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HomeMy WebLinkAbout1581DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -22.22 BOX 15 01581 1% NJ IN L ,` y , . 1 i I dL UL , 01581 ,� _: � •�. _ . -� , _.. ,_.„ _ ..� ..,ate_ ..�__ .._,.,..— ....._. r�-- _�- --:�» — - . - - - _ . I P UTNAM COUNTY DEPAS!TUM OF MALTH . Dlvlsiee of Elk.vhewmviitd Hedth Swwim& CMUWL N -Y -10612 to Pswlde Peeatlt I on CERMWICAT$ OF CBS NiMjUCHON PEIMtt FOR SEWAGE DMPOSAL SYSTEM ewai or VC®.�e 62-) 'per AV .�/ ii c.r a_ Lat / Tax Map Blob ✓ t� , owner /Appecom News �AM cv�A Rswsi_ 0 Revision vMAO Date of Peevvloons A}�ppprovel Town :pP Fnd -nsedX 1 en;niint- BWMg ape, S f (�C-A -tai �i�l'►1I WI Lot Ae, 2 Fm sftdm Only Depth Vdpme Nsher d fied<ose � '''' ��,,��Design Flow G P D � PC® Notification b Eestah" When F� b completed Separate %weeatie Spats to aetYsi d�bwj= Septic Table as, (,0'j 2- r 2' w I DE ff'V `f'R t cc+r To be ciessb eted by TO DST . Address Water Seipply1 pwft Sop* F� . Addteea on ---Pdnb Supply Deed by �D �`�` (' Addmaa Other Regalseesta 1 represencthat 1 am wholly and completely responsible to► the design and location of the proposed system(s); 1) that the a rate sew di sal stem above described will be constructed as shown on the approver! amendment there to and in accordance with the standards, rules a reou ns o e dam County Department of HmKI, and that on complet," thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Hea thwill be submitted to the Oapartm int, and a written guarantee will be furnished the owner, his successors, heirs or anions by the builder, that aid builder will piece in good operating condition any part of mid in — disposal system during th bd of two (2) yaws Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Complance of the origi 1 am of spelrs thereto: 2) that the drilled well described above will be located as shown on the appraie0 pan and that aid well wi11 Inst ice w h t standards. rubs and roou ns of the Putnam County Duel artmad of 4Health. Date Signed P.E.�yIR�A. Address V V` icenfe NoO�� APPROVED FOR CONSTRUCTION: This approval expires two as otn the date issued unless construction of the building .has been undertaken and Is revocable for cause or may be amended or modified when con d ary Dy Commissions► of Meatth. Any change or alteration of construction weou{►es a new mit. OOroved for disposal of domestic y age, a rivate water supply only. Rev. Title 10/88 f er ' NAM COUNTY DEPARTMENT OF HEALTH .IV_ISION::OEEN.VIitON1dIENTAL HEAL,��I_SERVICES -. ✓ :::r. C RT FICATE OF CONSTRUCTION COMPLIANC —E7 FOR SEWAGE TREATMENT SYSTEM PCIID NSTRUCTION PERMIT # 13-1 / Located at �' P'& L. �-r-_ Owner /Applicant Name Ell< -F>V I LDS Formerly FA M S Hlz-w lf-. Town or Village P�ZTe)QSQ \J Tax Map u J Block �J Lot '2a Subdivision Name c� l tT J �ct� .��L1 �STAZ OS Subd. Lot # 2-- Mailing Address 2- (Je AI L l --Arty Zip O,5-42. O Date Construction Permit Issued by PCHD (0 23 % Separate Sewerage System built by -SIC 13y I Lpl�Y. 6e,2QAddress X912'[ f+ S?a- t-,igm i Consisting of 12 Gallon Septic Tank and & & -7 Lf ef"44:;t Other Requirements: Water Supply: Public Supply From. Address or: Private Supply Drilled byTDR W'Sk Address $ox 2'7 1 kk&tJV_ 1Jy •Building.-Tgpe- If-i 6-L- 4!�__ Has erosion -control- been completed?... Number of Bedrooms Has garbage grinder been installed? 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 accordam with the ' PCHD Construction Permit and approved plans and the standards, rules and ' at' to ounty D artment of Health. Date: C9 ( Certified by P.E. �j R. A. i fcu N61' Design Professional) Address Lo7_ G►,��1�lpA ,�,,�2 ,er,� �� j�License# 0&77 6 � � Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are ubject to modification or change when, in the judgment of the Public Health Director, such revocatio o ification hange is necessary. By:. B . Title. la t e. / ,,�� z. White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 V VAN, f I i i GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name 51Q(f-> ul�-_ ���IL_q Building Type 2 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. Month Day 10 Year '� O General Contractor (Owner) - Signature C I 1" S G1I41h( Or`P Corporation Name (if corporation) Address: Z 1 S \%A 1 I I^tire. N S A 1 e r» State r' / Zip 1'JS (do Signature: Title: E 1� 3 v I L T, )11,16 C-0 P" e Corporation Name (if corporation) Address: 2 15 Vol t_ L -10 t-J State 14 . A Le,-I N Zip i05_60 Form GS -97 `PUTNAM ENGINEERING, PLLC LETTER OF TRANSMITTAL 102 Gleneida Avenue Carmel, NY 10512 Date: 2 cl g 91.4- 225 - 3_060.... Fax:�914- 225 -2955 RE: �;H& e \IAg=gU iii' 5HAV re. ✓� t � L,&N C �TD Fw re?219o'_i We are sending you attached under separate cover, the following items: Shop drawings Specifications Plans No. of CODies X Prints Copy of letter Other: Nocrrintinn SSLZ� AA -s— 75 u r L - PL.,4 sa C .4 2cxo -- P Nnit� ►� WSu._ twoc=� 2 These are transmitted: _ For approval _ Approved as submitted .-For-your-use- Approved as - noted-- As requested _ Returned for corrections ?X For review /comment _ Resubmit copies for approval Submit _ copies for distribution REMARKS: Copies to: SIGNED: if enclosures are not as noted, kindly notify this office. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well_L6d_& 6 'Street X dress: own/Vill age: 7–eUr Tax Grid #3 Map`) j Block3 '7 Lot(s) Z WellOwwner: Name: 6 r A AddressN d �� i� l4� Ga " SA Use of Well: - prnmary -see Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling ]Equipment Rotary Cable percussion --.4 Compressed air percussion Other (specify) Well Type Screened Open end casing ----b Open hole in bedrock Other Casing Details Total length eft. Length below grade ft. Diameter _�in. Weight per foot lb /ft. Materials- -- Steel --Plastic _ Other Joints: _ Welded_ Threaded _ Other Sealer, 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 Vest _ Bailed _ Pumped' Compressed Air Hours Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Lou If more detailed information descriptions or sieye_ana�yse�...: are available, please attach. Depth From Surface Water Beari>og Well Diameter(in) ]Formation Description ft. ft. Land Surface 0, �! . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth *�v Mode® Voltage HP 0 Tank Type Volume Date Wel C pie 3 � Putnam County Certification No. Date of R ort Well riller ignature) NOT E1 Exifct location of well with distances to at least two permanent 9andnlarks to be provided on a sepa=A., tan. Well Driller's Na a <i s � Address: 70 L Signature: Date: _ White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 � � � YML ENVIRONMENTAL SERVICES ' ` 321 Kear Street Heig{lt�u ` (9140 245-2800 Albert H. Padovani, Director LAB #: 33.406171 CLIENT #: 114 NON STAT PROC PAGE 1 TORLISH & SONS DATE/TIME TAKEN: 06/01/98 10:00A BOX 271 DATE/TIME REC'D: 06/01/98 11:03A ATTENTION; DWAYNE TORLISH REPORT DATE: 06/08/98 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITE: SHAWE VALLEY RD. SAMPLE TYPE..: POTABLE : SOUTHEAST PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: TANK COLIORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/01/98 MF T. COLIFORM ABSENT /100ML ABSENT 06/01/98 LEAD, (IMS) 1.0 ppb 0-15 ppb 06/01/98 NITRATE NITROG 0.58 MG/L 0 - 10 06/01/98 NITRITE NITROG <0.01 MG/L N/A 06/01/98 .'IRON (Fe) <0�06 MG/L 0-0.3 mg/l 06/01/98 MANGANESE (Mn) 0.019 MG/L 0-0.3 mg/1 06/01/98 SODIUM (Na) 9.98 MG/L N/A 06/01/98 pH 7.7 UNITS 6"5-8"5 06/01/98 HARDNESS,TOTAL 280 MG/L N/A 06/01/98 ALKALINITY (AS 88.0 MG/L N/A 01/98TURBIDITY. (TUR �'NTL} 0-:� -IDl1----_-_ COMMENTS: BACT THESE RESULTS INDICATE THAT THE S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIM�z�� THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED� AT THE TIME OF COLLECTION. Pb /CU LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. -tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution'points have a LEAD.value of more COPPER value of 1.3 mg/L, else water undertaken to reduce-the �aters corrosive ` Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium that for people on a conta�n no more than moderately restricte is s:gge��ed. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a d diet, a maximum of 270 mg/L of Sodium 1008 12345 9139 9146 2037 2037 / YML ENVIRONMENTAL,SERVICES . 321 Kear Street Yorktown Heights, ,Y., 1{)598'� ' --'--- (914) 245-2800 ' Albert H. Padovani, Director LAB #: 33.406171 CLIENT #f 114 NON STAT PROC PAGE 2 TORLISH & SONG DATE/TIME TAKEN: 06/01/98 10:00A BOX 27! DATE/TIME REC . D: 06/01/98 11:03A ATTENTION; DWAYNE*TORLISH REPORT DATE: 06/08/98 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITEs SHAWE VALLEY RD. ' SAMPLE TYPE..: POTABLE : SOUTHEAST PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: TANK ' COLIFORM METH: MF ~~~~~~~~~~~~~~~~ ~~~~~~~~~~"~~.~~.~~~~~~~~~~~~~~~r~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ` ^ SUBMITTED BY: Director ELAP# 10323 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, NY 10512 914.225 =3060 Fax: 914- 225 -2955 LETTER OF TRANSMITTAL Date: o�i �C&� RE. Ts- r3c-)lL.7r - fvi� We are sending you I attached under separate cover, the following items: Shop drawings Specifications Plans G Prints Copy of letter Other: These. are transmitted: _ For approval _ Approved as submitted __.._ .......:.:..... _ ..._ .. .�_ For your -u-se as rioted As requested _ Returned for corrections _ For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Pow== Copies to: SIGNED. L4U9L If enclosures are not as noted, kindly notify this office. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location' 5hawe 1/a1 /ey tamp Town ��.- 1FPr•;o� TM# 3tf- 5- a a., j 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 �f,,25 a . eptic t c size �I;� .:0....... ......other ................ b. Septic tank installe evel ................ ............................... 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 Juncft Bpxx roperly set ................ ............................ T Length required z;) Length installed G 7a 2. Distance to watercourse measured +a ,00 Ft.......... 3. Installed according to plan ....... ....... .......... 4. Slope of trench acceptable 6 - 2" foot ............. 5. 10 ft. from property line 20 ations.......... 6. Depth of trench <30 inches fro s ace .................. 7. Room all we or ex ansion, 100 %.... .. .......... 8. Size of gr 3/4 - 1 A" diameter cl an .................. 9. P90.4 f g n trench 12" m' ................ 10. P e e ds ca ed .................... ............................... g. Pum or osW Systems e o pump chamber ............. ............................... 2. 0 ow tank ........ ..... ........ ............................... 3. Alarm, visual/a io ....... :........................................ 4. Pump . ac i le anhole to grade ................. 5. First x b ......................... ............................... 6. Cycl . ess by H.D.estimated flow /cycle........... Date: 20 - - Inspected by: �e Owner ` sRm 5hawe Permit 'P-/3 -27 Subdivision Lot # 2 Shawe VA/1'v t III. House/Buildi' a. tiouse ocated er approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured .4- /6,0 , 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 YES N NO C COMMENTS X I" k el X X A - --j X o o 6M �i 4,25 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location Town TM# 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 Svstem y� a. Sep-tic tank size AkKov' ".. 25 .........other ................ b. Septic tank instael ................ ............................... 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 - properly set ................ ................................... 1. Length Length installed G 7,1 2. Distance to watercourse measured** coo Ft.......... 3. Installed according to plan .............. ��.................... 4. Slope of trench acceptable 6 - 2 foot ............. 5. 10 ft. from property line 20 ations.......... 6. Depth of trench <30 inches fro s ace .................. 7. Room all we or ex nsion, 100 %..... .. .......... 8. Size of gr 3/4 - 1 j" diameter cl an .................. 9. D of g in trench 12" m' ................ 10. P' e e ds ca ed........ .....:......... .............:.....: +:..... g. Pum or osW Systems e o pump cliamber ............. ............................... 2. 0 ow tank ..... .................... ............................... 3. Alarm, visual/* io .................. ............................... 4. Pump ac i le anhole to grade ................. 5. First x b .................... ............................... 6. Cycl ess by H.D.estimated flow /cycle........... III. House/Buildi Date: �4 Z 0 Inspected-by: g: Owner Pp� nm 5 ha w e Permit # P - / 3 -9,7 Subdivision Lot# 2 ShLc,/e Valley Fst a. House locatedjer approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured + 1y© . 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 orm C�4 COMMENTS e� 0 O D 10� I!� I!� IBM ION o�0 Mir orm C�4 .... -. ra: �,, �uy� D �y._ � .� � , 'l -4TH _ ��25 9,7 K U�25 X �.� FROM PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Apr. 17 1998 09:37AM P1 MEMO TO: FROM: PUTNAM ENGINEERING, PLLC DATE: -7 l [ RE: REQUEST FOR /SSDS AS BUILT INSPECTION PROJECT TITLE: dAta`nIe VALZ- L-(S;I-r 2, STREET ADDRESS: SH4W c--- ` AL,L11 tANer! (C.lf- Pouf o OZO TOWN: TAX MAP #: ✓'" �"� ' �" PERMIT #:r 13 I / . . . . . . . . . . . . . . . . . . . . . . . . .. • ♦ . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . _... _._. _PLEASE.N077Y.THIS OFFICE AFTER YOUR INSPECTION AT-(914) 225 -3060, IN. "...._.......:. ORDER FOR US TO NOTIFY THE CONTRACTOR/OWNER THAT BACKFELLING THE SYSTEM MAY BEGAN, I FileM1022 J Sa c v APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEM -S - REVIEW .SHEET for CONSTRUCTION PERMIT STREETLOCATION 57,0449' OAL" LAP NAMEOFOWNER 50MAW BY B. HEDGES R.MORRISOTHER DATE -r /K/ � g r=TAX MAP # DOCUMENTS. Y PERMIT APPLICATION C -1 WELL PERMITED PINS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS = VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION �= DIVISION APPR L CHECKED ICJ PERC RATE ft 1 A j A_ 667' = FILL REQUIRED DEPTH = CURTAIN DRAIN REQUIRED =STANDPIPES Y �EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE [E)4F PUMPED PIT & D BOX SHOWN & DETAILED ®® HOUSE - NO. OF BEDROOMS WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS HORIZONTAL: SLOPE 3:1 TO GRADE SPECS = FILL NOTES CERTIFICATION NOTE TI GAUGES PROFILE & DIMENSIONS VOLUME LJJU GENERAL ILL IN EXPANSION AREA W'm X- APPROVAL SSDS ADJ. LOTS VETLAND (TOWN/DEC PERMIT REQ ?) TRENCH �` 6 ATA ON DDS PLANS & PERMIT SAME LF TRENCH PROVIDED 6 =60 FT MAX - 1969 - NEIGHBOR NOTIFIFICATION PARALLEL TO CONTOURS ..._.._. _ -..T.. TERBILZBA..._ :::� M 100 % -EXPANSION-PROVIDED . _. _....... , = 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS FIELDS EWAGE SYSTEM PLAN - (NORTH ARROW) 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL SSDS HYDRAULIC PROFILE = GRAVITY FLOW 20' TO FOUNDATION WALLS DJ 15' WELL TO P.L CONSTRUCTION NOTES (GRINDER NOTE) 100 TO WELL, 200' IN D.L.O.D., 150' PITS DESIGN DATA: PERC AND DEEP RESULTS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) O -FOOT CONTOURS EXISTING & PROPOSED 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER DRIVEWAY & SLOPES CUT 10' TO WATER LINE (PITS -20') FOOTING /GUTTER/CURTAIN DRAINS 50' INTERMITTENT DRAINAGE COURSE EROSION CONTROL; HOUSE,WELL, SSDS 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,301- 2%,35' -1 %,100' <l% PERC & DEEP HOLES LOCATED 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK LOCATION MAP =10' FROM FOUNDATION; 50' TO WELL COMMENTS: DAM'S= DLSEC-C iL- SYS=Di Owner S L+A Vqr-- y�. y.. GS -i-... Address Rr-) IQSoCI Ir,--tg2d at (street) ED Fza,� Se r'. 3� $lock (indicate nearest. cross street) msnicipality Watershed Gib SOM P C MA -T-TCN TAT EAM RED(= TO BE .M W'= APP=Ch?'ICNS Date of Pre- Scaking • 413014 Date of Percolation Test HOLE IN& 30 a+ - LS I 3m NU--Z a= =X. II •' �� 3O 24 PE:?COL'7CN Run ELanse Depth to Water E`tQa i'2t°= Level No. Time Grovr_d Su.:face In I -ndles Soil Rate Stamm -Stc -p Min. Strom Stop Droo In M? -Vl:n Drop LrIC-hes Inches T -I&.es htd,�3 1 )x`14 10,`15 31 233/4 2 ID ' 16 IN& 30 a+ - LS I 3m 3 II II •' �� 3O 24 4 5 23 ZG' /z 2 Io'4-7 W11 '�-O 24 2Co j 4 5 . I ' 3 x. 4 ..ter... . IvC)ITS : 1. Tests to he repeate3 at same depth until approxia'ately egva_1 soil rates are cbtained.at each percolation test hole. All.data to'be suhnitted. for review. 2. Death aeast=e:mnts to be irade free top of hale. ,K TEST P= DATA MMUIFtF..Z7 TO BE SUEMr= W= APPLICATION DESCRIPTION OF SOILS ELMUNMMED IN TEST HOLES DEPTH..... EME NO. EME NO. Z EME NO. G.L. 2f 5' 6' 7' 8' 9' 10' 12' 13' 14' IND!= L-EVIM P.T WFla G2C LNrk -;T—c" IS =01NMER I? ZV�7ICC r = TO WF � C-E ik=, L= RIS. AEi'- B=G UZv'T=- NIA DEEP SOLE OSS-TVA'T'IC>vS MINDE BY: C--AT C-"' , , �L- ° tjye- D�.� i3f�- Pc1�ODP'Tz'• `� ?-� `�S Di:SIC�i Soil Rate Used min/1R Drop: S.D. Usable Area Provided On5-->n'sf No. of Bedrea= Septic Tank Caracity Z s'r�'> gels. Tyce Absorption Area Provided By �� -I L.F. x 24" width trench f� r Other _ Name eD-rNA r4 15aG I F4 Signature G f Ar3dress �� �t�- C. -l/C =. SEA, �`' T. THIS SPACE FOR USE BY ��r.TH DEPAIfL IfENZ' WILY: Sail Rate Acorcved sq.ft /gal.. ' Checked by Date 4. x ,r _ 1 �P.U.7G'N.AM COUNTY DEPARTMENT O1E' HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM' Name and Address of Applicant: B'rl. �5f4 , J- � � -tL- 6R�YVS1'�2 ivy f0sb`7 Name of Project: SFt&v`/)--- J - �TATEs Project Engineer: _grrO S H 3. Location T /V /C: FA11 S I ,SDt1 5. Address: . pCo�7 4�- �o 225 License Number: Number. Phone. . S. Tyoe of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) T. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X 18. Is a Draft Environmental Impact Statement (DEIS) required? ............. Nn 9. Has DEIS been completed and found acceptable by Lead Agency? ........... I�,(a 0': Name -o•f Lead Agency f _ 1. Is this project in an area under the control of local planning, zoning, \ or other officials, ordinances? ......... ............................... 2. If so, have plans been submitted to such authorities? 3. Has preliminary approval been granted by such authorities? Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N A 16. Waters index number (surface) .......................................... NA11 17. Is project located near a public water supply system? .................. N 1-H& � 18. If yes, name of water supply �11A Distance to water supplyl MlLof 19. Is project site near a public sewage collection or disposal system ?..... 140' Z0. Name of sewage system N Distance to sewage system jMaE ?1. Date observed: 91 20Icl S 23. Name of Health Inspector: !4. Project design flow (gallons per day)...... .. ............................. E)OO 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all, necessary papers on my behalf iu connection with this matter and to supervise the construction of said systems in conformity..dtfi- thii -i5 ovisniit - -df- rtitle 145 - c)r_'___' 147, Education Law��P�� tary Code. aJ�! a CountersigneC P.Eo, R.A., h 102- Address* is Health Law, and the Putnam County Sani- low Telephone Very truly yours, Signed j4o/--e� Owner,of Property Address ��. tlly Town Telephone Date�Z.l.._- �.�. Re: Property of Located at &HA -M-e \/A1,! a� -L-Ai"(M (T) F& Section J�-°o S].oc�s Lot �2 Subdivision of Si4AVUr--- Subdvo Lot # 12^ Filed ifap � � c�� Date "2- / ,21 / 1 Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all, necessary papers on my behalf iu connection with this matter and to supervise the construction of said systems in conformity..dtfi- thii -i5 ovisniit - -df- rtitle 145 - c)r_'___' 147, Education Law��P�� tary Code. aJ�! a CountersigneC P.Eo, R.A., h 102- Address* is Health Law, and the Putnam County Sani- low Telephone Very truly yours, Signed j4o/--e� Owner,of Property Address ��. tlly Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPL'I'CATION TO CONSTRUCT A WATER WELL' PCHD PERMIT WELL LOCATION Street Ad ress �N � � LA-Ns: Town/Village/City Tax Grid Number — - 2.-)- / WELL OWNER Name R�iA AWE M iling tP Address MI�VSTM Ll- .M [009 rivate D Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL D BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY D ABANDONED D OTHER (specify, O AMOUNT OF USE YIELD SOUGHT-5 M 1►J gpm /# O PLACE EXISTING SUPPLY XNEW SUPPLY NEW DWELLING PEOPLE SERVED (/EST. OF DAILY USAGE�tO pl O TEST /OBSERVATION 12 ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING l WELL TYPE ODRILLED DRIVEN EIDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _)�_NO IF WELL IS LOC TED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �VJ1� �til.P�lj"[.� Lot No. �- WATER WELL CONTRACTOR: Name TQ r 7QI,!�f T . Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY _...... —DISTANCE. TO PROPERTY -FROM.. NEAREST WATER. MAIN,: LOCATION SKETq & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET L (date) (signa PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilli operations be contained on this property and in such manner as not to degrade or othe •s contami ate surface or groundwater. Date of Issue: 2 3 19 6�y Date of Expiration /A / 19 4V4 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Acting Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 May 15, 1997 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, NY 10512 Re:. Proposed SSDS: Shawe Lot #2 Shawe Valley Lane (T) Patterson Dear Mr. Hurley; Review of plans and other supporting documents submitted at this time relative to the above - captioned 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 wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and Regulations of the; State -of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You shoulcFcontact city Officials iri thisu regard:" 1. The split system proposed is not acceptable. Please revise to a standard drop box or distribution box system. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer WjP PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR .. YES NO / Internal Use Only C ❑ Repair Permit issued in last 5 years ❑ of in Watershed El Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ � Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME iD 9"AW6 01"Ieli f.N , g2EW�t�� TM # NC EL t "W l)" tu4le-AtSC i_ PHONE# MAILING ADDRESS (0 1�tf- Wa VALL" t-N i t3CI;ylgEr , NY t0 m APPLICANT NOIFI-- MtFA40L f owom Name & Relationship (i.e., owner, tenant, contractor) DATE FACILITY TYPE 2iESM04X 2[2 S6M(, SIXIE 15 JAG PROPOSED INSTALLER PCHD COMPLAINT # PHONE # ADDRESS o REGISTRATION /LICENSE # 43 7-o of Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. conditions stated on this form TITLE 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved Proposal Denied Inspector's Signature Title Da td' COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE S�Z61U01, � LN R f`4 M a 17 d l� --� (� SURVEY NOTE HQU5E LOCATION AND 5ETBACK5 6ASED ON SURVEY 5Y T HRfi`( "�fi�Ep e1Vti�Qli 19gv I t t. 5--8U I LT MEASUREMENTS IN FEET ) 1 .2 3 4 5 '6 -7 5 q .10 '111 12 . 15' 14- 15" 16 I-T. 18 A 14 51 +7 4-3 - qty% 3g, 5ro . 37. 38 .4=� .. ,4 - . 47 1 6 : 9 5 95, .15 "12 11 g 42 2 ' 7 75%2 -72 6f 6,15 62- I23 120 - i8: 117 t : REV 1510N5 . NO - ... DATE DE5GRIPTION •: - 0 , UTNA - ENC- 1 Nil I N , LL o .23 °IS 'RSV !t' HD Cvrtt�EwTT". ENGINEERS PLANNERS-. 102 GLENEIPA. AVENUE, CAR.MEL,, NEW YORK -10512 (014). 225 -3060 FAX (914) 225 -x.955 PE ' � + -- .... � .._ - .�. +., o.. ..s -..., 4 ... �'J tom... -. vwr ..., ..s�J.rt.� - _t.:. �... -..8.' � ',3'.., .. _a ..�,., <s. �....,_�_.i::'x.+� . ?.. '•r 3�', _.._. _...- d��vc "•'ia" { 0 i t 0 Putnam County Department cKE Health UVIsion of Environmental Health Servioes Aj&F9vbd.ae noted Sor conftymance w1th �n Rule and e5ulations of the 'EOtI aea. t_, .;Lr Late 1 A5- BUILT: 4 15 16 17 18 20 2:1 22. 23 24 25 I. This Is to certify that' the constructed as indicated 1 1 # inspected by,Putnam Engin Co 5 `13� .� °j2 �2 �3 j 3 . ��- 5. �g I o �i� /2: The system was constrvcte + rules and regulations oP tf ' Health and -the New York 3 1 15 110 o '. 108 2. The 55e consists Gr,2_ � t concrete septic tank; trench , additional requirer SSDS AS -BUILT PREPARED >= OR:.ETIG BUILDERS D1 ._.oesGRir>roN F�V APRIL 1998 D GO M H EI 7T ..1 PR.oJEG MANAGER J iE VALLEY E5TATI=5 �y )) KH f5P_AM BY YL V l�LLE� ALA E GHEGICED BY SHANE c p Pe7r 6 PML TAX'MAP 34 BLOCK; 3' ;LOT 22 I(2) TQWN Oi= .:PATTERSO,N AS NorEn -.y. Y ._�_• J 'S.. ., i`,... <:.< <rus �rin -�- w.�. -l• ...I.r .. �,� . :..,. _ . . :,,, i.. u2u... xa,..._..,... a. cs.....:,!! F�._. �ri`..' tr�a<,.' �" Y_,,''>�c.�4_G`i:,'su'ri'+�...d �r>. t. rSr,.: �?�i.^.��i�:t:,'. <dti+J....:i�c? Z'•.'iT'- ti..ti1..., _. ._.. ... z