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HomeMy WebLinkAbout1584DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -22.25 BOX 15 r Low, i * i '� ,* ... , 4. JLLk 01584 PUTNAM COUNTY DEPARTMENT OF HEALTH _ ..,5;04�T.. , F ENVIRONMEN_ TAL HEALTF� CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #E_ p— I Located at SH&Wr_:- Y ALL Owner /Applicant Name 6TAC- ; C, ;W 1 4:�e, I NG Formerly FAeM S H,& W C Mailing Address ° SAD" 91 D(C-- Town or Village _F4- ., �-- Tax Map Blockr.>' Lot 22. Subdivision Name S 4&Wr-- V E5T41"915 Subd. Lot # Date Construction Permit Issued by PCHD 15 % Zip��� Separate Sewerage System built bysADftJ_: l�tDG Ho f-c, Address 16 Stirs �' iDg--' P-9 R o LM F—S ns H 1 L-s v-1 Consisting of 2�J� Gallon Septic Tank and rJ (� LE ©E e2-' WIRS Other Requirements: Water Supply: Public Supply From. Address or: Private Supply Drilled by Addressi PbfN•snwA<-_ 69ENS- .YL, _Building..TypeL SI- tJ6LI5,� .F/� , I►AA...... —Has erosion control been completed ? - - 7��- - ..._.......:. _.._ ..:... Number of Bedrooms Has garbage grinder been installed? N I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance wi the i CHD Construction Permit and approved plans and the standards, rules and regulati s ounty Dep ent of Health. Date: l l l _ Certified by P.E., pLyi '&M EN6't�1 ��Pl.LC(Desip Professional) Address(OZ 6tf�-f"1DQ *A-- e_t,-& y0_ i 2 License # Co] 4�w 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 revoca ' , modification or change is necessary. j By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 b PUTNAM .ENGINEER I NG9 F LLC 102 tGleneida Avenue Oaarmefl9 New York 10512 Date.- 914- 225°3 060 Faro 914 - 225 -2955 o To: FosEi'i mee g4s c ,m Il � 19I9-7 t,37' LoT WIE ARE S ENDVIcG YOU L Attached _ Under separate cover via the following items: —, Shop drawings _. Prints I Plans _ Copy of letter _ Change order Conies Date loo Samples _ Specifications Descirintio n # THESE ARIE TRANSMIMD as checked below: _ For approval _ Approved as submitted _ Resubmit _ copies for approval _ For your use — Approved as noted v Submit _ copies for distribution As requested _ Returned for corrections — Return _ corrected prints For review and comment i Other _ FOR BIDS DUE , 19,_ PRINTS RETURNED AFTER LOAN TO US c �.a COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. i° / -i i SGbs As.- I WALL LADG 13AcT T-G�' C�nlS�j�UG�lc�.11°Ll/�lG� �(LVl/L THESE ARIE TRANSMIMD as checked below: _ For approval _ Approved as submitted _ Resubmit _ copies for approval _ For your use — Approved as noted v Submit _ copies for distribution As requested _ Returned for corrections — Return _ corrected prints For review and comment i Other _ FOR BIDS DUE , 19,_ PRINTS RETURNED AFTER LOAN TO US c �.a COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. 110 -09 -97 08:44AM P02 PUTNAM COUNTY DEPARTMENT OF HEALTH - - HEALTH SERVICES DIVISION OJ N IROoMEoT I -- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building j1 I Building Constructed by S Ng U L- L.,),4 2- Location • Street Tax Map Block Lot Pa e -Pi- s 6t4 Town/ViIlage s IH #W � IIIQLE_� E.51T Subdivision Name ry7l, Building ype 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. Dated: Month, Day 4 Year snap General Contractor (Owner) - Signature g Signature: I SOt)L P. s N Eqb TAX Corporation Name (if corporation) Corporation Name (if corporation) Address: %�-D� 1 �Cr Address: / L. Ro HoL State d� S A Zip 6-3) State Zip 3� Form GS-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 07 ENVIRONMENTAL IEI[IEALTIH[ SERVICES WELL COMPLETION REPORT Wel➢ ]Loci4nonn ' Street Address: - ' Ice Pond. Road Town/Village: Brewster, NY Tax Grid Map tIBlock 01-1,10t(s) 5 Well Owner: Name: Address: Saddle Ridge Homes, Inc. , 15 Saddle Ridge Rd, Holmes, NY 12531 Use of Well: A- pri>mnary 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 __L Pumped g Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface- static (specify ft) overflows During yield test(ft) 400' Depth of completed well in feet 470' 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 13 Drillin in ove urden clay and boulders 13 Hit rock at 13' _:......:.13....._ ..._.31..- _ .: Drillin d-iri -rock - - set- casin . o . e. -_ - _....._....... 31 470 Drillind in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5�, m Depth 420' Model 5GS07412 Voltage 230 BP 3/4 Tank Type WX #250 Volume dal e Date Well Completed 8/8/97 Putnam County Certification No. Date of Report 10/20/97 W I r a ) 1 m Jr. NUT E: Exact location of well with distances to at least two permanent lanamarxs to ce provmea on a separate sneeuptan. Well Drillees Name Fo ea . Sons In . Address: 4 Putnam Avenue, Brewster, NY Signature: WY Date: 10/20/97 10509 Malcom T. Beal, Jr. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 RTH AMERICAN LAB. -0RI.ESj,-INC..,-, RAT CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 97 -6262 CLIENT: P F Beal & Sons 4 Putnam Ave Brewster NY 10509- . SAMPLING LOCATION: Saddle Ridge Homes, 5 Shau,,e Valley Est, Brewster COLLECTED BY: MTB DATE COLLECTED: 10/09/97 TIME COLLECTED: 11:30 AM DATE RECEIVED: 10/09/97 DATE OF REPORT: 10/14/97 ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent E. Coli Absent Must be "Absent' SM18(9223) 10/09/97 Must be "Absent' SM18(9223) 10/09/97 - - - fhis- sample; -as -subm tted-to--the•laboratoiy;-and as compared to the New -York State limits- for drinking water quality for the tests performed, was: ✓ ACCEPTABLE. _ NOT ACCEPTABLE. Richard W. Emerich, Laboratory Director NYS ELAP #11218 CT Lab Approval #PH -0171 *Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 -278 -7600 / Fax 914- 278 -7754 / E -mail: NoAmLab @aol.com a t ��r✓ P[ TIMM COUNTY DBPARIII MT OF EM"TH r Dbl" d EnAOMMasfal Held& Seevbm Cmmel. N.Y. 10512 ziigbew to PMvW PeaotY w CRRTRWATR OF CO C8 Potmk / — NSitUCMN > FOR 86WAfH; DLW OBAI. SYSIMM Imraaa ad �ki7�tN'� V11" 0A "f T(�Y 7` stih . oaNdAppilaattt Nt�e �A�n S���E Renewal_❑ > ❑ Date of Ptevlou. Approval MOM Ad *eve � � Town �S�L' � MP O Type 5 ! u&L6 fpm l Imt Are. - :J , 043.1 A G gpl Sectlan pnh Deem Yall.me Ntmber of Bedlooma Dear Flow G P D ) PCHD No tmdon Is Required When FM In comykted Separate Sewenye Sydm to aeialat d Z d SW& Tank -ad SO �-� 2f W'D9 AID- 'KM150 1 TKV,14Gd Te be eanatfuded by JD ,Wdrwe Water 54*z Pub& SW* From Addeeaa an X_Pdvab Sw* DrMed by 0 56 OCT A as Otber 1i emmbTKC-Acl t%5� Id 04 - 00al2 I(o' REMoy- Sr04r, WALL 's W likil M /01 OF !Z09 1 represent'.that 1 am wholly and completely responsible for the design and location of the proposed system(s)i 1) that the aeporats aawaga db�osal�rstem 000 above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and raguwtrons of -tm rutnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Hwlthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, fairs or assigns by the builder, that said builder will place in good operating condition any part of nld aawaga disposal system during the knd of two (2) yews Immediately following the date of the i n - once of the approval of the Certificate of Construction Compliance of the or 1 or a pairs therato; 2) that the drilled well described above will be located as shown on the approved plan and that laid well will be In of wi the standards, rules and raqu a�T Wn of the Putnam County Depart nnant of Health. Date &ML S,iig�nled ►,A�1 (—,fl P.E. � R.A. Address�uT�M • �~� �b� A� C*4W' - �� csnsa No APPROVED FOR CONSTRUCTION: This approval expires two y�rs fro the date construction of the building .has bean undertaken and Is revocable for au or be amended or modified when consid ry by on, of Health. Any change alteration of construction raouires a new' mil." AO oved for disposal of domestIc san , e ate, supply only Rev. 1088 veto `S ear Title APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- �. . WAIER_SUPPI1t,di:.S.U_BSiJItACE_,.5lldMGE_IDISPOSA- g- .SYS'I'E1bQS;..,;. .- REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER�y� BY B. HEDGES R.MORRIS OTHER DATE_ / 0/ 14�TAX MAP # DOCUMENTS. Y I ERMIT APPLICATION VC -1 LL PERMIT ED PWS LETTER INEERS AUTHORIZATION ESIGN DATA SHEET(DDS) CORPORATE RESOLUTION M PLANS THREE SETS M HOUSE PLANS - TWO SETS M VARIANCE REQUEST SUBDIVISION M LEGAL SUBDMSION CD SUBDIVISION APPR PWAL CHECKED m PERC RATE Al CIJ FILL REQUIRED DEPTH CD CURTAIN DRAIN REQUIRED mSTANDPIPES GENERAL 11EX- APPROVAL SSDS ADJ. LOTS ETLAND ( TOWN/DEC PERMIT REQ? ) DATA ON DDS PLANS & PERMIT SAME PRE- 1969 - NEIGHBOR NOTIFIFICATION 100 YR. FLOOD ELEVATION ' REQUIRED DETAILS ON PLANS 'SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE m GRAVITY FLOW CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS Y EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE F PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S W/IN 200 FT. OFTROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W/CLEANOUT '' FILL SYSTEMS CLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED _� Y M60 FT MAX 'PARALLEL TO CONTOURS 100% EXPANBION`PR©VIDED-.°_..._. ......_... 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS Ei 15' WELL TO P.L 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) TWO -FOOT CONTOURS EXISTING & PROPOSED VJ-J 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER DRIVEWAY & SLOPES CUT K200 0' TO WATER LINE (PITS -20') FOOTING /GUTTER/CURTAIN DRAINS 0' INTERMITTENT DRAINAGE COURSE EROSION CONTROL; HOUSE,WELL, SSDS FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE 5' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% PFRC & DEEP HOLES LOCATED L-Y-J 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. P SENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK . kOCATION MAP =I O' FROM FOUNDATION; 50' TO WELL COMMENTS: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 .- ..,.. ,..: -,,.: - APPLICATI .ON:..:TO'..CONSTRUCT "- A• • WATER WELT' :.:% -1: PCHD PERMIT # WELL LOCATION Street Address Town/ Village City Tax Grid Number - 2� , WELL OWNER Name f,-_ ail' Address b .Private O Public USE OF WELL 1 - primary 2- secondary ,RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION 0 INSTITUTIONAL 0 STAND -BY 0 ABANDONED 0 OTHER (specify p AMOUNT OF USE YIELD SOUGHT MI tJ S gpm /# PEOPLE SERVED ( FA^ /EST. OF DAILY USAGE_100 gal REASON FOR DRILLING E3 REPLACE EXISTING SUPPLY WNEW SUPPLY NEW DWELLING O TEST /OBSERVATION 12-ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DUG GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ ✓� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - 5 H Aw f- JAU - fje�[65 Lot No. WATER WELL CONTRACTOR: Name I D T5F! L, . Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: J� TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:. -. M I C LOCATION SKET & SOURCES OF CONTAMINATION PROVIDE ON SEPARATE SHEET AA P9 I L !A; P I q P:_ 17 (date) (signatu 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 thirt}• (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 drilk ng operations be contained on this property and in suc a manner as not to de rade or of r i con inate surface or groundwater. Date of Issue: 1 I 19 �f" Date of Expiratio ! 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 f p ! THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTEcrioH JOEL A. MIELE, SR., P.E. Commissioner Fti`�QO PRO ENT ^I. WILLIAM N. STASIUK, P.E.,Ph.D. .. N'N PHONE (914) 742 -2001 FAX (914) 742 -2027 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Re: Shawe Valley Estates - Lot 5 Patterson, Putnam County Log # 7016 East Branch Reservoir Dear Mr. Hurley, Bureau of Water Supply, Quality and Protection May 29, 1997 The New York City Department of Environmental" Protection (NYCDEP) received the . following materials on May 9, 1997: 0 Putnam County Department of Healths data sheets; Subsurface Sewage Disposal System, Drawing S -1, dated April 1997. While the separation distances to SSTS and wells on the subdivision lots are noted, please add the location-of SSTS and wells on adjacent properties. If there area no SSTS or wells wits yin 200 feet of the property line then please note this on the plan. Include NYCDEP in Note 6, or provide a similar note regarding NYCDEP inspection of the SSTS. Please revise the drawing to reflect the 10 foot separation distance required between the absorption field and the property line. In some areas it is shown as 7 feet separation. The required horizontal separation distance from a well to the septic tank and effluent line to distribution box is 50 feet. Please revise accordingly. Also, assuming that the seepage pit shown on the plan serves as a drywell, the horizontal separation distance from the dwelling should be 20 feet and not 10 feet as shown on the plan. It is difficult to determine whether the invert of the inlet is 2 inches above the invert of the outlet. 465 Columbus Avenue, Valhalla, New York 10595 -1336 Mr. Ken Hurley Page 2 of 2 RE: Shawe Valley Estates - Lot 5 May 29, 1997 Please revise the absorption trench detail to show 6 inches minimum of backfill above the geotextile filter fabric. Revise the distribution box detail to show a maximum of 12 inches backfill above the distribution box. Please revise the detail or add a note explaining that there are 9 outlets and others will be plugged. Inlet and outlet baffles shall extend a minimum of 16 inches and 18 inches, respectively, below the liquid level in tanks with a liquid depth greater than 40 inches. The detail shows the inlet baffle extending 13 inches below the liquid level. Please revise. Specify type of pipe and size to be used as effluent line from septic tank to distribution box. Your attention to the above mentioned is.appreciated. If you have any questions, please contact the undersigned at (914) 742 -2068. Sincerely, Jannine M. McColgan Staff Engineer Engineering Design & Review xc: Putnam County Department of Health 465 Columbus Avenue, Valhalla, New York 10595 -1336 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES T INAL SITE INSPECTION Date: Inspected by : S:ed Street Location Owner �iS%h2 Town A iso- -- Permit # TM # 3 `1> - - _a a . / Subdivision Lot #. 1. SeWage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ......( ,25 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost ....................................................... 3. Minimum 2 ft.Original soil between box & trenches. e. Junction Box - properly set ......................................... f. Trenches T. length required s� Length installed s0� 2. Distance to watercourse measured �Ft.. �. 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ ......... 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......::.......... - -1.9. -Pipe ends - capped :........ ............................... ................. g. PumR or Dosed Systems Size o pump chamber ................ .......... :.................... 2. Overflow tank...... ...... .. .:....................:. .............:......... 3. Alarm, visual / audio ........................ ............................. 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. ouse located per approved plans ............. �. ..... b. Number of bedrooms .................. ................ ........ .. ........ IV. Well a. Well located as per approved plans ....................... b. Distance from STS area measured ft.�5.. c. Casing 18" above grade ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. ............1)::. . ...: ............... b. All pipes partially backfilled ..:........ ............................... c. All pipes flush with inside of box ... ..........................:.... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 F,.,.,., rr_1 PC C O.0 NTY .... x) - _.z. .. _.,.._. ... - ..�..., r ... APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: FPM. -�Y�i✓ . J< D� EPa=NSTF=,2 i \jy 2. Name of Project: S vc/ J,� y Cam'(- .dTE.5 3. Location T /V /C: aTTrXSdtl 4. ` Project Engineer: ���TNQ M IGIN�L��I4G 5. Address: Gi l NY 10512 License Number: ��� +� Phone: 225 -304010 6. X Private/Residential of Project: 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)? Tyoe Status (Check One) Type I.. Exempt Type II. Unlisted _ X 8. Is a Draft Environmental Impact Statement'(DEIS) required? ............. No 9. Has DEIS been completed and found acceptable by Lead Agency? ........... IJ�i4 .-O Name .o.f. Lead. - _ _ ... ....__ _. _ - _ ...... ......._ _ _ . . . ...... .Agency 1. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... S. 2. If so, have plans been submitted to such authorities? S 3. Has preliminary approval been granted by such authorities? y�5. Date Granted: 4. Type of Sewage. Disposal System Discharge...... Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 1J A 5. Waters index number (surface) ........................................ N�Q T. Is project located near a public water supply system? 9. If yes, name of water supply 1JA .................. -0",J Distance to water supplyl M= i. Is project site near a public sewage collection or disposal system ?..... NO- ). Name of sewage system N1. ellegr Tli►.J Distance to sewage system IM4 I. Date observed: 9 1 20 1 c S 23. Name of Health Inspector: E51u— 4ED665s 1. Project design flow (gallons per day) ....... . .............................. E500 2, -�.5. IsStAti- .Pa..1.1utant. Discha ge...El.iad0at.1on ys_tem, (SPDES)_Permit _required? �o !6. Has SPOES Application been submitted to local DEC Office? !T, Is any portion of this project located within a designated Town or State wetland? .................................. ............................... y L-V-rs !S, Wetland ID Number ..... .....:....... ............................... .... N l,, !9. Is Wetland Permit required? .............< ,.............................. No Has application been made tc Town,or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... . 11. 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 12. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or + any other potential known source of contamination? .............. YES or NO DESCRIBE: 13. Is there a local master plan or file with the Tcwn or Village? ........... 14. Are community water, sewer facilities planned to be developed within 15 years? 15.1 Are any sewage disposal areas in excess of 15. slope? . ...................... 16. Tax Map ID Number ......................... ............................... 17. Approved Plans are to be returned to: ................ Applicant X Engineer :f 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 irovision 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 ny knowledge and belief. False statements made herein are punishable as a Class A Hildfmeanor pursuant to Section 210.43 of the Penal Law. TITLES: 1 A� �l �-'V`� �UT ►Jl�l� I D L &L4_51146-J DA SIGNATURES & OFFICIAL (AILING ADDRESS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date— Re : Property of Located at VAtAa"� (T) FA /,-1 Section Subdivision ofV�1� Subdv. Lot # Filed kbp Gentlemen: Block '�E> Lot 22 Date 2-/'Z 1 / I This letter is to authorize 1" (. 7i**- I rL:L 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' iri'"corfb'rinity with the provisions of Article 145- or 147, Education Law, tary Code. osOFNEW Countersigned? P.E., R.A., # lic Health Law, and the Putnam County Sani- X02 S1 Address Telephone Very truly yours, Signed a,,4, " _ JLV--e� Owner of Property Address W � N Y Ie�i Town Telephone - • r• �� � na- • � is a a�►• r: � • �• �i a �- � • �a w• :��r• r: -+a tea. DESIG,y DAM S - -SUBSUFACE Sr -3s-- DISPOSAL SYSTEM FILE NO. owner S1-- F1sv�� �%,dt.t_�y" �ESr. Address � � $ ��K , I`ty loSocl Lute at (S trLet) C� Fe -j l Se:.-. Hlock S L. 22 - ina -eate ne;rest.cross s',rat) - zu :cipali ty Watershed G�1Z� �► SOIL F C MA=CN =T DX—rk R== TO HE SIIEWr1=1 W= APP_,1CICICNS Bate of PrL•- Staking • 41301,q lv Date of Percolation Test SOLE NL3S-r_-� a= T -C. Fa ri Elamse No. TiMe S tar',. -S tC'D Min. P —TION P RCOU.1 -71 CN Depth to Hater Fran Grour_d Surface Start- S tolo W2tL_* Level In L*iczes Droo In Soil Rate M -in/IA Drop L*!Gfl?5 L*:cu?e5' L*:ches 1Z' 5& -z.`} 2 I: 3(1 1 t 57 21 2 3 ZS 3i� 3/ S 3• -1 3 2 �c� •2 � Io l 0 2� 2� 3 �.3 4 5 2 1.3�, .08 30 1./� 2 , 3 2; l 0 24 I/ 2� / 2 3• Z 4 5 ' 1 ' 2 3 IJO'I'ES 1. Tests to be repeated: at same depth until apprcxi.mately equal soil rates are obtained .at each percolation test hole. All. data to' be submittal for review. 2. Depth , ements to be made fray top of hole. r DFPTi -BOLE- N0: -.BOLE . NO. - .. _. G. L. 21 Al S' 61 71 81 91 101 11 121 131 LN+DIC,=_ LEVEL AT WHIal G_= ' t v IS Riff, ,Giv'Zi"M 1 + L��IC -T� LE�Jr TO W' -C N�Tll-_R L•EVr-'L. , ;RISC ALA EMG El9X0Zv'J_=- NIA DEEP SOLE OBSrlW7 rTcNS LAZE BY: GAT , MIL — M`✓Gr���. j314- P414pDA=: DES IGI Soil Rate Used S Min/I" Drop: S.D. Usable Area Provided Sr No. of Bedroams 4 Septic Tank Capacity 1 Z gals. Tyre Go�G Absorption Area Provided By SAO L.F. x 2411 width trench Other Nacre _ i�c_ J r� (JG (1��11�i Ca Sigrature THIS SPACE FOR USE BY F=H DEPAFcI =- CNILY: Soil Rate Aoorcved sq. ft /ga. Check by Date i� i _ iii_ � �o ............................. �o A5 ®5U I LT MEASUREMENTS( N FEET ) Putnam County r4_.�� :.. tMemt ��° Health Division.:;_' Eealth Services kppruvC.'" , �° _.- c:�;.-n-formuanee with app G ;::;.F. of the tla iJ-�psrtmen 4�L _ .. .'. 'i i n Pate 5- BUILT: -di This is to certify that the sewage disposal system was constructed as indicated on this plan and that the system was inspected by °utnam, Engineering, F.L.L.G. before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Futnarn County Dap artment of Health and the New York State, epartment of Health. The SSD5 consists of the following 1250 gallon precast concrete septic tank, 15I1 I.F. of 24" wide absorption trench , additional reopirernents: 55D5 FREFARED FOR: �,4G'1, C-izee<- ft-P. I r-iz: , SADDLE RIDGE HOMES SHANE VALLEY E5TATE5 LOT *5 5HAY4E VALLEY LANE gipX01-0, � G D 2 5 4 A 5 113 �2 1-25 � j 91 �-3 7 10 �4�2 Putnam County r4_.�� :.. tMemt ��° Health Division.:;_' Eealth Services kppruvC.'" , �° _.- c:�;.-n-formuanee with app G ;::;.F. of the tla iJ-�psrtmen 4�L _ .. .'. 'i i n Pate 5- BUILT: -di This is to certify that the sewage disposal system was constructed as indicated on this plan and that the system was inspected by °utnam, Engineering, F.L.L.G. before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Futnarn County Dap artment of Health and the New York State, epartment of Health. The SSD5 consists of the following 1250 gallon precast concrete septic tank, 15I1 I.F. of 24" wide absorption trench , additional reopirernents: 55D5 FREFARED FOR: �,4G'1, C-izee<- ft-P. I r-iz: , SADDLE RIDGE HOMES SHANE VALLEY E5TATE5 LOT *5 5HAY4E VALLEY LANE gipX01-0, �