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Home My WebLink About1583DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-5-22.24 BOX 15 i,yL r �., ` �� , ! - t , 01583 AM COUNTY DEPARTMENT OF HEALTH ° "'r VISIOI�I. Off' ENVIRONMENTAL, HEAL'I'�I SERVICES: CERT CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCIH CO TRUCTION PERMIT # P-" `� —9 Located at ,0e>04VJ1S VArL -K Town or Village T"C Owner /Applicant Name s C&WT Rai, t4c Tax Map Block j Lot Formerl Subdivision Name `J' WAvJV ✓,a -t--:�� Subd. Lot # Mailing Address Zip aI 5-0 9 Date Construction Permit Issued by PCHD 5 f (4 11 Separate Sewerage System built by giegg PQA�, Addressl (•JP(Cv�51 Kov,6 (o �s Consisting of _ I 250 Gallon Septic Tank and 502 L Z w l �RP�tol�t Other Requirements: Water Supply: Public Supply From, Address or: Private Supply Drilled by 6� 2� S9NL!9 Address4 Putt A-M— (� 6V62., - -. _.l�_uilding.T_ype cJlf��I-- .4M�It ;Has erosion .control- been completed? Number of Bedrooms 4 Has garbage grinder been installed? N 0> I certify that the system(s), as listed, serving the above premises were constmr ted essentially as shown on the as- built plans (copies of which are attached), in accord a iss CHD Ctotruction Permit and approved plans and the standards, rules and re�IIla ' of th o DepartmeHealth. Date: Certified by P.E. �s R. A. Imo✓ ti?.Es*n i pi1-�(Design Profession Address 16 x, (- t_EYJe1 DA A A,: &-ky -DEL 1051 Z License # 06'7,44(!o Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation m dification change is necessary. By: Title: 1414 Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 L_ _L. .". PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well ]Loadon Street Address: ` "-" '-' lIce.Pond Road Shawe Valle Ll Town/Village: Brewster Tax Grid # Map Block Lot(s) 4 Well Owner: Name: Address: Saddle Ridge Homes, Inc., 15 Saddle Ridge Road, Holmes, NY 12531 Use off Well: I- 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 31 ft. Length below grade 30 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 _�E_ Yield ___g_ gpm Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet 40' 540' 605' IID pth Data Well Log If more detailed information descriptions or sieve analyses._._... are available, please attach. Depth Fro Surface- Water Bearing Well Diameter(in) (Formation Description ft. ft. Land Surface 16 Drillini in overburden clay and boulders 16 Hit rodc at 16' 16_ __ - - 31__.. ...- Dri1.1-iI -- :z _roc ., -.-s et - 6as-incf qr. outed_.:... 31 605 Drillin in roc granite H drofr cked well If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5gp& Depth 560' Mode15GS10412 Voltage 230 HP 1 Tank Type WX250 Vol e 44 Date V@ Comp eted 8/13/97 Putnam County Certification No. 002 Date of Report 5/28/98 W ill r si a 01 Bea Jr. NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's N P • 1 & ns Inc. Address: 4 Putnam Ave. , Brewster Signature: Date: 5/28/98 co , White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY OF DANBVRy CT Curt: PH 4404 39 -3 } na; PLAIN ROAD - DANBURY, CT 06811. NYiCert: 11471 (263) 745 -7903 - FAX (203) 748 -0652 LABORwwACx REPORT -- WAFER buiric 'Y TESTING RLrP01d1T'0: F.F. 9EAL & SONS DATE SAMPLE COLLECTED: 5/28/98 4 PUTNAIM AVENUE TIME COLLECTED: 730 A.M. BREWSTER,.N.Y. 10509 COLLECTED BY: PERRY BEAL DATE RECEIVED Qa LAB: 5/28/98 TESTED BY: LAB# 11471 REPORT DATE: 6/1/98 LOT #4, SADDLE RIDGE HOME, SHAWE VALLEY ESTATES, IGE POND ROAD, BREWSTER, N.Y. 4"ET WELL -NEW N NE 12CdA 1 lraJUAN i ; TEST P>81? RM D RESULT: MAXIMUM CONTAMINANT I VEL BACTER�4: Total 1,C61iform (Bacteria) 0 per 100 ml 0 per 100 ml pHYSICi�i;,Si � ' plat 7.55 no designated limit Turbidity 1.4 NTUs 5 NTUs CHENIISTRY.: Nitrite N <0.01 mg/L as N 1 mg/L as N i Nitrate N <0.50 mgt as N 10 mg/L as N Alkalinity 115.0 mg/L no designated limits Hardness, 146.0 mg/L no desig>ated limits Iron 0.065 mg/L 0.30 mg/L i M as ese mgtL 0.30 mglL • . - ,[Notie:�C-ombined L- imit�fo - - n . lug. Manganese = 0.50 mg/L] Sodium 6.9 mg/L 20 mg;V* ` Lead <0.005 mg/L 0.015' ** ml °milliliter mg/L ° milliRru" per Liter ND ° none detected NTU —Units - Norf6cadae Lovel '* *Action Level RESULTS BASED ON S N[PLES SUBNIITTED:5 /28/98 (PER NEW TORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER Laboratory Director eNORj"HEAST 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 Client Name: P.F. DEAL & SONS Project Name: STANDARD ETL Sample Number: 186760jD Client I.D.: ICE POND RD OK8WSTER SALLDLE RIDGE HOMES Date Collected: 18'NAY'08 Matrix: 1 DrinkH20 Date Received: 18-MAY-98 Comments: Anal ysis Result Units Method Analyzed ABSENT ECOLI Remarks: Sample passes NYSDOH drinking water standards. ms Fullerton Avenue Newburgh, mY1oom Tel: (914)s62*u90 pxmwon��wwv�o pxx�1�s��1 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, NY 10512 Fax: 914 - 225 -2955 T0: ��Its , P6--- We are sending you X attached Shop drawings Specifications Plans No. of Copies LETTER OF TRANSMITTAL Date. ..._., e-e,. RE: 6N6vJS Cyr. l--oT L+ under separate cover, the following items: Prints Copy of letter Other: Descrintion S As-Lev) P" r-1 4D i'6E 6— t4zo 0 Wbc�'C`12_ �dIJAL. S� S y tzv J' � ua � -rte 1 =o•2N► These are transmitted: _ For approval- _ Approved as submitted _ As requested _ Returned for corrections _ For review /comment _ Resubmit copies for approval Submit _ copies for distribution REMARKS: Copies to: SIGNED: If enclosures are not as noted, kindly notify this office. i0 -09-97 08:44AM ' �,Y y !S, TV IF P02 A \ `1� ' 1 s If �, `� e� Q °�. T � 1, c � � A �R i �€ a n (' a ' a� • r , i' Grp q j�. i � h� �. `��Y 7 l�` 1� i '•�� f i @ �R i Y :I ��_ -� 1 . 1` � 6. 1 GUARANTEE OF SUBSURFACE SE WAGE TREATMENT SYSTEM Owner or Purchaser of Building !/ Building Corr. ructed by Location - Street Building Type Tax Mb Block Lot �vni- Village 1 wL ubdivision Name I--/- - - Subdivision Lot # .j 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" fofthc 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 _ sysfenn. 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 S Da. , - Year � � Signature: Ij l� ..�t �: Title*: L1 Gen ral Contractor (Ow e,�) S, ature a / / s � Corporation Name (if corporation) U Address: State ✓` `'�Zt' Zi` Corporation Name (if corporation) Address: State Zip Form GS-97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 15, 1998 Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Proposed Compliance: Stag's Creek Properties, Shawe Valley Lane, Lot 94 (T) Patterson, TM# 34 -5 -22.1 Dear Sir: BRUCE R. FOLEY Public Health Director Review of plans and oiher supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1) Please submit original laboratory results for water supply testing. Current codes do not allow the submission of photocopies. �2)_ -_.__ It.appears by the -well log record4haf -ihe' -well was hydrofracked.-- Please-be advised that well yields of less than 5 G.P.M. must be immediately reported to this Department. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve ly yours, , Robert Morris, P.E. RM-tn Public Health Engineer 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FTNAT. CTTF. TNCPVrTTnN Street Locaiion Town F'a.-fi'ef,,n,7 TM# 3 ,q -6 1. Sewage Svstem Area Date: x Inspected -by: Owner i�a tr1 S�,cc w e Permit # . -7 Subdivision Lot # 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 04 a. Septic tank size - 1,000 ........1,250 ......other ................ b. Septic tank installed level ............................................... - c. 10' minimum from foundation .......... ............................... d. Di tribtuion 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 ....................... ............................... i . Length required Length installed 2. Distance to watercourse measured f 2 a o F ......... J. Installed according to plan ........................ .......... 4. Slope of trench acceptable 1/16 - 1/32 " / k........ 5. 10 ft. from property line - 20 ft.- fo t' s.......... 6. Depth oft n <30 inches from s 7. Roo to d xpansion, 1 00 o ......................... 8. Si e o grave 3/4 -1%" di e r clean .................... 9. D p of ravel i e ch "minimum ................... 10. Pipe ends capped ... ................. ............................... 1. Size o aaumler� am er ................ ............................... 2. Ovelo arn 3. A i visual / w .... ......................... ............................... A ' 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. ouse ocated per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a7Well located as per approved plans . ............................... b. Distance from STS area measured +10 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 Form - COMMENTS s'a 0� 0 I�� J I!� IBM Iom IBM m e� �a Form - Ctlp' Z�Y1 �F Vc'h1 "f'O A ... .n ... .� .. � -a. a• .. ... ..��. a.. -.. _. .Y is .. C... v.. -.. .d.... -.. _.. a.. .. ..... _... wr .. ... a. .... �. .. +.. �. _ ....y .w, � a .. �.a r.1. d ... W. .. �. ... ....,.....w. .. ..�.. Fp'R7AM COt7Wf DBPARTl1GI�il' OF E0RALTH Dh" d Btvhn Seevtoea. Carmel. N if 1/612 Elsigilistsor to Provide Poll / �"�, en CER1f@LCATB OF S COMWEM M PZMW FOR SEWAGB D=PQW SYSTEM s� owe or V ®fie at— Ldi /" . Ta:'ll Block Owner /A/SYrrt Nis Date d Previoae Apprwd M1111118 Adiea KID # l Town TIP . R11, :;A. -�c�a _ 3111111108 Type Lot Are. L � Fm se—bn A-&- Li Dqptis Yoh m Nombw d Bes�000 Deai@I Flow G P D PC ® NoAdatlon b Regohvd When FN b completed Separate Sewerage sysion to Comm d JL.ZGeMon Saptic T,&1, mad 500 L F 2- W ( pE . A666011D t .' K61 ,G H To be.aaeattsicted b. y ' Addirm Water Sappb PdAo Sappy Fromm Addreae an X llrlvaee Sep* DrEed by 50 _ V56 Address o "r- WA WIG W l'iHl I li 10' D F . :L-A, cis 9�6 2QV► VeD 1 reprasant-.that.l am wholly and completely responsible for the design and location of the proposed system(s) ; 1) that the separate few dIs sal s Item above described will be constructed aa m shown on the approved amendment there to and in accordance with the standards, rules a regu ns o a County Department of HMRh% and that on completion thereof a - ceitifiicate of, Construction Compliance" satisfactory to the Commissioner of Healthwill be ' "mRted to the Oepartment,' ,and a written guarantee will be furnished the owner, his successors, hehs Or assigns by the bulkier, that said buildw will piece In good Operating condition any part of said sawage' disposal ,system during the per led of two (2) years immediately following thedate of the Imu- once of the awarat of. the Certificate of Construction Compliance of the or ina em or emirs thereto; 2) that the drilled well described above well be located as shoern on the approved plan and that old wall will a q ith iM standards. rules and regu TEns of the Putnam County Department of Health. Signed P� P.E. R.A. Address 1 lirN�►M G`'CSiA1 N(s 62. IV�v✓ uceLina No.t:r>� -! `T`�'� 'APPROVED FOR CONSTRUCTION: This approval expires two yyn rom hs date i unless construction of the uilding Ms been undertaken and is revocable for cause or mesa 00 amended or modified when cons _ ,Lr�Y' by the missioner of Health. Any change or alteration of Construction raaulres approved for disposal of •domaAk: sanit r' arid/ P ater supply only. Rev. Title .10'88 oats By (Mendel Pond 43 b 164 dries Cor;ers 62 7 1 to a of Ice "teinback Corners 60 o 0 Fi ners 62 HS OES 1\8 Brewster.. ol L; Pond ms L 312 51 312 bog DrOOK Reservoir V/ I Tree 0 in Brewst H E\ X Heights A 59 53 0 T, EN' 6 1 50 ter t" C111 4PI ` 1 N Ag, x4l ;a BOO S 6 ll,Qj ?OIWM tzsat 65 4mum, re" Lake JG `Charles4 1J Mount Ebo Corporate 65 late dice Old Southeast Church P .S FROM PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Apr. 15 1998 02:59PM PI MEMO 70: FROM: PUTNAM ENGPEERING, PLLC DATE: 4M5 1 RE: REQUEST FOR SSDS AS BUILT INSPECTION PROJECT TITLE: � Y�L LPT *� q STREET ADDRESS: �� I A,%M iCr-- PoNo Aa TOWN: Pi&°r i Ss>tlj - TAX MAP 22 -~ 5 . I �4 #: q PERMIT #: r 4 PLEASE NOTIFY THIS OFFICE AFTER YOUR INSPECTION AT (914) 225 -3060, IN ORDER FOR US TO NOTIFY THE CONTRACTORIOWNER THAT BACKFILLING THE SYSTEM MAY BEGIN. rilc"01022 V- 1�5 4"z� PV6 (sw -35c-) A.0 0 -5e -C-,J G� 6\/ To 1vl�sa ,ph1 b SS -ro LOT DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERA9IT # FALL LOCATION Street ddress �v�t� LA-� JG Town Village City Tax Grid Number -- - a*. . WELL OWNER Name Mail Address XPrivate O Public USE OF WELL 1 - primary 2 - secondary SIDENTIAL b BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify D INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT MW E)gpm /# O REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED EAM /EST. O TEST /OBSERVATION ® DEEPEN EXISTING WELL OF DAILY USAGE al ®:ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE WDRILLED ®DRIVEN ®DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: f+ -kju'F7 A!� :t � L�cy'C1�� Lot No. 'STATER WELL CONTRACTOR: Name TO 1&6 -21551 . Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: jJZA TOWN /VIL /CITY A- - DISTANCE TO- PROPERTY - -FROM: NEAREST WATER . MAIN : i - .. -� .. �'� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE "Sol f �N SEPARATE SHEET Q.I L c�5� —_? — (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 dr' g operations be contained on this property and in such.a m ner as not to degrade or r 'se cont 'nate surface or groundwater. Date of Issue:— 196f T Date of Expiration S 6 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller ... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of —FAM -54,1�bML Located at (T) t .b 1� Section J� Block Lot 22 Subdivision of Subdv. Lot # 4 Filed Map # 202- Date 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 in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145*or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigne P.E. , R.A. , # Address cAQ-1 L. L Telephone Very truly yours, Signed _ G%U Owner of Property D# e Address W es- N Y 10�i Town Telephone ". -, . .. - � � � :�-i�r •� � ��- _: _��:r -ter °�c�t '� � IEr >� � 1E�x �t � � � - �:.: �;1�:� � z� °� �t APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: E3Kt�iNS1' (� �-'J 2. Name of Project: S v�1 4L�— `"RTES 3. Location T /V /C: PAT7r=XSD1-J 4. ` Project Engineer: _f��TNa I G��l= �((46-n 5. Address: J492-GUa461Dk s � License Number: - -7 Phone: /Z- G. T e 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 Duality Review (SEOR)? Tyoe Status (Check One) Type I.. Exempt Type II. Unlisted X_ S. Is a Draft Environmental Impact Statement (DEIS) required? ............. I�0 9. Has DEIS been completed and found acceptable by Lead Agency? ........:.. NZ 1. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........ ............................... a 2. If so, have plans been submitted to such authorities? ................... S 3. Has preliminary approval been granted by such authorities? Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters S. If surface water discharge, what is the stream class designation ?........ 'J/A ,6. Waters index number (surface) ........... ............................... T. Is project located near a public water supply system? .................. S. If yes, name of water supply r` A Distance to water supplyi M!L-90 9. Is project site near a public sewage collection ar disposal system ?..... -n5VZ 4aaa•.a a 0. Name of sewage system N� Distance to sewage system 1. Date observed: q i 2-o l cJ S 23. Name of Health Inspector: f51u— 1+ED665S- BOO 4. Project design flow (gallons per day) ...... ............................... a 2. 15.''- I -s - State' Pollutant - Discharge- fl-imi -n-a -tion System (SPDES) Permit required ?.. !6. Has SPDES Application been submitted to local DEC Office? ................ N /Q !T. Is any porticri of this project located within a designated Town or State wetland? .............. ............................... .................. -- yF_S !8. Wetland ID Number .............................. N /A ?9. Is Wetland Permit required? .............. ............................... 1J t, Has application been made tee Town or Local DEC Office? .................. OVA 30. Does project require a DEC Stream Disturbance Permit? ................... NeD 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 or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazafdous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? .............:.YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... I 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15: slope? ........ 36. Tax Map ID Number ......................... ............................... .� 37. Approved Plans are to be returned to: Applicant X Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. 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 Hild0meanor pursuant to Section 210.45 of the Pena 1 Law. TITLES:. �A �UTnL�M NRI�I� cj IDs &z�r-aNaJ C0 I.:)s,,1 GA, � td's loSl2 SIGNATURES & OFFICIAL MAILING ADDRESS: DESIG,d DAM Sa c�- SUBSMACE SZq= DISPOSAL SMTEX NO. Caner 5 Of meted at (St:reet) I CE5 10� Ser- 5 Block ( in cii Cate ne merest . cross erect) ciW ► ty nom ' Watershed, G SO= P:..n TT_CN Pte?*? ==M TO BE SMm---,'T= ro= APPLIC -T ICNS Data of Pre-- scaking . 4 61 Date of Percolation Test S j ji g ROLE Naws-z—a a=K TL`s P CaI TICRV : SZ ?..n PE?ZD ^ _cat Run FJ.apse Depth to Water From W;--t--- Level- 17 Z� Tim Grour_d Surface In L*iches Soil Rate Stzj.- , -Stcn . min. Star -t. Stan Droo In 5"'V1I1 DrCD Inches I*:C?eS I.*1G:e5 4 5 2 I :34 2,oG *3 ZS 3 2: p -7 2 4c 3�5 25I i2 Yt 31 /`x.' 1 �• 2 4 5 1 2 A;02'fS : 1. "Tests to be repeated• at same depth until. approximately *equal soil rates are cbtained .at each per=laticn test hole. All.data to be submitted for review. 2. Uept-h • asuxene.nts to be irac a fran trip of hole. 2 = 32 : SZ ?..n 23 c;.-7 3 (:' 17 Z� 232 2�� ' . I 4 5 2 I :34 2,oG *3 ZS 3 2: p -7 2 4c 3�5 25I i2 Yt 31 /`x.' 1 �• 2 4 5 1 2 A;02'fS : 1. "Tests to be repeated• at same depth until. approximately *equal soil rates are cbtained .at each per=laticn test hole. All.data to be submitted for review. 2. Uept-h • asuxene.nts to be irac a fran trip of hole. TEST PIT DATA BE SUEMITTEa WITS APPLICATION DEPTH gpLE "NO: ., _ fiOLE =N0: �... e_ 2.:.:: _ -Ec G.L. 2' 3' Al 5' 6' 7' 8' G•W1► 9' - 10' 12' 13' 141 INDICATE LE' rJ:� PS Wr � C-� IS F,fiDG�''Ii.'�M �r JN-DIC =E LE%M TD WEICE �t�` � L-= RISES A= FENi G DEEP BOLE OBS �RVA -TI CvS V-30E BY: C,dT CA , M L - NYGrn e-P :13i4 - P414 PDp.r • g g-P 'j 5 DES IQ i � S� Soil Rate Used ( Min/1° Droo: S.D. Usable Ares. Provided No. of Bdiroans Septic Tank Carzcity gals . Tyre Absorption Area Provided BY L.F. x 2a" width trench Other Rojo, Naze j_ j ►`w Signature' Pddress 102 A-116 SEA r. � �rzm el, 7 FOp 744 THIS SPACE FOR USE BY E=H DEPARL',=- CN--rY: Soil Rate Aoproved. sq_ft /gal. - Checked by -- Date \ Re: \ \ \ nfF \ or b \ \ \ \ I \\ \\ \ \ \\ rP\ \\ \ \ \ \1 11 I I \ \\ \ \ \ \ \ \ 1 I I SIT - r+ i L, #4 \ \ \\ \\ \\ \ AC.± \ \ \ \ \ \ \\ \ I II I I II I I L \\ I 150.00, J� 1W cn Lo r CP 5,0, 6,0, 'Oz.. J� 1W cn ;4 v= r'y i is r; ?.r Y' I� ,j �i iA aS '.I •s 1 _ 'I l •l Putnam Coimtg Departmeut of Health Division oP Environmental Health Servioes ApExm".d. a noted. for. oonformanae �lttl laze > - It'Ok , and r%triLlationd oP.th$ lIxIalt."t Dop=tm L ignatur@ dl TBtke AS -BU I LT N(EASUREMF-NTS ( IN FEI= r) . 2 6 -7 g q Ip: 1I, 12 L 14 15 16 11 j'l2 P��. 9� i.f Lt8' /z 12� i3c'/i`, l07 122'/2 13G /Z 15�i 1 2 12� f33�i '1 _38 A } 76 ' 74. b1 '97k . Io8 . III i2n I I4 . 126. 42 i 1 :3' qS ka5. i 12 122 13 ►. /? S J 55D5`' PREPARED FOR , �'P�;6'S G ft2�P6Kt1�S i� OF OE9GRIPTION. 5, AM „VALLE"( E5TATE5' . -. 7. LO I W4 .. .. . i 7Hi9NE' " Y' F�LE 1 ,LANE, TAX MAP 34 BLOGK —OT 4} TOWN OP PP.TTER50N _.., _ .. � '} i �.ISt s ,�. . -d \ r N� � t .A C..- .>,:S. rrJ:. i..t.: •..... ., Y .. .. sr