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HomeMy WebLinkAbout1561DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -82 BOX 14 T 1 '6 - 1 01561 F 61 kill .L-J. IL 1r - 01561 PUTNAM COUNTY DEPARTMENT OF HEALTH - - - -.: _ -�I- VLSI -O.N -- OF.- ENVIRONMENTAL -HEALTH SERVICES, CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAG REATMENT SYSTEM t; R PCHD CONSTRUCTION PERMIT # _d Located of •%(/ n/n Y Town or Village �C%i aCrY1 Owner /Applicant Name L,'a,(`�- Tax Map 21� Block 4 Lot Formerly / alf- s-'rem #yn&-s Subdivision Name k'66-C1,tWD Subd. Lot # 14 Mailing Address %(� Al�c 57-, 1<472�^-(A-14 Zip 10036 Date Construction Permit Issued by PCHD / /�z j 6 ©d Separate Sewerage System built by A% C41SiZr" j4kZ46 Address /a 4I6k &ZZ 5T 1'-4TG Ars1 H,A/ Consisting of P060 Gallon Septic Tank and 6 ? 7 lig G IG Z , � eqn-rclrcond1J i Other Requirements: !�. �LC� ' ��� 0i��2✓ �i�/iL Water Su>anly: Public Supply From Address or: ✓ Private Supply Drilled by 4 -yOAA' W W2- Address Building Type / G,qM >��: Has erosion control been completed? Number of Bedrooms = Has garbage grinder been installed? 0�1l0 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 reguullattii'o'nss of am Coun Department of Health. Date: APOLZ ) Certified by P.E. l" R.A. (Design Professional) Address aliAl L-- G /n9r/1 /� QGLG, License # ® 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 nultand 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/16e) subject to modification or change when, in the judgment of the Public Health Director, such revocatio dificati r change is necessary. By: Title: V Date: 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 - - = GUARAN TEE�-OE`SUBSURFACE-SEWACiKY ATMENT SYSTEM Vwner or Purchaser or Building V__ 6 Location - Street e3 14 i - — Tax Map Block Lot Q 4ef��n IQ Town/V�,, illlage E'- ltd nn Subdivision Name Building Type � � � � Subdivision Lot # I 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 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 x t� Year (i Signature: Title: pa C6 General Contractor (Owner) - Signature h F. C fiF C, Ll ��-ro I-q AIRS Corporation Name (if corporation) Corporation Name (if corporation) Address: fl } (-� S Address: State fly Zip �3 State Zip 442` N 3 �O � Form GS -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well-Location .:- s, Street Address Tonmy Thurber Lane, Lot #4 Town/Villagb: Patterson Tax Grid #- Map,3i Block Lot(s) g,2— Well Owner: Name: Address: Saddle Ridje Homes, Inc., 12 Saddle Ride Court Holmes NY 12531 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion ' X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing (Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 380' Depth of completed well in feet 605' 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 10 Drilling in overburden 10 Hit rock at 10' 10 42 Drilling in ro 42 605 Drilli in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 161EL Depth 400' Model 7GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 a . Date Well Completed 10/17/00 Putnam County Certification No. 002 Date of Report 4/19/01 Well Dri (Sig r P a, NOTE: Exact location of well with distances to at least tw ermanent landmarks to be provided gll a separate sneevptan. Well Driller's Name P. F teaL ' Address: 4 RArm Ave., Brewster, NY 10509 Signature: Date: 4/19/01 Perry L. Bigal White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 W o UTNAM rrmL NEINEERINE, PLLC. Engineer-5i and Ar17/hJtect� ......� ,_... . SEPTIC SUBMISSION FORM TO: &'Y1 f A DATE:J PUTNAM COUNTY HEALTH EPARTMENT PROJECT: !' /1 4< i 4 77,lm ,v iii - ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN ❑ 2 COPIES OF THE HOUSE PLANS TION YzEu -P ATION dc /- HEALTH DEPARTMENT FEE ($ ) TION APP WA -97) ❑ LETTER OF EXPLAINATION REMARKS: COPIES TO: SIGNED: I OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - FAx (845) 279 -6769 - EMAIL: puteng @bestweb.net NE NORTHEAST LABORATORY ®F DANNURY �9 L`F�LA %N $GOAD _ UA1U1$URY, (:T ®6S'1 �" ° _-`C- T CeiF +1. 14404" LARS (203) 748 -7903 -FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D.# REPORT DATE: 4/2/2001 & 4/11/2001 4:30 P.M. PLB 4/3/2001 & 4/11/2001 LAB #11471 PFB-42 & pfb-45 4/18/2001 SADDLE RIDGE CONST., LOT #4, TOMMY THURBER LA.., BREWSTER. N.Y. HOSE BIB @ TANK WELL -NEW NONE MAXIMUM CONTAMINANT RESULTS METHOD # LEVEL (MCL) OR STANDARD m Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 10 - EPA 110.2 15 • Odor ND - - 3 Units o pH 6.14 - EPA 150.1 No designated limits ® Turbidity 8.0 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen 0.008 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen <0.20 mg/L as N SM 4500D 10 mg/L ® Alkalinity 42.0 mg/L SM 2320B No defined limits e.._._._ _-- -a_ Hardness _ w 46.0.... ._:.mg{L.:, -EP,4 }.302 -._._� ._. _ Y..._._.--- 4,ledefined?imits -� .__ ..._.:___..• .., m Iron (4/11/2001) 0.047 mg/L EPA 236.1 0.30 mg/L ® Manganese 0.017 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L ® Sodium 6.0 mg/L EPA 273.1 20.0 mg/L ** ® Lead (4/11/2001) <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L= milligrams per Liter ND =none detected MCI,-Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level COM31 ENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: 0 OTA-BLE IP or �OT POTABLE RESULTS BASED ON SAMPLES SUBNHTTED:4 /3/2001 & 4/11/2001 Laboratory Director ®NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 APR -20 -01 08:40 AM TOWN OF PATTERSON r . BRUCE _R FOLEY _ 9148782019 P.02 1.�RETTA MOLiIdARI RN„ KS-N,' Amoclara Frblte /YealeA Diwarar D"wor of ftdpel servtere: DEPARTML'NT OF HEALTH I Geneva. Road Brewster, Now York 10509 ia•1e9andAtal FISAI 1 (914) 271- 6170 V=(914) 278.74al Mir9ta Set+1ew (914127: • 61S8 WIC (914) 278 - 6678 Fat (914) 276.606: 94r1Y 10tirw4l1it18 (914) 2;8.6014 rrmhool (914) 278.6982 pot (914) 278.6648 C Gc S OWNERS NAME: %' 710 � TA.X .mAP FUUMBER: E911 ADDRESS, TOWN: �°flTTi�.Pso.J AUTHORIZED TOWN OFFICIAL: (Signature) HATE: The Pumaml 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. 8911 -si .rMI LJTNAM SEPTIC SUBMISSION FORM li/C�. lI �IE�R /f�lGa �u..c TO: T- i1G�2%CS , r L DATE: 4-19 zgoo PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: GC�i�3n cceJ� �! ENCLOSED, PLEASE FIND: )4 7 COPIES OF THE SSDS PLAN ® COPIES OF THE HOUSE PLANS >� CONSTRUCTION PERMIT APPLICATION (Revised) ® WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($150.00) r ® SHORT EAF - --- _.. ® DESIGN DATA FORM LETTER OF AUTHORIZATION ® APPLICATION FOR WASTEWATER TREATMENT (PC -97) ® LETTER OF EXPLANATION REMARKS: DU6 7-0 0"X'14 vic 1, -bj11N6- 7*'rc COPIES TO: Rte,®G f 'S ln1 -f-fo SIGNED: -� 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 0 (845) 279 -6789 • Fax (845) 279 -6769 a EMAIL: puteng @bestweb.net PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LEiTER OF AUTHORIZATION RE: Property of f7 C;LGY7770 1+-A2er Located at �ar�rr� ��✓L-� T/V Yi-,x1 t74 axJ Tax Map # 31( Block C% Lot 56.z' Subdivision of AN'C -Wajo Subdivision Lot # Filed Map Date Filed / Gentlemen: This letter is to authorize A 111VI ®G,L C- 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 Pumam 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 'M'-- conforinity-,Wiffthe pr- 16 145 and/or 147 -of the Education UiW," the Public Hedlth­ Law, and the Putn ? ��o`saint y ; . Code. , Countersigned: �'4' P.E., R.A., # Mailing Address 6j&0 � State A-17 Zip Telephone: at 71 6'? F7 Very truly yours, Signed: (Owner of Mailing Address: Id NIA 22 !s7T State Zip Telephone:] f L T AM PLLE. -_ _- .Engineers -and Architects` DUE TO THE ELEVATION IN THE SEWAGE DISPOSAL AREA, WHICH. IS HIGHER THAN THE PROPOSED FACILITIES, A SEWAGE PUMP PIT WILL BE REQUIRED. DOSING VOLUME FOR DOSING PURPOSES, IT HAS BEEN DETERMINED THAT A DOSE OF 75% OF THE VOLUME OF THE 4" PVC PIPE IN THE PRIMARY ABSORPTION SYSTEM BE UTILIZED. THEREFORE: 672 LF X (3.14) (0.167)2X 0.75 X 7.48 GAL /CF = 330 GALLONS /DOSE Zil u. 1. Q = 330 GAL /DOSE = 33 GPM, USE 33 GPM 10 MIN /DOSE 2. STATIC HEAD LOSS ELEVATION DISTRIBUTION BOX 994.0 ELEVATION PUMP PIT 993.0 1.0 3. FRICTION LOSSES Q = 33 GPM 2" DIAMETER PVC PIPE HEAD LOSS IN FT /100' OF PIPE = 1.8 HEAD LOSS FROM VALVES AND FITTINGS IN FT OF PIPE = 24' 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 . (845) 279 -6789 o FAX (845) 279 -6769 o EMAIL: puteng @bestweb.net 4. DYNAMIC LOSSES 1.8X(105 +24) = 2.3, USE 3' 100 TOTAL DYNAMIC HEAD = 1'+ 3'= 4' PUMP SELECTION CHOOSE GOULDS SUBMERSIBLE EFFLUENT PUMP MODEL 3885 SERIES WE0311L 50 GPM @ TDH = 4' PUMP CHAMBER A 9' -6" X 4' -6" X 4' -3" (INTERIOR DIMENSIONS) 1,250 GALLON PRECAST SEPTIC TANK SHALL BE USED WHICH WILL PROVIDE STORAGE ABOVE THE HIGH LEVEL ALARM. A DEPTH OF 1.0' WILL PROVIDE THE DOSE VOLUME. THE PUMP OPERATING ELEVATIONS ARE TO BE AS FOLLOWS: BOTTOM OF PUMP PIT EL 993.00 PUMP OFF EL 993.25 PUMP ON EL 994.25 HIGH LEVEL ALARM -EL L 994:75 .... _ _ .. 2" PVC FORCEMAIN INV. OUT EL 997.00 4" PVC INLET IN EL 997.25 (File FM00110) pUTNAM ENGINEERINS. PLLG Engineers and Architects 4 Oro ROUTE 6, BREWSTER, NEW YORK 10509 (845) 279 -6789 - FAX (845) 279 -6,769 - EMAIL: puteng@bestweb.net e. %2%JuL1JM I- WIV,II—.0 APPLICATIONS Specifically designed for the following uses: Homes Farms © Trailer courts Motels • Schools • Hospitals Industry o Effluent systems SPECIFICATIONS w Shaft: Corrosion - resistant, stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ® Fasteners: 300 series stainless steel. m Capable of running dry without damage to components. ® Designed for continuous operation when fully submerged. Pump 9 o Solids handling capabilities: = 2s %" maximum. MOTORS ® Discharge size: 2" NPT. is Fully submerged in high- ® Capacities: up to 140 GPM. grade turbine oil for lubrica- e Total heads: up to 128 feet tion and efficient heat TDH. transfer. ®.Temperature: ®Class B insulation. 104 °F (40 °C) continuous - - -- 140 °F (60 °C) intermittent. See order numbers on reverse side for specific HP, 1 METERS FEET 40 130 - Single phase: o Built -in overload with automatic reset. a All single phase models feature capacitor start motors for maximum starting torque. ® Y3 and 1/2 HP —16/3 SJTOW with 115 V or 230 V three prong plug. % -2 HP —14/3 STOW with bare leads. Three phase: ® Overload protection must be provided in starter unit. '/2 -2 HP —14/4 STOW with bare leads. m Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage. voltage, phase and RPM s wE,sHH available. 120 35 ; .... 110. ----- ... FEATURES 30k 100 . m Impeller: Cast iron, semi- 9 open, non -clog with pump- = 2s out vanes for mechanical seal protection. Balanced for r 20 smooth operation. Silicon bronze impeller available as a t5 an option 8 m Casing: Cast iron volute 1 type for maximum efficiency. 2" NPT discharge. m Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA -N elastomers. non r..,,lr+c P..Mnq 5 ....... .......... - .......... .. 90 • WE1 s 80 um ......... ... 70.. ,WE07H . . ............ m Bearings: Upper and lower heavy duty ball bearing construction. ® Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent Oil wicking. 20 foot standard with optional lengths available. m 0 -ring: Assures positive sealing against contaminants and oil leakage. m Consult factory for infor- mation On CSA listed models. AGENCY LISTINGS ts"h' Canadian StandardsAssadation Ws File 4LR38W9 0 Underwriters Laboratories UL File 483318 Goulds Pumps is ISO 9001 Registered. .... .. ............ .......... --------- .................;SERIES: 3885 :SIZE:' /; SOLIDS ._..._. ..... I .........:........ :RPM: 3500 & 1750 ...1..... s i }.........!........ ... } ........ ......... I..... Y .................. .....r...:....a..... ...:....... ................. L .� �� . 0 00..-10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160GPM I I I I I L I I I I 1` I I I I 0 5 10 15 20 25 30 35 m31h CAPACITY Goulds Pumps ITT Industries v. Gou� Baum %-11 COMPONENTS ~� Effluent Pump Item No. Description 1 Impeller _.._2 Casing 3 I Icon carbide`vs. silicon carbide Mechanical seal 4 Shaft 5 Motor 6 7 All Ball bearing Power cable 8 0 -ring MODELS 61 8 �6.,. �4 i- 3 .� heavy du design t 2 !" 1 Order No. HP Volts' Phase Max. Amp. RPM Solids Wt. lbs. Heaters WE0311L WE0318L WE0312L WE0311 M WE0318M WE0312M �' 115. 1 9.8 1750 % 56 WA 200 5.5 230 4.9 115 g 8 1750 5.5 230 4.9 WE0511H WE0518H 1 �= 115 14.5 3500 60 200 8.1 WE 0512H 230 7.3 WE0538H 200 3 4.1 K34 WE0532H WE0534H WE0511HH WE0518HH WE 5512HH WE0538HH WE0532HH WE0534HH 230 3.3 K32 460 1.7 K23 115 1 14.5 WA 200 8.1 230 7.3 200 3 4.1 K34 230 3.6 K33 460 1.8 K23 60 % 0 1 11.0 70 WA E0712H WE0738H 230 10. 200 3 6.2 K49 WE0732H WE0734H 230 5.4 K39 460 2.7 K28 WE1018H WE1012H 1 200 1 14.0 WA 230 130 8 2 3 8. 50 E1 032H 230. 7.0 43 1034 0 3.3 2 WEI518H WE1512H , 1 /2 200 1 17.5 50 30 2307 15.7 80 WA WE1538H WE1532H WE1534H WE1518HH WE1512HH WE153SHH WE1532HH WE1534HH 200 3 to.. 6 K54 230 9.2 K52 460 4.6 K36 206 1 17.5 WA 230 15.7 WA 200 3 10.6 55 60 230 9.2 PF36 460 4.6 WE2012H WE2038H WE2032H 2 230 1 18.0 - WA 200 3 12.0 K55 230 11.6 K55 WE2034H 460 5.8 K41 EFFLUENT EJECTOR SYSTEM Effluent ejector system BC@ 1P. offers ease of ordering and installation. A single ordering number specifies a complete system designed for most residential and I commercial sump and effluent pump applications. Package Includes: Submersible Effluent Pump WE0311L 12L or WE0311 M. 12M. WE0511 HH, 12HH Mechanical Level Control Switch A2 -5 (115V). A2 -6 (230V) Basin and Cover A7 -1830P Check Valve A9-2P Order No.: SWE0311L SWE0312L SWE0311M. SWE0312M. SWE051IHH. SWE0512HH. MODEL PERFORMANCE RATINGS (gallons per minute) Order No. WE03L WE03M WE05H WE07H WEIGH WE15H WEOSHH WEISHH WE20H HP '/r '/3 A2 3/, 1 1'/2 '/2 1'h 2 RPM 1750 1750 3500 3500 3500 3500 3500 3500 3500 5 86 10 70 65 78 94 - - 56 95 140 15 58 58 70 90 103 128 53 93 138 20 30 35 60 85 98 123 50 90 136 25 5 15 48 76 94 117 45 87 133 30 - - 35 67 88 111 40 84 130 3 35 - - 23 57 82 103 35 82 126 '0 40 - - 12 45 74 95 30 77 121 d 45 - - - 35 64 86 25 74 116 U. 50 - - - 25 53 77 18 70 110 55 60 - - - - - - 17 9 42 30 67 56 12 3 66 63 104 97 F 65 - - - - 20 46 - 58 90 70 - - - - 11 35 - 55 83 75 - - - - 4 25 - 51 75 80 - - - - - 15 - 47 66 90 - - - - - - - 37 51 - - - - - - - 28 30 t - - 17 10 - - - - - - - 8 - DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) KICK -BACK N Goulds Pumps - <k ITT Industries PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .._L.. -. 'CONSTRiJCTION PE AGE TREATMENT SYSTEM PERMIT # Located at -77/'Y✓ M !Z )t&< Town or Village 077&"0 11 Subdivision name �j��'woo 17 Subd. Lot # Tax Map 3¢ Block 4 Lot Date Subdivision Approved // ZOU 0 Owner /Applicant Name //W oif /7i'j'►'1 Mailing Address lo Amount of Fee Enclosed IF /,S (�/, 0 v Renewal Revision_ Date of Previous Approval ::? Zz- d0 Zip1� Building Type (,' &. Lot Area:?, - fhe -No. of Bedrooms Design Flow GPD49V Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /Z 2O gallon septic tank and / % 6 �G 2— r Gclt o4o- r i r Other Requirements: ay&eb � To be constructed by -jT 66 Address Water Supply: Public Supply From Address _ or:_ Private.Supply Drilled by 77 . 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 sXts em 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. Signed: P.E. Address kP4?;4 ' �I✓G �' �1�L ieJ� PGLC- R.A. Date %/ 8 Dry License # 1? 7 q 6TC0 6VWZ.6 ,d,2�i�lli�Z. AAJ /05'0c7 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 w n onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new Perm pproved f scharge of domestic sanitary sewage only. By: Title: o�% Date: i 2f 6J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ��I V1r: Vti: avwsv�ncn v/4RtM /�FM7MFMiMtM.M Mt---- IMMfPM "M Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERM Y GET A' TV ENT SYSTEM PERMIT # r-6-00 d- % p Located at —I–b M NA x./ Town or Village Subdivision name Subd. Lot # Tax Map Block Lot Date Subdivision Approved Fr-l# 281 ► lz000 Owner /Applicant Name�'1'�Ilij Ibma� Mailing Address __�® � – STY —Eie [•' �'�' Di.J�r h% `, So Amount of Fee Enclosed Renewal Revision Date of Previous Approval Zip Building Type S�n.� Lot Areal -2r9 No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of; �_ gallon septic tank and Other Requirements: Z �� -F) Lk., To be constructed by 1� s� �- / . Address Water Supply: Public Supply From Address ..- ,. - or:_ x _. -Ptivate- Supply. Drilled-by..--. -- . Cam ' ... . 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 accbrdance 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 repair to Signed: L� P.E. R.A. Date o Co . �'l ti �Yt.l. N b Address 102 e--,4 � ��. �sy� �A2_N�Q., N 1{ License # C��`7 ��� 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 a considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approve discharge of domestic sanitary sewage only / n By: Title: :�Y �ir�hi, Y Date: 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 _ aplease- print-or Well Location: Street Address: TownIx illage Tax Grid # L'6� rxT eaAeekJ Map -3 Block Ll Lots) S(+4 Well Owner: Name: �. � Address: pj= r =;, M G4 " � -S--7 a O Use of Well: — Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes �r No Name of subdivision 4 v° '-> Lot No. —it Water Well Contractor: !To 12I=-2:zT . Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: (mil Proposed well location & sources of contaminatio ed on separate s et/plan. Date: to Co 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 wat ll driller certified by Putnam County. Date of Issue Permit Iss ' g ff 'al: Date of Expiration Title: - !t Permit is Non- Transferra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAI, HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION - PERMIT r �' NAME OF OWNER: REVIEWED BY: Y _ N DOCUI�IE /`Z( JPER�ITf APPLICATION j_)(�WELL PERMIT OR PWS LETTER (�L )PC -97 14 AF C '�j_STREET LOCATION: /(MMt� / / L�'e- . 1 RM, GR, AS GATE: TAX MAP=: (CONFIRMED) NTS Y N (REQUIRED DETAILS ON PLANS CONT'D) I- % C_JLETTER OF AUTHORIZATION (�L,DESIGN DATA SHEET (DDS) (/ )L�CORPORATE RESOLUTION C/ )LJSHORT EAF (Z)(__)PLANS -THREE SETS C[,L,HOUSE PLANS - TWO SETS (,_)(,VARIANCE REQUEST SUBDIVISION (� JLEGAL SUBDIVISION (�)(_JSUBDIVISION APPROVAL CHECKED CULJPERC RATE 21-3U ( Z )LJFILL REQUIRED r� � - DEPTH (�� CURTAIN DRAIN REQUIRED GENERAL e C�LOCATED IN NYC WATERSHED C�PLANS SUBMITTED TO DEP L�L,)DELEGATED TO PCHD L_)C J )DEP APPROVAL, IF REQ'D (LJCJDEEP TEST HOLES OBSERVED ( /�/ (_)PERCS TO BE WITNESSED ( _)C_JEX- APPROVAL SSDS ADJ, LOTS (_J( �WETLANDS (TOWN/DEC PERMIT REQ'D ?) L /(_)DATA ON DDS PLANS & PERMIT SAME (__)PRE 1969 NEIGHBOR NOTIFICATION (_JC I )LETTER BI/ZBA (UL)100 YR, FLOOD -ELEVATION. W/1200'•• (_)(SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS t C�SEWAGE SYSTEM PLAN - (NORTH ARROW) C__)SSDS HYDRAULIC PROFILE C_)C GRAVITY FLOW Ja,� C� S'TRUCTIQi.N (UCH GN DATA: f ER i_?nSULTS CONTOURS EXISTING & PROPOSED. C OC�DRIVEWAY & SLOPES, CUT (�C.JFOOTING /GUTTER/CURTAIN DRAINS C_i)C�USDA SOIL TYPE BOUNDARIES (�C_jTITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# (L)LJDATE OF DRAWING/REVISION ( JC JDATUM REFERENCE ( ) _)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. UUPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS L /JC )WELLS & SSDS'S WAIN 200' OF SSTS CU)C_)PROPERTY METES & BOUNDS COMMENTS: (REVSHEET) C ,6L_)HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON 74— / (C_ )NO BE MAX BENDS 45° W /CLEANOUT RENEWALS , UUSTTE NOT O CHANGE) FILL SYSTEMS U(�10' HO ONTAL; PAST TRENC$ SLOPES 3:1 TO GRADE f(�C__)FILL SPECS/ FILL NOTES / -5 d S- PROFILE & DIMENSIONS C �C )FILL LN EXPANSION AREA FnL XkTIONDISTANC]'E R TAAN 2 FEET UU cL L)UFIIOTE U(JDE CJC )VO.B., UNCLASSIFIED & IMPERVIOUS (__)( JSE FROM TOE OF SLOPE TREN t �C JLF TRENCH PROVIDED 6 a _ 60FT MAX. (f)( _)PARALLEL TO CONTOURS CUC�100% EXPANSION PROVIDED Cam( _)DETAILTUST FREE CRUSHED STONE OR WASHED GRAVEL C/)C�GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS C J10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL )20' TO FOUNDATION WALLS ' ( _J100' TO WELL, 200' IN DLOD, 150' TO PITS 0100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) 6��Z_01 TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO_ W_ATE_R-L_L'IE_(pits C 76' ENTERMIITENI DRAINAGE COURSE ` �C__)200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (�( _J10' MIN TO LEDGE OUTCROP SEPTIC TANK (�C�10' FROI,l FOUNDATION; 50' TO WELL WELL ( JLJDIMENSIONS TO PROPERTY LINES (/ }(_)LOCATION OF SERVICE CONNECTION /U(_JML i 15' TO PROPERTY LINE SLOPE ((,)SLOPE IN SSTS AREA 9% (520 %) (_JL�REGRADED TO 1 REQUIRED OSE SYSTEMS (_J(f PUbIP NOTES (�C__)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (�(�DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) �CjPTI AND D -BOX SHOWN & DETAILED 0(4)1 DAY STORAGE ABOVE ALARM CURTAIN D UC__)STANDPIPESXwith ETAIL (_)L�15' 1V1IN to CD-3 %, 35' -1 %,100 % -<l% (_JL )20' 1V L 1 to CD 182 cons day discharge (_)C�10' hiLN to NPIPE BRUCE R FOLEY Public 'Health Director. L- ORETTA , MOLINARI Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New . York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6638 TO: DEPARTMENT OF ENGINTERING AND DESIGN REVIEW , DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: l t Aff /�y �✓�1- _ TAWN -G .&E ® K PV - DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: �� P U TN AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR - .. . - :.__::-- �.A�WAS1'EWATER�TREATMENiTSYS 1. Name and address of applicant: C L 2. Name of project: iA "F' <sadvuO 3. 4. Design Professional: (�i� -t ►•l�w�16�n(2-trJ65. 6. Drainage Basin: d.l Y I OS3C-0 Location TN: Address: t,02- 7. Type of Project: _ 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 Type II Unlisted V, 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency ►`11, 12. Is this project in an area under the control of local planning, zoning, or other _ K officials, ordinances? :.:::...................................... ............................... ........ 13. If so, have plans been submitted to such authorities? ........ ............................... g- 14. Has preliminary approval been granted by such authorities? Date granted: /s 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? N� 19. If yes, name of water supply Distance to water supply ( M l L-S 20. Is project site near a public sewage collection or treatment system? ................ t:I 21. Name of sewage system Distance to sewage system L JVXLt)e' 22. Date test holes observed 23. Name of Health Inspector PI L,,e D MAP t* 2t l 24. Project design flow (gallons per day) SO-0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... r1' 26. Has SPDES Application been submitted to local DEC office? tj /a 27. Is any portion of this project located within a designated Town or State wetland? O 28. Wetlands ID Number ............... ............................... _ 29. Is Wetlands Permit required? _ -. _ _... _.,.,.......: r ....... ..........:.:....: :........:. -, Has application been made to Town or Local DEC office? ............................... AI 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? f1i 0 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... rho 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map 5J Block Lot C2&l 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 W. atershed.-shall- -� ==w he sent-to the.Depa=ent and rieed'iidt'bi sent -in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP. for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application. must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNA TURFS & OFFICIAL TITLES. KIT 6 t r —A Y i r-S Mailing Address: ................................... �>`LM ��/ Alp WMIhd 130-38 oc 5 t 2 14 -16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR k Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL _ASSESSMENT „FORM. _ :...For UPILISTED 'ACTIONS 66i PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APLICANT /SPONSOR 2. PROJECT NAME I+ / " r i N& t- Strom L'e�_ 3. PROJECT LOCATION. FU ` Municipality bZS ®� County / 1v 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) L_Cj,-, - T-t,4D -j ►`'��� b SSA �C�^ 5. IS PROPOSED ACTION: ew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE P OJECT BRIEFLY: SI ►�L -ice-` t 7. AMOUNT OF-LAND AFFECTED: 2° 25 2 ' �S Initially acres Ultimately _ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. kHAT, IS PRESENT LAND USE IN VICINITY OF PROJECT? esidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAQ? ?� ❑ Yes p�No If yes, list agency(s) and permiVapprovais 11. DOES ANY ASP CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes o If yes, list agency name and permlVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: >� c l � i �tllc�.� -i Date: I Co q Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another, Involved agency. ❑ Yes ❑ No r-r—COULD.ACTION 'RESULT-IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, i} legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or.cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be Induced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible O iter 1 =1 �d Signature of Responsible Officer in Lead Agency Signature of Preparer (if different rgrwi ible of icerk �'la nod Date iii .7 A I- •t n w . 7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION �O�-F� ENVIRONMENTAL HEALTH SERVICES DESIGN DATA _SHEET - SUBSURFACE SEWAGE. TREAT,NMIENT SYSTEM .� Owner , Ci)�6"n Acmag� Address ! e-) S'2- Located at (Street)_ m I RUb YL L A r- � Tax Map Block Lot (indicate nearest cross street) Municipality Ii'V Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) Dep th to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 3 4 2. l :5c) l 5 2 `� 2 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. :- 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH 0.5' 1.0' 1.5' 2.0' 2.5' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' TEST PIT DATAs, DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. �_ HOLE INTO. 2-- HOLE N0. SIC_ 7.5'��I 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: ,�g g—z; r L I re, Address: QQj2- � �4 ' ��- rte....► ..��� `✓ I�C� � -7� is . 5��. � }�GH'��L � N�r �. Signatur Design Professional's Seal Wd q2 7 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at ` u TN -F,--T7 ra -`-, i Tax Map # 4 Block Lot-5&.,4 Sub d i v i s i o n ofd Subdivision Lot # Filed Map # 2 g `t Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer - or Registered Architect to apply for the required wastewater treatment and/or water supply permits) 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 Departure t and to sign all necessary papers on my behalf in connection with this matter and to s tv se the.cor�st�uct n -of said wastewater ::treatment- and /or --water supply. systems - ,' "� the Public Health in conformit��,nv t "45 priovjsions of Article 145 and/or 147 of the Education Law, Law, and the Pittnam.,C�opgty Sanitary Code. Countersigned: P.E., R.A., # Very truly yours, Signed: (Owner of Properr ) Mailing Address COL C-,t��1r'2',y4 164EF Mailing Address: State ►- Zip Telephone: GO 10 Mekeel Street Katonah State N.Y. Zip 10536 Telephone: 914-245-5817 . AFFEDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Gerard Farinella represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: H.A.F. Custom Homes Inc. Having offices at: 10 Mekeel Street, Katonah, N.Y. 10536 Whose Officers Are: President - Name: Gerard Farinella Address: 10 Mekeel Street, Katonah, N.Y. 10536 Vice President - Name: Address: Secretary -Name: Helen Farinella Address: 10 Mekeel Street, Katonah, N.Y. 10536 Treasurer - Name: Helen Farinella Address: 10 Mekeel Street, Katonah, 1J.Y. 10536 and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: L_�4 Sworn to befor me this _� day of _(m t)� (year) Notary Pub c R43EFif P. Notary Public, State of New YorS No. 460M Corporate Seal TouapfEi o ren Putnam County B I Form CA -97 f UTNAM NGINEERING.PLLC Engineers and Planners SEPTIC SUBMISSION FORM TO: DATE_ PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: H A F ADt--vt F-S -rb nrly T�A w p--o L�A,V gg!5 Fw O D L-UF '01 v :. ENCLOSED, PLEASE FIND: J COPIES OF THE SSDS PLAN r; 1 2 COPIES OF THE HOUSE PLANS , CONSTRUCTION PERMIT APPLICATION -I i WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($ ) j SHORT EAF DESIGN DATA FORM i LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLAINATION REMARKS: ; ti COPIES TO: SIGNED: 102 6LENEIDA AVENUE, CARMEL, NEW YORK 10512 •PHONE (914)225- 3060•F x (914) 225 -2955 „j TO P64d 4414111_� RE: 41A F et e, +moo (T) A --t4rsc,,__ Reservoir Basin Dear Date: The Putnam County Department of Health (Department) has determined that the above referenced . application, including fee, and received by this Department on �W Z4 .Joz@ is complete. The Department will notify you by d J, ,;-sue of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement.. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my t attention at the above address:: This . notice must include.y.Qurrame, the_location of the_ project, the-: off ce with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, 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 Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan SR:tn Public Health Technician ws2 . Fill ►d .: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL I1EATLII SERVICES,.,.. _ .. FIELD ACTIVITY'REPORT' Street Town State Zip PERSON IN CHARGE OR_TNTFRVTFWFT�: T-'yTlbl/g1"I ��C7, —_- Mite: }// PUMP TEST DOSE TEST vi- .0 r f REQUIRED GALLONS 4 3 0 �F fl �t 4e 116 1 �Ab A 3 it / , x T i � � � T , / .,J -- 4/ 2., e7s = -3���'L7 I � y 7, �z A �F fl �t 4e 116 1 �Ab A 3 it / , x T i � � � T , / .,J -- 4/ 2., e7s = -3���'L7 3 -j- 7, �z A d TNI-R PFrTQR* TFT Signature and Title RFPORT RF['F VF -D RY. I acknowledge receipt of this report: SIGNATURE; 02/96 Title; Rev. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspecte y: Street Location. 1-o yY7 �R � �iE Owner &4F �vSTO.�t �lo.HF� Town _p, Permit # ?- G -oa TM. 344 41 - S/. Subdivision Lot # `'TZos aon" 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. SeivaZe System s . 1, 250.. .....other ................ a. peptic tank size - 1 000 .... .:. b. Septic tank installed level ................ ............................... c. 10' mimmum.from -,foundation .......................................... d. 'Dist ' u ion. out ets�at same elevation° watefl _este&......... 2�"Pro ected belo frost.........- ...... ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Bo - properly set ........... ............................... f. ren "1 ches T-Ee-n--g-th required 6 7�?_ Length installed G 7.2- 2. Distance to watercourse measured -t•- i vo 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 ".minimum :..:......... - - 10 Pipe ends capped.... .................... .............................. g. 1_ oQosed- Systems : ........ ............................... ............................... .................... j nhole to gr de... �Y: .� III. House/Building a. ouse ocated per approved plans. ;:...:.�g►� ........:...... b. Number of bedrooms ....................`.7t .:..1.4 :................ 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 watercour g. Footing drains discharge away from STS area .............., h. Surface water protection adequate .. ............................... i. Erosion control provided ................. .............................., 0 ¢l BRUCE -R, ..FOLEY Public Health Director April 12, 2001 "- "° " "`LORET"i'A "'MOIINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Paul Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Field Inspect' - HAF Custom Homes Tommy Thurber Lane (T) Patterson ,'TM# 34 -4 -56.4 Dear Mr. Lynch: The separate sewage treatment system can be backfilled with exception to the pump tank and distribution box. The following comments must be corrected in the field: • A pump test needs to be performed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:cj Very truly yours, /4f'`` c . Gene D. Reed Environmental Health Engineering Aide e- BRUCE R. FOLEY Public Health Dimctox. -- LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT[' OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: /1.2- �o To: ..9(JL L y_n/Gtf ��e: LoT`#dl ``�oS�lyooD `• Fag #: 27q-676!2 No. Pages Z (Including cover sheet) From: Gene D. Reed Putnam County Department of Health /For your information.. . Please respond For your review Attached as requested As discussed Notes/Messages Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. '0 PUTNAM- COUNTY DEPARTMEI�IT OF-1E$�AL'i�[ _ DIVISION OF ENVIRONTMENTAL HEALTH SERVICES ATTENTION ADArvi GENE M011MISS For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # Located: ';644? y (T) (V) Owner /Applicant Name: TM �� Block Lot Formerly: f /i3F C "I`.frA" I -011 r Subdivision Name: �� o Subdivision Lot ?"r _ Is system fill completed? ` L-a Date:-------. u _ Is system complete? je5- Date: 14i Is system constructed as per plans9 C/ C Is well drilled? Date: Is well located as per plans? Are erosion control measures in place?' I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: - r i� l Certified bv:-\ 6 _ PE 2 RA esign Professional Address: Lic. 6 6 7 e;'6fi ,ee-urz 6 Comments: Form FIR -99 SHAY AND SXrru. Owus .... g... AND STOW FOR FUTURE USE. AS MINIMWI AS POSSIBLE TO OWN ON THE DRAWINGS OR AS BEEN NET AFTER FOOTINGS HAVE J POURED. MNSTRULTION OF THE BUILDING v TO DEPTH SHOWN OR TO VIRGIN i FINISHED GRADE UNLESS. CLEAN FILL, GRADE TO SLOPE )ATION WALLS, NO HEAVY MONS. 2,300 P.S.F. f AND STIFFLY, SIZE AS AND ?ORCED WITH (3)04 89-BASS AND i EXC$PT WHERE IT BEARS ON ROCK )TINCS TO ROCK, REINPOffiEMENT IN CDMPRBSSIVS STRENGTH OF owm BLOCK WITH OUR -0 -MAL ILID. i" CEMENT PARGE WITH ANTI -HYDRO PROVIDE WATERPSiDOF CEMENT as. WITH MINIMUM 12" GRAVEL. 'I -HYDRO AND TO DEVELOP AND 5I IN 28 DAYS D REINFORCED WITH 6X6, 410/10 R BARRIER AND 4" GRAVEL. SHIELD AHED PRBSSUAB TREATED HEMICALS TO BE ADDED DURING YORK STATE BUILDING CODS. TADS 41 DOUGLAS FIR HAVING 40R11AL DURATION DESIGN VALUE iT 19 %. ALL PRESSURE TREATED TO 89 USED FOR SILL PLATES i ALL SILL PLATES WITH -% "X13^ [NUN TWO BOLTS PER PLATS. 'ARTITIONS INCLUDING EXTERIOR 1" WIDER THAT THICKNESS OF I NAILED ON TOP AND BOTTOM ) 36" USE (2)2X4; 36 "-48" USE 3" USE (2)2X10's. ALL HEADERS (LESS OTHERWISE NOTED. )R OPENINGS ARE TO 88 6'-S" 1-0 EXTERIOR GRADE. 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