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HomeMy WebLinkAbout1586DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -22.27 BOX 15 �I : . 4ry ,. ' 1 {OL T 116 Nis `1 �I : . a TNAM COUNTY DEPARTMENT OF HEALTH ISION OF. ENVIRONMENTAL HEALTH. �WRVICES..... . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P —1,5-1-7 Located at Town or Village Owner /Applicant Name_ 4�> EN -Tr-1 l,1!--' Tax Map 34 Block Lot22 Formerl s fiAw l�-- Subdivision Name �a� -+A„� �,o I. t✓S�",� 5 Subd. Lot # Mailing Address F-D :W, 41 �(Z�'1N5 N L.Q Zip ado Date Construction Permit Issued by PCHD Separate Sewerage System built by �y'CeCs� ft� r R��P Address PezTi Consisting of ) 250 Gallon Septic Tank and 4E>a c F DF 'Z! W t DE ,e se►2PrLe�J 'R 6N e.;� , nil Na) is W ter contain n mc. e than 20 t,�� a., ref scddi= should not be u Other Requirements: Water Supply: mar u In ?70 L of sodium .'_::' '.s` r.or. t� i:.y��ci l�people on moderately ) '1 Su� ydrom �T , . Q ,'�, ";' T-$, T •ter 144. A I ray lestricte so lets. , . �._.. ,.. �— _> >� or: Private Supply Drilled by�� �- S�nIS 1 r-ze- Address r�32G'VIJS-( �_ �_ .,._BuildingType__ Stns �j�rnnl.[_� -( Has erosion. control'been.completed ?.4� _.._...:_.�_:....... Number of Bedrooms Has garbage grinder been installed? No 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 ' r fin' t i -the issu CHD Construction Permit and approved plans and the standards, rules and ulationstnam County De artment of Health. Date: to/ 1 &k-23 Certified by y � �� � --�- P.E. ,X_ R.A. (be signnrrofessional) Address [02 4S.t- 6r•3e.C>A C� �u 1D�12 License # oc. 744a 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 a ubject to modification or change when, in the judgment of the Public Health Director, such revocati o ificatio change is necessary. By: il Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 1e� I °e � �p �. ems -: �e� �- � � � - , �.� ss� •, �. �a � .� � ► � � � � � - f � . � ;., � � , .;; P02 GUARANTEE OF SUBSURFACE SE WAGE TREATMENT. SYSTEM Owner or Purchaser of Building Tax Map Block Lot Dl�c Pcx- i - Building Constructed by Town/Village S !�)Itv LIAR W--(f a &LL Location o Street Subdivision Name r .. Building Tyj e Subdivision b ®t 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' epprovcd plan or approved aaaiendmiht thereto, and in accordance with the standards, rides 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 put of said system constructed by me which fails to operate for e' period of two years immediately following the date of approval of the "Certificate of Construction"Compltance for the sewage treatment system, or any repairs made by me to such system, except Where the failure' to operate property 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 nog 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 General Contractor (Owner) o Signature G< Corporation Name (if corporation) Address: "-- .� State zip d Signature: Title: Corporation Name (if corporation) Address: �(� � „ Blz�e-uls4le State Zip !�5'O � Form GS-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Pis v� Well Location ':- Street Address -. ­: ' _. "' "'" "` Shawe Valley Estates Town/Village: ' Brewster Tax Grid # Map Block Lot(s) 7 Well Owner: Name: Address: Saddle Ridge Homes Inc. 15 Saddle Ride Rd Holmes NY'12531 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 'ft. Length below grade 40 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 Yield 7 gpm Depth Data Measure from land surface-static specify ft) 25' During yield test(ft) 160' Depth of completed well in feet 225' 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 5 Drilling in overburden clay and boulders 5 Hit rock at 5' 5 41 .. - 41 225 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7anm Depth 180' Model 7GS05412 Voltage 230 HP! Tank Type WX250 lume al . Date Well Completed Putnam County Certification No. 002 Date of Report 10/8/98 W8/13/98 Beal Nurh: rxact location of well with instances to at ifastytwo permanent ianamarxs to oe provta5"n a separate sneeupian. Well Driller'sName P.F. ns ric. AddressA Patna Me., Brewster, NY 10509 Signature: Date: 10/8/98 Perry L. B 1 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 I ,Q PUTNAM ENGINEERING, PLLC LETTER OF TRANSMITTAL 102 Gleneida Avenue 914- 225 -3060 Fax: 914- 225 -2955 RE: cwt=. VA"-.&l CSfA'TTes -7 TO: �o-r 1�s � P���► ��"M� 3 �I-- s -22. I C�; We are sending you attached under separate cover, the following items: Shop drawings Specifications Plans No. of Conies X Prints Copy of letter Other: Description Cps A5- ?,ukLLT t�LA H 0 -r-a a t* 1 Gayz- -r. OF I VJ'A'[' =YL ✓� NA L�� 1 S VJ E 110 431 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: Copies to: SIGNED: K i7J�L If enclosures are not as noted, kindly notify this office. t DEPARTMENT OF HEALTH Division of Environmental 'Health Services 4 Geneva Road'' Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 opub BRUCE R . FOLEY lic. - •Health.. Dir8ctor October 27, 1998 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Proposed Compliance Gentile, Lot #7 (T) Patterson, TM# 34 -5 -22.1 Dear Mr. Hurley: 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) The house constructed does not comply with the approved house plans. receipt of a- submission ; -revised'-to'i•efIect thaf` above coiiin ri s, this application will be considered further. RM:tn Ve ruly yours, "4/ Robert Morris, P.E. Public Health Engineer PUTNAM COUNVI'T DEPARTMENT OF HEALTH Dlwbba d Howboonsestild Eled% Sore CWMGL N.Y. Iasi? Effabow to FMVMO Possum it ass CERTIFICATE 0 MIT FOR SEWAGE DISPOSAL SYSTEM t Pemft 0 Town er V11loge --7 shock Applosialtionse PPM S HAW (S Daft of Pmvbm Approve! Aden Town. 13WW-q�i 12. I J4- zip Oho �j Oman TW 11, Am IL141(P FM Section Only Li Depth - Volume . Neveiier of BW.=,- Dodge Flow G P D (n PCHD Nodfleisdoo Is Requhad Wbon FM la consplated Sqm,b Srsrorege Systese 1. G.H. Septic Tack ,,,,-44� To be conwroded by T40 F-9'- VeT - Address Water SW* -PdAe Supply Folios Address an x Waco Supply Dr9led by 10 56 1291 --- Address Od., Tgew* 5 S5 -ro 56- to 1, n:, 0116& 1(0 - 2-P 5 L40P lrepresent that I am wholly and completely responsible for the design and location of the proposed systern(s), 1) that the di sal bows described will be constructed as shown on the approved amendment there to and. in accordance with the standards. rules MI'Ma"euMn 01 16�5;rn County Department of Heafth, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Dqwrtnwnt, and a written guarantee will be furnished the owner, his successors, holy$ or assigns by the builder, that said builder will place in good operating condition any port of said saws" disposal system during the Period of two (2) years Immediately following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the original Wstem of any repairs thereto; 2) that the drilled well described above will be located as shoes on the approved plan and that old well will be Instal ardotnpw � the standards, rules and rag–U%Tro—nsof the Putnam Count Department of Health. Dst*)WL� r-6� Signed P.E. t— P.A. G41(INEt_ Add... furNwj�NQ 1J-6M lbeGLi;JW(CA ke MLZR. 146 APPROVED FOR CONSTRUCTION: This approval expires two years *om t a date i ad s construction of the building has been undertaken and is b ssu 0� 'on." 0, "_" h y change or alteration of construction revocable for cause or ma be amended or modified when considered y by the C An iv U at.r supply "QuIres a r�aw Permit Approved for disposal of domestic sanitary' and/or OF Only. Rev. 10/88 Data By Title JOHN N. CALBO Building Inspector PUTNAM COUNTY Telephone PATTERSON, NEW YORK 12563 878 -6319 November 9, 1998 Mr. Lawrence Tambini Saddte Ridge Homez 5 Sdddte Ridge Road Hotmez, New Yonfi 12539 RE: TM - 34. -5 -22.27 Lot # 7 Shawe Vattey E .6tatu Ice Pond Road Pattenzon, New YoAk Dean Mr. Tambini, With Aupect to your inquiAy retati.ng to the above neUerenced pnem,izez, your Cert:bica-te ob Occupancy wilt reb.bec.t a 6oun (4) bedroom dwet..2ing ONLY. Any additi.onat bednoomz wou.Ed requiAe. Heatth Depan.tment approvat. __.� .._... �..:..... _.._.._.�.....__ .. - _.Z.&- l —may_ be .ob _.f urther .cus.&iz-ta.nce,— ptea6e -. do- not .hez ita te:.- to contact my o66ice. Sincerely, . Catbo, Enforcement Obj.icen JNC /c.s Nj�L q4NORTHEAST LABORATORY OF DANBURY T; Cert::PH -0404 r 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LUIS (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 DATE SAMPLE COLLECTED: 9/25/98 TIME COLLECTED: 3:20 P.M. COLLECTED BY: JON SCOTT DATE RECEIVED @ LAB: 9/25/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 10 /2/98 SADDLE RIDGE, SHAWE VALLEY EST., BREWSTER, N.Y. LOT #7, FAUCET WELL -NEW NONE RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 6.11 no designated limit Turbidity 4.7 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N 11301- Nitrate N 0.98 mg/L as N 10 mg/L as N Alkalinity 40.0 mg/L no designated limits Hardness 62.0 mg/L no designated limits ..Iron 0.144 mg/� ..._ ..... 0.30 mg/L Manganese 0.086 � mg/L .. � .., . 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L) Sodium 45.5** mg/L 20 mg/L** Lead 0.008 mg/L• 0.015 * ** m1= milliliter mg/L = milligams 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 NOT 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: •7 v 9 S ._ .. _ .Street Location . �i%fA: `w V.�t.L F .:LAND.. - _ -. .._._. Owner �,R �°�lln specte y:� Permit # TM # ff- — a J:, { Subdivision Lot # "�,yi4wG ✓,�+i c�Y 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.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 .... .......:..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 fr` ost .................. ................:...........:, 3. Minimum 2 ft.Original soil between box & trenche e. Junction Box - properly set ............ .............................:. f. Trenches TZeng i required q Length installed 2. Distance to watercourse measured -Ft.. t. A to y9 3. Installed according to plan ......... ................................ 4. Slope of trench acceptable 1/16 - 1/32 "/foot............ 5. 10 ft. from property line - 20 ft.- foundations......... 6. Depth of trench <30 inches from surface ................. 7. Room allowed for expansion, 100% ........................ 8. Size of gravel 3/4 - 1 %2" diameter clean.. .. ..:............. 9. Depth of gravel in trench 12" minimum ....:............. A. Pipe ends. capped ................................. : ............ :.:. :..: g m I Size or Dosed pump chamber s s ............... .............................., 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/Buildin a. House located per, approved .i.j. .............. ...... b. Number of bedrooms ......... .....�jrs� IV. Well See ker %s�cQ. .... . a: Well located as per approved plans ............................... b. Distance from STS area measured + M 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 watercou g. Footing drains discharge away from STS area ............. h. Surface water protection adequate . ............................... i. Erosion control provided ............... ............................... Rev. 6/97 i ��. THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION Dw JOEL A. MIELE,.SR., P.E. Commissioner PHONE (914) 742 -2001 FAX (914) 742 -2027 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Re: Shawe Valley Estates - Lot 7 Patterson, Putnam County Log # 7018 East Branch Reservoir Dear Mr. Hurley, ,.._. V 1LLIAM N,94SLU.K, P,f.,Ph.IX_- Deputy Commissioner Bureau of Water, Supply, Quality and Protection June 3, 1997 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. 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. _._......;... �..._ ' within 200 feet bf the property line then please note this on the plan: The required horizontal separation distance from a well to the'septic tank is 50 feet and approximately 45 feet is provided. 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 less than 15 feet is provided. 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. The SSTS profile is drawn to scale, however, the 10 foot separation between trenches is not shown accurately, please revise. The profile also shows that. approximately 6 inches 465 Columbus Avenue, Valhalla, New York 10595 -1336 .,Mr. Ken Hurley Page 2 of 2 RE: Shawe Valley Estates - Lot 7 June 3, 1997 of backfill will be placed above the junction boxes. However, given the maximum depth of i - th.a.absorption trenchYof_2.4;inches only inches, could -be placed, above- the.j unction- box:. Please clarify. Please show a detail of the `junction box with baffle'. 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. Sincerely, Jannine M. McColgan Staff Engineer Engineering Design & Review xc: Putnam County Department of Health 465 Columbus Avenue, Valhalla, New York 10595 -1336 Il000 / ♦ ROCK r Jv \ 6 7 6 IX CYF- 45 / - - -- 8 ♦ ♦I L.oT # —7 A KEA / I Tr��NG 1-t LAyouT 1��'r —� "Fi2E1LcNES Tc i3t JO)OZ. r IKJ. �O AJ54 LF A7 ROC \ \ \ \ \ \\ \\ \ \ \ \ Wa Ll"�v 0 F 67 Jo G � \ So oil �. / S44AY&— oV-r 30� -�-- ,�� ® -EI•►cHES Te i3C 10'64. MIN. LF AVA ILA, &-r-- Aefll i / DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 1PP:LICAT.ION:.,.TO- CONSTRUCT: A. WATER - W.ELL -- :....:.,.._;.:; ; ' • -_ ''f PCHD PERMIT # WELL LOCATION $ Strreeet, YAddress �� � n Village C ty Tax Grid Number -= 5 - 22 , WELL OWNER I� Name EMail�in�g. Address N A[Private O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT-MIN 'S gpm /# PEOPLE SERVED I fAM /EST. OF DAILY USAGE �00gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION XNEW SUPPLY NEW DWELLING Cl DEEPEN EXISTING WELL 14 ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE DRILLED ODRIVEN ODUG GRAVEL. [:] OTHER IS WELL SITE SUBJECT TO FLOODING? YES A NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: r tAj&Vy E VA 5.--ff XT E S , Lot No.--I WATER WELL CONTRACTOR: Name :jQ Eve 7SrI- Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SI,,T11E: YES _Y_NO NAME OF PUBLIC WATER SUPPLY: N ,%A TOWN /VIL /CITY DISTANCE. TO PROPERTY FROM NEAREST. WATER MAIN: LOCATION P.I L aP, L`i SKETC & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) ��— ( i ure) 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 any and all water or waste products from such well property and in such a manner as not to degrade o Date of Issue: 19 Date of Expiration 19 shall take appropriate action to assure that drill g operations be contained on this r oth vii amin a surface or groundwater. Permit Issuing Official Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 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 - . •BRUCE , R. TOLEY � Acting Public. Health Director May 15, 1997 Re: Proposed SSDS: Shawe Valley Estates Lot #7 ° Shawe Valley Lane (T) Patterson Dear Mr. Hurley; Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to. Article 128.1 of the official compilation of Codes, Rules and Regulations of the State of:New York. Title 10 relatiyc to;the.need for approvaLof individual sewage. disposal- systems by the City of New York. You should contact city Officials in this regard." 1. The proposed SSDS expansion area should be proposed the minimum of 100 feet from the small wetland area delineated outside of the Dept. of Environmental Conservation wetland. 2. Invert elevations of the drop boxes for the primary and expansion area is to be shown on the SSDS profile. Be advised the maximum cover for a trench is one foot, if required, fill for grading proposes is to be provided. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Ve yours, Robert Morris, P. E. Public Health Engineer pwjP PUTNAM COUNTY.. , DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date":­) Re: Property of Located at (T) l� Section Block Lot 22 Subdivision of1/V Subdv. Lot # - Filed I;f`ap # 2-��2- Date Gentlemen: This letter is to authorize a duly licensed professional engineer a or re gistered architect (Indicate (Indic 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 �- -- -syst-em--or •sys-tem-s-im 'conformity -wixth -the 'p'rovis'ions �of� Articl'e 145 or -- 147, Educati tary Code. Countersigne P.E., R.A., Address* cAf �-j �E I- Ny ros12 2 2S Telephone h Law, and the Putnam County Sani- ry truly yours, gne d JLX4� Owner of Property Address 5?- NY 105t�:� Town Telephone /��i�� x'r���f; .� s . �4' PC —' P UT NAM C O UN T Y D E PART ME N T O F HEALTH APPLICATION TOR "APPROVAL OF PLANS-FOR A'wASTEWATER-DISPOSAL SYSTEM' - 1. Name and Address of Applicant: 4L • BR�►N ST'S (Z �u �/ (QSo � 2. Name of Project: S �'�% V ,4u-S� C�- s`raTES 3. Location T /V /C: aTTr=R�t'.J I��lTN� MG�N�(�� 4. ` Project Engineer. P.JI�� 5. Address: License Number: ��� Phone: 2 -3000 —' 6, X Private/Residential of Project: Food Service Commercial Apartments Institutional Mobile Home Park _ Office Building Realty Subdivisicn Other (specify) T. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Un 1 i sted _X___ 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. I`10 9. Has DEIS been completed and found acceptable by Lead Agency? ........:.. I41A, 0. Name of Lead Agency O /A i. Is this project` "i'n' arr area -us er •the cont;-ol -o•f• • 1. oca .l...pl.ann.i.ng.,....zoni.ng., 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? Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water A Ground Waters S. If surface water discharge, what is the stream class designation ?........ N /A •6. Waters index number (surface) ......... ............................... N�'d T. Is project located near a public water supply system? .................. a S. If yes, name of water supply Distance to water supply) M!'� 9. Is project site near a public sewage collection or disposal system ?..... �A -TlgFZ 'rFi� ••� ,0. Name of sewage system Nd Distance to sewage system tM! :1. Date observed: I I S 23. Name of Health Inspector: 81L4- 1+FD695S- :4. Project design flow (gallons per day) ...... J300 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?„ 26 -. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland? ................................... ............................... _ 28. Wetland ID Number ...........:.... ............................... ...... l& 29. Is Wetland Permit required? .............. .......................... < >... N eD Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? 31, Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES 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: 13. Is there a local master plan or,file with the Town or Village? NL% 14. Are community water, sewer facilities planned to be developed within 15 years? Ar ,.e..an.y::.se.w49e._di.spg4a1 ,arias._i.n�.excess of_15M_ slope?...,...._.:.: :.,.._....... >_•-- •_..,._. ;...� .- _-- 6. Tax Map ID Number ......................... ............................... °5— 2.2 7. 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 pplication must be accompanied by a Letter of Authorization. Failure to comply with this rovision 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 I ief. False statements made herein are punishable as a Class A H d dpweanor pursuant to Section 210.45 of the Penal Law. : /NH s` '&w IGNATURES OFFICIAL TITLES _ �U1T 0 2 6L45_#t�N 0f� ,, � 2' q OILING ADDRESS: V�fs1 �� ���`I G"L o7 t0 '6 !'�- PUTNAM CO= MARMM CF BEALPM Dr=CN OF ENVIPMWENM EEA= CES ttqT 77 ------- I)F-SIC,11 DAM S=- -,c.UBSMCE SSqAC-E tt8k--S!S=M Owner :5 -+AWa 15s7r. Address *41 /0-SC=, Last at (Street) Se--- Block S 1,t (imeiiczte neaarest..=oss sere --t)' m=-licita llita, Watershed W- =10 � SOMME, PT---COrA=CN F=20= M BE -CUEK---T- =I- . W= APPLICA—TICKS Date- of Pre-sczkimg- Date of Pex-=laticn Test BOLE NUMMEM a= TIME P—=-ZC0LAT-1CN Run se Deoth to Water Fran Wet--- Level NO. Tine Ground SurfEace In Inches Sail' Rate Stax-t-Stc-p Min. start Stolo Droa In min",In Lrca Inches Inches' Inches k:A3 110-,41 alr� SS 20 --7 2 1 ' Z-41 ?-ef' 28'14 3 42 -7 3 )1"32 1!:s8 Z-6 ZB (/,t .8 4 5 Z-1- 2 3 4 2 3 Tests to be repeated: at s;--Te depth until apgroxmately'eaual Sail rate-- are cbtai-nea.at each percolation test hole. All. data to' be subaittba for review. 2. Deoth masurerents to be made from too of halle. DESCRIPTION OF SOBS EZKXXJLVI'ERF.,p Ili SST HOLES DEPTS HOLE NO � HOLE I40. 2 HOr NO. 2' 3Y�.rD� jYv� Al 5' 61 71 81 91 - 101 � � Y 121 13' 14' u NDIC= LEVEL AT WEICE C,C T—=. IS III+ =rj- =M .....� �_„�.. - -- - • _ - . _ _. -..... INDICzMEE KIEL TO WHICE W ?IMM I:EvrM RISr.j AFT --E-M EENG ENCOCUMM=- NIA DEEP EOLE OBSEEMWLTIONS M-a-DE BY: C-s4'T -C-A , ML- - 11GOLO- f 1314 - Pe•MDDA : 9 f.'s+ `7S DES IG i Soil Rate Used Min/l" Drco: S.D. Usable Area Provided SfCz*:-'> SF No. of Be irocros Septic Tank Ca-r.acity Z.so gals . Tyres Absorption Area Provided By 4-f I- L.F. x 24" width trench Other N2r,e 7PUT NAM Signature' ` •. W. e .Address )a 2 SEM, THIS SPACE FOR USE BY E'1TH DEPAE = CNMY: Fp 06 7A 0 P�FESi1�� Soil Rate Approved sq. f t /gal. -Checked by to APPENDIX 3 - PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONM AL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE. SEWAGE. DISPOSAL -;SYSTEMS - ""iZEVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER 15 U BY B. HEDGES R.MORRIS OTHER DATE —J--/ TAX MAP # DOCUMENTS. Y ERMIT APPLICATION C -1 WELL PERMIT PWS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS C= VARIANCE REQUEST 9�USUBDIVISION p� GAL SUBDIVISION l SUBDIVISION APPROVAL CHECKED M PERC RATE M FILL REQUIRED DEPTH M CURTAIN DRAIN REQUIRED =STANDPIPES Y m EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE m IF PUMPED PIT & D BOX SHOWN & DETAILED m HOUSE - NO. OF BEDROOMS m WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM m PROPERTY METES & BOUNDS m HOUSE SETBACK NECESSARY (TIGHT LOT) m HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE m NO BENDS; MAX. BENDS 450 W /CLEANOUT FILL SYSTEMS m CLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE C= FILL SPECS = FILL NOTES m FILL CERTIFICATION NOTE_ m DEPTH GAUGES CIS FILL PROFILE & DIMENSIONS m VOLUME / GENERAL = FILL IN EXPANSION AREA EX- APPROVAL SSDS ADJ. LOTS WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH ATA ON DDS PLANS & PERMIT SAME m LF TRENCH PROVIDED =60 FT MAX 1969 - NEIGHBOR NOTIFIFICATION CD PARALLEL TO CONTOURS .9PRE- LETTERBI/ZBA - 100% EXPANSION PROVIDED m 100 YR. FLOOD E' rxTION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS FIELDS m SEWAGE SYSTEM PLAN - (NORTH ARROW) m 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL m SSDS HYDRAULIC PROFILE = GRAVITY FLOW m 20' TO FOUNDATION WALLS DJ 15' WELL TO P.L m CONSTRUCTION NOTES (GRINDER NOTE) m 100 TO WELL, 200' IN D.L.O.D., 150' PITS m DESIGN DATA: PERC AND DEEP RESULTS m 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) m TWO -FOOT CONTOURS EXISTING & PROPOSED m 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER = DRIVEWAY & SLOPES CUT m 10' TO WATER LINE (PITS -20') m FOOTING /GUTTER/CURTAIN DRAINS m 50'.INTERMITTENT DRAINAGE COURSE m EROSION CONTROL; HOUSE,WELL, SSDS m 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS m EROSION CONTROL NOTE m 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3%,30' - 2%,35' -I %,100' <1% m PERC & DEEP HOLES LOCATED m 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. m REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK m LOCATION MAP =I 0, FROM FOUNDATION; 50' TO WELL COMMENTS: i r�r— rat- --{� -� i j • � - I. , � - '0 , WP" Tub BpXE� ....... _ - LIVINC �r I Ills Roots a L , O OATH. EL.. I 810EL , :. W YLT 7AM UNT° LEr � °,T =-''' a-i o o �.IN. _. �' a. i V JAI itle R 2ip �, x 1 dcip r } A TABLi PACE �..: Lye ° yn 5 ! - -- - - .l 403 f s 4'CN6 SIA * V � .r:�y• .. � ' • -mot-.. ��� °� i z - i — � • ��� -- l— I!/INC W. � � +cv Itt4o ROOM ' CATiA. E I mil$ PUT -"AN v UiJT. PLA1l. F ° °07ED = aiLd isle Uri to dU Oman di 6 . C ° 403 I 4 "Cm0 o S ' Y .s i i f 1 I s �{�{Nf�CC i L trl, Pf(vvlD 1n.;�L iL I WWVIvt 1=kt'..r. LF C1.45►"c 1. gLi P�ic4 B�Ar�� _Inc �f 1' -6' CAM A64VE' t- So 40 • i A, R VI: NT �- i CL 1+ TO it �:. {'.. ;,. :;•r:. •ii;:r;:i'` Vii.. !f:;: :Q ... ,� i • db ii7!:yr r ' rf: � � 5$ RE 11 FbR u T� i of 5D � II � i- CAMT i t t R F I s �{�{Nf�CC L trl, Pf(vvlD 1n.;�L iL 16P' LF C1.45►"c 1. gLi P�ic4 B�Ar�� _Inc �f 1' -6' CAM A64VE' t- • G'SL,6t -.Cif �- i 1+ aLWR" ii7!:yr r ' rf: � � 5$ RE 11 FbR u T� i of 5D � II � i- ENL AROED PLAN 50ALE: 1 " = 50' 1 Water analysis result for sodium o- a j ii. Water containing mole than 24 m !L e; se ium should not be used ft drinking by people on severely res! - ;ctz3 sodium diets. Water containing 1 mote than 270 mg/L of sodium should not b:; used by people on moderately } rearixted sodium diets. PUTNAM COUNTY DEPT. OF HEALTH AS -BUILT MEASUREMENTS ( IN FtET ) AS- BUILT: I. This Is to certifu that the sewage disposal system was constructed as indicated on this plan and that the system was Inspected by Putnam Engineering, F.L.L.O. before it was covered over The system was constructed in accordance with ail standard rules and regulations of the Futnom County Department of Health and the New York State Department of Health. 2. The 55D5 consists of the following Z`� gallon precast concrete septic tank, 4128 I.f. of 24" wide absorption trench , additional regyirements C-Ls ..vvur, 'REFARED FOR: 3HANE VALLEY' ESTATES LOT # 7 �.. . • ...r . / a 1 1 ems✓./ 1 A ♦ Ir i s i i i t' E i a 1 a dI f WELL SURVEY NOTE: HOU5E LOCATION AND 5E'rBAGK5 +• BASED ON 50RVEY BY TERKY CEL uyr c cP u %: +H•. Putnam County Department of Health t� BDivision of Environmental Health Services j Approved as noted for conformance with appli,ftlile Ru and Regulations of the Co le Health Department Signa a 'Title Ute OCTOBER 19-18 r KH DfiANW BY GY BY' A5—E3UILT 5.5.0.5. PROJECT Kft -ePR it DRAYI1tY /.RIMBER 3` t- 1 1 2 5 4 5 6 1. 1 0.. q i 10 11 12 15 14 15 16 I 18 Iii Zt G — BIZ 115/ 13 34 62 -71'f-q Ely, � 3z 9'L 5Z Lao bbVz .��i C��f -71` z- 77%Z 89 C19 ►o'� n . D — /OZYz 1 1 Cl Z 85 —76 ?2/y &0 1330 l?U / 2? I i -`1z I 1 z 1061 q9 �33 Cp9 43 43 -z 9 B ' AS- BUILT: I. This Is to certifu that the sewage disposal system was constructed as indicated on this plan and that the system was Inspected by Putnam Engineering, F.L.L.O. before it was covered over The system was constructed in accordance with ail standard rules and regulations of the Futnom County Department of Health and the New York State Department of Health. 2. The 55D5 consists of the following Z`� gallon precast concrete septic tank, 4128 I.f. of 24" wide absorption trench , additional regyirements C-Ls ..vvur, 'REFARED FOR: 3HANE VALLEY' ESTATES LOT # 7 �.. . • ...r . / a 1 1 ems✓./ 1 A ♦ Ir i s i i i t' E i a 1 a dI f WELL SURVEY NOTE: HOU5E LOCATION AND 5E'rBAGK5 +• BASED ON 50RVEY BY TERKY CEL uyr c cP u %: +H•. Putnam County Department of Health t� BDivision of Environmental Health Services j Approved as noted for conformance with appli,ftlile Ru and Regulations of the Co le Health Department Signa a 'Title Ute OCTOBER 19-18 r KH DfiANW BY GY BY' A5—E3UILT 5.5.0.5. PROJECT Kft -ePR it DRAYI1tY /.RIMBER 3` t- 1 Se (dt • I .,l � .1a0M'HM.g 9 - ! 1. o (,05 X73A4) i i_ ANV13._was h'T1r.9 OS21 yJC . 1�1 �S%dP, .Z6 i9 1 •1 �1Six3 Y i, i za Se (dt • I .,l � .1a0M'HM.g 9 - ! 1. o (,05 X73A4) i i_ ANV13._was h'T1r.9 OS21 yJC . 1�1 �S%dP, .Z6 i9 1 •1 �1Six3 Y i, i