Loading...
HomeMy WebLinkAbout1484DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -23.2 BOX 14 AL = f. I6 PUTNAM COUNTY DEPARTMENT OF HEALTH __ ... D VT:,�TO�IT_OE F�lT�7TR IN ME - :DF,.r� -LTV. c�'��?��JT�'ES -� - - CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at C Fl ',vc.y ry Town or Village f A-n i ✓5ar J Owner /Applicant Name Tax Map 3_ Block --; Lot 2 3, 7- Formerly Subdivision Name ST >L N6 1-1 "(6- Subd. Lot # Mailing Address CA-00LYJIJ JA y /firT . Y Zip Date Construction Permit Issued by PCHD -7- ' Separate Sewerage System built by G-11 6-ev y i W 6- Address Consisting of Z 5-0 Gallon Septic Tank and 50 Lr t Fetuc#-1 zs Lj i2 ,1 C c aA+J Other Requirements: Water Supply: Public Supply From Address or: '-- Private Supply Drilled by Wyg rT- b- Address 'Tl_.:. - #..-._ T- ..- ,a.... r,n TTr .. __ L �._.. 1_� ._..._.. -iJ U14111 1 �+ -- ski `t[•,L. r,._ 0 "(t -__.._.. "., ? _ .. 1 g 7Y n. i�krn(� lias CEO Co—Col -I.LV1 U Vait �Jili�I LC Number of Bedrooms Has 3 Bih�:5 been installed? N 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 'th the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the artment of Health. Date: 12 �R Certified by P.E. �4- I R.A. elx - /q,4/--� CAI Ca t-AtF -E?- NLG (Design Prof siona Address lug g7-1 pA p-q E. GA" p-im r,-L- LLy r License # 0Co-7-44 Lo Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoc ion, modificatio or change is necessary. n , c� By: /L Title: �", Date: 2 White copy - HD Fi e; Yell opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 0 AN. Al. YT.T.C.A . i_ .RE.P_CR.T._...,_ - 34CAR011FN:i: WAY > >! < » > > > >> : >i <> .. .... PANERSOI .::.:..::. > ..........:.::W ,1,5.63.::. ps Re3�ari adte ..::'!__. Pro pOtc STANDARD dab Number 198651 SampTe:,Number(s? .. I9a657 0.:.; :. .... y s Cercone b atory Director 315 Fullerton Avenue Newburgh, NY 12550 Committed To Yorr Success Tel: (914) 562 -0890 NYSDOH 10142 NJDEP 73015 CTDOHS PH -0554 EPA NY049 PA 68 -378 M -NY049 Fax: (914) 562 -0841 A - - - Coll �cte_cL � : ... __•, ; _- - - Federal. - or�ya 'is� Analys's..Dat Form I •• IN Client Name: STIEBELING ADAM Project Name:' STANDARD STL Sample Number: 198651 -01 Client I.D.: STIEBELING Date Collected: 04- FEB -99 Matrix: 1'DrinkH2O Date Received: 04- FEB -99 Comments: Analysis Result Units Method Analyzed :.otaC vlfprm ... ":: <:: RESENT .......::.:.. IIOU ML 9223 ".::::....04:; . g..9.. 1 Total Hardness 26.6 MG /C 200.7 08- FEB -99 7 curb ?diY: 0 62......... T 2I3O= B:`':'<:: FER. pH 6.0 4500 -HB 04- FEB -99 Remarks: 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562 -0890 comwnmm Your suaess NYSDOH 10142 NJDEP 73015 CTDOHS PH -0554 EPA NY049 PA 68 -378 M -NY049 Fax: (914) 562 -0841 m ` - The following data qualifiers are used to assist in the interpretation of analytical results. DATA QUALIFIERS CANBE FOUND TO THE RIGHT OF THE ANALYZED DATE Unless otherwise indicated by the data qualifier, the sample passes applicable drinking water standards. Qualifer Applicable Comment .; 1 Parameter fails applicable drinking water standards 2 Exceeds lead S_ WDA action level of 3 Exceeds copper SWDA action level of 1.3mg/l or 1300ug/l 4 The results indicate the water to be corrosive 5 The recommended sodium level for a moderate diet is 270mg/l The recommended sodium level for a restricted diet is 20mg/1 7 Hardness 0- 99mg /l = soft 100- 200mg /l = moderately hard 200 -over = very hard 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562 -0890 Committed To Your success Nvcnr)H +m4? NJnFP 73015 CTDOHS PH -0554 EPA NY049 PA 68 -378 M -NY049 Fax: (914) 562 -0841 Committed To Your Success NYSDOH 10142 NJDEP 73015 CTDOHS PH -0554 EPA NY049 PA 68378 M -NY049 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562 -0890 Fax: (914) 562 -0841 Sent By: SEVERN TRENT LABORATORIES; Client Name: STIEBELING ADAM STL Sample Number: 198651 -01 Client I.D.: SULGELING Date Collected: 04- FEB•99 Dace Received: 04- FEB -99 19145620841 ; Feb -17 -99 17:05; Page 213 Analysis Data Sheet Form I - IN Project Naw: STANDARD Matrix; i DrinkH2O 315 Fullerton Auenuo NewbuMh. NY 12650 rmrlggllbiEo6vmnw NVEDOW10142 PUMP MIS G M8� amNros PA W370 a Fog: (91 )662 Cowents: Analysis Result Units Method Analyzed ECOLI ABSENT. /100 MLi 9223 04.FEB -99 Ircn: :::::::::::::::::':.::.:: 6o: u; ::. :..::.:..:::::;:::::::::::::. .::::::Iii.:::::..:::::.::::.. ' ::::: :::::itt:�:.:.::.:.::::: ::b$gg: Lead 3.6 UGA 3113 I3 FEB 99 ..... i�?aa.se :.:.- :.::::::.::::. .':::':::::::::b :..... . &,:fi.:.::..::: a...... :`:J7 Nitrate (H) 0.2 U MG/L 300 05- FEB -99 Ntacite.:.t All 0;:412::.......:::::..:::.::::; ::. '..:::.:.::::.;rEiCa1L.::.:.`.. ...... ...........::.:.:...:;:.:::.::: Sodium 2.17 MGlL.• 200.7 08•FE8.99 Totikl :::C13:f:�orgm: 1 Total Hardness 26.6 M/L 200.7 0648.99 7 Ttuiliti ...:.:.:::::.::: ::;.:::::::::::::::...::.:. .......t9+ >..: '0:62'.:::::::::.:::: ?::::..::: - :.:.::.::::::: Ell:::: :::::::':`..::.:...:.:.::::;::' 21341: =8 ::::'::.'.:r:::::058'.<il9t :. PH 6.0 4500 -HB 04•fE0-99 Remarks: 315 Fullerton Auenuo NewbuMh. NY 12650 rmrlggllbiEo6vmnw NVEDOW10142 PUMP MIS G M8� amNros PA W370 a Fog: (91 )662 e nt By: SEVERN TRENT LABORATORIES; Ir 19145620841 Feb-16-99 12:23; Page 3/4 Client Name: PLJTNAM COUNTY HEALTH EPIT STL Sample Number: 198810-01 Client I.D.; 34 CAROLYN WAY STIESE ING Date Collected: 09•FEB-99 Date Received: 09-FEB-99 Comments: al" d" Col cs Analysis Data"Sheet Form I - IN Project Name: STANDARD Matrix: I DrinkH2Q Analysis Result Units Method Analyzed Total Colifotm ABSENT /100 mts 9223 09-FEB-99 Remarks: 315 Fulleflon avenue Newburgri, NY 12550 Tel: (914) 662-0890 r d., T. I= NYGOOH 1(742 WDEP73015 CTDOH5 PH-0554 MIA Ny1749 FA $6,370 M•NIOWS rax: (914) 562.OBAI _._....:.__ s,...,..... �,.,........._,_ �N��.... .._,�.............._M.�..,.:... ,�..w,..,.3...._.:.�:, -- ,.rte..__. _ �_:. s,: n, �.. �......,.._:......... �. __.M__..���._�c...,,,�......_�� . ,,.... _�� ,.. _ _ - �.,�--- .,:.._ __�,� 1 l Sent By: SEVERN TRENT LABORATORIES; 19145620841 ; Feb -17 -99 17:04; .__ ...., 'ANALfTs -CA L ?L�OR -T - -- Page 1/3 315 Full~ Ague N9wbugft NY M.. 50 Tel; (914) 582.0890 coast. I NY300M 10142 NJDKP amts c M+ asaa tPA W0H FA ee M M4rro4e Fax: (914) 5MM41 ent By: SEVERN TRENT LABORATORIES; 19145620841 ; Feb -16 -99 12:23; Page 2/4 W M W UY.1...1.0 A., R.:E.,,_0_x.1,, T OUKiY':PEf?'P OR.. htF tTN: '::ENE .:B,ITT•.NER:�:::: �::' .:::: .::::: : ::::::: :: 8R DER:;::.•::::.;'.::: ;'; .:.:: ; NY:::�050�'.::`::', 0 ffi � .omnkme T. ib.n smog. EPA 315 Fulenon Avenue NBwUurgh, NY 12550 Tel: (914) 5624)890 Fax: (914► 562.0841 ent By: SEVERN TRENT LABORATORIES; 19145620841 ; Feb -16 -99 12:23; Page 414 The following data q interpretatii DATA QUALIFIERS C OF THE lifiers are used to assist in the of analytical results. r BE FOUND TO THE RIGHT AL YZED DATE Unless otherwise indicate# by the data qualifier, the sample passes applicable drinkinj water standards. Qualifer I Applicable Comment x arameter fails applicable drinking water standards 2 xceeds lead SWDA action level of _� - -- 15ug/1- xceeds copper SWDA action level of 3 1.3mg/1 or 1300ug/1 4 I he results indicate the water to be corrosive 5 jhe recommended sodium level for a moderate diet is 270mg/1 4he recommended sodium level for a restricted diet is 20mg /1 7 H rdness 0- 99mg/1 = soft 100- 200mg/l = moderately hard 200 -aver = very hard t a 6 rour 5.� 1042 WDEP73015 ISMS PI 46bfA tPA NYDA9 PA iW47B 315 Fullerton Avenue Newburgh. NY 19550 Tel: Midi 5820890 Fax, 1914) 582.08x7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building t1i Nfa Building Constructed by 3 � Y Location - Street Building Type 3 ?3 Z Tax Map Block Lot P s ®tit TownNillage G77�_}i,-,Li1 ,i — Subdivision Name 7 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the s tciTi. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year Signature: ( > Title: Oc, XXtd, .- General Contractor (Owner) - Signathre Corporation Name (if corporation) C 2 s2 Address: � � �4y+a Dot"� State Zip 1 79_6a Corporation Name (if corporation) Address: S State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ please print or type PC HD iD Permlt # ' � ~� Well Location: Street Address: Town/Village Tax Grid # Sq Cqroi, W A �T1or� Map Block j Lot(s) 23, Z. Well Owner: Name: Address: Use of Well: __Ie!flesidential 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 600 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓few Supply (new dwelling) Deepen Existing Well Detailed Reason S,,, i „K e r oc. for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes / No Name of subdivision NIF- R.`f 4O►4, 5-n eakunrc(,– Lot No. I— Water Well Contractor: -T, Address: Is Public Water Supply available to site? ................................. ............................... Yes No Name of Public Water Supply: A, A TownNillage — Distance to property from nearest water m 'n: — Proposed well location & sources of contam ro n ep ate sheet/pl 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 wa r well driller certified by Putnam County. Date of Issue _ Permit Is ng Offici : Date of Expiration ' — Title: Permit is Non -Tra sferrab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - caner; 00range copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH _. llIVISION OF ENVIRONMENTAL HEALTH.. SERVICES LETTER OF AUTHORIZATION RE: Property of Located at S4 CA s-1-1 6L+ML- O?477SrisryN Tax Map # 31. Block Lot 23.7- Subdivision of 16 *15X Subdivision Lot # Z Gentlemen: Filed Map # 2--751 Date Filed (4-J5- 9 This letter is to authorize �tti'r.1.tit -�l�t r�11 l��i a duly licensed Professional Engineer dL 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 conformity with-the -provX Law, and the Putnam 4 Countersigned: P.E., R.A., # CG of said wastewater tretment and/or water supply systems in )45 and/or 147 of the Education Law, the Public Health. Mailing Address ,4­VF,-- State rl y Zip )01512- Telephone: 2ZS.- 3C>r�, o Very truly yours, Signed: aLmu lk ) (Owner of Property) Mailing Address: 31 C 4-RoL r4 JAY -" Q -C>Q M State W Zip Telephone: 111- 2Z-S- 77 ZI-% Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �4 2. Name of project: 3. Location TN: 4. Design Professional: 1&LG m 1ga w(1-5. Address: cvZ 6. Type of 'ect: Private/Residential Food Service Apartments Institutional Office Building Realty Subidvision CA2rN1i L I-AY Commercial Mobile Home Park Other (specify) _ 7. Is this project subject 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? ......................... K 9. Has DEIS been completed and found acceptable by Lead Agency? ............... /I 10. Name of Lead Agency 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... l ra S 12. If so, have plans been submitted to such authorities? ........ ............................... le_ C V .,.ev 13. Has preliminary approval been granted by such authorities ? YES Date granted: 1r 9 tz 14. Type of Sewage Treatment System Discharge ................. surface water a groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? ....... ............................... 1� o 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ t4 20. Name of sewage system Distance to sewage system 21. Date test holes observed Z 7 1 22. Name of Health Inspector &gg f, � +� Form PC -97 2 23 Project design foy.(gallns 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 25. Has SPDES Application been submitted to local DEC office? ............ No 26. Is any portion of this project located within a designated Town or State wetland? 'Je.5 27. Wetlands ID Number ........................................................... ....................:.......... 28. Is Wetlands Permit required? .............................................. ............................... N Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? .. ............................... N o 30. 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 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No DESCRIBE: '�4® 32. Is there a local master plan on file with the Town or Village? .......................... y E S 33. Are community water and/or sewer facilities planned to be developed within - - .15-years in or adjacent to project site?. ........... �........._ �_........a............... -- 34. Are any sewage treatment areas in excess of 15% slope? . ............................... iJ. 35. Tax Map ID Number ........................ ............................... Map 3 Block 3 Lot Z3 0 2— 36. Approved plans are to be returned to ..... Applicant Design Professional 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: ................................... I 9 2=x"6 310 of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -,SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address I M�acf_yt'l �Ay Located at (Street) -Tax Map 3ij Block Lot 23,2- Municipality ('Adicate nearest cross street) A 4+�& C U4 0 t4 Watershed I Date of SOIL -PERCOLATION TEST DATA Date of Percolation Test Form DD-97 . .. .. . ..... ... . . .. .... ......... .. . ... .. epthf Vi Ater W.- 4 er: ............ . . ... I .... . ......... .... . .... .. ....... . .... .. ........ ...... rom::. Iroun "F G d ':,':`,`,'Le'veF ercoa.. ''., I on, R" N Ttme1a se ime.:: h- :.:..Surface :#:n.e 0 �4'��AJF P" In ate ...... ............... ............ . on -�iInches ........... .............. ... . 1, ze 'so Z0,1Z. z 3 10 2 Z =©9 -so 7- o"I z 2 3 fl 3. Z5 9.2- 3 23.5 131 0 Z® Z-3 3 io 4 5 -V 20 2 -'03 2.1 z 1Z 3 17- 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are 'obtained at each percolation test hole. (i.e. :g I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES 2 DEPTH HOLE NO. HOLE NO: HOLE NO. W G.L. 0.5' Dee_ 7 ea -r-� V ®p- 6 a I bA t. ®� 13 (op %,A-- Lot _ 1.5' 2.0' 1"— 3Ge, Arm 36" 13`t. 49" LT. �6a!r 2.5' -J�tz.,Jtl Sd t�1/ oY Loeb S4►�n� I..owtw. i 3.0 4V9LV LOAM 5��� � LY e✓ r,.. 3.5' 4.0' 4.5' i 5.0 it 3b N - 9® 17A¢t� �I ae 3 � 93 G��bes:� 48et ts�f 5.5' 6.0' 6.5 Cme4�,�t, �. wseM Sw► 1-��r�� �streEL 7.0' Sbmwr. SM A"► QacaZ5 7.5'� 8.0' 8.5' 9.5 �0 8R'�orrLanc[p- o d�orrL�Mir- 10.0' Indicate level at which groundwater is encountered R0146 Indicate level at which mottling is observed i 10 K Indicate level to which water level rises after being encountered N A. Deep hole observations made by: Date 4 *16 1 MIMI Design Prof'essional's Seal %oF NEB'\ :,,;V 11101V TEST PIT PROFILES Hole # 4 Lot # Z Hole # Lot # Hole # Lot # Depth to water flame_ Depth to water Depth to water Depth .to- mottling - ��. Depth -to -mottliq.- - lllepthto'mottling` Depth to rock/imp. 7-0 + Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 p w" j o(� Sor V 0.5 0.5 1.0 1.0 1.0 2.0 6.,x_41 L-T N 2.0 2.0 3.0 S, L�. �Srtn�oy 3.0 3.0 4.0 L.o 4.0 4.0 5.0 C�vgy , 5.0 5.0 6.0 6.0 6.0 7.0 ff " - $4 . 7.0 7.0 8.0 &ns gjvr LcA,., 8.0 8.0 9.0 w% SIAMIL S 014i 9.0 9.0 10.0 10..0 10.0 Hole # Lot # Hole # Lot # Hole # Lot 9 Depth to water Depth to water Depth to water .Pe th to mottlgr� ... _- Depthao: mot#ling -- - - - - Depth-tomling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # .' Lot # Depth to water Depth to water Depth to water _ .... Depth to mottl�ig...__..:..... -:: Depth- to.mottling .. Depth to'ni6ttling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth-to mottling __ _ Depth to mottling... - - - =-D�pt tamottling _ ..._ . _.�_ Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. 4 G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Car._me1, -,NY 1.051.2 -- ... 914- 225 -3060 Fax: 914 - 225 -2955 We are sending you X attached Shop drawings Specifications Plans No. of Copies i" LETTER OF TRANSMITTAL RE: under separate cover, the following items: Prints Copy of letter Other: Description These are transmitted: _ For approval _ Approved as submitted As requested _ Returned for corrections For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Copies to: SIGNED: If enclosures are not as noted, kindly notify this office. Mr. Gary Tretsch Putnam Engineering 102 Gleneida Avenue Carmel, NY 10512 Dear Mr. Tretsch: BRUCE R. FOLEY '4 'Pubre- Health��Direclor DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road July 2, 1998 Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Re: Lot #2 - Stiebeling Realty Subdivision (T) Patterson East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 30, 1998 is complete. The Department will notify you by July 20, 1998 of its determination. If the- Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed $ule s . nil Regulations ._,If ihe.Department fails -to notif - you witl3ci .n.- 1 -0- days°of-the=receipt-of the- • °m _..._ _ �_._= 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 Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 148. Very truly yours, Michael J. Bud 'nski P. MJB /jp Director of Englneerin 14 -16-4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Quality Review SHORT -ENVIRGNNIERITi(L"NSS -ESSMENT fO -RMf�" For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (fo be completed by Applicant or Project sponsor) 1. APP NT /SPONSOR 2. PROJECT NAME CAW, ice. 5 11�Atc�t 3. PROJECT LOCATION: Municipality z'C>t�. County ?Trill -' 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 3 C OY JAY 1:' C IqM 1L-Ir V)'4 Y 5. IS PROPO ACTION: ew ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: �anc5ri2�c TtorkP O� S�KV -�tE �cY A .0 . 7. AMOUNT OF LAND AFFECTED: Initially im ?z 6 e acres Ultimately � 'OO acres 8. WILL SED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? lEffYes ❑ No If No, describe briefly 9. WHAT RESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Fore3VOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL' AGENCY (FEDERAL, STATE O CAL)? Yes ❑ No If yes, list agency(s) and permlVapprovals Col�(sTttvc't �I �fZwa �T — c t Zof�F 11: DO Y ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? es ❑ No If yes, list agency name and permlVapproval �'J3Di-l(S(Ghf An A0VOrt- 12. AS A RESULT OF P ED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes o I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: r' � f 'J • -f rL �7-' Date: Signature: W 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 TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes 0 •.B.. -WILL AC SIGN• RE6'SVE -COORDINATED.REVIEW,-AS, .PROVIDED FOR.UNLISTED AOTION$;I14,6-NYC1i PART :Et7 6 ?•; _..IL• No;- a_•negative declaration may be superseded by err Involved agency. ❑ Yes Leo 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: /v 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. AYD C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. / V ±r 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,- THE�IKELY TO BE, CONTROVERSY RELATED TO POTENT'IA'L ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes 0 0 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 and /or prepare a positive declaration. heck 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: of r,P-�7 Title of Responsible Officer . 2 AM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL HEALTH SERVICES CO TRU�jCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # --� `l q v Located at 39 CgevLs � AY Town or Village B Subdivision name Sr,+iAa LnxG- Subd. Lot # 7— Tax Map 3- Block 3 Lot Z3, Z Date Subdivision Approved Pm #27.5 I Renewal Revision Owner /Applicant Name Gkm LS . cJTr 1, La N Lr Date of Previous Approval Mailing Address 3 c. ni a - NY Zip 125-63 Amount of Fee Enclosed Building Type re0a" 6 Lot Area No. of Bedrooms Design Flow GPD 9C) G Fill Section Only Depth Volume Separate Sewerage System to consist of (Z :5 O gallon septic tank and s 00 L-1` A Other Requirements: To be constructed by To Z,z 1��r�,H �_ Address Water Su 1 Public Supply From Address or: Private Supply Drilled by 7_0 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the s. eparate 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 o issu a of the ap oval of the Certificate of Construction Compliance of the original Signed: Address portIII-M " R.A. Date 6 Ai� LFg, PCIL License # Oo 744lp [(97 ��t�4oa. Ny ID512 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 rmit. Approve or discharge of domestic sanitary sewage only. � e By: Title: Date: 7:4,-VF White copy - HD F &; Ye ow py - Building Inspector; Pink copy wnei, •ange copy - Design Professional Form CP -97 TNAM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL HEALTH SERVICES CON TTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # D Located at 31 CAILut -y to JAY Town or Village 74Tme—C.'e>4 Subdivision name Sr,zAy-Ldf L - Subd. Lot # 7— Tax Map 31 Block -25 Lot Z3,,2- Date Subdivision Approved 51199 Fm 027.51 Renewal Revision Owner /Applicant Name ADArm ST# & a0- Li N. L - Date of Previous Approval Mailing Address 14 C A -eot -y N l� A v ?,: gw ese*4 NY Zip 1 2.563 Amount of Fee Enclosed Building Type re*m 6 Lot Area ' © No. of Bedrooms Design Flow GPD $00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 13 5 O gallon septic tank and S 00 L-1: A Other Requirements: To be constructed by (o Zipz - p-mg „t,w D_ Address Water Supply: Public Supply From _Address _ or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment 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 o issu a of the ap oval of the Certificate of Construction Compliance of the original Signed: \� L ,'�� - -� �- R.A. Date 6141,70 Address F l3rtj/s-m ews t Nl:!LWA � I P[,(L License # OCp 7�-lp taz ��Q-& f-% e:k,. Ny 1v5l2 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 germit. Approve or discharge of domestic sanitary sewage only. c Title: Date: 291L White copy - HD F le; Ye ow py - Building Inspector; Pink copy wne , ange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: ++ t� I II. ll WC� Town/Village: C E 6- Tax Grid # 23,Z Map '>�{ Block '?j Lot(s) Well Owner: Name: / ) Address: 1 Adam n �eCJC'.l eve j Use of Well: 1- primary 2- secondary Residential Business Industrial 6blic Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion --K Compressed air percussion Other (specify) Well Type Screened Open end casing –X Open hole in bedrock _ Other Casing Details Total length _,62j_ft. Length below grade _eft. Diameter _7 in. Weight per foot � lb /ft. 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) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield 0 _& gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information '5 Pump Type ?5 Capacity Cow Depth '. ;o ®f Model -+s) Z 5 i Voltage 1.10 B? Tank Typed i- Volume3� X r(LJ:v S' © Date Well Completed /40 7 gif Putnam County Certification No. 007 Date of Report 1,0 b A Well Driller (signature) I A A-- NOTE: Vxact location of well with distances to at least two permanent lancloarks to be provided on a separarneevpian. Well Driller's Name &at Signature: Address: 1619 e ,3j/ /.2-tC (S6✓1 `v i Date: Ad White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: tip . Inspected by: Street Location Owner u,✓G Town Permit # ��- TM # a IL ? �2, Subdivision Lot # 2— 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ................:.............. d. Stone, brush, etc., greater than 15' from STS area.......... e.. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ........ 1, 250....... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1.AIl outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches TT—eng-th required 500 Length installed S-00 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ... :.............. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... 9. Depth of gravel in- trench -12 mini ..... 10. Pipe ends capped.. .................. ...... ............ ........... g. PUMD or Dosed Systems O I&f I t 1. Size of pump chamber .............. ...................... 2. Overflow tank ............:................ ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ....0.......................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured '71oo' ft........... c. Casing 18" above grade .................. ......... ................0...... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ..................... 0............................ b. All pipes partially backfilled ........ . ............... .................. c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 r.,,..., cT :Z i i .L ;h i A Z a 9 1 , JA gR' A a 9 1 , FL A CA¢oI.YN jf�` WA( SG?�LE: I" =100' . $E4,Lo . ? Vltm4kC e - TA,131.E: ,.B -5 t.00 IB 8.z'E 31,94' .d 5 1 zq'cWS 32:-q 0' . • .E S v8 I t oZ''e. 2 - 29,r7" � $ 31° 03 Oq'•'E z�7:ol, i1 S a9' ?S j41 "E q.y4'. S'le 6-71 We _Z 55 °22+bu "E .3.57to` .I 1 jg a I. AS —BUILT MEASUREMENTS ( IN FEET) Gvzdy(I DcD $Y CWN Ic 2) 1 , 7" am County H th Deentm c A5-BUILT: + I. This is to certify that the sewage disposal system was U y constructed as indicated on this plan and that the system was Inspected by Putnam Engineering, P.L.L.G. before It was covered over. The system was constructed In accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health. 2. The 55D5 consists of the following 12-50 gallon precast . concrete septic tonk,.504 I.F. of 24" wide absorption trench , additional' requirements (?) 3D5 PREPARED FOR: ADAM B. 5T I EBEL I NCG GAROLYN WAY t WELL E Z4 Yy i � 8 DECEMBER mcla JEGT MANAGER KH DRAWN BY CHECKED BY. GY A5 -E 1 LT 5.5.D.5. PROJECT NUMBER DRAWING NUMBER . AE3 I i 1' r• r 2 5 4 5 6 8 q 10 .II 12 13 14 15 Il 1-7 18 19. Z5 /q ZG 4 3q 4z 39Yz 99 /4 50 /4 3plz �c} /4 1z 99 /1 55/4 -71 /z -7Z-'/z- -7(n %z -71�1 /z 83Yq 8-7 34 B u-, Y'4 Co Ea Col %t (,9 -71Y9 7q y= ZZ' /z Z5 %a q3 /y 3y' /g .35 %Z 99 %q zi %q X0 %9 35 40 y5 50 -7 G 19 5q 'r uoysa'�beu a, u. ,LOOTw JlvleionAof Euvirommeat9SIA881th Be27looloe i g Q A"rOV& nkefar cotormaae..ith am County H th Deentm c A5-BUILT: + I. This is to certify that the sewage disposal system was U y constructed as indicated on this plan and that the system was Inspected by Putnam Engineering, P.L.L.G. before It was covered over. The system was constructed In accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health. 2. The 55D5 consists of the following 12-50 gallon precast . concrete septic tonk,.504 I.F. of 24" wide absorption trench , additional' requirements (?) 3D5 PREPARED FOR: ADAM B. 5T I EBEL I NCG GAROLYN WAY t WELL E Z4 Yy i � 8 DECEMBER mcla JEGT MANAGER KH DRAWN BY CHECKED BY. GY A5 -E 1 LT 5.5.D.5. PROJECT NUMBER DRAWING NUMBER . AE3 I i 1' r• r