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HomeMy WebLinkAbout0793DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -102 BOX 9 1 11 A, 17 i }� �, IN 1 . `,,r � ,1 ko! BE . , . go -1 J61B , 00793 V\ ' \� U� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION- OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWA T SYSTEM PCHD CONSTRUCTION PERMIT # P- Located at U N-AOLZ� DP-4VF-- Town or Village P��N Owner /Applicant Name. Formerly MALE 6 o MANJ 1 D Tax Map Block I Lot I Subdivision Name bI% ELh Subd. Lot # V5 Mailing Address Y-G 6 MD La" V P \C- Zip 10-Tel Date Construction Permit Issued by PCHD 106100 Separate Sewerage System built by DOV 6 PJyR-D 1L*- Address PO Consisting of I'�-s� Gallon Septic Tank and 44' LP A65 - TIZ&HC -R Other Requirements: NVAP '5 DTEM f6 P-.0-B. 1::iL L Water SuuolY: Public Supply From or: X Private Supply Drilled by Al �• �1�� � WOKS Building Type 46 IQ EHC.5 Number of Bedrooms 4 Address Address t D1% K 311 QMq,�Ojt (14) Has erosion control been completed? Has garbage grinder been installed? HD 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 Qf the Putnam County De neht of Health. Date: Address Z010 AT 22- l./i,�� . . . License # 562-41 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 . subject to odification or change when, in the judgment of the Public Health Director, such revocation, ification change is necessary. By: Title: Date: S o t White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 a.,.-rr..�., -rS-- " r PUTNA�M COUNTsI( HEALTHDEPT� 319A1cj 914% 1278.6130 4 QenevaxRoad BreVYS{e6,NY�10509 ��r°����;� M GOAL ON .� "Yn . �yG"' G^ 4"�' i1 }� y']F"" '.•i""� .t, Y.. ..4 _.�.,r...+.u«3+.+ v i N.^2.,.5"' .-:ti .tom 1..'.+T. S`iK"'. "_•S✓'tr'f ".�.s. T�k' r�LO����' ^t "�"' '� ,x" `. 'L'?^��3a �� ,�.x-rv..n '`'1rs.. 4'.., -•-' ,�`T "S= Y-.�3�c.c"�r- y^— +'� �,.r',v' °�� 3,x. `�, "�c. "a s.LSa�,rr.��k .4J�. �'�r. � ,�"L� OR- F 7't'' a�-7 r. „�"^v� -x �'� '",c .``��F 5; ";,-.5"ycay .�-Y"` t �' � -mot Ei >.s-�"���'''^.u,2c`'�`� -+.•aa y- wC,' �,.,'- "�'-r�^�ss- r,�'y^;:'��.�..;�-w �.�',�""k'�"�"""l.� - ��w %�.`.�'. .. ',«_..:�...0 �^-. ... ,"�^... ^° 4nL.. S?..' �'. ?2 ':�e7' ^.N�:�".4r�''= �...PS,._�- •.,.C�s:^X.S- -Y� '"�,.:".�L. {•_,ice- +Y'`S A CCU _ Office Use Only WELL ' COMPLETION REPORT eta . � DEPARTMENT OF ' HEALTH = ;Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH�O�# 3 WELL LOCATION STREET ADDRESS: WN/ I 7AX GAW NUMBEd: Aj� E/m d a � WELL OWNER NAM - AOORESS: �Ar�inork l' 1P055 k->gtJ Xf3 )!m N, P6IVATE O PUBLIC USE OF WELL 1- primary... 2 - secondary RESIDENTIAL O PUBLIC SUPPLY, ❑AIR /CONO. /HER ?PUMP D ABANDONED O BUSINESS. O FARM O TEST /OBSERVATION. . O OTHER (specify) O INDUSTRIAL O INSTITUTIONAL':` O: STAND -8Y. p MOUNT OF USE YIELD SOUGHT �_ gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY. 0 TEST /08ScAVATION t] REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 6oZs y ft STATIC WATER LEVEL _ft. DATE MEASURED DRILLING. EQUIPMENT O ROTARY COMPRESSED AIR PERCUSSION O DUG O WELL lr01NT O CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN ENO CASING OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH .._,30Z_'ft MATERIALS:, •STEEL O PLASTIC O OTHER LENGTH .BELOW GRADE ft. JOINTS: O WELDED THREADED ❑OTHER DIAMETER in. SEAL:OCEMENTGROUT BENTONITE OOTHER WEIGHT PER FOOT 17 Ib.lft DRIVE SHOE: YES ONO UNEA: O YES NO SCREEN O.ETAI _ . _. DIAMETER (in) SLOT SIZE LEND it) DEPTH TO SCREEN (ft) DEVELOPED? SRO Ho .._. GRAVEL PACK ° Y ONO GRAVEL SIZE: DIAMETER ' OF PACK.__ ln, TOP DEPTH n- BOTTOM DEPTH ft. WELL YIELD TEST � It detailed pumping METHOD: O PUMPED � tests were done is in- � Y7 COMPRESSED AIR ,formation attached? O BAILED O OTHER ; 0 YES ❑ NO WELL LOG f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE I'L fL 1waw gqr, ing We71 Oia- mew FORMATION DESCRIPTION poE WELL DEPTH tl DURATION hr. min. ORAWOOWN ft. YIELD pFm. SuAue ,�Qy' o� ✓ 6 2 Box 171A / %� ✓� PATTERSON, NEW YORK 12563 WATER CLEAR TEMP. QUALITY O Cl000Y HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES D NO STORAGE TANK: TYPE . CAPACITY GAL. WELL DRILLER NAME GATE ALp6E� M. HYATT &SONS, INC. /Q /3 Well Drilling SIG +ntiURE Rte. 311 R. R. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP 2 Box 171A / %� ✓� PATTERSON, NEW YORK 12563 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ,&,�Ab[ t7eAoorz' DTTAuin Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village Q (0 ��. Location - Street G Subdiv ion 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 L4 Day a Year Q I Signature: 4. c Title: A General tontractor (Owner) - Signature nn C r 'on Name rporation) Corporation Name (if corporation) Address: a f o (� �,,,,� Address: P d ,1S&x 6'3a &,U� State Zip I 0 ,Oq State &w Zip v So Form GS -97 L ADS NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811: CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 5/1/2001 7:30 A.M. . M. DOTTAVIO 5/1/2001 LAB #11471 NY-41 5/4/2001 MAXIMUM CONTAMINANT LEVEL (MCQ OR STANDARD 0 per 100 ml PHYSICALS: LABORATORY REPORT REPORT TO: MR. MICHAEL DOTTHAVIO DATE SAMPLE COLLECTED: 26 BRADLEY DRIVE TIME COLLECTED: BREWSTER, N.Y. 10509 COLLECTED BY: • Odor DATE RECEIVED @ LAB: - TESTED BY: 3 Units LAB LD:# 7.17 REPORT DATE: SAMPLE SITE: AS`ABOVE SAMPLE POINT: KITCHEN FAUCET SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULTS METHOD.# BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 5/1/2001 7:30 A.M. . M. DOTTAVIO 5/1/2001 LAB #11471 NY-41 5/4/2001 MAXIMUM CONTAMINANT LEVEL (MCQ OR STANDARD 0 per 100 ml PHYSICALS: • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.17 - EPA 150.1 No designated limits • Turbidity 0.66 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 0.23 mg/L as N SM 4500D 10 mg/L • Alkalinity 110.0 mg/L SM.2320B No defined limits - • Hardness 128.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 3.7 mg/L EPA 273.1 20.0 mg/L ** • Lead- <0.001 mg/L EPA 239.2 0:015 mg/L *"* ml= milliliter mg/L=nul igrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: OVOTABLE or DOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 5 /1/2001 r. �A Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 =654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES /.T 6 /00. a ,r FINAL SITE INSPECTION Yx„ Street Locati�'ri'�L ' Town PAT'T 072 So.N 1. Sewage System Area a. STS area located as per approved plans ......:............... b. Fill section = date of placement 3:1 barrier , . , L' gth. Width Avg.Dpth c: Natural 'soil not stripped. .................. ............................... d. Stone, brush, .etc.,' greater than 15' from STS area., ......... e. 100' from water; course / wetlands ...... ............................... IL Sewage S stem a. Septic t c size - 1,000 .:......1,25 other ......:......... b. Septic tar�kiristalled level ..........:..... .......................:....... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. out ets at same elevation -water tested ...........:..... 2: Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f, Trenches TZength required Length installedS fi 2 stan ce to watercourse measured �;-� O.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, 100 % ......................... 8. Size of gravel 3/4 - 1 Vz" diameter clean .................... 9OlDe of gravel in trench 12 "minimum ................... nds capped ..... ................ ............................... PDosed S stems 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 Buildin a. House located per approved plans . ...................::.......... b. Number of bedrooms ............ ............................... IV. Well Date: Z 3 o a Inspecte y: a, e Owner 'D `©rawep Permit # Subdivision Lot # a=3 j54,M " a. Nell located as per approved plans ....................... 4 b. Distance from STS area measured t 01 ft........... C. Casing. 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. ..Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ....... ..... :.................. c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .......:...... e. Curtain,drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ..........:...... ............................... Rev. 6/97 .NO 1. COMMENTS 6ee 'Gym R —An PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEGE T ATMENT SYSTEM PERMIT # Located at DP.Ap I-a-? D;L-W E-: Town or Village Subdivision name al E Lii Subd. Lot # 9-'4 Tax Map iw Block 1 Lot . Date Subdivision Approved 41 V t 11-- Renewal Revision Owner /Applicant Name �-E Q1 0' ABU Date of Previous Approval I �� Mailing Address Zip Amount of Fee Enclosed Building Type P-66 lQa%� Lot Area'�AW No. of Bedrooms 1' Design Flow GPD 8co Fill Section Only Depth Volume PCHD. NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1(3-6o gallon septic tank and LF- Other Requirements: To be constructed by Address0 Water Supply: Public Supply From Address S�- Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment ay stern 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 OL�110�1 License # r) C ! m 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 w n c nsidered Vecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t prove discharge of domestic sanitary sew; o .;.zg k , (' By: Title: Pu Date: .13 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 AM A'a t Sheet of PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLH SERVICES FIELD ACTIVITY REPORT `f'Pl: AT)1)RR�.�> t � 2�! , f' ��,121 k'f 1�.4 oi�/ A Street Town State Zip ° PERSON IN CHARGE Thte Name an Title TYPE OF FACELITY : FINDINGS: iNa vv TNSPECTnR'T -r ©.._ � -� -- TF.T: a % 2 r 1 Signature and Title RFPQRT RFC EIVED RY: I acknowledge receipt of this report; SIGNATURE: 02/96 Title :� Rev. ..v,� LAURENT ENGINEERING i \ ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 3 MiAtown Road Brewster, New York 10509 CONSULTING' SITE ENGINEERS oa No.. 68o 4q Zryj SHEET No. OF 2. COMPUTED BY `JM GATE CHECKED BY 14M —DATE SCALE 2. ��... ._- .... :...__.__...._.__._:_.__ ..:.....��_:Lr...._:..:.. �_ .. : LAURENT ENGINEERING \ ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE \ Route 22 & Milltown Road - Brewster, New York .10509 CONSULTING SITE ENGINEERS JOB No. • ob ( ++" SHEET No. OF COMPUTED BY DATE. - -- - - CHECKED BY DATE SCALE - a-. ...; - - r LU iL �.� ..- I• tom. 1..�.:/� �i: L.�/!_L�i).. _ .............� . _ 21 O, D - - -.._ ............. ....... _..._._....._..... _... .... ... - - - a-. ...; - - • •. �_� X `off •� � � •• � - _.._...._.__.._..- - - -- - - - - - -- - - -- - - - - -- -- -- - _ 6 - - - -- • •. �_� X `off •� � � •• � - BS: y" h'O U W ts".. Goulds Subrnersible - Sewage Pumps ..3887 M, aw g construction , 1 11-1-11,;-11 � WC '66i7ij6d 4 provides secondary m`ois� oote am 4icki 0- -'AS`Surp? PRp �'-96a " ".". . , . , , 6fita'' in aPTIR! i leakkid.' Effective J ' M 5 UM E,rBF 18 9M ^V. 1170d BF P1230 3:B B, BEM BF 4230 460 3 , T'�2.9" 3H' _,BFIUZ, 2n0' t 11.0 KNM, 12 0/230 7.0 3 Wit, A kk` YS'tE M­4]� � .......... ............. re n'facill ei o :6iistin Also ear%tJe used !6rseptic ns where a laint must be etor 3alt!f,etV'.re=-q-iuoitlrae*0[06ffv-q.i', ti tions -,q , toj yJ io,,'.r .......... in le-pisposarsystems PC A FALLS NEW YORK 8148 Goulds SWORN=- Submersible �' 5 Sewage - -6 :Pumps PIP BF and Models B" Models 3887 rh - ri T P W BFI W 11 . _4 W.. W,PB BFY S05348 BF 11 re 17'. , �"..,epppt:Y4HP.loandl,MPlo�,-,2 $'p not Ued for cqn!!ryctioq_-,, lficatfona i` 41 2 Standards Association ..,.-. j of Mines ior' non face applications L BOTE CHANGE WITHOUT NOTICE... !-'_PRINTE[ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES y DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM O-wner 1`�ll �� 0�/��! �� Address— p�@,mTo I`1�Mt.� g-'p , 6PS1 IoSaq Located at (Street) �Rj p�"w� I ' Tax Map ��' Block y Lot (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No.. Run No. Time Start - Stop Else Time Alin.) NDe th to Water rom Ground Surface (Inches) Start Stop Water Level Dro In Inc�es Percolation Rate lvlin/Inch 2 3 Ip "A 4 5 eA 5/1 3 Wtv - 4 , 5 l �� of P o IC 2 3. 1 a 4 F�pRNo. 6124 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained aL percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hold. Form DD -97 r V DEPARTMENT OF HEALTH Division of Environmental Health.. Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Date: To: 6w S2 a From: Gene D. Reed Putnam County Department of Health .BRUCE R. FOLEY Public Health Director Fax #: 02%6 — -2 6!2-;6 No. Pages 3 (Including cover sheet) - X For your information Please respond For your review Attached as requested As discussed Please call Notes/Messages In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. A C�� Sheet of * * PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLII SERVICES y0 FIELD ACTIVITY REPORT NAME-4 Tel; Street PERSON IN CHARGE OR TNTFR VTFWFT): Town State Zip Pate= Flame and Title TYPE OF FACILITY: FINDINGS: D e,a 4-! C 6 _ -- _ 7 -7 - ©, 75 — - 7'5 X 'D roe �T o, 3 -2 x 7, � � = � a -7 cie- l — TFT ! — Signature and Title RETORT REC IVE-D RV: — I acknowledge receipt of this report: 02/96 SIGNATURE; Title; - - -- - - - -- — — — ly 12-21-1999 01:18PM FROM TO o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EMUONVIENTAL HEALTH SERVICES Fqr. PCHD Construction Permit Located Ae4 D. ZE - Fill- Trcncbe-14 92787921 P.02 OwnerA.Pplicant Name. Block Lo 61 4� Formerly Subdivision #e2 3 Is system fill completed? Is system complete? Date Is system constructed as pen puzz. Is well' drilled? Is well locatedas per ' P1=7 Are erosion control measures in place?---K--L- I certify that the system(s), as listed, at the aboti*,PreTlscs 1JLUkcan constructed and I have inspected and verified their completion in &cordanc Ipt a PCHD Constrtiction Permit and approved plans wid the Standards, Rules and team County Department of Health. au Date:——. Certified by: PE RA_ Comments:. Lv —20M-7, 207- Form FIR-99 TOTAL P.02 SAN(% Pre WAS S' 10 Pfa`: 1C -GL -1777 wlwlrml rKU111 fu 92787921 P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �1'YI l C� l~ I/iQ Address fit/ /(/ Located at (Street) WAU F 0161,` ` Tax Map °� • Block f I,ot /0z (indicate nearest cross street) Municipality DA !t,"" Drainage Basin Cf'j')T� 11�:•) -. /'. �.v , r:,th1 •r•v��,M ,•1 . r rte- AWN-- -� -. i . i... .L. .. i..... Date. of pre. - soaking ck -- Cf G . Date of Percolation Test Hole No. Run No. Time Start -Stop Ela se Time Iia.) Ae t6 to Water front Ground 5urfa�e (Inches) Start Stop Water Level Dro In Indies Pereolatiot Rate Min/itacb 3 z 2s' s' -t/v. 4. S. 4 s �- 2 G 3 A 4 5 IN TES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at e: percolation test hole. (i.e. s I min for 1.30 mintinch, s 2 min for 31 -60 min/inch) All data to b� submitted for review. 2. Depth measurements to be made from top of hole. ��•`/� T VJ�� Form DD-97 ZU! 7 -7ri v7lc)A.-,- &Alf BATH BEDROOM 4 y' 8.` x 12.0•. `'J ;`.J ORESSING- BEDROOM,. WALK' CLOSET ' r - _ - MASTER BEDROOM N I17'-0 it 18.8.. BEDROOM z _- ° PM.N DEPARTMENT 0 HEAD 11' O" x /5' 8' — c0 F 1 HOUSE PLANS APP VED FOR <: ' moms OUNT 0 Y; �. SECOND FLOOR 1344SF ?..nature & Title ppt� 3 KITCHEN • i ,. .1p : I M..•• r DINING HOOM I MORNING ROOM 12' 0" « 12'•0.. L. r • •t OPEN 1 ABOVE I LIVING ROOM w� 1s.•0.. . FOYER FIRST FLOOR 1N • FAMILY ROOM 13' 0•• • 17' 0'• 4828 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT F . R S TREATMENT SYSTEM PERMIT # P- M _ Tb Located at alZ,oL-6y P Town or Village f NTTEP -6QN Subdivision name � 1G E l-M Subd. Lot # 23 Tax Map JA Block Lot 109- Date Subdivision Approved 1� I N TL, Owner /Applicant Name M� �4 °T?"/�V 4o Mailing Address Amount of Fee Enclosed Building Type Rzh%o1E�k,Llc,- if-5oao Renewal Revision A Date of Previous Approval 9` (0' 1b 1r 6m1 '-1 H Y ' Zip 10154 Lot Area ti1*6 No. of Bedrooms `4 Design Flow GPD 8QQ Fill Section Only X Depth 1 Volume � o so PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System to consist of 1 q-60 gallon septic tank and Other Requirements: pV t Q `� JMCIN To be constructed by -TbQ Address Water Supply: Public Supply From Address Private Supply Drilled by Address 4% Lf - hm 14HUN r.f 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.E. Address 14 Ml"T% 14 P4D oeof-"fiV ykt) 1wno� R.A. Date 1)',P N License # 15G, ' 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 whejvvNsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe A roved discharge of domestic sanitary sewage only. By: Title: Date: L� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 LAURENT ENGINEERING \ \ ASSOCIATES, P.C. Milltown town Road Brewster, New York 10509 j \ (914 )278.6108 - (Fox)278 -2658 n Harry W. Nichols Jr., P.E. CONSULTING SITE ENGINEERS September 27, 1999 Robert Morris, P.E. . Putnam. County Health Department 4 Geneva Boulevard Brewster, NY .10,509 RE: Individual SSDS (Revision) Big Elm Subdivision'- Lot #23 Bradley.Drive Town of Patterson Dear Robert: Enclosed are'the fallowing: 1. .One.(1).print of SS -23, 17roposed SSDS," dated'9- 27 -99. 2. Three (3) prints of SF -23, "Preliminary Plan for Fill Placement Only," dated 9- 27 -99. 3. Revised "Construction Permit for Sewage Disposal System," dated 5.2.1 °v9 4: `-`Letter of Authorization," dated-9- 27 -99. 5. Review Fee in the amount of $100.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. N ols Jr., P.E. HWN:his 88044 -23 BRUCE R. FOLEY Public Health Director L � LORETTA—MOLINARI R.N., M.S.N. Associate Public Health Director . Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 =6085 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: D'Ottavio Bradely Drive, Lot #23 (T) Patterson, TM# 24. -1 -102 Dear Mr. Nichols: October 5, 1999 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) Remove relay from pump pit detail. The current and any future plans showing this relay will not be approved by this Department. 2) Pump pit wall thickness is to be noted and outside dimensions shown. 3) Force main�deta "ilis to be provided. Ir�GN Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very A ly yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer LAURENT ENGINEERING ASSOCIATES, P.C. j� MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 / (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS May 22, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSDS - Ross Alan Bradley Drive - Lot #23 . (T).Patterson TM# 24.4-102 Dear Mr. Moms: In response to your review letter dated May 20, 1998, we offer the following: 1. Plan has been revised to conform to the Putnam County Department of Health Procedures and Policies. 2. The title block now shows street address of property. We trust the above adequately addresses your concerns. Kindly issue the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:JM:bd 88044 -23 PUTNAin COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Propertyof Mi �' OIT"A',110 +_Jl XPHF_ gloi- mic) Located at Dq-1gP ev pPt�l�i Tax Maps Block Lot !b�_ Subdivision of �--L1 Subdivision Lot r Filed Map Date Filed Gentlemen: This letter is to authorize 1+ AF +P . W, H�G"UA , J'P- f E- a duly licensed Professional Engineer _Y 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 treatment 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 C2uzjy Sanitary Code. y�P- l�•N'COB Very truly youcs, Countersigned: W Sided P.E., R. A., r z ncr of P /opera) ft O No. 66124 Mailing Address' Mailing Address: State N zip �0IT° Telephone: C0\0% State Telephone: N� Zip 105b 9M- �_nq - 019D\ For-: L.,.97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI PERMIT # F-1110 IS l( Located at 5RADLI!�? Subdivision name 51C4 Subd. Lot # Date Subdivision Approved Owner/Applicant Name AFL -►J E TREATMENT SYSTEM Town or Village Tax Map Q4 Renewal PAIT15 g.6 0 f-4 Block 1 Lot 101- Revision Date of Previous Approval Mailing Address ib F,Y V--NM Lo< -E P-0 AD mLm o rN- I rA � Zip 105 ow Amount of Fee Enclosed Building Type Mlr Lot Area `IA %5 No. of Bedrooms 4 Design Flow GPD 8 00 Fill Section Only Depth °h Volume 10r20 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 44 5 1-F 1 � W \DE mbr.0R-m'K t? -E1-u dES Other Requirements: To be constructed by T'b -O - Address Water Supply: Public Supply From Address or. X Private.-Supply Drilled by 1401 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seFarate 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: R.A. Date 41'L S1R% Address i.P W\<WU- N5 � MY341AWS U M \u;Vpa40 P-Mt License # 561PA my \ vat 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 modifie w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new of domestic sanitary se a only. By: Title: y Date: / White copy - 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 print or type PCHD Permit it r l Well Location: Street Address: Town/Village Tax Grid # t' PLMLE� Da-IVE pA��oH Map M Block Lot(s) Well Owner: Name: Address: Wz5 ALLAN `J 10.6 5%ew11 t..� kFkD A PLM041 (4T jrjQLi Use of Well: 1 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 5+ gpm # People Served 4 Est. of Daily Usage CM gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling k New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type k Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes 5L No Name of subdivision B1 (A EtJ'\ `-)1J%0N( �hoN Lot No. ZrA Water Well Contractor: T, %-D, Address: Is Public Water Supply available to site? .................................. ............................... Yes No 'Yt Name of Public Water Supply: — Town/Village Distance to property from nearest water main: -' Proposed well location & sources of contaminatio to be pr vid d on se at sheet/plan. Date. t� `�'%' �% 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 design ated 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 wate 1 driller certified by Putnam County. Date of Issue / Permit Is s wmltc i Date of Expiratio W,9-j Title: Pe rmit is Non -Trans err ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 , Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 May 20, 1998 Harry. Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Ross Alan Bradley Drive, Lot #23 (T) Patterson, TM# 24 -1 -102 Reservoir Basin East Branch Dear: Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 12, 1998 is complete. The Department will notify you by June 8, 1998 of its determination. tR The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines.set forth in the Watershed Agreement.. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Ver iruly yours, 4 ' b � mo Robert Morris, PE RM :tn Public Health Engineer 14-16-4 (2187)—Text 12 PROJECT I.D. NUMBER 614.21 SEAR APParidIX' C State Environmental Quality Revlew SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT IN (robe completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR n ,� A N 4 A LA 2. PROJECT NAME. 01(i ELFA S0601'4IshO LO'r•'A p"Q %Te. 3. PROJECT LOCATION: p AJT11�-_SON Municipality 1" County `iNAli\ 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 6. IS PROPOSED ACTION: 8 New ❑ Expansion ❑ Modificatlon/alteration 6. DESCRIBE PROJECT BRIEFLY: cwgalluv t o of- Sir W1 a Fwv 7. AMOUNT OF LAND AFFECTED: {- It Initially. acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? &es . ❑ No If No, describe briefly 9. WHHIAT'IS PRESENT LAND USE IN VICINITY OF PROJECT? {a Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 1 �aliw► ��r�l.� 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? �I Yes No If yes, list agency(s) and permlUapprovals '(bWK Off- PpvJp'J bOA jxk �IVIW\ QE 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL ?' ❑ Yes MNo If yes, list agency name and permit/approval 12. AS A RESULT OFF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? , ❑ Yes I tCINo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE' BEST OF MY KNOWLEDGE �' ' "0-43, 9.6 A�4E�Ar Applicant1sponsor name: Date: Signature: v i If. the action is In the Coastal Area, and you area state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by 4gency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 8 NYCRR, PART 817.12? If yes, coordinate the review process and use'the FULL F. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 817.6? If No, a negative declaration may be superseded by another Involved agency. Cl Yes ❑ No. y. . C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. If legible) Ct. Existing air quality, suriace' or `groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brlefly C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other.effects not Identlfied,ln C1-05? Explain briefly. rtl Q?'... C C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. I ✓ T�y�. C:O A> C7 . r?t D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? N "--f ❑ Yes - ❑ No If Yes, explain briefly tJJ 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. ❑ Check this box If you have Ident:lfied one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL, NOT result In any significant adverse environmental Impacts AND provide on attachments as. necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date `11 Title oT Responsible Officer ignature of Preparer (if different from.responsiole o icer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: P\ 0 S S ?,h &P-AM A4 .ROAD �P -N►ow� ,'�vY - I osa4, 2. Name of project: a1'� 04' !�Jbwglil °H" L0T �-�'. 3. Location T/V; PATrEP� OH 4. Design Professional: 404V4 V0 W(.,4&64fE-. 5. Address: LAJk-W e'mQiNEM►� AS PUPKES PL. 6. Drainage Basin: GROT °H 20 MIWTOatl P* 9REWS*V- N�? 1060q 7. Tyne of Protect: k Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is -this project subject to State Environmental Quality Review (SEQR)? Type Status (check - one) ...................... ............. ...................... Type I Exempt X Type II -Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. ..Has' DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency — 12. Is this project in an. area under the control of local planning, zoning, or other officials, ordinances? 13. If so, have plans been submitted to such authorities? No 14.. Has preliminary approval been granted by-such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? ..................... 1 17. Waters index number (surface) ......................................... ................................. 18. Is project located near a public water supply system? ....... ............................... N o 19. If yes; name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system: Distance to sewage system 22. Date test holes observed Ihl 109 23. Name of Health Inspector M146 R,VU44W 24. Project design flow (gallons per day) ....................:............ ............................... 25. Is State Pollutant Discharge Elimination System" ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... . boo Mo Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? N J 28. Wetlands 'ID Number .......:...... ............................... 29. Is Wetlands Permit required? ...... ......................................................................... No Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? N ° 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .........:.................. Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste. site, salt stockpile, landfill, sludge disposal site or any other potentially .known source of contamination? ............................... Yes/No N �0 DESCRIBE: 33. Is there a local master plan" on file with the Town or Village? ......................... N�-5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ........................... .............................:. N 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ....:...: ::::.:.......... ............................... Map Block I Lot Ion 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review.and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation. of impervious surfaces, and the project. applicant should obtain the appropriate forms for such activities frm 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 afrm, 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 Pen 1 , w SIGNATURES do OFFICIAL TITLES: Mai(iQ;Mdre9s- AW86 ........................ I.AJPZ -r AJJF4,'pC-. SOIA S 1Ii"I ` 3H AU M 11.1 -Toh4N pw n BFLEWSlo- 'rf? 10501 .AINnOO WVIdJIN 03AI3338 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner P0465 ALAN Address BVM ^ L&4 PAID Agmotw.W im Located at (Street) BM DU!, M—NC-J &4 R-0 . Tax Map Block Lot I ��-- (indicate nearest cross street) Municipality PRf�'�oN Drainage Basin GF -N"o� SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation. Test Hole No. , .:Run No. Time Start - Stop Ela se Time (PMin.) De�ppth to Water From Ground Surface (Inches) Start. 'Stop Water Level Drop In Inches Percolation Rate ' A in/Inch. . 3 qss 101q tiIn. 2�► �" g11 4 5. . 3 4 U i'1 4 5 1 2 3 . F-1 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are outamea at eacn percolation test.hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5' 0'G4 1.0' 1.5' 2.0' CON- H�'�i� 2.5' 3.0' 35' TON011. PIE' 4AW SI1J1r 8.0' - f+H� SpN'p 4.0 4.5' _ 5.0' 5.5 4-(9 6.0' tyo wi'�t NQ WPB 6.5' 0,611 r Top601L I Fite C.111,09 " -� 4 9-04t- 0- 4%- aft . . No Wot� 2 7.0' . 7.5' CD 8.0' 9.0' o 9:5' .. 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed — Indicate level to which water level rises after being encountered Deep hole observations made by: 1- E •R• j P0+P Date VL1I 9l Design Professional Name: }1•AO." W - H\okL-6 , f •E . Address: LM W 0 ►kPW -+N(, PIE W. 141 NO CO LU Signature: = r No. 5024 4i Design Professional's Seal �O�ROF'ESS\��a�� Lim PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of {-0196 ALAN Located at BD.AOLE� Dp-►VE TN PhTrEP-6 ON Tax Map # 'y'1 Block I Lot �-- Subdivision of �1t4 ELM 45APD '41510H Subdivision Lot # Filed Map # 1-462A Date Filed Gentlemen: This letter is to authorize 14 "4 0' N►L�°I -S� PE 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 HealthDirector 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 treatment 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: NEw 09 Signed: &i�= o P.E., R.A., # Nic (Owner of Property) Mailing Address 'L * Q! s Mailing Address: 25 �c0 State NEVS e Zip`` Telephone: (°I m) v)% - (2) w a State . NEN ` rj4* Zip b 6 b"A Telephone: (Cim) no)— Form LA -97 • DEPARTMENT. OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSDS: Ross Alan Bradely Drive; Lot #23 (T) Patterson, TM# 24. -1 -102 Dear Mr. Nichols: May 20, 1998 BRUCE R. FOLEY Public Health :Director 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. You should contact. local .wetlands officials in this regard." 1) Revise plan as per guideline set forth in the Putnam County Department of Health Procedure and Polices Subsurface Sewage Treatment and Water Supply Facility Program Guidelines for fill sections greater than 2 feet. 2) Title block is to provide street address of property. Upon receipt of a submission, revised to reflect the above, this application will be considered further. •I. `i'i1 Very ruly yours, v No, Robert Morris, P: E. Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH COMMENTS: DIVISION OF ENVIRONi11E\TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT n ^ p n �IL-� Q��' P/`- y STREET LOCATION -'[ NAME OF OWNER REVIEIVED BY AS, I%IB, Btl D A E "L ( TAX. NIAP# Y DOCUMENTS Y N 1, Vr3PERMIT APPLICATION 37 EROSION CONTROL:HOUSE,WELL, SSDS 3 PC -1 38 PERC & DEEP HOLES LOCATED ELL PERMIT _ PWS LETTER 39 REPRESENTATIVE OF PRIMARY & EXPANSION 4 -ETTER OF AUTHORIZATION 40 LOCATION MAP 5 DESIGN DATA SHEET (DDS) 41 EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE 6 ZORPORATE RESOLUTION 42 IF PUMPED, PIT & D BOX SHOWN & DETAILED 7 SHORT EAF. 43 HOUSE - NO.OF BEDROOMS 8 LANS - THREE SETS 44 WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. 9 to HOUSE PLANS - TWO SETS 45 PROPERTY METES & BOUNDS 10 VARIANCE REQUEST 46 HOUSE SETBACK NECESSARY (TIGHT LOT) FEE 47 HOUSE SEWER - 1 /4 "PT.4 "O; TYPE PIPE SUBDIVISION 48 NO BENDS; MAX.BENDS 45° W /CLEANOUT LEGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL CHECKED 49 CLAY BARRIER PERC RATE 50 10- FT. I IORIZONTAL;SLOPE 3:1 TO GRADE 11 FILL REQUIRED DEPTH 51 FILL SPECS PILL NOTES 12 CURTAIN DRAIN REQUIRED 52 FILL CERTIFICATION NOTE 13 STANDPIPES 53 DEPTH GAUGES GENERAL 54 rlLL PROFILE & DIMENSIONS LOCATED IN NYC WATERSHED S5 VOLUME PLANS SUBMITTED TO DEP 56 FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D 57 LF TRENCH PROVIDED 60 FT MAX. 14 DEEP TEST HOLES OBSERVED 58 PARALLEL TO CONTOURS 15 PERCS TO BE WITNESSED 59 100% EXPANSION PROVIDED 16 EX- APPROVAL SSDS ADJ.,LOTS IEPARAT :S SPECIFIE12 17 WETLANDS (TOWN /DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS 18 DATA ON DDS PLANS & PERMIT SAME 60 10' TO P.L., DRIVEWAY,,LARGE TREES, TOP OF FILL - 19 ' . ' PRE-1969-NEIGHBOR NOTIFICATION 61• 20' TO FOUNDATION WALLS _15'WELL TO PL 2p LETTER BI /ZBA 62 100' TO WELL, 200' IN DLOD, 150' PITS 21 100 YR. FLOOD ELEVATION 63 l OV TO STREAM WATERCOURSE LAKE (inc. expan) 22 OTHER REQ'D PER,%fIT(S) 64 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 65 10' TO WATERLINE (pits -20') 23 SEWAGE SYSTEM PLAN - (NORTH ARROV06 50' INTERMITTENT DRAINAGE COURSE 24. SSDS HYDRAULIC PROFILE 67 200'/500' RESERVOIR, ETC. ,150' GALLEY SYSTEMS 25 GRAVITY FLOW 26 CONSTRUCTION NOTES 68 15' MINtoCDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <l %' 27 DESIGN DATA: PERC & DEEP RESULTS 69 20'M IN to CD discharge /I 00'with 182 cons day discharge 28 T CONTOURS EXISTING & PROPOSED SEPTIC TANK 29 DRIVEWAY & SLOPES, CUT 70 m 10' FROM FOUNDATION; 50' TO WELL 30 FOOTING /GUTTER/CURTAIN DRAINS V t 31 SOIL TYPE BOUNDARIES 71 DIMENSIONS TO PROPERTY LINE 32 TITLE BLOCK; OWNERS NAME,ADDRESS72 LOCATION OF SERVICE CONNECTION _ TM #,PE/RA; NAME,ADDRESS,PHONE# 33 DATE OF DRAWING /REVISION 34 DATUM REFERENCE 35 LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET 36 mPROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: I LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster,.New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS April 29, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road' Brewster, NY 10509 RE: Individual sSDS Big Elm Subdivision -:Lot 23 (T) Patterson Dear Mr. Morris: Enclosed are the following: t: 1. 'Five (5) prints of SS -23 "Proposed, SSDS ", dated 4/28/98. 2. Five (5) prints of SF -23 "Preliminary . Plan For Fill Placement Only ", dated 4/28/98. 3. "Short EAF ", dated 4/28/98. 4. "Application For Approval of Plans For a Wastewater Disposal System ". 5. "Construction Permit, for Sewage Disposal System ", dated 4/28/98. 6.. "Application to Construct a Water Well ", dated 4 /28/98. 7. "Design Data Sheet ". 8. "Letter of Authorization ", dated 4/28/98. 9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 10. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Ni ols, Jr., P.E. HWN:JM:bd 88044 -23 LAURENT ENGINEERING �j ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE' Route 22 6 Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 W ICHOLS JR., P.E. \ CONSULTING SITE. ENGINEERS Date: �o 2 To: nC H D 4 G,EHr,-NA . �R EASTER- N (p 50 °� Attention: G"tlemen: We enclose (� ) copies of: B/W Prints ❑ Reproducibles O Specifications Description: Job No.: 0 00 q - tin? Project: $I(A EUn S��DIVlS11)s� (T) f`A1TLRJ-11 O Reports ❑ Tracings ❑ Memorandum O Copy of Letter )) Tp SS'ti� Sh i 5 QLAd 4 -ti'h • Rt=umEN* -Pv► f-0- frl:; pt.�muj� Revision /Date. No. 51Zzly�, 61 llq� -61.0 9 . Sent Via: @,dur Messenger ❑ Blueprinter ❑ First Class Mail O Special Delivery ❑ Your Messenger O Hand Delivery O Copy to: Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Per: 611"t, /%; DIMENSION CHART (in feet) Number A a I : ", (,) - 101 2 tv) t') . � I . 2A 3 1%191 201-15 -f 193' 2- T s 199, 21U WAS 220.5' 225' qV 12 201' Wl% 1-7U Is tcill 1-75, 1(0 197.9 1001, 17 2031 IST IV 8211 273! 10 "w r 0.1y r,b soup pw- oAp- 12" rAtW- M f C.3 C.11 M f