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HomeMy WebLinkAbout1690DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -4.2 BOX 15 I No !,�% - . 4 It , , r Y ., Is r `. I Is I N Is • • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE . -SEW TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # "- ���,��_ Located at I6-1 64 f5LH PAP Town or Village � ng RRADH Owner /Applicant Name 1 Qh wbi_ff �' Formerly C LA W- Tax Map �) 6 Block 4 Lot 4 ° 2- Subdivision Name i✓l -804f, Subd. Lot # Mailing Address 5& F0- -1 C-1 ' 6 6TO— SAD 1✓A,()TL45 NY Zip 1610"1 Date Construction Permit Issued by PCHD Separate Sewerage System built by P eIL_ Address P-0 `' WC 1 005 W-10- 1, togq Consisting of I I-S 8 Gallon Septic Tank and (o6 I L-f- K�6 Other Requirements: I 0 EQ M )A C W H Water Supply: Public Supply From Address or: Private Supply Drilled by M10-0H W01T Address O L '�1j1 W WW O Ai Building Type Has erosion control been completed?— Number of Bedrooms 4 Has garbage grinder been installed? 0o 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 f the Putnam County De nt of Health. Date: �`�_ Certified by P.E. X R.A. rofes ional) Address �p %�-- e)}�`td Des' 10,701 License # 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , dificatio change is necessary. ` Z- By: Title: Date. a G White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT x' 19 Uozation : Street Q.ddress: l "l TownN`11a er <° f1 1 Tax = Grid #i _ . : •... .. Map r0 � Block 4 Lot(s) Well Owner: Nam - Addressj%:. 1 ���\ ,('�'1A \J t(�/ Vt 0% Use of Well: 1- primary 2- secondary Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion C mpressed air percussion Other (specify) Well. Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade 4�ft. Diameter _7in. Weight per foot /7 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded __X Threaded _ Other Seal: _ Cement grout I . Bentonite _Other Drive shoe: Yes No I Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped -X Compressed Air Hours _6 Yield J 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 7 7 7"C7 . ... ... J f If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 400 () - Pump Type 54- Capacity _1 Depth `?4D Model ib J Voltage �`�n HP � 1_ Tank Type 17,,P< 02- Volume TL7d Date Well Completed Putnam County Certification No. Date of Report SO Well Driller (signature) NOTE: Ekact location of well with distances to at least two permanent'landrftarks to be provided on a separateevplan. j 1 Well Driller's Name /> 6 AddressI6 ? ft V L1.. n�en, Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUN COUNTY DEPARTMENT OF ALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map.... Block,__, Lot 551 Building Constructed by TownNillage 1316 - Location.- Street ' Subdivision Name.. Buildin g Type Y -- ' Subdivision Lot # 1 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 Depart. nent..of Health., and hereby guarantee to the ovmer, his successors, heirs or�assigns, to place to good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment'system, or-any repairs made by me to such system,..except where the failure to. ' rp e _i caused b - the v illful cr -ne- I ,t� aet-of the-occu * t oft%e-budl-din utiliiin th.e.__�,_.. _.._ P P} ly.. Y g g l g g 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:. MonthA %± 'Day oaf Year .. General Contractor (Owner). - Signature Corporation Name (if corporation) - Address: State.._ .. Zip Zo, S-3 Signature: Title: t a �/ %L PLIE Corporation Name _ . (if corporation) Address: LCD (nX 6V _ State L /o,S'� rr/ .r ... zip Form GS -91 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Telephone (845) 279-4003 Fax (845) 279 -4567 September 20, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Wolff- Lot #1 167 Big Elm Road Patterson, NY T.M. #35.4-4.2 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built Plan," dated 6- 28 -02. - 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 9-20-. 02. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System," dated 8-26 - 02. 4. Laboratory Report, dated 6- 11 -02 -02 & 6- 27 -02. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 7. "E -911 address verification form," dated .9- 20 -02. Kindly process the enclosed at your earliest convenience. Very truly yours, Harry -W. Nichof Jr., P.E. HWN:his 00- 119.01 - YML ENVIRONMENTAL SERVICES 321 K Street St�et Yorktown' ' ` � / � 'g' ' - - Y.-'1 5. (914) 245-2800 Albert H. Padovani, Director LAB #: 93.201564 CLIENT #: 55592 NON STAT PR8C PAGE 1 WOLFF, THOMAS W DATE/TIME TAKEN: 06/04/02 10:00A 56 MANCGESTER RD DATE/TIME REC'D: 06/04/02 11:30A EASTCHESTER, NY 10709 REPORT DATE: 06/11/02 PHONE: (845)-277-0805 SAMPLING SITE: 167 BIG ELM RD : PATTERSON NY 10509 COL/D BY: THOMAS WOLFF JR NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ - DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/04/02 Ml:-" T. COLIFORM ABSENT /100 ML ABSENT 06/04/02 LEAD (IMS) 3.2 ppb 0-15 ppb 06/04/02 NITRATE NITROG 0.32 MG/L 0 - 10 06/84/02 NITRITE NITROG <0.01 MG/L N/A 08/04/02 IRON (Fe) 0.3B4 MG/L 0-0.3mg/l 06/04/{)2 MANGANESE (Mn) 0.027 MG/L 0-0.3 mg/I 06/04/02 SODIUM (Na) 5.20 MG/L N/A 06/04/02 pH 6.9 UNITS 6.5-8.5 06/04/02 HARDNESG,TOTAL 128 MG/L N/A 06/04/02 ALKALINITY (AS 78.0 MG/L N/A ..'`{)6/04/02—,--~7URB�ZDITY-�TUR-' COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI���[�~7HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /CU LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. .iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Siodium 1008 9101 9139 9146 2037 2037 ` YML ENVIRONMENTAL SERVICES - 321 Kear Street �--- - -Yorktown (914) 245-2800 LAB #: 93.201564 CLIENT #: 55592 NON STAT PROC PAGE 2 ~~~~~~~~~m°~~~-~~~~~~~~~~~~~~~~~~~~~~~~ °~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~ W8LFF, THOMAS W 56 MANCGESTER RD EASTCHESTER, NY 10709 DATE/TIME TAKEN: 06/04/02 10:00A DATE/TIME REC'D: 06/04/02 11:30A REPORT DATE: 06/11/02 � PHONE: (845)-277-0805 SAMPLING SITE: 167 BIG ELM RD SAMPLE TYPE..: POTABLE : PATTERSON NY 10509 PRESERVATIVES: NONE C8L'D BY: THOMAS'WOLFF JR -''`~TEMPERATURE..: <'41: NOTES...: KITCHEN TAP COLIFORM METH: MF DATE FLAB PROCEDURE RESULT NORMAL - RA14BE METHOD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ is suggested. PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND -FIXTURESv--THE-NORMAL RANGE-OF pH-IS-665 TO 80.-- Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM | CONCENTRATION9 BOTH EXPRESSED HARDNESS MAY RANGE FROM 0 TO SOURCE AND TREATMENT TO WHICH ---°-GQFT-WATER*'8-7010'L=-~"'-...... MODERATELY HARD WATER: 70-140 HARD WATER: 140-300 MG/L SUBMITTED BY: AS CALCIUM CARBONATE, IN MG/L. THE 1UNDRBDS OF MG/L, DEPENDS ON THE THE WATER HAS BEEN SUBJECTED. --- ' HAR[>WATERvABOVE.30(>-M--'- MG/L MG/L = MILLIGRAM PER LITER (1 grain/gallon = 17.2 MG/L) Albert Direc*f ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director | LAB #: 93.201853 CLIENT #: 55680 NON STAT PROC PAGE � WDLFF, THOMAS DATE/TlME TAKEN: 06/26/O2 04:OO 10 KING LANE DATE/TlME REC'D: 06/27/02 10:0O BREWSTER, NY 10509 REPORT DATE: O7/O2/O2 PHONE: (845)-277-O850 SAMPLING SITE: 167 BIG ELM RD, PATTERSON, NY SAMPLE TYPE..: POTA8LE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: THOMAS WOLFF TEMF�RATURE..: NOTES...: COLIFORM METH� N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/27/02 IRON <Fe> <0.060 MG/L 0-O.3 mg/l 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SM IT TED BY UB : ELAP# 10323 .�� ,_.. . ,....... �,..:..a��;;�r �R ��'1:.�:�,�ti -; -... . , .. -. _ � - .. �. .,�:.- ,..�F.:�'�I•� "� +G;:�f:1-� tied.; M.S'� - - �ublic Hralrh- Dl rotor AaccWt- Public Ktaltl� Dfreeta ' 04r'cra of Palttnr Savrcu DEPARTNIENT OF HEALTH 1 Geneva Road' Browster, New York 10509 - - - $orkvomititi) ricaltb (914) 2N • 6170 Fit (941) 271.7921 NunWI Scrvica (914)271.6151 WIC (914)271.6671 .Fax(914) 271.6095 9Wriy *toU MoB6o'(914)271*•6014 Pracbool (914)271-6012 Put(914)171'•6641 E211 ADDRESS VERIFICATION FORM _ OWNERS NAME: TAX MAP NUMBER: E911.ADDRESS: TOWN: AUTHORIZED TOWN OFMC1AL: (Signature) -.._ DATE: �1;2 0 b5 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed,' i.e., a legal E911 address is assigned by an authorized town official. This; form is to be submitted'. -- - witb the application fo-r:_a C.irtificate of Construction Compliance. (E91 I VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE PERMIT # 7 S Located Subdivision name Ed.M PAD C- L-PkWF-1 Date Subdivision Approved Owner /Applicant Name Subd. 'd.il 111 PATP -%Ci- C LA Mailing Address 1�1`'' EWN Amount of Fee Enclosed Town or Village # ri Tax Map! Renewal PArtcR&�4 Block I' Lot 44- Revision Date of Previous Approval R iYD ' W Zip 15�� ,t00°o Building Type f207'1061'44e Lot Area 14 -7 ANLo. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S sy tem to consist of 00 gallon septic tank ands 1-�65 Other Requirements: d ' �' LJ, V:O�, 1.648 W H (n To be constructed by T'b 0 • Address Water Supply: Public Supply From or: Private Supply Drilled by T �D Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate 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: y Address P.E. X �,rhFr t4)1 1-0d R.A. Date to // °i J 9� License # % r if 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 PC eia ause or may be amended or modified whe sidered necessary by the Public Health Director. AIV,s i on or aIt r nnoof the approved plan requires a new permi ro ved f ischarge of domestic sanitary sewage olMil €.,. Iw 3H A13 By: Title: 1134023d �%� 1134023d I White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH M: DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. FINAL SITE INSPECTION Inspecte y: G, yo Street Location r Owner .c,- I' e- ZAas E Town *? ,....y �. �� Permit # 'P- X1'2 ....� TM r ~ - .� �.�, Subdivision Lot # 1. Sewage Svstetn Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped... ................ .....:......................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... . II. Sewage System a. :Septic tank size -1,000 .......50 .)......6ther ................ b. Septic tank installed level ..:..., .:....... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bo . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches I . eL ngth required 6 r 7 Length installed 2. Distance to watercourse measured #- /dv® Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1 %" diameter clean ...................: 9: cpitrc3fgravel n`tfdTich`l2 "iniriimuni:..::. ::: :::.:.. 10. Pipe ends capped......... ................ ............................... g. PumR or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade. ................ 5. First box baffled ............................................... ..... :....... 6. Cycle witnessed by H.D.estumted flow /cycle........... III House[Buildi a` Mouse ocated'� er a roved_ Tans...... .... ?.......: P� - -R _ p b Dumber of bedrooms ....................... ............................... . �-==-a V+�ell�locate' "d as per approved plans ............................ b. Distance from STS area measured 4- 10 I ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercour% COMMENTS >C X s ' � V-A� C? - )c , I . "i - - See P14 dl k, See P14 dl PMAM COUNTY DUARTUM 07 MALTI.K DIVMCM OT? YMDMMrALUQTKSVMCZS AWENUON ADAM Van RZQIMST fat: Flu All Wormsdon must be Aly cmplcted prior to UY TftwUl impecdoms W* =do. PC At o C:45 4 L :- Lot Owner/Appiow am L . . cam SubdIvWco NLMCI SubdMd a Lot . is system a campkie AV14 Date: Is syst,cm, somms? — Yx a I Dec: 2:3 is "em comuVowlas Pee Phu? Is won drilled? Is well imild 0A par PIM? Are trosiotco*U01 MOM 12 F6W? Date: I ca* that the #y$sm(sX- a AuA et the above pmm4es has been conmeW ad I have ippeted sod verMad their cmVWdou in socordwe with the bsued -PCHD, Coamcdon Permh and approved plan and the Studu&, Rules and Regulations of the Pumam County Dopuwat of HcAltk --0 C"ad by". �.,� E RA ID 66-P -W p, facs5kaj - Addtcu.- 90 1 %. 12-1 C4r)MOMW Form m" BRCJCE R: ' FOLEY "" ` Public Health Director _.., "LORETTA�MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT ®F HEALTH 1 -Geneva Road Brewster, New York 10509 Environmental Health (845)278-6136 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 Harry Nichols, P. E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Field Inspection: Clarke Big Elm Road, Patterson Lot #2, TM #35 -4 -4.2 Dear Mr. Nichols: The following comments must be corrected in the field: 1. Install the silt fence in the ground. 2. No house or well at time of inspection. May 29, 2001 If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR/jp Public Health Director DEPARTMETIT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORET A l�fOLI1 AR1� RN.,: IvI.C: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 (845)278-6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 December 27, 2001 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Field Inspection: Clarke Big Elm Road, Lot #2 (T) Patterson, TM# 35 -4 -4.2 Dear Mr. Nichols: The following comments must be corrected in the field: No further comments. - If you have any questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Ae-� 0, Gene D. Reed Environmental Health Engineering Aide GDR:tn LAURENT ENGINEERING \ ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Q C9 \ R (914)278-6108 - (FAX) 278 -265a HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS December 7, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Clarke - L 7 IL Big Elm Road Town of Patterson Dear Mr. Morris: In response to your review letters dated November 3 and 9, 1998, we offer the following: 1. Groundwater was monitored by the Putnam Countv Health Department 2. Standpipes are not 3. Well dimensions ai 4. Curtain Drain Deu We trust the above adequf Construction Permit at yoi Very truly yours, LAURENT ENGINEERE Harry W. ichols, Jr., RE HWN:JM:hs 98033 M Sk Kr BRUCE_ R. FOLEY Pu6 is Heiahh bifddtor DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 November 3, 1998 Tel. (914) 278-6130 Fax (914) 278-7921 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE:, Clarke Big Elm Road, Lot #2 (T) Patterson, Reservoir Basin East Branch Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 28, 1998 is complete. The Department will notify you by November 23, 1998 of its determination. 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 M tl:e ��'utc.shcd �;greameat. 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 should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. 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, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. 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 Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 76130 ext. 166. Very t ly yours .:.'t oelll 04-:7 Robert Morris, PE TT. 10 r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONINIENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT S STERIS. "-RiMEiV SHEET FOR CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER REVIEWED BY RNI, GR, AS, MB, BH Y N DOCUi1ENTS PERMIT APPLICATION. PC -1 WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS .VARIANCE REQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES 11 GE—NERA LOCATED N NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED / EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME. PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTNG & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWNG/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET (PROPOSED FINISH FLOOR AND BASEMENT EL. DATE EROSION CONTROL:HOUSE;WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP W. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE TJi0 BENDS; MAX.BENDS 45° W /CLEANOUT // FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME ILL IN EXPANSION AREA BENCH t LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED COMMENTS: TAXNIAP# ON PLAN - FROM SSTS -- '.C' DRIVEWAY, LARGE T'KEES,•TOPOF FILL - 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LINE (pits -201) 50' INTERMITTENT DRAINAGE COURSE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MN to CDS= >5 %,10'- 4 1/o,25'- 3 1/o,30'- 2 %,35' -I %,100' - <I% 20 'MIN to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION L� #� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES y DESIGN DATA SHEET - SUBSURFACE Sl!,WAG. TATMENT_S''IrE11 _, ......� .:: _. -Owner^ - -. �.� ..��_� _..���� .Address Tk>S�t//v Located at (Street) �j l � d��J Tax Map ' • Block 4 Lot indicate nearest cross street) Municipality - 7-),rR Drainage Basin —V p,S®r1, �? M E COLATION TST DATA Date of Pre - soaking / —&� 4? S/ Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time i I n.) Depth to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 /, Z t- 2 4 5 4 5 1 2- 3 4 5 NOTES:: 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 OT* 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. --HOLE G.L. 0.5' 1.01 1.51 2.0' 2.51 3.0' 3.5' 4.01 4.51 5.0' 55 6.0' 6.51 7.0' 7.5' 8.0' 8.5' 9.01 10.01 f y /V,/) goe-ik Na Rack Ala AO4,t my 77Z-)AI Ao7 Indicate level at which groundwater is encountered ­0 7-0 Indicate level at which mottling is observed 31,0p/ 7'61 54L4 Indicate level to which water level rises after being encountered D -0 Deep hole observations made by: 6, /i/;r"- Ileo 4 Date /0 Design Professional Name: 119-14iF10- f1V(Wx/F_16e1,,06 Address: Signature Design Professional's Seal 15 NEW MICH NO. 56124 �OAAOFESSIO�P DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road . Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 27g - 7921 November 3, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Clarke Big Elm Road. (T) Patterson;- -TM# 35=4=4-:2 Dear Mr. Nichols: MCE 'R. - FOLEY Public Health Director 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 Environmental on this lot, percolation tests ' must be witnessed by a representative of this Department. 1) An acceptable method of lowering groundwater must be provided as outlined in bulletin ST -19. Groundwater levels must be monitored during the seasonal high ground water period of March. I5th - June 15th. 2) Curtain drain standpipes have not been provided. 3) Dimension from the well to the property lines are to be noted. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve ly yours, atv Robert Morris, P.E. RM:tn Public Health Engineer i IFUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPWA_ ')7ION TO CONSTRUCT A WA'$EllB.WELlI, .. __.. please print or type PCHD Permit # Well Location: Street Address: 16� Town/Village Tax Grid # 1Cg eL4A PAD Rh'TY 0-60N Map • Block 4 Lot(s)44— Well Owner: Name: Address: FAMU--C Cw k OK 151-M F-0,P 8lZ&h,,ey, tq>' 101a0el Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage &eO gal. Reason for Replace Existing Supply Test/Observation Additional Supply Dirlllinng 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 X Is well located in a realty subdivision? ...................................... ............................... Yes A No Name of subdivision fA?IZ 1 Gad Gib x.96 Lot No. IL Water Well Contractor: T-6.A Address: Is Public Water Supply available to site? .................................. ............................... Yes No 3Y Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separat sheet/plan. 1 patew - �� J: _� Applicant. Srgnature::.. 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: l) 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 driller certified by Putnam County. Date of Issue % Permit Issuin g 0 c'al Date of Expiration Title: Permit is Doan- Tlraansffe abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES UftER OF AUTHORIZATION RE: Property of Located atiA 4Q E LNs P4 W T/V PA-60 N Tax Map #5 " Block 4 Lot '�` 2- Subdivision of Cl' Subdivision Lot #- Gentlemen: Filed Map # 109A Date Filed This letter is to authorize 14fl \N " N1 CIML�, . J�" Fe 4-16-% a duly licensed Professional Engineer k or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers -on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam -- �; PIE Lid y Countersigned P.E., R. A., # -1 v Mailing Address F)P-5-�'�rF5 �_ State N5%4 ' cjq-- Zip l Q Z6\ Telephone: �q)q ) Very truly yours, 1 Signed: (Owner of Pro Mailing Address: l(:4 eLH P D.Ap SA_F=Mri >*P, State NF-W d Qom- Zip Telephone: i Form LA -97 F. MIMI!l!1MA7MIIlIAA IMVlM� P4j& .617.20 ` ,_Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED, ACTIONS Only 'art 1 - PROJECT INFORMATION (To,be,.completed by Applicant or Project'sponsor) 1. APPLICANT /SPONSOR: P TR��Ii G�n f/ 1`— �Y-�► 2. PROJECT. NAME: LJOT. I '114M IDEAL. 6o05 3. PROJECT LOCATION: ' '+ PT��� -6,d1� ��, n� Municipality County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) 5. PROPOSED ACTION IS: tKNew OExpansion OModification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially. �(p J"� acres Ultimately U41 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 6Ves ONo If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF, PROJECT? AReSideritial ❑Industrial_, ,_,_ OCoMcnercial OAgricultural OPark /Forest /Open space 00ther Describe: Ab)H61L -a 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Oyes ANo If yes, list agency(s) name and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? OYes IgNo If yes, list agency(s) name and permit /approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes gNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 1S TRUE TO THE BEST OF MY KNOWLEDGE 711 w ».J t.1 / ..�1 1L� �/ •/ �AI 1rhI tin 1 ppi,,r -n i•`_:;::cnsor game: 1 '41ynu ter—, ,L; -i•%a 7"r-r-+I w ►TI'ri., i. 1 If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR; PART 617.47 If yes, coordinate the review process and use the FULL EAF. OYes ONo ' B. WILL ACTION RECEIVE COORDINATED .REVIE`AI.AS.PPOVISDED FOR UNLISTED ACTIONS'IN`6"NYCR"i,RPAR1 617.67 If No, a F negative -debratkion may be superseded by another involved agency. ❑Yes ❑No C. COULD. ACTION RESULT IN ANY.-, ADVERSE, EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe 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'brie'fly: 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. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTFNTIAI. ADVERSE E,%-f AL IMPACTS? ❑`!es . ❑No If Y&s,-exp) in b"riefiy: i Part III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add art; chments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed-action on the environmental characteristics of the CEA. i ❑ 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 a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the,proposed action WILL NOT result in any'significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Date Print cr Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different fronn responsitle c-:: PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J APPLICATION FOR APPROVAL OF PLANS FOR _ A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: PAts�CV_ CLAk -a fiG U-�A P—ON1D 2. Name of project: i or 2- 3. Location TN: PArraP-60f'+ 4. Design Professional: 14A* 5. Address: 6. Drainage Basin: EpeT 4 7. Type of Project: �t Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency No NA 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........... ...:.. ...... .............. : ...... 'o 13. If so, have plans been submitted to such authorities? ........ ............................... N 14. Has preliminary approval been granted by such authorities? NO Date granted: N � 15. Type of Sewage Treatment System Discharge ................. surface water �( groundwater 16. If surface water discharge, what is the stream class designation? .................... NA 17. Waters index number (surface) N A 18. Is project located near a public water supply system? No 19. If yes, name of water supply NA Distance to water supply NA 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system NA Distance to sewage system NA 22. Date test holes observed 23. Name of Health Inspector r i� h►� 24. Project design flow (gallons per day) $a° 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... NA Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number HA ..........................................................: ......................:....:..: .. . -. 9. Is Wetlands Permit required? ......................................:....... ... ............................. k o Has application been made to Town or Local DEC office? ............................... KA 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 14 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .................... I........ Yes/No � 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site; salt stockpile, landfill, sludge disposal site "or any other potentially known source of contamination? ............................... Yes/No MO DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... YC-15 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... ND 35. Are any sewage treatment areas in excess of 15% slope? .......................... 36. Tax Map ID Number .......................... ............................... Map ' 6, Block '4 Lot 4,� &- 37. Approved plans are to be returned to ..... Applicant A Design Professional NOTE:_ All applications for review and approval of anew SSTS to-be located within-the NYC V!iatershe. shall Ue sent to-the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP. and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. ,False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the P;pa4aw. SIGNVATU ES & OFFICIAL TITLES: RA14-61 W, 441 G 0LA, JP PE . Al� AG,ENr Mailing Address: ................................... 'Lo 90AP yr, N loi�oq j� \ ASSOC A EIS P.C. ING .,:; I1IjzLBROOKF OFFICE. CENTRE_-._.. Route 22 d Milltown Road Brewster, New York 10509 October 14, 1998 (914)279 -610e • (FAX) 278-2658 HARRY W. NICHOLS JR., P.E. V \ CONSULTING SITE ENGINEERS Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Patrick Clarke Big Elm Road -Lot #2 Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -2 "Proposed SSTS," dated 10/13/98 2. "Short EAF," dated 10/13/98 3. "Application for Approval of Plans For a Wastewater Disposal System." 4. "Construction Permit foi Sewage Disposal System," dated 10/13/98 5. "Application to Construct a Water Well," dated 10/13/98 "DegigwData,Sheet" ' ­- 7. "Letter of Authorization." dated 10/13/98 8.. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only." 9. Review Fee in the amount of $300.00. Very truly yours, LAUREN ENGINEERING ASSOCIATES, P.C. cam• Harry W. Nichol Jr., P.E. HWN:JM:hs 98033 -2 S :£ lid L Z 100 86 AN3 03A 1303? PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _ REVIEW.SHEET FOR CONSTRUCTION- PE,111,•T -. -- ­77 STREET LOCATION NAME OF OWNER REVIEWED BY RM, GR, AS, NIB, BH DATE TAX MAP # Y N DOCUMENTS Y N PERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS PC -I PERC & DEEP HOLES LOCATED WELL PERMIT PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION TM #,PE/RA; NAM E,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE - LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET =PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION FILL SYSTEMS LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 450 W /CLEANOUT . SUBDIVISION APPROVAL CHECKED CLAY BARRIER PERC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH FILL SPECS FILL NOTES CURTAIN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES MNO GENERAL FILL PROFILE & DIMENSIONS TM #,PE/RA; NAM E,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE - LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET =PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: LEGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL CHECKED CLAY BARRIER PERC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH FILL SPECS FILL NOTES CURTAIN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS LOCATED IN NYC WATERSHED VOLUME PLANS $UBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D. LF TRENCH PROVIDED 60 FT MAX. DEEP TEST HOLES OBSERVED PARALLEL TO CONTOURS PERCS TO BE WITNESSED 100% EXPANSION PROVIDED EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA ON DDS PLANS & PERMIT SAME 10' TO P.L.; DRIVEWAY, LARGE-TREE$; TOP. OF FILL_' P PE 46 A..,I"HBOr NO IF'CA T ivN ' " --- --"' 20-TO FOUNDATION WALLS _15'WELL TO PL LETTER BI/ZBA 100' TO WELL, 200' IN DLOD, 150' PITS 100 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW CONSTRUCTION NOTES 15'MIN to CDS= >5°/g10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT = I O' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS ® LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAM E,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE - LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET =PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: DIMENSION : CHART (in feet): Number A 8 125 137 2 140 136 3 146 142 .4 152 148 5 1 59 154 6 1 64 160 7 1 70 1.66 8 i 76 1 72 9 1 81. 1 79 10 1 87 1 85 1 1 .193 190 1 2 200 1 196 13 206 2`02 14 138 150 15 144 155 17 156 166 I8 162 171 19 168 177 20 174 182 21 180 188 22 186 194 23 .192 200 24 198 206 2s Z04 2.12 I M O Q p Oo ►0,00" w 0 . I 0 125 SEPTI -k I M . ............ G 03. 10,00" w 74 11 - -- - —=77-7 Ex I ST. 4 BR. RESIDENCE A 4 PVC ON 0 o�E N b (7Y P DCEP P.7 All tRA1t4 �.0 � 0 1250 r.AL. SE 4'71 C TA N 0 3bea, J4 36 LF ASS Tq.,C, 15 Ifil 17 is, 0/ 1 Izo 20 _7 (--0 X LVA P NS:IbN a I A 9 E A 4� P,/c 'ry 22 Z3 10 if 25 12 0.J. —ry—P EXIST. W ELL Putnam County Department of Hei Division of Environmental Health S Approved as noted for oonformanoi app 10 Pul and Regulations Co Health Departmez