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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.08 -1 -14 BOX 35 04679 ` t k 4 m e tMap +c�ari' �nnd Tax' ntunber. ' } t ed canponents %• ti.ed �to two y fixed pc ,gal. concrete septic t by' one ;foot +4 L t 9 . t E 1 `� t',c,,L ci l •pr '_` a, ti 5 K'-,p x � ��i _ u yl+ } Yx1 t ♦y �tY y 4 � gPHODTE �r 52, 6233 •�� '�%i'a u�` y"� pry- d rt a ,� t �,OTHON& �u��,YP �i'x S � YJ �44 '. 'i a'1 J..h 1• t , Lsewages�diso :,zsystem: �professiohaT7ehgineer �z Wn- y�d'C'},�t, .. K,1✓x 2 is s�7�,2,�'. �, $�''��tii ��' �T \D �; :. }rt. Y t w - n '` NPi gaQ IL�jRte1� ' N w`i r✓ a y Hf -1 � A ' t L t t Ji. X t .q,house corners). ree , precast',6.;' diam. x' 6' .deep' 4 _ �sa1�; and. conditions.' • t at} L ✓ I:V/ Cbo �x a, © e__ � .r 17"O L" P WA-m Q0 -,j � y . Ile-,4 C-1-4- b &Fj , 628 -4526 Joseph A. Mantovi :�A 7-,E7,e JA 2 -7 Die 70 S, �2 0, kA/ 17:7 GOA- 56-1- L F1 i L6 A Gz .7. -7. C, :�A 7-,E7,e JA 2 -7 Die 70 S, �2 0, kA/ 17:7 GOA- 56-1- L PUTNAM. COUNTY HEALTH DEPART DIVISION OF ENVIRONNEWAL HEALTH SERVICES _.. - <,�,.:. - ;, 225 -3838 /225 -3$; 3/225- 3641..w..: PROPOSAL FOR SEfi�GE DISFO6AL SYSTFl►� REPAIR ► _ . ..x - - ter- - - - - - -- -- - -_ -- -- -OWM'S .NAMME Joseph Drella PHONE 528 -6233 -_ -- SITE- LOCATION Ppekski l l Hollow Turner kP MAILING ADDRESS Putnam Valley, N.Y. 10579 PERSON INTERVIEWED Joseph Drella Coyne PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE 4/23/87 TYPE FACILITY residence PROPOSE) INSTALLER Mahonac Sani to -ion Septic, Inc. PHONE 628 -4526 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approved 7. 20 Inspector ° s Signature's Title Proposal Disapproved conditions: Submission of as built repair sketch in duplicate showing: ao Owner's name. bo Site Street Name, Town and Tax Map number. co Location of installed components tied to two fixed points do System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). ea Installer's name and number. Da e (eog,,house 'corners). three precast 61 diame x 61 deep 3. System repair to be performed in accordance with the above proposal and conditions. I, as own , eported Aclent of owner agree to the above conditions. r- p SIGNATURE TITLE f t DATE O X�'IES: 14Ate (PQID) ® YeUcw (Tam 131); Pink (k#iamt) jj 11 Y t� y i" Ff p.. .yti i yy T � i ` 7 vi v 'j o t } r - 4 t 1 r f - a I Zi Y4 - G h } '� '�� D1eMo� at)�vAr�seeltl Betllfi Saroloee. MW"10011 NTY DE P OtMiXB dir" N.Y. lesu M In CE TEO P1!PW-1F0D'SZWA88 ,D1Sl0W5T9PM at Sobd.X�if ;z Tat NIM mod ell 0orm/Affnd bi Klass, ROVIdet, 0 DI" of A zkwowd T� pate Subdivision jee- Enc-losedR ed A 6 • FM Sft-dw On .. Velama PCM 111R0qdM When FM6,c;6moieted st9mb saft"ge SY'l*M to Dai" 41 Clum A00 0V J_ hy -,:�kio,e . .04�, To 6 calstregiled A" 10 -1417 Water LWt:—PdJWk Sw* Fmm Adlifrove an Stub Ddftd by —Ad&vn 06. R.0k.waft .1 represent that I am wholly and Completely. rosOonW6'for'tK*-d6iijnind 166tion of. the Proposed system s); 1) that the separate, dIWI %u M_T 4�02.! abmie described will be constructed as*shown on the'opproved amendment there to and In accordance with the standards. rules so County Department of H"RI% and that on completion thereof &; "Certlflcate of Construction, Complianci i the Commissioner of H"Ithwill be submitted to the qaoartms�tt and 0a,:,:t4rjisfi*d In* owner,,his, successors, bulklai, that i.sid'builder will PWO in good operetin flowing the'dat f 4 Condilion _tiny' jort.-of 'aid sawa"'dispo"I svii4mllurinii the period Of two r o the lau- ance of the approval of lh*rC*rt'fkatQ of Construction -Compliance of or or any to rilled well described above VMS be locited as shoorn on-thi approved plan andi,thatu' id-*44 will be Installed ccordanc with th S. ons, of ,the - Putnam C A D f rtment Oun y "a 0 04guilth. Date 'Sig R.A. Address—� No GXP iee� SIMP" APPROVED FOR CONSTRUCTION: This approval ireftwi r ,,. the date isstfod unless const s been undertaken And is revocable for cause or may be amended or modified when consid'arti , dniwkury'by the C . n 0 or of or . alteration of construction . ,S,r� I of ommi '"uIres • nalf P-41t. -Approved for d oss domestic son and/or Or it r, IV Rev. 10/88 Data BY Ti Ti M DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 r' - '-..'O: =%ar "mss ..; A'-7ti. �yC .r -. �0.;•' PCHD PERMIT J ALL LOCATION Street Address ,�,�� // Town/Vi, lla a City VjZ Tax Grid Number OWNER WELL OWNER a Ma' ling d Tess / ��� to a9 , rivate ® Public USE OF WELL 1 - primary 2 - secondary RE DENTIAL 0 USINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP ® ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT .-$777 gpm /# PEOPLE SERVED_ /EST. O REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION MIfEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL OF DAILY USAGE 0e' 12-ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG C] GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES A-,"" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name M. 42h Address: A.-I'VeP47 � //'t IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES d/° NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ..;'_.DiS 'A. DICE :`TOk.FRd�!?BRTY- .:F'RO I,.NF;ARk `I �WArER'. .AI i, •'. ��; .: .. ..:,: .:. `:. �� � :`..; ` < =' . . LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET da e) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3, (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in ;suTca panner as not to degrade or of a ise conta ' ate surface or groundwater. Date of Issue: � �� 19 (6& Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller . 6„ r Punm oxTM,DEPART4ENT OF HEALTH DI'VISION OF ENVIPDNME= HEALTH SERVICES d'_'.' 1' i7i`f,~ LiTp;. 'u7111:+.Jli`iJJ1..ASVL'v�r•ci: X14. y7wa••' L'*' b`: C» rk':-' li;t €i'rG'+-.d_':3= '�`;,:f':'q. 1''.1L1�,�k`N .:. .i:- ....:�L`. ,I- ..:.•. w. •.� � Ares aowner &jll � Located at (Street) -4 /eki� /. �� Block 611 Lot (indicate nearest cross street). Municipality %��% Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 2 Date of Percolation Test' 6 HOLE KMER CLOCK TDIE, PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches rr 7 3 �.. 2 /(),t �z {5- a0 -1o1 V- 7 3 4 5 2 3 In q-4 'a 1/ o 5 N=: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 MARVIN O'DELL Bldg. Inspector TOWN HALL PUTNAM VALLEY, N.Y. (914) 526 2377 oalrra alrntvitIfl-cm JOHN MAHONEY Bldg. Dept. Clerk Deputy Zoning Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT June 18, 1996 . .... .. Mr. Joseph Drella 17 Peekskill Hollow Turnpike Putnam Valley, N.Y. 10579 Re: Building Lot #4 Drella Estates TM#91.8-1-14 Dear Mr. Drella: The:above noted parcel is a pre-existing building lot approved by the Town of Putnam Valley Planning Board on November 8, 1975, known as subdivision Drella Estates. 7T Very truly yours, MO'D: es MARVIN O'DEL Building & Zoning Inspector. a .� +a- .,r:<. y+;;�j -j=... :c° -' 'r' .. . ��• . . . ./ �. .Y..,. -.. .,�:�:'::. „ i. .. _. ..:cws�.. ��� ��. "v'a�'YI -V+y c: 'r'��.r' -.. ... ^ "h'�� .:d.: ii '', r .`.^�.f.,'i+.'dv:daii:.%���.i.� ..r'f' JOSEPH F. SULLIVAN, P.E. �P teA4 2972 Fernerest Drive Yorktown Heights, New York 10698 (914) 962 -4248 June 24,1996 Mr. Robert Morris, P. E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Proposed Separate Sewage Disposal System - Drella Old Peekskill Hollow Turnpike Lot # 4 Putnam Valley, New York Dear Mr. Morris: Enclosed please find letter from Mr. Odell regarding the status of the above lot. _ ._:., .:._.r: T�Qr ➢dell oleo a�adicated'ttiere ai'e.nu wetl�ioe�, pri blemt wlth: this'llot-,"the-obt., � requirement being the 100 foot distance from the brook. Very truly yours, .- --I --� q 11 C; ILI Joseph F. Sullivan, P. E. JFS /ats Enclosures 96-43 refl E BRUCE R. FOLEY, R.S. - - "°`•' ��`: "- '::"la�ctielg•Pu'Zil'rc FieSlth•Di;oet ®r �:.�.. .�� DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 June 10, 1996 Mr. Frank Sullivan, P. E. (914) 278 76130 2972 Ferncrest .Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Drella Old Peekskill Hollow Turnpike Lot # (T) Putnam Valley Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: 13 The construction of this sewage disposal system may be subject to local wetlands regulations. A letter from the local wetlands officials is required. stating their position on the proposed project. A letter is required from the town building department stating the above captioned lot hs a.legal building lot. l.3) . p test -holes and-liercolation tests nitist be witn± d -by a repr'esew9 ive of this. ; Department - k7pe use sewer is to note �nininauan slope of 1 /4 " /l$. Garbage grinder note is not on plan. ansion trenches are to be shown on plan, dashed lines are acceptable. marking difference between the erosion control and the contour lines cannot be distinguished, revise accordingly. th abo th 1' 'll Upon rec tpt of a submission, revmd to ect a vu, comments, is app "a un wt .w be considered fin Cher. RM/jp e Very truly yours, Robert Morris, P. E. Public Health Engineer Division RUC S. S. '�''•,� Acting Publi He�Director DEPARTMENT OF HEALTH cill� Of Environmental Health Services 4 Geneva �r Road, Brewster, New York 10509 Mr. Frank Sullivan, P. E. (914> 278 -6130 2972 Fermcrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: June 10, 1996 Re: Proposed SSDS: Drella Old Peekskill Hollow Turnpike Lot #4 (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. A letter from the local wetlands officials is required. stating their sition on the proposed project. 2. A letter is required from the town building department stating the above captioned lot is.u.iegal- building lot,. _ - ev— �... -w.., ..... ru_..... r... ..... ..tea, .�.. -.._o. ,- ..'. -� t...-- ........... ... -.—.�. ... .... ..�. .�....- �.....w... ..�. �- .• -.,.. a.... ... ... .... ...... ....«. ..— .,..... 3 Deep test holes and percolation tests must be witnessed 'by a representative of this , Department.. /4. House sewer is to note minimum slope of 1 /4 " /ft. • 5. Garbage grinder note is not on plan. /6. Expansion trenches are to be shown on plan, dashed lines are acceptable. V411 7. The marking difference between the erosion control and the contour lines cannot be distinguished, revise accordingly. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer RM/jP PC-1 ®7E°' APP,LICAT,.ION . FOR -APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM .ems :.: �.�.... ; :', -; . :z.':;�. :.;jt. :: •:. �.,1 4x�_'� �..,'Ns :: '..:' , "" .::v .. '� '... .. _. ,,F � , _ _ - _ .. . t' '..-s •-- ,•Fri:. Si ..�o?' :. // .'- �'.::�';';,�. :: .. _ « ,. .. - .. :.:� 1. Name and Address of Applicant: Al A C., Aem __Z Zg,�ZW 2. Name of Project: ��s�� 3e Locati n T /V /C: w/� 4. Project Engineer: 5. Address: _�4� �"�•���'p�i�l%- License Number: Phone 6. Type of ro.iect:• Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review.(SEQR)? A/ el Type Status (Check One.) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ..eeeee.�ae 9. Has DE_S been .completed and found acceptable,hy„Lead Agency? 10. Name of Lead Agency 11. Is this project in an area under the coltrol of local planning, zoning, ,or%other officials, .ordinances? - .e.,e e.a e o 4 o,.;re.e.a�.e.e a o 0 0 o e .. . ... - . � ..._. _ _ . .. r v..! - o . y- a- .........._tr s ... ..r.y .. ..� .yy-. yy. _ _ I , � p.q :. . C- .- r r�.yv •ar ....e o. 12. If so, have plans be n;;.subrhitted to such'aUth6rit'i'esg a .. a :.. a .......... �. 13. Has preliminary approval- been granted by such authorities / Date Granted:_ZE:Z4 14. Type of Sewage Disposal System Discharge .....e Surf /ace dater /,,,"- Ground Waters 15. If surface water discharge, what is the stream class desiq� nation? ........ . 16. Waters index number (surface) e...o..... .................... i/. ....... 17. Is project located near a public rater supply 'system? ...... A. )e ....... 18. If yes, name of water supply Distance to water supply ;9. Is prciect site near.a public sewage collection or disposal system ?..... o 20. Name of sewage system Distance to sewage system 21. Date ctserved: 23. Name of Health Inspector: 24. Project design flow (gallons per day) ..................................... =a' 2 . 25. Is State Pollutant Discharge Elimination System (SPOES) Permit required ?.. 4/0' Al °i i otieas "PDES r� s :eu „✓ :;.: -.." , .o:c ---- '27. Is any portion of this project located within a designated Town or State I 28. Wetland ID Number ................ ...... ............................... 'M Is Wetland Permit:required ?, ......... All, Has application been made to Town or Local DEC Office? .................. 130. Does project require a DEC Stream Disturbance Permit? ................... Ale.- 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..appl.ication or industrial activity? ........ YES or NO. 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ...............YES or NO Ala DESCRIBE: �. Is there a local master plan or file with the Town or Village? . Are community water, sewer facilities planned to be developed within 15 years? — I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210,45 of the Pena 7 Law. i >IGNATURES &OFFICIAL TITLES:_ (AILING ADDRESS: 35. Are any sewage disposal areas in excess of 15% slope? ........................ ®✓a :36. Tax Map ID Number ..:.. ..... .... .::......::.: t 37. Approved Plans are to be returned to: ................ Applicant AzEngineer {f the application is signed by a person other than the applicant shown in Item 1, the Application must be accompanied by a. Letter of Authorization. Failure to comply with this brovision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210,45 of the Pena 7 Law. i >IGNATURES &OFFICIAL TITLES:_ (AILING ADDRESS: APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES __ VJVJj j_ - ,1._WATE!K, SUPPLY &- SUBSURFACE SEWAGE DISPOSAL .SYSTEM-S ;,• _' 'd R IEW SHEET for CONSTRUCTION PERMIT STREET LOCATION P NAME OF OWNER BY B. HEDGES R.MORRIS_IZOTHER DATE �/ / TAX MAP # DOCUMENTS. Y N PERMIT APPLICATION PC -1 WELL PERMIT PWS LETTER ENGINEERS AUTHORIZATION CD DESIGN DATA SHEET(DDS) CORPORATE RESOLUTION F9PLANS THREE SETS 2 HOUSE PLANS - TWO SETS ET-1 VARIANCE REQUEST SUBDIVISION CD LEGAL SUBDIVISION SUBDIVISION APPROVAL-CHECKED FT-1 PERC RATE m FILL REQUIRED DEPTH m CURTAIN DRAIN REQUIRED MSTANDPIPES GENERAL m EX- APPROVA -AD3. S m WETLAND TOWN/DEC P REQ? ) m DATA ON DDS PLANS & PERMIT SAME m TP�✓� -- �) 9 y N%El R NOTIFIFICATION ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE m GRAVITY FLOW En CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS EROSION CONTROL; HOUSE,WELL, SSDS ROSION CONTROL NOTE PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION Y EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM m PROPERTY METES & BOUNDS m HOUSE SETBACK F_CES Y (TIGHT LOT) m HOUSE SEWER - 4" ; TYPE PIPE m NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS CLAYBARRIER En 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES R ILL PROFILE & DIMENSIONS VOLUME m FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED -= 60 FT MAX SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 0' TO FOUNDATION WALLS M 15' WELL'TO P.I 100 TO WELL, 200' IN D.L.O.D., 150' PITS 51100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50'TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER �M,�.� 10' TO WATERLINE (PITS -20') 0' INTERMITTENT DRAINAGE COURSE ff?00 FL RESERVOIR, ETC.m 150 FL GALLEY SYSTEMS , 5' MIN TO C.D. S=>5%,20'-4%,251-3%,301-2%,351-1%,100'<I% TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS, SEPTIC TANK En 10' FROM FOUNDATION; 50' TO WELL - COMMENTS: /• •• 1 olvo to 1 IZ. • . .. -5 ?-v s'V. - `y,- - W :y v .,- rt c*F , .... 'fidv 1uy�.'... iG'. _ .:sji :.W >^ ;i• wa DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �°/ ! Q' Address / 7'Ts/l r %f /����'y /h Located at ( Street )1%90�//�/ / / / /v+9/ e /ice Sec. P- d',f Block �_ Lot (indicate nearest cross street) Municipality �� 1� % %y Watershed SOIL PERCOLATION TEST DATA PIWIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test 6 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Freon Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 22714 4 5 . 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeatel at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. --.. n /or- TEST PIT DATA REQUIRED. TO BE SUBMITTED WITH APPLICATION DESCRIPTION. OF sonS ENCOUNTERED IN TEST HOLES , :� �,F - 4, .. — .. . �-;MPTH G.L. 21 jq ieam- 31 4' 51 61 71 89 go 10, ill 12' 13' INDICATE LEM AT WHICH GROUNDWATER IS ENCOUNTERED Ale 0e- INDICATE LEVEL To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED.-- 0-01 DEEP HOLE OBSERVATIONS MADE BY:- DATE: DESIGN • Soil Rate Used Min/1" Drop: S.D. Usable Area Provided �aO00 No. of Bedrooms Septic Tank Capacity /v 0 a _ gals. Type Absorption Area Provided By 3 j?&9 L.F. x 24" width trench Other Name Address THIS SPACE FOR USE BY HEALTH Soil Rate Approved ' r"'Riv, ONLY: sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at (T)-ZV Subdivision of Date it/ Section Block ---Z ---�—Lot � Subdv. Lot # Al Filed Map Gentlemen: D ate lG This letter is to authorize 0 -s (d! / /�Y+ a duly licensed professional engineer ' or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property.in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam 'County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to 'supervise the construction of said system or systems' i h- "conformity n 'for mi with e provisions- of Ar 5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, � Signed Countersign OF NEW P.E., R.A U�ir�-AXZ -I'Vi- W"M ess &4� 01 2�2 Telep*hone Town -5- )-F - Telephone -I' - I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 01INSTRUC�JI=ION PERIi7iT FO ATMENT SYSTE1VI PERMIT # fk /25 Located at A ,f %f%ii l� ���`�'� i�• Town or Village IaAal w / �t ,%de-; Subdivision name ,O' -'e //,? Subd. Lot # Tax Map 9/ g Block / Lot Date Subdivision Approved & /V/ V Renewal ✓ Revision Owner /Applicant Name /1%i e` 102i^e1114 Date of Previous Approval /y /d Mailing Address 6' ? /`f ®ar'e- it�r � �� e l(�y /a-� Zip `es:;�i Amount of Fee Enclosed ` 3 o 0 Building Type Lot Area No. of Bedrooms 3 Design Flow GPD o G Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to /consist of / OB e' gallon septic tank and Cie �re�%r-T Other Requirements: To be constructed by Address Wafer Supply: Public Supply From Address na-• i Pnv teSupply.Orilled. I regesent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgpaate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accadance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thenof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Deprtment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said buiWr 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 systm or any repairs thereto. Signed: of NSF, R.A. Date r- Adl:ess Z ���- �a"r+ C�sa'r� `� s� License # 2- APiROVED'VFOR CONSTRUCTION: This > t ears from the date issued unless construction of the serge treatment system has been completed an ' mafied when considered necess b e Public a nw pMit. Aphoved pr isc ► rge domestic san e By. l S4 nN W4- r>— YLXIIl Title: — Wke copy - HD File; Yellow copy - Building Inspector; Pink KHD and is revocable for cause or may be amended or Any revision or alteration of the appr ved plan requires only. t {_ Date: 1 3 a D y- Owner; Orange copy - Design professional Form CP -97 IN .a PUT NAM COUNTY DEPARTMENT 07 HEALTH DngSION OF ENVIRONMENTAL HEALTH S ERVEC ES .APP]Lff CATION TO CONSTRUCT A WATER WELL - y PCHD Permit # ",4 ' —q (o please print or type Well Location: Street Address: Town/Village Tax Grid # ���� / ���/f'd��, y� �,// �iIJq YrJ% Map /. �' Block ` Lot(s) Well Owner: Name: IAII;ri Address: Use of Well: Residential Public Supply. Air /Cond/Heat Pump Irrigation I- primairy Business Farm Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield Sought J gpm # People Served Est. of Daily Usage 6e! gal. Reason ffoir . Replace Existing Supply Test/Observation Additional Supply Drilling ;-"'New Supply (new dwelling) Deepen Existing Well Detailed Reason ffon- Drilling Well Type �/' Drilled Driven Gravel Other Is well site subject to flooding? .......................................... ............................... ... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes Y No Name of subdivision '00'e-J14' r j Lot No. _!!�9! Water Well Contractor: /V '0' crn a ri 17 o Address: Zqa Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: /Ji' /r-y Proposed well location & sources of contamination to be provided on separate sheet/plan. Date :_ .:-pp,'icant_Signatar ;u::.. &G� PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED 'YOR 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 ph requires a new permit. Well to be constructed by a watAr well dril r c rt' iLyPutnam County. Date of Issues a Permit Iss ng Official: Date of Expiratio fo Title: Pcrmit is Non- Transffcrra llc White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 fit. L: n Q� PUTNAM COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES t.... . --. r -. Yl v .v •� �.. � +1. r c -\ r.'.. ... _ ._ ... ... mss, .f .Y♦ ... .-... n .I1.. !° Ct� 'p.f KJ F Ve! _ ♦ .a +.C�. .. [. -`: Jp .y. .T '`v1 =`.. " .: 3'.s ti�'i.'...:_ .4 4.G\ .it �. .rjy.� �.uu '♦ �- APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 1-111C,Xel Vr el to ? Iva a ✓ � fZ Y't�irJ J.! � 2. Name of project: 3510 C 3. Location TN: 4. Design Professional: 5.. Address: ;2,9,72- fir-• -�Gr� �!. 6. Type of Project: ___ZPrivate/Residential Apartments Office Building Food Service Institutional Realty Subidvision Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? h/ , Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... v 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency 'fIf this�project is an area'under'the control of local"planning, zoning, or other officials, ordinances? ............................... ..............................I . .......................... 3 12. If so, have plans been submitted to such authorities? ........ ............................... _ 13. Has preliminary approval been granted by such authorities? _ Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water a groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... — 17. Is project located near a public water supply system? ....... ............................... _A d- i M . ' 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment,system? ................ //4/ 20. Name of sewage system °-- Distance to sewage system JG� 21. Date test holes observed /9 yG 22. Name of Health Inspector,,�6f o Form PC -97 b � 2 23. Project design f pw (gallons p.e day) ........... „......................... ....... - 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Ale 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? 27. Wetlands ID Number ........................................................... ..... ........................... 28. Is Wetlands Permit required? .. ............................... .............. Al C/ Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? .. ............................... Alel 30. Is of was project site used for agricultural activity involving applic�tidn of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? Yes/No 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? .... Yes/No Ala DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... Ilel 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................... 34. Are any sewage treatment areas in excess of 15% slope? ............................... d 35. Tax Map ID Number .......................... ............................... Map 9/. � Block / Lot lW- 36. Approved plans are to be returned to ..... Applicant _A,--f Design Professional 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 210.45 of the Penal Law. r� L SIGNATURES �& OFFICIAL TITLES: o` Mailing Address: ZE Z/ PUTN.ANI COUN Y DEP'ARTMEN'T OF HEALTH[ DIVISION OF E1\'VIR01®'MENTAL : EALTH SERVICES,- LETTER OF AUTBORIZATI:ON RE. property of /v/ ,-c,/ Located at 0/ Tai. Map # c1 %• _ - -- -Block Lot. Subdivision of d� d�"�7�"�``�✓ _ Subdivision Lot 4 _ _ _ _filed Map # /Y"d S Date Filed -f — A(r % Gentlemen: This letter is to auth01 -Izc a duly li nsecl Professional L1i Meer or Re islcled �chitect to apply for the required � g PA y wastewater treatrnent and /or water supply peimit(s) to serve the Above -noted property in accordance with the. st.&Izdards, rules or regulations as promulgated by the PLiblic Acalth Director of the Putnam County .Ifealth Department, and to sign atl necessary papers on my behalf in this matter aI]0 t0 stipervlse the Co1IStrllctian ofsaid wastewater tretmeut Auld /or water supply systems in con:lormity with the provisions ol� Article 145 and /or 147 ol'the Education Law, the :Pciblic Health. r:..... 1�1', llld.t��t "hlltllc�I1`I:Cour�ty,arrit�iry �r?cll,:_ _.._, ,:._.... . r / � Very truly yours, Countersigned: Signed: r.,,4 P .L:., 1 , .4 ^ -_7' Y O - -- (owner of Property) Meiling Ad ,,/114 State /C, 15, 5-- Tetephone -.%/y Mailing Address: AlL Zip / Telephoue: Form .LA -97 State . 14.164 (W7) —Tay I? rPRQJECT I.D. NUMBER. .rol ^-••%^•- v -:..rr -- -.b i r. .�. ,. +rte.- q�a•�:a rCw-.: :.A,c� <..1 •did.. .. �:: .T ...- .'' -..ti _ _.ps..;:.q -� -v v..h. -. .- ., �r >'-- 1.frT'- -v :. a -v^+.. -.. ".r -f ...1 .r - "f State EnvinwimIntol oustity RaWow SHORT ENVIRONMENTAL AUESSMENT FORM Fw UNLIUED A=ONS Only PART 8— PROJEC7' INFORMATION (To be completed by AppOcant or Projoct aporlsor) 1. APPLICANT ISP NSOR ?.. 4"ROIECT NAME 3. PROJECT LOCATION: Munlc•ipaIlty 4 PRECISE LOCATION (Street address and road Inform e, prominent landmarks, aft.. or provldo mapi S. IS PROPOSED ACTION- 0 Expansion y ❑ Modificatmnlailsrotlon �_.— _. _. _.� ._- - -. -- _ _ _.___ _ ___._ _.- -•- -...... 6. DESCRIBE PROJECT BRIEFLY• i Y. .AMOUNT OF U AFF,[fC]L�ED: _— inifiolly ___!'- acr®e 1111Imataly A-1 ecrosa. WILL PROr 6 ED ACTION COMPLY WITH EXISTING :CON THER EXISTING LAND USE At W RJCTIOWS7 AYOU No If No, dwrlbo briefly 9. W}}H�HAAT__ IS PRESENT LAND USE USE IN 'V4CiN(TY OF PROJCCr? r LJ tssidenlfal Industrial LD Cornmorclol D Agrloullurs , psrklForosVOpon aspaco Other - V 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTiMATIELY FV101, ANY OTHER GOVERNMENTAL AGENCY (FEDERAL., STATE OR LOCAL) ?rr-•t lxYes t J No If yan, Ilol ®(lancy(s) and pcmttliJupptovels Aw 4Gr% 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PEPWIT OR APPROVA' � xYOS ❑ No it yes, ilat sWey name and p�lrmiVapproval � � ��% yoi �.r V'x 12 AS A R1E5UlT F' • OPOSED ACTION WILL EXISTING PERMITJAPPROVAL REQUIRE MOD 4F)CA'I' ION � 0 r You No v CERTIFY THAT THE INFORMATION PROVIDPO ABOVE IS '$AUE TO THE WEST OF MY VO4OWLEME Appllcanb'spattaor rtamm:.._�._L —' — .— ...-- -•— .__� Oats: /� --- rte•- •� /- -. —_— Signature:' -- r'`- //- - --- -- -- -y�/ / ° -- -- If the action is In tho Oo &Ittal Are*, mod you are a state 090rocy, comploto qho ComRtal Assosame nt Form before gr®ce®dlrap with this a9wasmont ') VER a SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 26, 2007 Re: Proposed SSTS Renewal — Kanter Peekskill Hollow Turnpike, (T) Putnam Valley T.M. # 91.08 -1 -14 This office has received and reviewed the most recent set of plans for the above - mentioned project.. We would like to offer the following comments for your review and consideration. 1. The updated construction permit notes from Bulletin ST -19, Appendix C are to be provided (ST -19 was revised this past July). 2. Note # 6 pertaining to the well is to be removed since no well is being drilled. 3. A letter from the water supplier stating that adequate pressure is available to the site is to _be provided. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP: ens Very truly' yours, Joseph tr f Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 =6648 -1 J I': B i I t j''ti ,'1 i`W a { ", � z 'i i e I �' r ,. �'; o r RE: Property of LETTER OF AUTHORIZATION lov ,l- Located at P✓ T V Tax Map # it Block / Lot Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in �confbrmity with, the; p nArticle,145 .. and/or.147 o heEducation Law;: Public.Health l Law, and the Putnam County Sanitary Code. r l Countersigne, P.E., R.A., #4 0 F FRANCS L Very truly yours, Signed: (Owner of Property) n O Mailing Ad s 472-1 Mailing Address: State I Zip /G O�r State A� Telephone: �/� /�' �� �� y Telephone: Form LA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 26, 2007 Re: Proposed SSTS Renewal — Kanter Peekskill Hollow Turnpike, (T) Putnam Valley T.M. # 91.08 -1 -14 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. /1. The updated construction permit notes from Bulletin ST -19, Appendix C are to be provided (ST -19 was revised this past July). A Note # 6 pertaining to the well is to be removed since no well is being drilled. �3. A letter from the water supplier stating that adequate pressure is available to the site is to " ...zbe:- rovided.q-�Grr This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP: ens Very truly yours, 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 76558 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 DRWSHON 07 ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR E" \\ \ c, i TREATMENT SYSTEM Located at ��,�/�y ,' /� ,, f /�0r Town or Village /�""1�70477 K �c Subdivision name 47 Subd. Lot # Tax Map ? /,g Block 1 Lot Date Subdivision Approved 412 &7.4 Owner /Applicant Name,, �rl,- Z �al eAe Mailing Address Amount of Fee Enclosed -1-jaa Renewal 1/` Revision Date of Previous Approval r ^, y Zip s Building Type Lot Area %• i No. of Bedrooms -3 Design Flow GPD e f FUI Section Only Depth \V®Iuume PCHID NOTIFICATION IS REQUIRED WHEN ]KILL IS COMPLETED Sepaa•ate Sewea•age System to consist of / 00 c lr gallon septic tank and 3 �� • F Other Requirements: -- To be constructed by Address -atgLS.UADP 1y.- Public Supply From �--� Address or: Private Supply Drihed�by /!� h r��,� Address f" j! J✓y' I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P Address .297P 0� R.A. Date EELcense # APPROVED FOR CONSTRUCTION: This approval expi ® 4W date issued unless construction of the sewage treatment system has been completed and inspected by ocable for cause or may be amended or modified when considered necessary by the Public Health Direct r alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage By �` Title: Date: D� copy %D File; Yellow copy - Bui ding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AyPf+yTPLICATION TO CONSTRUCT A WATER WELL •*�ei�t Vfty i,•T0.. •�pc... ..:j.N.•.a ►•.. �•• g�� 9 •'r`� �V 'ANY'- ♦O . Pw :'Ys�.. \10.:. TI r.•Hi�i.• 1 Well Location: Street Address: Town/Village Tax Grid # In f� �' Mapf) .I' Block./ Lot(s) Well Owner: Name: Address: f -I q jp-, Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 3'' gpm # People Served 4 Est. of Daily Usage J;L gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ............. .......................... ............................... Yeses No Name of subdivision Lot No. Water Well Contractor: Wr» Address: 111E, Is Public Water Supply available to site? .................................. ............................... Yes No if" Name of Public Water Supply: -- Town/Village Distance to property from nearest water main: 11)iIe. '4 Proposed well location & sources of contamination.to be provided on separate sheet/plan. pa_ to :, a " Applicant Signature:.., 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 ► y D Permit I ss g 0 ffici Date of Expiration 0 p Title: Permit is Non-Transfdrablb White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Commissioner of Health 1LOR ETTA I OLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: October 11, 2005 County Executive Re: Proposed SSTS Renewal— Kantor Peekskill Hollow Turnpike (T) Putnam Valley, TM# 91.08 -1 -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. Tax map number provided appears to be incorrect. 2. There is no field testing shown in the expansion area. Ell (-2:'PV This office will continue its review upon consideration of the above mentioned comments: Please feel free to`contact rile afex;:. any T,aesdons aria ;. 21_'f 5 JSP:cj Sincerely, 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 SHERLITA ,�MLER, MIA, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Frank Sullivan, PE 2972 Femcrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: October 11, 2005 ROBF.J2T l RONDI County Executive J Re: Proposed SSTS Renewal — Kantor Peekskill Hollow Turnpike (T) Putnam Valley, TM# 91.08 -1 -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. Tax map number provided appears to be incorrect. 2. There is no field testing shown in the expansion area. This office will continue its review upon consideration of the above mentioned comments. Please -:.._: fi✓el: ire :lcr:��c,� rn .at e x� 1:S �i :an alu stj w afJk ': ea r- JSP:cj Sincerely, 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 }.���J'fT1CNR A�' M�cC®��TJNTY DEPARTMENT OF IHIE.�A1.71�L��T'H/^1V� ••• •�T�= Y'+`- �ti�f..~v ^.1W Ji Y 1L AJ��li�V'e ®A �iV V 11���1Ya.LiJ�iV �1L�1��111����'��i:lell�l V ��1.�1L'J�_ti'� �_: .- -- .: -.- LETTER OF AUTHORIZATION RE: Property of ���-�' rG�rl 104v- Located at i� r. T/V 14a5' 17, Tax Map # Block Lot Subdivision of%- ���gj/`' Subdivision Lot # l- Filed Map # Gentlemen: This letter is to authorize d o_�5 �p A7 Date Filed / 'W a duly licensed Professional Engineer _for Registered Architect to apply for the required wastewater treatment and/or water supply 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 147 of the Education Law, the Public Health Law; aiid the Putnam CUurty' Sariigarj Code.— ~ �� P.E., R.A., co, Very truly yours, Signed: (Owner of Property) ,K a Mailing A ° ° �c %L'�� Mailing Address: 7 2g8 5 State '2;, Zip /�59>' State /VV Zip e ~l Telephone: �f ` �' Telephone: j/ Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ _-__ .%.:" ... .•.�,,. ;-i ^wlaG .;:..pii'.; r'•.•. .;r. ... 4-�w r. CONSTRUCTION PERMIT FOR SE TR MENT SYSTEM PERMIT # PY Located at �'� %�7 �� l' /�d� Ja,,, Town or Village v d a Subdivision name 0r0' //v �5-s 7' Subd. Lot # - Tax Map Block / Lot Date Subdivision Approved i% /d 7,4 Renewal *"** Revision Owner /Applicant Name ���°'�'� /�G1 h y� /� Date of Previous Approval _ Mailing Address�� /�% /i %� << G✓ �����! �� /901/✓ Zip A5 go Amount of Fee Enclosed d d Building Type c'�!���i'CC' Lot Area/ J7 No. of Bedrooms 3 Design Flow GPD e0 Fill Section Only. Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of % t7yy gallon septic tank and ,3 v v • F Other Requirements: •Ir To be constructed by Address Water Sunnly: Public Supply From Address or: ` -r `� Pi�i°vafe SuiStiTv Drilled l v -; 7�' �" � Address '.i /";. //A v I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. of NEW cis o . Signed: y F.E. A-' R.A. Date Address r �" !4,44- License # Z y Y 9r-i' APPROVED FOR CONSTRUCT - val expires two years from the date issued unless construction of the sewage treatment system has been complete an 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 perjpit. Approved for discharge of domestic sanitary sewage only. �9,6opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 IPUTNAM COUNTY DEPARTMENT ®IF HEALTH IIDffWSff(DN OF ENVIRONMENTAL HEALTH S ERWCIES APPLICATION TO CONSTRUCT A WATER WELL .,. .Nr :. -.Fa- c _ - .._' �= �r �yF: "d P print or type 'CHD Permit # 13 ^ d (, Well➢ Location: Street Address: Town/Village Tax Grid # Y✓ %� �/ V �''�I� a�r Map / Alock / Lot(s) 4 WeRlOwner: Name: 5)-zlreJo la, K IM (dress: // 11 4 A-W v///, Use of Welk esidential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield Sought _,I' gpm # People Served -_4 Est. of Daily Usage po gal. Reason for Replace Existing Supply Test/Observation Additional Supply ➢DriMa'g d/ONew Supply (new dwelling) Deepen Existing Well Detailed Reason -1-V erzviL& "4v e I ffor IIDAWmg WeU Type _Ae"brilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? .................................... ............................... Yeses No Name of subdivision Lot No. OC Water Well Contractor: 4' • A Ja or f:g® ra Address: yam'`/ � �- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: --9 Town/Village -� Distance to property from nearest water main: , Proposed well well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature:_. 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 fl 3 ° l ° Permit Iss ing Official: A�z;ie� f oC Date of Expiration t v Po /y Title: Permit is lion- T>ransffer rabRe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller . Form WP -97 FA LORETTA MOLINARI R.N., M.S.N. Public Health Director October 27, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Dear Mr. Sullivan: ROBERT J. BONDI County Executive Proposed SSTS Renewal - Kantor Old Peekskill Hollow Tpk., (T) Putnam Valley TM# 91.8 -1 -14 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. X-1. Please provide a note stating that'the SSTS area must be staked by a licensed land surveyor before any construction begins. Please clarify expansion area trenches, show and label lengths and provide more topography ni 2G- tale p1an,�o SIoI cart etf:zr� d:ov _ y:and -Z iii itie er..pru expansion area; �.• Is there a 100 -year flood plain present due to the brook? If so, please show flood plain limits and elevation of 100 -year flood plan. Please show any driveway FegaWiag. re1pJ .,% / Owners name on plan is incorrect. Effluent pipe label needs to include `@ 1 % minimum' in both the plan and the profile view. R3enewal site note needs to be provided. Well needs to be a minimum of 25 feet from footing /roof leader drains. It appears a small portion of the property is in Westchester County. Please show county line on plans. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, �, !a" Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE:. Property of Located at LETTER OF AUTHORIZATION T/V /��� Tax Map # 5V Block J Lot - -- Subdivision of Prti J4 G=-� Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize 0}''o aduly licensed Professional EngineW r Registered Architect to apply for the required viastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance viith 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 natter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with. the., provisions. of...Article 1.45_ and/or 147 of the Education,I,aw, the ]?ublic Health...., ;...... ... ... .. ....4... _. o. �-. .•. ...a -. yr y._..s.+. .. ..:.� -':'. .. .. r. .�.:..++• w-... . .. �..�r. ��.. .. .. q, ...�.v r.... ..ayt. ... .Q .. .",,. • .. .t,. - .a. ...w M law, and the Putnam bounty Sanitary bode. Countersigned: l.E., R.A., # ° _ CO Kailing A * a.'- state % Zip telephone: Very truly yours, Signed: (Owner of Property) Mailing w Address: / State A if Zip lUS& 7 Telephone: ���--�4 6 0// Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH r - DIVISION OF ENVIRO �,y� NMENTAL HEALTH - INl)TVIDjJAL WATER. S' PLY :�c_$LIBSUI�F+O��W,G'Li4iVTENT 5YS'TENiS ' • : �,, r: '`- : » -• ` jj,�� " l(= " REVIEW SHEET T FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: © ,I lee4 k-s k<<1 Ik14� ILEVIEWED.BY: RM, GR, SRDATE: 3y, 473 TAX MAP #: (CONFIRMED) (' Y N DOCUMENTS `)PERMIT APPLICATION 4--Y )WELL PERMIT OR PWS LETTER OF AUTHORIZATION DATA SHEET (DDS) LATE RESOLUTION SHORT EAF PLANS -THREE SETS UVA(___)R USE PLANS - TWO SETS ARIANCE REQUEST SUBDIVISION T (LiGAL SUBDIVISION ' SUBDIVISION APPROVAL CHECKED UUPBRC RATEE, �- ��--- - / J� (�U)FfLL vucLD DEPTH ,� " � . �fTRTAIN DRAIN REQUIRED GENERAL U :01�OCATED 3N NYC WATERSHED U TLANS SUBMITTED TO DEP t �7� 1D LEGATED TO PCE (. J (,::::OEP APPROVAL, IF REQ'D `EP TEST HOLES OBSERVED L m CS TO BE WITNESSED (� - APPROVAL SSDS ADJ, LOTS ULANDS (TOWN/DEC PERMIT REQ'D ?) U TA ON DDS PLAN'S & PERMIT SAME (� 1969 NEIGHBOR NOTIFICATION IL TESTING LOTS >10 YEARS OLD MVIRED •DETAILS ON PLANS )ZWAGE SYSTEM PLAN-(NORTH ARROW) )51)S HYDRAULIC PROFILE WUVTTY FLOW (mNSTRUCTION NOTES 1 -15 ICSIGN DATA: PERC & DEEP RESULTS CONTOLt�T & PROPOSED (_1VEWAI' & SLOPE S,gj�' DRAINS G'DA SOIL. TYPE BOUNDARIES ( �7�I'LE BLOCK; OWNERS NAME ADDRESS -TU, PE/RA; NAME, ADDRESS, PHONE# OF DRAWINGMEVISION Ct:jU_JIk7UM REFERENCE . (&, r UCATION OF WATERCOURSES, PONDS IMS,WE'TLANDS WrrH]I 200' OF P.L. �ROPOSED FINISH FLOOR AND ESEMENT ELEVATIONS U)L V&lLS .4 SSDS S WAN 200' OF SSTS I;QPERTY METES & BOUNDS (_� EOSION CONTROL FOA HOUSE, WELL & STS, EROSION CONTROL NOTE Y /1`i ( REOUIRED DETA M ON PLA -S CONT'D? )HOUSE SEWER - I/P FT. 4 "0'; TYPE PIPE. CAST IRON C-- )E20 2, 0 BENDS; MAX BENDS 45' W /CLEANOUT L)�ITE NOTE (NO CHANGE _ FILL SYSTETid (__)(-J-10' HORIZONTAL; PAST TRENCH SLO ),GRADE • (___)( FILL SPECS / FILL NO /U�� FILL P DR4E S- • UU IMENslaNS .. IN EXPANSION AREA FILL GREATER THA.N2 FEET vU CLAY BARRIER (__)UFILL CERTIFICA ©'1" /�/ __)DEPTH G N PLAN FOR R.O.B.,'UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM•TOE OF SLOPE "C5 JLF TRENCH PROVIDED MAX 60FT MA ~ lZ a end ,PARALLEL TO CONTOURS ( ✓S 100% EXPANSION PROVIDED DET*fL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL CxX-_ )GEOTEXTMt COVER - SEPARATION DISTANCES ON PLAN - F12,OM -SSTS ( H10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL MTO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE, (Inc., ezp n). • • . , ; _ _ ::, (! art 50! TOAC'A 4SIPi 35' TO:�Ii�Ji�AIN,�I'YPED WAT]Eit '> r (�� 10' TO WATER LINE (pits - 201) Fr 50'- INTERMITTENT DRAINAGE COURSE ( s/ 0200'/500' RESERVOM ETC. 150' GALLEY SYSTEMS ( (__)10' MIN TO LEDGE OUTCROP SEPTIC TANK L(,_)10' FROM FOUNDATION; 50' TO WELL WELL L&-}DIMENSIONS TO PROPERTY LINES //(__)1, jLOCATION OF SERVICE CONNECTION (MIN 15' TO'PROPERTY LINE IN SSTTS AREA .DED T ®1$ %, II' REQUIRED. -� UL-)Pump NOTES . UUDOSE 95% OF PH'E UW OSE VOLUME NOTED r (U( )DETAIL FO CKHAIN, (PIPE TYPE, ETC.) (.J(—JPIT -BOX SHOWN & DETAILED (- -JL-)k AY STORAGE; ABOVE ALARM CURTAIN D )STANDPIPES, 5' BOTH , DETAIL C-(__ --)15' MYN to CD o, 20' -4 %, 25' -3 %, 35' -1 %,100 % - <1% LU(__.)20' MAN DISCHARGE/100' with 102 cons day discharge I . U to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DHVISION OF ENVIRONMENTAL HEAL THSERVICES COMTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village Subdivision name Vim' - //-? Subd.. Lot# Date,, Subdivision Approved /W 7,vl Owner /Applicant Name IV,'C4 e-11 elllo Mailing Address Amount of Fee Enclosed 0 -30 Tax Map -fl. 9 Block � Lot' -44 Renewal 41" Revision Date of Previous Approval Zip Building Type e C Lot Area No. of Bedrooms 3 Design Flow GPD Fill Section, Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S d, 4rl y.stem to consist of 14 gallon septic tank and .477't Other Requirements: To be constructed by Address Wate��Supply: Public Supply From Address iva-te Supply,.DaZ�&b I represent, that I am wholly- and completely responsible for the design and location of the pr posqd (s) and :that system separate sewage treatment system described above will be constructed as s-9hown oni the ,;'aippr eo, aTgpdm6ntf�erpio�,andin accordance with the standards, rules and regulations of the Putnam t of th;`:x`,` that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will bi. 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. /. /-A, / ze f Z��, Signed: Address f r APFROVEIIFOR CONSTRUCTION: This approval sewage treatment system has been completed and inspect 4 " modified when considered necessary bvjhePuk�� of NE R.A. Date 0 License # 2 t anew pf e j {nit. Ap 6 ve, i rg sanitary ew& By: Ti itle. White copy - HD File; Yellow copy - Building Inspector; Pink cop the date issued unless construction of the s teVocable for cause or may be,arnended or sion or alteration of the appr ved plan. requires 5 v n arm Date: i >3 c7 0 t - Owner; Orange copy - Design irofessioiial. Form CP-97 117 M VILEY 20 "OgH141.¢ asks MST w o/c c i 1 t Ia; 9 705 RD hous a useum Adams Corners 3 ` ✓urn 11 ! Cem - •� f 9 MLL Hill Park Cem .. _ ia:. :�_#:" - ��, - � w _ "••fir ..: � _ Mohegan� ry`' Lake iG f s � co h i `T L t z MLLL POND yy Y � Oq Q W ��J= y y Q' S ✓ �J'�4 i o FODUk' IKE P Q � W L O x m S =i�u Q m ¢ 'ry l:l n a m e NpllpW , -NAM C ®U � alle VALLEY . HEST E .. _ ia:. :�_#:" - ��, - � w _ "••fir ..: � _ Mohegan� ry`' Lake iG f s � co h i 11 -20 -2007 13:41 GEMERAL ICE MACHINE COR 845 528 8581 :....'+ Y..: TOWN OF CORTLANDT DEPARTMENT OF TECHNICAL WATER DIVISION LINDA D. Pt1GLIS1 Town Hall, 1 Heady Street, Cortlandt Manor, NY 10561 Town Supervisor www.townofcortlandt.coni Town Board Mernbers (914) 734 -1026 JOSEPH D, CERRETO FAX (914) 734 -1029 FRANCIS X. FARRELL ANN UNDAU JOHN E, SLOAN ovember 20, 2007 Mr. Joe Paravati Putnam Cbunty Dept. oi'Health 1 Geneva Road Brewster; NY 10509 Re: Kantor Old Peekskill Hollow Turnpike Town of Cortlandt/Putnam Valley Section 13.09 Block 2 Lot 5 (Town of Cortlandt) Section 91.8 Block 1 Lot 14 (Putnam Valley) PAGE1 EDWARD VERGANO, P,E. Director STEPHEN J. FERREIRA, P.E. Deputy Director. ROBERT J. FOSTER Distribution Superintendont Dear Mr - Paravati: Parcel Section 13.09 Block 2 Lot 5 is within the Cortlandt Consolidated Water s°ietter-is•ty certify tlz;.t -this -Town- W4 eT di ,trlbi tier systert providing the required supply and pressure for the proposed single family home. Sin.ce_rely, Stephen J. Fe eira, P.E. Deputy Director of Technical Services Water Division YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 _ rp zII ♦•o __ (914_) 245 28.00 w�ritiw .'+�aas ��i• irR'^f! R.• R!+•.`9� 1'1n - ...... � .� 9 Wi+.•K T. ':'T- 't.C•�.40�'',rj':.:,.��vry1 i.V'CA ��Ob-�s51 �a?. M.. n �P�.. LAB #: 1.101431 CLIENT #: 62431 NON STAT PROC PAGE: 1 of 1 KANTER, STEVEN DATE /TIME TAKEN: 04/11/11 10:45 45 RED MILL RD DATE %TIME REC'D: 04/11/11 12:10 CORTLANDT MANOR, NY 10567 REPORT DATE: 04/12/11 PHONE: (914)- 879 -0090 SAMPLING SITE: 5 PEEKSKILL HOLLOW TYPKN : PUTNAM VALLEY, NY BATH COLD BY: STEVEN KANTER NOTES.... DATE FLAG PROCEDURE 04/12/11 MF T. COLIFORM COMMENTS: FAX TO 528 -5088 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE — : < 4C COL,IFORM METH: MF RESULT NORMAL - RANGE METHOD ABSENT '/100 ML ABSENT SM 18 -20 9222B COMMENTS: .MFTC oliform = This result indicates that (was), (was not) of a satisfactory sanitary w York State and EPA federal drinking this parameter. This comment applies to the only. the water quality according to water standard for Total Coliform test THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE LY TO T ESE PLES RECEIVED BY THE LAB SUBMITTED BY: Albert H. adovani, M.T.(ASC ) Director ELAP# 10323 Rpr 12 2011 16:57 HP LRSERJET FRX YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 14 ) "'�'4� -�� Albert H. Padovani, Director p.1 LAB #: 1.101431 CLIENT #: 62431 14ON STAT PROC PAGE: 1 of 1 N N N N w w w N N y N N M N N N N N N N N M N N N y N N N w N N N N N N y N N N N N N N N M N N N y N y N -------------- N ------ KANTER, STEVEN DATE /TIME TAKEN: 04/11/11 10:45 45 RED MILL RD DATE /TIME RECD: 04/11/11 12 :10 CORTLANDT FOR, XY 10567 REPORT DATE: 04/12/11 PHONE: (914)- 879 -0090 SAMPLING SITE: 5 PEEKSKILL HOLLOW TYPKN SAMPLE TYPE..: POTABLE PUTXRM VALLEY, .NY BATH PRESERVATIVES: ATONE COLD BY: STEVEN KANTER. TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF N M N N N y M MN N N N w N N N N N N N N N N N N N y y N N N N N y N M N N N M N N N N N N N N N N N N N w N N N y N N y y N N y M N N N N w N N w r N N N DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 04/12/11 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222E COMMENTS: FAX TO 528 -5088 COMMENTS: MFTC oliform = This result indicates that the water (was)-, _ (was not) of a satisfactory sanitary quality according to w York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. .fir # .�.� - .. w ,,,�� ...........� -. .. .... `..,0.,.. ....a .t.v- "t • '"'Ot « , . ... ,fir �.�-� � - . _ ... �w.. � -.... -..v -. , o .... �.r.. .- �:.� avw:'R .. _•.,},. �.-5 .. :. �. THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF MELAC, AND RELATE Y TO SE PLES RECEIVED BY THE LAB I SUBMITTED BY: Albert adovani, M.T.(ASC ) Director ELAP# 10323 04 -12 -2011 15:49 PAGaE1 SHERLITA'AMLER, MD, - MS, FAAP Commissioner of Health ROBERT MORRIS, PE Director of Environmental Health April 1, 2011 Frank Sullivan, P.E. -2972Ferncrest-Drive Yorktown Heights, NY. 10598 Dear Mr. Sullivan: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Office (845) 808-.1390 Fax (845) 278-7921 or (845) 808-1937 Re: Construction Compliance — Kanter Peekskill Hollow Turnpike (T) Putnam.Valley PAUL ELDRIDGE County Executive 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. The E-911 address form has not been provided. he E-911 address is to be provided on all documents and plans. s. A water analysis for bacteria only is to be provided. 1_4,,'-Ihe driveway is to be shown on the plans. 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. Vefy truly yours f J seph S Paravati, Jr., P.E. Assistant an� Public Health Engineer JSP:cW SEEERfVII!!A!'1LLVna. AMD, MS FL9tf11C Commissioner ofHealth Director of Environmental Health . April 1, 2011 Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights, NY. 10598 Dear Mr. Sullivan: PAUL L' 1W10.1`s811/GE County Executive «;�G.= .y "�.�yt."! . �.gT,.vh..�Q..•a::I��.;�.�.R.cP I v.�'�D ^JCIP�G..¢wn�!1.1� DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ®mice (845) 8084390 Fax .(845) 278 -7921 or (845) 808 -1937 Re: Construction Compliance — Kanter Peekskill Hollow Turnpike (T) Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the - following comments for your review and consideration. 1. The E -911 address form has not been provided. 2. The E -911 address is to be provided on all documents and plans. 3. A water analysis for bacteria only is to be provided. w.... p.. � -...:. - �. V�i'. �o'VP1Y C-��1'E.�v'�.i:c'�a.'.. .. ....mow -.+►r �. •.,�.. .••co- r. ...�. <.._. +�0 -... e. - � .�� es..q .�.+. w....;vr -. o. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly J seph S. Pazavati, Jr., P.E. Assistant Public Health Engineer JSP:cw SMRLITA AMLFA NA MS, FAAP Commissioner ofHealth ROBERT MORRIS, PE �'�► '�' `Director of E+rvir ®r�n�nf� March 21, 2011 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 4390 Fax (845) 278 -7921 or (845) 808 -1937 Re: Field Inspection Peekskill Hollow Turnpike (T) Putnam Valley, TM 91.8 -1 -14 PAUL ELDRIDGE County Executive A re- inspection at the above referenced property has been completed. There are no further comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw 4� SHERLITA AMLER, MD, IBIS, FAAP ,Commissioner of,Heak{ -. . •.Ow. . . CY � r1 j .. u. � LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: IR®BERT,I. B ®NDI �. 21' l: '..c 'Y Tl�Gt^NryTC�':•i- n tO:- '1....1 •.�iw. '.:�..Qpr„.�'►- .�.�,•..rv.w DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health September 29, 2008 Re: Field Inspection Peekskill Hollow Turnpike (T) Putnam Valley, TM # 91.8 -1 -14 . r. ,_ -. �),_�.z�... ,�. - c. ..�>...�_�., .�; .._ •_ -' •. ••- i._ .•w r+:,,. �, .. ...yes..... -c.:.. °ci-' . . ri -•_^^- N.�. -„�.. _�. .- aa•..- ..� -. -. co -dv^- ..�. �- ;.�...,.� >.. r. The above referenced separate sewage treatment system can be backfilled. The following comment needs to be addressed. o A bedroom count needs to be performed by this Department upon completion of construction. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 11 1 4'11 [1231'9 nip COUNTY DEPARTMENT 0IF HEALTH XON OF IENWRONMENTAIL HEALTH ..;asi,'2 -:: �:.�. :.r -.. ..y- .. .- .. �.. _ . _,.. '� .. Vii•. +KC,it"C..�.',tiL'. a'•.::'�S E..�.,Y .�. d- � s NSTRU CTffGN P ERMIT FOR S.EWAGE TR EATMENT SYSTE V� /\ � Located J; �C ®J lsrb/ �� Town or Village ap /.- e—jl Subdivision name &ubd. Lot # j4. Tax Map9'Block Lot Date Subdivision Approved :g4/f,4 /? Renewal Revision Owner /Applicant Name Date of Previous Approval Mailing Address �/ %y� / /i/.� Zip Amount of Fee Enclosed ��DO Building Type Lot Area /Ofoo. of Bedrooms 3 Design Flow GPD Vie& IFiRl Section Only Depth Volume PCIEIHID I\ YO'Il'11IFIICATION IS Ili 1< IR E1<D WHEN FILL IS COMPLETED Sepairate Sewerage System to consist of /o v © gallon septic tank and 50- e2!� w ;k 12-4tzr,�Z Other Requirements: To be constructed by Address WateL S222-1y: Public Supply From Address �a .. .. __ . ... Private Supply �Dt lled by .: Address- _ _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage.treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any paft-of said sewage treatment system during the period of two (2) years immediately following the date of the is ;ofmthe approval of the Certificate of Construction Compliance of the original system or any repairs thereto. 0,01() F N E CO, Signe s ` -� `� P.E. k R.A. Date Address C° License # al* d;F FY— APPROVPYFOR CONS 'I' I :'-This a 1 expires two years from the date issued unless construction of the sewage treatment system has be ected by the PCHD and is revocable for cause or may be amended or modified when considered necess Health Director. Any revision or alteration of the approved plan requires a new p it. Appro d fo ischarge of dom tic sanitary sewage only. � -� Pf Y: Title: Date: r L,)#107 hit copy - HD File; Yellow copy - Buildi Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEAL � - �- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # - Located at &-- A1Z AJIOgl Town or Village Owner /Applicant Name �yZ° %!yr!/`�/` Tax Map / Block Lot 14- Formerly Subdivision Name Vl- e—ll oecr- 1 s Subd. Lot #" Mailing Address r"v r/�lj� /�i �! �i�l �i'!� / v%� Zip Date Construction Permit Issued by PCHD d-2--t-bo 7 Separate Sewerage System built by .!'f� n � �t5 2 ?Address ' -, Consisting of lee b Gallon Septic Tank and OO !t mT W) Other Requirements: Water Supply: _ /e Public Supply From (r7/ e!`w / /�,Oe�iAddress Gar �� 'I or: Private Supply Drilled by Address - - Building Type eiri aG 'Has erosion control been completed? Number of Bedrooms 3 Has garbage grinder been installed? We' I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD'Construction Permit and approved plans and the standards, rules and regulations of the Putnar1_.0ft'-1-g'Pp tment of Health. Date: 3 / J11. Certified by P i 1 (Design rdf goon I Address 29r 7 fJ An er n occupying remises served b the above s "shall Y P PYmg p Y Y ,. ) to secure the correction of any unsanitary conditions resulting. from treatment system shall become null and void as soon as a I of the private water supply shall become null and void approvals are subject to modification or change when, revocation, modification or change is necessary. when a P.E. A"" R.A. ' nse # )tly�te such action as may be necessary usage. Approval of the separate sewage ewer becomes available and the approval water supply becomes available. Such in the judgment of the Public Health Director, such Date: _6� o !! Wh' a copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 09/24/2008 01:07 9149624248 FRANK I PAGE 01 e� ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMINTAL HEALTH SERVI( "JO EPH ❑ GENE 1 EOUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. PCHD Constmction Permit # /2 r / 3- �� For: Fi.II Located: ec:- lev Mc Owner /,Applicant Name: r r, TM _ Formerly: __ _ — Subdivision Name:. Comments: Subdivision Lot # — ls system fill completed? Date:. Is system complete? Date: Is system constructed as per plans . Is well drilled? __ �% //a'� Date: Is well located as per plazas? 16-t Are erosion control measures in place? --� Trenches f� r !. V Blo k �_ Lot i-W- I certify that the system(s), as listed, at the above premises has been constructed d I have inspected and verified their completion in accordance with the issued PCHD Consiruction Permit and � approved plans and the Standards, Rules and Regulations of the Putnam 'Co ty Departxment of j Date'. ' d Certified by: ;v/I�t��'' Design Professional Address: r' r/� �- Lic. # Comments: u Form FIR -99 0 P1 r >AK /V-e- 9F V, e- -el -, PE RA 2Hy Public Heahk Director DEPARTNENT OF FMAL `H 1 Geneva Road, Brewster, New York 10509 C- c., Associate Public Health Director Director of Patient Services Environnie®tal Health (845)278-6130 Pax(845)278-7921 Nursing Services (845) 278 - 6558 WIC (845) 278.6678 Fax (843) 278.6085 Early 8nlerwnflow?reschoo0 (845) 278 e 6014 1?an (843) 278 - 6648 9911 ADDRESS VERIFICATION FOR OWNERS NAME: KANTF.R TAX MAP NUMBER: 91.8-1-14 TOWN: Putnam Valley G AUTHORIZED TOWN OFFICIAL: (Sign& re) Doreen C. Piacente ..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 Certificatc of Construction Compliance. (E911 ver&m) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ •1i • .. �.: `i':..,. . r .^fi � a v 'w ° °. „ � `a' ... �A i.... �Y'�.'Sy ^. ' e .,'.'ry ` a. T...: r .. %ti .9 �= li'' • .'fa .., • %. 4.: z8 .. '.,. -;�z' � »'G qy . ■ ...Y►- i'..'1,.. .T.r� ..... �I GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 1�r Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Town/Village Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the ,.._.. �.. .system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated:. Month ay y z Year Ao If Signature: Title: �w 10 r� General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Corporation Name (if corporation) Address: State Zip Form GS -97 �E 3 ' PUTNAM COUNTY DEPARTMENTO fALTH DWISION OF E /IRON 1EALT SEOICES. Iris APPROVED A NOTED COP1F CiMANCE V41TH z :7o _ 93 APPLICABLE RUL:rS AND REGULATIONS OF THE 9 . 7b &►a •, 'F PUTNAM COUPtIY HEALTH- _DcrPARTMENT__.,� j2.X 5, �° s ,r� 9a 9•s' 6T1TLE. DATE., • m 4t a at yoh A; ', '�'." ;"- � ' � } . � � f�� • :� 11 Q� ' l:h+L tom'' ; ao? 0:�,, 91(2 41Y 4 0 ��. �..