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631- 589 -8100
33. -2 -35
BOX 13
01413
/ PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. 8 ,
f Division of EnvirdnmentAl ENakb Servicex,'Carmel; Kt.
{F I Engineer Must Provide p_'g
P.C.H.D: Permit M
4
CERTIF7 q_1 F CONSTRUCTION COMPLIANCE FOR SEWAGE
Located at 1
caner /applicant
Address
Separate Sewerage System built bye. i • EC—M, GE Address
Consisting of Gillon Septic Tank and Ca�? L
Town or V01ego
Ta=1ep_Block
Subdivision NameEPda§lef OjUdv Lot p _
Date Permit issued j �b
Water Supply: Public Supply FromAddress /� � � �
orsr— Private S.npply Drilled by S Ad�rees�LT v w
Building Types yr� Hue Erosion Control Been Completed?ter- s
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructs,' essentially as shorn on th lan f e completed work ( copies
of which are attached), and in accordance with the'etandards, rules and regula i s, in acco anc the l d the permit issued by the
Putnam Countyrr D,epartmyent' Of //Health.
• oats
�J ` �s' id Certified by C P.E.X_ R.A.
Address License No.
Any person occupying promises served by,the above system(s) shall promptly take such act ass may be necessary to secure the correction .of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubt'n sanitary .sewer becomes
' available and the approval of. the Oiivate water - supply shall become null. and void when a public water supply becomes available. Such approvals are
subject .to mod ificatIon or change when9ifn the judgment ,of the Commissioner o �M -adc�► evocation, modification or change Is Snecessary.
1 Oats
e
Ftii t:r1 f COJM..f DZPA?;MXD,T OE' h kVjl i
DIVISION OF 'VI�iO�?! ��1 �L fi =Irf SzPVICFS
.VJ
O n, nor or _) &.aser of - i:lding
. 1
Building nstrlicte3 by
Location - Stre_t
t irucirel i �/�-y
K;L°S -',��i 6{
BuIlding 'Dype
Section B?_cr,�'C 'TI
Sl�ivi s i o._I
Subdivision Lot
CJJ3�_ k_.11 . O^ SUE-1-SU?..:. -.Ct Sa,, r D!SEO& r, SXS�r^_<•i
i
J_ reDresent L?at I aTl wholly and Completely resconsible for the I '1Gn,
n = }mot.= lSl)_D, _ ^•.?i°_.lc'l� .consI�_7:C 10:? cs)d. drulP.cge Oi: '-he sewage C11SpOSZI SVSic_il
ser—va.ng the above Cescxil�� _L'rOi.a LY, c:C1.t -h li !�ZS rJC -crl CX)7StT11CtEd cS :i? C:2
i=} e coDLOVC' J D1cC1 Or c_DDZOVEQ c� en in ni_ t hereto, Znd. in. ac-cordarice vi i "l L-1 I
stand.ar 7s, r iieS and regu atlons Of. the : `�lli-n2*F.I C0Un'L � _t��et�?S?` Oi �P�_'i_a1, G 7r;
n- i•e =+'� suaz - '?ttc-? .o the C�Y'i:`Cr his s—uc— •`SSOrs, C:e1rS or assigns, ,i=0 place in Gc <;.�
operating CJ CO[ Clli 10i1 any part- OE SelCl SySi E l COnsLrL'Ci Ed by lie ;ah i Ch ia?.1S i:0
OCti? tC Or a i u") Cd O i_r;� I eaz5 ? Tedial y iollC�ti']Pg t_rIC GZ;t ° O` c��'OVa�_ 0.1` _ i_r:t�
"Cer -i "ic to of ConstrLGL-zOr7 CC— .tttpl? ancett for Lne sCx•YCge cluscos2.l� Sys-L.4—an, Or =t�'
.rerL rS iii."? by :l% o su.CC'I -S SiC -il, E_XOeDC w",ere &.e ia?ilire bo operate 0r0Pr °7_�_'
CaUSC by U:7r l; i�_li:L�_ O` ; ?2g�_1Gent act of- uie Ccck :.. 1i .o L?@ U _��..__.....
The U^Cerslgne& rll::i% °r aCjrEES I =0 a.CCCUL aS CNnCI.IS].v.e_ iie .
Lile Dirc--CLO_ O:: i=[ ?@ Division Oi ._<1� �0 _ ?`(?il �_ G'��_u`1 ("-Or,r ;ce_S of t.. ^.C' C! U.. _
Oi 1(?a�.t11 as ',:,0 r.- t?ei -h-a -_ C_ n0'.' the Lailure Oi. i °
SySi E1 %O CG rGi '. '.•?s
C =US i
F� by ^C Fr).jj_iUj Or cCi . O the GCCUC?ni? 01= t}7P buildirg
Lhe Sys.
= tc this of -
`
g// ( S1Gna
' 1
/ • � Tit] -e
'3' 'JU•�
C.0 -, �) . )
corporat10C1 Nauma (2Z Corp.-)
,PcUxess
/,vM c`o 0
\
sL WELL GUF1rLt11ULV MEXUal
DEPARTMENT OF HEALTH
of- Envirortmental- Health
�� Y �� PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
-
WELL LOCATION
STREET ADO ESS: WNW VIEEXCIOCI I Y TAX GRID NUMBER:
Jennifer Lane, Lot #14, Carmel, New York 1
WELL OWNER
NAME. AODRESS:P . 0. Box 555
Pyramid Custom Home Corp. Ridgefield, CT 06877
® PBIVATE
O PUBLIC
USE OF WELL
(A- primary
2 - secondary
0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS 0 FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) [] DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 445 ft.
STATIC WATER LEVEL OF 2913P
DATE MEASURED 3/27/96
DRILLING
EQUIPMENT
6d ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING 0 OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH 71 _ fL
MATERIALS: ® STEEL O PLASTIC O OTHER
LENGTH BELOW GRADE 70 ft.
JOINTS: ❑ WELDED Q THREADED O OTHER
DETAILS
DIAMETER 6 in.
SEAL: 0 CEMENT GROUT 0 BENTONITE ❑OTHER
WEIGHT
PER FOOT 1 1b./ft.
I DRIVE SHOE. 9 YES ❑ NO
LINER: G YES Q NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (1t)
DEPTH TU SCREEN (1t)
DEVELOPED?
FIRST
a YES ONO
HOURS -
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST t If detailed pumping
METHOD: O PUMPED tests were done is in-
COMPRESSED AIR , ormation attached?
O BAILED 0 OTHER ❑ YES O NO
1�JELL LOG If more detailed formation descriptions or sieve analyses '
are available, please attach.
DEPTH FROM
SURFACE
water
Bear-
inq
We11
Dia-
lmeter
FORMATION DESCRIPTION
CAGE
It.
it.
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
gym.
Surface
56
Drilling
in overburden clay & boul
er
56
Hit
r
ck at 56,
445
6 hr
380
5
56
71
Drilling
in rock, set casing, grouted
71
445__Dr11l:i_ng
in rock granite
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES ONO
STORAGE TANK: TYPE WX #250
CAPACITY 44 GAT,.
PUMP INFORMATION
TYPE s u hm P s i b 1 ? CAPACITY 5CIprYt_
MAKER Goulds DEPTH 400 ,
MODEL 5ES07412 VOLTAGE23OHp_W
WELL DRILLER NAME P.F. Bea 1 & Sons./Inc. / 3/96
ADORESs 4 Putnam Avenue SIGNATURE
Brewster, NY 10509
3/89 "Mal`colrfl T. Beal, Jr.
LAB ID NUMBER: i
CLIENT:
I
SAMPLING LOCATZOI .-
COLLECTED BY:
DATE COLLECTED:
DATE RECEIVED:
DATE OF REPORT:
96.3026
P F Beal do Sons
4 Putnam Ave
Brewster NY 10509
Pyramid Const., Lot #14, Jennifer Ln, Carmel NY
C. Beal
05/23/96 TIME COL UCTED; 10:00 AM
;05/23/96
05/28/96
F' . 2!^•
rHUE Q1
Total Coliform ' .A,b6ent Must be "Abmnt" SM18 (9223) 05 /23 /96
E. Coli Absent Must be "Absent" SM18(9m) 05/23/96
I
TWs sample, as stibn-dtted to the iaboratory, and as compured to the NQw York State limits for drinking
wafter quality for the tests performed, wart
ACCE ABLE, NOT ACCEPTABLE,
NYS FLAP $11218
Maryan CT Lab Aye Oval OH-0171
" UMerlined mWis axe unaccept kb1a according to health depaArr..ent and /or U$ EPA codes,
Nfaadmum Corktambwt Levu1. (�. nximum permissibls concent- atior: a lowed by health depart;ne,nt sad /or U$ EPA codes),
i
i
I
iil8 G1ryt;1; Tower Commons, t�rrwsfar, N't` ]0.509.9��r1 / 41•r..l;�.; `:��; s�nx ;:= r��'3 -i7S�
1
mmpnw/Awp0OW -
Daft of Previons Approval
M~S~=__-_- T. '[K
Date Subdivision AD'roved ` .
W"W
.-P Addreas
, I reprasent-1hat I am wholly and Coffiphtltely nNSPonsiblefor the design and location of the proposed syStem(s); 1) that the par t* a sliqui 1 $1011
described will be constructed as shown on the approved amendment there to and in accordance with the standards. eslani r4equIlMons Main
County Department of Health. and that on completion thereof a "Certificato of construction CompliancWl satisfactory to the Commissioner of Healthwill
be submitt
to the Osipartment. and a written guarantee will be furnished the owner, his,successors. heirs or assigns by the WNW. that said,bulkler will
in good dMathM condition any Part of am g di- I - it during the PlItiod of two 12) ye""'Immediatelly following the datai of the &nu-
ance of the approval of the Certificate of Construction Comolism' f t orig I system or any repairs tt#'ito; 2) that the drilled well described A a" I
will be located as dmwm on thes'p ovei'plain and that OW well will lm;slnoft in =rds wit stand& S. ruwj a regulations of the Putnam
County Department of Multh.
Clot-
Af*RqVED FOR CONSTRUCTION, This approval expires.two years from 4o date i.Wd unless construction of the buildinghas been undwtaken and is
:=or y be amenew or modified when considered necesser of Health. Any change or alteration of construction
t7ul Approved for like sanitary t su
Rev.
Title
�T
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130.
APPLICATION TO 'CONSTRUCT -A WATER"- WELL'
PCHD PERMIT 0
WELL .LOCATION
Street Address
Town/Village/City Tax Grid Number
WELL OWNER
Name
Mailing Address
5i G
®Private
D Public
USE OF WELL
- primary
2 - secondary
(RESIDENTIAL
® BUSINESS
® INDUSTRIAL
OPUBLIC SUPPLY QAIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
®ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED -b- jr /EST. OF DAILY USAGE,_&Vj2_Sa1
O REPLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY
L&NEW SUPPLY NEW DWELLING .® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
gr-S 19
E:W 4=�
WELL TYPE
DRILLED
®DRIVEN ®DUG ®GRAVEL.
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES )� NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t^
Lot No.
WATER WELL CONTRACTOR: Name 713a Address:
IS PUBLIC WATER.SUPPLY AVAILABLE TO SITE: YES __2(_NO
NAME OF PUBLIC WATER SUPPLY: KII TOWN /VIL /CITY
-- TO PROPERTY-FROM ..NEAREST_V TER. MAIN:T_
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE
(DON SEPARATE SHEET
/
(date) s
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
thirty (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 tike appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in s a manner as n_ot to degrade or otherwise co amina or groundwater.
Date of Issue: / . 19 /
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
r
Second Floor
o EOk00a 3
1<'- 1' X 16'- O'
i
1y' 16'
c~ OEOROOK 2 Ji
ti_ ---�
^_ I
It, .3'z Io'.o'
�--� �'JTNAI'i Coull D PARTMENT OF HEALTH
r- n;:r� p ; :��'- FOR
fi0?T,,�. i..
EE
4 G'
! Signature &Title ..
First Floor _
C( i\w KITCHEN
\ DINING ROO1r .'z 13' -o
II - STER BEoRoOK
4'. 1' X I3'- O'
M
ROD}{
- -- Date
STANDARD NEWFOUNDLAND FEATURES
Fireplace Options Available
•
Luxurious First Floor faster Suite Consult an Compartmentalized First Floor lath v ✓ith F�uthorized �'�estchester Builder
• 'Two Separate Vc..nities fCr a Complete List of Options
• Formal Entry Fo}'er gist's ren!erinz�s and Floor ?!an oi,rPnsions zre
^:iica io .s n sc tr wri; en in ;,he
aprrc•r�ea:e.r .-.
• Formal Dining Room Cor,;racL 1•D oral co„i;io:-
• Formal Living Room
• Spacious Eat -in Kitchen
ESTCHESTER ODULAR OMES, INC.
• >.'. I' J Win
i Reagan 's fi11 Rea d dale, NY 12S94 9
L
(914)832 -9400 • (800j 832 -3888
1
�: 1g
.v
-
V
J
STANDARD NEWFOUNDLAND FEATURES
Fireplace Options Available
•
Luxurious First Floor faster Suite Consult an Compartmentalized First Floor lath v ✓ith F�uthorized �'�estchester Builder
• 'Two Separate Vc..nities fCr a Complete List of Options
• Formal Entry Fo}'er gist's ren!erinz�s and Floor ?!an oi,rPnsions zre
^:iica io .s n sc tr wri; en in ;,he
aprrc•r�ea:e.r .-.
• Formal Dining Room Cor,;racL 1•D oral co„i;io:-
• Formal Living Room
• Spacious Eat -in Kitchen
ESTCHESTER ODULAR OMES, INC.
• >.'. I' J Win
i Reagan 's fi11 Rea d dale, NY 12S94 9
L
(914)832 -9400 • (800j 832 -3888
i
U NT
- ENGINEERING
ASSOCIATES, P C
CENTRE " '' NILLBROOKE OFFICE '
_ -- -
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FA)O 278 -2658
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
November 16, 1995
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS.
Pyramid Custom Home Corp.
Jennifer Lane
Lot 14 Windsor Oaks Subdivision
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. One (1) print.of Drawing SS -14 "Proposed SSDS - Lot 14 ", dated 11- 16 -95.
2. Three (3) prints of Drawing SF -14 "Preliminary Plan For Fill Placement Only ", dated
11- 16 -95.
3. "Application For Approval of Plans For A Wastewater Disposal System ".
4. "Construction Permit for Sewage Disposal System ", dated 11- 16 -95.
5. "Application to Construct a Water Well ", dated 11- 16 -95.
6. "Design Data Sheet ".
7. "Letter of Authorization ", dated 2 -8 -95.
8. "Pump Calculations" and "Pump Catalog Cut Sheet ", dated 11- 16 -95.
9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ".
10. Affidavit - Corporate Owner Application, dated 12- 20 -93.
11. Money order in the amount of $300.00, review fee.
Novernber_16,.1995. _
Page 2
95011
We would appreciate your review, approval and issuance of the Construction Permit at your
earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
r'
Harry W. Ni iUs, Jr., P.E.
HWN:bd
95011 -14
cc: Mr. J. Mirra w /enc.
�w Putnam "emu Department of Health
Division '.vironmental Sanitation
AFFIDAVIT - CORPORATE a <JNER APPLICATION
FOR PERMIT. APPLICATION. S1JBMTTTE.D•. T.O.....,_..........
PUTNAM COUNTY t(EALTH DOA RTMENT
TO: Commissioner of Health - In the matter of application for '
represent.
that .I am an officer or employee of the corporation and am: authorized '
to act for_ f�� lM i � ^�(i � b`�Gy/ IL110
(name of corp-0tion
having offices at
Whose officers -are
President — �CSC�/ _l%% -li A NY
-' Name end A-ddress)—
Vice - President _ _
— (Name and— Address)
Secretary ._—
(Narr�e and Addr— ess)_ •
Treasurer'
' ^- - - - - -- (Name and Address)
and that I- amend will be individually responsible for) any' or all .aPfiP
of. the- corporation with respect to the approval, requested and•all .sub_ F
seoue`n't acts xelating -thereto
• F'
S'— orr� to tie fore �;,e this %fit%' day Signed — ^ —
o f c(" � b&L__. 19 Title
Notary Pu1) ic"
t •. I I
MINE J.
Corporcite Seal
t
I
P Ai�i GOUi�TY HPART�LENT OF_jj'`ALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- Daze a• --_c� }
Re: Property of-
Located at P�711t'/
(T) Section 33 Block Lot �y
Subdivision of W111
Subdy. Lot ;1 jq F iled 11an J1 Date —
Gentlemen:
This letter is to authorize-- , rr�Y �✓ �� V —
a duly licensed professional engineer X or registered architect__
(Indicate)
to• apply for a Construction. Permit for a separate sewage system, to
serve the above .noted property in accordance with the standards., rules•
or regulations..as promulagated by the Commissioner of the Putnam Count:
Department of Health, an to' sign, al'1 necjessary papers
on-my behalf. in
connection with this matter and to supervise the construction of said
system or systems in conformity saitlz the provisions of :Article 145 or
147, Education La7o�,,; the •Publ;ic Health Lai, *,; and the Putnam County Sani–
Lary Code ic,
ti
'.,, ,t Very truly Yours,
s .^ Signed
p ;,-ner of Property ,
Countersigne
raL4-� L� Cvs�oK, �ow, �rp
P.E. , R.A. Address
Millbrooke -Office Centre / �� /yaw Croce of. lbS/
Address Town.
$rewster, NY 10509
Telephone
914- 278 -6108
Telephone
_ PUTNAM COUNTY DEPARTmENr OF HEALTH __-- --
DIVISION OF ENVIRONME T HEALTH SERVICES
DESIGN' DATA :SHEET- SUBSUFACE� SEWAGE DISPOSAL SYST fit FILE NO
Owner n • n �JSTC M i�D►�1 C0'.P� Address
I ' Sec. Block Lot
Located at (Street) `�-
(indicate nearest cross street)
r Watershed G�2% �''
Municipality
SOIL PERCOLATION TEST DATA•REQUIRED TO BE SUBMIT WITH APPLICATIONS
Date of Pre - Soaking Date of Percolation Test
HOLE PERCOLATION
NUMBER CLOCK TIME PERCOLATION
Run Elapse Depth to Water From Water-Level
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min. :Start Stop Drop In Min /In Drop
Inches Inches Inches
2'
.3
4
�5
. i
2
3
4
5
1
2
3
4
5
�Q{ PLAT.
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.
2_ Depth measurements to be made frcm top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
14'
_ ._.. -
INDICATE LEVEL AT WHICH GROUNDWATER IS EN OUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ��- Q ►' �
DEEP HOLE OBSERVATIONS MADE BYs DATE:
DESIGN
Soil Rate Used 'J& Min /1" Drop: S.D. Usable Area Provided
No, of Bedroans Septic Tank Capacity I CLOG) gals.
Type Co�IG
Absorption Area Provided By (0 7 L. F. x.24" Width trench
Other -7'
I L OF N Eu- ��`y.'�•,
Nance —_�i— A� �'n`i� ii�1 X11 /2)i jo Signature �c t
Address I I P�r'J/ >!�E ��F� G� Gt"►3 i '�'y;Y" w
�� SEAL . ; � •�-c •��'' j..._.._..
�tt+C
No. 55121 k'�y
oFESS10N�'�'- .
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft %gal. Checked by Date
�2UT�T•.A.� •COYJN''r''X"' S�E�.,A,�'xME�7T O;t✓' HEAx.T�
APPLLCATI ,_QhL_FOR.
APPROVAL- _-OF -PLANS FOR A KASTE4tAiER DSPOS'AL` SYSTEK
i. Name and Address of Applicant: C. Yaa���G�;¢v�� .4,�e �y
• _ p��. 6'vx ysi
NY ivsi 7
2. Name of Project: .3..-.-Location T/V /C•
4. Project Engineer:. R'iA `� W QljhH 5, Address: MM
•� .. .; ... , ; _ • ��7�- tJ Y 1050 `�
License Number:_ (012 Phone: 21 _ Gfo5
6. T
of Project:
•- -'• 1: � .
Private /Residential Food.Service ....Commercial
Apartments Institutional Mobile Home'Park
Office Building', Realty Subdivision Other (specify)
7. Is this project subject`to State Environmental-Quality Review (SEQR)?
T oe Status (Check One) Type I.. Exempt ✓
Type II. Unlisted
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. F U U
s. Has DEIS been completed and found acceptable by Lead Agency? ............
0.. Rame of Lead Agency _ 0A
.1. Is this project in an area under the control of -local( planning,, zoning,.
or -other officials, ordinances? : ...:.:...:... :...,'.. .............. Klo
2.. if so, have plans been_sub,7itted to such.authorities ?....__.,,,
3.. Has preliminary approval' been 'granted by such authorities? u3 /A Date Granted:
Type of Sewage Disposal; System* Discharge......^ Surface Water ✓ Ground waters
5. If surface water discharge, what is the stream class designation ?........
5. Waters index number (surface) A,
Is project located near a
public water supply system? .................. ►J D
If yes, name or water supply Q1 A Distance to''water supply ,
Is project site near a public sewage collection or disposal system ?..... IJo
Name of sewage system ►J /� Distance to sewage system
Date observed: 23. Name of Health Inspector:
Project design flow (gallons per day) ..................................... 60o
2
25. Is .State Pollutant Discharge Elimination•System (SPDES) Permit required ?.. Q0
26. Has+SPDES Application been submitted to `local DEC Office? ��
27. Is any portion of this project located within a designated Town or State Y�5
wetland? .................................. ...............................
28. Wetland ID. Number ......................... ...................'...........
29. •Is Wetland Pemit-required? .. � S
Has' appl ication been made to Town or.-Local DEC.Office?
30. Does project require a DEC Stream Disturbance Permit? .....:............. f.JG�
31-. Is or was project site used for agricultural activity. involving application
of pesticide$ to orchards or other crops,.solid or hazardous waste disposal,
land"illing, sludge application or industrial activity? .....YES or NO __,t)y
32. Is project located -within 1,000•feet of- existence of abandoned landfill,
-hazardous waste site; salt stockpile, landfill, sludge.dfsposal site -or
any other potential known -source of contamination ?= ................. YES :or NO = �1(L-
DESCRIBE:
33. Is.there a local master plan or file with the .Town -or Village?
34..Are community water, sewer facilities planned to be developed within -1.5 years? 0 NLrJ010N
35. Are any sewage disposal areas in excess of 15% slope? ..........: ......... Q—
36. Tax Nap ID dumber ............. .. 3�� —� '=?_
37. Approved Plans are to••be; returned to: .... r........... • Applicant _� Engineer
If the application is signed by a person other than the applicant shown in Item -1, the.
application must be-accompanied by -a Letter of Authorization Failure to comply with this
provision maybe 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 Nisde—,,eanor p rsuant to Section 210.45 of
the Penal Law. '
SIGNATURES & OFFICIAL TITLES: ��
r�AILING ADDRESS:
J
-Y50!J '
LAURENT ENGINEERING
ASSOCIATES, P.C.
\ MILLBROOKE OFFICE CENTRE
Route 22 6 Milltown Road
- Brewster, New York 90509-
CONSULTING SITE ENGINEERS
JOB No.
SHEET No. OF
COMPUTED BY . - _.. DATE _. � �. 1 64
CHECKED BY `N N' DATE
cry PJ M p G I-0 21
.....: _
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tti %',1 t 1
Bulletin 1.10.
SP25
Submersible
Pump for
Residential and
Industrial Sump
and Effluentw.
Service
HYDROMATIC
PUMPS
A Marley Pump Company
Outstanding Features:
1. Oil- filled ball bearing motor provides life -long
quiet operation. Motor is '/4 HP single phase,
1750 rpm with built -in automatic reset overload
- 'p'rotection:. _ .... . - -.... ...... —
2. Exclusive single rotor and shaft are'supperted by
one long bronze sleeve bearing, lubricated for life
with oil in motor.
3. Non -clog cast iron impeller, threaded to steel
shaft, allows all ordinary sump deposits, includ-
ing washing machine lint, to be pumped without
binding. No suction screens to clean.
4. Mechanical shaft seal, carbon and ceramic faced,
super lapped for perfect sealing. Buna N rubber,
brass and stainless steel used in seal parts.
5. Choice of cast iron or bronze construction.
6 D' d f f' I
eslgne or le d serviceability. Motor stator
winding, mechanical seal, or level control switch
can be replaced quickly without the use of spe-
cial tools.
7. Each unit given a complete operating test before
shipment to assure exacting specifications will
be met.
Applications
•Septic tank effluent
Flood control units
-Air conditioning condensate
Industrial circulators
Transfer tanks
Basement sumps
-Elevator pits
*Water coolers
r' H DROMATIC
PUMPS
SECTION 100
PERFORMANCE DATA &
DIMENSIONAL DRAWING
MODEL: SP25A 377
6'/4 45 /e O 1'/4 STD. PIPE
O
I
® 53A
O
I �
7 V2
I
25/0
T �
NOTE: CASTING DIMS. MAY VARY '/e
..... ..... .
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5 -K -.i.67R a ...... ?t-:"6-*� P 5, PM 18
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qt
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