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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-5-22.26 BOX 15 01585 0 , , , r SW x; Ir �Qml . ' '� 01585 ,._..,...,riv,ve......,.. .. .,.. .. r. -.. .. .; - . ...,. .,..... .,. -. >�:.. � r .. ,�� ... .. ..na^ y- tw �. -em-- . �""^tW'C"'•i".�- ?ti:, —•.�.. rt+.`>^...:v� PUTNAM COUNTY DEPARTMENT OF HEALTH _ . DIVISION OF-.ENVIRONMENTAL HEALTH .$IZCES.;._.., .. , CERTIFICATE OF CONSTRUCTIONN COMPLIANCE FOR SEWAGE T STEM PCHD CONSTRUCTION PERMIT #P- - I 4:: cI - Located at SAawrs LA f-is Town or Villa g e �aTT�- YLSp�I Owner /Applicant NamGom r®r`ISK-F�►? Tax Map Block Lot 22- - I C(°� Formerly Subdivision Name SP,,fuv4C-- VAUUN i�S'fa'T Subd. Lot # �p Mailing Address 22 \1tiLAn LA-IJS Zip -&L �e'7 Date Construction Permit Issued by PCHD � J 30 1i Separate Sewerage System built by SR14 LAN09:AA W., 1KC- Address 2 SeC)Dr s rz roc, . R2. P Consisting of 2 � Gallon Septic Tank and (P22 � c�� 2 y`r D� A,BS `15,9- 17K�� H Other Requirements: j o-t.4 ,r-- r Lo rJ D-X w/ CAtf!l=(� Water Supply: Public Supply From Address. or: Private Supply Drilled by 1 � g L SO�.I s Address bluer W ST L-)9- -• . Building- Type i Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? O 1, certify that the system(s), as listed, serving the above premises wer structed essentially as shown on the as- '3' t' (copies of which are attached), in acco with issued P Construction Permit and approved 'Plans and the standards, rules ons of County De ent of Health. Date: �'(� Certified by P.E. R.A. Address (oz c-sL r4 e r DA .a- License # 6C,' � +- 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, d' cation ange is necessary. 1 p By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 t^' PUTNAM ENGINEERING, PLLC LETTER OF TRANSMITTAL 102 Gleneida Avenue Carmel, NY 105.12 Date: 914- 225 -3060 _ .:Fax:. --914. 225 -2955 - ..... _...... _ . _.:.._, RE: SNwJE v'att.p: _.. We are sending you attached under separate cover, the following items: Shop drawings 7` Prints Specifications Copy of letter Plans Other: No. of Copies I Description c'7MRT I F1 411 ys I OF CBNScT tom. b L 3 l=— LoG Q� WAzt cs-y2_ These are transmitted: For approval _ Approved as submitted For your use Approved as noted _ As requested — Returned for corrections For review /comment — Resubmit copies for approval — Submit _ copies for distribution REMARKS: s 15� M t�s Pt_Ac,es o 'BV �:Imrf2_ ma c = c c.e✓ . OF - e7yz- ,dt-4�t,gS t S W I TH THL RCSuL T' . "� Gl.t tic- �ROf�P�t� "C! -l1✓ 81e.(� r r L e -TV I F 'it�y T om, u c a� r� rz e L —PaLf" AT L b 1 Copies to: SIGNED: k4e— H if enclosures are not as noted, kindly notify this office. i.. 4 PUTNAM AVENUE i N V U 1 L E Y� 9REWSTE R, NEW YORK 10509: " 'Established 1891 -Over 12,000 Wells Completed (914) 279 -2460 - 2461 -- invoice Number: 025285 _ ARTESIAN WELLS e WATER SYSTEMS ,�.. linvoice .11ate:`.11 /02/98 sr, age. 1 -.7 TnOMAS OUNSKA :,S1Tk SHAWS �V,4LLEY To: ftMI" AVE' ) c'`,, ICE FUND_ RD LOT #6 :.... ...:: em t I.D. ° °`� 015505 s ° For your cone %ience, w e will accept MasterCard, Visa, American Express, or Disc us your card number, expiration date, and authorized signature. 0 MasterCard 0 VISA 0 American Express 0 Discover 0 Other -- 'Perms ° . ° ° : NET 30 Subtotal: Y; Tax ° ° ° °.: Payments: 1 j. Total. 1 )R CHARGE INCLUDES TRAVEL TIME TO AND FROM JOB 5.G': 75-0- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location - lWellOwner: Street Address: _.Ice;Pond.:Rd,...Shawe =- Valley Town/Village: BreVSter_ _ = =; �: Tax Grid # Maps -,-; -Block- �- Lot(s)•:,6- Name: Address: Thomas W. Gonska, Root Avenue, Carmel, NY 10512 Use of Well: 1- primary 2- secondary x Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) 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_6_1 Yield in gpm Depth Data Measure from an surface- static (specify ft) 30' During yield test(ft) 260' Depth of completed well in feet 305' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface.. Water Bearing Well Diameter(in) Formation Description tit. ft. Land Surface 5 Drilliriz in burden cla y and boulders 5 Hit rTin t 51 5 31 Drilln r se s ' 31 3-05 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _Z-4a Depth 280' Model. 7GS07412 Voltage 230 HP 3/4 Tank Type 1jW50 Volume 44 Date Well Completed 8/15/98 Putnam County Certification No. 002 Date of Report 9/24/98 Weil r' re e 1 NOTE: t tact location of well with arstances to least two permanent tanamarKs to oe-provraea on a separate sneeuptan. Well Driller's Name ' P & S Inc. Address: 4 Pl Ayp -, Apr., NY JrFM Signature: Date: 9/14/98 Perry L. Bfitfl White copy: HD File; `Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION RPTORT Well Location Street Address: Ice Pond Rd, Shawe Valley Town/Village: Brewster Tax Grid # _ . ry Map Block Lot(s) 6 Well Owner: Name: Address: Thomas W. Gonska, Root Avenue, Carml, NY 10512 Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) 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: _ 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 _ Yet No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield _]Q gpm Depth Data Measurelrom land surface -static (specify ft) 30' During yield test(ft) 260' Depth of completed well in feet 305' Well Log If more detailed information descriptions or sieve analyses are avatla�le, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 5 Drillin in oveiburden clay and boulders 5 Hit r at 5' 5 31 Drillin in r se .- s - - 3 R If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 1� Depth 280' Model 7G 007412 Voltage 230 HP 3/4 Tank Type Thn50 Volume 44 Date Well Completed Putnam 8/15/98 County Certification No. 002 Date of Report 9/24/98 ;Well e r.1 riv a c: cxact rocarton or wets wrut atstances I'mast two permanent tanamarics to be prorKaea on a separate sheevptan. Well Drillees Name P & S Inc. Address: 4 FtrtrjEn Am.. Ba w+pr. w irgN Signature: Date: 9/14/98 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location - Street Address: Ices :Pond• = Rd -;• ,Shawe� Valley -_ Town/Village: --Brewster ,.�. Tax Grid # Map .. Block.:._ . Lo (s) 6 Well Owner: Name: Address: Thomas W. Gonska, Root Avenue, Carmel, NY 10512 Use of Well: 1 -primary 2- secondary x Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) 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: _ Cement grout _ Bentonite Other Drive shoe: * Yes _ No Liner Yes X No Screen Details Diameter (in) Slot Size Length(ft) I Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test . _ Bailed _X Pumped X Compressed Air Hours -6 —1 Yield gym Depth Data Measure from ans 30' - static (specify ft) During yield test(ft) 260' Depth of completed well in feet 305' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description fL ft. Land Surface 5 Drilling in burden clay* and boulders 5 Hit r at 51 5 31 Drillin in rd6, set c _ _ ... .._ ...... a. - ....... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7a�cm Depth 280, Model 7GS07412 Voltage 230 HP 3/4 Tank Type TnW50 Volume 44 Date Well Completed 8/15/98 Putnam County Certification No. 002 Date of Report 9/24/98 Well re 1 NUTL: hxact location of well with distances to y least two permanent IanamarKS to oe prowtaea on .a separate sneevptan. Well Driller's Name F Signature: _ Perry L. White copy: HD File; Address: irwy, Am., Rna&-tior, ►1 1 ISIS D. 9/14/98 ellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE ®F.SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tak Map Block Lot Building. Constructed by Town/Village Location - Street Subdivision Name 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 a& 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 .ainunediately 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, e Cept 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 . Year 9' Signat, n n i j- % r. Title: General Cgfifractor (Owner) - Signature Corporation Naive (if Corporation Name (if corporation) Address :. 91'flQ-E/6ddress: `,?- 5ADDc -ie7 State A ! y/ zip 3 State +�.t,% Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SE`?VAGE.TREATMENT SYSTEM�� s - nM, Ar5 lnO L Sr. A -;?4 5— 22.1 �c , Owner or Purchaser of Building Tax'Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name 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 Year. Signati Title: General C#ractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: - s / 1 -E4ddress: 5 ADDLZ R -14--YrE Zb State y 4 S Zip `— State V Zip /.-2S Form GS -97 i NORTHEAST LABORATORY of DANBURY 39 -3 BIML PLAN ROAD - DiNBVRY, CT 06811 03), 743. - 7903 .- ;FAZ.(203).743. -0652 .. ....... ate. _ _... �:. LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS A PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) CHEMISTRY: Sodium Lead CT Cert: PH -0404 MY Cert: 11471 DATE SAMPLE COLLECTED: 10 /9/98 11ME COLLECTED: 10:00 A.M. COLLECTED BY: R DeVALL DATE RECEIVED @ LAB: 10 /9/98 TESTED BY: LAB# 11471. &.11301 REPORT DATE: 10 /15/98 GONSKA, LOT #6, SHAWE VALLEY, BREWSTER, N.Y. HOSE BIB WELL NONE RESULT: 0 22.5* <0.005 ml = milliliter mg/L`= milligrams per Liter **Notification Level ** *Action Level N1AKIDVI1jM CONTAMINANT LEVEL per 100 ml 0 per 100 ml mg/L 20 mg/L ** mg/L 0.015* ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED-.10/9/98 SAMPLE, AS TESTED ABOVE: X�POTABLE . or POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director ®NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037® (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 a OUTSIDE CT: 800 -654 -1230 LABS ■ NORTHEAST LABORATORY of DANBURY 39 -3 MML PLAM ROAD - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0662 Cr Cert: PH -0404 NY Cert: 11471 ..-+x . e. \t:}.e J..... ♦ to F •. . -n..,,.... .. .... . - LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) E Coli (Bacteria) PHYSICALS: pH Turbidity CHEMISTRY: '.Nitrite N 11301 -Nitrate N Alkalinity .Hardness Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 9/25/98 !BE COLLECTED: 3:15 P.M. COLLECTED BY: JON SCOTT DATE RECEIVED @ LAB: 9/25/98 TESTED BY: LAB# 11471 & 11301 REPORT DATE: 9/29/98 GONSKA, LOT #6, SHAWE VALLEY, BREWSTER, N.Y. FAUCET WELL -NEW NONE RESULT: 10 per 100 ml NEGATIVE 6.62 37.0 0.02 0.36 68.0 132.0 —1-40 0.077 20.4 0.045*** NTUs mg/L as N mg/L as N mg/L mg/L mg/L mg/L mg/L mg/L MA)GMUM CONTAMINANT LEVEL 0 per 100 ml no designated limit 5 NTUs 1 mg/L as N 10. mg/L asN no designated limits no designated limits 0.30 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 20 mg/L ** 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units - Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:9/25 /98 SAMPLE, AS TESTED ABOVE: OPOTABLE or MINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) ' Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 a OUTSIDE CT: 800 -654 -1230 mI im DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York ..10509 Tel. (914) 278-6136 Fax (914) 278-7921 December 10, 1998 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 . Re: Propossed Compliance: Gonska Shawe Valley Lane, Lot #6 (T) Patterson, TM# 34 -5 -22.1 Dear Mr. Hurley: BRUCE R. FOLEY F b'lic'Nialt i °DirecloY Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1) Water results submitted is a photocopy. Current codes requires original documentation be submitted. _._.. .. _ . 2). The results for iron - exceeds current standards: It is,dvised.th�t.thesy tem_... �- -' is flushed and the water re- sampled. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Public Health Engineer RITSIM, TNAM COUNTY DEPARTMENT OF WEALTH rTIFICATE ION OF ENVIRONMENTAL HEALTH SERVICES OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PC UCTION PERMIT # Located at VA -LLIF-� L6&E: Town or Village Owner /Applicant Name -7nM_Cej D14!5�kA_ Tax Map '5'1- Block 5' Lot 69) Formerly Subdivision Name �AAW i,' VALJ FY I T T Subd. Lot # LP Mailing Address 2 Cv V A- L 1—F Zip • -- Date Construction Permit Issued by PCHD 4l3 D! W. GZ� Separate Sewerage System built by 5 a-�+ L�}/lJ7--44TPNf Tf�dress o- 5APoc -E 171 D&F- P-D. Consisting of Gallon Septic Tank and -r_z H S Other Requirements: -I-Qj L(-nc4 264 wA Water Supply: Public Supply From Address or: Private Supply Drilled by Xg f2 6AL–f SOit/lAddress �Pf(i1�ST� Bwlding:Type. s1.�1%girc/ L.�(__ . Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? �0 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 ed-P6 Construction Permit and approved plans and the standards, rules and regulations ounty Departm)nt of Health. Date: lslo4 Certified by �P&OVA PA FAIG IV Address P.E. X R.A. 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, modification or change is necessary. Ln Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 W -- - PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue LETTER OF TRANSMITTAL Carm4; NY..1051.2 914 - 225 -3060 Fax: 914- 225 -2955 RE: T"tyA A-S e-dc CSI�Ar A yclE� VA t_.t_. F Y L- OT'4,(o TO: 9QBEE7 -- /fin 9 P l5 dam. �u�`fl�lii°sM c-, ii FF(LTE -f Z Cll7T We are sending you I attached under separate cover, the following items: Shop drawings Specifications Plans Nn of C'nniPs Prints Copy of letter Other: Description ♦ V .G.LOI. .rA These are - transmitted: For approval _ Approved,as submitted _ For your use - _ Approved as noted ti _ As requested _ Returned for corrections For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: OV G ►.. ��C� �4 c�� L N°iAl.tJ.� '�l�1ry o rT• -N-% ORje.'iNaL W-roZ- au}sis (t4crT PcT. w L GS ) • -1744E LAM IS 'FMNAELPI C6 OP l6IN4Z, TO pV O��(t.� • 0 Po f4 -,�t1- W i t_L MG F-aw4 fz.D'EII i a VSVez Of F c Copies to: SIGNED: la-�, 64-Z'71-9 If enclosures are not as noted, kindly notify this office. s • a 1 i% NORTHEAST LABORATORY OP DAN BURY CT Cert: PH -0404 - 39 -3,`M r; P �t-RdAD - -DA'N iUkk; .,.. , . . LAW .� .. NY'Cert: 114'11 • (203) 748- 7903.- FAX (203) 748 -0652 LABORATORY REPORT WATER SUPPLY TESTING PORT TO: r P F BEAL & SONS DATE SAMPLE COLLECTED: 10 /9/98 ry4 P.UTNAM AVENUE TIME. COLLECTED' 10:00 A.M, } BREWSTER; N.Y. 10509 COLLECTED BY: R. DeVALL DATE RECEIVED @LAB: 10 /9/98 TESTED BY: LAB #11471 & 11301 ' REPORT,DATE:10 /15/98. `- SAMPLE. SITE: ' - GONSKA, LOT #6, SHAVVE VALLEY BREWSTER, N.Y. SAMPLING POINT: HOSE BIB 'SOURCE:' WELL ` TREATMENT: NONE TEST.PERFORMED RESULT:. MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total.Coliform (Bacteria) 0 per 100 ml 0 per 100 ml CHEMISTRY: ' Sodium _ - 22.5* * mg/L 20 mg/L ** Lead <0.005 mg/L 0.0f5***_. 1 ml milliliter mg/L'= milligrams per-Liter, ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED10 /9/98 SAMPLE, AS TESTED ABOVE: �X OTABLE or OT POTABLE PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)' Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 . f 1� Gonska NORTHEAST LABORATORY OF DANB'URY CT Cert: PH -0404 39- 3.,MmL -.P%..R0AD=.- DANBUity,4CT: 06811 (203) 748 -7903 - FAX (203) 748 -0652 (LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) . E Coli (Bacteria) PHYSICALS: pH Turbidity CHEMISTRY: DATE SAMPLE COLLECTED: 9/25/98 TIME COLLECTED: 3:15 P.M. COLLECTED BY: JON SCOTT DATE RECEIVED @ LAB: 9/25/98 TESTED BY: LAB# 11471 & 11301 REPORT (DATE: 9/29/98 GONSKA, LOT #6, SHAWE VALLEY, BREWSTER, N.Y. FAUCET WELL -NEW NONE RESULT: MAXIMUM CONTAMINANT LEVEL 10 per 100 ml 0 per 100 ml NEGATIVE 6.62 no designated limit 37.0 NTUs 5 NTUs Nitrite N 0.02 11301 -Nitrate N 0.36 Alkalinity 68.0 Hardness 132.0 - - --Iron 1.40 Manganese 0.077 Sodium 20.4 Lead 0.045*** ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L. no designated limits, mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015*** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED:9 /25/98 SAMPLE, AS TESTED ABOVE: OPOTABLE or MOT ]POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) ►lam, r�g,�s. Laboratory Director a *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037m (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARAA��'TE ��`vUB9URAC��WAG T`REATIVY1'I'`S"Y+STIVI V . -1lht,4 65 6fo 04 6- 2-2.1 Owner or Purchaser of Building Tax Map Block Lot S7- f4- FM- aD-61 Building Constructed by TownNillage Location - Street Subdivision Name s ` -� 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 - Year -, Signati Title: General Cq0actor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: S4 C ddress: 1.2 5AD0LZ R-/4Aa F7 RP Iq State 6L Z S Zip State Zip Form GS -97 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES N'I'EE- OF -SUBSURFACE -SE-WA_GE-' PJ AXTM1ENT SYSTEM :34 Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street S' 0 q Le 4 i Building ype OALLr`JZ�17;- Subdivision Name )_d A( G 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 --�e Year Signati Title: e ° I General CQractor (Owner) - Signature sRV re-, - - Corporation Name (if corporation) Corporation Name (if corporation) Address: = ddress: d� S V194-o5: ,e/lxa� �� vL/1'1 .. S State ,4 1 �J Zip 3 State Zip /.-253/ Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUAItIy'EEYOF�SiJBSURF�4C SEArE1TNiEi�ITYSYS'Ei�f ° . _...�;n .. Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name I v, q Le 40C 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. _ ._:....:......4__- . __ :.._.:.... . 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 -__3ff Year Signati n f) JE:] Title: General Cgiractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address:. SA C l - ddress: ��- SDD �lLYcr� �1� State �L Zip 3 State � V Zip /�1 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well! 2 tiow .:� = S - - - ,._r_,...— Map Block Lots) 6 Well Owner: N Name: Address: Thomas W. Gonska, Root Avenue, Carmel, NY 10512 Use of Well: x x Residential Public Supply Air cond/heat pump Irrigation Drilling Equipment X X Rotary Cable. percussion X Compressed air percussion Other (specify) Well Type S Screened Open end casing X Open hole in bedrock Other Casing Details L Total length 31 ft. M Materials: X Steel _ Plastic _ Other Joints: _ ^ Seal: _X_ Cement grout _ Bentonite Other Drive shoe: X Yes ! No L Liner _ Yes X No Screen Details F Diameter (in) S Slot Size L Length(ft) D Depth to Screen (ft) D Developed? First Y Yes—No Second H Well:Yield Test _ _ Bailed X Pumped X Compressed Air H Hours Y Yield 10 gpm Depth Data M Measure from land s ace - static (specify ft) D During yield test(ft) D Depth of completed well in feet Well Log D Depth From S Surface W Water W Well F Formation fft. f fft. B Land Surface 5 5 D Drillinz i in overburden c clay* and boulders 5 H Hit roc a at 5' 5 3 31 D Drillin . . -in .x-oc> , ,.set casi 7 z >c;l - 31 If yield was tested F Feet G Gallons Per Minute P Pump /Storage Tank Information Pump Type sub Capacity 79rz Date ell Completed P Putnam County CerU cation No. D Date of Report W Well NOTE: Exact location of well with distances to >`ell Drillees Name P & S lature: i 71 Perri• L. 1 11 a least two permanent landmarks to be prooctea on a separate sneevpian. D. •: , to copy: IT File; ellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES ...FINAL SITE INSPECTION Date: Street Location _ -' '� - Town 7.#7- rg`RSo�v � Permit # -7 7 TM .--' 3 y — 5 — 9a. ( ' Subdivision Lot #' _6 "�HAirE V�c«v EST" 1. Sewage System Area a. STS area located as per approved plans ...........:::...:. ........ b. Fill section - date of placement 3:1 barrier Lgth:. Width Avg:ppth' c. Natural soil not stopped .................... ............'....0............. d. Stone, brush, etc., greater than 15' from STS.Oea.......... e. 100' from water course / wetlands ..... ............................... II. Sewage System t _ a. septic t c size —1,000 ........1, 25.. 0 ..::.other.' ............... b. Septic tank installed level ... :............ .................... ............ c. 10' minimum from foundation .....:.... .............. :................ d. Distribtuiofi Box 1. All out ets at same elevation -water tested,; .............. 2. Protected below frost ...................... .. ............:.............. 3. �� u murn 2 ft.Original soil between box.& trenches unctio Box - properly set ...................... .......:.......t:.............. 1. Length required , -7 S Length installed G 5- 2. Distance to watercourse measured -� aZO4 Ft.......... 3. Installed according to plan .... . .. .......�.;:.............. . 4: Slope of tre acceptabl =1/ 2" /foot ............. 5. 10 m line - 2 oundations.......... 6. D f trench <30 inches hem. j** facp ;� ............... 7. Room alloy, fo x ion ° .. ; :............ 8. Si a 1 4 a6ete an.. ' ............. 9. De " o in trench 12" minimum.. ;................ 10. Pip ds capped ........................ ............................... .�_.. -g PurTi' -'or Dosed TN:sfems _ _...._ - ,_.__..._...: Size ot pump c er ............. ..am ............. ;4............. 2. Overflow tank ............................. .. 3. Alarm, visual / audio . ............................... ,;............. 4. Pump easily accessible, manhole:to grade:L .............. 5.. First box baffled ..................................... .............. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. ouse/Building ' a. house located per approved plans ............................... b Number of bedrooms.: ... .............................r: ............. IV. Well -; a: -Well located as per approved plans. .... ........ b. Distance from STS area measured © 01 ft ........... c. Casing 18" above grade ........................................ ........ . I Surface drainage around well accet able.....::: :............ V. Overall Workmanship i a. Boxes properly grouted .................. .... ............... b. All pipes partially backfilled ....... :.................................. c. All pipes flush with inside of box ............. .I ..................... d. Backfill material contains stones, <4" diameter............ :. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drain °s discharge away.from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided., ............................................... Rev. 1/97 ..ks i'fi"'`• zk'y fa tT' ? - .; � � v �.. i'��` : fit,! r r'� i�t ? i'�`�£:�'..a?•.'a ° r " «„eft" ,'.�r'a7 ,� •r �4?��.... � .. � s�,� ^.� �,>+ r � 2r � � b r .zrs� 9 F K^r•' " 9 -� t r..r ' �, y ' . ' .s � s. rS4 ' f., � i �r �r , �. t _.. : y..? r tci't a..k'•�,,: ,au. •a`' -*.-�f s- �us�,x� b � �- 'E - �:b'{�y w r rd- "�,, :� �a"'ix t,s' ., � ' ;T • � , r OODNTYD�ADTA�TP,OFffiFr1I.TH �a�� �} � �: t'• � 4 Y'. � � �"' '�"�` . "' , y DI.Mart d iv6oseWlrHedl� Seevloao. Camel. N %`1061? § `� �'� &Dear �o�Faovlde�Pesfslt / G '� '�j � ;�a�+ � " ` �" A •- . r:, �:; �;owCB417I+ICAT6�OFyCO � � r ,. � Farolt i'`4h3 � � Ota�ar�ARYe�t NasO P�'v 1 Y V ~ K a ' 7--) .Date u division Fee Enclosed' y s 5, �N rat o > s. r � - .�✓ � n r���.art�.,..'F�op 6s. E D ' ®O�" - `:. PCHD NOt1�110ssI{ �"BilgQleed?WhOSaiFm�0�: - ;' 2 Wrrr�:� ��esB'SoRf''flo� - Se�rarge S7s/eet le eotftilet d GrBaa SapUc Tack m y �IttWSS -,r .,,�� /rt +��+, �� �-'!` � z1Nf. ns• pxg 'w'>r *"' d ° a ��.afi L "� �`tl� ��_ `}•-• WT ^."'i ••1G -MhY �� < , r s .e R O /'.© r b' c ouu21� /�.S.GoPzx� r. µRgn!�v� �foNE ,v�dgws w �tttN .sl 55 DS 0a fuOmlttW to flit; j 6epartment4anra vrritlanqua[anNe w�i110re furnished tMLe►wrl hs;;futpsfat, M6001 asaiphf t►y tM puildN that:faid'pu61dN will Opeo in "hood ofa eriltiMsacondit�n„, �ny�pan�of��Yasiw�gital�iyr,Qem d�urfn� tt� l,e �io�d'yo /two (8) Yom;! bmmediribly 4olk►wkq tMdate of tM,b�u- aiia of t1N approval of th6 CMilicate oY Construction ComPlince oP ,Qhe o►na1 a kf tM►eto 2T tliot tM;dillled' well deta�[tt abode wilt t» lO�ted aftiflawwronitla,apP ! owd Plan anelithatsalA welliwillNwti sta w i`•,w r t standaralf, ruNa and rpuZai erns of the. 'Putnam COYMy DeWrtmenf' OI�tlialthr `�"��' •��` r ,, � juf -ri ' � r �'' ''� � r+ � �ate�l'I�I L1 [TI E z Sgnedz _ fur j P A. Addreo ^f iSTIJAM � �. �li�i�i.�® N g �.. t., OIgB - #PPROVED FOR CONSTRUCTION T..hif approval expires two' r from'stheadata •issutid unless eonstruc4bn 04 the Owldlny has been undertaken and if ..,h- ..;r �. -ertmrn, =>ti """V' -' r�, um •.�r� �».»s*',n: <au - i .: .. ievOeaOle for. eaufeor maY;OerimMWeA or modified when t0 £ _ ;.��`_., ry y""Ifo, �CommissiOnsr oP lieattlf. • An Ilia Or alteration 04 eo'mtruttbn g roquiref a .new permit zApWOVad <for disposal 04 domes! fewaye pvbvafe rooter oupply only. Rev. oat. �Z3 ` °` 4 10/88 M Ta410 y I�`.... -. �.�_.,r,•.,,.q.,.m„a.;. -..,- ... -.-R. ...,. ......... ��..: y^ er=+ rv., v^_+-..;•, �... �.; v.-.. r, �w'. ;rT-v,°C.Fr?ar4"7:7Y °ls.'9Aa ° ?T ..yin, "?"'?n' ^°.24�F,wcy f�iT'6�J e'•: n".�.v. .. �* ..r -t� .,.,;�+�'lt ^.�i`"�i"'. '}.^' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road,-Brewster, New.York 10509 (914) 278 -6130 �APPLTCAfiION TO` `CO1JST�2UCT A WATER WELL: - PCHD PERMIT #/ WELL LOCATION Street Address Town/Village/City Tax Grid Number +4p LA; J-V_ A 3 - 5 - 2-2 WELL OWNER Name Mailing Address Private 7�M'S AWE RD � S&tn t om- N tDSO 13-Public USE OF WELL 1 - primary 2- secondary ARESIDENTIAL []PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT MIM S gpm/ # PEOPLE SERVED FidM /EST. OF DAILY USAGE '909 gal REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING)- 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE I 06RILLED DRIVEN []DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name `rp G6 `� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _4_N0 NAME OF PUBLIC WATER SUPPLY: 041 TOWN /VIL /CITY . DISTANCE --TO -- PROPERTY . FROM, NEAREST..:WATER- ,MAIN:..(g��ATM- - -1 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE ON SEPARATE SHEET R� (date) s 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 ail well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or oth ise conta 'pate surface or groundwater. Date of Issue: Z 3 19 q Date of Expiration 3 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 ��Klp7Y OEP4Rr D A THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION t� JOEL A. MIELE, SR., P.E. Commissioner DNIl,LIAM iV STA IUK, P• „Phi® _... E "T"` °` Deputy Commissioner PHONE (914) 742 -2008 Bureau of Water Supply, FAX (914) 742 -2027 Quality and Protection June 2, 1997 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, New York 1051.2 Re: Shawe Valley Estates - Lot 6 Patterson, Putnam County Log # 7016 East Branch Reservoir Dear Mr. Hurley, The New York City Department of Environmental Protection (NYCDEP) received the following materials on May 9, 1997: Putnam County 'Department. of Healths data sheets; ® Subsurface Sewage'Disposal System, Drawing S =1, dated April 1997. - -- VVhile- the - separation - distances to SETS 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 within 200 feet of the property line then please note this on the plan. The information on the data sheets conflicts with the information given on the plan. The data sheets state that 667 linear feet of absorption trench is required whereas the plans show 675 linear feet. Please clarify. Furthermore; as required by New York State Department of Health Appendix 75 -A.,. single dosing units are required when- the absorption trench length is greater than 500 linear feet. The required horizontal separati m on distance fro a well to the septic tank is 50 feet and only 25 feet is provided. Similarly, the. horizontal separation distance from a well to the effluent line to distribution box is 50 feet. The distribution box and absorption field should be located a minimum of 100 feet from any well, the plan shows approximately 95 feet of separation. 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. 465 Columbus Avenue, Valhalla, New York 10595 -1336 Mr. Ken Hurley RE: Shave Valley Estates - Lot 6 Page 2 of 2 June 2, 1997 Please show the location of all deep hole tests performed. Data sheets indicate that three deep. holes were dug and only two are shown on the plan. Please. revise plan. 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. It is difficult to determine whether the invert of the inlet is 2 inches above the invert of the outlet of the septic tank. 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 the correct number of outlets and that others will be plugged. Specify type of pipe and size to be used as effluent line from septic tank to distribution box. Include NYCDEP in Note 6, or provide a similar note regarding NYCDEP inspection of the SSTS. Your attention to the above mentioned is appreciated. If you have any questions, please contact the undersigned at (914) 742 -2068. xc: Si cerely, _ L/ annine M. IcColgan _ Staff Engineer Engineering Design & Review Putnam County Department of Health 465 Columbus Avenue, Valhalla, New York 10595 -1336 DESICnIq DM Sacc""T -S RS CE Sag. -, �"s-s 1�ISFQ..e�L SY5�1 �'n'.F' �7• Cleaner 46Wwrgy-- IZsr. Address LO,—, ted at (Stre--t) Se—c El=xc i ndic--te nearest. cross s treet) - ima1_ity Watershed SOIL ATIM DAMM P—rCU = M BE S re=l APPLIC- ?'IMS Date of Pre- Scakirg �! I I �' Date of Perc claticn Test s Z q(, SOLE . NL?�_.MM 'r � =-E PE:RCOI - -1 CN Run Kanse Leon to meter Fraa meter Level No. Time Grcumd S=. face In Inches Soil Rate Star t -Stec min . Stax -t Stoic Drcc III P'.:1�I1 LYCO LrIc :es Inches Tmches 1 l0:3� 10; 0 TEST PIT DATA R G.L. 1t Tcp SO t L _ -j"OP 1.� - 2' 31 '6.N�� 5a�Vy AT 5' 6' 71 8' 9' _ - 10f 11' . 12' 13' 14' IND:= L•EVrZ AT WF?Crl CMC CNC 'T'F.P, IS Mti=U_ =M _ +......_.. _.._ .__ ._._... _ ....... . Iv'DIC' =� LEVrm TO WHIG kM=11— LEV'Z RIS- A, =_ E M G ENC7J01iT�'� N�r4 DES fiOLE OFS Vt�TICCvS I�Ln17E" BY: GdT�� i3t4-Pe_taDDA =: g� i5 s DESIC�i Soil Rate Used _2� Min/1" Drop: S.D. Usable Area Provided 8!�nc 3r– No. of Besdrecros Septic Tank Capacity ® gals. Tyce CO^� Absorption Area Provided By L.F. x'24.11 width trench 0� . Other Nitre 1`%,d/- I 65K– �G Sigrature Address /42 6%_ -IS N4 9(4;4 A✓G S ALL 6A P-H L Io A N`� sl1- 0 71u 4 THIS SPACE FOR USE BY EF-AS,TH DEPAMIEN' CNILY: Soil Rate Approved sq.ft /gal. -Checked by Pate ZEST PIT LAM =UIRF.D TO BE SUBMIT= Y+= APPLICATION DESCRIPTION OF SOILS ENCDUNMM IN TEST EMES E= NO. EOLE NO. G. L. ° 2' 3` 4 51 61 71 0Y, . F—AD W SANray LDh r� -mow IJ L -0A, M M15t) . -BP-o jr-1 5WO y C,oa M 8` 9' 101 �t 12' 13' 14' IN-D = LEV"�L, - AT MIMES GRIXJr1Ek-A. -1--m IS E vMCjNfiG. M INL_C n _ LEVEL T Wr?! Ch Wa= LEV- RIS—r z At BEING EM?� IJIT= ��. DEEP HOLE OBSERVATIONS MI DE BY: - � P�. - o YG be p DA =: 9 DES IGN Sail Rate Used �_ Min/1" Droo: S.D. Usable Area Provided Son No. of Bedreams Seotic Tank Capacity ZSD gee <fe�G . Absorption Area Provided By L.F. x 24" width trench NEb Other Name , l l`t"I�� i`'1. � GI h WS Signature ' i Address Ave-, SEAL v �Q 67446 THIS SPACE FOR USE BY F-ALTH DEPAM= ONLY: Soil Rate Aogrovcd sq. f t /gal. - Choker by Date • • �- • �� v :ice r: a� DFSIGN DAM S—== -..t7BSMCE SBgAGE DISPOSAL SYSTEM FILE M. tee` sit; ��u.�y �S�-. � 6 Armes Locates at (street) Sec. Block Let (indicate nearest. cross street) - ftniciral.ity Watershed SOIL PaRC OLACICN TE'S'T Ltin'?'�� P-B= ID TO BE SURM.171= WITH APPLIC:ASICNS Date of Pre- Scaking Date of Percolation Test HOLE NU-W= CTS TIME PmCOLA'r'ICN Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Stazrt Stop Drop In X n /ln Drop Z*iches Inches, Inches 1 2 3 4 5 1 2 3 4 5 N=S: 1. Tests to be repeated.• at same depth until approximately .equal soil rates are cbtained.at each percolation test hole. All.data to' be submitted for review. 2. Depth measurements to be made fran too of hole.. PC —:t APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 9. Name and Address of Applicant: 5HAVNh . 2. , 4, BKENV �fz iQy fpsaCT Flame of Project: SK4m--_ Project En g ineer: 91TNA G►N�L License Number: ��°� 1O _ Phone: 225 "3oC 3. S. Location T /V /C: aSnr-J Address: � 94--leQ, NY ►0,72 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)? Tvoe Status (Check One) Type I.. Exempt Type II. Unlisted B. Is a Draft Environmental Impact Statement (DEIS) required? ............. Ill® 9. Has DEIS been completeAAd� and found acceptable by Lead Agency? ........... PJ� 0. Name-of Lead, Agency 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? \1&s - Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ J/A 0. Waters index number (surface) ....... ............................... Nl'06�' F. Is project located near a public water supply system? 3. If yes, name of water supply 1JA .................. I\1 Distance to dater supply! M i. Is project site near a public sewage collection or disposal system ?..... i!0. conr 46bo"s ). Name of sewage system N Distance to sewage system I. Date observed: -9 1 20 Ici S 23. Name of Health Inspector: E51 U_ 4 �. Project design flow (gallons per day) ...... ............................... BOO P 2. 25. Is. State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 26. Has SPOES Application been submitted to local DEC Office? ............... N �LL 2T. 28. 29. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... Wetland ID Number ........................ ............................... N/A Is Wetland Permit required? .......... ............................... 1J Has application been made to Town.or Local DEC Office? .................. N�•d 30. Does project require a DEC Stream Disturbance Permit? ................... Nc) 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, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 133. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? '35.-Are 'a'n'y sewage disposal' areas in" excess of 15-0,,''s1 o0e? ....:....::...:......... ' 136. Tax Map ID Number ......................... ............................... '- —5-22 137. 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 3rovision 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 be 1 ief. Fa Ise statements 'made herein are punishable as a C l ass A H it d0meanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: q Io2 &L�6PJ&JDA AVle-- TAILING ADDRESS: �5�� �� 1 �� �y�� G M oq loSl2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of PAM 5` ,4t"W L Located at HA- WL� (T)FA i-1 Section ��r'°o 'Block Lot Subdivision of Subdvo Lot # Filed iffip # ���� Date q-f 21 /cT -7 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 ofArticle 145 or 147, Education Law, the Lary Code. Countersigne ealth Law, and the Putnam County Sani- P.E. , R.AO , m AVe Address CAEM foe 12- Telephone truly yours, e Owner of Property ej- Address v� Y I Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, NY 10512 Re: Dear Mr. Hurley; -"' ' "BRUCE R. FOLEY — " Acting Public Health Director May 15, 1997 Proposed SSDS: Shawe Lot # 6 ' Shawe Valley Lane (T) Patterson 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 -o- f New York,-Title 1`0; relative to the need-for approval of ifidividual sewage disposal" systems by the City of New York. You should contact city Officials in this regard." 1. The split system proposed (3 -way) is not acceptable. If it is your intention to reduce the number of D -Box outlets, each outlet can go to a junction box to feed (2) 45 feet lines, otherwise, each line is to have an outlet from the one D -Box. 2. Current codes allows a conventional drop box system for SSDS 667 feet or less. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Ve truly yours, h� Robert Morris, P. E. Public Health Engineer RNVjp r � ,- M j, � i,, . i. 1': i Water analysis result for sodium (Na) is }22 Water.containing more than 20 mg/L ofd it m s Quid not be used for i} k drinking bypeople on severely res'_ridcJ sodium diets. Water containing more than 270 mg/L of sodium should not be used by people on moderately restricted sodium diets. PUTNAM COUNTY DEPT. OF HE4%L•VV -' ! i /l Q !' AS -BUILT MEASUREMENTS( IN FEET) ? I 2 3 4 5 h �7 8 q IO II I2 I3 ;•I4 15 6 1 Ig Lq 20 21 22 23. . 3, 5(o si3 63l� lag -7S BzYZ y q�Yz �V�/� 33 4 (. I. {P- 55" COfo -7 (o .9( 7 ;.i�i� row I;►.`' t 3 B — 83A f�)�j 90 aS rcoyq I c&Yq ii> IzD !28 5z (Do 76 .i8o qa 10.1. /to rrR'. Iii" i 1 i Z 5ra G711 Putnam County Department of Health ; Division'of Environmental Health Servioea 4 Approved as noted for conformance with appli 1 Rules a Regulations of the 1+ i County, alth Departmen •+ t - at � +� SS tune 6+ Title ate A5- BUILT: ( :. SURVEY�NpTE; I. This Is to certify that the sewage disposal system was # ---_ constructed as Indicated on this plan and that the system was HOu5E'LGjGATION AND 5ET6AGK5 . ! Inspected by Putnam Engineering, P.L.LG. before it was covered over. BA5ED ON 5URVEY BY 1. The system was constructed in accordance with all standard rEEi^{ EC'LtFltC�c'>~ Cot LINS rules and regulations of the Putnam County Department of t�4FEDt I� -07 •4$ Health and the) New York State Department of Health. 2. The 55DS consists of the following Uf!jio gallon precast ' oncrete septic tank, (n-79 LP- of 24" 64lde absorption trench , adcigbonal requirements ljptr .ium (Na) is ,ZZ :. 'g/L. f 20 mo!of dium s, Auld not be used for sly restricted sodium dies. Water containing ' ,um should not'b:; used by people on moderately . PUTNAM COUNTY DEPT. OF HE4} -Vi/ T .I BENTS ( IN FEET ) &1-7 1algi1o111 -75 1 azy?I 9a 1/z 19 -7 vz I iv (o:q 1 �33 ! 1my9 I /WXi I )►3 1 /ZO 1 X2-0 1 5.2- arty Department of Health nvironmental Health Servioes noted for conformance with toles Regulations: of the ounty alth Departmen & Title ate age disposal system was tis plan and that the system was ng, P.L.L.G. before it Was covered over. 1 accordance with oil standard utnam Gounty Department of e Department of Health. lowing t gallon precast f. of 24" Wide absorption s a 12 ? I5 14 15 16 1-7 a (P0 70 80 qa 10:1 Ito �5URVEY10TE: HOUSE'L�GATION AND 5ET5AGK5 BASED' N SURVEY BY 'Y'E2ir'(: �CL�flttiX)P-F COLLI N5 VAT'r'D:; 10 -02- -CI B a l_ 1'� ESTATES'. _ �P�ENE{yY �J Y -`� _ DATE OCTOBERIit DRAWING - .. qq T�r ��� '��I�• 1 1 PRO_IEGT MANA6�ER � KH Tj¢'''��Y AWINb NUMBER