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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.32-1-3 BOX 36 oil . , I lo�o'� . N4 , ,' �94 , . , T No , No No ,�� a , I 1.6 No �' _ f IL r Ir r rillo Nip- I �, PUTNAM COUNTY DEPARTMENT OF HEALTH 2010• DIVISION OF ENVIRONMENTAL HEALTH SERVICES RIC tllfell Perini �`� Y" IVIO WFI_L COMPLETION REPORT Well Location Street Address: Town/Villa e: 9 Tax Ma p # p � � t �Z- � �' 3 Map r BlockZ,. G;f?S) ' Well Owner: Name: Address: .F� a.Yhc.4 r' Use of Well: 1- Primary 2- Secondary VResidential _Public Supply Air cond /heat pump _Irrigation Business Farm Testimonitoring —Other(specify) Industrial Institutional Standby Drilling Equipment IRotary _Cable percussion _Compressed air percussion _Other(specify) Well Type _Screened Open end casing _ Open hole in bedrock _Other Casing Details Total Length a-1 ft. Length below grade�0ft.;:: Diameter �P in. Weight per foot 14 lb/ft . Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: Yes Y No Liner: _Yes�No Screen Details Diameter in Slot Size Length (ft) Dept to Screen ft eevelo ed? First _Yes _No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours lYield gpm Depth Date easure from land surface-static specs ft '30 During yield test (ft) Depth o competed well In ft. 1 300 Well. , Log If more detailed inforl7lation. _ _ descriptions or'' sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter (in) Formation Description ft. ft. Land Surface (P :© _ nib _ _..___ -17 6.°7 777777 ._�. '1 L-.. .—. 1.,.7Je If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type S n-erri bbe Capacity $ 011 Depth 2-1 Model .SSof -f 3 Voltage 4)- 3C' HP Tank Type W DSO Volume .V Datrk'X : i' eX d Comple � 5?e � � 5 1r'UY e IP Dxf:. l; r llefArH Pel M'.9�'"y,,,,;"�!.x& 1 3 t�+ 4°°a' aX;• MiY �,axe�' � � � � �� (�, ,�rQ � �� � .�. � R'�� '�{R�X�I�� •II�T�� � � d : T S Y JI', �E fYxia`'tY,iagg.` Well plrlllerulame1 dress n �� X� " 3' Tiz`x1,va��.� �'� �y Pum`InstallerNamB Addr�ess Y x4kLK 3 Le X k.. x Sr PTA. Y6ia':La AR: mt� �.aJ� „�'Fil'r" ��il��— iG�'�: A� k�.� �1��'Y 5� �� �•,� ��. �-, r1.,`Ype� . Sf. 3.' xx�? 5rffi': A'£ i? i' �` d. <.���^:eatae?,!+3a:ilra�i9'b.w z� n� •x +^#x' ..i}:9 =Xi��:�.w` ... t .X� *?"". :. � x S�GSd�� .�'. %..� "'_"fF'£�Y Alrlri =- Fvnrt I ne ntinn of wall with rlictnnrac to at IPact two nprmanent landmarks to be provide f filler stgna lfe'' �, Installer is nat r , "�K �. .. 'f'i� rp Ar:lf�$ r'� #'x'^ � .iF � i:X Ar.X4 ax � .T *+3. 'k..�...,Cir�xv§� on a separate she tJplan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 BRUCE R. FOLEY Public Health Director LORET'TA MOLMARI R.N., M.S.K. Associate Public Health Dtreetor Director of Patient Serrfcer DEPARTMENT OF B EALTH 1 Geneva Road, Brewster, New Fork 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 992I Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early YaterventiontPresc600l (845) 278 - 6014 Fax (845) 278 - 6688 �� OWNERS NAME: iW E911 ADDRESS: TOWN: 9 WQ' i e •� Y[ ��z V '�t 1 GV-0 L (,LGf J Cp, P q► -32 M EE AU'6HORIZED TOWN OFFICIAL:_. DATE: G go/ 1". S K 1 (Signature)' The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (M lverfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,fip WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # IMap t Block; Z. Lot(s)j3 GPS Well Owner: Name: Address: 'T L-1C ,- ( w iL gl, ' I ff7`I� Use of Well: 1- Primary 2-Secondary VResidential' Public Supply Air cond/heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment lRotary _Cable percussion _Compressed air percussion _Other(specify) Well Type Screened Y Open end casing Open hole in bedrock Other Casing Details Total Length oZA ft. Length below grade,1,0ft 'Joints: Diameter 47 in. Weight per foot /41 lb/ft Materials: 3_<Steel Plastic Other _Welded X _Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: _Yes Z No Liner: _Yes�No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft ) Devel opqd? First —Yes No Hours Second Well Yield Test Bailed Pumped Comprested Air Hours Yield gpm Depth Date Measure from and Zurtace-static (specify ft) ' 30 During yield test (ft) Depth of completed well in ft. 1 300 Well: Log If more detailed information sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land surface_.:. 4 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Types ^Zrrj 61-e Capacity S P11 Depth 2-1 Model 54:el Voltage Q- 341 HP Tank Type hL aSo Volume Date e �'NWStg y,, 64 E- "H N, "M E F,10,1�&j P. State T Pump Installer "IName "z &Add , - %- AR *C "WiN t 11 nit re E ns a eri( NOTE: Exact Location of well with distances to at least two nprm;;npnt 1.qndM;irk.q to ha nmviri rVnn n -,zanPr-qfP czhP1&t/n1nn White copy: HD File;. Yellow copy -Building Inspector; Pink copy -Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 °J 1�UTNAM COUNTY DEPARTMENT OF HEALTH DffVffSffQN OF ENVIROMMEN7AL.-HEALT-H SEER VICES CERTIFICATE OF CONSTRUCTION COMI?LffANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # � U ` O 3 — OG Located at 12om Town or Village &e X/1-:,g tl &e Owner /Applicant Name:rHy11 - up1Le1,1ZA640P Tax Map -9/, 32— Block Lot Formerly Z&V (5c11alc,OZ 4L Subdivision Name Subd. Lot # Mailing Address 33 ,�}i,2g19-;4,f- &yp 14)OV ®13y% /V7 Zip _ /l-7.:7 Date Construction Permit Issued by PCHD / Sejparate Sewerage System built by ®4<r2-A C614V Address 7-27 C,�,�tllu 1/4/« 1474 Consisting of /G��I/ Gallon Septic Tank and 3 -33' 1. r. �'!` z. y Other Requirements: Water SuIpnly: Public Supply From. or: VIL Private Supply Drilled by Address 1(b4plw Ai✓!'b -i Ay Address SQL RA1'V1Z'Sr .. ,.Building- Type -- - -� E�-� _� Has erosion control been.completed? Number of Bedrooms ,'-� Has garbage grinder been installed? AV 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 a Pu. County Department of Health. Date: % 'ZS' A j41 Certified by P.E. R.A. n 1 / (Design Professional) Address A ®� ���' K f q� 7/11 ..iy//( /L �/� C'7 C i:, 77C, License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. � B / p n^ —. Title: ��✓ �.r� S Date: ` 0 / O il:e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E_ NVIRONMENTAL HEALTH SERVICES.. yy GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owher or Purchaser eff Building Building Constructed by ZZ7 CAx,,04clS Location - Street 'A� �,M /4 r1l P e,- t, F - . a2e�v bkw 66 Building Type 1-1 %i3-- — I - . -3 Tax Map Block Lot PV_VZ&c', Tov4iNillage Subdivision Name. 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 utilizftthe 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; 1�95th 1Z_,-,?,-Pay If Year "Zoto Signature: r Jzc Title: Ocn�erid Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: c?,-1 cw�� rej_ /*ddress: State Zip State Zip Form GS-97 o- •. .:r YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 1lbea.t H.:-Zadbvari, DJreetCii >-:-• h' e LAB #: 1.004735 CLIENT #: 62244 NON STAT PROC PAGE: 1 of 2 --- - - - - -- ----- ~~- ~ ------- ~~ ---------- ����������� DSF CONSTRUCTION CORP 227 CANOPUS HOLLOW RD PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN: 11/02/10 11:45 DATE /TIME RECD: 11/02/10 04:10 REPORT DATE: 11/10/10 PHONE: (914)- 490 -7596 SAMPLING SITE: 11 ELM STREET, LAKE PEEKSKILL, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: STEVE AUTH TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF -------- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/03/10 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 11/05/10 LEAD (IMS) 2.2 ppb 0 -15 ppb SM 18 -19 3113B 11/09/10 NITRATE NITROG 7.37 MG /L 0 - 10 SM18- 20450ONO3 11/05/10 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 204500NO2 11/09/10 IRON (Fe) 0.402 MG /L 0 =0.3 mg /l SM 18 -20 3111B 11/08/10 MANGANESE (Mn) 0.014 MG /L 0 -0.3 mg /l SM 18 -20 3111B 11/09/10 SODIUM (Na) 224 MG /L N/A SM 18 -20 3111B 11/03/10 pH 6.9 UNITS 6.5 -8.5 SM18 -20 4500HB 11/04/10 HARDNESS,TOTAL 514 MG /L N/A SM 18 -20 2340C 11/04/10 ALKALINITY (AS 288 MG /L N/A SM 18 -20 2320B 11/04/10 TURBIDITY (TUR 3.9 NTU 0 -5 NTU SM 18 (2130B) - .- ♦. _ - 'r �' .a y. -_ -.+ _ _ ... .. ♦ .. e _ i Y , � w- ✓ . r '.-3 ni - -. r .-. r � r- ....,; . � r- _ _ . V' ♦ . f ♦ ra ^.. r Y.. _ COMMENTS: MFTC ata oliform = This result indicates that (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 Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. a. b, YML ENVIRONMENTAL SERVICES 321 Kear Street - Yorktown Heights, N.Y. 10598 (914) 245 -2800 Pado- vani,:.,D ,re *.9. LAB ##: 1.004735 CLIENT ##: 62244 NON STAT PROC PAGE: 2 of 2 DSF CONSTRUCTION CORP DATE /TIME TAKEN: 11/02/10 11:45 227 CANOPUS HOLLOW RD DATE /TIME RECD: 11/02/10 04:10 PUTNAM VALLEY, N.Y 10579 REPORT DATE: 11 /10 /10 PHONE: (914)- 490 -7596 SAMPLING SITE: 11 ELM STREET, LAKE PEEKSKILL, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: STEVE AUTH TEMPERATURE..: < 4C NOTES...: COLIFORM METH:. MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH IS A FIELD MEASUREMENT AND IS REPORTED FOR REFERENCE ONLY. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE.300 MG /L MODERATELY HARD WATER: 70 -140 MG /L . MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONLY TA THEaE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Director ELAP## 10323 Nov 17 2010 15:13 HP LRSERJET FAX i p.1 - 11 4 YML ENVIRONMENTAL SERVICES 321 Kear Street a _ Yari tov� i heights,, NvY. 20598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.004908 CLIENT #: 62244 DSF CONSTRUCTION CORP 227 CANOPUS HOLLOW RD PUTNAM VALLEY, NY 10579 -t'. ;. NON STAT PROC PAGE: 1 of 1 DATE /TIME TAKEN: 11/10/10 02:36 DATE /TIME REC °D: 11 /10 /10 02:50 REPORT DATE: 11/17/10 PHONE: (914)- 490 -7596 SAMPLING SITE: 11 ELM RD, LAKE PEEKSKILL, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: STEVE RUTH TEMPERATURE..: NOTES...: COLIFORM METH: N/A N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N w N N N N N N N N N N N N N N N w N N N w N N N N N w N N --------- N N N N DATE FLAG PROCEDURE 11/17/10 IRON (Fe) COMMENTS: FAX TO 845- 528 -1322 RESULT .e0.060 MG /L NORMAL - RANGE 0 -0.3 mg /l COMMENTS: Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. METHOD SM 18 -20 3111B THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELAX ONLY TQ THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert Padovani, .T.(ASCP) Director ELAP# 10323 .. ........... I _:.�..._.: 1 ...__ ... _......_.._.._. .._____a... in i P. — - 1" - -� _ - - ... O m .............. _...._..._... - .. ._...._ ---- on c� LOCATION MAP �0000 000�� AS -BUILT SURVEY INFORMATION: MATHEW NOVIELLO, P.E., LS. 77 HUGHSON ROAD CARMEL, NY 10512 PREMSES SHOWN HB9EONBEINGL07S 129 THROUGH 137ASSHOWN ON MAP ENO7LED YAAEPE6K8K1LLSEC7ObV D, RLED/N THE PUMO /OOUNn•CLERKS OgMFONM4Y281829, ASMAPft 185C "NO GARBAGE GRINDER WAS INSTALLED" 0f \ i ,•, \�F t^/n, P1iEFA ED BY., s7ayE wALL OF Arm Yo9K t9lo1+Tti \ CENE 4y CN - -,i,#- PT 2 \ 20 LF }�(O —� —ioe% sw}mroN — \_ p SE 0 C M1K 1 — ` 4t' R– \ \ sr 4\30 \ f2 ss• 4 PUTM.1k1 COUfJTY LEPi� „TPJEIVT CE, \ 3 D!ViSI01V OF nN R Ni'tEl`!TrL hici;CTFI SERVICES. \ ��< la/-o 3-06 44� \ „ ;;n ; laPPROVL!: s.:3ldf!7EU (()_•: �. �. � �m�5�1.tNCiS 1>U'ITFI AR 6= 2Y,% APPUGt`,ELE hu!.I.rs AMC, GF IHE' t> '1 "N11PA ('.;pip!''" F!fiili: i Fi DEP /tRT��IE( @T. fit” H� � "AS- eu►Lr" �0 SUBSURFACE SEWAGE DISPOSAL SYSTEM .IqO GRAPHIC SCALE WATERSHED: w 0 is a0 w 120 HUDSON RIVER INSTALLED BY.. D.S.F. CONSTRUCTION CORP. IN FEET) – 227CANOPUS HOUOW RD. l Anch = 30 ft„ PUTNAM VALLEY, NY 10579 i.:. T BE OW7S HAS BEEN CONSTRUCTED IN ACCORDANCE WITH " THERE ARE NO 'DEC' WETLANDS STREAMS OR PONDS TIIF RULES AND REGULA71ONS FOR THE DESIGN OF It is a violation of the New York State Education Law, Article 145, Section WITHIN 200 OF THE PROPOSED SSTS AREA AND THE AREA RESIDENTL4L SUBSURFACE SEWAGE TREATMENT SYSTEMS AND 7209(2), for any person, unless he is acting under the direction of a licensed IS NOT WITHIN 5017 OF ANY RESERVOIRS OR RESERVOIR STEMS. DRILLED WELLS IN PUTNAM COUNTY, NEW YORK.. professional engineer or land surveyor, to alter any item on this plan in any way. If 4,':. any item bearing the seal of an engineer or land surveyor is attend, the altering THERE ARE NO EXISTING OR PROPOSED WELLS WITHIN I AT 77iB DESIGN PROFESSIONAL HAS SUPERVISED TIM engineer or land surveyor shall affix to the item his seal and the notation "altered AT A HIGHER ELEVATION OR 200' AT A'c.OWER DIRECTION OF THE CONSTRUCTTONOF 7718 0WIN AND CERTIFIES TTR? by" followed by his aigianue and the date of such alteration, and a specific PROPOSED SEPTIC SYSTEM, IN A DIRECT LINE OF FLOW. INSTALLA77ON TO BE IN ACCORDANCE WITH TIM APPROVED description of the alteration. r PLANS.. P q BOX 1047 NEW MQFORD, CT 06776 '2 END CAP& {TYP.) 14 m his m N 'ate tn m :Z SSDS LAYOUT ,'AS— BUILT" PREPARWYUR IH GROUP LLC /JCR GROUP 33 FAIRBANKS BLVD WOODBURY NY MVATE DNTRE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SECT 91.32 BLK 1 LOT.• PUTIVAM COUNTY # PV– DATE. NOVEMBER ?8 2010 Re-211512 v..1b10 m- "....._..._.... C C� _' 1v R R =125 .. -. L L =27.1 �0000 000�� AS -BUILT SURVEY INFORMATION: MATHEW NOVIELLO, P.E., LS. 77 HUGHSON ROAD CARMEL, NY 10512 PREMSES SHOWN HB9EONBEINGL07S 129 THROUGH 137ASSHOWN ON MAP ENO7LED YAAEPE6K8K1LLSEC7ObV D, RLED/N THE PUMO /OOUNn•CLERKS OgMFONM4Y281829, ASMAPft 185C "NO GARBAGE GRINDER WAS INSTALLED" 0f \ i ,•, \�F t^/n, P1iEFA ED BY., s7ayE wALL OF Arm Yo9K t9lo1+Tti \ CENE 4y CN - -,i,#- PT 2 \ 20 LF }�(O —� —ioe% sw}mroN — \_ p SE 0 C M1K 1 — ` 4t' R– \ \ sr 4\30 \ f2 ss• 4 PUTM.1k1 COUfJTY LEPi� „TPJEIVT CE, \ 3 D!ViSI01V OF nN R Ni'tEl`!TrL hici;CTFI SERVICES. \ ��< la/-o 3-06 44� \ „ ;;n ; laPPROVL!: s.:3ldf!7EU (()_•: �. �. � �m�5�1.tNCiS 1>U'ITFI AR 6= 2Y,% APPUGt`,ELE hu!.I.rs AMC, GF IHE' t> '1 "N11PA ('.;pip!''" F!fiili: i Fi DEP /tRT��IE( @T. fit” H� � "AS- eu►Lr" �0 SUBSURFACE SEWAGE DISPOSAL SYSTEM .IqO GRAPHIC SCALE WATERSHED: w 0 is a0 w 120 HUDSON RIVER INSTALLED BY.. D.S.F. CONSTRUCTION CORP. IN FEET) – 227CANOPUS HOUOW RD. l Anch = 30 ft„ PUTNAM VALLEY, NY 10579 i.:. T BE OW7S HAS BEEN CONSTRUCTED IN ACCORDANCE WITH " THERE ARE NO 'DEC' WETLANDS STREAMS OR PONDS TIIF RULES AND REGULA71ONS FOR THE DESIGN OF It is a violation of the New York State Education Law, Article 145, Section WITHIN 200 OF THE PROPOSED SSTS AREA AND THE AREA RESIDENTL4L SUBSURFACE SEWAGE TREATMENT SYSTEMS AND 7209(2), for any person, unless he is acting under the direction of a licensed IS NOT WITHIN 5017 OF ANY RESERVOIRS OR RESERVOIR STEMS. DRILLED WELLS IN PUTNAM COUNTY, NEW YORK.. professional engineer or land surveyor, to alter any item on this plan in any way. If 4,':. any item bearing the seal of an engineer or land surveyor is attend, the altering THERE ARE NO EXISTING OR PROPOSED WELLS WITHIN I AT 77iB DESIGN PROFESSIONAL HAS SUPERVISED TIM engineer or land surveyor shall affix to the item his seal and the notation "altered AT A HIGHER ELEVATION OR 200' AT A'c.OWER DIRECTION OF THE CONSTRUCTTONOF 7718 0WIN AND CERTIFIES TTR? by" followed by his aigianue and the date of such alteration, and a specific PROPOSED SEPTIC SYSTEM, IN A DIRECT LINE OF FLOW. INSTALLA77ON TO BE IN ACCORDANCE WITH TIM APPROVED description of the alteration. r PLANS.. P q BOX 1047 NEW MQFORD, CT 06776 '2 END CAP& {TYP.) 14 m his m N 'ate tn m :Z SSDS LAYOUT ,'AS— BUILT" PREPARWYUR IH GROUP LLC /JCR GROUP 33 FAIRBANKS BLVD WOODBURY NY MVATE DNTRE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SECT 91.32 BLK 1 LOT.• PUTIVAM COUNTY # PV– DATE. NOVEMBER ?8 2010 Re-211512 v..1b10 m- AS -BUILT SURVEY INFORMATION: MATHEW NOVIELLO, P.E., LS. 77 HUGHSON ROAD CARMEL, NY 10512 PREMSES SHOWN HB9EONBEINGL07S 129 THROUGH 137ASSHOWN ON MAP ENO7LED YAAEPE6K8K1LLSEC7ObV D, RLED/N THE PUMO /OOUNn•CLERKS OgMFONM4Y281829, ASMAPft 185C "NO GARBAGE GRINDER WAS INSTALLED" 0f \ i ,•, \�F t^/n, P1iEFA ED BY., s7ayE wALL OF Arm Yo9K t9lo1+Tti \ CENE 4y CN - -,i,#- PT 2 \ 20 LF }�(O —� —ioe% sw}mroN — \_ p SE 0 C M1K 1 — ` 4t' R– \ \ sr 4\30 \ f2 ss• 4 PUTM.1k1 COUfJTY LEPi� „TPJEIVT CE, \ 3 D!ViSI01V OF nN R Ni'tEl`!TrL hici;CTFI SERVICES. \ ��< la/-o 3-06 44� \ „ ;;n ; laPPROVL!: s.:3ldf!7EU (()_•: �. �. � �m�5�1.tNCiS 1>U'ITFI AR 6= 2Y,% APPUGt`,ELE hu!.I.rs AMC, GF IHE' t> '1 "N11PA ('.;pip!''" F!fiili: i Fi DEP /tRT��IE( @T. fit” H� � "AS- eu►Lr" �0 SUBSURFACE SEWAGE DISPOSAL SYSTEM .IqO GRAPHIC SCALE WATERSHED: w 0 is a0 w 120 HUDSON RIVER INSTALLED BY.. D.S.F. CONSTRUCTION CORP. IN FEET) – 227CANOPUS HOUOW RD. l Anch = 30 ft„ PUTNAM VALLEY, NY 10579 i.:. T BE OW7S HAS BEEN CONSTRUCTED IN ACCORDANCE WITH " THERE ARE NO 'DEC' WETLANDS STREAMS OR PONDS TIIF RULES AND REGULA71ONS FOR THE DESIGN OF It is a violation of the New York State Education Law, Article 145, Section WITHIN 200 OF THE PROPOSED SSTS AREA AND THE AREA RESIDENTL4L SUBSURFACE SEWAGE TREATMENT SYSTEMS AND 7209(2), for any person, unless he is acting under the direction of a licensed IS NOT WITHIN 5017 OF ANY RESERVOIRS OR RESERVOIR STEMS. DRILLED WELLS IN PUTNAM COUNTY, NEW YORK.. professional engineer or land surveyor, to alter any item on this plan in any way. If 4,':. any item bearing the seal of an engineer or land surveyor is attend, the altering THERE ARE NO EXISTING OR PROPOSED WELLS WITHIN I AT 77iB DESIGN PROFESSIONAL HAS SUPERVISED TIM engineer or land surveyor shall affix to the item his seal and the notation "altered AT A HIGHER ELEVATION OR 200' AT A'c.OWER DIRECTION OF THE CONSTRUCTTONOF 7718 0WIN AND CERTIFIES TTR? by" followed by his aigianue and the date of such alteration, and a specific PROPOSED SEPTIC SYSTEM, IN A DIRECT LINE OF FLOW. INSTALLA77ON TO BE IN ACCORDANCE WITH TIM APPROVED description of the alteration. r PLANS.. P q BOX 1047 NEW MQFORD, CT 06776 '2 END CAP& {TYP.) 14 m his m N 'ate tn m :Z SSDS LAYOUT ,'AS— BUILT" PREPARWYUR IH GROUP LLC /JCR GROUP 33 FAIRBANKS BLVD WOODBURY NY MVATE DNTRE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SECT 91.32 BLK 1 LOT.• PUTIVAM COUNTY # PV– DATE. NOVEMBER ?8 2010 Re-211512 v..1b10 m- It is a violation of the New York State Education Law, Article 145, Section WITHIN 200 OF THE PROPOSED SSTS AREA AND THE AREA RESIDENTL4L SUBSURFACE SEWAGE TREATMENT SYSTEMS AND 7209(2), for any person, unless he is acting under the direction of a licensed IS NOT WITHIN 5017 OF ANY RESERVOIRS OR RESERVOIR STEMS. DRILLED WELLS IN PUTNAM COUNTY, NEW YORK.. professional engineer or land surveyor, to alter any item on this plan in any way. If 4,':. any item bearing the seal of an engineer or land surveyor is attend, the altering THERE ARE NO EXISTING OR PROPOSED WELLS WITHIN I AT 77iB DESIGN PROFESSIONAL HAS SUPERVISED TIM engineer or land surveyor shall affix to the item his seal and the notation "altered AT A HIGHER ELEVATION OR 200' AT A'c.OWER DIRECTION OF THE CONSTRUCTTONOF 7718 0WIN AND CERTIFIES TTR? by" followed by his aigianue and the date of such alteration, and a specific PROPOSED SEPTIC SYSTEM, IN A DIRECT LINE OF FLOW. INSTALLA77ON TO BE IN ACCORDANCE WITH TIM APPROVED description of the alteration. r PLANS.. P q BOX 1047 NEW MQFORD, CT 06776 '2 END CAP& {TYP.) 14 m his m N 'ate tn m :Z SSDS LAYOUT ,'AS— BUILT" PREPARWYUR IH GROUP LLC /JCR GROUP 33 FAIRBANKS BLVD WOODBURY NY MVATE DNTRE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SECT 91.32 BLK 1 LOT.• PUTIVAM COUNTY # PV– DATE. NOVEMBER ?8 2010 Re-211512 v..1b10 m- P q BOX 1047 NEW MQFORD, CT 06776 '2 END CAP& {TYP.) 14 m his m N 'ate tn m :Z SSDS LAYOUT ,'AS— BUILT" PREPARWYUR IH GROUP LLC /JCR GROUP 33 FAIRBANKS BLVD WOODBURY NY MVATE DNTRE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SECT 91.32 BLK 1 LOT.• PUTIVAM COUNTY # PV– DATE. NOVEMBER ?8 2010 Re-211512 v..1b10 m- Sherlita Amler, MD, MS, FAAP Commissioner of Health - Robert Morris, PE _ -Directo! ;of,& , irtl tewri il:HVdlth y r May 4, 2010 Stephen J. Ferreira, PE P.O. Box 1047 New Milford, CT 06776 Dear Mr. Ferreira: Robert J. Bondi 1. County'Executive Department of Health 1 Geneva Road, Brewster, NY 10509 Re: Field Inspection — Schnieder Elm Road (T) Putnam Valley, TM # 91.32 -1 -3 & 4 The above referenced lot has been re- inspected. There are no further comments to be addressed in reference to this Department's open work inspection. If you. have any further, questions, - please contact me at (845) 278 -6130, ext. 43261.. 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 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITA AMLER, IVID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health December 8, 2009 Stephen J. Ferreira, PE P.O. Box 1047 New Milford, CT 06776 Dear Mr. Ferreira: DEPARTMENT OF HEALTH I Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive. ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Schnieder Elm Road (T) Putnam Valley, TM # 91.32 -1 -3 & 4 The above referenced lot has been completed. The following comments must be addressed. 1. 2. The septic tank and its pipe connections need to be inspected upon completion. A bedroom count needs to be performed b_y. thjs Depaztment._ The welI*ne�ds'to be inspected-upon cofi pletilft orconitruction. If you have any further questions, please contact me at (845) 278 -6130, ext. 43261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (843) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 226 -6186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 0 03/30/2010 ,14:09 9147341029 _ �PUTNAA WNTY DEPARTMENT OF IEIEA. lk - DWISiON OF ENVIRONMENTAL HEALTH SERVICES ATTEN UIOM Cl JOSEPH REOUE ''T FOR FILIAL INSu—= XGENE For: Fill PAGE 01 All infoi cation rnust be fully completed prior to any Wrenches inspeeti( t)s being made. � �- � . �, 4 e PCHD C instruction Permit # Q Located; • _ r�Mt . J(2&,4,0 Qv�mer /� pplicaYat Nanue. Tf 1 ..._.. 'I'M Block .`i _ Lot Formed; : -,7ojtN e-e _ Subdivision Marne: -- Subdivision Lot # r Is system -511 completed? Is system c.omplete? ?-t3 Is systen oonstructed as per plans? Is well d i.11ed ?5. Is well R 4ated as per plans? Zes Are eros Dn control measures in place? Date: gc,OE Idit Date: Date: Z�7 -O /O I certify t i t the system(s), as listed, at the above premises has been constructed and I have inspected and verz. ied their eormpletion in accordance with the issued PCHD Construction Permit and approvec plans and the Standards, Rules and Regulations of the Putnam Couaty Department of Date: R l--O/ 0 Certified by: PE , RA Design Professional Address:. Lic. # 74 Z7 - -- - Commen s: Form FIR 99 PUTNAM COUNT.' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 'Date: eL=atoriY L`Zc7i4 (�" Town &7 -AmAl jJ41_&dizL Permit # PV •- TM # 9, Subdivision Lot # t----- 1. Sewage System Area a. STS area located as per approved plans .......... .................. b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped...... ............... ...................:....:...... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands .... :................................. II. Sewage System a. Septic tank size - ,,00 ......... 1,250 ......... other ..... ..... b. ' S eptic'tank in'sta a level ................................. . .. .... . c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested....'............. 2. Protected below frost .........:.......... ............................... 3. .. Mmimum 2 ft.Original soil between box & trenches e. Junction Box properly set .......... .................:............. 6. Trenches 1: Length required 33-3 Length, installed 3 3 2. Distance to watercourse measured o v Ft.......... 3. Installed according to plan ..................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......:... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 10.0 %............I............ 8. Size. of gravel 3/4 - 1112." diameter clean ...:...............: 9. Depth of gravel in trench 12" minimum ..................... 10m. Pipe;ends capped::.:. �..:.............................................. g. Pump or Dosed Systems 1. Size of pump chamber .................................................. 2. Overflow tank ............... ........ ..................................... 3. Alarm, visual / audio .................:.. ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled....... ............:....... ............................... 6.. Cycle witnessed by H.D:estimated flow /cycle........... III. House/Buildirag a. House located er approved plans... .,,.� 16 b..Number of bedpooms ..................... .� / '..:..........:. G IV. Well ; Well located as per approved plans ...5. .. -t.' t b. Distance from STS area measured ..Jap ft........... c. Casing. 187 above grade ................ .........:...:....:............ d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ............ ............................... c. All pipes flush with inside of box .. ................... ............. d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area..::........ h. Surface water protection adequate ..... ...:.......................... i. Erosion control provided ................ . ............................... Rev. 12/02 COUNTS 12/02/2009 09:54 9147341029 PAGE 01 I'MANI COUNTY DUAIITlIIIMT OF HEALTII DIVISION OF ENVIRONMENTAL IIEALTH SERVICES ATTEN rloN JosEPg 3GENE 1.:1 EO n �iSpFcTIOly For: rill ,Al infor retion must be fatly completed prior to arty Trenches,,_ inspecdc ms being made - PCHD C }:r, =tion Permit # Pt/ a a o Loeated:. to (T) (V) v t n0404 vweav Owner /A pplicant Name.- -sew ul gigef TNI 1, 31- Bloek ^ j,., , Lot Fornal} ; l '.¢o c L . Subdivision No= Subdivision Lot # is systm Jill completed? .. y.. ,�f o , date: r Is systetr complete? fr cc, as Date; `_0 Is systm constructed as per plans? Is well 4 filled? No Date: Is well lc .. ted as per plans? : -- Are erosi »a control measures in place? � I certify tl at the system(s), as listod, at the above premi ses has been constructed and I have iaTected and w6l .ed their compWon in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Rcgulatioas of the Putnam County Depar4ment of Ory Date: _ O Certificd by: PE k RA Design fessionel Address: ., Po0 'l % Lie. # o7L Gornmeni Forth FIR, 99 WI IGH OF IENVIRONMEN I'AL HEALTH S ERVffC - V CONS'I'118U CUON PERMIT 1F ®118 SEWAGE TREATMENT SYSTEM r PIEI8hUT # PV-C)3-0(::P Located at 40 0 � jv 4U-- Town or Village Subdivision name Subd. Lot #, Tax Map Block Lot Date Subdivision Approved Renewal _ Revision Owner /Applicant Name , C, _Pot// ��a�o� Date of Previous Approval S Z Mailing Address � yQ T c�S' Zip Zl sZ Amount of Fee Enclosed 2 Building Type Silk. Lot Area A 1C. of Bedrooms -3 Design Flow GPD 1FiRR Section Only Depth Vollanmme PCHD NOTIFICATION IS REQUIRED WHEN JKLL IS COMPLETED Sepata•ate Sewerage SS, stemm to consist of %W gallon septic tank and Other Requirements: To be constructed by rte. P • Address W2tea• SaaPXRy: Public Supply From Address -� --- -_ Private Supply I�riTi�tl t�q ,�, ��'� _ -._ ., _ .Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 16O Z 5— 4 License # e-7422.7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. B Title: Date: a it opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO-CONSTRUCT A WATER WELL. please orinYorWoe PCHDPe - Well Location Street Address: Town/Villa e: Tax Map # am 414,0 Ma Block Lot(s) �1lT p - Z' 1 4 Well Owner: Name: Address: Pho e # �eN�v 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 gpm # People Served tt Est. of Daily usage ,600 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling r New Supply (new dwelling) Deepen Existing Well Detailed Reason D4i✓C� for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes No Is well located in a realty subdivision? ........................................... ............................... Yes Nom Name of subdivision '�` Lot No. � 16,04114Y7-- Water Well Contractor: Address: Is Public Water Supply available on site? ....................................... ............................... Yes N Name of Public Water Supply: t— . Town/Village Distance to property from nearest water main: lanc Proposed well location & sources of contamination to be provi on separ sheetiplan. .Date:. . ®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. 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 Commissioner of Health. 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 i �'� Permit Issuing Offici I: . . Date of Expiration 0 Title: S; ifs LG Permit is Non- Transfbrabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 nip wavInearInv ma less June 24, 2008 ... _ Stephen J Ferreira, P.E P.O. Box 1047 New Milford, Connecticut 06776 Joe Paravati Larry Werper Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: SSDS Construction Renewal Schnieder - Elm Road, Lake Peekskill Tax ID#: 91.32 -1 -4 Dear Mr. Paravati / Werper: Please find the attached plan and application for the renewal of the Septic System and well permit. Please feel free to contact me at (914) 804 -4209 if there are any further questions or information required. ......... . S' ely Y , Stephen J. Ferreira 'AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICI - - •... - - CONSTRUCTIO� N PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # V ) � Cro Located at L Ao Town or Village fyr;V14A g Subdivision name A 014- _ Subd. Lot # &I- /3% Tax Map 9 a s Z Block !` Lot Date Subdivision Approved Au Z& f �Z f Owner /Applicant Name vyi`% _YWAlle6ex Mailing Address 7 Renewal Revision Date of Previous Approval Amount of Fee Enclosed r� 2 Building Type SgGG /m!�Z Lot A=2 L ly co. of Bedrooms v� Zip Design Flow GPD 6W Fill Section Only Depth Volume Separate Sewerage System to consist of /0,00 gallon septic tank and 333 L ' Cif 9-9 WAO/F Other Requirements: To be constructed by 7_-,610 Address Water Supply: Public Supply From Address d_r: 12ri'vate Supply Drilled by =•�ycr/�ND%�r/ - -%� �•vc: - - -:-: - �ddress 4 1111... I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date ld dAlo License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By: Title: k�-f Date: 6 b ite opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY IIDIEPAflg'll'IVIiIENT OIF HEALTH IIDI{VffSIION OF IENWRONM ENTAIL IIIIIEAILTIHI SIEII W CIES APPLICATION TO COIYSTRU.CIT,A WATER WELL *a'se prini or type PCI HD Permit Well Location: Street Address: Town/Village Tax Grid # &/%l R, Aoq /1 Map f JL Block Lot(s)3 4- Well Owner: Name: Address: 7 & Use of Well: JL Residential Public Supply Air /Cond/Heat Pump _Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought __:5� gpm # People Served Est. of Daily Usage ,boo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason v 14, 1�Jia� for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ,' . No _ Name of subdivision ��C'�N�l.��'!G/�L YSrLC�7o7�%D y HZY Z!WIV S-G Lot No. IZ9 ::66 Water Well Contractor: Address: IS`?_ 19- ✓ _ Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: -1 05' Proposed well location & sources of contamination to be provided on separate sheet/plan. Late 4-14) 16 6 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 Permit Iss TS 'g Offici Date of Expiration Title: 3�z L� �� i �1e - Permit is Non- Tiransffc>r zbRe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PART II •- IMPACT ASSESSMENT. To. be. completed by:'Lead Agency,- A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and`use the FUL'CEAF. Yes VNo B. WILL ACT16K RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6? If No, a negative declaration YN, uperseded by another involved agency. Yes C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl*. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: A/0 /LP--. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or.comniuriity or neighborhood character? Explain briefly: A "D C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change.in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: ��flr C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly:; D. _..�Y WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTA REA (CEA)? (If es, ex lain briefly: No _ E. IS THERE, OR I THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Xes ex lain: Yes P o - PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude: If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse.impacts have been identified and adequately addressed. If question d of part ii was. checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FU EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting IN determination. Name of Lead Agency Date �St'P�a S ; �` —��.b ��, ✓- � J / � -S i S fz,�� f %Ju��l�•c f f� �, i-�� ��r 4�NCe. Print or Type Name of_Kesponsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) f 617.20 SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW -r - SHO.RT,ENVIRONMENTAL. ASSESSMENT FORM - -�. _ ... L "for UNLISTED ACTIONS On.ly.. PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR T N � �c �� � i =.D�1� �-��y'�✓l�/��� 2. PROJECT NAME ` Scla �► �,E'D �E,� . 1PROJECT LOCATION: j P,iJ-TAIAA PV Municipality V County 7;41)+A4 4. PRECISE LOCATION: Street Addess and oad// Intersections, Prominent landmarks etc -or . provide map ' �/Vl �s�Q G ICS � KSK /Lii 5. IS PROPOSED ACTION: (r7l New El Expansion El Modification /.alteration 6. DESCRIBE PROJECT BRIEFLY: A MBE/ LJ� GL � S, "071C 7. AMOUNT OF LAND AFFECTED: D a �J Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no, describe briefly: _.: �.. ..c.a _. ...-- Fys- ._•!+`.- _yc _.. T - ........ r �. .o -.. -r G'.y. .. a- may. .., - ^.^.. ... .ro. -. e �w .v r.-�.. •� ^... ^P _... ... .. ... .�.-• •4- IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as. apply.) �9..�WHAT Commercial —]Agriculture Park /Forest /Open Space ❑Other (describe) I J� I Residential ❑ Industrial El' 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY- (Federal, State or Local) Ord p L..&VA,1Al. � Yes El No If yes, list agency name and permit / approval: /vtvN Vr� 11. DOES AN ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes F7 No If yes, list agency name and permit / approval:, 12. AS A ELSULT OF PROPOSED ACTION WILL, EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE. INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant Sp r me 5% N/��/ Date: 3 �1A i nature rA If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before'proceeding with this assessment SHERLITA AMLER, MD, MS, FAAP Commissioner of Health 17 LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Stephen J. Ferreira 123 Washington Ridge Road New Milford, CT 06776 Dear Mr. Ferreira: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 16, 2006 Re: Proposed SSTS — Schnieder Elm Street, (T) Putnam Valley TM# 91.32-1-3 & 4 This office, has received and reviewed the most recent set of plans for the above-mentioned project. We would like to offer the following comments for your review and consideration. 1. The junction box that was being provided as a cleanout box was removed. Please provide it and label what its purpose is. _2_ The total, length of primary trenches appears to.. be less. than the required 333. LF. . This office will continue its review upon consideration of the above-mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. , JSP/kly Very truly yours, Joseph oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278-6130 Fax (845) 278-7921 Water Supply Section (845) 225-5186 Fax (845) 225-5418 Nursing Services (845) 278-6558 Fax (845) 278-6026 WIC (845) 278-6678 Nursing Home Care Fax (845) 278-6085 Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648 SHERLITA AMLER, MD, MS, I:AAP Commissioner of Health L ®RETTA: MOLIINARI, Ill; ffs . Associate Commissioner of Health Stephen J. Ferreira 123 Washington Ridge Road New Milford, CT 06776 Dear Mr. Ferreira: ROBERT L H®NIDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 April 6, 2006 Re: Proposed SSTS - Schnieder Elm Street, (T) Putnam Valley TM# 91.32 -1 -3 & 4 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, Q9 JI., 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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Y, Please show the expansion area like the primary area (boxes, 2 foot solid pipe, etc.) Z Please show the 2 foot solid pipe after each junction box. 0'�;,,> vvk) 3' Please show the driveway in the profile. S-aR-M the driveway: - '�- t -Please provide -a 6- -=cmp-sleeve -nor, t- he- porhimro' the under- 5,ri�- ww 5. Please note on the plan what the purpose of the first junction box is. Please show footing/roof leader route and discharge location. a ✓`" ,Yr`�Ye✓ a 5 Please provide a datum reference. Well needs to be a minimum of 15' from the property lines. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, Q9 JI., 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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAk COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH lNl>IVIDUAL WATER SUPPLY & SUBSURFACE SA:CTiiEAiv1ENT SYSTEIVIS r :..-_ ;,:<��•.:: t Re'�IEW SHEET 1!'0A76 TRUCTIONPERMIT NAME OF OWNER: �G ° STREET LOCATION: �'� S •�rf REVIEWED.BY: RM, GR, oal S RDATE: �C TAX MAN: (CONi.IRNMI G/�- l 3� 41L, WELL DOCUMENTS Y N ( REOUIRED. DETAILS ON PLANS CONT'DI PERMIT APPLICATION OUSE SEWER -'/<" FT. 4 "0'; TYPE PIPE.CAST IRON / PERMIT OR PW5 LETTER 0 BENDS; MAX BENDS 45' W /CLEANOUT �PC =97 i RENEW&I4 (� LETTER OF AUTHORIZATION (�(� 0 CHANGE) ( J�DESIGN DATA SHEET (DDS) FILL SYSTEMS (� CORPORATE RESOLUTION (__)(.10' HORIZONTAL; PAST THE •-SLO EP S 31 Tjd E SHORT EAF ()(FILL SPECS / FILL • S 1 -5 �v /G (PLANS -THREE SETS (�FILL PRO & DIMENSIONS (� HOUSE PLANS -TWO SETS EXPANSION AREA UUVARIA,NCE REQUEST �l5r�ic "l , ' FILL GREATER THAN2 FEET e r SUBDIVISION �� •UU CLAY BARRIER �(f (� tGAL SUBDIVISION (�UFILL'CERTIFICA TE ° UUSUBD'IVISION APPROV CKE�} �n - (__)(__)DEPTH G UUPERC RATE - / �/��' (_)UVOL PLAN FOR R.O.B.,'tTNCLASSIFIED & EYIPERVIOUS (�(_} D• DEPTH (� ARATION DISTANCE FROM•TOE OF SLOPE CURTAIN DRAIN REQUIRED TRENCH GENERAL �)LF. TRENCH PROVIDED 60FT MAX. .3 3 3 IUY411 (_) LOCATED .IN NYC WATERSHED ( )J)PA.RALLEL 'TO CONTOURS TED. TO DEP (�U100% EXPANSION PROVIDED ED TO PCHD DETAdLDUST FREE CRUSHED'STONE OR WASHED GRAVEL �(� E AP OVAL, IF REQ'D C!J(._.. )GEOTEXTILE COVER D EP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN, ]EkGM'SSTS _ ARCS TO BE WITNESSED TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL . '�) - APPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS TLANDS (TOWN/DEC PERMIT REQ'D ?) ✓ 100' TO WELL, 200' TN DLOD,150' TO, PATS DATA ON DDS. PLANS & PERMIT SAME ( )/�, )100' TO STREAM, WATERCOURSE, LAKE..(iac; ezpan.)... _ 1969 NEIGHBOR NOTIFICATION S —. 50' --.TO .CATCH B,ASI1 ;.35`_S T.L?RNIDRA]N; P ED-WA,- *R' -�. BLOOD ELEVATION W7I 200' 10 TO WATER LINE (pits .20') (! 50'• INTER1vIITTENT DRAINAGE COURSE SOIL TESTING LOTS>IO YEARS OLD U 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS UIRED •DE AILS N PLANTS : (, 110' MIN TO LEDGE OUTCROP SEWAGE SYSTEM PLAN- (NORTH ARROW) y SEMIIC TANK :�SSDS HYDRAULIC PROFILE (__)(- __)10' FROM FOUNDATION; 50' TO WELL GRAVM FLOW .!f) (.,-)CONS NOTES 1 -I5 Ce jL )DIMENSIONS TO PROPERTY LINES )DESIGN DATA: PERC & DEEP RESULTS ((�- CATION OF S NNECTION 2' CONTOURS EXISTING & PROPOSED 15' AY & SLOPES. _ FOOTING/ CURTAIND S (�5 OPE IN SSTS AREA (S20 %) C USDA SOIL TYPE BOUND TITLE BLOCK; OWNERS NAME ADDRESS (—) REGRADED TO 1S %, IF REQUIRED TM #, PE/RA; NAME, ADDRESS, PHONE# DOE UMP S �- DA DR RAVVING/REVISION UUP.UMP NOTES . OF N- U(_ }DOSE' 75% OF P LUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS (- )LJDETAIL FO RCE:14fAIN, (PIPE TYPE, ETC.) LA XXS,WETLANDS WIT>�i 200' OF P.L. (--�U1 -BOX SHOWN &DETAILED .. �(�PROPOSED FINISH FLOOR AND ( I I STORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN D ! (__)(_,)STANDPIPES; 5' BO WELLS 4 SSDS S WaN 200 'OF SSTS ` PROPERTY METES & BOUNDS ,. ,DETAIL (�U15' MIN to CONTROL FOkHOUSE, WELL & UL--)20' NW<CD DISCHARGE/100' with 182 cons day discharge _)EROSION SSTS, TROSION CONTROL NOTE to N NO PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,.APPLICATION FOR APPROVAL OF PLANS FOR - A WASTEWATER TREATMENT SYSTEM' i r .. - �. 1. Name and address of applicant: J611,4% .SCW/rIl J!�V 2. Name of project: 3. Location TN: �J/IV- Al 4. Design Professional: 5^? P/%%��i l,�✓r4 5. Address: 1,o-&X /0(,/7 6. Drainage Basin: keh)lU OU c7' 04 70 7. Tyne of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10.' Has DEIS been completed and found acceptable by Lead Agency? ............... 1 L. Name of Lead Agency NO h U 12. Is this project in an area under the control of local planning, zoning, or other ®tdinknces. :... ..........�.. .f 13. If so, have plans been submitted .to such authorities? .. 14. Has preliminary approval been granted by such authorities? yJ' Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... . 17. Waters index number (surface) ........................................... .............:..........:...... - 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply f, o Distance to water supply — 20. Is project site near a public sewage collection or treatment system? ................ 21. .Name of. sewage system 22. Date test holes observed N� Distance to sewage system 23: Name of Health Inspector 3zw 1 i1, A Q AT 24. Project design flow (gallons per day) NO 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N 26. Has SPDES Application been submitted to local DEC office? N° ..................... Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland ?' ftO 28._ Wetlands ID Number...... • 29. Is Wetlands Permit required? .............................................. ............................... v Has application been made to Town or Local DEC office? ............................... �- o 30. Does project require a.DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................. Ye /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/��vo DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................f' 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent -to project site ? ..................: /--0 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number ............................. ............................ Map /, 3V Block Lot 3 37. Approved plans are to be returned to ..... Applicant _ Design Professional ! agpiieatiQnns.f6i3r6,✓ie_w and - approval` -of a few lie- located withlrY'the1N'YC wa:iCrshed'shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information prodded 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�PenaI Laws) SIGNATUKES do OFFICA r I� ES'1. F � J Mailing Address:...... 7..... 641 tj -771 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 5�:kGE TREATMETWSYSTEM Owner Address Located at (Street) , 64-Af 42%-e indicate nearest cross street) Municipality 4LI—All9A2 / Tax Map /,J�Block / Lot_"_�, Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test NOTES: 1. 2. Tests to be repeated at same depth until approximately equal percolation rates are'obtained at each percolation test hole. (i.e. <_ I min for 1-30 min/inch,< 2 min for 31-60 min/inch). All data to be submitted for review. Depth measuremep & ade from top of hole. Form DD-97 Pg. 1 oft . . . . . . . . . . . .. . M. ; 2 W1. rDepth from Groaned Eli � IMF, Hole Raul Na ,T Z5" 2 3 4 --22 ------------- oV7 2 ".1117 4 2 3 4 j 5 j NOTES: 1. 2. Tests to be repeated at same depth until approximately equal percolation rates are'obtained at each percolation test hole. (i.e. <_ I min for 1-30 min/inch,< 2 min for 31-60 min/inch). All data to be submitted for review. Depth measuremep & ade from top of hole. Form DD-97 Pg. 1 oft TEST PIT DATA DES ON OF SOILS ENCOMITERED Ili TEST DOLES DEPTH HOLE, -NO- O.L. d/L Z-2 0.5' 1.0' C 1.5' t7A47UUlt- 41�AI 6244-A) 6t, 2.0' e8N ft Pd" 2.5' 4K 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Am1�'f2 Indicate level at which groundwater is encountered AID A-) Indicate level at which mottling is observed Indicate level to which water level rises after being encounter d --- Deep hole observations made by: rJ ! F�724 7/ l d ate f f Z o 6 Design Professional Name- e, d - 6 e X /o z/7 Axev 11;�rol'kAO c% oa 77,6 Signature: Address: E Design ProfessionaR=s Seafl I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.y'.1; `TMi`� +•`- ce.... _.v.:.l,:p � w� -.. '• .!•i•(•;�A'. :,y: %�.y: e��.•T.er •ia:�- .`= v= �i:- e:.t., h.:: .�i= ..u"+.`q.a..y, :•ti- +4.: r�lo A:. ��' %� w.►n:_sR'•:..�air �iS. it �+i..::7�':,a•�.}Yi:,:Y LETTER OF AUTHORIZATION RE: Property of Located at OJ-M 4,44 TN pa-milm, VA Tax Map # . % 32 Block Lot ' Subdivision ofk� Subdivision Lot # /1-?'- 13 7 Filed Map # Af & Date Filed A% 9811&y Gentlemen: This letter is to authorize /426/ A a duly licensed Professional Engineer X 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 conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: Signed: P.E., R.A., # _ _ 0 /2a Mailing Address State G`i- ZiP O(0 `7 7 f-' Telephone: (8 -64)f ^G _ Zq�)? fmar of Property) Mailing Address: 7 AK-72�1,--� -r' State Telephone: 8 y O Z%- Fom LA -97 or -.f! Box .No. /V ZLM CiO, State, LP;W -------------------------------------- /, 10— nop— �'- /OS ',9 *#-`' &IM 'IM RREOEilp (Domestic Mal /Ox r Off) Jr 'W" L rC_jj Fo eliffer fififtrftj _yj ill Si UK El C Rcs Qi: Rkc� A Postage rn Certified Fee M M Return Receipt Fee C3 (Endorsement. Required) or -.f! Box .No. /V ZLM CiO, State, LP;W -------------------------------------- /, 10— nop— �'- /OS M to a ru Postage $ Certified Fee O Return Re ce- C3 (Endorsement R Ipt Fee . squired) C3 Restricted Delivery Fee —0 (Endorsement Required) Total Postage & Fees $ � Sent To �0491, ................ UNT 'D: 0096 Postmark Here KSTZ07 4464 03116106 --------------- rM, &IM 'IM RREOEilp (Domestic Mal /Ox r Off) Jr 'W" L rC_jj Fo eliffer fififtrftj _yj ill Si UK El C Rcs Qi: Rkc� A Postage rn Certified Fee M M Return Receipt Fee C3 (Endorsement. Required) M M to a ru Postage $ Certified Fee O Return Re ce- C3 (Endorsement R Ipt Fee . squired) C3 Restricted Delivery Fee —0 (Endorsement Required) Total Postage & Fees $ � Sent To �0491, ................ UNT 'D: 0096 Postmark Here KSTZ07 4464 03116106 --------------- rM, &IM 'IM —1� S CMIX r Off) Jr L rC_jj Fo eliffer fififtrftj _yj ill Si UK El C Rcs Qi: Rkc� A Postage rn Certified Fee M M Return Receipt Fee C3 (Endorsement. Required) M ricted D ver, Fee Re or' (End. t R 'red) I'W"OHOW et, Apt. No. - PO B. No. --------- - ------------------------- -------- - ----- ------------------- — --- -------------------- P S, For r 7RE M d AY /,--/OV-77WAc i t 118 + 116.Bp 121 1 --------x------ -- - --- 122 rr• �t a- 4 GV °7-I Fi -10 /3� TiAliAl I r• 1a ______' SUNNYSIDE /4a 3s' - --- "7- 68.17 aP -------- -- - - - -- _ a ,�• 123 ya ------- ' -------- -_ w 124 V © _______- Q -- -- u - - --- $ 1 C D m y i 86.36 r : g , � .36 _____________1 . 6 6s 32 24: 128 J 3 3 -eo ----- ----- ---- _ 62 G e1 ' ° 46 - 4 -- - - -- _' -- 6 -- -- .te — ----- ---- 7 1 61 728 _____ ... � ____________ r J __ 117.88 ___________� ___ , 128 - 100.08 100,00 , 100.00 57 ' 30 - - - -- -4 18 u w S66 22 8- pQ 8 -- --- - -- _ .i' 48 ,---1a1 a 91 - -- -' 4° - ° fat fl__� __ - 0 r• 2 u u ------------------------ w 1w �\ m --- -- - - -- - -- - - -- - -- - - ---- - - - - -- is IS 68 - - - - -- 62 gi 6f __________ 13� 3 `;�'- -- --- --- - - - --- n ^D b 63 21 r: __________ ___ 138 .. 62 fl y _ w P 737 47 39 ________ ,( 107.0.7 w g --- O D ------------- -- - -5 2 -- $ 71 3a as 138 ' 46 ^ 38 --- ---- --- ----- 72 -- g 160.00 - -- 1 41 g 100.00 u 38 -- - - --t- X 40 uo � - � - -------- -- _ J6 e7 20 •, $ g -------- ---- ---- -- --- - -�. 8 - 42 43 $ Y 74 29 B 1 -- -----------se =- g 6 142 171,1H MOD ' - CORTLANDT 37 f i, ,r ii ki 51P ZAA42S, aF AE WY OF AM VaW 3 BEDROOM HOUSE J, f tt . 54Z I —It P��'s�kCyNr,v FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION f / Name of Project (T)(V) V 1 County. Site Location- Building construction begun Extent Is property within NYC Watershed ? ................. F7 'Yes �No SECTION & TOPOGRAPHY (Please check all appropriate boxes) 1. ❑ Hilly -❑ Rolling � -Steep slope Gentle slope 2. ❑ Evidence of wetlands Low area subject to flooding ❑ Drainage ditches ❑ Rock outcrops 3. . Property lines.or comers evident ..............:.... ............................... 4. - 'Do water courses exist on or adjoin the-property? ............................ 5: Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ................... 7 Will extensive grading be necessary? ............................... ................... ;g: :Will extensive. fill.be necessary for-SSTS ? .:.::::....::. 9. Do filled areas exist within the SSTS area? ........ ........................ ...:.... (—EZ, Flat ❑- Bodies of water_ t!�_Yes No ❑ ` Yes No ❑. Yes N' h? r✓yc:0 ❑ Yes No ❑ Yes No Yes' No ❑Yes'. No If yes, what is the condition of the fill? . SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: d Gravel �am ❑ Clay ❑ Hardpan [A �ixture 11. Observed- from: ❑ Borings ❑ Bank cut ackhoe excavations ; 12. Soil borings /excavations observed by ' i-ri44_z:� on ► l �d c �G 13. Depth•to groundwater !� `k on, 14. Depthto mottling on 15. Are test holes representative of primary & reserve areas .....: ............ .................... Yes No 16: _Soil percolation tests made by on 17. Soil percolation tests witnessed by 4 (1 on . SECTION D (on back) Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes �No 19. Will groundwater or surface drainage require special consideration? .,..4A��:: Yes ' No 411.e 20. Will gullies; ditches, etc:, be filled and watercourses be relocated ? .............. .. Yes E] No SECTION E. REDS. 21. If a common water supply is proposed; has aninspection been made of theU''`� 5. existing or proposed source and facilities? .............. ............................... Yes Q No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ........................:...... Myles a .No 23. Additional comments S2k_v , p A/'s t..' ll l S'S P 24. Site observer /inspector and title J "• 25.. Date(s)• of observation(s)inspection(s) h . TEST PIT PROFILES .Hole # Lot # Hole # 'Lot # Hole # Lot # p Depth to water Depth water. Depth to water - - - r -De fh P to mbtdin g Depth to mottling D ePt. h to mottling Depth to rocklimp. Depth to rocklimp. Depth to rock/imp... . G.L. G.L. G.L. a.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 -�---- / g Mr 5.0 5.0 . 5.0 .6. 0 /1" 57-1 6.0 v 6 L� 6.0 ' Gv�t� 7.0 7.0 9.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0. 10.0 10.0 C DER {. OF PRACTICE I , YORK SLATE SURVEYORS ?� E INDIVIDUALS - s HE TITLE POLICY ONS ARE NOT R ; ' OF T+1 E C ITY N OF N -EW s YO R K G�. *0 19 . 2\ �,P \25'OO 57oNe ,i ' 00. 83' CoM p � �s I, 196.84' MAP, 3gg q,� WALL AWL LtJ AJ )A �y 9 1 Z � f 3,9G.00 o i� \S loo' wr;WCU• —'1:' ��pt .SIR C�a ppp rA - �i� ` R\ O •1 Ro'� � (�. �fi'(- �-s'. ��� �`a`•.r. -mac., ��•. �w� Ada - ti WG LOTS P N MAP AREA = 31159Z. of = 0.725 SECTION D° J P ti• �-Ty cLer�lcs' _ ti 5 MAP ND. IHSG. L ` �i q PUTNAM COUNTY DEPARTMENT OF HEALTH 4 f Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit A 1 on CERTIFICATE OF COMPLIANCE Permit rY CONSTR ' -. ON PERMIT FOR SEWAGE DISPOSAL SYSTEM ,09�, 4vl� I A /Io y Town or Village 7 Subdivision Name - k • P e S�`> J Sabd. Lot # 13)__ Ta. Map A Block l Lotrd� Renewal— Revision ❑ Owner/Applicant Name .� !J t1/f3 �..P !iK /� �iE� r / 1 �f Date of Previous Approval {� q Melling Address _2 / p [a Legs 0,1 W,4 G i[ , 'e / • Town Zip % 'l 61/V Y, Building Type ° "d ,zy/ F4,4 i 7,7 f, Lot Area 06 � Fill Section Only Depth , et� volume 7 J I L° Number of Bedrooms - Design Flow G P D w a PCHD Notification is Required When Fill Is completed Separate Sewerage System to consist of ZOO Gallon Septic Tank and To be constructed by 4 d-Z,_? % Address Water Supply. / Public Supply From Address or: ✓ n•tvate Supply Drilled by Id Z-42 Address Other Requirements 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with, the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 disposal system during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed !n accordan a with the standards, rules and reguls ions of the Putnam County Depart�fHe . _ Date Signed �` P.E._ R.A. Address SA944 64 !tense No APPROVED FOR CONSTRUCTION: This approval expires two years from date issued unless construction of the .building has been undertaken and is revocable for cause or may be amended or modified when considered n.celsa y by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and /or private water supply only. Rev- -- - ^' - -^— -- — _ 1/87 Date By _ Title G� JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 January 3, 1992 Vincent Ettari, P. E. 1065 Spillway Road Shrub Oak, MY 10588 Re: Proposed Construction Permit Grabert, Elm Road (T) Putnam Valley 091.32- 1 -2 -3A Dear Hr. Ettari a Review of plans dated September 22; 1991 and other material relative to a construction permit for the above captioned property has been completed by the Department. Based upon such review, and pursuant to the provisions of Article III of the Putnam County Sanitary Code, you are hereby advised that.the proposed method providing water supply and sewage disposal are considered inadequate as set forth below, therefore, approval of these plans cannot be granted. - a ,ssnp .;neap er,� >9 2�1 -2 ..are - rioter desc i - d iai- he _curx end 3 min= a sp ry. book. It appears that subdivision approval would be required by both the Town of Putnam Valley and this Department. Please submit a letter from the Building Inspector stating that the lot described above is a building lot. 2> The sewage disposal system, as designed does not allow for future expansion. Future expansion area available must be equal to 100% of the primary absorption area. 3. The proposed well is shown 59' from the existing sewage disposal system to the south. A minimum of 100' is required (150' if the existing leaching area .is considered leaching pits). 4. The proposed well is 68 feet from the proposed leaching area. 100' minimum is required. 5. The proposed well is 79' from the proposed toe of slope. 100' minimum is required., 6. The west side of the fill section is proposed with a one on one slope. A 3 on 1 slope minimum is required. 7. The _proposed septic tank is 5' from the foundation. A 10' minimum is required. 8. The proposed leaching area is 10' from the foundation. A 20' minimum is required. 9. The roof and footing drains discharge in the area of the proposed expansion . area. A 15' minimum separation distance is required. 10. Plans should,shov fill section only on lots requiring a depth of 2 feet of ROB fill or more. 11. Perc test holes must be a minimum depth of 30 inches. If you have any questions, please call me at Ext. 304. JK /jp ref11, Jr. , P. E. Health Director PI1I'NAM `couNTY DEPARTMENT OF HEALTH DIVISION oF. -ENv3m0NMENM.. HEALTH SERVICES DESIGN'. L1�,TA ` SUBS Ai E SEWAGE DISPOSAL SYSTDI , FILE N0. Owner U W4 l� �7 . Address c9 y� Sc�fr fltv,Fl G,� . t'19 %le , 2) Located at (Street) Sec. 9! 3 Block �J Lo? - 3 (indica nearest cross eet) lty .,.: 7Li✓/� . Municipal,'. �u 'Watershed lee �i // .. , SOIL pE.RCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date 'of pre- Soaking �X / Date of Percolation -Test HOLE NU4BER CLOCK TIME - PERCOLATION PERCOLATION Run No. 1 2 3 4 Time Start -Stop Min. Inches dater Fran. Water Level. Surf e-\ In Inches toP'�) drop In. Soil Rate Min /In Drop 5 9 i 5 -1:4 'ate 4 -2- o�0 5 2 .3 ' � ( 4 5 NOTES: 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. 4 2. Depth measurernnts to be made fran top of hole. rev. 9/85 OF DEPTH HOLE NO. G. L.' Q .6AIVI 20 30. rr WITH APPLICATION IN TEST HOLES HOLE NO• o� J// T HOLE NO. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED o1%UBy e DEEP HOLE OBSERVATIONS MADE BY: - C/%L�r �� �� DATE: d2 DESIGN C/. Soil Rate Used _.�� Min /1" Drop: S.D. Usable Area Provided i0 No. of Bedrooms Septic Tank Capacity / v ° gals. Type O o.,✓g- Absorption Area Provided By ���» L.F. x 24" width trench Ot h Nane �/ n/ c �. f�- ��7�fi9/1�. u�Signature Address , c / /t,i SEAL tox ONLY-. Soil Rate Approved sq•ft /gal• Checked by Date No. TO. JOHN SCHNEIDER I OACCORDANCE WITH THE EXISTING DE OF PRACTICE FOR LAND SURVEYS OPTED BY THE NEW YORK STATE SOCIATION OF PROFESSIONAL LAND CATIONS SHALL RUN ONLY TO INDIVIDUALS AND INSTITUTIONS HEREON UNDER THE TITLE NUMBER SHOWN ABOVE. SAID CATIONS ARE NOT TRANSFERABLE COPYRIGHT C 2006 BUNNEY ASSOCIATES, ALL RIGHTS RESERVED, UNAUTHORIZED DUPLICATION IS A VIOLATION OF APPLICABLE LAWS PREMISES SHOWN HEREON BEING EOTS 128 THROUGH 137AS SHOWN ON MAP EN T?L E D' L A KE P E E K S K/ E L S E C T/ O N D, F ILED IN THEPUTNAMCOUNTYCLERKS OFFICEONMAY281929, ASMAPAb 185C. ALL CERTIFICATIONS HEREON ARE VALID FOR THE MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES HEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. SURVEYED &AS80CPREPARED 8Y BUNNEYIATES LAND SURVEYORS 301 FIELDS LANE, BREWSTER NEW YORK 10509 PH. (845-277,3404) v m e z• I t , a 0.522 ACRES A i a LANDS OF THE 6=125-00' C17Y OF NEW YORK �.. TO A SURVEY MAP BEARING A LICENSED =2_725 N35' 2'30 "E EAST FACE OF STONV - T ' _ _ CW\ _ GE 1 QN NE c 196.83' - \ \ THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS, IF ANY KKtST, ARE NOT CERTIFIED. R 28.98' .: S43 JO'W ;. EL/y G' S•: 09 "Spy O�A f i zZ1.1s ' ROAD. 3 f i SURVEY OF PROPERTY. SITUATE IN THE TOWN OF PUTNAM VALLEY PUTNAM COUNTY- NEW YORK SCALE: V--30' DATE: FEBRUARY 27, 2006 .J _ .n t AREA= 22,744 S.F. a 0.522 ACRES A i UNAUTHORIZED ALTERATION OR ADDITION �.. TO A SURVEY MAP BEARING A LICENSED S LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209,'SUB— DIVISION 2, OF THE-NEW YORK STATE EDUCATION LAW. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS, IF ANY KKtST, ARE NOT CERTIFIED. 09 "Spy O�A f i zZ1.1s ' ROAD. 3 f i SURVEY OF PROPERTY. SITUATE IN THE TOWN OF PUTNAM VALLEY PUTNAM COUNTY- NEW YORK SCALE: V--30' DATE: FEBRUARY 27, 2006 .J _ .n s R =125 _ L =27.j5 . 733 \ � ry� PROVIDEI CURBING FOR o DRIVEWAYFBOTH SIDES O PROPOSED WELL O - L x + „ F � t � PREMISES S OWN HEREOAI BEING LOTS 129 THROUGH I3�AS SHOWN ON MAP EN T7 TL ED ' L i ll fE P EE KS KI L L- S E C T/ O N D;