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HomeMy WebLinkAbout1518DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -12.1 BOX 14 01518 IT �. Is 01518 ZN PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE 2 REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at t1J TQM M Y T H 0 (ZZEg, STN E-Town or Village P pt C �-. Q Owner /Applicant Name\/ E -L &U A N SW(,K fax Map 4 , Block _ Lot Formerly Subdivision Name S 4 �<' U-- L\ Subd. Lot # Mailing Address 106 C �t F �-T E�,) V�Z\V F �©N \<,,U5 rJ Zip 1 Date Construction Permit Issued by PCHD Separate Sewerage System built by Chd N Address Consisting of \ J O0 Gallon Septic Tank and ; DO L.F, kQ)'� \O N T C- E- H Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by yb WA UI AN S F L, AddressQP-MCLI IVY 0 512 Building Type L- Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? ND d 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 Coynty Dppartment of Health. Date: (9- kS --O` Certified by Address2 h 0 (Zo 1) T E i P.E. v /� R.A. 00 License # 1 2-T Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals subject to modification or change when, in the judgment of the Public Health Director, such revocati m dificatio change is necessary. r By: Title: Date: ,3 0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well r6d2iti6ri " `" ' Street Address: °"° ownNillage: 7­ r "" Tax Grid# Map'+ Block Lot(s) VL Well Owner: Name: Ltq,'Ui � c0- Address: LlmiVZk � Use of Well: 1- primary 2- secondary Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Y-Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 21 ft. Length below grade 7- C; ft. Diameter _min. Weight per foot )�1 lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _K 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 T�Compressed Air Hours Yield 26 gpm Depth Data Measure from land surface - static (specify ft) /F ) During yield test(ft) I l d2iic.0 610lJ Depth of completed well in feet aJ 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 3 -Sc✓rld- h'// 20< �nrSUG��Z %lip i iVl-- 9), Imo' r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type S(J17 Capacity I�ot Depth 18 Model I ly'7 -j2. Voltage Z'x? HP Tank Type 3`;b X� Volume Date Well Co�mjpleted{ Putnam County Certification No. Date of Report j� Well riller signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prov on ate,�arat�tteevplan. j e4) �� ill (' ^Ji�U i ✓✓ Well Driller's Name _ r) e.5 b'1 k J { I � Address: 16 Sy rc — Z Signature: Date: 12-161 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 3 0 FINAL SITE INSPECTION Date:. 1-- �._ T' -� -:t - -r -- _. -d- Street Location O �'t Ohv�� e Owner sk�(' -c( , Town ka Permit # F —/ q — f9 TM # ?4- Subdivision Lot # /_ 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 t c. Natural soil. not stripped ...................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage S stem j� U a. Septic t size - 1,000 ......... 1,250 ......... other ..... .. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost.............. ..... ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly set..... v I . Length required �� Length installed 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 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ......................... ............................... g. Pump or .Dosed Systems 1. Size o 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/Building a. House ocated per approved plan .............................. b. Number of bedrooms .......................... ..................... IV. Well a. Well located as per approved plans ................. t.............. b. Distance from STS area measured �7 Zoo ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 Form PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES_. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM VhS EL �,, ©�_LI A 12 Owner or Purchaser of Building Tax Map Block Lot OW NT, Building Constructed by to i0MM v T)t4jRK R, LANE Location - Street R 1t6ENCE Building Type QP�7T E N TownNillage ��4 KR L ) Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate properly is caused by_the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. 6 Dated: Month Day S Yea`r`��J I Signature: �ag Title: wZ►CI- General Coneactor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Corporation Name (if corporation) Address: i I omcm Rvv'tor State �!IZALI sue► X Zip y Form GS -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 c _ _ =8 ewster, NY 10509. - Telephone (845) 279 -4003 Fax (845) 279 -4567 July 2, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Shkreli Subdivision, Lot #1 10 Tommy Thurber Lane Patterson, NY 12563 T.M. # 34.4.12 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -1, "As -Built SSTS," dated 6- 26 -01. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 6- 15 -01. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 6-.15 -01. 4. Laboratory Report, dated 6- 26 -01. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 6. "E -911 Address Verification Form," dated 6- 29 -01. 7. "Well Completion Report," dated 6- 12 -01. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nichols Jr., P.E. HWN: his 00- 064.00 NE LABS NORTHEAST LABORATORY of DANBURY Iwo kN A000,9 39 MILL PLAIN ROAD - DANBURY, CT 06811. CT_Cert :,H -0404. -203) 7464WS - ] _ i2 748 -0652 -� NY Cert: 11471 - U � REPORT TO: MR. & MRS. VASEL SHKRELI 6 TOMMY THRUBER LANE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. # REPORT DATE: AS ABOVE BATHROOM SINK WELL -NEW NONE RESULTS METHOD # 0 per 100 ml SM 9222B 6/26/2001 10:30 A.M. V. SHKRELI 6/26/2001 LAB #11471 NY -72 7/2/2001. MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.27 - EPA 150.1 No designated limits • Turbidity 0.82 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen _ _ . _.. <0.005 m as N EPA 354.1 • 1:0 mgfL • Nitrate Nitrogen 0.74 mg/L as N SM 4500D 10 mg/L • Alkalinity 20.0 mg/L SM 2320B No defined limits • Hardness 34.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L ' Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 4.1 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.014 mg/L EPA 239.2 0.015 mg/L*** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count . "Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: OPOTABLE or nOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED:6 /26/2001 E-010 li `;��� ? � �,t I� !1►,:t�.' Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 ., . _ ....: BRUCE p��,:;.. FOLE� •..._...: = ..: - <x ::::.... . _ _ .._. _ _ Public Health Director a :..r <. - �.:= LORETTl�'�R401;1NARI "RN:, -• 1�:�S:N. � -: < . _..._.... 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)278-6559 WIC (914)278-6678 Fax (914) 278-6085 Early' tutervep6o -(914) 278.6014 Preschool (914) 27&6082 Fax(914)27f.6648 OWNERS NAME: ,j As E L. TAX MAP NUMBER: 3 A i "C .\ — `? o E911 ADDRESS: � -T o TOWN: PAS AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 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 address is assigned by an authorized'town.official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) .➢ M[ M➢ M[ M➢ M➢ MiMdM". M[ M[ M➢ M➢ M➢ MiM[ M➢ M€ MiMLM3MeM+ MaMaM€ MenntM:_ M' MBMFMPMiM [M:M�MaMSM%M�M;M�nn.MnXnn -MM•M �p y WDEP _ PUTNAM COUNTY DEPARTMENT 1 O , O " . CONSTRUCTION PERMIT FOR .SEWAGE TREATMENT SYSTEM PERMIT # r-1 l ° [ 1sd� F Located at ..I o M i-A 1 JAv �15� Lk � �, 9 < own or Village r 1111 Tr5 P-60 H Subdivision name �l Date Subdivision Approved Subd. Lot # 71ciJq-1 Owner /Applicant Name V h6c1L -}- MLdN �1�1 L•1 Mailing Address 106 0P-P4 Amount of Fee Enclosed 00 .6�. Building Type Tax Map 114 , Block 4 Lot 11- Renewal Revision Date of Previous Approval yPv4 l Zip 0-111 j2E� i®cMLC- Lot Area 9" NItxNo. of Bedrooms J Design Flow GPD 1,000 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ?"fit -�iINY Other Requirements: , ALL To be constructed by `-60 1600 Water Supply: Public Supply_ From _ ®r: Private Supply Drilled by gallon septic tank and 61D4 Address Address Address L� AB-e? I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments ystem 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. A Signed: Address o mg-- OW4 12-on X X P.E. �C (59ZW5 -r R-- lip R.A. Date G I V N I License # 15 (01,4 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatm system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en c sidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proved ischarge of domestic sanitary sewage only. By: Title: Date: JC- U, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # - 9 Well Location: Street Address: Town/Village Tax Grid # ToHHt j 4}J IL LA�Mj� PXTVaP-60W Map 'b4 Block 4 Lot(s) Well Owner: Name: - \]a561�t Del'ii. Address: Use of Well: X 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 Fi+ gpm # People Served -6 Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 1G New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ................. Yes A No Name of subdivision Lot No. Water Well Contractor: 1 b -D Address: Is Public Water Supply available to 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 separ a sheet/plan. Date: 1'L1 i°� Applicant Signature: #z;t 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 waterWeN driller certified by Putnam County. Date of Issue cJO Permit Issuing O ial: 1h"1 Date of Expiratio Title: Permit is Non - Transfer ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 • 1 . J. breakfast Rt i kitchen 1 •r family rm r J 1tf Q:K2CRCT. 3 f c :: r � t KftF1►MQ:CL � - is � ➢1p[.'TLRG � uaax>a rr• �. � • RIRCiG.Ztc4RJ£i living tm. CKRd[ MEAL \ t[ RR1i!IIai# _ d (ri I n g r m. 1 - LG4Lit�S6 •. r ;ire MT= 0 � R�lr•ER (OyLt Cd'G(> EIa i>•MJtf Fcurpl+i 6K61� KtLSR�f•'Ts��['ii2 iYK41rRt @.'t7sh11' 1CY191F 1Ci��FJr KFA ' A:Y EY + covered porch FIRST F LOO 11 PUTNAM COUNTY DEPARTMENT OF HEALTH ea HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY9 3, k� 5 :BEDROOMS ai ', ALL SU E9UENT P.� S IS ON[ALTERATIONS TO THESE HOUSE P ST EE S TIED '1O THE PCDOH FOR APPROVALi 'r c DATE SI NATURE & TITLE i is ,W Gull �. xlttinp rm.� � beA rm -1 a bed rm. �i F mostbr bed rm . c1�rR bed rm. II II I, SECOND FLOOR S. i { 4 LAURENT ENGINEERING ASSOCIATES, P.C. 20 Milltown Road :. -..... _.... _ Brewster, New York 10509, HARRY W. MCHOLS JR , P.E. (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS July 7, 1999 Mr. Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Skreli Thurber Lane Town of Patterson TM# 34.4-12 Dear Mr. Morris: In response to your review letter dated July 2, 1999, we offer the following: 1. House Plans are now enclosed. 2. The drainage basin for this lot is the East Branch. . -..- -- •- .ire trust that-the. above addresses Al -of y-oui concerns and we.. request _ the issuance -of the. Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Py Harry W. Nichols, Jr., P.E. HWN: JM: his 95077 ..��:.�;:BRUCE,- R:- •.:IOLEY .:...... . ....._ . ,:..._ _. _._... __.._. ._ .. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORE9A,: MOLINARL. RN., M.S.N. .. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 August 11, 1999 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Shkreli Tommy Thunber Lane (T) Patterson, TM# 34 -4 -12 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should -contact local wetlands7-officials in_this, regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) Limits of the 100 -year flood plain, or a note added if it is within 200 feet of the property line. 2) Show all watercourses, streams and wetland boundaries within 250 feet of the property, or add a note indicating none exists. 3) 1 foot of fill is to be provided over the entire SSTS. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve Wily yours, ,,1'h'_'__.. Robert Morris, P.E. Senior Public Health Engineer ,ORKGTV DEPART,yE T ti 2 0 ofto THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL,PROTECTION, F " JOEL A. MIELE, SR., RE :`Commissioner � K FMTAL PRO WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner PHONE (914) 742.2001 Bureau of Water Supply, FAX (914) 742.2027 Quality and Protection July 26, 1999 Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Shkreli. Lot 1 Tommy Thurber Lane Carmel, Putnam DEP Log # 9519 (Joint Review) Dear Mr. Morris: The following information is necessary to complete the above - referenced application: ® Limits of 100 =year flood plain must be shown_.gn the_plarx,, or, a note added indicating ifit is, in.200.' ,.. ".ofproperty line; _ _. . _ -- - - - - - - ® Show all watercourses, streams and wetland boundaries within 250 feet of the property line, or add a note indicating none exist. If you have any questions regarding this matter, you may contact me at (914) 773 -4416. Sincerely, 6-ayl C _� .-t a (-- Sissy De La Ossa Assistant Civil Engineer Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 ,.. BRUCE Public Health Director _-- ...�L•'OR�P�'I'�1- .,Mt�)sINARd. RN:;:: M:S.N:� - --.- :., 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Application to Construct a Subsurface Sewage Treatment System at Skreli, Thurber Lane (T) Patterson, TM# 34.4-12 Dear Mr. Nichols: July 2, 1999 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on June 25, 1999 is incomplete. Please be advised that the following information is required before the Department may commence its review. • House plans for the above - referenced project must be submitted. - - - Y • Please verify the drainage basin for this Lot. The Design Data Sheet was not complete with regard to this information. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 2166. RM/tn Very truly yours, f�t'QAf)� 0-�� (TW Robert Morris, P. E. Senior Public Health Engineer LAURE ASSOCIATES, P.C. MG .... -,..._ ... ._ ... r_ 201r, -Nirwn Road . - •. •. R •Brewster, New YoriF 10409- : (914 )278 -6108 - (FAX) 278 -2648 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS June 21, 1999 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Shkreli Subdivison Lot #1 Town of Patterson Dear Robert, Enclosed are the following: 1. Five (5) prints of SS -1, "Proposed SSDS," dated 6- 21 -99. 2. "Short EAF," dated 6- 21 -99. 3. "Application For Approval of Plans for a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 6- 21 -99. 5. "Application to Construct a Water Well," dated 6- 21 -99. 6. "Design Data Sheet." 7. "Letter of Authodzation," dated 6-21-99.". 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. H W. Nic is Jr. P.E. HWN:JM:his 95077 -1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner V ""Sa✓L Address 10G YOR�sp -5i� io1T)i Located at_(Street) 1"Z�OiA4 LP, W Tax Map M Block 4 Lot 1q, (indicate nearest cross street) Municipality FNT-A Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test i Bole No. Run No. Time Start - Stop Ela se Time Min.) D?th to Water From Ground Surface (Inches) Start Stop Water Level Drop n Inches Percolation Rate Aun/Inch t Iriq 10 + 2 t� ' l() 3 4 5 2 1 look 1��� ('). 221��. �s4� � 4 1 j 3 4 5 1 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. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed— NOME Indicate level to which water level rises after being encountered NA Deep hole observations made by: DME JIDWia�AU f), 1AW-j6 H H Date Design Professional Name: 14-A W, i-AKA L, i, J9- M, Address: NEw ro GI ��J I �R- j ►� 1Gi �O�j �`P��y NICtjo Signature: lf-Qiv�,, fjj, ` // Design Professional's Seal C, a w Uj ��'�'�(• NO. 56124 �C� \A9�FESSiO1�� �` DEPTH HOLE NO. HOLE NO. HOLE NO. J G.L. 0.5' �L TO��oi1. TcapoiV . 1.0' 1.5' 3►�oWH Fed b nV fixrsiA 2.0' LZ AM �o-� M Lo Acr• 2.5' , 3.0' 3.5' 4.0' 4.5' �2 +a� sANp f, c�Hp 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed— NOME Indicate level to which water level rises after being encountered NA Deep hole observations made by: DME JIDWia�AU f), 1AW-j6 H H Date Design Professional Name: 14-A W, i-AKA L, i, J9- M, Address: NEw ro GI ��J I �R- j ►� 1Gi �O�j �`P��y NICtjo Signature: lf-Qiv�,, fjj, ` // Design Professional's Seal C, a w Uj ��'�'�(• NO. 56124 �C� \A9�FESSiO1�� 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: CF-U A )0(, �lC�YER- FRIG '; O ly1L BR'S ' i o'1 Q j 2. Name of project: L-6 I 1i4Di V JNL- �Tb 3. Locatioriv: 4. Design Professional: 144-�A W' '` \(AOL6 4- Sr-- 5. Address: 20 m►LMI.49 P-MV 6. Drainage Basin: 7. Type of Proiet: K Private/Residential Food Service Commercial . Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status check one Type I Exempt X Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? Na 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency H A _...._....._. 12. Is this project in an area under the control of loc al-planning, zoning, or other - �c5 ..... officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? 14. Has preliminary approval been granted by such authorities? NO Date granted: N A 15. Type of Sewage Treatment System Discharge..:.............. surface water x' groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) .................:........................ ............................... N �. 18. Is project located near a public water supply system? 1-40 19. If yes, name of water supply N A Distance to water supply i`' R 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system ►v Distance to sewage system 22. Date test holes observed 71 � 1 `I% 23. Name of Health Inspector KPI '^ 24. Project design flow (gallons per day) 3� 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... HA 26. Has SPDES Application been submitted to local DEC office? 1�As Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland ?. No 28._ Wetlands ID Number.. .................................................................. .................... 29. Is Wetlands Permit required? .............................................................. .......I........... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Nt NA No 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 active Yes/No N01 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 Na DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... X55 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? No 35.. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number ........................... ............................... Map 14 Block 4- Lot Y)- 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities 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 L97v. /) n SIGNATURES & OFFICIAL TITLES: 14ML � A6 MiEi4l Mailing Address 9--o 1.41 �- -1 0 W M F4-0 p Q 14.16 -4 (9/95) —Text 12 PROJECT I.D. NUMBER 617.20 Appendix C _. Stet e Envlronmentaf- Qtiallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR 1. APPLICANT /SPONSOR A6 - 4 pl WA 5►-�t�i2 -��i 2. PROJECT NAME i.-or t �M�►�i��;l t, � 3. PROJECT LOCATION: D r� pt` i I Municipality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) v4) IA-N L�L, ' 41K) 5. IS POSED ACTION: ZNew 0 Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 1MUi•,i IpJ�t, �i 5 7. AMOUNT OF LAND AFFECTED: 4 -w Initially _ acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 0 No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential 0 Industrial 0 Commercial 0 Agriculture ❑ Park/Forest/Open space... 0 Other .. - DescrIb 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? 0 Yes 51No If yes, list agency(s) and permlUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes [9No It yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 0 Yes [No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE N t 0 �� ' d "G A/b r=�4 AppllcanUsponsor name: Date: .,Signature: (1/ v 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 Mf $ t� wJb�v PUTNAM COUNTY DEPARTMENT OF HEALTH DIViSIO\ OF E \VIRO \1fEYtAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERIN11T .. -. k t-lt_ 50/k�e_ C14 STREET LOCATION / /1 O"'�'`�- NAME OF OWNER RENTENVED BY R-NI, G11, CS, i IB, B $ K DATE TAX NTAP 9 Y N DOCUMENTS Y N Lo - f I PERNIIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS PC -1- PC 9iz PERC & DEEP HOLES LOCATED WELL PER��IIT _ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION / LETTER OF AUTHORIZATION / LOCATION MAP DESIGN I DATA SHEET (DDS) / EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE / CORPORATE RESOLUTION UMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF HOUSE - NO.OF BEDROOMS PLANS - THREE SETS / WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. JSE PLANS =TWOS TS`' PROPERTY METES & BOUNDS ® VARIANCE REQUEST HOUSE SETBACK NECESSARY (TIGHT LOT) FEE / HOUSE SEINER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION / NO BENDS; MAX,BENDS 45o W /CLEANOUT LEGAL SUBDMSION FILL SYSTEMS SUBDMSION APPROVAL CHECKED CLAY BARRIER ® /S- ye / PERC RATE ,t /s� j 1.2 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILLREQUIRED DEPTH40 FILL SPECS %'5 FILLNOTES S� CURTAIN DRAIN REQUIRED SDI - l FILL CERTIFICATION NOTE / STANDPIPES DEPTH GAUGES GENERAL p, FILL PROFILE & DIMENSIONS F/71_ LOCATED IN NYC WATERSHED VOLUivlE PLANS SUBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED �' 60 FT MAX. DEEP TEST HOLES OBSERVED r/-rl PARALLEL TO CONTOURS / PPRCS TO BE WITNESSED Ffn 100% EXPANSION PROVIDED / EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA ON DDS PLANS & PERMIT SAME 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL /PRI969TIECGH$ORfi0T1FICATIOV 20'TO`FOUIDATIbiVWALLS _f'f5' WELLTOPL"__.....-.._.. .._..,_::__........._..... -. - -- LETTER BI/LBA 100' TO WELL, 200' IN DLOD,150' PITS FL`QQE.LEVATIO I ® 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMIT(S) ,� 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS ! 10' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN - (NORTH ARROW) ® 50' INTERMITTENT DRAINAGE COURSE / SSDS HYDRAULIC PROFILE 00'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS / GRAVITY FLOW .2D` CONSTRUCTION NOTES. 'MIN to CDS= >50/oo- 4 0/o,25'- 3 0/o,30'- 2 %,35'- 1%,100' - <I% DESIGN DATA: PERC & DEEP RESULTS 'MfN to CD discharge /I00'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK / DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL / FOOTING /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES / DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS Ifl LOCATION OF SERVICE CONNECTION TM ",PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION /DATUM REFERENCE F7nLOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: 11 (wAoll bp'° )') PUTT ASS COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .._, �._ .•._.-.... � .__ .........0 : �_ .... T_.. �.. '�T- ER_.0:�'_AUT;�iORi.��T'��4ti .... �.,- ,:.__......_•.- ;....._.�.... - -,,.. _. _�Y.�.,- . RE: Property of VA66 —+ PEEL-I� rv14i' iA Located at 1-ID rA Aq T i44-eeR- Lkr+f-� Tax Map /b4- Block Lot 12 Subdivision of Stu- t2-EV► Subdivision Lot # I 1 Gentlemen: Filed Map r V 1 Date Filed %- '1-`-7 This letter is to authorize }+A VJ • N It, la ors , JP, f& a duly licensed Professional Engineer . ')( or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 143 and/or 147 of the Education-Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P. E., R. A.) r _ Mailing Address State Telephone: Zip y O's o e\ �_n13 - (0108 Very truly you , Signed (Owner of P,roverv) Mailing Address: 14r Ya t4"96 State N� Zip q (0l' 6i" Form LA-97 ` qvep A re on Py ` MM Owner- Rou Type -.11iist.E'rosion control-6 ` qvep A re on Py BACTERIA"PER ML-. (Agar".plate count "at '35 Q. 7 COLIFORM. GROUP (Mos4 p7o5alile',No /100m1.) LESS "THAN 2. 2 ARDNESS, TOTAL- ppin DETERGENTS - ppm ' NITRATES (as N) -.pprn IRON, TOTAL = ppm_ WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 + Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK ��� � °'� �- �'•}�is �'eport - +s «fo= Eie"l;o�ipi�ted=6y '�itelP driHe�= and•submittedMto� Courity HeaitFi'�D'epartmerit 4oge' �Tie� >intitf+- iaboPatory�re�ott�af- - • - =• ��`= =w� analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. FREPO MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Me Glasson Builders ADDRESS Avery Rd., Carmel, N.Y. LOCATION OF WELL Bullet (No. 8 Street) Hole Rd., Carmel, (Town) N.Y. (Lot Number) PROPOSED USE OF WELL C DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ CONDITIONING LJ TEST WELL El (SPe cif y) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) 18 9 DIAMETER(1nches) t1 WEIGHT PER FOOT 26 THREADED ❑ WELDED DRIVE SHOE il YES El NO WAS CASING (MUTED? 7 YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED C COMPRESSED AIR 1 2 G.P.M. 6 YIELD (G.P.M.) 6 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 209 DURING YIELD TEST [feet) total drawdown Depth of Completed Well in feet below Land surface:215 SCREEN MAKE C LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 6 Overburden BOYD A.BTE.SI.AN WELL GI RFD 3 6 215 Ledge If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 22 2 DATE OF REPORT 9/ O 2 JWEL:��DRVLLER (Signature) ROUTE 52 CF P14EL, N.Yb VPW'M� Al C6LAV_ cam. Owner or Purchaser of Building Building Connss "tructed by 94 Location - St eet do Log 10- Building Type Municipality Section Block Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on 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 guaranty to the owner, his succes- sors, 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 initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negl -igent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the 'Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willfu or negligent act of the 000c��cu,.p /�ant of the building utilizing the system. Dated this c)V iday of [ "� 19Z -. Signature G IF Title (if corporation, give name and address) U -- - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3):COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health - - PUTNAM COUNTX ' DEPART1vIENT "OF HEALTH Division of Enwronmental:,Hea /th Services Carmel M -Y 105.12 4 , CONSTRUCi ION, PERMIT FOR -SEWAGE DISPOSAL, SYSTEM, a PdttC.rSn ." r { _ Town or Village Holmes `Road L`ocaietl 8t Section Block Subdivision - Lot S0872 Edward .J McGlasson Gleneida :Avenue Owner Address _ Y Bultlmg Type Frame Lot'. Area '15 468 A. Carmel New York{ 10512 Four. 1260' o 11 Number, of :Betlrooms Total Habitable Space n 1 Fl r Square Feet Separate se' werage; =System to consist of 1:250 -Gal Septic .Tank ' 20.0 lineal feet x 36 nCb width .trench r To be 'cgnstructetl '.by ? Address - , F Water 56pplY Public SuP.PIy From A Private .Supply -to 'be drilled by Address' Other Requirements I• represent that 1 ain`,wholly,;and completely..responsitile for the•design'antlklOCation of the p►Oposed sy5tem(s) - 1`) that the separate sewage,dispo3al'system .- - .. above described w.ill;be constructed as "shown on the approved amendritent there: to and.•in;aecordancIe withahe3ta�dards;'rulesan regga "ions o : u na_m County Department of Health, and that on'comple'tion thereof a Certificate : of •ConstructionCompliance satisfactory;to fhe. Commissioner 6f-Le. tthwill be. submittetl to the Department and a written guarantee will be f,u"rnished the owner his auccessors,;heirs or. assigns by 4" builder, :that said builder,.will place -in good operating .condition :any part cof said; sewage.tlisposal `systems. during. the period of two (2) years immediately foIIowing•thetlate of, the "issu ance `of the approval of..the Certificate of- Construct ion Compliance., of the. original iystem';or any repairi;thereto;'2) that the drilled well described. above } Will be located as ihawn on,the apprgyed plan and that °said well wilt tie insta in accordance- with the an artls, rules acid regulaions o; f " the• : Putnam _ .. County Department` of. Health, d, k, Date 9/]2/72= signed P E: X RA . Add ese 'R. R 6 $ox :_353. C' 611 New. York -1 512 License NO. 29206' APPROVED FOR CONSTRUCTION ' This approval expires one 'from the date issued' uriless 'instruction of the 'building has been undertaken and: is revocable for cause or may; be amended or',modified when considered necesse,ry by the Commission of Health. Any change -Or alteration Of construction 3 requires a new p itAppvetl or disposal of domestir•san da agea or nvatewa - _ only. Date /..��. BY v�'* -ti, Title 0 0 - ..- PUTNAM._. COUNTY DEPARTMENT .:.OF ,HEALTH., - DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner AFA&gWaf Afr Address A /AMVV.S 9 Located at Street � /� . Sec. Block Lot � indicate nearest7 cross street) Municipality /�gr - j�.� ®� Watershed �e SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse DepEH_f_o77a7er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches I 1 100. 2 U 3 IV 4 1 2 4 Notes: 1) Tuts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION - OF' "SOILS ENCOUNTERED 'IN TEST HOLES... DEPTH HOLE NO . _ HOLE HOLE G. L. 611 1211 1811 24" 30" 3611 4211 1 48" 5411 6011 6611 7211 7811 8411 INDICATE -FUEL AT INDICATE LEVEL TO `TESTS MAnF BY APez, Soil Rate Used No. of Bedrooms Absorption Area ilrentiss, Address r,,p. -6 tax 353 d GGRROO WATER IS ENCOUNTERED ®c�� WATEU1R IZVZL RISES AFTER BEI�� COUNTERED d�� A • a- �A �%5 5m, /gZ li✓, , • Date P � 7/9 t 1 "Drop : S.D. Usable Area Provided Septic Tank Capacity 0 p RPIDge, s Type By � L. F. x2411 c% width trench. Other THIS SPACE FOR USE BY HEALTH DEPARTME-NT ONLY: 1 Soil Rate Approved Sq. Ft /Cal. Che Date GGRROO WATER IS ENCOUNTERED ®c�� WATEU1R IZVZL RISES AFTER BEI�� COUNTERED d�� A • a- �A �%5 5m, /gZ li✓, , • Date P � 7/9 t 1 "Drop : S.D. Usable Area Provided Septic Tank Capacity 0 p RPIDge, s Type By � L. F. x2411 c% width trench. Other THIS SPACE FOR USE BY HEALTH DEPARTME-NT ONLY: 1 Soil Rate Approved Sq. Ft /Cal. Che Date 01 -11 -2000 03 :32PM FROM TO 92787921 P.01 PUTN"i COUNTY DEPARTy1EN -T OF HEALTH .0 DIVISION OF ENVIRONMENTAL HEALTH SERVICES yT . Gam!... �_ MU ST FOR E _tiA tSPECTION For: Fill Trenches ,SAO PCHD Construction Permit 1r Located om fxEn6fS01%l Owner /Applicant Name_ _� 1Q / TM 1: Block—, 4 Lot /X Formerly- Subdivision Name Is system fill completed? Date All* Is system complete? Date -- Ayey Is system constructed as per ply ? _ Is well drilled ?_ [dtr'v _ Date /^ e2OO U Is well located as per plans? Are erosion control measures in place? I certi:y that the system(s), as listed, at the above premises has been constructed and I have inspected and verif.,ed their completion In a:card.ce %NYth the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department ofHaalth. t�a� deg ro �tP� .N1cH�`?¢ Pate: — OaU Certified by: PE RA - - Address, ,�LD -k,v Ll9C, xCA, -7— 71' '-/ .S 0 '/ ' I ,47- form FIR -99 TOTAL P.01 01-12-2000 02:30PM FROM Post-It' brand fax transmittal memo 7671 GOV TO 92787921 P.01 #of Poges 1, Fwavareo spor mw PROP056D #00r#r0,0r1W,0R41NS PERC014WIV AW 10CArION tp 41-5r PIT L CZWPON EXISRIVS We LL Exlsrllva ssos EXISTING MICE LI&C 4. EX /STING STONE MAIL moposeo saraivce AV0,00SCIO STRAW 1614L.6 10/1VE noted for coiN i in opli= Rules Regulations of ths, P . Coun,&Salth DepartmMi. / 4D A?PWVAL, STAMP � "z unty Department of Health #W U ctftnvironmental Health Services noted for coiN i in opli= Rules Regulations of ths, P . Coun,&Salth DepartmMi. / 4D A?PWVAL, STAMP � •��I' w / � •i� 'fir / / � � / � I / / � % / i m `� � .. � yam. /i i/ � .. // ./ : /•' � : ' / / �� CL OD N Wv/ ON / j el oo, / / / 0 N f VP LL CL , CD a �.�..� i it •i r i. �,•i! ate' wilco �a It or i� cow H /' // /' r .. soma �!r .� :APOACRre.S#OWjy.ON TOW)V OF PATrE�u ol 0r OESIS)v rZ OW- .9fS1,OfNT1A4 / / I / . ,� /� �/� SOEOROOM.S�. 2�6.P0• = iaoo G.P.O. A RSORPiiON MfW# � t � �•- r.•d'• �a�owa so�(at .. 1'6 6'O- AW-9 G,EY A"O REP omwdv 44" � �• .. 1 • :: +:. t - . � ,fir �ir6•o • - • .. l `. ` I `• ti Z'6". :7'D" *ter MAID i �N, , ` •'` s0'd Lz6L8LZ6 01 W08A Wdi2:ZO 0002 -ZL -iO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date- 1 f c Inspe Owner - cte ri =- Street Locatio roiNCy- L A nir. °5 t-(, �2 E �! Town �,q 7 _, ?_s -� Permit # 'P­12-99- TM # Subdivision Lot # - - -- 1. Sewage Svstem 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 ... ...2.....other.. /f_ b. Septic tank installed level ............... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All 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 T.—L—en-oh required Length installed 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' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10.: P.ip;e: ends .capped. ... ......... .." ........ ... ............................... g. Pump or Dosed Systems Size ot 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. HouseBuildin� a. House per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercoun g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 Z }' 1\ VI \ �\ \ \ 'A\ \\: N\ I �// /// / / \v\\ \'. 1 1� I j Ij. I I C 1 III I I 1 � \ \ \\ I \I I II WT­ t �/ / / / ' 1. i s \ •CE� \ � \ \ / ��•••• l / l•�.'I• I l ! � I of �' \���� \•- \ \ II 11 \ (,j7�•U)i �, h I.I Iii, ./ ..� •` - a h ..\ °.\ \ 1 \ . \. / /. NN _ -' I •I I 1 I l I I 1 J � _fit ;� i� ,� •/ /� il. •/ - / / �/ l //'1 I 1. / i - - - - -� 155. OD z� I / ,, ,olo int // � n x I (36 41 IV EXISTING SITE LOC DIMENSION CHART (in feet) Number A ' 2t, 2- �(�' g L ►5' 3 sU � 90► 5' 1105' 7 too-s' 12Z'5' q 1121 135' 10 119 14�, 109' .. 13 .._ _ I I� ►5' _ ___..� .1.13,5'.._ _ . 14 121.5' 120' 15 129.5' 12.4' I(� 12q' i29 ►5' i i 133' l 3� ►�' 141,5. 147' ?0 145,5' 152' 21 150,5' 157 10 �y N\ . ryo a _ 519 °32'►, "W ,�� � E ' V ? ; m WI f