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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -58 BOX 15 01645 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR WWI, ATMENT SYSTEM PCHD CONSTRUCTION PERMIT #� i / 5! �i 3 Located at (=� � f Al Xb Town or Village S p Owner /Applicant Name YlAi (:t--?N �- A 601j61i Tax Map ? �/3 Block Lot �B Formerly -LL 6 M 2 Subdivision Name /V rLS': A t se�d 6i4,y ", �rirr� Subd. Lot # S Mailing Address aY yQ -v �� lt;�� i ��— A Zip D.'O Date Construction Permit Issued by PCHD Separate Sewerage System built by 0 � -1 Address IG; Consisting � of / ZS�� Gallon Septic Tank and (g nn L y � Other Requirements: 3 —3,S'- g 6 ,0, 'god'/3. gt�' Water Supply: Public Supply From Address /� or: Private Supply Drilled by k 4 v.471- d Address ti,)e /�3/I /i M2 Building Type Has erosion control been completed? =s Number of Bedrooms _ Has garbage grinder been installed? 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: 3 Certified by P.E. R.A. Address 2- License # Y z k 6 % 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 ar s bject to modification or change when, in the judgment of the Public Health Director, such revocati % ; o ficati or change is necessary. / By: � '� Title: '� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRUCE R. FOLEY ;qbjic.,..gSalth Director .4 ,LORETTA MOLINARI P Associate Public Health Director 'DI -'-r 61 Patielit Services rvices DEPARTNENT. _QE TTC Irlij Brewster, New York 10509 Environmental Health (914)27a-6130 Fax (914) 278 - 7921 Nursing, Services (914)27a-655a Fax (914) 278 - 6085 Early Intervertion (914)27a-6014 Fax (914) 278 - 6648 WIC (914)217a - 6678 Fax (914) 278 - 6085 COVER SHEET PROJECT (O%vners Name).- Vd2 C6-XZr /`1 Q W041UL STREET-._! NfUNrICIPALITY: TAX NIAP NUMBER: Y, DESIGN PROFESSIONAL: wlcc:'6,�.rA DATE- Z-1?1,6 3 0 N:... REQUESTED ADDITIONAL LNF'OR.NI.ATION OTHER 6ell'rt Iv BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services ]Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 January 24, 2003 William F. Zeiler, P.E. 28 Concord Road Mahopac, NY 10541 RE: Proposed Compliance: McGough Cannon Road, Lot #5 (T) Patterson, TM# 34.13 -1 -58 Dear Mr. Zeiler: 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: I.. ..... ..... _P..lease.be.advised.that the maximum scale: of an as-built plan allowable by current codes is 111=30'. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT ell Location Street Address: Q Gel nr,0;'1 Town/Village: j; Tax'Gr"id'# Maps &Block / Lot(s) :rg Well Owner: Name: Address: Use of Well: 1- primary 2- secondary / Residet& 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 _'Zft. Length below grade 2 ft. Diameter 7 in. Weight per foot _Ll_lb /ft. Materials: Steel _Plastic _Other Joints: _ Welded Threaded _ Other Seal: ,)C Cement grout _ Bentonite Other Drive shoe: ' 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 Pumped Compressed Air Hours -C� Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 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 1 .. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information O 6 / Pump Type ?- Capacity Depth 9-0 Model 7,d_5 d l Voltage _J,A HP � Tank Type Volume 19 •(35 Date Well Completed / Putnam County Certification No. 0,6 Date of Report Well Driller (signature) NOTE: EyAct location of well with distances to at least two permanenylandnlarlcs to be proviaea on a separate srvptan. Well Driller's Name A r IS Address: Signature: >,,, Date: t'1- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.14., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF IMALTH 1 Geneva Road, Brewster, New York 10509 ]Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 ]Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 William F. Zeiler, P.E. 28 Concord Road Mahopac, NY 10541 Re: Proposed Compliance: McGough Cannon Road, Lot #5 (T) Patterson, TM# 34.13 -1 -58 Dear Mr. Zeiler: 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: -- A.- As -built plan title block is to note street address, and ,tax map number: 2. As -built plan is to show the entire property, with metes and bounds, at any. convenient scale. 3. As -built plan is to note source of as-built survey. 4. E -911 address form has not been submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V y your Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE K FOLEY LORETTA MOLWAR1 R.N., M.S.\,,, Public Health Director Associate Public Health Director --virector of TatieAt.-Services" DEPARTNENT. OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914)27S-6130 Fax (914) 278 - 7921 Nursing Services (914)278-6538 Fax (914) 279 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PROJECT (Ow-ners Name): STREET: COVER SHEET X) A�tn iNTLTNICIPALITY: &r16 OA/ TAX MAP NUMBER: ,13 9 DESIGN PROFESSIONAL. IIIT III-11f 11C DATE: ?,Ik W :.. `,RENrIS-IO.N /19. /pc-"� 03 REQUESTED ADDITIONAL LNFORI ,LAMON OTHER AF& �D/y a BRUCE R. FOLEY LORETTA MOLINARI -R.N., M.S.N. Public Health: -.Dimdor-. - .;:. _ .. �'� � - � O�`� -= - - ..Associate Pub bic °` Health' "Director " Director of Patient Services DEPARTMENT OF PIEALTT-T 1 Geneva Road Brewster,- New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MM1'X�BER: E911 ADDRESS: TOWN: v C /3— / — 5-1 - �_ zi-I � AUTHORIZED TOWN ®k'F1C][Aa.,: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above ford is completed*, i.e., a legal E911 address is assigned by an authorized town official. This forge is to be submitted with the application. for .a Certificate of (Construction (Complia''cc. (E911VERFRIvi) a P 9rAV MR 7 14 -7- v:F- WeL 1- 0" 1h F,4K Ay I'll' CO, A— M,w ra, AL A z 10-le 20.49, ..w L "- 7 21.54, ".2"up'-w N/ r-Putnam'County Department Of Health MAJ11ion of Environmental Health ServiO68 moved as noted for Conformance with Pule and tegulations of the Eaj Ca H 7 t eaj��Jh epart L Date q.!g-Llature 8o Title C7,4"Vxmv TP. L SYSTM. 072TIFY THAT Th-E MR.0' r" AT p.rM C,!,r r,,klq AND 71i- - s CIA' s IT WAS Coo --,- c D BY MT 1:rjS SYSTEM WAS CO' km REMJUTIOBS Of " JIM ALL M R'-'r'M COW11t jjwARv.'ZYiT 07 NMI% 2/`f.3' 4 /07.a r,AAMF,A O P 9rAV MR 7 14 -7- v:F- WeL 1- 0" 1h F,4K Ay I'll' CO, A— M,w ra, AL A z 10-le 20.49, ..w L "- 7 21.54, ".2"up'-w N/ r-Putnam'County Department Of Health MAJ11ion of Environmental Health ServiO68 moved as noted for Conformance with Pule and tegulations of the Eaj Ca H 7 t eaj��Jh epart L Date q.!g-Llature 8o Title C7,4"Vxmv TP. L SYSTM. 072TIFY THAT Th-E MR.0' r" AT p.rM C,!,r r,,klq AND 71i- - s CIA' s IT WAS Coo --,- c D BY MT 1:rjS SYSTEM WAS CO' km REMJUTIOBS Of " JIM ALL M R'-'r'M COW11t jjwARv.'ZYiT 07 NMI% I 4-6u/1-T—sdt(/49x s'PC-wx BY C', UWAC A-. 0 N. 'Y 2/`f.3' /07.a //Z.3 1119.4 133.9 /3/-0 166.0 to 2-; "'V, 0 sr- //Y, 13 //0.0 I y Z,,4. S7, /zO,j- MI. 109.5 10!V-3,e I ,04'7'� 11118102— I 4-6u/1-T—sdt(/49x s'PC-wx BY C', UWAC A-. 0 N. 'Y BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. -....-Public. -Health. Director Associate Public Health Director .. .... If Director a Patient SerV1ces---- DEPARTIVMNT - OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914)27a-6130 Far (914) 27a-7921 Nursing Services (914)278-6538 Fax(914)278-6085 Early Intervention (914)278-6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 . PROJECT (Owners Name): STREET: COVER SHEET M/A N-flSiNrICIPALITY: . hrz5zsy/i!—. _TAX MAP NUNMER: DESIGN PROFESSIONAL: /P//Z46�w g � -z , - DATE. RENrisibN REQUESTED ADDITIONAL LNF'ORNL;kTION )04 OTHER 0 �e 0A Ak/ NE NORTHEAST LABORATORY ®IF Il�ANBUR�I o \� ACppgoq� 39 MILL PLAIN ROAD - DANBURY 06811 CT Cert: PH -0404 0 (203) 748'"I903� "PAY(203) 748 -0652 �` °" - NY Cert: 11471 L"s www.NORTHEAST LABORATORIES.com LABORATORY REPORT REPORT TO: REILLY CONSTRUCTION C/O TOM BILLING 155 MAIN STREET BREWSTER, NY 10509 12130102 = FAX #: (845) 278 -0931 ATTN: "FLO" DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: DATE TESTED: _7,,iRj7��3� /J� LAB I.D.# 7 REPORT DATE: SAMPLE SITE: 9 CANNON ROAD, NEW YORK SAMPLE POINT: WATER TANK SOURCE: WELL WATER TREATMENT: NONE TEST PERFORMED RESULTS METHOD # BACTERIAL: m Total Coliform (Bacteria) ABSENT per 100 ml SM 9223 PHYSICALS: • Color (Apparent) 0 - EPA 110.2 • Odor ND - - o pH 7.24 - ASTM- D1293 -99 • Turbidity 0.21 NTUs EPA 180.1 CHEMISTRY: ® Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 o Nitrate Nitrogen 0.82 mg/L as N EPA 353.3 o Alkalinity 34 mg/L SM 2320B o Hardness 50 mg/L EPA 130.2 o Iron <0.03. _.. mg/L EPA 236.1 o Manganese <0.01 mg/L EPA 243.1 12/16/2002 7:00 AM TOM BILLINGS 12/16/2002 LAB #11471 & 11301 12/16 - 12/20/2002 REILLY CONSTRUCTION 12/26/2002 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml(ABSENT) 15 units 3 Units No designated limits 5 NTUs 1.0 mg/L 10 mg/L No designated limits -No designated limits :. 0.30 2 mg/L -. 0.30 2 mg/L 2 Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 10.5 mg/L EPA 273.1 No designated limits 3 • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** • Chlorine Residual <0.05 mg(L - - - -- ml= milliliter mg/L= milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level 3 =Water containing more than 20 mg/L of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing rr than 270 mg/L of sodium should not be used for drinking by people on moderately restricted sodium diets. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) ✓-� Quality t® WA`° ,e ar 0&440V I! N 9 Laboratory Director r> °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 ®j �D WA`° ,e ar 0&440V I! N 9 Laboratory Director r> °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 ®j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: ZZ Z�_ 4&.17 Street Locat _ _ _ Inspected by ion... Town p,�T� Permit # A- q - 8 7 TM # Subdivision Lot # 5- A. 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. Se�wa `e stye a. Septic tank size - 1,000 .......:1,25 .........other................. b. Septic tank installed level ................ ............................... c. 10 "minimum from; foundation .......... ......... ....................... d. Distribtui n Box . outlets at same elevation -water tested ................. 2. Protected below frost ........................ ..................... .3. ',Minimum 2 ft.Original soil between box &,.trenches Junction Box - properly set ....................... :.............................. . engtFi required o© Length installed ©o 2. ;Distance to watercourse measured °t- I vo Ft.......... 3. Installed according to plan.... ..... ............................... 4. Slope of trench acceptable .1116 -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'%" diameter clean .................... 9. ,Depth of gravel in trench 12" minimum ................... 10.. Pipe. ends capped ........................ ............................... g. , Pum or Dased stems Size ot pump chamber ................ ............................... 2. 'Overflow tank..' ank .........:................... ..................:............ 3. Alarm, visu; audio ................... ............................... 4. ,Pump easily accessible, manhole to grade ................. 5. 'First box baffled .......................... ............................... 6. -',Cycle witnessed by H.D.estimated flow /cycle........... M. House/Build a. House located per approved plans ................ b. Number of bedrooms . ................:........:�.... ......... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured -f 10 o. ft........... c. Casing 18" above grade .................. ............................... d. Sufface 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. 1/97 Form A BRUCE R. FOLEY' Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ]Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 27, 2002 William Zeiler, PE 28 Concord Road Mahopac, New York 10541 Re: Field Inspection - Ganz Cannon Road, (T) Patterson Lot # 5, TM# 34.13 -1 -58 Dear Mr. Zeiler: The above referenced separate sewage treatment system can be backf led. No open comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, loe- Gene D. Reed GDR: cj Environmental Health Engineering Aide - • - -« . { ' ;'' '- _ - ' ' f W *AM COUNTY DEPARTMENT = OPHEALTH 02 NOV 2 ") !UYN OF ENVIRONMENTAL HEALTH SERVICES ATTENTION El ADAM GENE ` ':QUEST FOR FINAL INSPECTION For: All information must be fully completed prior to any inspections being made. Fill / Trenches PCHD Construction Permit # Located:... Owner /Applicant Name: / /,�.�/�L:�/� '�, �D�.l'.; TM -9 Block _ Lot Foimerlq: _ _(�} -,fit Subdivision Name: Al . &CayJ CWAr a AAA- -1 Subdivision Lot # b� Is-system fill completed ?. _)'cr-S Date: Is-system complete? mss ,,.Date: Is system constructed as per plans? &well drilled? Yes Date: Is well located as per plans? /es' Are erosion control measures in place? �S I certify that the system(s), as listed, at the above premises has teen constructed and I have inspected and verified their completion 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: / 0 Certified by: PE RA Design Profe nal Address: Lic. Comments: Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTF,M Owner or Purchaser of Building Building Constructed by Location - Street Building Type _ 3 y. i,-? — i —S 4-' Tax Map Block Lot TownNillage A/t�Sg* , �3 Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material; construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition an), part of said system constructed by me which fails to operate for a period of two years immediately, following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Days Year��� -�" General Contractor (Owner) - Signature Corporation Name (if corporation) f L� Address: l CA State r q Zip o Signature: 2V Title: (7215s) az,61,�-w - ctc Corporation Name (if corporation) // r ! r Address:/ /n&,2- s!e'l l State /V ' Y. zip -Z f z) 6� Fomi GS -97 - 1; - ,. f. { ., '=� , Y. b -�` ..y ,I _ _ �._ 7'.. .yam '- f �. - - -: S 11 D C I+ O ; f�^ S. V -...� M* F .. ,'•. i, q -It �Y „_,t p�+d°' 'r .I - 4 :pC § �. I . ,'�J ¢ 3, _� i + 3” ^b ,f .4 r ' t t I . z m' � � --� :Sheet -` �,,, r _. o:f .� s � - * PUTNAM.C_OUNTYMPARM NT OF IMALTR i- . t. ' �. DIV =ISION OIL' -,E- ,NVIRON1°�IIENTAL_HE.�. 'LH SER�IICLS . s ., , ` �'W, YOB '_ . FIELD ACTIVITY REPORT � a f i � �, ,� '.k', = , ;R -ter 3 .x < . r,, , I,. I'll , NAMF . G '• F T S. y 11 I ^ >J >4 �� '� q� ^F 'i S .w `%- _ I '17+�� .')` .,�. §�T}$.Fk `Y �§ .� - - %_a ai',k �,./ %31L P= ' /�$ }-� n "~ I __ , . L .. 4 �/Y LfI�O /V FF—��� K�B /\/ r te 1, J �(/ 7 3' _ = _ Street Town State' Zip'. 2=!" ' _ I k.� f - 6� .. x 4 4 t ra m o # } ,,PERSON . - IN CHARGE e ". � r �'F s ,-� � .j. _� �� QR 1NTFRUTFWFT) �GI lG l2 (C i i�atP_ 0 /7VeOQ -Name and Title° TYPE OF FACILITY R S x z� �� kx -ALLLL{{� �- �h A Ys FINDINGS ' ,5 SAS ;w �5 �.�'Y8 y �r E .i JVL-1L —UU MU 0. 44 AM f 'JA ;N fY 6 N V tii!5L!'H ,FAk i10. 1 P, 3 P'U'TI�i d C® PHiY DEPAIi"il ladT OF HEALTIff 1DI ISION OF ENVMONMENTAL EMALTH SERVICES !ATTENTION AIDAryg AIGENE L FYNAt�IN�P�TiO1V Fog: kill All Wormation must be fully completed prior to any Trenches inspections being made. PCFTD Construction Permit # Located:.. e °.��i� t/ (T) (V) �r K1_ Oymer /Applient Name: zfm.L-jL,1 Formerly: Subdivision Name: �✓ +�' � � �� W . i Subdivision Lot # Is system Till completed? Date: Kzz s /G' Is system complete'? U Date: Is system constructed as per plans? Is well drilled? A)o Date: Is well located as per plans? Were erosion control measures in place ?,� I certify that the system(s), as listed, at the above premises has been constructed and I have inspected . 4i1verified a taeib corpleiOl:.in aGGlueaZ w tt 14 i5si,egd K"a Co =actaq Permit, and approved plans and the Standards, Rules and ReSulations of the Putnam County Departmeht of 'health. Date:': _ 1. vim.. - Certified by:. PE RA Design Profcs al Adda�s; d, e 1) Lic. # Comments: cn C97 cis p Form FIR 99 BRUCE R. FOLEY LORETTA MOLMARI RN., M.S.N. : �.._._...... K.... ._.� :�e�.Fz�b.�i.�_,- his'�Csh.. D.�rector,_:::r;•.;..:;.:`.,< Director of Patient Services DEPARTMENT.. OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COVER SHEET PROJECT (Onvners Name): _� C-e- &-X / L'�� STREET: d i.^r. =yYJE� .16 MUNICIPALITY: /"%Tl�7Z�'1i� TAX NIAP NUNIBER: DESIGN PROFESSIONAL: 1 ��/ i.�%1� ��7LL'7� DATE: - z, REQUESTED ADDITIONAL INFOIWATION OTHER ......:. - "BRUEE• `R: ' FOLEY ' ...., _ ... ... .. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental health (845)278-6130 . Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845)'278-6014 Fax (845) 278 - 6648 October 7, 2002 William Zeiler, PE 28 Concord Road' Mahopac, New York 10541 Dear W Zeiler: Re: Ganz, Cannon Road, (T) Patterson Lot # 5, TM## 34.13 -1 -58 An inspection of the fill pad at the above referenced project has been completed. Trench plans must be-submitted to this Department for final approval. Please note that field measurements by this Department in no way suggests the exact size, depth and location of the fill pad. If youtave -any further uestions please -contact meat" 845 278 = 613'0' ext. `2261.` " Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. PERMIT # ZIP 1 1 7 Located at Subdivision name 6*w � � a;s.�'i Subd. Lot # 6"' Town or Village Tax Map 311.i3 Block i Lot 511' Date Subdivision Approved 7! a 3 kC- Renewal Revision ✓ Owner /Applicant Name d—"LtgrJ c4wa Date of Previous Approval l jt- c7% Mailing Address Amount of Fee Enclosed r-,4113 0, d ,. Zip lele Building Type ! , Lot Area yU2. No. of Bedrooms _,y Design Flow GPD 04,0e9 %/-& Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I `ZrO gallon septic tank and G yc Z-- Other Requirements: 2 _ i-1 C, t.. To be constructed by eFNA) Cgif /Pfi Address j" T Water Sunbly: Public Supply From Address or: Private Su 1 Drilled b - Address _ . _ 1p_ y.. _..._...__.. _.y� �j_ - - - -_ N 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 system 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 II Date j�7 d L APPROVED FOR CONSTRRUCTION: This approval 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 perrpqtj Approved for discharge of domestic sanitary sewage only. By: jJ&HAA Title: Oft..= Date: f.0 OZ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION, OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ��' t�t.ra�- Address ` -.�� Located at (Street) (��csy;l Tax Map3V,1 -3 Block % Lot indicate nearest cross street) Municipality `�f Watershed S`2� SOIL PERCOLATION TEST DATA IAI Date of Pre - soaking L ai- Date of Percolation Test »: Depth to Water From Ground ' Vater Level Percolat<on Hole No R T�ute Start.- StopLn.) Ala se Ttme Surface ()Guches) Start Sta P dropp In Indies Rate Mru/Inch . 1 � ' 3 2, c �� �/ 2 Y, 2-7- r� ry 4 5 � — J 2 zg1 3 I 10 Z9"' 4 5 1 2 3 4 .5 N_ OTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES 2 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0'� 4.5' A �.r 5.0' ; 5.5' ...� 6.5' 7.0' _.40� 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date 4,6go 0 Design Professional Name: W1 Address: Signature: {i CAE, Design Professional's Seal ea rot . 4A, 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: 2. Name of project: keexl c �>_- 3. Location TN: r,1e_4 -6i✓ 4. Design Professional:&),, ��� � 2igrGe72- 5. Address: 2_,�- t�i,elcal 6. T e'of ro'ect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status check one) .............................................. ........ Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 6 9. Has DEIS been completed and found acceptable by Lead Agency? ............... �......::...._ .:_10. Name of-Lead Agency_. __... -- :.....;. 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ....... ......................... �s 12. If so, have plans been submitted to such authorities? ........ ............................... . s 13. Has preliminary approval been granted by such authorities ?ki Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water //groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? ....... ............................... ,/ a 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ d 20. Name of sewage system Distance to sewage system 21. Date test holes observed 22. Name of Health Inspector ca,CL a Form PC -97 K 23. Project design flow (gallons per day) ........................ �8 a. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? V0 27. Wetlands ID Number ........................................................... ............................... 28. Is Wetlands Permit required? .............................................. ............................... D Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? .. ............................... 30. 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 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... e-S 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent t_o. . roJ ect site? ...... ........ .................................................. ... 34. Are any sewage treatment areas in excess of 15% slope? . ............................... k o 35. Tax Map ID Number ....... 7..,'/,.. z. 3 .... ................ ................ Map 2 _y,5 Block_ Lot 36. Approved plans are to be returned to ..... Applicant &,�Design Professional 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 any knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATUIBES & ®T'T'I I ffTLES. Mailing �:.. ............ q /D 14 -16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C -. • -• _ State Environme.ntel.quallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) ewl 1. APPLICAN /SPONSOR 2. PROJECT NAME 3. -PR JEC LOCATION: .. _._ ... . . Municipality / (% S p(J County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PR— ACTION: ,OP96ED 2'New' ❑ Expansion ❑ ModificationlalteratIon 6. DESCRIBE PROJECT BRIEFLY: C'aovs�r2�✓ cr 7. AMOUNT OF LAND AFFECTED: 0 v 1i - . Initially . a acres Ultimately. acres 8. WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAJA PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE 0 LOCAL)? Yes ❑ No If yes, list agency(s) and permiVapprovals vl" 1A16 � •�(� 11. D0ft§ ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? �t es ❑ No If yes, list agency name and permlUapproval 12. AS A RESULT OF P OSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes o I- CERTIFY THAT THE INFORMATION PROVIQW ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE � � Applicant /sponsor name: Date: /s adgu Signature: 6y ./ a 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 EXC D ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF. ❑ Yes No B. WILL ACTION. RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No 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 briefly 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:rIS THERE,.04 —IS THERE•L•IKEL-Y TO BE, CONTROVERSY RELATED- ,TO- P07ENTIAL .ADVEfiSE_ENVIRONMENTAL.IMOACTd? :... . ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro 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 (f) 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 and/or prepare appositive 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: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agenc ?' .I HV L CU336 go Title of Responsible Officer '- ►. . Signature o Responsible Officer in Lea Agency � e, i i ` iAnature o Preparer (► different from responsible officer) ,L1frA0, C7 Date 2 r' M: Mt MfM1M[ M: M( M( M! M! M/ M( MIMIMt MtM; MEM€ M( M6M1Mt M( M! MTM( M( M! M( M( MIMfMIMIMI! LMMIMIMIM (!L�U.1f1:M!MlM(MeMIMIM (y W?1lyIVy�W(�111I1fy7Wly (WI1lyiWlWlylilYyl ' y(yylyy7Hyailtie.[ 'iy'ytWSW:W!yY1W5yy1V y:ytilyylllyiW5lfy:Wt — iYy; l/ y! yL: W( �/ ylilti (y1"�tilNlW!WlWtyylyy!i/yfY N liJ T AM COUNTY DEPt /tME U OIF HEALTH MVISION OF IENWRONMENTAL H EAUTH SERVHC ES CONSTRUCTION ION P ERMllT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village AS, 77-92 , Qd Subdivision name e)�` Subd. Lot # Tax Map AW319lock 0 Lot Date Subdivision Approved 43 kr" Renewal Revision Owner /Applicant Name 1" 4 Date of Previous Approval Mailing Address I?s—& 21m,4,04) A4 i - 3 b��< ��y.��.r �,�_ Zip Idd d Amount of Fee Enclosed -A j o 0. e y Building Type Run b ksjZ-j[�e Lot Area 02- %No. of Bedrooms Design Flow GPD Pe c) Fill Section Only Depth° Volume PCHD NOTIFICATION IS RE UIRE D WHEN MLL IS COMPLETED Sejairste Sewemge System to consist of Z 2 <d gallon septic tank and t Ud Lr Other Requirements: _—. C. To be constructed by Wt 2J Address Bo L-to lep 612= a Wateir Supply: Public Supply From Address oin : ° Pnvate Su 1 Drilled b _ Add>•ess a� . _ —z �y I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sv tern 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 R.A. Date License # 1Y 7—k J�7 ff APPROVED FOR CONSTRUCTION: This approval 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 w c nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. lopprove discharge of domestic sanitary sewage only. r By: Title: U Date: .3 `'J1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ .please print & type J : PCHDf Perriiit # - Well Location: Street Address: Town/Village Tax Grid # P 4-r� Al Map Block I Lot(s)rz.S ' Well Owner: Name: Address: 4-V 1-3 Mor d c v' Use of Well: L,,-Residential Public Supply Air/ ond/Heat Pump Irrigation 1- primary ' Business Farm Test/Monitoring Other (specify) - secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served _ Est. of Daily Usage d® al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓ New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .............................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes t/ No Name of subdivision /4�e.c.sc�J f c ' C '"P It Aid >/ Lot No. ;- Water Well Contractor: 1�1= �i t_ �' �er�s Address: /4' &,m Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: oA -,_ / 000 ' Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: : ef . oo Applicant Signature: l /C PERMIT 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. APPROVED.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/A- driller c rtifeed by Putnam County. Date of Issue Permit Issuing O ial: Date of Expiration Title: e Permit is Non- Transfe ra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Al BRUCE R. FOEEY' Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)279-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 William Zeiler, P.E. 28 Concord Road Mahopac NY 10541 Re: Proposed SSTS: Ganz Cannon Road, Lot #5 (T) Patterson, TM# 34.13 -1 -58 Dear Mr. Zeiler: June 26, 2001 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: J.- Well detail should be shown on the Fill Placement Plan. _.._ 2. For fill sections greater than 2 feet, all separation distances are to be taken from the toe of the fill section. Therefore, the minimum distance from the fill to the property line is 10 feet, from the fill to the well is 100 feet. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be . considered further. RM:tn Very truly yours, Robert Morris, P.E. Senior Public Health Engineer BRUCE 'R. -FOLEY' Public Health Director Y ` 0103TTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC .(845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 February 28, 2001 William Zeiler 28 Concord Road Mahopac NY 10541 Re: Proposed SSTS: Ganz Cannon Road; Lot #5 (T) Patterson, TM# 34.13 -1 -58 Dear Mr. Zeiler: 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. _.. _. _... 2) 3) 4) SSTS profile scale has not been noted. The minimum of 3.5 feet of R.O.B. fill is required according to the design data sheet submitted. Depth gauges are to be shown in the fill pad. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve Ily yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer e BRUCE R. FOLEY __ ...__ .._....... Public Health Director _...., LORETTA MOLINARI _R_N.,�M.S.N- Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COVER SHE�T PROJECT (Ovmears Name): L L -f-Al b �-� STREET: 1� �4�/�a A 6 l•IUti'ICIPALITY: /�-�I LrIZS`D� TAX MAP NUMBER: SV,13 - I IFe DESIGN PROFESSIONAL: &-h 972-- DATE: REVISION REQUESTED ADDITIONAL INFORKATION 11 OTHER `Ii T� BRUCE - R:; -F0: :..:;: -,:_ ...::..._:.:..: Public Health Director . z LORET-TA:=•M©LINARI:- R.N:,-:- M.S.N. > Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PROJECT (OiNmers Name) STREET: /J %-RJNi ICIPALITY:. TAX MAP NUMBER: , /3 -l.—• DESIGN PROFESSIONAL: �� /��. f` Z� DATE: RENISION REQUESTED ADDITIONAL INFORIVIATION COVER SHEET ,at `. a9) 1461,A�d %-,V- (S�W-0— 4 11 OTHER William F. Zeller, P.E. 28.Concord Road Mahopac, New York 10541 (914)628 -4764 January 31, 2000 Shawn Rogan Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Proposed SSTS: Ganz Cannon Road, TM# 34.13 -1 -58 Town of Patterson Dear Mr. Rogan, Thank you for your comments of December 22, 2000 concerning the above referenced SSTS. The resolution of your comments are as follows: 1. The title box has been corrected. 2. Note 21 has been added stated that the property is not within the FEMA 100 year flood plain. 3. Construction notes #9 and # 15 have been added as notes 19 and 20. 4. Footing /gutter drains are shown on the 20 scale plan. 5. USDA soil type boundaries have been shown. 6. -. Erosion control measures have been shown._: 7. Fill notes have been added to the fill plan. 8. Fill pad has been dimensioned and labeled. 9. Separation distances have been labeled on the 20 scale plan. 10. Dimensions from the well to the property lines have been added to the 50 scale plan and the water service connection shown on the 20 scale plan. If you have any additional questions, please contact me. Thank you for your time on this matter. Sincerely, Willi . Zeiler, P.E. 02/16/2001 13:35 914 - 708 -8231 NYSDOT FIELD OFFICE FAX COVER SHEET .S14,+W ,J Y& CAA) Number of Pages: Date: �-� (� /0/ (Including Cover Sheet) Z� sj7/C �a -S- /,f ) 7" y 3 3 -- /- r? 02/16/2001 13:35 914-708-8231 Wiflism F. Zollov, P.E. Mahopw' fen York 1MI February 14, 2001 ftwn Rogan Putnam County Depwimeot of Health I Geneva Road Brewster, New York 10509 Dear Mr. Rogan, NYSDOT FIELD OFFICE PAGE 02 Re: Proposed SETS: Cmaz Cannon koad, TM# 34,13-1-58 Town of Favmon Thank you Jot your comments of December 22, 2000 concerning the above referenced SSTS.- The resolution of your comments are as follows: I . The title box has been corrected. 2. Note 21 hu been added stated that the property is not within the FEMA 100 year. Rood plain. 3. Construction notes #9 and #15 have been added as notes 19 and 20. 4. FootbWgutter drains are shown on the 20 scale plan. 5. USDA soil type bowxWks have been shown. 6. Erosion control measures have been shown: 7. Fill notes have been added to the fill plan. 8. Fill pad has been dimensioned and labeled. tWes have been labeled on the 20 scale. plan.. - 10. Dimensions fwm the well to the property lines have een b adde d 16'tlie 50 -k& pleat and the water service connection shown on the 20 scale plan. Additionally, the absorption field has been reconfigured due to the location of a well on the adjob3ing parcel. If you have any additional questions, please contact me. Thank you for your time on this matter. Sincerely, e rdlAiam F. P.E. h fr IE BRUCE R. FOLEY Public Health....Director. .:.........:..- DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public. Health. Director.. Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 December 22, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 William Zeiler, PE 28 Concord Road Mahopac, New York 10541 Re: Proposed SSTS: Ganz Cannon Road, TM# 34.13 -1 -58 Town of Patterson . Dear Mr. Zeiler: 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands. officials in this regard. If percolation tests were not'witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. -I'll. Title box to note "preliminary design for fill placement only ". ✓2. Provide the FEMA 100 year flood plain or,a note stating none exists within 200 feet of the property. -~ -- Construction notes '9 and°#15-are to be-provided--(enclosure). - 4. Show footing and gutter drains. J5. Provide USDA soil type boundaries. /6. Provide erosion control for the house, well and SSTS. ✓7. LPProvide fill notes 1 - 5, (enclosure). ✓Pdimensions-All — --�� 8. rovide fill pad certification note, depth guigca_,es�with theAppropriate detail and 11 volume for ROB,/&classified, and impervious. 9. Separat'on distances are to be provided from the toe of the slope. a. 0 feet to driveway. !b. 20 feet to foundation walls. vac. 100 feet to well. 10. Provide the dimensions from the (well -to property lines., Also show the location of theLwater service connection. iYl Cc•i'ii P<:. -f- � %i��7e1��J•c'Y7 n c� �2� t� V"e cY /' co� �o'c; f3: Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONINIENTAL HEALTH � INDIVIDUAL WATER SUPPLY &SUBSURFACE SEWAGE TREATMENT SYSTEMS -� .—......,REVIEW—SHEET FOR CO\STRUCTION PERMIT.;. NA',fE OF OINNER. STREET LOCATION: REVIEWED BY: RM, GR, AS, OB ATE: TAX 1,,fAPR: (CONFI MED) Y N DOCUMENTS ,�X)UPERi•IIT APPLICATION (_)WELL PERMIT OR PWS LETTER UUPC -9; UULETTER OF AUTHORIZATION SIGN DATA SHEET (DDS) UUCORPOR .kTE RESOLUTION U(,JSHORT EAF (_ZJUPLANS -THREE SETS UUHOUSE PLANS -TWO SETS UUVARL -UNCE REQUEST r SUBDMSION C- LEGAL SUBDIVISION (SUBDIVISION APPROVAL CHECKED 9UPERC RATE (,�_J (_.-_)FILL REQUIRED = DEPTH U( )CURTAIN DRAIN REQUIRED GENERAL (_I(__)LOCATED IN NYC WATERSHED (_)PLANS SUBMITTED TO DEP ( )(/ )DELEGATED TO.PCHD (_�3(Q1)EP APPROVAL IF REQ'D (_Z(_)DEEP TEST HOLES OBSERVED (�UPERCS TO BE WITNESSED (�(f) EX- APPROVAL SSDS ADJ, LOTS UOWETL.ANDS (TOWN/DEC PERMIT REQ'D ?) (Zj(__)DATA O_N DDS PLANS & PERMIT SAME ( _)(PRE 1969 NEIGHBOR NOTIFICATION U(=LETTER BI/ZBA 10.0 .YR.- FLOOD ELEVATION NY/l. 200' ..._. �.UU (�L_)SOIL TESTING LOTS >10 YEARS OLD REOUTRED DETAILS ON PLANS (fiUSEWAGE SYSTEM PLAN - (NORTH ARROW) (_,.-J(_JSSDS HYDRAULIC PROFILE (/j( JGRAVITY FLOW.. U(�jCOiVSTRUCTIOiY,NOTES 1 5 (j6(JDESIGN DATA. PERC & DEEP RESULTS (Zj(__)2' CONTOURS EXISTING & PROPOSED (ej(_JDRIVEWAY & SLOPES, CUT U(_)FOOTING /GUTTER/CURTAINi t DRAINS UUUSDA SOIL TYPE BOUNDARIES . C,-n(__)TITLE BLOCK; OWNERS NAME ADDRESS TM, PE/RA; NAME, ADDRESS, PHONE# (__)UDATE OF DRAWING/REVISION (_j( )DATUiti1 REFERENCE ((__)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ((__)PROPOSED FINISH FLOOR AND Y N (REQUIRED DETAILS ON PLANS CONT'Dl UHOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON 0 BENDS: MAX- BENDS 45° W /CLEANOUT RENEWALS (__)USITE NOTE (NO CHANGE) FILL SYSTEMS UU10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE O(FILL SPEC / FILL N0 UUFILL PROFIL 1 ENSIONS V)UFILL IN EXPANSION AREA FILL GREATER TITAN 2 FEET U 3 U ( J(_J •OL: ON PLANFO CLASSIFIED & IMPERVIOUS UUSEPARATION DISTANCE FROM TOE OF SLOPE THE C UULF TRENCH PROVIDED S 6OFT bIAX. UUPARALLEL TO CONTOURS (__)100% EXPANSION PROVIDED P(• )DETAIL/DUST.FREE CRUSHED STONE OR WASHED GRAVEL /)UGEOTEXTILE COVER SEPA NCES ON PLAN - FROM SSTS (__)( TREE , TOP OF FILL N,WALLS 6 00' IN DLOD 150' O PITS U :(!!nU100' TO STREA. -M, WATERCOURSE, LAKE (inc. expan) UU50' TO CATCH BASIN, 35' STORbIDRAIN, PIPED WATER JF– (__)10' TO WATER LINE (pits - 20') (__)50' INTERMITTENT DRAINAGE COURSE - U(_}200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS [�U10' bIIN TO LEDGE OUTCROP SEPTIC TANK (,6(_J10' FROM FOUNDATION; 50' TO WELL WELL (_)UDIYIENSIONS TO PROPERTY LINES ( J(__J-LOGATION OF SERVICE:CONNECTIO_N UUUUyIIN-15' TO PROPERTY LINE SLOPE (jUSLOPE IN SSTS AREA (520 %) (__)VJREGRADED TO 15 %, IF REQUIRED OSE/P t SYSTEMS CUUPUMP NOTES (�( JDOSE Tfi o OF PIPE OL ME/DOSE VOLUME NOTED ((__)DETAIL F FO E N IN, (PIPE TYPE, ETC.) UUPIT AND D -B SHOD i & DETAILED UUl DAY STO G B VE ALARM BASEMENT ELEVATIONS (�( _JWELLS & SSDS'S W/IN 200' OF SSTS UU15' MLN o (�( JPROPERTY METES & BOUNDS UU15' MIN to (__)(EROSION CONTROL FOR HOUSE, WELL & U- (— Jlo, MIN to SSTS, ERbSION CONTROL NOTE UU10' bIIN to COMMENTS: (REVSHEET)09 /01100 6TH SID S, DETAIL %,2 0'- /o, 25' -3 %, 35' -1 %,100 % -<l% " E /100' with 182 cons day discharge 2FORATED PIPE BRUCE R. FOLEY Public -• Health. Director-•. -.• — _ ..... DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA iMOLINARI R.N., i+✓1.S.i•1. 'Associate-- Public-Health' Director, . Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 -6678 Fax (845) 278 - 6085 December 22, 2000 . Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 William Zeiler, PE 28 Concord Road Mahopac, New York 10541 Re: Ganz, Cannon Road, TM# 34.13 -1 -58 (T) Patterson Reservoir Basin - Middle Branch Dear Mr'. Zeiler: The Putnam County Department of Health (Department) has determined. that the above referenced application, including fee, and received by this Department on December 18, 2000 is complete. The Department will notify you by January 11, 2001 of its determination. 0 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the. Watershed Agreement. If the Department fails to notify you - within the above referenced time frame, you may notify the Department of its failure by Certified Mail, Return Receipt Requested. The notice would be sent to my, attention at the above address. . This notice- must include- your -name', the-location-of -the the application originally, and a statement that a decision is sought in accordance with Section 18 -23 (d) (6) of the New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subj ect to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Pro±Pctinn. regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2159. Sincerely, q64_z6r Shawn Rogan Public Health Technician SR:cj PUINAM COMM E- RT is CF HEALTH DIVISION OF ENVIRCNMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SS+AAGE DISPOSAL SYSTEM FILE NO. Owner 44 C.CiII Address 9e— %V Leo.4puAV 23 13 Located at (Street) `Az/x/ AJ Q a & L c AL-4r- Sec. .-7 7 Block _� Lot Za s (indicate nearest cross street) Municipality Watershed �LS> RZ,¢,</&V SOIL PEI200LATION TEST DATA REQUIRED TO BE SUBMITTID WITH APPLICATIONS Date of Pre - Soaking a0 Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PE RCOI ATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop .Min. Start Stop Drop In Min /In Drop Inches Inches Inches z 117.1 2 2:3z -3=07-- 30 23 2 20 3 3:0't - 3:36 30 Z 3 5 3Die 2 z / �3 /6 2�yz 4' 5 1 2 3 4 5 NOTES: 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 fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. %� Q�6.,��dC�. Y ,�s tf. / 1P' 1' nk�D rsfl �ee- ���' S',� -•u. s� A-s # - S�! -ucc3 �-�' SQL �/, S fA,101 LOAM 21 3 3' A(CZ> �1i1/crC- 5' �l 6' 71 8' 9' 10' I 11' 12' 13' t 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED ~A INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED �oAJE DEEP HOLE OBSERVATIONS MADE BY: ��� �. �, f¢. DATE: b 00 DESIGN Soil Rate Used 2 0 Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /ZS-Z) gals. Type e�/c6,72,' Absorption Area Provided By 6,00 L.F. x 24" width trench Other xc:� Signature s urze _C6 -Oxo A) . SEAL =�z a. THIS`SPAIM FOR USE BY HEALTH DEPAR]MENr ONLY: Soil Rate Approved sq.ft /gal. Checked by Date $ ill C P• • 1. . �A OG s y w�.ryry 4 3 T.s, g a-n '^+F :37 Ar a'' �ti" -.Nd" ya h'Y'�'vY' i.,p y �< r a .,,. a ��; }. Y Sheet�_of1_ ` * Ha PUTNAM COUI�ITYDEPARTIVIENTOF fIEALTII _ �M, y � DIVj zON OF ENV�IROlYl1'IENI�AL ilil —A L.�.�S]�RVICESw -1111 d �W y04 k : MELD ACTIVITY REPORT sr Ii- -It , , •3` 5 x B . � f r. r 416— I, KELIVTF�Z TPl_�/� f r 1, - /f/}- /,y/r AT�T- R F C C ^J, - 1 4 -' i`.TT . , %�s�f �Pf` T %� �+!¢ i �✓e 1. :, Street: X. `� To�wn� ,� Y ` State Zip iI� S £ cn , ii v 3' a' C f ,} arr i PERSON IN CHARGE a k s ; ' $� . 1. I. I $ TNTFRVTFWFT�7 }LL.�fi�%� T7atPfv %��b'8 ii- 'X �` -.�. .. p `v Name and Title - r 11- a TYPE OF •FACII,ITY r' . ' , , A x --._ .� a 3 c . f .. IaP x FINDINGS Q` ;: �.w. ,, �., � -a. a -' 3. `+... 5s: �. ice' �' -j:s _ ii� _.r 9 c ',- t z4£ sue. 3" - ,. _ - - 11, k -- " � 7 T - , Y � If q P :. `y 3 it F r z . a ;�; a r - 4 d r yV '`' ` .rC 3 F I 1°-5. n `a , ar �' "'`J'X;L , .% 'c"- E -., S 1 'x.: r - ;, ` �° _ C c !a r y J R � C 6, P i 3°r' ,iwu. _ % 'Y ui S i. , f G :§ a� �? , w w iz }a a ' .. ,, 3. Win' 4�y y - ., s'� . "r`^ x' 7�' Y; t* ..a r}„ a' e u ` .� +e' 6 ,� '�'� • - - r . �. - .- �ti.'� `,� ., i - ,, a _ s `�. ` r� .s_ 3 'S .,a �G n*,r�':� f� i. � � ri�a��s a`'`'� F f -� u a xr: 4"�'..� F`°�, < ,�v- � '�w s'� � -Y, r° f . 11 1. `~', -r k2 { 1, a� �^" s -'r. t,yF -•fi "'`v,tx �t Ffig Krsg _%i „yi - n s� 'S _ s fig. ty _ F - tl_ e �3 r 3 . � 6i , .i er ., r ' .- u' ; "� vv'- ? t �, a rC+' 3 . ati €� y �i } d _8 dr' <• - e - ,.. 3., - _ 11 .z o- s' ' a r - - 5'_' -. - a -: .z a y..� '3 f: `_” C -1' k 1�"'`- "_ w� a' a ' `s �z ..a- �. 1 ,. 777 7' 4. s .'' t 3 -w ,, i F ° rh z.. -a•- 1 ,F .. 4 -p k r - ,x fin* r .. I. ' `' SS�gnature and Title `� 4 - v I. _.- 11 �{ 12FYlV'r,l RaF:[',�T�TFTI$RaV: r _ rya ft 'J .. 5 I acknowledge receipt of this report SIGNATURE: zt s -� per` .s- 02/96 � : �y Title: "' � T r= sa. ,. — .. All . MAY -13-00 F R I a: 02 A M ?UNAM 1,74Y ENV HEALTH FAX NC. 19142707921 °. i7 .. 40 BRUCE R. FOLEY Public Health Director DEFAR.TNMNT OF HEALTH 1 Geneva Road Brewster, Now York 10509 QUESI FOR FIELD TEMN, LORETTA MOLINARI R.N., N1.S•N.- Associate Public Health Director Director of Patient Servic#8 ' ATTENTION: 0 ADAM STIEEE]LING o GENE REED A11 information below must be gig completed prior to any scheduling. DATE: • 1 UU k�IdGr1�E izc 0� i tL � ! PRONE #: (0.ze— p�p_ Z9y 4 t MASON: DEEPS: ff-' PERCS: ®/ PUMP'TEST: a •►...� YES NO ® IR/ © pro" . a Q-- Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. Proposed SSTS within 300 feet of a reservoir, reservoir stem or control lake. Proposed SSTS - within 200 feet of a- watercourse or-as DEC-wetland Proposed SSTS design flow greater than 1000 gallons /day or SMS Permit required. Proposed SSTS for a Commerical Project. It is the responsibility of the design Professional to provide the above information prior to soil testing. This rNpPrtmert will determine the NYCDEP project status (Joint or Delegated) based on the response. If you attsweredyo, to any of the questions, NYCDEP must witness tote soil testing. This Department will coordinate a mutually suitable time for field testing with the iPCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and .theta subsequent information indicates NYCDEP is'required to witness the toil testing, it will be the sole responsibility of the design professional to schedule re-witnessing of the soil testing %ith NYCDEP. YOlt MUPPi'Y USE ONLY � I i DATL TIM- _. a ��' ®MR4F,IUT6, .`-30 zz 4 (FIELDTEST) O C� �i � O /q F/ R7 M FFD Corner w_ s Derr a S . C e � / ES ES • 'b 11 1 \ t i l i .12531 84 a ^` ' o .\ \ I` 1 164 �L UC" FD ou , aQ ff ay \ Corn' i ilk ff u Town 8 31f 18 P (a _ jI _.... __ ake� 4fg Rs p a 46 RIO, (� Dean( Pond' t o rn i L' 1 e rners 84 c), d i 44 _ Ir 1 � n 51 i Rey wo d ,►' a ff �\ D em X12 3 , w x+ k ..KVU w 1 k c �CARMEL HS ■County Courthouse { P 41 County Oft. Building 1 _ I 311 . + b11 Ludington \ U ' onument ( l ai 6 \ I I �►� / Gleneada ; Till ,( a Fost ewwnn Mom c ,. Putnam Ptez w P S.0 eat I , y / ��s Ides Tree ■ In �k _ BRUCE R. FOLEY.. .... _. _ .. _ . Public .Health Director _ .. . LORETTA MOLINARI R.N., M _S.N.., r Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York" 10509 -Environmental Health (845) 278 - 6130 Fax (845) 278 -.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 October 13, 2000 William Zeiler 28 Concord Road Mahopac NY 10541 RE: Application to Construct a Subsurface Sewage Treatment System at Ganz Cannon Road, Lot #5 (T) Patterson Dear Mr. Zeiler: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on September 26, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. -r o subdivision plat titled "Nilsen, Nilsen, Ganz & Bueti" notes that 3 feet of fill is required. Therefore, fill plans meeting current guidelines must be submitted or contact Gene Reed, Department of Health Services for additional deep tests. 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 Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. Ver�o�� Robert Morris, P. E. RM:tn Senior Public Health Engineer a.ef 3�11 PUTNAM COUNTY DEPARTMENT OF HEALTH Z_0y DIVISION OF ENVIRONMENTAL HEALTH SERVICES- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM eA^lgoly ROAD Owner Address .0,C_,4 R2oAD! Located at (Street) —Tax Map 3f4il� Block' Lot (indicate nearest cross street) Municipality Watershed ":5-1 SOIL PERCOLATION TEST DATA Date of Pre-soaking Zz zie�� Date of Percolation Test- .......... ................................ .. ..... ............ .......... 2 4 ZVQ 7- 2 3 4 5 A 42 7 2 0119 _01V 16 P-f,/;L 3 4 5 'Nujiho: i. i ests to oe repeatea at same aepin unin approximately equal percoianon rates are omamea at eacn percolation test hole. (i.e. :g I min for 1-30 min/inch, :g 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIS' DATA 2 (DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES L)EPTH' HOLE 140. G.L. 1W 67ztaumAl 0.5' ��, �� �'' T 1.0' _ 1.5' e� 2.0' l Sg 2.5' 3.0' 3.5' Me 4.0' e 4.5' �� S 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' . 8.0' 8.5' 9.0'... 9.5' 10.0' Indicate level at which groundwater is encountered lee Indicate level at which mottling is observed A/"6 Indicate level to which water level rises after being encountered Deep hole observations made by: 4aAeg 7FEe 12 �, �, �, �-¢e. Date Design Professional Name: Address: Signature: (Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS , 4 _.... ... REVIEW SHEET FOR CONSTRUCTION„PERMTT _ - - r...v..w -_ .,- , ...r u......t ♦. ♦ a.... -A v'i. ten;. L -.,. .. ,. .v -�_. ... .. - _ . ....+.. ,. -. . e .....> 1 - NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAPR: (CONFIRMED) Y N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) (_)()PERMIT APPLICATION . (_)(_)HOUSE SEWER -'/4" FT. 4 "0'; TYPE PIPE CAST .IRON U)WELL PERMIT OR PWS LETTER U(__)NO BENDS; MAX BENDS 451 W /CLEANOUT UUPC-97 RENEWALS (_)U)LETTER OF AUTHORIZATION (_)(_)STTE NOTE (NO CHANGE) (_)U)DESIGN DATA SHEET (DDS) FILL SYSTEMS C--)(—)CORPORATE RESOLUTION (__)(__)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (UL_)SHORT EAF U(__)FILL SPECS/ FILL NOTES 1 -5 U(UPLANS -THREE SETS U(_JFILL PROFILE & DIMENSIONS ((__)HOUSE PLANS - TWO SETS UUFILL IN EXPANSION AREA (U(.:fJ-VARIANCE REQUEST GREATER THAN2 FEET SUBDIVISION ,-'ILL UU CLAY BARRIER 1 LEGAL SUBDIVISION (U(UFILL CERTIFICATION NOTE SUBDIVISION APPROVAL CHECKED PERC RATE i G,3 —EDP_^ UUDEPTH GAUGES (— )UVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS FILL REQUIR DEPTH CURTAIN O ( U(-- )SEPARATION DISTANCE FROM TOE OF SLOPE DRAIN REQUIRED A 6 GENERAL (_)(_)LOCATED IN NYC WATERSHED GULF TRENCH PROVIDED GOFT MAX. (_)(_)PLANS SUBMITTED TO DEP UUpARALLEL TO CONTOURS ` U)U)DELEGATED TO PCHD (_)U)100 % EXPANSION PROVIDED U)U)DEP APPROVAL, IF REQ'D UUDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL U) TEST HOLES OBSERVED UUGEOTEXTILE COVER _)DEEP UUEX BE WITNESSED SEPARATION DISTANCES ON PLAN =FROM SSTS -APR (U(UEX- APPROVAL SSDS ADJ; SOTS UU10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (UU,WETLANDS (TOWN/DEC PERMIT REQ'D ?) UU20' TO FOUNDATION WALLS U)(_)DATA ON DDS PLANS & PERMIT SAME UCU100' TO WELL, 200' IN DLOD, 150' TO PITS LU(UPRE 19G9 NEIGHBOR NOTIFICATION UU100' TO STREAM, WATERCOURSE, LAKE (inc. expan) U�ULETTER BUZBA UU50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER J.U100 YR FLOOD ELEYATION W/I200' UU10' TO WATER LINE ' (pits - 20 ) (U(_REQ TESTIN G YEARS OLD (_)( =)50' -)50'-INTERMITTENT-DRAINAGE COURSE REQUIRED DETAILS ON PLANS DETAILS UU200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS U)(—)SEWAGE SYSTEM PLAN - (NORTH ARROW) UU10' MIN TO LEDGE OUTCROP (U(USSDS HYDRAULIC PROFILE I SEPTIC TANK UU10' FROM FOUNDATION; 50' TO WELL C--)( ITY FLOW WELL U(__)CONSTRUCTIONNQTES 1 -15 C- TO PROPERTY LINES (__)(__)DESIGN DATA: PERC &DEEP RESULTS -�UDIMENSIONS (— )C_)LOCATION OF SERVICE CONNECTION (_JC_J ' CONTOURS EXISTING & PROPOSED UUMIN 15' TO PROPERTY LINE U_)DRIVEWAY & SLOPES, CUT SLOPE UUFOOTING /GUTTER/CURTAIN DRAINS UUUSDA SOIL TYPE BOUNDARIES UUSLOPE IN SSTS AREA (520 %) (U(UTTTLE BLOCK; OWNERS NAME ADDRESS L—)�— )GRADED TO 15 %, IF REQUIRED TM #, PE/RA; NAME, ADDRESS, PHONE# DOSEIPUMP SYSTEMS (_)U)DATE OF DRAWING/REVISION UUPUMP NOTES UUDATUM REFERENCE U(___)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED UULOCATION OF WATERCOURSES, PONDS U(_JDETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. C--)( --)PIT AND D -BOX SHOWN & DETAILED (ULUPROPOSED FINISH FLOOR AND UUl DAY STORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN DRAIN U(UWELLS & SSDS'S W/IN 200' OF SSTS UUSTANDPIPES, 5' BOTH SIDES, DETAIL (_ (— JPROPERTY METES & BOUNDS UU15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %, 100 % -<1% (_)(UEROSION CONTROL FOR HOUSE, WELL & C_J( —)20' MIN to CD DISCHARGE /100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE UU10' MIN to NON - PERFORATED PIPE COMMENTS: (REVSHEET)09 /01 /00 BRUCE R:. -FOLEY Public Health Director LORETTA MOLINARI R:N.;:•;M.&N:-` Associate Public Health Director --Director of Patient Services DEPARTMENT OF ]MEAL_ TH 1 Geneva Road Brewster, New York .10509. Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COWER. SHE"'ITET PROJECT (Ovmers Name): 4=C4'x_'V STREET: 20 oz=-c- Zf , ,, je:F,J 'IMCIPALITY: ATr-c u o N TAX MAP NUMBER: 7-7-1-12-r DESIGN PROFESSIONAL: %c "4*1, ���c� DATE: i 00 !� REVISION -/4C�NE-7J''4 4--- 11 REQUESTED ADDITIONAL INFORMATION OTHER 6 A BRUCE R:. -FOLEY Public Health Director LORETTA MOLINARI R:N.;:•;M.&N:-` Associate Public Health Director --Director of Patient Services DEPARTMENT OF ]MEAL_ TH 1 Geneva Road Brewster, New York .10509. Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COWER. SHE"'ITET PROJECT (Ovmers Name): 4=C4'x_'V STREET: 20 oz=-c- Zf , ,, je:F,J 'IMCIPALITY: ATr-c u o N TAX MAP NUMBER: 7-7-1-12-r DESIGN PROFESSIONAL: %c "4*1, ���c� DATE: i 00 !� REVISION -/4C�NE-7J''4 4--- 11 REQUESTED ADDITIONAL INFORMATION OTHER .37.9/' NO• -JT. 40 ".0 - 247.73' { 89' w .... t ..ni liz �s.it tLe : 2 3 LoT Ilk ARzA. 4.402 Ae q--s �j SCALE: //OR/FO.VTAL - /1- � SB4•- 45' -;O'E, /4.95' i/.ERT /LAL - /"_ /�' - � � . NOTES SE1✓ ACED /SPOSAL•SYSTEM ToBELvsrALLEOToCaviaR.n TO SPEC /F /CAT /ONS AS rAo l,"eOUNTY1&Q.ZTNG�PARTiNENT. • L?_ . PE.+ IOVE�L <TEESJI%7.V /N%O'OFS.SD./9. .t: ,3. TNEAREAS DEI /NEATEOFO.P �SrEI✓'7GE D/, Sf�SA. LF /E.CRS�Ea'A��tIS /ONAREf/TOLQE L � P. VYS /G'ALLY/�7RKEOLLV7.EC�erOU!�O �'NO EA.PlN/r101� /N6 QPCO.✓ST.PUCT /ON .EouiP.7E,vrjS To BE ALLCwEOJ�vT �55e/%PE�ES ExcePT//s�PEmui eFO /Se �p C'cwcrneucriov OFTE:S'YsrE.a. d. Wiµ 4. Z417,0*eTORTOLusTALL &- WlL. %FowBYGRAY /rX ; Y ti� S. %✓t'lL CAS /NG TO . rZ.VO IB':ABoY.�Fi.✓.�L G.P.v<'.� �` tj $aic Q./yq G..EX /STiNC WELL To �EAaA.vcouEO A.voF /LLEO Wry Cavee.ErE. aF6 Eracwt.. srl.• J7c � �� Se,t r �C. L J G-C TJd L) G ?G N h fkros�o 4�: /J w24' / -• 4' .S'ANDr 4AM� , •� PC.t •,(art 8- /OHrd�� .' P.eAFOAXW.0 FOR .. • TOWN OFPATT.ERSON-PUTNr9/Yl C'OU/vTY -N.-,W YORK 6BL , \ // a , G9O f.4 4,1 SW. /✓W D/DTE' fEBRvmey 14, HS 7 \ Ale, I Y o euv2 •_.LEGEND i��!/: %%iCC' /f y 17P7 4e iee• OF NEw YOR ti O ` *�0 h - o ° DcsrAieuria vBax • P.eRtOLAr /ON,TSri�iiLE' PREOAREG LSY �j� :J�'"`r ' m S2'- 59'•50'w; 20.49' s D6EVTsrt/cuE i{/ELt i✓ /.0 C /f�/Y1 F.E /C.EiQ SURYEYO e � 514•• 46 '•40 `W, 2/. SO' y G80. PROFESS /ONAL ENG /NEE.P p`L.4iv0 /� w S4'24 °.30'Wnz.49' _s'82t_9T: /e'E,. /4.sr' =_;:._ .. GONCO.PD.eAV-/�iA.YOPAC-N"/ Yoxx 10-541 - 'PRO FESS•' v �, , . -_ _ _ ; �. -''of 3 " sr•oz• -so-E za.or (9/4) 628 - 47G4 d. I ,� Y �.I .W- 3 w s W h o .) x a v W p W u cl 2 w SOLID ROCK �2 MIN GROUT >EaL. THICKNESS 12 �+-- — — '— r- I •I ASS EALTIC RING .I. - INLET III II �1 I BOLTS CONCRETE SEPTIC TANK I L_IU-J ' SLABS POURED IN PLACE II ARE DESIGNED TO SUPPORT A MIN. LOAD OF 300 PSF. PLAN CASING 20 FT. MIN. LOCATION STAKE --tip LENGTH UNDER ANY CONDITIONS: REMOVABLE MANHOLE, Y /A3 B.4 RS, 6 " Ot. 20 1. MIN. OPENING 7 - USE CLAY PUDDLE CORE CAST IRON PIPE, %WITH BETWEEN CASING AND TIGHT JOINTS DRILL HOLE. V41 FT. MIN. SLOPE INLET 1 ._ .. CAULKED JOINT CASING, 10 MIN.' IN ROCK SANITARY ...TEE _ ._...._._ -. _. SANITARY SEAL ON WELL CAP SCREEN VENT WELDED SLEEVE 48 MIN. IP TYPE COUPLING o. FROM PUMP TO' PUMP WELL CASING trFLIE�AD G OR CAULKI NG P TYPICAL SECTION OF DRILLED ' WELL I -� O �I it 12 .. MIN. REMOVABLE MANHOLE, 20" MIN. OPENING 36" MAX. 4" SOLID PIPE WITH TIGHT JOINTS, GRADED 1/8 .. /FT. MIN. 5 OUTLET •--rn CAULKED,, JOINT SANITARY 6" MIN. WALL THICKNESS FOR POURED IN PLACE CONCRETE -PEA GRAVEL OR S ECTION CLEAN SAND TYPICAL 1200 GAL. CONCRETE SEPTIC ' TANK SEPTIC DETAILS prepared for prepared by WILLIAM F. ZEILER V v New ro F. IFS Tr FP Professional Engineer & Land Surveyor ���� No qv. o Concord Road - Mahopac -New York 10541 iysf (914)-628-4764 °ROFessw�a� Z e� s i f asPHaulc SEAL Z INVERT OF INLET rj R, IOF OUTLET. L10UID LE1L�I nl I I I_m '.I ✓BAFFLES MAY BE I r , � USED INSTEAD OF SANITARY, ..TES. ' 14 I W. ZI p 1��'�CEMENT PARGING ON INSIDE - ' _o C J 7 5 OUTLET •--rn CAULKED,, JOINT SANITARY 6" MIN. WALL THICKNESS FOR POURED IN PLACE CONCRETE -PEA GRAVEL OR S ECTION CLEAN SAND TYPICAL 1200 GAL. CONCRETE SEPTIC ' TANK SEPTIC DETAILS prepared for prepared by WILLIAM F. ZEILER V v New ro F. IFS Tr FP Professional Engineer & Land Surveyor ���� No qv. o Concord Road - Mahopac -New York 10541 iysf (914)-628-4764 °ROFessw�a� Z e� s i f 24" IB -2r SECTION j BUILDING PAPER, UNTREATED �EARTH BACKFILL j MIN. 314, MAX. 1 112- WASHED OR CRUSHED STONE. DISPOSAL INLET Baffif CONSTRUCTION NOTES SUBSURFACE SEWAGE'DISPOSAL SYSTEMS_ S WELL WATER SUPPLIES S° MIN.- !I" MAX. SERVING SINGLE FAMILY_ RESIDENCES 2" MIN. s" .i • .�:. j. •. �: • • i 6" MIN. 4" PERFORATED BOTTOM OF TRENCH GRADED 1/16 FT ' L4. . PIPE, GRADE I/le- 60" MIN. Basic Required Notes 1. AiUl trees within 10 feet of the proposed SSDS shall be removed.. PROFILE GROUND WATER ROCK 2. SSDS to be ]Suspected by the design engineer /architect and the Putnam - County Health Department after construction and prior to backfill. 3. No trucks, machinery, building materials, nor excavated earth shall.be TRENCH DETAIL i INSTALL 6 ON CENTER) allowed in the sewage disposal area. Construction of SSns to be in DISTRIBUTION BOX DETAIL Re nOVeaWe —Cover oo• se e • eo D O• v 5:O�RfORRTED PIPE prepared by WILLIAM F. ZEILER Professional Engineer S Land Surveyor Concord Road - Mahopac -New York 10541 (914)628 -4764 s�3 accordance with these plans, any revisions thereto, and the rules and regulations of the permit issuing, governmental agency. 4. Miniumnn well yield of 5 gpm is required. Yields less than 5 gpn rgill be imuediately reported to the Putnam County Department of Health. Notes Required When Fill Proposed 1. Fi11 must be allowed to stabilize for 60 to 90 days following placement and be inspected by the Putnam County Department of Health for acceptance, prior to installation of the sewage system. Date of placement must'be reported to Putnam County Department of Health. • ° . 2. Run of bank fill shall be suitable for sewage absorption, be free of fines ?o ° °.• or other unsuitable material and shall have an in -place percolation: rate at least equal to that in the natural soil after the required stabilization e C a '• ° period. The engineer /architect shall perform a final percolation testin b • • • the fill after stabilization. goo o C 3: Impervious fill, clay barrier, shall be a dense clayey soil with little or • , no sewage absorption capacity.. v e °D .- 0 SEPTIC DETAILS °so •• prepared for oo• se e • eo D O• v 5:O�RfORRTED PIPE prepared by WILLIAM F. ZEILER Professional Engineer S Land Surveyor Concord Road - Mahopac -New York 10541 (914)628 -4764 s�3 PUTNAM COUNTY DEPARTMENT OF HEALTH ..DIVISIOY:OF. ENVIRONMENTAL, HEALTH. .:SERVIC. FS_ Gentlemen: This letter is to authorize a duly licensed professional engineer &`�or registered architect (Indicate to.apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in y_ connection with , this-matter and . to --supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tart' Code. Very truly yours, Signed, a, Countersigned: Owner of Property P. E . R�.7 # �L fil / / �111'1 .S Address A11_�_ /-,!; le Address- Town, " &iff6flAC 79 Telephone Telephone Date Re: Property of LL�r,�/ Aycl Located at,✓.�/��J /C•7 pye��/ t`tpc� -i� (T) 14; �es0,<l Section %7 Block /. Lot 12-S' Subdivision of PN1lye✓A T-AIO >`l,3 n A& /7,7 P &tel-j Subdv. Lot # L6 Filed Map # 214949 Date Gentlemen: This letter is to authorize a duly licensed professional engineer &`�or registered architect (Indicate to.apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in y_ connection with , this-matter and . to --supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tart' Code. Very truly yours, Signed, a, Countersigned: Owner of Property P. E . R�.7 # �L fil / / �111'1 .S Address A11_�_ /-,!; le Address- Town, " &iff6flAC 79 Telephone Telephone a® PUTNAM COUNTY DEPARTMENT-OF HEALTH Rev. 3/86 ( Division of Environmental Healtti Services. Carmel N.Y 10514 CERPIFICA�r I to Provide Permit q ` �f� �. on TE OF CO1bIPLIANCE CONSTRUCTION PERMrY F0 EWAGE -DISPOSAL' SYSTEM : Permif "q Lorated:at t1.L L �..'(€ Teem or village Subdivlslon'Name ��� ���� ��� ,Sabel. Lot q Tad Map �'� Block Lat Re aewal_"❑ Revision ❑ Owner /Appllcaat Name .bit ��L•d�AJ . �,D �q,� "�, . Date of Previous APP Mailing Address � "ll -� Town Building .Type �r�'f 1) el, 71h Lot Area- � O Z �• Fi11 Section "Only Depth Number of Bedrooms Design Flow G/P/D �d PCHD NetlHc.ifou is Reafalred Wtiea FIR is:completed Separate Sewerage System to consist of ems®© Gallon Septic Tank and To be constructed by ° . "�!/!L �`��.' : Address �/�tiG" 2J OV Water SuPpl)': Pabllc: Supply From Addeos® or Private' Supply Drilled by� - Addeesi Oilier Requirements Fepresent.that I am wholly. antl completely responsible for'the design and location of the proposed systems) 1); that the`.separate sewage disposal system above described will be constructed as shown on the approved amendment there. to and in, accordance with`the standards,, rules an regulations o e Putnam County'. Department ,oh 'Health, and that on completion thereofa Certificate, _of Construction Compliance satisfactory : to -the Conimissioner..gf Healthwill be submitted to" the Department,' and -a wntten,guaranteee will be furnished she owner, his successors, lihrs or assigns "by the builder, that said builder will place, in good,, operating conddi,on any ;part of said sewage d�sDQsal; system ,during F.ttie W.iod,of two (2) years immediately follow ng,.thedate of the issu- ance`;of they approval of. the 'Certificate of Construction Compliance of the original. system or %any repairs theretol2) that the drilled well described above will be located as shomvn on the approved plan and "that said well will:be installed': "in" accor ance' with `the standards., les and regu a on�f the Putnam County Department: of He- Date 8. o % `'df 1' ` Si9ned P.E. R.A. - Address ' ` �/ i-I license No 2,P V APPROVED FOR CON_ STRUCTION: This a revocable for cause or may -.be amended or m requires anew ptrm`iitt. A ovetl for disp, Date- � 1 DEPARTMENT OF HEALTH Division oI EnviYonmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ... w-.: 'Ai?PL_ILCATLON:. TO: := CON.STRUCT :A- _WATER_. WELL.,: PCHD PERMIT ..•# WELL LOCATION Street Addre s To Village /City Tax ,01-1*,, Grid Number s . WELL OWNER N me Address ® . j -. 4XV private Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL OPUBLIC SUPPLY ❑AIR /COND /HEAT PUMP ❑ BUSINESS O FARM O TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT______&_ gpm/ # PFOPLE SERVED_ /EST. OF DAILY .USAGE gal REASON FOR DRILLING OKEW SUPPLY []PROVIDE ADDITIONAL SUPPLY OREPLACF EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING •° WELL TYPE L3ftILLED ® DRIVEN ®DUG ® GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WEL�L /IS!LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: V, i- c°�'A./ I ) r /_([, IC iF C ° ' dP_1 7 Lot No. �+ WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM - NEAREST WATER MAIN::• - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION lam- S TE SH c (signature) (si • (date) g 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 proviqgo by a utnam Count Health Depart4hent. Date of Issue: _..� 19_� Date of Expiration: 19 P rmit Issuing fficial Permit is Non - Transferrable I.M. -, PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH William Zeiler, P. E. Division Of EnvironWp a� H2ealth 9gyices Concord Road Kahopac, New York 10541 RE: Gantz Subdivision Lots 1, 4, 5 (T) Patterson Dear Mr. Zeiler: JOHN SIMMONS, M.D. Deputy Commissioner 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: Lot 5 1. well permit application not provided 2. show clearly that well is within lower section of. property not upper offset. 3. design data is not a fill. plan 4. two foot proposed contours are not provided Lot 4 1. see #1 Lot 5 2. - see #4 Lot 5 _.:. _..,..... 3. the location of the well on the adjacent lot has been shown moved to the property line. This well should be shown in the original subdivision location separated from the well on this lot in order that they do not interfere with each other. Lot 1 1. see #1 Lot 5 2. see #2 Lot 5 3. The plan does not provide for fill 10 feet to each side of the trenches. 4. see #3 Lot .5 5. see #4 Lot 5 Upon receipt of a submission, revi ed to this application will be considered fAU4 L 11, Jr, P. E. ve comments, JK : pt Df rector, cc:JK Environmental Health File Services 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ,i �I r: BRUCE R: :.. FOLEY ...... _. _ ._ ..... ... . Public Health Director LORETTA . MOLINARI, R:N.;, M.S.N:9 Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278.- 6085 COVER SHEET PROJECT (0«-ners lame): eqL( 6/tl STREET: INKMI CIPALITY: ��'� �l% TAX MAP NUMBER: 31f- Z? DESIGN PROFESSIONAL: 14(11jw A Z67 � �' DATE: 4(?1() REVISION At / Ste- SAS S REQUESTED ADDITIONAL INFORMATION 11 OTHER o n BRUCE R. FOLEY Public Health Director LORETTA: MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTWENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)279-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 24, 2001 William Zeiler 28 Concord Road Mahopac NY 10541 Re: Proposed SSTS: Ganz Cannon Road, Lot #5 (T) Patterson,_TM #.34.13 -1 -58 _ ....- _ _ . --- .- ------ - .- .. - -Dear Mr: Zeiler:...... -- - - - - - -- - - - -- -- - - - ..... - - -- - - -- -- _ .._. -.:. -- - - -- -- -- -- - -- 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 plans, as submitted, are not acceptable. Please review Bulletin ST -19 for proper submission procedures. The fill plan shall be separate from the trench plan. Revise .accordingly.. _ ...:..:......._.__.:,.... ... _.. .. u...._...... The construction of this sewage disposal system may be subject to local wetlands regulations. You - - - - should contact .local wetlands officials in this regards. Upon receipt of a submission, revised to reflect the above comments, this application will. be - - -._.. - - _- -- - ss -- -- - -- --- -. - - -- -ab - --- --_...- n -- - -- _ __ -... - - - -- - - considered further. Very y yours, I� Robert Morris, P.E. Senior Public Health Engineer . RM:tn �s PUTNAM COUNTY DEPART INDIVIDUAL Try= APPENDIX B. OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES :E SEWAGE DISPOSAL .-. -,� .__ '..... REVIEWr - SHEET,.. - CONSTRU ION.. PERMrT - -' ` ? e, DA BY: (i of Owner) (Street Location) iOCUMENTS lermit Application brporate Resolution 'laps - Three sets :ngineers Authorization )esign Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth louse P sets Tell �*stl ; Pw•5 letter ►ariance a2\TERAL, .,egal Subdivision > ubdivision Approval Checked �x- approval SSDS Adj. Lots Checked Wetland (Tcwn /DEC Permit R & D) )ata On DDS Plans & Permit Same tEQUIRED DETAILS ON PLANS wage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow ,ill Profile & Dimensions - Volume or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Jell Detail, Service Line if over :onstruction Notes )esign._ Data:...pearc. and deep.. r Liao -Foot Contours Existing.'Proposed )riveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) ?erc & Deep Holes Located Representative of primary and expansion �xpansion Area;shcwn;gravity flow,suff. size If PmTed Pit & D Box Shown & Detailed louse - No. of Bedrooms dells & SSDS's w /in 200 ft. of Proposed System Property rtes & Bounds louse Setback Necessary (Tight lot) Souse Sewer - 1 /4 " /ft. 4 "0; Type pipe . No Bends; Max. Bends 45" w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi' 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, lake (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercour 10'. to Water Line (pits -20') 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well L' s/s SUBDIVISION Perc V (3) Fill cd 15' Well PL IAJOv 11 PQ_'L hi � A P44, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of //'(j Located at LGGar'7" Ace - (T) Aj¢j[[?7%,�� Section Block / Lot Subdivision of Subdvo Lot # Filed Map # c;&',LQ FQ Date A3 Gentlemen: This letter is to authorize 141L a duly licensed professional engineer -- 6"1/ or registered architect (Indicae 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 1: - . -.- - • - •.- syst-em.. -or-- .sys•tt- ms- - -in -- born-- ormity with-the -provisions of - Article- - 245 -car 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. "F fY '! Y0 Very truly yours, NM F. Signed ?c., wner of Property Countersigne. P. E. , e , # P-- Address Address Town A) ry 91 �) qa 8 - 3 /n Telephone ( - V76 Telephone j. PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEr RQ S 4E(- O - 5' i � ;� 8 - 8 1�2 g' _ 1 11/2 ' ' 14,-0 I/2 - - — 9'- 4 t 16 20 2 28 32 36 1 40 44 48 mature & Ti t 3 Data 1 14 I' 3 t AT 1 Pi N C LLO. t -Q lo'- a 1/4 z - 3 lo- 0 3,4 2 1(�1NIN Z _ --FF �I BEDROOM 4� BEDROOM ! E ECT. DROP / STUR. �.__.. —.. - -9, -10 > D D C © I "FILLER CiI 3 r��I QC 1,. o ta 3315 2i 0 HALL 43e. � 2 d c I / - t - - - --� ------ - - - - -- .{ 7•'_ 2 3/4 _ 6'- 10 CLO . c D❑ Z D ` =QI BEDROOM 2 Q° BEDROOM 3 LIVING F uj 1 1'-101/ 2'-0' 9 -9" � 19' -2 3/q CLO. CLO N _ t. �;\ 1 — 1 - 0 G) 6'_4' V 1 O 13' -0I/2" © 10' 11 9' -8 �8 -- - -- 8! -0 — ENTRY p 36 40 44 ', 48 19' -4 1/y 25' -03 /q, y17'- 8 1�8' $71 OOP P1 AN G r. PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH William Zeiler, P. E. Division Of EnvironRpp& F{ alth 4gvices Concord Road Mahopac, New York 10541 RE: Gantz Subdivision Lots 1, 4, 5 (T) Patterson Dear Mr. Zeiler: 1- 16-- JOHN SIMMONS, M.D. Deputy Commissioner 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: Lo f 5 well permit application not provided show clearly that well is within lower section of property not . upper offset. design data is not a fill plan A two foot proposed contours are not provided Lot 4 1. see #1 Lot 5 -2." s66-44 Lot 5 3. the location of the well on the adjacent lot has been shown moved to the property line. This well should be shown in the original subdivision location separated from the well on this lot in order that they do not interfere with each other. Lot 1 1. see #1 Lot 5 2. see #2 Lot 5 3. The plan does not provide for fill 10 feet to each side of the trenches. 4. see #3 Lot 5 5. see #4 Lot 5 Upon receipt of a submission, reviAed to r ec her Bove comments, this application will be considere u he — e tr , n Ka ell, Jr, P. E. JK:pt D rector, cc:JK Environmental Health File Services 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 1... cwicciwn 9. Er-L't c 912. #11 Box 242 Coneod cRi r(afi0#ae, c� T. 1 0541 q14 -628-4764 March 7, 1987 Putnam County Department of Health Division of Environmental Health Services 110 Old Route Six Center Carmel, N.Y. 10512 Re: Nilsen, Nilsen, Ganz, & Bueti Subdivision Lots 1, 4, & 5 (T) Patterson Dear Mr. Karell, As requested in your memo-of March 2, 1987, I have made the revisions you suggested and am returning the Septic Plans __:for your - a.proval'...,...' .____.. ___„__.._ _<_..._.._.._ .__ ___ .. ._. . ._w__..__.�,.__.._ Please note that the well adjacent to Lot # 4 cannot be moved= it is an existing well. My plans for Lot # 3 were not followed. Also, a new engineer took over the inspection of the septic system installation and placement of the well on Lot # 3. If you have any further questions, please feel free to °call . very truly yours, Willi Zeiler r• •• � �• • •�r is • : y �. � •' • � �• •: is v •i �• •�� DESIGN DATA SHEET- SUWLMCE SEWAGE DISPOSAL SYSTEM FILE NO. Owner %%� � c ,y C4 A-) Address q S _OV12Rrk q&V1MW4y �,�,r�c- l � •� �•w' /J Located at (Street) /e4 Sec. 7 i Block / Lot (indicate nearest cross street) Municipality /'I TEiZSo.t% Watershed SOIL PERCOLATION TEST DATA P37 RED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground. Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 116"d 3 .n / Z �/Q �'Y %'�g"� /SCD —/0 e 5 1 ' VA 3 4 5 NOTES: 1. Tests to be repeated at same depth until appraximately equal soil rates are obtained.at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 M9T PIT DATA • E• r• Er TO BE SUBMITTED WITH APPLICATION PESCRIPTION OF SOILS-ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1 ° S�4LJ, y L,),4.01 2° 3° 49 5° 6° 7° 8° 9° 10° 11° 12° 13° 14° INDICATE LEV]Et AT'WHICH "MWN °IS" ENOOUNTEE2ED /�D:tJCs� "._...._.�,_._ _..__.-- _rte__.. _r_.�._..a...• INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: /_L� /G%'�i'.... DATE: Z_ars�- DESIGN Soil Rate Used –/O M3.n /1" Drop: S.D. Usable Area Provide 5-000 --r j',--' No. of Bedrooms Septic Tank Capacity /'Z v 0 gals. ripe 0(y ,ye _ Absorption Area Provided By L.F. x 24" width trench �- Other 0 Name �'V /GG��f�/ /_ /LG`�- Signature GAL LiL9 Address 14%d Z— SEAL �, ,y � V 0. 042a� N. 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