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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-5-37.2 BOX 15 I' J� r oil ;M L •� '� 'I I'6 ' 'T 01591 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location = Street Address: &J, N -fo o- Town/Village: ) A Tax Grid # Map 3'- Block Lot(s) 3 -7r Well Owner: Name: Address: V U e of Well: primary 2- secondary Resi tial. Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion ✓ Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length __g_ft. Length below grade '�p ft. Diameter *7in. Weight per foot —1-7—lb/ft. -1-7—lb/ft. Materials: Steel _.Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test, _ Bailed _ Pumped Compressed Air Hours Yield AL gpm Depth Data Measure from land surface- static specify ft) During yield test(ft) Depth of completed well in feet 95 e Well Log If more detailed to rnl3tion ri de otions r ��{{ �� P siei� analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface y-- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth o Mode Voltage ¢� HP Tank Type 6Le. &t p j Volume � Date Well - Coompll tted Putnam County Certification No. Date of Report Well Driller rsig-nature Nu,x'h: Exact location of well with distances to at least two permanentfancirrtarks to be provided on a separat®'sheet/plan. Well Drillees Name A, //,b Illiat Signature: Address- Date: Date: White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 m �y INSITE- ENGINEERING, SURVEYING & L , aNDSCAPEARCHMECrURE P.C. LETTER OF TRANSMITTAL Route 22 __.__. (914 278;4990 _ ... Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter Date: 5 -19 -99 Job No. 94175.302 Attn: Robert Morris, P.E. Re: SSTS As -Built for Reilly Construction (formerly Tischler - Lot 2) - (T) Patterson TM# 34 -5 -37.2 ® Attached ❑ Under separate cover via ® Prints ❑ Change Order ❑ Plans ❑ Samples the following items: ❑ Specifications COPIES DATE NO. I DESCRIPTION 4 4 -14 -99 AB -1 As -Built Drawing 1 5 -18 -99 CC -97 Construction Compliance - 3 5 -12 -99 m Guarantee 1 4 -28 -99 — $200.00 money order ( #117471706) 1 3 -28 -99 WC -97 Well Completetion Report 1 4 -29 -99 — Water Analysis Report 1 ; 4 -30 -99 — Bacteriological Examination of Water THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit. _ ❑ For your use ❑ Approved as noted ❑ Submit ~ ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot copies for approval copies for distribution corrected prints SIGNED: re Cont I , P.E. G►nw) IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 'IPUTNCOUNTY DE�AB��EN� .O F. HEALTH -. IIDIVIISI GN OF IENVIIIIBONMIENTAL HIEAIL'll'IHI SIERVVR CIES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Reilly Construction 34 5 37.2 Owner or Purchaser of Building Tax Map Block Lot Reilly Construction Building Constructed by Farm to Market Road Location — Street Residential Building Type P rsbn illage Tischler Subdivision Name 2 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 it 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 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 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 /"Z DayL Year ,eej 2aA General Contractor ( r ) — Signature Reilly Construction, Inc Corporation Name (if corporation) Address: 155 E Main Street, Brewster Signature: <2j Title: Owner 1I CLC- Corporation Name (if corporation) Address: 6 East King Street, Danbury State: New York Zip 10509 State Connecticut Zip 06811 `lee : T''`AP, � PUTNAM COUNTY DEPARTMENT OF HEALTH PvYnP Te5-- DIVISION OF ENVIRONMENTAL HEALTH SERVICE m n dffl j� ate, FINAL SITE INSPECTION Date: ' �1 Inspected by: 11 go treet Loc_ati ZJi .... ;i !t ...._ -Owrie'r _- Town Permit # r TM # 34 .!T - 3**� 2 _ Subdivision Lot 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetland II. Sewage System a. Septic c size - 1,000 ......... .t.h ..e..r. .............................. . b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. r'I enc; ems length required _ Length installed 2. Distance to watercourse measured 7 k""t.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10.. Pipe ends _capped................................................ ._ g. PumR or Dosed Systems Size ot- pump c am er ....... ............................... 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 plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well 1 ' a. Well located as per approved plans ....................y ... b. Distance from STS area measured 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/w Form Sr-3 I acknowledge receipt.of this, 'tepo'rt: ` SIGNA 02/96 Rev. RE RECORD OF PHONE.CO Y RSATION Time: Date: 7 //6 Person calling: aD`jh -lSeP4 Phone k Q Reason Inspection: X42 ( ) Deeps and /or Peres: Scheduled Field Meeting i Time: Date: Y N Tentative /to be confirmed() ( ) Town: Road /Street: Tax Map T: r:�5> � — C, --,R Z �,. Comments: SMITH LABORATORY 50 SCENIC..DRIVE 3 RTE. 8 HYDE PARK, NY 12536 LAB NO. e.,r.LIIM s.., .,.,b 92Z-292 r ' ��••I•"'•" IN— v"' . ". X. `~"' �; TYPE OF FACILITY 1` •� / , { -� " ��' off" '.--' ❑ PUBLIC WATER SUPPLY (ID # ) • - :..NAME' , n c s . j - y RIVATE RESIDENCE ❑WASTEWATER FACILITY TREATMENT , STREET ADDRESS) }r } ' tt %. 1 � ❑OTHER: i y >^ �•t• -� I rl r!i i` 1 - ° r a �(� ' ��t ) 1 ' -� Y. r . STATE ZIP,' CITY VA FACILITY NAME:, ../ ADDRESS 'fJ+ �i A"I Y,, Yi r rJ PHONE.# A ' SAM 'LING'POINT•..- f'. )`,c1 C r y; s,! , ❑ MONITORING SAMPLE v= . ' ❑ CHECK SAMPLE ,�+ -. .;. .rp k !. ,.,.: ,._ „•f r•1 i- SOURCE:.] DRINKING WATER;; ❑SURFACE WATER, ❑ WASTE WATER ', .. a i F .. �!� ! ..1 ❑OTHER; 1 � •, a e.: A �wS =��r,,4 ❑FREE RESIDUAL ,., °�§ r' ,.c •. ,'+ � •. ?. i.'i. Y �¢. ' TREATMENT: C] CHLORINATED( FPM L ❑ UV Cl OTHER:--- El TOTAL RESIDUA COLLECTED BY: -f 1' (; :' =i? > f`r RECEIVED AT LAB BY. c� ;• • t 'SAMPLE$OTTLE: ''� DELIVERED BY. .I'•.)`- t41 ....': DATE SAMPLED '•4.. TIME ' f . t�� .'ICED': RECEIVED TIME ICED EXAMINED. ,3 TIME r� i -REPORTED- TECHNICIANS) YES t� t , PM ,YES f + ' f rJ , AM �, / NO: ` , y ;yd jpm -r° ❑ MFT ❑ MPN [�(PA TOTAL•COLIFORM -� �sE PER 100 ML ❑ MFT ❑ MPN FECAL COLIFORM COUNT PER 100; ML El MFT I? .> ... .FECAL STREP: `COUNT " l: _ + `- PER 100 ML ❑ HETEROTROPHIC PLATE COUNT'• " 6' ' f COLONY FORMING UNtIt PER f ML ❑ E. COLI, "' ' . ❑ OTHER .0 .�,. BACTERIOLOGICAL EXAMINATION OF WATER HEALTH DEPT. COPY REP,OR MOT-VALIO WITHOUT CORPORATE STEAL LAB DIRECTOR N.Y.S. APPROVED LAB. NO. 10924 C1•ient : SMITH LABORATORY ENVIRONMENTAL TESTING 50 SCENIC DRIVE'& RT- 9 _ - HYDE PARK, NEW YORK 12538 (914) 229 -6536 WATER ANALYSIS REPORT Hyatt Pump Service RR 2 Box 141C Holmes, NY 12531 sample identification: sample type: sample location: sample collected by: sample lab nuumber: date sampled: date received: Ana.lyte Lead Iron Manganese Sodium Calcium Magnesium Total Hardness as mg /L CaCo3 Nitrite - Nitrogen Nitrate- Nitrogen pH @ 25 .deg C . - = -- Alkalinity" to pH 4.5 as mg /L CaCO3 Turbidity Rielly Construction Farm to Market Rd., Brewster, NY 10509 public drinking water supply tank client C -2058 04 -29 -99 04 -29 -99 Test Results* < 0.001 mg /L 0.08 mg /L 0.01 mg /L 14 mg /L 17 mg /L 1.9 mg /L Date Tested 05 -07 -99 05 -08 -99 05 -08 -99 05 -08 -99 05 -01 -99 05 -01 -99 50 mg /L 05 -01 -99 < 0.01 mg /L 04 -30 -99 0.32 mg /L 05 -05 -99 7.2 SU 04 -29 -99 18 mg /L 05 -11 -99 1.6 NTU 04 -30 -99 EPA 200.9 SM18 3111D SM18 3111D SM18 3111D SM18 3111.D SM18 3111D. SM16 314A SM18 4500 NO2 Orion 1985 SM18 4500 •.HB SM18 2320 B EPA 180.1 • results expressed as milligrams per liter unless otherwise specified • pH result expressed as Standard pH Units • Turbidi.ty test result expressed as Nephelometric Turbidity Units Anne Smith Laboratory Director NYSHD ELAP ID #10924 YS DEC WETLAND BR-6 BOUNDARY N 18*21'55" w 31.67' 7 � N 0024 w 4, 04'01-37— E 98 LOT 2 AREA p5 1.753 ACRES I (76,369 s. f of L01 J N 05 -59,28 t 20 ---'CD- 0 02,4 E io8.22' S 3 o7 42'37r" E DWELLING WELL DPIVFWAY ----------- 181.98 �22 Lo • YS DEC WETLAND BR-6 BOUNDARY N 18*21'55" w 31.67' 7 � N 0024 w 4, 04'01-37— E 98 LOT 2 AREA p5 1.753 ACRES I (76,369 s. f of L01 J N 05 -59,28 t 20 ---'CD- 0 02,4 E io8.22' S 3 o7 42'37r" E DWELLING WELL DPIVFWAY ----------- 181.98 MARKET e.l t' NO. A B REMARKS 1 18' 20' 1250 GALLON sEP77C TANK 2 21' 27' PUMP PI T N0. C e.l t' NO. A B REMARKS 1 18' 20' 1250 GALLON sEP77C TANK 2 21' 27' PUMP PI T N0. C D REMARKS., OF 3 110' 65' JUNCTION 8,64 4 109' 68' JUNCTION BOX -', 5 104' 74' JUNCTION BOXY 6 100' .87' JUNCTION . BOX1. 7 93' 90' JUNCTION BOXY .; 8 109' 82' JUNCTION BOX 9 72' 104' END OF TRENH 10 70' 105' END OF TREK ,H• S 06'15'29" E 14.06' 11 58' 116' END OF TRENCH 12 50' 125' END OF TRENCH 13 36' 139' END OF TRENCH 1.4 149' 36' END OF TRENCH 15 150' 41 ' END OF TRENCH 16 150' 46' END OF TRENCH 17 148' 52' END OF TRENCH 18 148'. 58' END OF TRENCH 19 149' 63' END OF TRENCH 20 59' 130' BEGINNING OF CURTAIN DRAIN 21.. 169 1 1 ' CORNER OF CURTAIN DRAIN 22 165' 85' END OF CURTAIN DRAIN PUTNAM CO TNTY DEPARTMENT OF HEALTH DIVISION' OF. ENVOI.ONIltIENTAL. HEALTH_.S.ERVICES.,_ CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P / - 1725. l� Located at !'XzM -r-n M &a a- r- r i2P. or Village �r4 -rTE S° Owner /Applicant Name, Yx' � &,J51-r- J 1-�+�, i �a'k Map 3 ` f Block S Lot 3 7.2- Formerly 'I S C H LC(L- Subdivision Name ER f y Subd. Lot # Z , g 1 Mailin Address f"l'd� ^� i ! PLC i✓ o Zip Date Construction Permit Issued by PCHD /' 2 0- 10 Separate Sewerage stem built by TAl c12 0Y(,A rfl�C . = Address �� E ,1< <.�c, `� P,a -•�$� h yT'1 0681.1 Consisting of i 2 S 0 Gallon Septic Tank and .SCo Lx o P- 2' Som PT la, cal -rR5,M e14 E S Other Requirements: `Po m P P r r F i i, L To C-- FAA, n a -rte i s I Water Sup Id: Public Supply From Address. or: _ Private Supply Drilled by t'► / c-�,J Address 10 18 (2-r , f'ATf -)zsisJ -wilding Type - i�� .. °-.. _ - .....Has erosion control -been I N 5TA� D.. YES. Number of Bedrooms 4 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 the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: �' `� Certified by P.E. X esign P ssional) AND�D Address ZW S i•rE P-W u License # 1 y 31 laRc0rraetuQP7V4• iR 'C2Z 1050'1 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 revocati , odifica ' or change is necessary. By: Title: Date:`i ,1+ Y• —Q� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 IFUTNAM (COUNTY IlDIEPAI[81I'IViIIENT OIF IFIIIEAIL'll'IHI IIDIIMON OIF IENWRONMIENTAIL HEALTH SIERWCIES APFUCAT ION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Wen ILocadon: Street Address: To illage Tax Grid # (NzM IT M M���ro (Aa-C 1-5 0--r� Map S+ Block S Lot(s) 37, -Z- Wen owner: Name: mo u Plot?-11E1. Address: v 5 C-iq 557 6 ke-r- trT-67 r Nita -5 Soohe-- 25 Wy 105701 Use of Wen: X Residential Public Supply Air /Cond/Heat Pump Irrigation - nimmzlry Business Farm Test/Monitoring Other (specify) 2- secondalry Industrial Institutional Standby Amount of Use Yield Sought 5gpm # People Served 4 Est. of Daily Usage 3 00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply DlrnIlllnng )4- New Supply (new dwelling) Deepen Existing Well Detafled Reason for D>rmkg Wen Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 'A, Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision T 1 S LN t-C-'K— Lo No. Z Water Well Contractor: U,VKr-) own} Address: u tv ILNoE.a Is Public Water Supply available to site? Yes No Name of Public Water Supply: sJ I A- Town/'Village ,✓ / A' Distance to property from nearest water main: ,,i A— Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: r 8 Applicant Signature: `� PERhUT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. AIEPROVIED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue / /j Zo A i- . Permit Muini? OffieW: Date of Expiration i / L n/ Z",> Title: (/cj 1,( Peirmmnt is Non- T>ransffeftzbR White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH i DIVISION OF ENVIRONMENTAL HEALTH SERVICE CONSTRUCT ON PERMIT FOR SEWAGE TREATMENT SYSTEM PE # 2 ( c Located at FA(e K iv m m--Kel' pz yfl) To r Village Subdivision name Subd. Lot # 7� Date Subdivision Approved Owner /Applicant Name Dttvl D Tax Map 3q— Block Lot 37, *7,-- Renewal Revision Date of Previous Approval Mailing Address A) Zip 10 5'%j Amount of Fee Enclosed 300, 00 Building Type 9 t5fI Lot Area 11 -75'344o. of Bedrooms + Design Flow GPD 90) Fill Section Only Depth Volume Separate Sewerage System to consist of Z '5 -0 gallon septic tank and Ac t350 77 n T?�---Jc -(4es Other Requirements: 19()m to 1',fj Fitt Tv G -zxAVE 7a t S;f,, To be constructed by aA) lwo �) 1 Address Water Suooly: , Public Supply From 40wift"U3 Address Private Supply Drilled by .vrccvo ov Address........a� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address Date S 1 qb License # 611 S I yy 7 APPROVED FOR C6NSTRUCTION: Tgis appfoval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pep6ji Approved or discharge of domestic sanitary sewage only. By: �� Date: J��vw Title: � White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 z'^' ;k � r '� TF7.l�; P If 5y� i x� p� .y 27'8" X 48'o 2656 Sq. Ft. Second Floor MASTFR BEDROOM IT' -2i2 x 16'- 8" PUTNAM COU141' I S"PXFTMENi OF T'H r, T. A? N A �.'r'r'i ''i' 7 FOIR V First Floor BEDROOM4 BEDROOM3 11' -0" x 9'- T" IV-0"X 13' -0" J . ... r 27 n 8 BEROOM 2 16' -4 P. x 13' -0" I KITCHEN 1, BREAKFAST 12'4'x 13'-0" 8' -5" x 13' -0" i - gINING ROOM 0 13'- 9" x 13= 0" i i FAMILY ROOM 20' -0 "x 13' -0" 48' ViNG -ROOM - 18'-9"x 13' -0" 27'8" STANDARD SCARSDALE It FEATURES • 4- Spacious Bedrooms © Framingham Pediment on Front Door • 2%2 Baths o Fireplace Options Available • Open Two -Story Entry Foyer o "Boxed -out" and "Angle Bay' Options • Formal Dining Room Available • Formal Living Room o Consult an Authorised Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry o Artist's renderings and Floor Plan Dimensions are • "Cottage-Style" 3056 Lower Level Windows approximate. All specifications must be Written in the Contract No oral conditions. with Architraves on Front } w ESTCHESTER 0 ®OLAR ®ESg INC. P.O. Box 900 o Dover Plains, IVY 12522 Ili (914) 832 -9400 o )800) 832 -3888 DEPARTMENT OF HEALTH Division of. Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Date: 2-12-q a BRUCE R. FOLEY . ' Public - Health Diret7or To: 4 AI I AI L Fax #' y-7 3- 03 4 3 No. Pages ; Z— Z (Including cover sheet) From: "� S Putnam County Environmental Health Notes/Nlessages As '-p—E—QueGrED 10 (F- "Mf-�,2( AP-L Ag N ao f LoA1 S aD UPASE C—A LL . In the event of transmission/reception difficulties, please contact this office. fNAM C• UNN DEPARTMENT OF HEALZ DIVISION • ENVIPUZEMM BEALTH SERVICES DESIGN DATA DISPOSAL SYSTEM =FILE Owner P,4wP P7Ukj9t E5, -7-15C,# Address 46,_+grq jo W,,4rte 15ke-05TWZ, 1YV Located 'at (Street) --" ,v omn:f Sec. -3 4-v Block 5 Lot (indicate nearest cross street) Z-07- Municipality IPA -rr&-7.?,5, Watershed e_ko-roju SOM. PERCOLATION TEST DATA REOUIRM TO BE SUBMI= WITH APPLICATIONS Date of Pre-Soaking O/e/75 _ _ Date of Percolation Test 44NM560 IST MRAA&Aga t-LOX0 6VVYC-926E1 HOLE 2 /L 0 NU-MR CLOCK TIME PERC0=ON 3 PERCOLATION Run Elapse Depth to Water From Water Level 4 NO. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches 5 2 /L 0 3 Z C rZ 3 ll;o7— 37 3,&,� 4 A) 5 - ZZ Yf 4 Z-1 5 1 2 3 4 5 N=: 1. Tests. to be repeated' at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made from top of hole. 2 /L 0 rZ 3 ll;o7— 37 3,&,� A) - ZZ Yf 4 Z-1 5 1 2 3 4 5 N=: 1. Tests. to be repeated' at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made from top of hole. TEST PIT _ .1'A RDQUIRED TO BE SUBMITTED WI'1__ APPLICATION DESCR=ION OF SOILS ENCOUNTERED IN TEST HOLES e _ DEPTH HOLE NO. QI _�.� HOLE No. HOLE N0. _ G.L. 1, 'Top SOIL- 21 Goan Pf�Gt� 31 S Y LOAD) s�- S41vo 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED A/�q INDICATE LEVEL TO WHICH WATER LEVEL RISES AF'T'ER BEING ENCOUNTERED LV DEEP HOLE OBSERVATIONS MADE BY: hlt-L DATE: S_ DESIGN Soil Rate Used /1 —IS Min /1" Drop: S.D. Usable Area Provided 7dpp S.I, No. of Bedrocros Septic Tank Capacity /Z sd gals. Type oo^<AdW Absorption Area Provided By S oO L.F. x 24" width trench Other Almio PIT-. AOA, Name Jef Fgl--�L( J • C"00TG-t ..'-w , � • Signature Address Insite Engineering & Surveying P.C. SEAL :` Route 22 . ;.. Brewster, NY 10509`x';' THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEALTII INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSI•EMS' ` REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION L U NrYi11E Olt OWNli12 %974�N REVIEWED BY CR AS, MB, BH DATE g.'/2 A TAX MAP # Y N DOCUMENTS V N PERMIT APPLICATION l:R.(QStON --e T130t ttODgE 1V, ELC. SSDS PC I F/ PERC & DEEP HOLES LOCATED L OF AUTHORIZATION -- A JO 5eccj DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION PLANS- THREE SETS REQUEST ® FEE SUBDIVISION LEGAL SUBDIVISION vv SUBDIVISIO -OVAL CHECKED f IRC RA. t7 LL REQ DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD EP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN /DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME NEIGHBOR NOTIFICATION ttlTM BI /ZBA 166 Y FLOOD ELEVATION ZEQ'D PL'RMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN- (NORTII ARROW) REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE t•F-1 dMPED, PIT & D BOX SHOWN & DETAILED WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. SEWER 4/-4—"F-t>4"0; TYPE PIPE 5gow a4 plain eL g welt et-s' prz-i(//e FILL SYSTEMS LAY BARRIER 1 - HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPE FILL NOTES FILL CERTIFIC N NOTE DEPTH GAUGES FILL PROFILE SIO VOLU L13ML IN EXPANSION AREA �. TRENCH VtDEMD 60 FT MAX. PARALLEL TO CONTOURS C %`C taLl?R VIDI: SEPARATION DISTANCES SPECIFIED - . • ON-PLAN - FROM -SSTS V O , • P FILL Q jtLQFtfitHiCTCO - ILL-: Ellm ' > 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. cxpan) 50-1'0 CATCI I BASIN, 35' S'I'ORMDRAIN, PIPED WA'T'ER 10' TO WATER LINE (pits -20') 50' INTF•.RMITfGN'I' DRAINAGE COURSI: 200'/500' RESERVOIR, E,I•C. 150' GALLEY SYSTEMS GRAVITY FLOW 19TES 1-1 to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' - <1% DESIGN DATA: PERC & DEEP RESULTS to CD discharge /100'with 182 cons day discharge i CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m _ , m.U'l�L -:!" '" �10.t7 NG/ W E EB @[1N tES S-T(`i-PBOLr1�1 FDATEOJFDRAWING/REVISION LOCK -,< NAME<A_12p t 'S FT]a l'QC11 G131it CQIYNt _ 8 /RA; NAME,ADDRESS,PHONE# REFERENCE ON OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mRkM39EDFINISH FLOOR AND S COM IN'I ENTS: le 1dc37F -1y 5La6' c�lt� a[5� �4t�ui �X �uytgtl'c��vt �:zyea I l' , V -e� o d/ ha V e h *°' wW-1i Li, NCp 3 u u/ a OPERATIONS & ENGINEEUIVG *BS VOL IIA I/S AVENUE Coner suirE � VALNALL4, IVEW YORK YOSSS Shoot FAX &#M- 0343 Transmit to FAX# 2?9- 792 Number of Pepes' Z Dam �14 l Cotter Sheep De!ttier To: mD From � . MeC a,r, more, Subject: TISC H tAM a57-f-> OTZ 1 C7 I NFL, Ta I u: 7HM ARE AW PAOMZW REGARDING THIS FAX PLEASE CAL, 914- 1 [109P WE CRY OF G4EW YORK DEMME= of E{4�fDUMMMENAI PR ®Ui ROW flOE L b. HOELE, SR, P.E. CoA4 missionw ` M0.0.MN 0. iur,� oao ®epM Commissioner PHONE (904) 7,62. "Di Bureau of Water supple' JFIM (914) 942-2027 Quzli*V and Protwdon March 9, 1995 Robert Morris. PuW= County Department of Health Division of Environmental Health 4 Geneva Road Brewster, Now York 10509 Re: Proposed Subsurface Sewage Treatment System (Joint Review) Tischler Property - Lot # 2 Patterson, Putnam County Log # 3015 Dear 11/ir- Morris: This letter is to infom you that the New York City Department of Environmental Protection (Department) has no objection to the approval of the above referenced regulated activity for the property located on Farm to Market Road in the Town of Patterson, Tax Map# 34 -5 -37.2, Lot #2. This determination is based on the review of submitted documents including the plan titled `SSTS for Tischler' dated December 29,1997; last . revised February 26, 1995 by bnsite Engineering & Surveying ,P.C.- the Department reserves the right to _ ., _...... _. modify, suspend,.or revoke-th i-appioval based on the grounds set forth in Section 15 -26 of the Regulations: Once the project has been completed and inspected by a representative of this Department, a copy of the as- built plan shall be sent to this office. The applicant must contact Jannine McColgan at 914 - 742 -2065 at least 2 days prior to the start of construction. of the Subsurface Sewage Treatment System (SSTS) so that the Department may inspect and monitor the installation. If you have pxXquestions, please contact Jannine McColgan at (914) 742 -2065. Mar*et L16yd, P.E. v Supervisor JF.wgineering Design and Review xc: James Covey, P.E., NYSDOH bxc: Sadosky LloydlMcColgan File . 465 Columbus Avenue, Valhalla, New York 10595 -1336 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 BRUCE R. FOLEY Acting Public Health Director DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM i-zT "X V4- 3 L' -S- 31, Z Project: `r[ S C',!� � . i 1 QiM -1-:, ' MA216a V CT-) Town: ?0 Fma.,-e %J NOTICE OF COMPLETE APPLICATION: Delegated_ Joint Review DATE: PgTTNAM COUNTY i)EPliR'g'MlE1VT OF H]EA]C,'II'II DIVISION OF. ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of DALAI� : V400 -(a— T(5C%it,E2 Located at CV 1 "fill 5 Subdivision of Subdivision Lot # Gentlemen: WM -rO vo A- ,2( -CI' go" Tax Map # 34 'C`t `' C, h-1 LC'1Z Block Lot 3 7, Z Filed Map # SZ Date Filed `) - -' This letter is to authorize Insite Engineering & Surveying, P.C. (Jeffrey J.Contelmo, P.E. ) a duly licensed Professional Engineer — - to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems ....:i�..0.onforrPity with the provisions of.Article .1.45. and/.or. L47_o£,the Education. Law., -the Public- Health.... -.: Law, and the Putnam County Sanitary Code. Very truly yours, � 40 d/ . Y Countersigned: Signed: X VY1�'^1 1?.E., R.A., # 619 3 (Owner of Property) Mailing Address Insite Engineering & Mailing Address: Surveying,.P.C. Route 22 Brewster 5 State New York Zip 10509 State Zip 1 SS l Telephone: _ ( 914) 278 -4990 ;Telephone. z7 -7 — I -7 `_5 Z.__ Form LA -97 r4 KI u "CLOSED I-AC DistG 4 DAI A �o VoLu 04e r. 5 .1 � ��,= Z sir 3 12 3S, ZS�3 5,� -7-40 6A L- /.� 3 "ID ► PC- VOLUME Tr Z ' 500-FT 3 l ENGINEERING & 1L 1 �Y �U1t �1L'a SURVEYING, For Wastewater Facilities Prepared for the SSTS Tischler Farm to Market Road Town of Patterson, New York January 5, 1998 INTRODUCTION The proposed project is located on Farm to Market Road, in the Town of Patterson, Putnam County, New York. The site is designated as Tax Parcel 34 -5 -37.2 and is 1.753 + /- acres. The site is currently wooded with moderate slopes. The applicant proposes to construct a four - bedroom dwelling, driveway, SSTS, and well. Sewage disposal will be into a new subsurface sewage treatment system. The proposed construction will require a Building Permit. The elevation of the proposed SSTS is higher than the 10 -year flood elevation. SEWAGE DISPOSAL It is proposed to construct a new subsurface sewage treatment system to service the proposed dwelling. Percolation and deep test holes were conducted on the lot to determine the design parameters. o Percolation Tests Two acceptable percolation tests were conducted on the lot. The tests yielded stabilized pe "rcolation rates of 15 -and 13'min. in. ,As such, a design percolation rate o 11 -15 min. /in. has been established for the lot. o Deep Hole Tests Two acceptable deep test holes were excavated on the lot. The soil profile generally consists of topsoil to 1' and compacted sandy loam and sand to 7' and greater. No groundwater or mottling was observed. Design Flow The design flow for calculating the required length of absorption trench is 200 gpd/bedroom. 4 bedrooms x 200 gpd/bedroom = 800 gpd Absorption Trenches A design percolation rate of 11 -15 min. /in. requires 500 L.F. of 2' wide absorption trenches based on Putnam County Health Department design requirements. o Septic Tank Er94175.doc The minimum septic tank volume required based on Putnam County Health Department requirements is 1250 gallons. A 1250 gallon septic tank is proposed to service the dwelling; Of NEW �� atiV J. COt�r, 04.f INSIT -- SENGLNEERIG URVEnNGNP & ...,,.< Pump Pit Design for SSTS for Tischler Design Flow = 800 gallons per day Use peak hourly flow 10 times average daily flow January 5, 1998 Q Peak = 800 10) = 5.6 GPM (24)(60) Static Head = ±21 feet C = 130 d= 2" L = f160 feet GPM = 47 GPM Equivalent L (Bend & Valve Losses) _ ±50 feet Total L = ±210 feet HL = 10.44 Total L GPM (1.85) = 11 feet C .85) d .Total Dynamic Head 21 feet ± -11 feet - 32 feet : - .- ........ _. Use Goulds Pump model #3885 series WE05H (or approved equal) This pump will pump 47 GPM with a total dynamic head of 32 feet at 4.8 FPS. Insite File No. 94175.302 1230ppd.doc e z APPLIC�TIONS,1,�� ,•,� ^-a Specifically designedxfoN e 4 following�usesM.-��,.�� � �4 ! Trailer�Gour£sr...f.. Ustry:� x Efr l+Ct t�i �* uenuSysterai'is� G. C Jr .Y ci' a 1 i Y id Handling papa I I I I s AAA .......... ....a i,xc <f _ ... _ ..- 5 x Stat o'nary% Se 4r ;300 Series' Sta n�essLbteel Mei �Parts,Rl1NA N��lactnm`ar`s ..: . F Goulds SubmersiNe Effluent PUMPS NODEIL %30.85 ETL LISTED SUBMERSIBLE PUMP CLASS I AND II DIV. 2 AND G1086131480 CLASS III DIV. 1 AND 2, ETL TESTING LABORATORIES, INC. CORTLAND. NEW YORK. 17015 -- •- YF,z} a�•+'��' +ems '•�i'- .y�W: T P�,+n.. yy "",_ Y"`r , t i r FEATURES 3`t'HP 15 orb 50'RPM �t ��t� y �'Hz�°3500 RPM° ` s'Impeller Cast iron „semi open, 1 E. non clo with um out vanes for IP„ 230V, 60 Hz; * ik g p p mechanical sear protection Balanced . i with,�automafic for smooth operation Bronze ,Y t impeller- availabl- an option C' f astng Casironvolute typebfor maximum efficten�y 2 «: NPT HPfhru 1 /Z H�}P;, ,� discharge adaptable for slide rail ' 6&Hz 9-eC h Ty 4 _ 1 yF 1 'syStenls,---,,: �n, overload kx ' s,Mechanical .Seal Ceramic vs sr carbon sealing faces Stainless steel bey oTvidedkm =� fis ` a metal arts BUNS N elastomers .V .t tfA Cott' 1; nnres stant ; 1, 4Q.wsi enes.,,.pk,, stain ss steel Threaded design t v ' E A « h three Locknut phase models eanngs uppe <�... F= guartl�against�cornp�onent darn oniaccidental reverse rotation: foot standard ti ;' f rotor " -Fully s'ubmer,.ged in high lengts MIV n< tL " grade turbine oif for lutricafioi and Land' /z HP 1:6/3 r efficient heat transfer F 4 „ Designed for,Contiriuousi.} ,� prong plug�u _ ,Operation Of ratings are ": 4/3 ST0 with ° Within the motor�manufact .... , 49 }° recd mmendetl workin limits; can thrualf' /zrHP 14/4r be: operated continuo s lytwithout �ads' iodels. 20'" damage. ' Bearings Upper antl Lower heavy f 1 d S1M, are 4 duty I l 66fih g "con'st`ruction "` P $� �Power.Cable: Severe duty rated, tJy r ;k # o . and water;re�sistant,',Epoxyseal ,�5 rr 4w on motor -'end prpvitlessecondary ° moisture barrier 1n case of'. outer iaeket damage and to prgventroil',a ' wicking ; Assures�positive sealing rp st,k c 3 against contaminants and oil leakage - % "A�� F °Effective December 199j ,s e z APPLIC�TIONS,1,�� ,•,� ^-a Specifically designedxfoN e 4 following�usesM.-��,.�� � �4 ! Trailer�Gour£sr...f.. Ustry:� x Efr l+Ct t�i �* uenuSysterai'is� G. C Jr .Y ci' a 1 i Y id Handling papa I I I I s AAA .......... ....a i,xc <f _ ... _ ..- 5 x Stat o'nary% Se 4r ;300 Series' Sta n�essLbteel Mei �Parts,Rl1NA N��lactnm`ar`s ..: . F Goulds SubmersiNe Effluent PUMPS NODEIL %30.85 ETL LISTED SUBMERSIBLE PUMP CLASS I AND II DIV. 2 AND G1086131480 CLASS III DIV. 1 AND 2, ETL TESTING LABORATORIES, INC. CORTLAND. NEW YORK. 17015 -- •- YF,z} a�•+'��' +ems '•�i'- .y�W: T P�,+n.. yy "",_ Y"`r , t i r FEATURES 3`t'HP 15 orb 50'RPM �t ��t� y �'Hz�°3500 RPM° ` s'Impeller Cast iron „semi open, 1 E. non clo with um out vanes for IP„ 230V, 60 Hz; * ik g p p mechanical sear protection Balanced . i with,�automafic for smooth operation Bronze ,Y t impeller- availabl- an option C' f astng Casironvolute typebfor maximum efficten�y 2 «: NPT HPfhru 1 /Z H�}P;, ,� discharge adaptable for slide rail ' 6&Hz 9-eC h Ty 4 _ 1 yF 1 'syStenls,---,,: �n, overload kx ' s,Mechanical .Seal Ceramic vs sr carbon sealing faces Stainless steel bey oTvidedkm =� fis ` a metal arts BUNS N elastomers .V .t tfA Cott' 1; nnres stant ; 1, 4Q.wsi enes.,,.pk,, stain ss steel Threaded design t v ' E A « h three Locknut phase models eanngs uppe <�... F= guartl�against�cornp�onent darn oniaccidental reverse rotation: foot standard ti ;' f rotor " -Fully s'ubmer,.ged in high lengts MIV n< tL " grade turbine oif for lutricafioi and Land' /z HP 1:6/3 r efficient heat transfer F 4 „ Designed for,Contiriuousi.} ,� prong plug�u _ ,Operation Of ratings are ": 4/3 ST0 with ° Within the motor�manufact .... , 49 }° recd mmendetl workin limits; can thrualf' /zrHP 14/4r be: operated continuo s lytwithout �ads' iodels. 20'" damage. ' Bearings Upper antl Lower heavy f 1 d S1M, are 4 duty I l 66fih g "con'st`ruction "` P $� �Power.Cable: Severe duty rated, tJy r ;k # o . and water;re�sistant,',Epoxyseal ,�5 rr 4w on motor -'end prpvitlessecondary ° moisture barrier 1n case of'. outer iaeket damage and to prgventroil',a ' wicking ; Assures�positive sealing rp st,k c 3 against contaminants and oil leakage - % "A�� F °Effective December 199j FEATURES 1. irnpeller, 2: Casing . 3. Mechanical— 7__ Seal d. 4. Shaft 5. Motor p. Bearings Upper & Lower 7. Power cable 8.O -Ring ®R, 22 Goulds submersible Effluent-, .Pumps,. 3.8,81.15. ks W" A _i�;JN WEO:!1!2HHHHT1WE1512HH V1 ift1532Hk V El L!' 0E1, 4HH J T� AM .2� '956Q1"-' 3500: �7 q 1- -53',; � 7 .,100:1[ 1. 4 5 96rjE 740 i2' 92 f 35 ;f L " 65;' .54*,, 3. m7 4-1-2 HN&WE1 0. 2 PRINTED ED IN. US , INT. . . 0 6,, T A 7 J 1 '' r-j40 7 -2 JR m7 4-1-2 HN&WE1 0. 2 PRINTED ED IN. US , INT. . . CuRvas METERS FEET 25 20 0 15- 10- 5 - 0- �'b E -is 6� fluent Sub ni,..z4ai F PumpsINN -..EN q- 120 mommommommmomomm 35 110 100 30 FAMMR 25• 80 70 H, 1 20- 60 0 0 50 15 - 40 10- 30 20 5 10 0— 0 oii': ° ■i�is�ii■iii■ii OWN] 120 01985 Goulds Pumps, Inc. 0 10 20 30 40 50 60 70 80 90 100 - 110 120 GPM I L I I 0 10 20 30 ml/h CAPACITY Effective July, 1985 35 110 100 30 90 25• 80 70 H, 1 20- 60 0 50 15 - 40 10- 30 20 5 10 0— 0 01985 Goulds Pumps, Inc. 0 10 20 30 40 50 60 70 80 90 100 - 110 120 GPM I L I I 0 10 20 30 ml/h CAPACITY Effective July, 1985 INSITE-0 SUR NGINEERING &. EYING, P.C. Route 22 Brewster, New York 10509 (914) 278 -4990 Fax: (914) 278 -6392 - „7.,DeLav_er ne,Avenue _• ,. Wappingers Falls, New York 12590 (914 _297- 17.42 ... 1-- TO: P. c, N "P, LETTER OF TRANSMITTAL DATE ' / JOB NO. ATTENTION RE: 5 s T5 F� ris\ i-Oz- . WE ARE SENDING YOU ttached ❑ Under separate cover via the following items: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ THESE ARE TF)AN .SMITTED asjaheckpd below: I I Z'/ 1 619 7 1677 3tv- do CElzT (;71 ep Cf4 TK For ap ro al ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS: iw ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO: SIGNED: 31-0 iF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE INSJTE-0 ENGINEERING & SURVEYING, P.C. Route 22 914 278 -4990 Brewster, New York 10509 Fax: 914; 278 -6392 7 DeLauergne A%mrive- Wa TO: ,-- 7 (914), ?97 -1742 DATE a JOB NO. ATTENTION._ RE: WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop Drawings Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ THEGE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE REMARKS: ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO: SIGNED: /! IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10.509 Tel. (914) 278-6130 Fax (914).278-7921 January 16, 1998 Insite Engineering & Survey Route 22 Brewster NY 10509 r BRUCE R. FOLEY _ PdNie' Health'`"Dir"&tor'' RE: Application to Construct a Subsurface Sewage Treatment System at Farm to Market Road, Tischler Lot 2, TM# 34 -5 -37.2 (T) Kent Dear Sirs: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 9, 1998 is incomplete. Please be advised that the following information is required before the Department may commence its review. Lodaticn ..o£.service- connection .from the well .to the.hot se_is.to.be.shown...____ The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Dept. Of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. , Very truly yours, /J e�il.rll 19�1��4 Robert Morris, P. E. RM /tn Public Health Engineer •r SoUs .hest epa 'N� Ybirk �Ci ��� �ff Oruject Name: TOSC9LER E�6 QJECT t Permit No.: Date: June 9. 4995 - Soil Test No. 6wners name: Davin B. And Muriel B. Tischler 4 y' Owners Address: Farm to Market Road 4 Brewster New York 10509 Tax Map No. Mw'34. §lk 5. Lot 37 Building Permit Ago. laer olation Test data Clock Time Depth to gaiter LC7't" from ground surface Hole Run Elapsed Start Stop Change No. no. Staft Tone Stop Time Time inches inches inches E minutes Soil Rate minlin R.0014 Fl Nr, �' SAN LaAM Zo z.o OLA v 6 ;BROwti 4A N 1-0 C�op3a t.Gs' AND PtAy,N6 POcJ 6 1 P, N4; TIT L-ON." L.IO 93' 0 T,� 5�o'ts' C3��ow ,�76 l7 C- C, U_ �v ►.� C� tZOG<< v pO c.k. E r� �.ocyst i C SA m D-I LO yg-LJ—awcs o� N Zo z.o OLA v 6 ;BROwti 4A N 1-0 C�op3a t.Gs' AND PtAy,N6 POcJ SOM6- 93' 0 T,� APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL - SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT rY;_S FREET I:OCATION A121v1 .. -D.. fl' K ET R 0-442' NAM'E'OF-OWNE9 -iAVlb it MU�P`l �G"�` %5G,4 4R BY B. HEDGES R.MORRIS DOCUMENTS. Y PERMIT APPLICATION PC -1 -- OTHER_ -e*. R 6 6 DATE l 98 TAX MAP 7 WELL PERM ITaz--� ENGT�S A_;,UTIOI /VD S rn DESIGN DATA SHEET(DDS) E RESOLUTION j:1kNS THREE SETS OUSE PLANS -TWO SETS -= " dU E REQUEST SUBDIVISION SAL SUBDMSION ,DMSION APPROVAL CHECKED CRATE 0-16 -REQUIRED DEPTH ZTAIN DRAIN REQUIRED =STANDPIPES :C TEST WITNESSED BY NYCDEP? GENERAL .J EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE K HOUSE - NO. OF BEDROOMS — 4132 WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/47FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W /CLEA \`OUT FILL SYSTEM'S CLAYBARRIER m 10 ONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOT 0 FILL CERTIFICATI 0 DEPTH GAUGES 0 FILL PROFI, r Vouu L IN EXPANSION AREA X- APPROVAL SSDS ADJ. LOTS W'ETLAN'D ( TOWN/DEC PERMIT REQ ?) TRENCH DATA ON DDS PLANS & PERMIT SAME LF TRENCH PROVIDED �60 FT NIAX - NEIGHBOR NOTIFIFICATION PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ranD ELEVATION SEWAGE SYSTEM PLAN - (NORT AldnOW) SSDS HYDRAULIC PROFILE EWGRAVITYFLOW CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS �V O -FOOT CONTOURS EXISTING & PROPOSED EROSION CONTROL; HOUSE,WELL, SSDS EROSION CONTROL NOTE REPRESENTATIVE OF PRIMARY AND EXPANSION .LOCATION MAP ( MIN 2 BEDROOM HOUSE) LIIJ IV FROM FOUNDATION; 50' TO WELL DATUM REFERENCE, NOTE SURVEY SOURCE W L LOCATION OF WATERCOURSES,PONDS,LAKES, MENSIONS TO PROPERTY LINES WETLANDS WITHIN 200 FEET LION`.OF SERVICE'CO 1rMON PROPOSED FINISH. FLOOR AND BASEMENT EL. IW TO P.L., DRIVEWAY, LARGE TREES, P. OF FILL 20' TO FOUNDATION WALLS EJA I V 100 TO WELL, 200' IN D.L.O.D., 150' PITS PO TO STREAM WATERCOURSE LAKE (LNC.EXPAN) 50' TO CATCH BASIN, 35' STORhIDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' L,,rrERMITTEN'T-DRAINAQfCOURSE 200 FT. RESERVOIR, ETC.M 150 FT. GALLEY SYSTEMS 15' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3%,30'- 2 %,35'- l%,100' <l ") X20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. TLE BLOCK; NAME, ADDRESS PROPERTY LOCATION(street NAME & ADDRESS PE /RA, D REVISION Well (owner) , TM I#, & municipality) ATE OF DRAWING/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: DA y't, 2. Name of project SS 7 6 H 07 ( rr+e(r K( L. L 5 �S FiYL fi5CHCM , .3. Locatio 1A- rrCP' :'- 4. Design Professional: Jeffrey s. Contelmo, P.E6. Address: Insite Engineering & Surveying, P. c. Route 22 6. Drainage Basin: Brewster, New York 10509 7. Tvne ofProiect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................... ........................... Type I Exempt Type II. Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Pa 10. Has DEIS been completed and found acceptable by Lead Agency? ............... jil Ar 11. Name of Lead Agency A114 12. I this project in an area under the control of local planning, zoning, or other fficials; ordinances? ....................... - . .. _ . ........ : .... ....,................ X151: 4r.6 PeY 13. If so, have plans been submitted to such authorities? ......... ............................... 0 o 14. as preliminary approval been granted by such authorities? #0 Date granted: IJI 14' 15. Type of Sewage Treatment System Discharge................. surface water ground water 16. If surface water discharge, what is the stream class designation? .................... ;4,/�A- 17. Waters index number (surface) .............................. ......... ............................... /4- 18. Is project located near a public water supply system? ....... ............................... /J 0 I9. If yes, name of water supply A Distance to water supply N 20. Is project site near a public sewage collection or treatment system? ................. 21. Name of sewage system lu (A- Distance to sewage system 22. Date test holes observed _62 q 23. Name of Health. Inspector 1viK6 24. Project design flow (gallons per day) ............ :.................................................. ... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... ° 26. Has SPDES Application been 'submitted- to local DEC office? N I A- Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? y 28. Wetlands ID Number .............................................. ............ ............................... `............ ............................... y'So�C C�f�i- 6 29. Is Wetlands Permit required? . . ° Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... rJ D 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/No 'o.° 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ..............;................ Yes/No o DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 2Mc,)0 (.v01) 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project sites 35. Are any sewage treatment areas in excess of 15% slope? .........................Y&I 36. Tax Map ID Number .......................... ............................... Map 34- Block `�`� Lot 57,-7- 37. Approved plans are to be returned to ..... Applicant_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent,to the Department,. and° need .not -be sent-- induplicate to the-DER, although'the project may require DEP' - approval of the SSTS prior to final approval.by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my.knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & ®FFICiAL TITLES. Mailing Address: ........... .................... 14.164 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Ouallty Review .... , �..,_,,... _..__...._.._......._ .. _....._ SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant..or Project sponsor) 1. *PPtle*N:msPONSOR ggc // 2. PROJECT NAME. � TS 1-"`b� T I Lf-1 LL-YZ - &CJT Z 3. PROJECT LOCATION- I���L�S °^� p vTr� Ate✓( Municipality �! l County f 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Sc� C�vS77�!v17-C-&-J D.�.9 c✓ t aC 5. IS PROPOSED ACTION: ew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: C,,V 5 _r 7Z � + (v C--D L ,vC-7 S s t v �ZL r _ u iLI r/eG/({ 7. AMOUNT OF LAND AFFECTED: 1 ,'75 -3 ± (r -7 5_ ' Initially acre s Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? pQyes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? VResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesUOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE O�� R LOCAL)? ��yy LS�Yes ❑ No If yes, list agency(s) and permlt/approvals (T� PAriL,7T501v 5cnC-7. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes' 'fgNo It yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE °r� 0 K� �� ` Appk- inVsponsor name: w Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete• the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by 4gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAR ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.61 If No, a negative declaration may be superseded,by another.involved -,-.,may El Yes ❑No .. - agency. ,-. ..... ., . , ..: ......... .. T , _.. - , ...... ., C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE' FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be Induced-by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes 040-, No If Yes, explain briefly PART III- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF.andlor prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsi6le Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Tit e of Responfible O ficer Signature of Preparer (if different from responsible officer) / let - . -. Q �� :. �- ... jam•, �•i�T".. L .. . ,�.. ,.•. ,.. ». -.., New York City ow Department of �wP Environmental Protection OPE" TIONS A ENGINEERING Far 455 COL!/A/SUS AYENUE covev su» � _ VALNALLA, JVEW WAK f0595 SAwt FAX 0775- 0343 Transmit to FAX# q E - 2-T - 7 G , Nurnber of pages: 'Z� Date: andudng Cover Sheet) N Der To: Ro p q1 q - X42 -Zo ,�AWNtN� t Phone: IF THM ARE ANY PROBLEMS REGARDING THIS FAX PLEASE CALL 914 , TO'd 9Z:ST 86, 2Z qa3 ib20- 2z2- VT6:xp3 ONI833NION3 cm SAN t�oiuJwc �� 64 1a� 6� = 4363- (5?- ----436 N 007¢35 =W 75.24: N O4'ol'j7- f 436--'- N -L7.5-59�-, 15552',. 440 S87 LOT -7 x fl �2- Z-'I; 44 , —1 AREA uer- 1-75, A (J) I250 (76 LQ 50 A4 0 450 S 825C -s-p Li 0 L C S 8359 27' k k SSDS EXPANSION AA • P -4f.0 0 < L Al ON 47 G S 82*49'50" E 2 108.22' S 02'49'01" t, 181.98, S 03-42'37- El 478— N7 S 067529' E 14.06' vs i T' 4f �Pwr Cwf fao,4r-_'r_' T 0 PA IFAIrM,� F A /M.'". FiNCE Posm DMMV kW. 16- kVro Q?MM