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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -50 BOX 13 01461 Lti I ire t1kc. ' 16 ql IN Ir 16.2 .� 01461 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Type _Screened _Open end casing X Open hole in bedrock _Other OHM mite Total Length 7D ft. Length below grade Wt. Diameter _in. Weight per foot LjIb1ft Materials: Steel Plastic Other WELL COMPLETION REPORT Seal: Cement grout Bentonite Other Drive shoe: Yes _ No Liner: _Yes No Well Location Street Address: Diameter (in) Town /Village: Tax Map # Dept to Screen (ft) GPS First ,34-T `.wr"�e- � A Q -6 'r� Mapc3 Block Lot(s)S4 Second Well Owner: Name: Address: Well Yield Test _Bailed _Pumped Compressed Air Hours A Yield o10 gpm j �'n / 6)44 ()M uring yie test tt Depth of completed we m Use of Well: _ResidentialU _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Ycompressed air percussion_Other(specify) Well Type _Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 7D ft. Length below grade Wt. Diameter _in. Weight per foot LjIb1ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite Other Drive shoe: Yes _ No Liner: _Yes No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Developed? First _Yes _No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours A Yield o10 gpm Depth Date Measure from Ian surface- static (sped ft) , uring yie test tt Depth of completed we m Well Log Depth From Surface well uiameter If more detailed ft. ft. Water Bearing in Formation Description information Land Surface descriptions or sieve analyses :y are available, please attach. 4 If yield was tested Feet Gallons Per Minute Pump /storage i anK inrormatton at different depths Pump Type Capacity during drilling Depth Model list: Voltage HP Tank Tvve Volume NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PU NAM COUNTY DEPARTMENT OF HEALTH 4 DffV SffDN DID ENVIRONMENTAL HEALTH SERVICE CERTIFICATE OF CONS'T'RUCTION COMPLIANCE FOR SEWAGE TREATMENT T S PCHD CONSTRUCTION PERMIT # /o ° /,-r' Located at 31- Z1Ir!'O'fi ®/e- TGPi Town or Village A&aK50101 Owner /Applicant Name A Ot�(:ac � / %MR°s, JC. Tax Map 3 Block Lot c5'0 Formerly Subdivision Name 5H6 -GrGor 7�n rGvcJ 5H6 Subd. Lot # Ir Mailing Address S� ���w� ;�` Oi'!� � &24 , /t%.% Zip s Date Construction Permit Issued by PCHD Z;; -%O - ®a- Separate Sewerage System built by /,,� C&rf i G!j Address N-Y Consisting of /aZ S W Gallon Septic Tank and "74.f. e,4M � o� JI'C61C-A Other Requirements: Water Sunnlv: Public Supply From, /, Address or: Private Supply Drilled by yq� 4A01 Sv•wS Address /9&r,?y�i _ .... _ .Building.Type Has erosion control been completed? �fe S Number of Bedrooms �{` Has garbage grinder been installed? 190 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: C-,7-10 Certified by Address L P.E. ✓ R.A. Professional) License # dJ'r 2 `¢' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Director /Commissioner, such revocation, modificatiA or change is necessary. A , /11 e Date: 6--/0"-/V White copy - HD Fine; Ye to copy - Building Inspector; Pink copy �bwnerLdrange copy - Design Professional // Form CC -97 Sep 26 05 03:53p TOWN OF PRTTERSO 845- 878 -2019 p.2 o9/28/05 MON 15:10 TEL 914 277 8210 BIBBO ASSOCIATES LLP wjUU9 CMG . a. � Y tia Lr?.ti.E7�'A .l�AL?LZ�IARI_[i.N.: M.S.N. _. BRUCE R. FOLEY �` �'F Ass ociair Public 'fiedlih Liirecicir Public 'faulth Dirccfor �({/ i� i]ircrotor of Patient services DEPARTMENT OF HEALTH 1 Geneva Koad' Brewster, Ncw - York 10509 [uvirounKntal llerlth (914)278•bf70 r.= (914) 271 -7921 IVur�ing Services (91,)27B-655S IYIC (914) 278 - 6678 Fox (914) 2711 - 6065 linrty t,1tervcn0on (914).278 -6014 ?MChool (914)278.6081 Fyc(9l4)27d 6648 OWNERS NAME: . TAX tiiA.P NUMBE1Z: E911 ADDRESS: TOWN: 3 y rh �o �o�E TiQAr� AUT,,v^ uGED TONVN OFFICIAL: (Signature) DA'rE: `/ %1/G � The Putnam County Department of Health. will not -issue a Certificate of - - - - - Construction Compliance unless the above form is completed, i.e., a legal E911 addl-css is assigned by an authorized town official. This fol-m is to be submitted NY* the ai�p(ic•1tion foe- a Certificate of Construction Coanhliance. (;g 1 1 vEI;U -1U t) 09/26/05 MON 15;34 [TX /RX NO 59781 01002 May 28 2010 10:57 HP LnSERJET Fnx YML ENVIRONMENTAL SERVICES 321 Kear Street _.......K.._....__ ....._... _ �:.. yC ,98 Yorktown �.�.e�g'�iC.s; "i�T. - -- �� -' (914) 245 -2800 Albert H. Padovani, Director P.1 LAB #: 1. 001859-- R CLIENT - #: 6471 - -� - -� -- ��_�y�STATMPROC�� -� -�� -PAGE: I of -2-- NORTH - COUNTY - HOMES DATE /TIME TAKEN: 05/20/10 10:00 156 TOMAHAWK ST DATE /TIME RECD: 05/20/10 10:50 YORKTOWN HGTS, NY 10598 REPORT DATE: 05/28/10 PHONE: (914) - 447 -8780 SAMPLING SITE: 5 THEODORE TRAIL, PATTESON, NY SAMPLE TYPE..: POTABLE WELL PUMP PRESERVATIVES: NONE TEMPERATURE..: < 4C COL'D.BY: JOE FESTO COLIFORM METH: MF NOTES. . - -..- �.. -��� --------------------------------- - -_ - -- DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 05/20/10 MF T. COLIFORM 05/25/10 LEAD (IMS) 05/21/10 NITRATE NITROG 05/21/10 NITRITE NITROG 05/25/10 IRON (Fe) 05/20/10 MANGANESE (Mn) 05/20/10 . SODIUM (Na) 05/20/10 pH 05/21/10 HARDNESS,TOTAL 05/21/10 ALKALINITY (AS 05/21/10 TURBIDITY (TUR RESULT PRESNT /100 ML 2.1 ppb 1.71 MG /L <0.01 MG /L 0.970 MG /L <0.010 MG /L 39.1 MG /L 6.7 UNITS 256 MG /L 138 MG /L 8.3 NTU NORMAL - RANGE ABSENT 0 -15 ppb 0 - 10 1.0 MG /L 0 -0.3 mg /1 0 -0.3 mg /1 N/A 6.5 -8.5 N/A N/A 0 -5 NTU SA 20 / -g0 - -E. C"OLI (C- -. ?LESE'1`T?' ? QO /ML.. AT-SENT- 0 METHOD SM 18 -20 9222B $M 18 -19 3113B SM18- 20450ONO3 SM18- 20450ONO2 SM 18 -20 3111B SM 18 -20 3111B SM 18 -20 3111B SMIS -20 450OHB SM 18 -20 2340C SM 18 -20 2320B SM 18 (2130B) COMMENTS: MFTC Total Colif This result indicates that the water ),.. was not of a satisfactory sanitary quality according to the New Yor State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. PH pH SCALE IN.WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. 05/28/10 FRI 08:44 [TX /RX NO 57891 [x]001 -- _ g�,0 -.�00 �10. cam\ `� NYSDEc PSI. or �a .30' Re, 7 ti� � AM-,— Exist Wel "q T Exist \� Stone ROOF DRAIN Re t. all LEVEL SPREADER \ 3 \ \ 1266 GAL - ' P/C CONC CN A OEM TANK IM t1E N Eris t. Clay Sorrier 1260 P/C C40M PUMP CHAMBER i 60 `�;y "poll ` J 333734'E 40.90' -Stone Re t. Wall ti. AI 5G 114 it IN p(I0 ROOM \ oENO \. '' Exist �y /• JJ Boulder , j ' `` Re t. Wall " J;J� tar \ SOPUo Mon "A" Lot 4 s �.� SOX `\ �` \ `• �� ` A \\ \\ \\ \ UO Tel. Ped. � 8epac Paved Ele. Box Mon "B" - -- s soo46-46rz »o.es TM0D0i 18" HDPE DAM Drainage Easement --,,., DMH of N a h doh, 7� ;r /G /PDT g ? FOOTING DRAIN LEVEL SPREADER OFFSET DIMENSIONS -- -�_ # ITEM "A" "en 1 ST -1N 1b' 38' 2 ST-OUT 215 42.6' 3 PC 30' 46,5' Mon "A" Mon "B" 4 DB 17' 89' 6 JB 15.5' or 6 TE 14.6' 97' 7 TE 17' 67.6' 8 TE 14' 82' 9 TE 20.6' 85.6' 10 TE 28.6' 84' 11 TE 33' 83' 12 TE 40' 82.6' 13 TE 47' 82' 14 TE 84.6' 21' 15 TE 65.6' 18' 1a TE 92' 2Z 17 TE 97' 29' 18 TE 102..5' 38' _-'- __... - TE . -_ .._.. _.. ,P06,— p..""1C -- _, ... "43 " -....- _ 20 TE 113.5' 5000' 21 TE 119.6' 58' PLAN GRAPHIC SCALE (IN rm) wwuMWM rutE161WW AW ADDI► W M IM = OF n� s► T ZXMII w SAW. \ Wrjff l& +o �wv M t 6 LOCA HOUSE LOCATION Al FROM SURVEY PREP SURVEYING, P.0 , YC FIELD REQUIRED: 81 FIELD INSTALLED: 8 PUMP & AUDIO / VI, DATE: 6.28.10 DRAW: 13" DOSE: 333 GAL AUDIO/ VISUAL AL THIS IS TO CERTIFY THAT THE SEWAI CONSTRUCTED AS INDICATED ON TF WAS INSPECTED BY BIBBO ASSOCIA COVERED OVER. THE SYSTEM WAS C WITH ALL STANDARDS RULES AND R t'%ni IAITV MCMACMACK r nc u=wi Yu n a PUTNAM COUNTY DEPARTMENT OF HEAL 9 DIVISION OF ENVIRONMENTAL HEALTH SER + CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village Subdivision nameP(6- -(jrgw�g�ah Subd. Lot # kf- Tax Map 74 Block ;7- Lot L.I—a Date Subdivision Approved Gf. 2,1, 200/ Renewal k Revision Owner /Applicant Name NOrtl? C-awo ,, llaAyc.S' Date of Previous Approval 9-1a - 0,6' Mailing Address T s�Atwa+% ��`", iIork�Jn �% Zip J;,'1,J-7B Amount of Fee Enclosed 11 ` 270 ow Building Type Lot Area.4-7 No. of Bedrooms _!!y _ Design Flow GPD RcW Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of J�cS'O gallon septic tank and 62r %L ,5eg �,O, T17i rill Other Requirements: /o j-a S c,- 1, A04fA a er�`*j&e* To be constructed by L , G'grJi r Address Zi^C4 -zo Water Supply: Public Supply From Address -n.; ..._.. P:k-ut - Supply Lrilleu.'oy- /i ►7'` o�yort� ; itc ., Add css 4a'i'l�i'.5'U/��:: .✓ - - ✓ . 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 Director /Commissioner 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. )< R.A. Date -, =I ¢ -/O License # aS-S -j-Zf APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and 'is revocable for cause or may be amended or modified when considered necessary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new p4rmit. ApprovedAr discharge of domestic sanitary sev*ge only. LI-Im White copy - HD Fi Title: lding Inspector; Pink copy - / Date: copy - Design Professional Form CP -97 v , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. .......... APPLICATION TO CONSTRUCT A WATER WELL please print or typenew #�s� . »..4 Well Location Street Address: Town/Village: Tax Map # %0a70'e"4'*1 Map34- Block Lots) v`c0 Well Owner: Name: Address: Phone #: � bit� t ry �l �7` �`-GeJ� M$ � Use of Well: J_Residential _Public Supply Air /coed /heat pump _Irrigation . 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought t gpm # People Served Est. of Daily usage X00: gal. Replace Existing Supply . Test/Observation Additional Supply Reason for Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No �! Is well located in a realty subdivision? ........................................... ............................... Yes X No Name of subdivision .SHG - G/zr�a1r1 Lot No.- Water Well Contractor: Address: 1906� , V-50' Is Public Water Supply availab on site? ....................................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheeVplan. /* Latz c. Date: vim= Applicant Signature: �, -- orr/��D�p/ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam Countv Health Deoartmei take appropriate action to assure that'any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C4nty. A , Date of Issue r — o Permit Issu' g Official: Date -of Expiration 17, � Title: Permit is Non -Tra sferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Orange copy - Well driller Form WP -97 Rev. 3/06 BRUCE„ R.. FOLEY_. Public Health Director - -. . - , ... • iw _���•'i• cfivs:il�rtl<�� �.P::, :v;: "� -.IV. .... _.. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (9I4) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 AA-4E 0 TO: DEPART NI NT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: °' S K , P� DATE L S �rE APP �,O V n-A L - T NOTICE OF COMPLETE APPLICATION DATE: `(0 , 1. 1 D Sherlita Amler, MD, MS, FAAP Cpmmissioner of Health .. Robe-11, Morris., PE Director of Environmental Health June 1, 2010 Mr. Joseph Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: Department of Health 1 Geneva Road, Brewster, NY 10509 Re: North County Homes, Lot 5 — SMG /Gramaton RS 34 Theodore Trail (T) Patterson, TM # 34. -2 -50 Middle Branch Reservoir Basin Robert J. Bondi County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 28, 2010 is complete. The Department will notify you by June 21, 2010 of its determination. 0 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. El 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 receiptxegliestPd. 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department 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 Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 43148. Michael J. Bunski E Director of eeri Q MJB:kly Environmental Health (845) 278 -6130 F 845) 278 -7921 Water Supply Section (845) 225 -5186 F Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 ' PUTNAM COUNTY DEPARTMENT OF HEALTH ._- DIVISI.ON OF ENVI?RON�I =HE LTH- SERVICES _ ... LETTER OF AUTHORIZATION RE: Property of Located at X34 iOG/Os�G Tsui T/V Ioa e Xaoi Tax Map # �¢ Block eZ Lot .57-d Subdivision of s'/''j�.- �rgs�A -,"? Subdivision Lot # Filed Map # .2 77 Date Filed jepy", 2ea7/ Gentlemen: This letter is to authorize a duly licensed Professional Engineer j/ 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' ithhisions � of-the £uucatiori iaw, tiie�Pub is Health .- .v Law, and the Putnam County Sanitary Code. Countersigned: ZA '' P_E , R.A., # h S`S92I Mailing Address SISBO ASSOCLATEFS LLP 293 Route 100 - Su to 203 Or ers, Y 10589 State (9141% 2 05 Telephone: Very truly yours, Signed: of Mailing"Address:/I�r�jj C'oti„ItfAtaS;..�r,�_ State zipkO.S"YB Telephone: mil' /¢ -,2¢8 - ✓¢6` Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ........r.... _. D.IYIS ON Off'- ENYIRONMEIVI'T' L- HE AT ,TH-SE:RVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Jj ;'',;1�7 C�/�cs'f �,c�:yti /�✓ �'�`� -� /� that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: _ Having offices at: Whose Officers Are: President - Name: Address: Vice President - Name: Address: I C Secretary -Name: Address: Treasurer - Name: Address: bns5� and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: Sworn to before me this /� day of .� (mon ZLO Ltd (year) Notary Pub ' c DENIS J. TIMONE NOTARY No 60 State of New York Corporate Seal Qualified In Westchester County Commission Expires April 30.1 Form CA -97 r. Bibbo Associates, L.L.P. MW Pond Offices 293 Route 100, Suite 203 LETTER OF TRANSMITTAL 914.277-5805 914.277.8210 fax TO WE ARE SENDING YOU ❑ ATTACHED ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE DATE JOB NO. ATTENTION '.�,f� 0,,e RE ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment J 71-Al Ly -f 19 0 Vn ,sop 051rn h- e5;4 & z the following items: ❑ samples ❑ Specifications COPIES DATE NO. DESCRIPTION as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ b&7 V; 19 ,sop 051rn h- e5;4 & z V THESE ARE TRANSMITTED as chocked below: UZ/For ❑ Approved approval as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS ❑ Resubmit _copies for approval ❑ Submit _copies for distribution ❑ Return _corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US Bibbo Associates, L.L.P. Mill Pond Offices 293 Route 100, Suite 203 LETTER OF TRANSMITTAL 914.277-5805 014.277.8210 fax DATE JOB NO. WE ARE SENDING YOU ❑ ATTACHED ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Copy of letter ❑ Change order ❑ Plans C1 J-- oz.;,-- _copies for approval ATTENTION 0 RE Z& "4- *,If- ❑ Return -corrected prints the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION I - Ci V THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19. REMARKS ❑ Resubmit _copies for approval ❑ Submit copies for distribution ❑ Return -corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US � / co Z a a� 'I AxIi:1, Street Town. State PERSON IN CHARGE S _ l� Name Tit _ TYPE O F. FACILITY: '- l l i. p , F Signature a -'RFPOR RFC-PTV-PT T acknowledge receipt oft. is rep SIGNATURE: 02 / 96 ' Title; Rev. 05%25/10 TUE 08:29 TEL 914 277 8210 BIBBO ASSOCIATES LLP 444 PCHD BIBBO ASSOCIATES, LLP 293 Route 100 — Suite 203 NY 10589 Somers, (914) 277= 580 (914) 277 -8210 FAX bibbo @optonline.net PLEASE DELIVER TO: NAME gale.. - "Fxw, FROM: e/�!✓�'G�yn�i - FAX COVER SHEET COMPANY 2001 FAX NUMBER SUBJECT: DATE: COMMENTS: �GtF's'/-'`v %plits�►�,S`%�.�i9S��.%i v�► G»�'' AS REQUESTED FOR YOUR APPROVAL FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMITTEp INCLUDING THIS PAGE Hard copy being sent? No Regular Mail Overnight it you do not receive all pages in legible condition, please call (914) 277 -5805. 05/25/10 TUE 08:29 TEL 914 277 8210 BIBBO ASSOCIATES LLP 4 PCHD ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION' OF ENMRONMENTAL HEALTH SERVICES 11 JOSEPH - El GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit #. 10-1cr-6u- (T) M Owner/Applicant Naxna'i -FOOT-TM 21- _Block Lot Ja Formerly: Subdivision Name: gipV7 7 6 2C) Subdivision Lot # Is system fill, completed? Is system complete? 9w 5 Is SYStem constructed as per plans? Is well drilled?. %7 It well located as per plans? Axe. erosion control measures in place? Date: Date: Date: 16:7-,7-6P7 I ceitfy chat the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion is accordance with the issued PCHD Construction Permit and approved. plans and the Standards, Rules and Regulations of the Putnam'Cop4ty pepartme;atof Heifth;- Date: -0-O!� Certified by. PE RA LLB 15esip Professional Address: 29;8 ROUis 100 - SWR 203 Lic. 4 f �*0401 Comments: Form FIR-99 [a 002 3� c n c r tr �t C n: m [_] r m I n, y NEW YORK ELECTRICAL INSPECTION SERVICES 54 North Central Avenue, Elmsford, NY 10523.914- 347 -43N .I�C)IJC'aH�ilTCa INSPECTION z 0 8 ' -• W First Notice Ir `. Second Nfliiee JG a First F1, - Second Fl, Third Fl, o Multi F1, Basement, Outside, 'Garage 9 �eenarts r/t / + r .. I ff _ t •u t PU tt 1 1 , 1 t r i W f 3 + Y G 0 w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: /© id d 7 Street Location Lr D Do /6 V?A t�_ Inspected by: %� Town Permit # ��r l vim° Q 5 TM # Subdivision Lot # S 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15 from STS area.......... e. 100' from water course /wetlands .............. ..................... IL Sewage System a. Septic tank size - 1,000 .... ..... 1, 250 ......... other ................ b. 'S eptic' tank installed level ........... ............................... .. c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. h1inimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. 'renc es / / /-� 1. Length required 6 b / Length installed 67 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1116 - 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°/x ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................; 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends capped ........................... ................... a g: , F11 p.or D ^se Systems, ......_.. - ........ _ ✓. 1. Size of pump chamber ..............................} .......... 2. Overflow tank ......................... .... .............:................. 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box bafflled .......................... ............4.................. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildine a. mouse located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well Well located as per approved plans .......:........ b. Distance from STS area measured �a0 ft ........... c. Casing. 18" above grade ................ .............:................. d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially back lled............4........ ..................... 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :.......................... i. Erosion control provided ................. .............. .................. Rev. 12/02 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI,.RN, MSN Associate Commissioner of Health October 15, 2007 Mr. Joseph Buschynski Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — North County Homes 34 Theodore Trail (T) Patterson, T.M. # 34 -2 -50 Lot 5 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Pipes not flush inside distribution box, please trim. 2. Force main not installed at time of inspection. CP.lt i7!hPn.ready for -Yuma If you have any further questions, please contact me at (845) 278 -6130. JD:ens all :p1i Digit ironmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 10/10/07 WED 04:23 TEL 914 277 8210 BIBBO ASSOCIATES LLP PCHD X001 PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 0 ,1OSEPH GENE REOUES F FOR kINAL TNSPE ON For: Fill All information must be fully completed prior to any Trenches inspections being made. Q PCHD Construction Pe t # 1 �' ^ cc f% Located: 3 `i Aco 2-c -rAWR - (T) (V) Owner /Applicant Name: N &A w Cdu•u7y A40nss r-tc Tm _ 3 Y Alock Z Lot X—Q Formerly: Subdivision Name: S 6�rr14-irk Subdivision Lot # is system fill completed? eulIq Date: Is system Complete? �' Date = a 7 Is system constructed as per plans? Is well drilled? _ Hc—s Date: „ Is well located as per ansl ?� .p,re.erosion control measures ' lace? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Constrraction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of F-ea1t1a,..._ Date: Q 7 Certified by: - PE RA 91BBd A$8CLjkTE$ LLP 6esip Professional PAWW 100 me me Lic. # Address: ��—,� (914 X77 -5805 Comments: Form FIR -99 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at i:l - 7I%eoyi(one Town or Village Subdivision name JNa Subd. Lot # c� Date Subdivision Approved A4%, , X00 / Owner /Applicant Name&keZ- h CyG,sy�i �S C. Tax Map Qt- Block 9 Lot cS"O Renewal I Revision Date of Previous Approval Mailing Address /5G d�a/ S1`•, I%:!�! Zip Amount of Fee Enclosed X1_ ® Building Type QSi oe . Lot Area. +7 No. of Bedrooms I- Design Flow GPD 9®® Fill Section Only Depth Volume PCIID NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1075 _a gallon septic tank and 667 �� oA Other Requirements: 1.2,s —a !?A, To be constructed by %;,, ,®, Address Water Supply: Public Supply From Address _ ._...._.piivat, Suppl �.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 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. R.A. Date 10-10 -Ou" License # e,7Q 'QS_9�:f Jv� A/,y iva"2011 APPROVED FOR CONSTRUCTION: This approval'expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected,by,the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. , Any revision or alteration of the approved plan requires a new p rmit. Approved fo discharge of domestic sanitary sewa only. By: -- Title: A4 Date: J vo "0(c.:�, White copy - HD Fi , Yello co y - Building Inspector; Pink copy - Ow ; Or ge 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 # I Well Location: Street Tax Grid # �Address: ,Town/Village 10a 6j -z'oti Map 4-, Block Z Lot(s)�p Well Owner: Name: [Address: t LL OeX �un✓- /3 / J- >'6'GT�.rG �f sf) r� %v4/srj iU `I Id�`ZB Use of Well: s/' Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served Est. of Daily Usage Z7yo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type e' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes-;;;;- No Name of subdivision - Lot No. s' Water Well Contractor: ,T. a,,O- Address: Is Public Water Supply available to site? .................................. ............................... Yes No t/' Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: O- /3-Od-- Applicant-Signature: _.. �. - -� - - _ ... , - . - - -- - . .- , . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. I A Date of Issue ,3 to- O Permit Is Date of Expiration 3-10-05 Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller G" Form WP -97 BIBBO ASSOCIATES LLP 293 ROUTE 100 'SUITE 203 SOMERS, NY 10589 (914) 277 -5805 bibbo //aaMtonline. net TO /G�,%/7O�i� C�OG>��G9 % / �A �f�! 4/�i/✓� WE ARE SENDING YOU ❑ Attached • ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE n V ATTENTION /' RE: L / O 1 O i�7�l o bT c°cf the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION Ile- 5 THESE ARE TRANSMITTED as checked below: • For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints , ❑ For review and comment ❑. �ZG� rihC� � l.%• c° �� ❑ FOR BIDS DUE 19 1 ❑ PRINTS RETURNED AFTER LOAN TO USS�® REMARKS tf'� Giles �i Oh �O �s Zo t� 10 i'1 -�ow� A o� e //e R - � ard -6 - j 7.4--e, h � • e lo > ' 61 e Y'001Ah . JOF w COPY TO SIGNED: ' `y SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Joseph Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, New York 10589 Dear Mr. Buschynski: DEPARTMENT' OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: March 6, 2006 L-11 ROBERT J. BONDI j County Executive ROBERT MORRIS, PE Director of Environmental Health Proposed' SSTS for Lot # 5 GDC Realty Subdivision, North Country Homes . 34 Theodore Trail, (T) Patterson TM# 34 -2 -50 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. I. The plan shall specify the trenches as being a minimum of 50 feet from the dwelling. In addition, an impervious barrier is to be proposed between the trenches and retaining wall to prevent effluent from traveling through the wall and/or to the footing drains. �2. The location of the drainage pipe in .the drainage easement is to be shown and all trenches are to be a minimum of 35 feet from the pipe. �3. The. distribution. box detail shall show the force main terminating with a 90 degree downward __ _...__...._ . _.. facing elbow. 4. The plan shall specify the house as being a maximum of four (4) bedrooms and the required and proposed lengths of absorption trenches should be indicated. 5. The distribution box detail should show the box being supported on pea gravel to below the frost line. In addition, the minimum and maximum cover depths are to be specified. �6. The retaining wall should be limited to a maximum height of four . (4) feet, otherwise an engineered design for the wall is to be submitted. 7. Please see the enclosed sheet for the correct pump pit notes. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB: cj Respectfullv, f ichael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax. (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ' 9 EM 3 Trench detail for force main, specify pipe type and rating, bedding and . cover. - Note stating, "All electrical work and material, for pump installation shall comply with the National Electrical Code." - Note stating, "An electrical Underwriter's Certificate for the pump chamber must be provided to the Department prior to the Department conducting a final-inspection on the pump chamber. - Note stating, "The pump control panel and alarms shall be located inside the house." s. Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. 8. Two (2) sets of house plans with title block as specified in 7(k) above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality. Upon approval of the. Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only ". 9. If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. 10. Well�'ermit�Application, if require'. (App�"naix I� 11. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners. contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. j w- L 616130 ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 27.7 -5805 277 �8210-�AX -. -- - - • - - .. _ -.. - bibbo aC optonline.net TO 1J2/J'74. WE ARE SENDING YOU ❑ Attached , ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ [`ATE >JG3, RE: ❑ For approval moo- n, s Approved as submitted ❑ Resubmit the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION s THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US // REMARKS _2 A? G� G G�irO��r7G� / /' Z� R. /� zw S fPi O 24-42g:,t 02 S� OOS' // COPY TO SIGNED: COPY TO SIGNED: SHERLITA AMLER, MD, MS, FAAP -- = Cu.:.mi^sionerofHealth - - - - • - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Joe Buschynski Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: ROBERT J. BONDI - - County axecutive - DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 28, 2005 Re: Proposed SSTS: North County Homes 34 Theodore Trail (T) Patterson, TM # 34 -2 -50 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: 1. No part of the SSTS, including the force main and the D -box, can be closer than 10 feet to the property line. 2. Pump pit calculations are to be noted on the plan, this includes dose calculation and reserve above the alarm. The coristruciion of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation test must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V�ryruly yo , Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _-v - REVIEW SHEET FOP, CONSTRL'CTIGN'PEisir NAME OF OWNER: STREET LOCATION: REVIEWED BY: .RM, OR, AS, SRDATE: Y N DOCUMENTS _L _)PERMIT APPLICATION ;__)(_)WELL PERMIT OR PWS LETTER _(_)PC -97 _(_)LETTER OF AUTHORIZATION _(_)DESIGN DATA SHEET (DDS) _)L_)CORPORATE RESOLUTION _(_)SHORT RAF (_)(_)PLANS -THREE SETS (_)(HOUSE PLANS - TWO SETS (_(_VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED C__)PERC RATE (_< L)FILL REQUIRED -'DEPTH (_,L_DCURTAIN DRAIN REQUIRED GENERAL (� LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD CEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PPRCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME -'RE 1969 NEIGHBORNOTIFICATION LETTER BI/ZBA UJ luu YIi F'LUOD F✓LF;VATiuN Wii i0U` ( �( )SOIL TESTING LOTS >10 YEARS OLD GE SYS`'PEM PLAN - (NORTH ARROW) 3YDRAUiIC PROFILE CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS ONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS . SDA SOIL TYPE BOUNDARIES )TITLE BLOCK; OWNERS NAME ADDRESS M #, PE/RA; NAME, ADDRESS, PHONE# (� ATE OF DRAWING/REVISION, DATUM REFERENCE L LOCATION OF WATERCOURSES, PONDS / LAKES,WETLANDS WITHIN 200' OF P.L. (� )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (_) WELLS & SSDS'S W/IN 200' OF SSTS (PROPERTY METES & BOUNDS EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE 'OMMENTS: aEVSHEET)09 /01/00 TAX MAP #: (CONFIRMED) Y ' (REQUIRED DETAILS ON PLANS CONT'D) L�HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS �JI.USITE NOTE (NO CHANGE) FILL SYSTEMS , 10' HORIZONTAL; PAST TRENCH SLOPES 3 :1 TO GRADE FILL SPECS/ FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN2 FEET. CLAY BARRIER L CERTIFICATION NOTE x DEPTH GAUGES VOL. ON PLAN FOR R O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS (_)100% EXPANSION PROVIDED (_) DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILR; 1 TO P.L. DRIVEWAY, J�ARGE TREES, TOP OF FILL Y100'TO WELL, 200' IN DLOD,150' TO PITS 0' TO STREAM, WATERCOURSE, LAKE (inc. expan) ' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 110' TO WATER LINE (pits - 20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS TO LEDGE OUTCROP SEPTIC TANK L-KS10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES k�LOCATION OF SERVICE CONNECTION U (MIN 15' TO PROPERTY LINE SLOPE U SLOPE IN SSTS AREA (S20 %) ZUMPNOTES EGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED ,2DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED U,LUl DAY STORAGE ABOVE ALARM CURTAIN DRAIN ANDPIPES, 5' BOTH SIDES, DETAIL (� 15' MIN to CDS = >S %, 20'-4%,25'-3%,35'-1%3 100 % - <l% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge (� t 0' MIN to NON - PERFORATED PIPE BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914).27.1-5805 14 277.8 1 FAX - -- bibb6(a)bpt661ine:nef TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ DATE JOB NO: ATTENTION R� vrr� RE: 1-dV57 6hrajjera 25t, ��. � •ra" the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION Cow ,-, G.*Je � r� • � 'cs ,/ -. / C06 r/i ' / G-�f i �7 G A o� ✓ h/y C-19 /C S'- .� Oy c G)HS -THE L An^E-TRANSiviITeE au c,hecked-below: Itd'tor approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted ❑ Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints - 19 0 PRINTS RETURNED AFTER LOAN T,0 US COPY TO SIGNED: If enclosures are not as noted, kindly notify ul at once. PUTNAM COUNTY DEPARTMENT OF HEALTH ...._ VISION.O,F F,NVTRONMENTAL= HEALTH-SERVI.C:E.S.y_`.. LETTER OF AU'T'HORIZATION RE: Property of Located at i71- �'�j � o �.� z ; */ T/V 7�'�'o�r Tax Map # �: Block Lot S© Subdivision of Subdivision Lot # Filed Map # 7 7 Date Filed Gentlemen: This letter is to authorizes a duly licensed Professional Engineer 4/' 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- conform ty_ ith._the_proAlisio-ns ofd. ticle.l,;.5-and/cr- 447-ofthe Education Law, the Puniiu- altli -- Law, and the Putnam County Sanitary Code. Countersigned: 4V P.E., R.A., # g- Mailing Address 02-4l State Zip Telephone: Very truly yours, Signed: "0 oo ner of rope A Mailing Address;Or7�fI �Ocv�7 /ism. State Zip Telephone:— Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: / \ \ r I . ----I , that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: Whose Officers Are: President - Name: Address: L T C, w Vice President - Name: Alto, u Address: `� L ��� C �C� • f 1�c� Secretary -Name: - ...... .- .:.. _- Address:-..__.. __._ _�..,....,.- _.___...,_..._.. _.__. -...__ ._.: ._ .... -- ....._.._ _......._...._._. _.,-� ..,.__.._.....-- �_...._. Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day of e(month) 0200 (year) Notary Public KATHLEEN R PACELLA Notary Public, State of New Yo* No. OIPA6092646 Qualified in Westchester County Commission Expires May 27, 200, Form CA -97 r Signed: Title: 6� 1A 0 Corporate Seal s. 293 Route 100 - Suite 203 Designer: JB Somers, NY 10589 Checked: JB Date: 10/11/2005 DOSING CALCULATION PER PCHD CODE: 0.5 GAL/ L.F.ABSORPTION TRENCH PUMP CALCULATION - DOSE REQUIRED 0.5 gal. /I.f., x 667 I.f. = 333 gal. 2" POLY FORCE MAIN where Q =V x A V(FPS)= 3 A(FT2) 0.0218 Q(CFS)= 0.0654 Q(GPM)= 29.30 USE Q= 30 GPM LENGTH OF FORCE MAIN (ft.)= 80 ADDITIONAL EQUIVALENT LENGTH DUE TO FITTING LOSSES (ft.)= 16 FRICTION LOSSES HF= 1.81 ft. /100 ft. HF (ft.)= 1.81 ft. /100 x 96 = 1.7 H(ft.)= 666 -642 = 24 TDH (ft.)= 24 + 1.7 = 25.7 USE GOULDS MODEL WE05H RATED 47 GPM @ 26 FT. SEE ATTACHED SHEET FOR PUMP CURVE APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: W, maximum. • Discharge size: 2" NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon - - -- carbide - rotary seat/Silicon carbide - stationary seat, 300 series stainless steel metal parts, BUNA -N elastomers. • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor Single phase: • '/3 HP,115 V, 200 V, 230 V, 60 Hz, 1750 RPM;' /2 HP, 115 V, 60 Hz, 3500 RPM; '/ HP —1'/2 HP, 230 V, 60 Hz, 3500 RPM. • Built -in overload with automatic reset. • Class B insulation. Three phase: •'/2 HP —1'/2 HP 200/230/ 460 V, 60 Hz, 3500 RPM. • Class B insulation. Goulds Submersible Ltl19100-M e • Overload protection must smooth operation. Silicon can be operated continuously be provided in starter unit. bronze impeller available as without damage. • Shaft: threaded, 400 series an option. ■ Bearings: Upper and stainless steel. ■ Casing: Cast iron volute lower heavy duty ball bearing • Bearings: ball bearings type for maximum efficiency. construction. upper and lower. • Power cord: 20 foot 2" NPT discharge adaptable ■ Power Cable: Severe duty standard length (optional for slide rail systems. rated, oil and water resistant. lengths available). m Mechanical Seal: SILICON Epoxy seal on motor end Single phase: se CARBIDE VS. SILICON provides secondary moisture •' /a and'/ —16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket with 115 V or 230 V three Stainless steel metal parts, damage and to prevent oil prong plug. BUNA -N elastomers. wicking. • % -1 %2 HP —14/3 STO with ■ Shaft: Corrosion - resistant ■ 0 -ring: Assures positive bare leads. stainless steel. Threaded sealing against contaminants Three phase: design. Locknut on three and oil leakage. •'/2 -1 Y2 HP —14/4 STO phase models to guard with bare leads. On CSA against component damage AGENCY LISTINGS listed models — 20 foot on accidental reverse rotation. length SJTW and STW ■ Motor: Fully submerged in SP Canadian StandardsAssociation are standard. high -grade turbine oil for - -FEATURES -. - -- ...__.. lubrication and efficient heat U11 Underwriters Laboratories ■ Impeller: Cast iron, semi - open, non -clog with pump - out vanes for mechanical seal protection. Balanced for METERS FEET 25 20 0 a W U a 15 Z 0 J a 10 r ■ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM 0 10 20 30 m3 /h CAPACITY Q 1995 Goulds Pumps Effective May, 1995 83885 MENEM EMM ■■■ ��■ ■ MIN I ■■i MEN ■ ■ ■ ■ ■ ■ ■ ■■ ■.� ■ ■�� ■■■■■■■■■■■■■■■■ . U ■2iv �� �_-��� 111MMEMMEM ■■■■■■■ in I �� ��' MEN a, I MEM ■■■■ M■■■■■■■■ ■ ■■ ■ ■ ■ ■� ■ 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM 0 10 20 30 m3 /h CAPACITY Q 1995 Goulds Pumps Effective May, 1995 83885 PUTNAM COUNTY DEPARTMENT OF HEALTH/,X``� DIVISION OF ENVIRONMENTAL HEALTH SERVICES -DESIIGN-.,D-A.7F-A.-SHEET ;;: SUBSURFACE SEWAGE TREATMENTSYSUM" A Owner "c, Address, V- Located at (Street) ax Map 3 Block ;Z Lot tfZp (indicate nearest cross street) Municipality J --L-1 I Drainage-B.asin SOIL PERCOLATION TEST DATA Date of Pre - soaking -/-Z—/-.2,� -: Date of Percolation Test 1�2 - ,%� '-."'- &.F%,Q«uaLoaiiirufzl)tlluiitii approximately equaipercolation rates are obtained at each percolation test hole. (i.e.. s I min for 1-30 minhnch,.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 Depth to Water Water Hole No. Run No. Time Time - Stop Stop Man Time n-) From Ground Surface (Inches) Start Stop Level I ro D In nc%es Percolation Rate Min/Inch 2 3 2 4 e7 �5 2, 3 ;2- 4 3c 5 2 3 4 5 '-."'- &.F%,Q«uaLoaiiirufzl)tlluiitii approximately equaipercolation rates are obtained at each percolation test hole. (i.e.. s I min for 1-30 minhnch,.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 2 DEPTH G.L. - - 0.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES HOLE NO. HOLE N0. HOLE NO. 1.0' 1.51 ,�� -'.%7` 2.0' 2.5' 3.0' 3.5' 4.0' M11 Mul 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10111 ,S g �s.ZI e 6,Xle 7' 1ILe -Z owtiT /tee lace sS��� s.• /7; �r�ce � h c � �� d� / 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: .gl, Date Design Professional N Design Prof'essional's Seal ...� �;. 1uscy �- rr `,�`'' \ \` r.� -J'{: .. Tai, J,•�i /� li 14.16.4 (1/87)—Text 12 PROJECT I.D. NUMBER 617.21 Appendix C • Mete Enylronmonta! Oua!!t Review SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEAR - 1. APPLICANT /SPONSOR xla,- A 2. PROJECT NAME S 3. PROJECT LOCATION: Municipality p/7 County e 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Tl ea�r>'T/�r,•/ s- �� /c>�s Cortie� .�'r'c� 5. IS PROPOSED ACTION: S New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially .2-f:7 acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ „Id( Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? „1�1 Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? JxYes ❑ No If yes, list agency(s) and permll/approvals J�71`�Crsor .� /� , Q�of- - .� /�. ✓`��rv.,• J` 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? &Yes ❑ No If yes, list agency name and permit/approval /�C/�O - ,fit ea /y c�'as•6ol�fJ/'�vu/ 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? iObFr ❑ Yes .t51 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: z ✓ko ��lrl /�1 0ih�S,!.LIT� Date: Signature: If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART Ii— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration _ ..:may he. - ssgQre:ded•by �rrotherdnvolved agency. _ - _ -. _.. -• _ . ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels,. existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 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 Identified In C1•C5? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE.ENVIRONMEN.TAL IMPACTS ?_ ... ❑ Yes LJ No If Yes, explain briefly 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 identified one or more potentially large 'or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF andlor 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.Of icer in Lead Agency ' Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (11 different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. _ �pp,>r.TrT�R Al°�areV�: O RL�,Iers F ......... A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project:4 s',S,,y�zZ/� � 3. Location TN: 4. Design Professionalr,s -, L Zeo 6. Drainage Basin: 7. Type of Project: Private/Residential Apartments Office Building 5. Address: &o- 7f_ 100 Food Service _ Institutional 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 Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 11114 _ 10. Has DEIS been completed and found acceptable by Lead Agency? ............... J(J,,¢. 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or .other _ _ r _of cials,-oruir�d —nces9 -.-.:...: :.:.:.:... .:.::.:............................................. .... :.. .:. :.. :.. _.. , ..... _ ..._ 13. If so, have plans been submitted to such authorities? ........................................ G s 14. Has preliminary approval been granted by such authorities? Date granted; O/ 15. Type of Sewage Treatment System Discharge ................. ✓ surface water V-10 groundwater 16. If surface water discharge, what is the stream class designation? ................ ..... W4 17. Waters index number (surface) ........................................... ............................... l% '4, 18. Is project located near a public water supply system? ....... ............................... 44! 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ /Vo 21. Name of sewage. system Distance to sewage system 22. Date test holes observed Abram, AMP 23. Name of Health Inspector 4gol s, %�% /•� 24. Project design flow (gallons per day) .... ..............:................ ...... ...... .............:....... 84th 25: Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? /%v Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? o 28. Wetlands ID Number. _......._... _ ..... ._ . . ., . 29. Is Wetlands Permit required? ................. Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... A4 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 m 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 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... &J 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Ab .................... Ma is Block Lot iS�d 36. Tax Map ID Number ..... ............................... pc3 ,Z 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.vathin the NYC:Waterslied shall. - . r...._ ...._ be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit. those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury; that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address:....... 4.1.:.1, . K9 .. t, .,.1�0 a� / y rColh le_ co F