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631- 589 -8100
34. -5 -22.27
BOX 15
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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
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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� ....... _
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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
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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
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q
i
10
11
12
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14
15
16
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115/
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62
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'
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
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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`
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