth. Po Dat Certified by P.E. n«± esig P d ss' al) Address Z) ids . ..-, ri'-c J ' � s License # 1 `1 `�— 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 modificati or change when, in the judgment of the Public Health Director, such revocati , mo catio or ch e i n cessary. g Title: , Date: Y- — White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COMPLETION R.EPQRT, Well Location trect Address: T illage- i IMapl@.5'. I'ax Grid Mock Lot(s)Ot? Well Owner: Name: Addres Use of Well: 1- primary Z- secondary Residential Public Supply Air cond /heat pump Irrigation Business Farm - I Test/monitoring Other(specify) Industrial Institutional .........- Standby Drilling Equipment 7t. Rotary Cable percussion Compressed air percussion Other (speciE'y) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length 5 ft. Length below grade AF `z-ft. Diameter in. Weight per foot /G lb /ft. Materials: Steel _ Plastic _ Other Joints: � Welded,,!!: Threaded _ Other Seal: �;;< Cement g rout _ Bentonite Other Drive shoe:,>< Yes _ No Liner _ _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First YesNo Flours Second Well Yield Test _Bailed _ _Pumped ?< Compressed Air Hours / Yield /U gpm Depth Data Measure from land surface- static (specify ti) -30 ' During yield test(ft) ""✓- -' Depth of completed well in feet —fD LD Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface S� / r >O , If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump "hype � Capacity Depth 2. K4) Mode ISo� Voltage U HP 4&1 , / Tank ,rype,�LUev Volume r..� . 7 Date Well Co piece Putnam County Certification No. Date of Report Well Driller (signature) NOTE/ hxa�t location or well wttn atstances to at least two permanent ianatnarxs to t)e provtaeo on a separate sneevptan. Well Driller's Name ,c,,� ��zr� —c Address: /f� cox ��•v!m. Signature: 11 Date: White copy: HD Idle; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ' YML ENVIRONMENTAL SERVICES 321 Kear Street � AIbert H. Padovani, Director LAB #: 32.002122 CLIENT #: 10701 NON CTAT PROC PAGE 1 ---------------------------- 11 --- ---- ------------ ---------- --l—�� 3ASTINE CONTRACTINB CO #8 APPLE SUMMITT LANE LA GRANGEVILLE, NY 12540 DATE/TIME TAKEN: 04/18/00 12-30P DATE/TIME REC'D: 04/18/00 01:30P REPORT DATE: 04/21/00 PHONE: (91411-227-4357 SAMPLING SITE: LOT #3 THE MEADOWS SAMPLE TYPE..: POTABLE : MEADOW CREST LANE, PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: DANIEL E. GARAY JR. TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF - ---------- ------ ------------ - ^1 ------� DATE FLAG PROCEDURE PUTNAM CNTY 04 8/00 04/1B/0O 04/18/00 04/18/00 04/18/00 04/1B/00 04/1B/00 04 /1.9, 04/18/00 04/18/00 4.<-1 F,/00 RESULT NORMAL - RANGE PROFILE MF T. COLIFORN. ABSENT /100 ML LEAD (IMS) <1 p�b NITRATE NITROG <0.2 M8/L NITRITE NITROG <0.01 MG/L IRON (Fe) 0.279 MG/L MANGANESE (Mm > 0.117 MG/L SODIUM (Na, B.96 MG/L OH 6.9 UNITS HARDNEBS;TOTAL 230 MG/L ALKALINITY (AS 138 MG/L '^?URB1D�TY'l-TUR��.�.�. 2�1�Nl�U. ABSENT D-15 ppb 0 - 10 N/A 0-0.3 ma /I 0-0.3 mg/1 N/A 6.5-8"5 N/A 0-5 NTLJ�- COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING-TO-THE NEW YORK STATE AND EPA FEDERAL D,RINKING WATER STANDARDS, FOR THE PARAMETERS TESTED. AT THE TIME OF COLLECTION. METHOD 1008 91O1 9139 9146 2037 9043 Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper RuIe for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters cmrrosive potentiel. ' Fe/Mn If both iron and manganese are presentr 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 moder�tely restricted diet, a maximum of 270 mg/L of Sodium iS sugCested. � YML ENVIRONMENTAL SERVICES _ 321 Kear street ' (914> 245-2800 Alb e, Dire ctor LAB #:32.002122 CLIENT #: 10701 NON BTAT PROC PAGE 2 JASTINE C�O�TRACTING CO ` DATE/TIME T�KEN: 04/1B/00 12:30P #8 APPLE SUMMITT LANE DATE/TIME REC'D: 04/18/00 01:30P LA GRAl'QBEVILLE, NY 12540 REPORT DATE: 04/2l/00 PHONE: (914)-227-4357 SAMPLINB SITE ': LOT #3 THE MEADOWS SAMPLE TYPE..: POTABLE : MEADOW CREST LANE; PUTNAM VALLEY, NY PRESERVATIVE�� NONE COL/D BY. DAN'IEL E. GARAY JR. TEMPERATURE.. 4C NOTES. .°: KIT TAP COL IF0RM METH: MF ------------ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-114. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED T��=TS IN WATER CHEMI9TRY. WATER W%TH A LOW -H MIGHT BE CO�ROSIVE TO METAL PIPES AND FIXTIRES. THE NORMAL RANGE OF pH IS 6.5 T 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM � MAG@ESIUM CONCENTRATION, BOTH EXPF<ESSED AS CALCIUM CARBONATE. IN MG/L^ THE HARDNESS I MiAY RANGE FROM O TO HUNDREDS OF MB/L, DEPENDS ON THE SOURCE AND TREATMBVT TO WHICH THE WATER' HAS BEEN SUBJECTED. : CAR -70 M8/L ' VERY � HARD WATER: PBOVE 30O B''�ATE��~-^~' �'� - -|��-�- ��M ,i ��I��.LJTER'�� HARD WATER: 140-300 MG/L . 17.2 M8/L) SUBMITTED BY: �+"= ° ^ F, a,"",=''; Director ELAP# 10323 � P"UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM bZel'JAI& Owner -or Purchaser of Building S AI::�--11 J � Co V-7 --COCO Building Constructed by --7t/1 Mew 2.;A Location - Street Building Type Tax Map Block Lot J r fia2/4 0-( �-4 C� TownNillage 5 � Subdivision Name 4 ��f, 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 Qf Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operag C44ition any part of said system constructed by me which fails to operate for a period "f t�"ears immediately following the date of approval of the "Certificate of Construction Complance" :foithe sewage treatment system, or any repairs made by me to such system, except where the��.faiWii to operate properly is caused by the willful or negligent act of the occupant of the buildilag utilizing the ._ - system.. , • r`: 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 � H system. Dated: Month Dayc L3 Year C� Name (if corporation) Addressr`�' State AL V r'U- Zip / r �j Signature: gn � Title: 6owl Tr- Corporation Name (if corporation) Address: State�a,11 Pay' % Zip 1�7.SZ, Form GS -97 Apr 26 00 10:40a Planning Board BRUCE R. FOLEY Public Health Director (914) 526-3307 P.1 LORETTA MOLINARI RX, M.S.N. Associate Public Health Director Din aor of Patient Services DEPARTNIENT OF HEALTH I Geneva Road Brewster, New York 10509 Eavircumtntal Health (9(4)278 -6130 Fox (914) 278 -792) Nursing Services (914) 278.6558 WIC (914) 278 - 6679 Fox (914) 278.6085 Early Intervention (914) 273 - 6014 Preschool (914) 27"082 Fax (914) 279 - 66" OWNERS NAME; TAX MAP NUMBER: E911 ADDRESS: TOWN: WAN W, AUTUORIZED TOWN OFMIAL: (Signature) X lkll/ V 414 DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VER1RW DANIEL J. DONAHUE, P.E. Pilo CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 914.628-7576 April 24, 2000 Putnam County Department of Health Geneva Road Brewster, N.Y. 1,0509 Att: A. Steiblincy RE- As Built SSTS Lot #3 Meadowcrest Drive Putnam Valley'rM# 85.07-1-28 Dear Mr. Steibling, Enclosed please find: L Certification of Construction Compliance 2, Well Log and Bacti Results 3, Guarantee and two copies 4. four copies of the asbuilt plan 5. filing fee of $200.00 B Daniel J. Donahue, P-E. OFFICIAL CHECK 0-0c I Z' NO, 971-290133 P"AM COUNTY HEALTH DEPT. 4 Geneva Road (914) 278-6130 Brewster, NY 10509 Rec,eivd of The Sm Of For /f [-j C was- 11-] Chock 67 /-7 - / -,�O 2 14 8 6 Date.__.... Dollars $ 4�, , Al .. . . ...... . -- ...... . ....... THAN -O, 0 Gredil Card By . . ........... YOU! 1020 DOLLARS 0 BRUCE= `KE"TOE Public Health Director April 17, 2000 ;; t : �I: ORETTA�. OL�tR Rt' 'R:N:,- R�.S�N... Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (9 14)278-6558 WIC (914)278-6678 Fax (914) 278 - 6085 Early Intervention (914) 278.6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Dan Donahue, PE 1.20 Breckenridge Road Mahopac, New York 10541 Re: Meadows Realty Subdivision, Lot #3 TM# 85.07 -2 -28, (T) Putnam Valley Deal-Mr. Donahue: This'office has conducted a second final site inspection of the above referenced. project this date. I o fer the following comments for your review. Cast iron pipe to be trimmed flush inside septic tank. Remove concrete spillage inside septic tank over baffles. Remove all, trees within 10.0' ofthe systemri.n.theirenti.rety. 4. Well head less than minimum 18 "above grade, as required. r Please contact this office by way of form RF1 -99 to schedule a second site inspection. Upon completion of the above, this application will be considered further. Please feel free to call if you have any questions. Very truly yours, 6�4A SQ Adam B. Stiebeling Assistant Public Health Engineer -..._ , -L-:,k -n-z\ t L�it„N 1 Ut HEALTH DIVISION OF EN- IRUNME\ ?AL HEALTH SERVICES FINNXL SITE INSPECTION Street Location 2 5 1. S_en•age Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Av&Dpth C. N?L -iral soil not stripped ................... ............................... d. Stone, brush,-etc., greater than 15' from STS �-rea ......... e. 100' from water course/ w,e la. nds ...... ............................... II. Sewase Svstem 'optic tan size - 1,000 ......... 1,250 ......... other ..............:. a. I . Septic tank installed level ................ ............................... c. 10' minimum from foundation ............................ .. d. Distribtuion Box 1 outlets at same elevation -water tested.......... ,... 2. Protected below frost.......... . 3. Minimum 2 ft.Orioinal soil ttveen box teche; Junction Bo -,Property set .. , -i;t� �q e . 1 nth insta ed Distance viate c • 1 se meal ed Ft 3. Instal accordino t , lan ..... . .....:.. ........... -1% Slop oftrench accep le 1 /16 1/32" /foot ............ 5. 10 L. from property l - 20 ft. -t ound4 i s.......... 6. Depth of trench <30 inc es from s pace. ............. 7. R • om allowed for exp sion,100% .. ............... 8. S e of gtavel3 /4 - 1' /: "diameter clzn.................. a 9. pt n of gravel in trend 12" minim ..... 10 P P ends c -v ed Date: f i:D dJ Inspected by: Owner x,416 Subdivision Lo r P_um r. -Dosed SN'stems- 1 P, Pur�ip criam E er. 2. Ov, -flow t?2t ... ............................... .... . 3. At , visual/audio .. .... ........................A...... 4. Pum easily accessib , manhole to grad ................. 5. First b, baffled . ............................ .................... 6. Cycle v, eesed D.estimated;f ow/cycle........... III. Je HouseBuilding ou —e ocated per approved plans ............................. eh� b. Number of bedrooms ............:...... ............................... IV. Well Fell located as per approve plans ...........:.................. b. Distance from STS area measured c. Casing 18" above ade................................................. d. Surface drain around well acceptable ....................... V. Overall Wor - nshiIn COMN ENTS a. Boxes f6perly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ................. I................ = — d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area................ h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Riv.1197 z 0 gkttE Public Health Director' May 1, 2000 DEPARTMENT 1 Geneva Brewster, New OF HEALTH Road York 10509 Lt3fiETTti4RY0Li)`1�ift1- I KK. Associate Public ,Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Dan Donahue, PE 1.20 .Breckenridge Road Mahopac, New York 1041 Re: Meadowvcrest Drive TM4 85.07 -1 -2S, L.ot K3 (T) Putnam, Valley Dear Mr. Donahue: This office has received and reviewed the most recent Compliance Application for the above mentioned project. We would like to offer the following comments for your consideration. A Certificate of Construction Compliance can not be issued until such time as all items required of inspection letter of April 17, 2000 are corrected and inspected. Please notify this office of completion of the above stated inspection letter attached. 'Phis office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Sti.ebeling Assistant Public ILealth Engineer ABS:cj - Public Health Director = --. LORETrA" MOLINARI RN:,- M.S:N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH .l Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 RUE Early Intervention (914) 278.6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 4 ii., L. (r Z.C7p 0 Mr. Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 1.0541 Re: Meadows Realty Subdivision, Lot m3 gat TMft 85.07 -2 -28, (T) Putnam Valley Dear Mr. Donahue: /V This office has conducted a final site inspection of the above referenced project this date. I offer the following comments for your review. 1. Cast iron pipe not connected from house to talik. �... ----" 2. Sep ank covered with dirt, unable to in%jpe e. Uncover. 3. Remove, � in 4. :First two feet from bo'`Eo =fknch to be "solid pipe" as shown on approved plan. Remove and replace wi . o id pipe. Cut pi ack lush inside drop boxes. 6. AVell ove all trees within 10' of system. 7. head less than minimum 18" above glade as required. Please contact this office by way of form R.FI -99 to schedule a second site inspection. Upon completion of the above, this application will be considered further. Please feel free to call if you have any questions. Very truly yours, au. .. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUTNAM COUNTY DEPARTMENT OF HEALTH E \ V .LIRONME V 31 1 L HEALTH ,►J'llJRWCE1J' CONSTRUCTION PERMIT FOR SEWAGE TR1EA MEN S STEM PERMIT V- Located at A7 4-1—P j"-" I own or Village ,, �P , % , Subdivision name Subd. Lot # Date Subdivision Approved OwnerlApplicant. Name�J, I -. 7 /N" e, r- X, Tax Map Block 2 Lot i -- Renewal Revision 4,` Date of Previous Attiroval Mailing Address T 17A)y e– J'� „A. r "—/ L-4-N L. .,, r �/ �`y _ Zip /.)- Jr,16 Amount of Fee Enclosed S�' 1� ' Si New. iz Building Type I '14,:7 Lot Area #'� No. of Bedrooms "/- Design Flow GPD+ Fill Section Only Depth Volume PCHI]fD NOTIFICATION IS RE UIRFD WHEN FILL IS COMPLETED Selarate Sewerage System to consist of fV ` gallon septic tank and Other Requirements: To be constructed by _� Address Wtr Sul Public Supply From - Address or:� Private Supply Drilled by Address I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: � P.E. Et.A. Date % Address rJ � �,,►� f /i✓'�` �r/V ' License # 4 /,( AFPROV111>CD 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 anew pe it. A ved ch ge domestic sanitary sewa e only. Bar: Title: Late: No White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro ession 1 Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES rP;PLICATION TO.CONSTRUCT A WATER.W.ELL__... please print or type w PCHD' I'erm`it # ~ Well Location: Street Address: TownNillage Tax Grid _# Map ,L� Block, I..ot(s)a Well Owner: Name: Address: .9S frJ/r�' [?i?`jir Lf? rfi' f' /j� f►�i r' "ssr. +r � �,ri✓ �� ts,-w ,.S l ,. , 11'r `4`7 —/ Use of Well: ,i�Z Residential Public Supply Air /Cond/Heat Pump Irrigation - rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ,S"- gpm e Est. of Daily Usage %) gal. Reason for Replace Existing Supply _ Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ayv< y ,t for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................ ............................... Yes No A— Is well located in a realty subdivision? ...................................... ............................... Yes t--' 'No Name of subdivision Vt Zoc,,,,L Lot No. ;3 Water Well Contractor: " %3.J Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: '" TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be rovided on separate sheet/plan. Date: pplicarit- Signature: `--- t 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 certifie b Putnam County. QL k Date of Issue 1 r -x q Permit Issuin Official: Date of Expiration 11112- c' Title: Permit is Non - Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P'UTNAMI COUNTY DEPARTMENT OF HEALTH DIIVf SffDN OF IEl`VWRONM ENTAL HEALTH S ERW CIES LETTER OF AUTHORIZATION R]E:. Property of —J 0 0 Located at ! P 4_y) `� ,�`�' ` /- `�/ Tax Map #bi ~it lock Lot Subdivision of l Lm Subdivision Lot # Filed Map # f Date Filed ;. Gentlemen: This letter is to authorize XA i c 6_ a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water sup �ly permits) 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, Law, the Pub_lic_Health.:. -_ Law, and the Putnam County Sanitary Code. t - u _ - Countersigned: P.E., R.A.; # Mailing Address f' State /-/I Zip f ryl Telephone:° ? r ? et Very Signed: (Owner of Property) Mailing Address: `�- v �Y;''A" ! ' State Telephone: VI t'Lf Zip 1 .: V C Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH 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: Board of Health Approval i' ;f Or e,� _/Lv r 1, Daniel E. Garay, Jr. _ represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Jastine Contracing Corp. Having offices at: 8 Apple Summit Lane, Lagrangeville, New York 12540 Whose Officers Are: President - Name: Christine L. Garay Address: 8 Apple Summit Lane, Lagrangeville, New York 12540 Vice President - Name: Danie! E. Garay, Jr. Address: 8 Apple Summit Lane, Lagrangeville, New York 12540 Secretary -Name: _ Address: 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 me this day of aSUSANJ. (year) otary Pub Notary Public, State of New York No. 4901244 Qualified in Westchester County. Commission Expires Aug. 3,_` Form CA -97 Sid Tit Corporate Seal DANIEL J. DONAHUE9 P.E. CONSUL ING ENGINEERS: 120 Breckenridge Road Mahopac, N.Y. 10541 914-628.7576 October 26, 1999 Putnam County Department of Health Geneva Road Brewster N.Y. 1,0509 Att: Mr. Adam Steibling. RE: SSTS Permit & Well Permit Property of Jastine Contracting Corp. Meadows R.S. Lot #3 Putnam Valley Dear Mr. Steibling: Enclosed herewith please find the following: 1. Form PC-1 2. SSTS application 3. Well permit application 4. Design data sheet 5. Letter of authorization 6. Fee in the amount of $300.00 6ft - - Sb E F A .7. 1 - 8. Corporate Affidavit 9. Two sets of house plans. By: Daniel J. Donahue, P.E. Site - Sanitary - Environmental 7-EPAET MIENT oF nuTH DIVISION OF ENMONMENTAL HEALTH SERVICES, f r W.V. For: Fill Date Trencbes k PCHD Construction Permit # P y 3 6A-- P Located: Owner/Applicant N .IN 2L42;hlock .4,4.9 -alt Formerly: Subdivision Name;,`„_,,A� Is "en fin completed? )V14 13 System complete? Is system constructed as per p low? e- Is well drilled? Is well located as per plans? Are erosion convol measures in place? Subdivision Lot 0 Date: Date: y Date: f Zte L4O It - I ca* that the sy n*s). as listed, a the abm prenuses W been constructed and I have inspected and verified tW completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Due. Certified by.- PE'-'_<,._ RA Design Professional / 110 Lic - ft.- R11 410(-- CD FOR: ADAM 60M 0 (NAME) r.2 Form FIR-99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APKICATIONIF0 ^RA VAL A WASTEWATER TREATMENT SYSTEM 1 Name and address of applicant: b-)s" rIlV6 /E'. J'411-1�tl 7 2 Name of project: tLte.,,<4w,4 % 3. Locatio 4. Design Professfbnal:�N.. D 0,V 4 9 U F �Pf 5. Address: az_; 6. Drainage Basin: Pee "14,C" 3/ 4i' 141 ely 0 IV 7. Tvne of Proiect: ��_Pnvatdl*sidential 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 11 Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ..... ...... ............. A/C 10. Has DEIS been completed and found acceptable by Lead Agency? ............... /y ZA 11. Name of Lead Agency nl 12. Is this project in an area under the control of local planning, zoning, or other ffi ocial, ordinances? - - ... -... . . - - s4nan �L - ................. . . . . . .. 13. If so, have plans been submitted to such authorities? ...................... ........ No 14. Has preliminary approval been granted by such authorities? fig Date granted: 15. Type of Sewage Treatment System Discharge ........... surface water gro undwater 16. If surface water discharge, what is the stream class designation? .................... Nlef 17. Waters index number (surface) ......................................................................... . 4/!f 18. Is project located near a public water supply system? ....... ............................... ZpV- 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .... 1, ... I ...... ZVO 21. Name of sewage system Distance to sewage system. 9ZAV 22. Date test holes observedlf 23. Name of Health Inspector e- R4 el: 7'� 24. Project design flow (gallons per day) ......... ........... ... ......... ....... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 2 27. Is any portion of this project located within a designated Town or State wetland ?, A/ _ 28. Wetlands ID Number ... ................................................... ............................... 29. Is Wetlands Permit required? .............................. ................... I ........ .................... r— Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... the 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, I and fill•ing,.sludge application or industrial activity? ............................ Y'es/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? ...........I ............. �- .. _.._; �:.` n6fte inity w�ten.ar� r sitiv2r fac lit�es-pl edffo oe"d ve oiled "tvithi:ri 15 years in or adjacent to project site?........... ...................... ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... �6/p 36. Tax Map ID Number ........................ ............................... Map �j lock Lot 37. Approved plans are to be returned to ..... Applicant ___.< Design Professional NOTE-. All applications for review and approval of a new SSTS to be located 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 I .,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, sander penalty of perjury, that information pfovided on this form Is true to the best of Ivry knowledge and belief, False statements grade herein are punishable as a Class A misdemeanor pursuant to Section 210.95 ire Penal Law. SIGNYATURES & Ol~'F'.ICL4L TITLE'S: Mailing Address: .�. �a..,,_ w_�'',� ,• ; j:; i" , -� ,�n , . _ -2t! . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �c •- /r�:.i.' :� • .w• ao y. �; :'y` :' �.,: - - ''t'.r� .n .« .j-= .:. -x .�.:d: "� =:.. i:• :.. .. -.: r.:.a� �. -v. _a =...s =•iv.: v .: .i.� S:w ^..5,._ .. .- ..r. .. _ -. .:.L" ":'::•.;� .. :.�� ►.:'.i DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner j S' '1_jA X, Cel Address P 1ba % Located at (Street) I've;, C/2'r o fd �r°�� -�— Tax M*44 , 4? Block J. Lot -2e (indicate nearest cross street) Municipality fl 1(r►,�•,�, 14, 1"le Watershed SOIL PERCOLATION TEST DATA Date of Pre- soaking `,' Date of Percolation Test Hole No Run No.: Time. Start -Stop Elapse Time (Min.) . Depth io Water From Ground Surface (Inches) Start Stop Water Level Drop In p Inches Percolation Rate „ Min/Inch ':. JJ j 3 4 5 2 3 2” 3 6 - 4 5 1 2 3 4 5 NOTES: 1. Tests to he reneated At same denth until annrnximately enuAl nerrnlatinn ratPc ara nhtainPrl at aarh 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 TEST PIT DATA IDESCIUPTION OF SOILS ENCOUNTERED IN TEST HOLES 2. w_�'.;ri..,�•, v..i '.:t% ..'7 a r r� �. ;..K 4..`d "no". -+'^" '.::... ij.w•� "n._ ��. v o- :;-..; .. . •%..g, v.'= cy :.-:,1 '_D'1~;P'`l;I�. h.��E'N(5:'��. -.... ' ��`i•I.;��C�. ��I`bt;�-I�7�:' 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' °y:J` 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed C`{r Indicate level to which water level rises after being encountered Deep hole observations made by: R, t re / r,�c J'� Date t Design Professional Name:�'�/I�l,= Address: Signature: Design Professional's Seal Uj i r 14•16 ,4 {2187} —Test 12 PROJECT I.D. NUMBER 6117.ep/2�1 �� ..4...y:;, ._., - - -- -°-• — SIste Environmental Ouslity Review SHORT ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or ProjOCt aponaOO FORM SEOR 1. APPLICANT !SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: �� 7d /r/ (, /�G -L•%'' � County L.. Munici;a�ity (�G�� 1�� t. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc , or provide mao) S. IS PROPOSED ACTION: >vtw u Ex;aeslon u Modl flea IiontalteraIIon C. OESCRl8E PAOJiCT BniEFLY: can,aIle 4) A7i0A) off.. 4111vr.= t 4HV rir J. A!.tOUNT OF LAND AFFECTED: r Initially acres Ultimately acres S. VALL PAOFOSEO ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes r—I No It No, describe brlalty 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �Residentia! 0Indusvial ❑Commercial ❑Agric ulture ❑Park/For"110psnopace n (..!Other. .. _� •, Describe:_ to. HOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAt, STATE OR LOCAL}? 0— Yes [] No It yes, list agency($) Ind pennittapprovals �L �� f,(i Ii. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes k No it yes, list agency name and permlUapprovat 12• AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOWRE MODIFICATION? Q Yes NO I CERTIFY THAT THE INFORRMATIONPROVIDED ABOVE IS TRUE TO THE BE$T OF MY KNOWLEDGE Applicantispon$or �F �.deG= �f / j�f,1 ref "°! name: Date: Signature: It the action Is in the. Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER I PART 11 —ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE t THRESHOLD IN E NYCRR, PART 617,127 if yes, tioordlnate the rmtow process and use the FULL EAF. 0 Yes i qo _ _ .. ... _B. VliL� ACX!rip�t~rlY✓f1;i A�tidE'.ilE`1: ?a •r fiViQESi'> Otii2tt51'E�i Ali nP6c3 IN 9 PIYCtr; PART 617.62 It No, a negative dec:araticn ;ray be"superseded by another Invalvod ogancy. . (l Yes * BN6 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ci. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potonlial for erosion, drainage or flooding problomo? Explain Wofiy: deAjr C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: p14) C3, vegetation or fauna, fish, sheillish or wildlife species, significant habitats, or threatened or endangered species? Explain brlefiy; Ca A community's existing plans or goals as officially adopted, at a change in use Or Intensity of use of land or other natural resources? Explain briefly CS. Growth, subsequent development, or related activities likely to be Induced by the proposod action? Explain briefly, qt C& Long term, snort term, cumulative, or other affects not identified in CIZA7 Explain bdoffy. C7. Otter impacts (including changes In use of either quantity or typo of energy)? Explain briefly. s� �)— rrs=ii iizPre,'DR ii THERS "LIKEcy ruaee- C6NTK(5vER5Y REILI ?tcC! TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes Uft If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; to) geographic scope; and (f) magnitude. if necessary, add attachmonto or mforence supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts hove been Identifiod and adoquatoly addressed. Cl Check this box If you have identified one or more potentially largo or significant adverse impacts which MAY occur. Then proceed directly to the FULL E4:F and/or prepare a' positive declaration. G Check this box if you have determined, basted on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any aiignificant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this detormination: Name of lead Aaency Print at Tyoe K spomibT#_Oflicor in Lead Apeney Titjq of eiponit a Officer ��" ,andtGrt o espon1! a Utficer in L;-ad AsencY isnotwe of Yteparer different from responsi e o titer) —" eta ASHUIL I' P1.AN SEWAGE TREATA'IENI' SYS'IL•M JASI1NL'•'DEVELOPMENI'CORP MEADOWCREST DRIVE Co 0 '1',. 89.07.1 -28 PU'I'NAM VAIAT.Y (I) —61011 oi' E:Ivi onmental liealth Service, _;:;PFlovEfl'9A' *dd.io-:'• Pormano�I vi+ y '' ..' r..:;�.� =�; r4'�'01aabYe d5 a dgu�t10t18 Of tL a mw'• "='�. CONSULTING ENGINEERS °u Cc ea D ; meat.. fi28 -7576 MAIIOPAC, N.Y. 10941 e DNI'L: APRIL 24, 2000 �?anntetTn X T1t1 a SCALE P- 30 ' BURVAY 13Y. ILG[,AND [,INK, L.S. THIS IS TO CERTIFY THAT'um SEWAGE DISK)SAL SYSTEM WA-S CONSTRUCTED AS INIXXFED ON THIS Mi N AND THAT THE, SY..T11M WAS INSPECTED HY DII, BEFORE AT WAS COYTiRED ovrR,,rm,, SYSQ M WAS CONSTRUt:'11i,D N' ACCORDANCE: WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUMI'Y or form., DEPAW11MEN-r OF HEAL•EEI AND THE NEW YORK STATE DEPARTM1 EN*I' OF IIEALTI1, 56 / °06'34"W 58 / °38 ,04"W j SUBDIVISION MAP PREPARED FOR HENRY WIRTZ" 37.75' 035.39' 1 filed April 24, 1987 as map no. 2226 PAINT MARK ` 1 t PAINT MARK ON WALL _� —.5600525 4W ! ! 9.08 ON WALL N STAKE SET r OLD STONE WALL GENERALLY ON PROPERTY LINE 30 ft. R_FAM tSD,:3AC� LINE o AREA: i 45,302 sq. ft. jC�Y1:��r O� ,Ceres 'o RNSED ' p WOOD Plt WOOD r� �J ®STEPS l� :1 • 13 `I ONE STY. HAY C LANDING IZ 3 ••Y fI r ..1p66 ' •� -. n � " ...:w:•+.o �' -:...� .,._. .,.o ._.. .. ... ....r. ,JO +'on `SSTS TIE - INS (ML'•'ASURED R) r'ADPN O 36.8' foundation Ile � 1j Q h r o SETBACK LINE ,$ STAKE a 50'ft• FR_C Arw— w SET _ 4 > O U act WELL 4 O / LocArroN g I l+�J1J P,=43 STAKE SET.�(1) r GJ L° t 01.201 V Dela = ! ix 9 004 STAKE rOUND peli�l E A D O W D P' i 0 N i T SrAKE SET UNIT A H SEPTIC TANK. 31 41 J. H,1 67 81 2 C7 89 3 68 89 4 69 94 5 69 98 6 70 101 END OF TRENCH 7 126 144 8 126, 142 9 126 141) 10 126 137 11 126 135 12 127 131 13 38 91 14 31 89 15 26 82 16 23 76 17 2U 69 18 20 62, r | . .... ..� -� ..�.._....�..... .: f BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road Brewster, New York 10509 .N'-c, LORETTA MOLINARI�R.N.,, M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845).278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 218 - 6014 Preschool (845) 228 =76108 Fax (845) 278 - 6648 April 16, 2001 John Bernardi 11 Meadow Crest Drive Mahopac, NY 10541 Re: Addition - Bernardi, Meadow Crest Drive No Increases in Number of Bedrooms (T)Putnam Valley #85.7 -2 -28 Dear Mr. Bernardi: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated April 13, 2001. The addition is. approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval ...... by this depa.Ttineiit. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley_ If you have any questions, please contact me at your convenience. ML:lm cc: BI(T)Putnam Valley Very truly yours Michael Luke Public Health Technician ...- - -- d B RUCE . R:--'zFOL9 -Y _. z Public Health Director ORETTA MOLINARI RAT., M.S.N Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET / / A(26 Ly) �ea j . TOWN I iQ TX MAP# 7- Z - NAM[E J ohs �a ,, PxoNE VS-S2-6 -'177? PcHID# MAILING ADDRESS DESCRIPTION OF ADDITION Fi N t J ►" NUMBER OF EXISTING BEDROOMS 4—PROPOSED # OF 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 sections of the Putnam County SanitaTCode. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan .(drawn to scale, with name, street, and tax map 4) *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Khouseguidelines OS'y BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. . ,' 4ssocciate Public . Reald. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 rt Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 'WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: �� ,L, Re: Residence Tax Map Town According to records maintained by the Town, the above noted dwelling IS . in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: 'XII ASSESSORS RECORD: OTHER Building Inspector BFhouseguidelines K_nce n' PUT NAM COUNTY DEPARTM ENT OF HEALTH Go DIVISION OF ENVIRONMEN'T'AL HEALTH SERVICE ;T ^.�...' ...: �... _ -. .4 .. C. z - .. - . _ .< .... A - , as rN4�°�'••n •�- .. .. .. .4 4n a - - - - CERTIFICATE OF CONSTRUCTION COMPLIANCE F \\ ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at /� &6 k/ e .0174 Pof % Town Village Owner /Applicant Name�4X&I -e ,Oe&,-e' /4 4i13 Tax Map Block / Lot 0 Formerly � 1 Subdivision Name /d'IR -11 d Ot-1 �p Subd. Lot # Q9 Mailing Address ,�/i�L� �('�ap I /7' ��'!`� ��'��" %�`� Zip 11 5zei Date Construction Permit Issued by PCHD fJ�� Separate Sewerage System built by Q4j& Address Consisting of /a- _ Gallon Septic Tank and 7 /f �'72 Other Requirements: Water Sunnly: Public Supply From Address or: Private Supply Drilled by AV A 46�-la& Address J-/ d��e� Building.Type. L' &e Z dY Has erosion control been completed?.- Number of Bedrooms Has garbage grinder been installed? �*X% I certify that the system(s), as listed, serving the above premises were constructed essentially as sFQwn�ri#he as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Perm an_dapproved plans and the standards, rules and regulations of th tnam County Department of Health. 1 4 Dat Certified by P.E. _ �J esigg Profess al) '� �:i •`' � Address :�T,- �G %,�,, �'�� s�< �� `�License # �-6i 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 9-T or change when, in the judgment of the Public He th Director, such revocation. mo catio cessary. [-� ®c� By Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 3901 -3 now or formerly BUNYEA 5,51'56-34W 381 °3B'O4M/ 1 „ SUBDIVISION MAP PREPARED FOR HENRY WIRTZ. 37.75' 035,39' 1, filed April 24, 1987 as map no..2226 .. ; �.. . w - '..•.;f'. -; PAINr. LARK• - - \l , 0, . .. .. -. n a-� n - . , �ON•WALL' ` \ ••�,;-- .•..�t30 ". 2'S4"W 'J 1.9.VV' 'ON LARK'• i — ,'ON wa.L OLO STONE WALL GENERALLY ON PROPERTY LINE i O STAKE SET STAKE FOUND N 30 ft. REAR SE75ACK I i AREA: 7 45,302: sq. ft. / 1.040 acre i' �Ix RAISED i WDOO DECK i _ SJEPS ut ONE STY. LAY cow_ O I LANDING 74V17 STY 'no cvr WA I jE DWPLL/lVG 36.8' f ddu— I I o>' w� I �,p SETB!tiCK LINE 50 1t. FRO��N w • O Lr Q: WELL LL O / LOGIRON (�lSIA2E Oa _ R =431.1,6' L °80.20' 25 %0 �' 0 .4"k7., Delta= _.�7 A D 0 v. ,.E II • r,� E ; D . I . R . • THE PREMISES SHOWN HEREON DESIGNATED AS LOT No. 3 AS MAP' ENTITLED ' FINAL PLAT SHOWING SUBDIVISION OF PROPERT MEADOWS ', MADE BY BAXTER LAND SURVEYING, P.C. PROFESS SURVEYORS AND FILED IN THE PUTNAM COUNTY CLERK'S OFFICI 2803. • PREMISES ARE DESIGNATED ON THE TAX MAPS FOR THE TOWN of PUTNAM VALLEY os: SECTION ;BLOCK ;L07 • ENCROACHMENTS BELOW GRADE AND /OR SUBSURFACE FEATURE' IF ANY, NOT LOCATED OR SHOWN HEREON. • UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEA A LICENSED LAND SURVEYORS SEAL IS A V10LATION OF SECTIOI SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAWS. •,ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WIT AN ORIGINAL OF THE LAND SURVEYORS SEAL SHALL BE CONSID .TO BE. TRUE VALID COPIES. • CER77f/C4770NS INDICATED HEREON SIGNIFY THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY CONDUCTED ON THE DATE SHOWN AND THAT SAID SURVEY WAS PERFORMED IN ACC WITH THE EXIS77NO ' CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATX OF PROFES BR LAND SURVEYORS THIS CERTIFICATION SHALL RUN ONLY TO FOR WHOM THIS SURVEY WAS PREPARED AND ON THEIR B THE 1171£ COMPANY AND LENDING INSTITUTION LISTED HER N. CERTIFICATION SHALL NOT BE TRANSFERABLE. CERTIFIED TO: s DANNY GARAY ( JASTINE CONTRACTING ) 7WN ON A CERTAIN KNOWN AS THE JAL LAND 4S FILED MAP No. LINE I s i �o ly I� I� I� STAKE SET o1 gq STAKE SET STAKE SET SURVEY OF PROPERTY SITUATE IN THE TO WN of PUTNAM VALLEY VG PUTNAM COUNTY 7209, NEW YORK, ED SCALE : 1 40' SURVEYED NOVEMBER 1, 1999 VfyO PROPERTY MARKERS SET NOV. 5, 1999 r�0 K. 9 FINAL AS -BUILT SURVEY APRIL 1, 2000 2� ROLAND K. LINK, P.L.L. C. 16 SPRING BROOK DRIVE MAHOPAC, N.Y. 10541 fe; 6 00 13 ry f s 21 � (fax) ° - L " . R S NEII YORX STATE Lf NS D LAND SURVEYOR NO. O,"RZ8 ASBUILT PLAN SEWAGE TREATMENT SYSTEM JASTINE DEVELOPMENT CORP MEADOWCREST DRIVE UvO 85.07-1-28 i LL W+:+W (.Uw" UtlI al'LWtll1 UI EISorvl PUTNAM VALLEY M aviaion of Environmental Health Sorvioc DAITIELJ.DONAHUE,P.E. lDDr °ved as noted for confatloneeofithe "_a ent,„ CONSULTING ENGINEERS 628 - 7576 MAHOPAC, N.Y. 10541 DATE: APRIL 24, 2000 SCALE 1"= 30' SURVEY BY: ROLAND LINK, L.S. TEBS IM CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THIN PUTNAM COUNTY Or form, DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 361 006'34 "W 36 / 038'04OW I SUBDIVISION MAP PREPARED FOR HENRY WIRTZ" 37.75' 035.39' 1 II filed April 24, 1987 as map no. 2226 PAINT WALL . � 1 380052 54"W 1 1 9.08' PAINT MARK ON WALL j 1 OLD STONE WALL GENERALLY ON PROPERTY LINE Q 30 ft. REAR SSEVCC LINE n _ AREA 45,302` sq'. `ft. too.. .. � es .I t !o z -' I RAISED WOOD DECK P/q SeP* 1W i.�cr' ®STEPS / •�',' ••� 3 ' y W ONE STY. gqy CONC. � "j— STAKE' 2 ' . J . LANDING /L r, SET rgRR foundatan SSTS TIE - INS (MEASURED BY TAPE) A CAGE FRAME DWFLUNG UNIT A B 36.8' I / SEPTIC TANK 31 41 foundation O J. B:1 67 81 2 67 85 iouun -8 �. 3 68 89 n 4 69 94 5 69 98 6 70 103 END OF TRENCH EE1 ELL 7 126 144 Q 8 126 142 �3 h O' a 126 140 N 5 lt. FROG aN SETBACK LINE W SET E Q p 126 137 Q 11 126 135 d, O Q 12 127 131 W ! Q: rr }3- 38 91 WELL a p ° 14 31 89 Q f LOCATION p / 15 26 82 R=43 ro Q 16 23 76 20 69 STAKE SET a . ^�80�2D6' I 18 20 62 V � � 2 � p � — � L=60.20.1 10° 9'29° ((� R // EAU Delta= 1 STAKE SET N 1 i �O 00� �T STAKE FOUND �. L l �/ ' lLni. v O .- .r•_'r;'t� �+.. �°i�. ..e a °.:.'b�_:..t /Lr �..'y%�vrb':imh �'... D R I 3 LAAJA 3£k�V��'� I !Y% b 5• %- 0)'0�0 i _ I: Zrlo I.WvLiL" I A Al' I`A LCg KJ - I `'s° S.LID6K •y '�� 'ice PL y' 6 i F T All 4eC.M a 3 t :AUY W 1y X 35 'f /'fdt -vv U/ g 7- G (/S Y i,GOB. cr SL,4 B- I , 1( -7 e y T �(P ' X v Y� I 7 � n U PUTNAM COUNTY DEPARTMENT OF HEALTH I DoaL A, .�dLLS kA \J i HOUSE PLANS APPROVED FOR ' v — / BEO ,OOi COU'JT OhhY; Ic Si;naurc Date . }. _ —.. . I ' _� x4 13,° x-46` UP I�I O u I t" _ 0 �' ,OF G It 3• `Y..: ; O 1, ' I_ Q �/4 a« flGC. F:vv \X 'Sd"x emu I' 1_.... �p ��.i7� ®�/+.� 14K`�116'I,ts ,• � '7"'. I „ �S Io ' n q�o _ p, w.c a I ✓eutr ?w c.l.e".•. i_ 1 �\°9 it FkFI f— i 1 14 � \ .4 G —=c Z I I DAN I A LA - -- -. =v �.' MF--P� m _. . -! . -- .___. UN F LOLi. �FCEhi G V.yr'; .0 4 L . I �`sdv tj � _ c.,2 lu•r.AI.E ac�cBE..° °c: 1. Z� 2" �, .� 4 14.4 �i _o, I 4 - -' - .__..._:... �. -' - ._ -_z1 -_ 6O Me? n" ; m I -� gr 1 - 1 � TR/►Y GEJLi.:b - -- - - — 3� .._ .... 3G "xss.4 1 .0 ; y t o .0 v - o . cl �4_.: _ _. y 31� 91 .-._ _ -. -V.-Q 10 - o PUTNAM COUNTY DEPARTMENT � HEALTH l - 1 _Q // zKS. RapT. ¢ cellA[ _7iE`> 'r ^• ' HOUSE PLANS APPROVED FOR °.. — �� BEDROOM COUNT ONLY, 4 i BEDROOMS _• I � -' " . .:.r:'. Date ,t :1 •s