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Home My WebLink About1406DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyou rdocs.com 631- 589 -8100 33. -2 -28 BOX 13 A ,Jim f 1 _ 1a - . UL A Rev. 318 PUTNAM COUNTY DEPARTMENT 00-E ua. Division of-Envlronmental Health Seces, Corm rvi CERTIFIC F CONSTRUCTION COMP Located at ._ Owner /applicant .Name. — Melling Address' Separate Sewerage System hallt by / 1 1 naoiesst Consisting of WJ5 - -- Gallon Septic Tank and -k- Water Supply: Public.Sapply.From qq Address or: _Private Supply Drilled by lv: A ��le- Address ';1n� )( �1- D �I�►�j Banding Typo T� Has Erosion Control Been. Completed? Number of Bedroolms "cam Has Garbage Grinder Been,InstanedY eg Other R airements I certify that the system(s) :a listed iervinq the above premises were constructed essentially as shown n the plans of the completed work ( copies of which are attached), and in accordance with the standards; rules and seg lationa, in accordance wi the iled plan, and the permit issued by the Putnam County Department Of Health. Date �� /� - -� Certified by A' w�^ P.E. R.A. Address D 4' Any person occupying' premisas'served by'the, above system(s) shall 'promptly take such action as may necessary to secure the correction of any unsanitary conditions resulting from such usage ApproveI'of the'.seperate rewitape system shall become null and void as soon as • pub(;: Unitary sewer becomes available and the approval of the private water supply shah'become null and-.void when a public water supply becomes available. Such approvals are subject :t /o modification or change when, in the judgment of the Cornmissionak of Health, such revocation, modification or change' Is necessary. Date z 13 TRIO .AM CAL /�i _ WJ•,LL l.VP1rLL11V1V 1CL:rVAl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH .Office Use Only r}- WELL LOCATION STREET AOURESS: WNIVI71,�Al9kkf0lvl Y TAX GRID NUMBER: ` �� 3 WELL OWNER NAME. ooaess: Z G s BIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary ESIOENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT —L,_ gpm. 1N0. PEOPLE SERVED -3_ -, / EST. OF DAILY USAGE O� gal. REASON FOR DRILLING nREP E EXISTING SUPPLY ❑TEST /OBSERVATION [:]ADDITIONAL SUPPLY C�.pF�UPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL ft. I DATE MEASURED �_ PT Yuv DRILLING EQUIPMENT 0 ROTARY O0CRESSED AIR PERCUSSION ❑ DUG ❑WELL POINT. ABLE P RCUSSION ❑OTHER (specify): WELL TYPE ❑ SCREENED U,0AEN END CASING 0 OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH_ ft. MATERIALS: EEL O PL TIC ❑ OTHER LENGTH, BELOW GRADE ft.. JOINTS: O WELDED HREADED : O OTHER. DIAMETER in. SEAL: ENT GROUT O BENTONITE 13 OTHER WEIGHT PER FOOT 1 lb./ft. DRIVE SHOE ❑ NO LINER: DYES gUW CCRRF?J DIAMETER (in) 'SLOT SIZE LENGTH (Lt) =DEPTH TO SCREEN i DEVELOPED? `"' "' DETAILS/ IRST O YES ONO HOURS St phLf GRAVEL PACK Y ❑ NO AV SIZE: DIAM ACK In, TOP ft. BO .OM OEM It. WELL YIELD TEST If detailed pumping METHOD PUMPED ; tests were done is in- O C PRESSED AIR , formation attached? BAILED ❑ OTHER 0 YES 0 NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE. water Bear- leg Well tell meter FORMATION DESCRIPTION cone ft. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land urface -co d� C G ► WATER PafAR TEMP. S QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? YES ❑ NO ANALYSIS ATTACHED? ES O NO STORAGE TANK: TYPEt ,6,'761y ��f CAPACITY d GAL. O PUMP INFORMATION Ilnn TYPE _ �L_" 1! CAPACITY MAKER (�.v — DEPTH �---"— MODEL 1 Q -4r� vOLTAGbt.� HP WELL DRILLER NAME nn �A�� (/ DATE' s ADOaESS g o �' 1 /3 )3 SIGil7fTUR C d,� 2 ". J, leew_ 13 ion i YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heishts, N.Y. 10598 (914) 245-2800 LAB #: 93.008223 CLIENT #: 26 NON STAT PROC PAGE 1 DENNIS mALAwcHuK DATE/TIME TAKEN: 10/13/93 09:45 PO BOX 313 DATE/TIME REC'D: 10/13/93 16:08 CROTON FALLS, NY 10519 REPORT DATE: 10/15/93 PHONE: (914)-277-3192 SAMPLING SITE: HIGHVIEW DR KITCHEN TAP SAMPLETYPE..: POTABLE : PATTERSON, NY PRESERVATIVES: NONE COL'D BY: DENNIS MALANCHUK TEMPERATURE..: {_4C NOTES...: COLIFOHM METH: MF . DATE FLAG PROCEDURE RESULT NORMAL - RAN6E 10/15/93 NF T. COLIFORM ABSENT /100 ML B=-;ENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) 7_-FA' SATISFACTORY SANITARY QUALITY ACCORDI��-��THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.. SUBMITTED BY: -------- ��_��-,--_-_--------- Albert H. Padovani, M.T.(ASCP) Director - ELAP# 10323 RTI1MM COUNTY DEPART1✓EWr OF HEALTH DIVISION OF ENViRON, .fiEAT,Tfi SERViCFS • _.. . Owner or Purchaser of Building �� l7 •i��U l i:.� i N c4 I NG Building Constructed by Location - Street Manic . p lity Building S vision blame Subdivision Lot 7 GUARANTEE OF SUBSURFACE S091 -GE DISPOSAL SYSM -1 I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has -been constructed as shown on tiie approved, plan. or approved' amendment thereto,. and im accordance, with the.. .. standards, rules and regulations of the Putnam County Department of Health, and ,hereby guarantee to the owner, his successors, heirs or assignsr to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years i=ediately following the date of approval of the ..'Cent ficate. of.. Construct io4-.Campliance_'.' 'for _t. be._secwage disposal .systan� .: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 Director of the Division of Environh ntal Health Services 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 utilizin the system. -5 _ Dated this LP day of 2 19'Y72 Signa jP Title - Si4nature Corporation tangy (if Corp.) �PM 77. V . M.-InIllpffs . . Mdress n:t 0s M Ave . Neil 6Hy-wo- o d 14,91 rev. 9/8S mk Section _ Block Lot S vision blame Subdivision Lot 7 GUARANTEE OF SUBSURFACE S091 -GE DISPOSAL SYSM -1 I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has -been constructed as shown on tiie approved, plan. or approved' amendment thereto,. and im accordance, with the.. .. standards, rules and regulations of the Putnam County Department of Health, and ,hereby guarantee to the owner, his successors, heirs or assignsr to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years i=ediately following the date of approval of the ..'Cent ficate. of.. Construct io4-.Campliance_'.' 'for _t. be._secwage disposal .systan� .: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 Director of the Division of Environh ntal Health Services 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 utilizin the system. -5 _ Dated this LP day of 2 19'Y72 Signa jP Title - Si4nature Corporation tangy (if Corp.) �PM 77. V . M.-InIllpffs . . Mdress n:t 0s M Ave . Neil 6Hy-wo- o d 14,91 rev. 9/8S mk 11 °36'77'W nmew*ipw 1i1.1i -T (1N rn too p a� 3 Z4 3 L S \ < A .0 THIS IS TO CERTIFY THAT THE SEWAGE D6PD°5AL SYSTEM. WA0 CONSTRUGTED A5 INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS IN5PECTE0 5Y ME 6EFORE IT WAS COV5ICED OVER- . THE 5YSTEM WAS GON5TRUCTED IN ACCO2DA90E WITH ALL STANDARD RULES AMC) REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPA!ZTMENT OF HEALTH . qr5 : HIPEK20 4 wt`LLl VkeGt7 ON 1' *0U v ey OE }�Df'�1�'(Y" f fit%PAI��r� UY Tli�'( ('I��EUOOt'1`P Gof.1.JtJ� °5�2x V 1 �1G•G a 2 58.0 1G.0 0 2 1DB.5 115.0 Q2 F v" 5 L� 101.0 104.0 /� O� 1� 1UU.5 x '\ '( c t too p a� 3 Z4 3 L S \ < A .0 THIS IS TO CERTIFY THAT THE SEWAGE D6PD°5AL SYSTEM. WA0 CONSTRUGTED A5 INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS IN5PECTE0 5Y ME 6EFORE IT WAS COV5ICED OVER- . THE 5YSTEM WAS GON5TRUCTED IN ACCO2DA90E WITH ALL STANDARD RULES AMC) REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPA!ZTMENT OF HEALTH . qr5 : HIPEK20 4 wt`LLl VkeGt7 ON 1' *0U v ey OE }�Df'�1�'(Y" f fit%PAI��r� UY Tli�'( ('I��EUOOt'1`P Gof.1.JtJ� °5�2x V 1 �1G•G ?�i.0 2 58.0 1G.0 g 1DB.5 115.0 5 101.0 104.0 /� 1UU.5 102.0 '( 100.0 101,0 8 °I�1.5 qa.0 q 158.0 151.0 10 156.0 15.0 11 151.0 155.0 It 158.0 iJ 4.0 lei 1GD.9 1540 14 560 11.0 15 51.0 (i�J.D 1 G 48.0 Sq.Ci 11 0 55.0 to a3.0 gl.o too p a� 3 Z4 3 L S \ < A .0 THIS IS TO CERTIFY THAT THE SEWAGE D6PD°5AL SYSTEM. WA0 CONSTRUGTED A5 INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS IN5PECTE0 5Y ME 6EFORE IT WAS COV5ICED OVER- . THE 5YSTEM WAS GON5TRUCTED IN ACCO2DA90E WITH ALL STANDARD RULES AMC) REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPA!ZTMENT OF HEALTH . qr5 : HIPEK20 4 wt`LLl VkeGt7 ON 1' *0U v ey OE }�Df'�1�'(Y" f fit%PAI��r� UY Tli�'( ('I��EUOOt'1`P Gof.1.JtJ� °5�2x PUTNAM COUNTY DEPARTNMNT OF JMAM DIeMw s><Dil�iidl HaMA Saetlesa. Ctrl. N.Y. lOSI? to Pn�ilde an CEM FICATB OF COM MANIM' , IS�OiAL sYS!®I Peed Vii✓ o 3rAi�biw Djt :��7T c) f1i3/�%ct�bd Lat / G Tae - £ ,awe Map CA � 'ta°°"'l_ ❑ erW'° o...d ypiC.. 14 ZV r-# 1-� 1--p N& a / Q� /� , / ' .. \ /� Deft of Pn wkw Approval Kdbg A&kn �15 O lj'-',kT T AVE: , A�_ d� G n 7J/p� Date Subdivision Awnroved Fee Enclosed AmM nr`K ✓U v • r r riA d ,,�. 2 .:Qg Fm Alan 0* c MUNI Deslpo Flog G P D PCHD Notldatlon In Raali4ed W6aa FrD IS a� sel.aa sow«ap sip= so o ad d/ saptle Twa md CO 0�0 L 2 5 , To M: esnafa'elad by T� TJ Address WaMr. Sal*t - Pine Sopp4 Otsee Address I represent -tnat n am wholly. a" FOnlPletely responsible for the.Aesign end location of the proposed system(s). 11 that the separate few di sal s slam above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a rpu ns o ha County 0e00rtmsnt of HMRIy and that on corn p»tion thereof a !•Certificate of Construction Compliance" Satisfactory to the Commissioner Of Healthwill be submitted to the Dpartnient, and A written' guarantee will be furnished the owner. his succnfors. hells or anions by the builder; that Said bulkier will ge.q in fOOd .OPerating cwnditbn any pert of said sewage disposal system during the period Of two (2) years immediately following the date Of the ifeu- ange of the appeeal of the Certificate of: Construction Compliance of the original system or any r irs than ; 2) that the drilled well deweed ebofe "ee »cateAOs Yawn oWthe app ► oired -p »n;and that Said well will M 1 al in actor nq ith the fi r uNs and rpu ns . Of the Fulham County Department, of ✓j "� nth. Date l!/% Signed --��11 �L L�11 ✓� G C / P.E. R A. Add/eIS —1J APPROVED FOR CONSTRUCTIONS This approves expires two yurs from the data issued unless construction of the building has been undertaken and is revocaeN for cause or may be am"Wed o► modifie0 when considered neowry by _th Omminlonar of Health. Any change or alteration of construction reauires a new permit. A Prn for disposal Of domestic % an�,, s e a stn NAu only. Bev. _ a W /ace D al. �-_�.� Tit» a L1!5� in �uTt��4M C®uNT- mF -ALTli DEPT =30 `1r3j5 5 Road_` Brewster, NY 1 0509" M Date � � 1 : 1.9 9 7 - Received s ,� < 1 The: For k 3 Q 'HA� �i�� ❑Cash ❑Credit Car-- By �1 ,cc( co vl- / Z l __- - -- - -- -- - -- - - f BOG �1 7AA DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 AF Li-;Z.`Or�i TO CONSTRI CT A `WATER WELL DfNVT nwm"IrT Y WELL LOCATION Street Address wn Vill a Ci y Tax Ab&dV1r-6j 29'40)V6 53 Grid Number WELL Name f L Mail LM_r4gP, �Ll / J4�L� Private O- Public SE OF WELL - primary - secondary 9RESIDENTIAL D BUSINESS D INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY _ ® ABANDONED O OTHER (specify D AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED O -5 /EST. OF DAILY USAGE &" gal O REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION CtADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL ,O REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED 13DRIVEN ODUG OGRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES i/- NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: S Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1 _NO NAME OF PUBLIC WATER SUPPLY: /414 TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION / (DON SEPARATE SHEET (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirti, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19�' Date of Exp' ation 19 �� j Permit Issuing icirl Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller ^ T�rr.;12m County Department of ifealth Division of Cnv�ronmenia� Sanxra� ion AFFIDAVIT - CORPORATE 9-INER APPLZ_CATXON kOn i'ERM;T T . A PP-t,ICAT•xON SV3MITTED' TO - PUTNAtS COUNTY ?IEALTf{ DEPARTMENT 1 T0: Com,lissi.or7er of Health It) the matter of application f'or �..., r t ePreaellt that .T am an officer ar erpYoyee of y , the corporation and am ;lAut•horli ed to act fox- L-4 I<1 as V1 , `(na me of COI'poratitin .,r " __ !-� • having off-ices ar •H ' .`+. !�" .T 1_ �� rr �•�• �'n ~ � �. • � +T IMF r� . Whose a£ re iden�f/��fd .''•"... fivers •g" re Vice- .P'resldent Address •" 41AZV_�AL��_ its � _ (Ndrne a- AddrL'ss} Tres ."Urea'' x. U_ c • ,(ur Name and Tddress)r` and that wal1 be individually responsible f'o� any* o£ the- corpora tjorl 4 {ith respect to the approvaz re ' st d seque�rit ac_rs re]ntxng •thereto. s. l •sub - sqwOrnf td bQf42'@ n e this _day Signed I.9�� TfCIe Vi (1* tF 4ta F�11ili�. .. ' N'ATALIE M. COLLETTA NOTARY PUBLIC, State of New York No. 4993008• : . Oualltled in Ulster Ci Commission �Xpir T Corpor4te Seal ..._._- PUTNAM •• UM DEPARDAADqP OF BEALTH / FP • /rT .LVISIN • F E NVI M MX � HEALTH SERVI CES r DESIGN DATA SH=-SUBSUFACE SEWAGE DISPOSSAL SYSTER FILE 'NO. 4. - , _', � . . ---l- Jocated at (Street) Z2g Sec. Block lot Und-icate nearest cross street) t-=-icipality - A-TT i= ,e-5e AJ Watershed C�TVIO Son PEPmu-,TICN TEST mm Pzwmm To BE suag= wrm AppijamcNs Date of Pre-Soaking— Date of Percolation Test BOLE C1= TIME PERCOLATICN P.EROD=C?N Run Elapse Depth to Water Fran Water Level No. Ti Ground Surface In Inches Soil Rate Start-Stop Min. StaX4- t Stop Drop In Min/In Drop Inches Inches Inches -7q'7 2 2 ��o�7/ 7�8 �5 -7 7/g3 4 1 5 • -b/ L 3 . 'q-7 L 4 2 3 4 5 -7 5z , 7/g 7/9 NOTES: 1.* Tests to be repeated: at same depth until appmaimately equal soil rates are . obtained at each percolation test hole... All data to'be submitted for review..... 2.:; Depth ffeasureTents to be made frcm top of hole. rev. 9/85- LALI.)J. r.L.L L.u- L.a.c1 1%LA4UJ -X � Iv nr. ovncu .L.LZJJ rv.L.La r�.rrL.�.t�t•�t.�.:�ty DESCRIPTION OF SOILS ET}OOUNTERED IN TEST HOLES DEPTH HOLE NO. f HOLE NO. BOLE NO_ G.L. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' '13 14 �... . INDICATE LEVEL AT w-aica GROGN MM IS FN)COUNTE 3 IN -DIME LEVEL TO WHICH KATER LEVEL RISES A.F= BEING ENCOUNTERED DEEP HOLE OESERVATIONS MADr. BY: DATE: DESIGN Soil Rate Used��y� Min/1" Drop: S.D. Usable Area Provided No. of Bedroms 2? Septic Tank Capacity % gals.• Type Absorption Area Provided By (o L.F. x 24" width trench Other Name �� , %�SSCC° • , �: C , Signatur c o ;j z Address Y�, �%� /L� /%� I t/� SEAL �`-- 1? ~ Zs F"0 No. r 04578 A 9OFESSIC THTS SPACE FUR USE BY •HEALTH DEPAEEENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUT NAM COUNTY DEPART MEN T O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: 3.._. Location T/V /C: 4. Project Engineer: X�A l /1LPf4 U) 5. Address: 174, License Number: Phone: O 6. Me of Pro ect: :.._ : �� . -. -• Private /Residential Food-Service ...Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject'* ubject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted_ 8. Is a Draft Environmental Impact Statement (DEIS) required? Ilia 9. Has DEIS been completed and found acceptable by Lead Agency? ........... /o /4 10. Name of Lead Agency I.,s.- this..rroject....in_.an. ar -pa. under - the control - -of - 1cc41-- •pl -a,n,n-4, n5 , zon'sng _ _ - - -- - - - - - -- or other officials, ordinances? ......... ............................... Yel; 12. If so, have plans been..submitted to such. author .sties ?..................... �1,,� b 13. Has preliminary approval been granted by such authorities ?iWli Date Granted 14. Type of Sewage Disposal- System? Discharge...... Surface Water _Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 44 :6. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. 0 8. If yes, name of water supply A)/ 4 Distance to water supply :9. Is project site near a public sewage collection or disposal system ?..... /1) o 0. Name of sewage system A lid' Distance to sewage system /U //4 1. Date observed: 23. Name of Health Inspector: Ul�l�/1�4GtJ1�/ 4. Project design flow (gallons per day) ...... ............................... LD L•. �2- �. `25./`I -s �tate� Foil- u�Lar7i::. i3iscnargt.A cl- imination "Syscc:m' - (SPDESj.Fermit �rec�ui -reds: - --- :F':�`.� T' - 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... IV(,' 28. Wetland ID Number ........................................................ 29. -Is Wetland Permit required? ... L. ��: !'U��:. �. L.�.� .................. �S Has application been made to Town or Local DEC Office? .................. o)o 30. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal;F'`` landfilling,*sludge application or industrial activity? YES or NO A) d 32. Is project located within 1;OOO - feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known - source of contamination? .....'.........YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or'Vi'llage? ........... /06 34. Are community water, sewer facilities planned to be developed within 15 years ?. 35-.--Are -any sewage disposal- areas Arrexcess-of 15%.- slope? .......................... - -0 36. Tax Hap ID Number ........................................................... � 13, 37. Approved Plans are to "be returned to: ................ . Applicant X Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by y-a Letter of Authorization: Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury,- that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: TAILING ADDRESS: 6t) 4AV)eZ iJ T P� (I ANT EE� IMAJ04A 73 /� //a FI E r D Vie llJ�F 11 -Ti - =X:3eA� Al / /�� to 6 5 6 4 1 2 3 Goulds z5uolmersible Ram— Sump • �: =�� -��.• MODEL - LSP03 ,PARTS DIMENSIONS AND WEIGHTS Item No.., Part Description Horsepower 1/3 6' /e DIA. 1 Casing , Voltage . 1.15 2•, /e= 2 .;:: •.;: Impeller Amps Max + 3 Sbbtidn Strainer Phase 1 4 Shaft Seal with Cover RPM 3400 1' /i' NPT 5 :, Motor CHAR . GE 6 Bearing (Ail dimensions in inches and weights in'Ibs. Do not use for construction purposes. Drawing is not I . 7 Capacitor to scale.) . 9 3/." .�....._ -r.._. ,..._ __ ..... >__.__ ._.. .,5 ...: IGIAX. 5VL1T3 -O -Ring- -- - � - - -- - - - - - -. 9 Float Switch SIZE3 18". PERFORMANCE RATING(�� INSTALLATION Total Head -Ft.' 20 15 10 5 Gallons Per Hour 300 1200 1740 2220 ,(In gallons per hour) I5 'Vertical distance from water level to st poi discharge —plus pipe friction. Maximum pump submergence is 10 ft. SBJECA FAILS tkwlDPoC DIGS 11" MIN. TILE OR BASIN 14 ".!N CHECK VALVE UNION POWER. CORD: 16/3 SJT WITH NEMA 5 -15P 3 PRONG GROUNDING PLUG -115' VOLT TETHER LENGTH: B =2" MIN. 3'/2" MAX. APPROXIMATE ON -OFF LEVELS: A =6" TO 11" A i. BOTTOM OF FLOAT_. 1" MIN. TO BOTTOM OF PUMP PRINTED IN U.S.A. APPLICATIONS Specially designed for the following uses: Basement Draining Water Transfer Dewatering SPECIFICATIONS Pump: 0 Discharge size: 1'/2" NPT. - Capacities: to 40 GPM. Maximum head: 21 feet TDH. Power cord: o Heavy duty 3-wire 16/3 SJT with NEMA-5-15 P 3-prong grounding, plug, 115 volts. Power cord length: 10 feet. e Temperature: 104 °F (40 °C) maximum liquid temperature. 0 1989 Goulds Pumps, Inc. Motor: • 1/3 HP, 115 volt, 60 HZ, Single phase, 3400 RPM. • Built-in thermal overload protectio with automatic reset..,.., • Permanent - Split- Capacitor type. • Amps: 2.6 maximum.-.-. • Cl ass F insu lation. • Stainless steel shaft., V� OM— Separate Float Switch is supplied with pump. . • Heavy duty 3-wire 16/3 SJT electrical cord with NEMA 5- 15P 3-prong grounding plug Series-connected ("Piggy- back" type). • Switch cord length: 10 feet. MODEL '1 '',FEATURES Corrosion- resistant cons truction. 304 Stainless. Steel motor casing and fastners. G lass-f i I led thermoplastic impeller and volute Ball, bearing construction. Both upper and lower bearings are greased for life. - - M,dt6f is driTiane extended service life and is powered continuous operation. All ratings are Within the working limits of the motor., 303 Stainless Steel shaft. Separate float switch is attached to the pump at the factory. Float switch is adjustable for various liquid levels. Easily . removed for direct pump operation or switch replacement. Complete unit is lightweight, portable and easy to service. Effective January, 1989 N \ n Lr SS J.G t z, z•owsrz. r �, aorta a�+ nis ott wo p � suM1Li Vas tNCGW BAFFLe CrJX IO.5 PIS wet 160 ~0 a"?Tlmr . oNe v Y-y eTOa.wc —t6�•G .any 4 -I 19 N N rzI NOTCS,: &10 I. GONYfR -AGiOR SHALL OGTGtZMIN?. LGNGtN�i Of' lZ64VIfLe17 6LPrxfR1OAV GAPiLE ANO AVAILAVLE VOLTA6,E9 P121OV f00WWI9 ,RNG CQUIPMENY. 2. ANLL- WIt21NG hHAL - CONFORM 10 NA11ONAL X85 t/L ,C,Tlr1C,AL C-00e, 6 I.ODAL 60VCi ;Ze, ` QVIR�MENTy . \ N i MWN f: �00 `0 1� 0 29� �yge• /� a } .. k rr,or.. oor<I I �I I ^I R r-410 AYF. C