Loading...
HomeMy WebLinkAbout1746DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -85 BOX 16 3 -. F . 6 L ok. k+P 01746 PUTNAM COUNTY _DEPMOF HEAA ~ Divlalon dEnvhoomental HeaN6 Servloea, Carmel, N.Y 1OS12 PSsghteerMast Proride H.D. Peimlt N > y LATE, OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEMy� Located at ``� � K, Ce Tax ±MaP- _ Blodl Lot � (hwaedappllcant Name / I oemeely Sibdlvlelon Name ? Ma1>bi Addre�a k a ` A46qel h Subdv. tot 4 Fee Enclosed Amourit' Date Permit Issued 16 . "S' Sq write Sewevage System bWh by "1 dU1A#L ..(� (;drrl. Address l ► ' y� Gallon ,91 Tank acid _ » �+,' Water Supply:_ Public Supply Flom __ Address on vats Supply Drilled by ' , r/�t. —Sam_ Addreeb �!' �— a Type, t Lot'Size.. i �,, as Erosion Cant, n.1 Epp,,, m CmilorPA7 Number of Bedrot ns Has Garbage'Grl * been Installed! Omer Requirements I certify that the spstm(s) as. listed - saiyinq,the above pzmisea ware .con tructed essentially ss on the lens of the coepletsd work ( copies 5. of which are attached)..and in'aceordbnce with the standards, rules aril lationa.- in ac dance w f' ed plan, and the peimit - issued by the rutnsa County Depatrtnentt Of imith. Oats I :° I Ce►tif 6' Addiass License No. Any pwson, occupying promises served by tM above systems) she11 promptly take; wcn aetbn as may be neoswry to sawn tM correction of any unsanitary conditions . ►ssuRins from sucn;; usase. ' Approval. of tM tepa►sti.'.wwwap system flMll beCO1M nuN, aid ,voW as soon as s ptsDi;. pnnary siww beoontse I. ovellible end. tM approvil of the, private wabr_ supply` shall become null and. vokb wMn a 1R7 y barons eyailo1o, _ Such approvals we subject fkatbn /moo► .change' whin; in the. judgment Of'th* ComTlftbiMr MRA, ion, HkS tIon or ehanpa ^is ireaY /V�) date TNNl� 3/89 C�& .14P_ WELL CUMFLETIUN mxuni DEPARTMENT OF HEALTH Division iii --0rrv7irdnmenta3.-:H sir —Se l:v ices PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION sr I Auunrij. TAi GRID NUMBER: -bl, 3 P - '5- WELL OWNER NAME: ADDRESS: PRIVATE 0 PUBLIC USE -OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUB SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT ___5_ gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE gal. REASON FOR DRILLING C],REPLACE EXISTING SUPPLY []TEST/OBSERVATION []ADDITIONAL SUPPLY PINEW SUPPLY (NEW DWELLING) ODEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC WATER LEVEL _�S ft. I DATE MEASURED DRILLING — EQUIPMENT C3 ROTARY dCOMPRESSED AIR PERCUSSION ❑ DUG 7' 0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING dOPEN HOLE IN BEDROCK. ❑ OTHER CASING TOTAL LENGTH ft MATERIALS: 9STEEL 0 PLASTIC ❑ OTHER LENGTH BELOW GRADE _j:<Q ft.— JOINTS: OWELDED &THREADED OOTHER DETAILS DIAMETER in. SEAL: 0 CEMENT GROUT 0 BENTONITE THE o WEIGHT PER FOOT 17 Ib./ft. , DRIVE SHOE YES ONO I LINER:OYES NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (It) DEVELOPED? FIRST I 0 YES ONO HOURS SECOND '.- . I - __ - I I—- ­! . ­­.- GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP DEPTH ft. BOTTOM I DEPTH h. WELL YIELD TEST 1. If detailed pumping 7 00: ❑ PUMPED i tests were done is in- COMPRESSED AIR !ormation attached? 0 BAILED 0 OTHER 0 YES C3 NO If more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPT FROM SURFACE ri I wafer Bear- ing Well Dia- meter In FORMATION DESCRIPTION CODE WELL DEPTH It. DURATION hr. min. DRAWDOWN It. YIELD 9pm. Cana Surface 540 3W- Cirwu C/o a- WATER III CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? 0 YES ❑ NO STORAGE TANK: TYPE CAPACITY GAIL. PUMP INEA R ON TYPE CAP= MAKER 0(e�ze� er_ C_, - MODEL VOLTAGE HP WELL DRILLER NAME DATE 7T INC. AooA"ERT M. HYATT 8, SONS, SIGNATURE Well Drilling Rte, 311.,,R,R* 2 A ve �ox 171!6653 JTOA r M NORTH AMERICAN LABORATORIES, INC. ANALYSIS DATA SHEET TYPE: PW LOCATION: <3 Pheasant Crossing Lane, Brewster, NY REPORT TO: Michael & Nuala Donnelly ADDRESS: 3 Pheasant Crossing Lane CITY, STATE, ZIP: Brewster, NY 10509 DATE COLLECTED: 11 -30 -94 TIME COLLECTED: COLLECTED BY: REPORT DATE: LAB # SAMPLE SOURCE: 12:00 PM M. "Donnelly 12 -01 -94 94 -7999A Bathroom sink DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent COLILERT 11 -30 -94 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKING WATER STANDARDS. Laboratory' "Director" NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914 - 278.7600 / Fax 914. 297 -0536 • • Ot • • LT alt _ —! ieliln 3 S . owner or Purchaser of Buildini Section. Block Lot Building Constructed by PI Location n-- Street Subdivision 3 Municipality Subdivision Lot Building Type GUAF N= OF SUBSURFACE SEMMM DISPOSAL SYSTEM .1 represent that 'l am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has-been constructed as shown on the approved plan or approved amendment thereto, -and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and ,hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction. Compliance" for the sewage dis�Sal, system., oz_. aiiy_: " -re 7 1 «s mode 'by ine to such systdii;_ except 'wiiere 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 Director of the Division of EnvirorrTental Health Services 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 buildina utilizing the system. Dated this day. of 1LLoU,;7,,VA 191T Signature Title General Contractor ( ) - Signature Corporation h'ai� (if Corp.) Address rev. 9/85 Mk IV xI,_az_I_f-z4__ xw-, 0� � �z ,Corporation Marne (if Corp.) Address APPENDIX C FINAL SITE INSPECTION .... I Y . IJ, _. w. -_.. _ ... PERMIT # TM # OR SUBDIVISION LOT # SEWAGE DISPOSAL AREA a. SDS-area located as Der approved Dlans b. Fill section - date of placement 2:1 barrier LGTH WIDTH c. Natural soil not stripped d. Stone.brush.etc..greater than 15' from e. 100 ft. from water course /wetlands 11 SEWAGE DISPOSAL SYSTEM a. Septic tank size - 1.000 b. Septic tank installed level c. 10' minimum from foundation d. DISTRIBUTION BOX 1. All outlets at same elevation - wate 2. Protected below frost 3. Minimum 2 ft. original soil between I e. .JUNCT 1 ON BOX - properly set- f. TRENCHES 1: Length required - Lei 2. Distance to watercourse measured 3. Installed according to plan 4. Slope of trench acceptable 1/16 - 1/: 5. 10 feet from property line - 20 feet 6. Depth of trench < 30 inches frcm surf 7. Room allowed for expansion. 100`. 8. Size of gravel 3/4 - 13" diameter cl( 9 -. -. Death ..of -gravel in trench 12" minimum 10. Pipe ends capoeai - g . PUrP OR DOSE SYSTEMS 1. Size of puny chamber 2. Overflow tank 3. Alarm. visual /audio 4. Purr easily accessible manhole to gr� 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cycle 111. HOUSE a. House located per approved plans b. Number of bedrooms V. WELL a. Well located as Der approved plans b. Distance from SDS area measured c. Casing A" above grade d. Surface drainage around well acceptabl r . OVERALL W ORKMANSH I P a. Boxes properly grouted b. All Pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" e. Curtain drain installed according to p f. Curtain drain outfall protected & dir g. Footing drains discharge away from SDS h. Surface water Protection adequate i. Erosion control provided YES I W I 0M.Ews .�."n'-+.yT": .-..-v'?".e+xrr arracca+.•a -a--w ivn.�+w.- .m- n...- +a+ -.w- .«.s..- — `!A'.'x', .. "'.u.. ` _ PUTNAM CODIf!'Y DEPARTKINT OF SWALTH 111b / 'A DIv61m®at Sew(aee: !. Id.H 1®311, as (mB'l� n O CO . 1 ' MR SEWAGE DEPOSAL SYSTIM - 5* �~ .. _ S116iolrlw hla i;ii,i �6." -.. T4111:. sr O..r /A�t Imo. � �/ 1-���L �_�1,1 f3,1.�'I7B ,1ki►�`f �°�'°�— � Dote at nne oeu Appsrwsh Klima AV Z10 Date Subdivision Approved. Fee Enclosed ears TYO Lm Ates 'l : S . ± Fm seedow o . vat NsssabeQ a[ Design Fbw G P D ° 1i PCHD Nofmaliob le WgdWrl W1sM F®b ootapletsd Swings s4weliliv Syden t9 eesld at "e < :.GsHse Sepile To* md �PT°� �% 5 T ►JG�{ : Td bib anookedid by Adz e wai- sopplr=` —PA Ya slio* Psose Adilwas Wi=tle Sgpb DilMed by AMli .. 1 represent that'1 am wholly And. compNteIV rafpomibk+ for t a dasiyn ali6 location of the proposed system(:); 1) that ter separate sew $00"I system ab011e described will'be ooiistruct00 asshovrp on theapp►ovad arnerldmsnt"thao "to aria inaccordanee With staridaids, rules a regulations o na! t:ouritY t>"Wtniuit o1_ iNHth. anit that on compbii",thereof a •'Certificate of 'Construction Compliance" setishcto►y to the "Coinmipbibr ohNeilthwill be submitted to the OaperGflafit and _a wrltt"- aua►antae will be; furnishaa the owner, his sucoaaae►s, Mks er empress by the 6ulider that aid buikler will OUCe kt pea ;opMatinO condNbn ariy part of ,fain' snap aisposat systini durkq ter parbtl.of two (2) yws h"madbtNy folbwihil tf»data if the law onoe; of the approval .of the 'Certificate of Construction Compliance of, the original system or I any Firs thereto; Y) .that the drilled well "dem bed above srMl "M beitu0 st'fhoawi on�th�.app►ov�d plan and that saidwell. will be In 1 in' accordance with. 4 standards, rubs and feguTairons of " the Putnam county D�pertlneiit of Nealth.:. " .:- .' ,. .. . Date (�;� rj,= Gt�j sgnoa. P.E. li It — Address L " : b lice"" No 2 APPROVED FOR CONSTRt1CT10N This approval hcpMestwo years from the date .;sued u loss construction of the building has been undertaken and is revocelib fa e�um or •1My.bf afnended• or tii Alfied when eonsklared necessary by the COmmissionor of i eelth, Any ehang.a or alteration of eonStrudbn "Qu'res a, nsw mit., Approved ffor, "disposal of "domest k: "wnitiy seeniao; ivate wat supply only. 1088 • � _—e DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 - �:.:r.-•- ��P�?C. �' r�??=:;. �n.;:? I�. ��' RT: ��'.. �'._:' niA�' �R_:.I��I�:.:��:a�.,°.a:; < -;. -• _ -- -.d...., PCHD PERMIT #,b 1'9 -W WELL LOCATION Street Address 5 G- o Village City Tax Grid Number ' WELL OWNER Name U Mailing Addres ®'Private O Public USE OF WELL ®- primary 2- secondary (8' RESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /CO /HEAT PUMP ""- O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY M NEW SUPPLY NEW DWELLING PEOPLE SERVED �j_A5 /EST. OF DAILY USAGE, O TEST/ OBSERVATION GIADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MDRILLED DRIVEN ODUG OGRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name `ice Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES f/ NO NAME OF PUBLIC WATER SUPPLY: qA- TOWN /VIL /CITY D STANCE TO PROPERTY--FROM NEAREST- - WATER -MAIN: __— -- . - -- - -- ---- -. - - -- _..� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (DON SEPARATE SHEET , (date) s gnature) 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 thirt3 (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear.. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: �P�% 19� Date of Expiration 19, 7,�< Permit Issuing Off' ial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller P,,t q- ,�l p�C7'TNAL`� COiJN'TX 7.�EP.A.RTMCF�TT' OF 1;3EAL'�'JE3 �,�'n"LrCATTc�H. Fc�4 1! F?PR ^yAl...n� �!.A`�'- - Pr_,r� A }1a�TEwp >. ER T5F x yA _ . ^� E.M.. . _ ._ ..., .... . _. 1. Name and Address of Applicant: �i.J� G(�I oLAb1-16- 12/20K F_ (-(`_ 2. NaJne of Project: I�t'LtIPD��t� ��l�5 '3 -. Location (,�WC: 4. Project Engineer: W. -fit- _. 5. Address: ���4(Zi✓I�1%t� 1"Jfzl�l� to License Number: ��012�' Phone:- 1 1 0b 6. Type of Project: r � �^ ' -, ,: irk,. _ - • _�.:• - . _ . Private /Residential' Food Service ...Commercial Apartments Institutional Mobile Home Park Office Building : Realty Subdivision 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? �lU 9 ::Has DEIS been completed and found acceptable by.Lead.Agency? :...:.:....`_ A 10. Name of Lead Agency .1.1..Is this project in. an area under the control of•local planning,. zoning, or other officials, ordinances? ........ ............................... �1d 12. If so, have plans been _submitted to such, author .sties ?..................... t��A 13. Has preliminary approval been granted by such authorities? �3 h Date Granted: 14. Type of Sewage Disposal; System Discharge...... Surface Water v Ground Waters 15. If surface water discharge, what is the stream class designation ?........ O /A :6. Waters index number (surface) ........... ............................... Klp, i7. Is project located near a public water supply system? .................. nJr1 S. If yes, name of water supply 4.1 /A Distance td water supply , 9. Is project site near a public sewage collection or disposal system ?..... IJD 0- Name of sewage system Q/A Distance to sewage system 1. Date observed: r5 23. Name of Health Inspector: _— Project design flow (gallons per day)..... .. 9X-10 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. K) Q 26. Has SPDES Application been submitted to local DEC Office? ..............: 01A 27. Is any portion of this project located within a designated Town or State wetland ?.. ................ .......... ............................... r.0 23. Wetland ID Number ......................... .............................. k) /4 29. -Is Wetland Permit• required?* .............. ............................... �►�_ Has application been made to Town or Local DEC Office? 30. Does project require a DEC Stream Disturbance Permit? ................... 00. 31. is or was project site used for agricultural activity involving application of pesticides, to orchards or other crops, solid or hazardous waste disposal',} "`. landfilling,'sludge application or industrial activity? ........ YES or NO t.)0 32. Is project located-within 1;000•feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? .....'.........YES or NO d DESCRIBE: ` 33. Is there a' local miaster plan or file:with the Town or Village. ..::....... 34. Are community water, sewer facilities planned to be developed within 15 years? V :f aJAOQ -Are any sewage,. disposal. areas i•n excess .of 15'-;_•slope? _1 �_D_.�w _ 36. Tax Hap ID Number ......................................................... !Z55.- 37. Approved Plans are to"ba returned to: ................ • App- 1ic6nt _�L_ Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by•a Letter of Authorization: Failure to comply with this ,Provision maybe 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 Hisdemeanor pursuant to Section 210_45 of the Pena 1 La K. A SIGNATURES & OFFICIAL TITLES: 'JAILING ADDRESS: M o tK) LL 4- DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION, Street Address f-rr To Village City Tax Grid Number �� -1 WELL OWNER Name Mail* g ddress MPrivate O Public E OF WELL primary 2 - secondary 8"RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP ❑ ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT _ gpm /# PEOPLE SERVED<) S /EST. OF DAILY USAGE.peal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GIADDITIONAL SUPPLY NEM SUPPLY-(NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING L°S WELL TYPE &DRILLED ®DRIVEN ®DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES v"` NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:ZC0e4 Lot No. WATER WELL CONTRACTOR: Name %j Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DiSTAIvCE TO PROPERTY FROG NEAREST WATER INAI-,d: LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET C' (date) ( nature 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 thirt3r (3p) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall ke appropriate action to assure that any and all water or waste oducts from such well drill' g o rati s be cont 'ned o this property and in such a ma r as not to deg ade or othe ise ont a ce or roundwater. Date of Issue: 19 D f E 4­f-4^n 3� 19 Pe it Issuin Official C L te o xp Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller t n . 1.1 II. I-• Ili to I-• �• - r) - I• • r•I, I •• 11 � r• ��- I . 1j1 l,l fit t-, 1 II I •. 11, j r, 1,{ It l In - I•I I (11 to r I1 r) .• l v I•• 1,1 1 •• n1 cm nt to t�1 M M P1 t�l r.t t• ° ►1 rJ (� i m o 1-rt rn rn Iu 11 rn t -t .1 ►-� N I--1 to F-+ U Ic7 1 IU Il ly � IG I1 11 1U ,'. IU la; l- nl 11' (1 n l!I o rD o 0 1 'r, it I I -11 I 1Zt ly it I'• tI In .a n , 111 !I Itt n 11, �1 in r1 rl• I I •• In -� F. - o o - - h. X11 111 (i1 n, in IU 11t'1. ( I1 1 I 1 ly I-• f11 t - u r�•((� n I1 rr n I� 1 I• h In 1.1 p, I'I' , t I I••• u'1 U 111 111 �t rr I• I' rn to ,) rn I w. �t h n CI Irl lu ( f7 1 1 1. t� r 1 c) t o I 1; I' t(1 �' fl ,:, n1 , 11 11 I t. (l, (I �� I tf), in rl �1 <i r1 r 1 :.1 {�. ly i'I. [n I1 r It! `11 IIJ r rn I, I n u Ib c7 1 1 n rn u t 1,1 n (li I' • rn l I 1 ft' // I 11� tl 1 111 S, (1 • .. ly , C) I' I 111 (:. ti, 1 '1' 1�• ( +. 1 I •• Ill ill l:- 1 "I I j Ill Il 1, tl I:1 1 I11 rf It , -1 ill t' 1 I I� (1 ICI I'I' , �1 III fl 1..1 1' 1 r \I 1-1 �} L t'1 .. 11 1 1' (n I ( 11I , I tlt 1 •. 'I ' �' �' I I fP I* (n f) 1 • ;.t �.,. (D In /. l• 1••I lu � 1 l 1 !�• It h (l,. ll1 Iii I •�' IU - n Itl IU (I' I11 IU I- ;''II' 111 UI rl1 I'• u r , C) ;:{ tll 1� I �• (, I(I In :3 .. (11 , �, / U 1 t Li l'1 r1 to n ( cl r,• d yy rr I -l. 1(j �; tlt 0 1b to Ili r -I I ' U111.1 In (It In r) t.l 1�• 1, 1�, ,r jIj !7+ •�, tyl IrI IU IU (� 1s ly Iy y I ,.,. t l,t�t Iti Irt {u I� t•1tt1 I'• u1 i� Hl �� n ,;,, P m 11 ul II'; In r 1 u �1 ,., (;' i, u I 111 In 11. r� 1 ,• (:..:. C Iti s 111 rrl 1.1. `,, "1 I. �• G • 1 (I In ( ,J 1 ( � 27 1 u 1'1 I I { 1, 1' • 111 '\ l I �( I:1 fl Ill (') 1 f(i a rl 1 It n ri 't ' n rl 111 , in a -• r, I I,. I! I u. I ' I r r (S l.. C1 lu (_ a fl I•• III N• t11' N r Ir)' i 1 1' 11 t] �T1 „ Irl 1 I •• i't I il, n 111 1'1 III, In I 1 I I 1 111 I..I. 1 • '1 Ilt lI ,J It ; -) mil•• ,� I 111) I, III ,;1 111 , t t'I 11 y I• � l 1� III C] 111 r1 I j 1. tl I Itl , •• t.,• I IIl :I � 1•I 111 d� ,tom I' 1 I' I nt I( , •• I ill n 1-I t) a to f 7 I n - .. lu 1 111 ['t .III I ::1 III I 1 ; , i,l L.• I i ,. I- , II _, „ I n rn .; a 1, I ( i rb ;7 ►:, . I r (t ip r Ci I•. to I uI u I iii f' 1 1 I' 1 I I :.i I '• I ( 111 ri if 1 1 ., , , 11 (�;� ,.... I 1 I1: iI ,l) Ill• •(• (Ut:U t7 If1 I , n 11 t;: III jil R1 1 I'1 fit 11i I, li, ,., rlt Irr 11 Ili, rl ,, -t U IU I:J (i��• 1'I 1 h PII 'I _ t[1 I t ( :' I I Il {ll, , 1 r l 1-I rt L 11; 1-• /, (t, 1..1 ; ,, 1 , ( 11 l�l , I (, 1- • I I 1 l.7 1 -• ` IL ~ , ) I� ,1 (1 ( °• { I•• 111 DI U - 1 ! 17t �•' 1-• 1 i �!� 1 n i t r-1 r, I1 �,. ; i t 1 lt1 I • 11 � I,!. tl �1. l7 (11 cj II; t[i jl 1i� t1. its 111.„ ,I'1 In } n �1 III I( '1.1.111 I 1. jlil iI ('1 111 f j t3 Iv 1'1 IU 111 I ' I'll ill IIl ItI no rr 1fl (1 Il>1 (1t I •• ti ( Ilj C- I!� rn I In n n1 1 . Iitu ri r: lil II. II' nl :: i In nl ' � W j trl !'7 t! h• i= IIt l i,l I r I J RI 11• RI 11 { �r (7 t.i I -• f U I• I. 11 j j i' ;U 111 ,l 111 III 'a h •tl 1-• rl' I ; I 1 (n 1 •• l 7 t-1 In 1' IIl 14 rfl hI 1 :.1 ICI to in (11 .0 rn I -• r fl' I ry ril 1� (... ,.I• r 1 , •p I.,. I p I•,• Il r�i ri yj 11 Irl n �, I-•I 171 f II w 1�I � 1r1 �• 1 ri N <� lam' Ilt n' nn. ±4 to IJ Fit rJ 1' t• 'U II: C,� rJ v l,• , III 1 -. � • n > I ti rrl c• u 11, to ,•1' I. �t� III r1 i 1 i f1i Iii It 11 rl it �l ( 1' t(i{ IU �1 • Iln III In i t1-1 m ly tri fit I•t n In t-, II ly tj,� a Ih (It II I1, 1-� �' �' ' ti1 II'• 1 Ill Ill, �11 I lath 1 (l Ft Ill ���� -- - -- -. T ��\R i, \t `\ I nt to t�1 M M P1 t�l r.t t• ° ►1 rJ (� i m o 1-rt rn rn Iu 11 rn t -t .1 ►-� N I--1 to F-+ U Ic7 1 IU Il ly � IG I1 11 1U ,'. IU la; l- nl 11' (1 n l!I o rD o 0 1 'r, it I I -11 I 1Zt ly it I'• tI In .a n , 111 !I Itt n 11, �1 in r1 rl• I I •• In -� F. - o o - - h. X11 111 (i1 n, in IU 11t'1. ( I1 1 I 1 ly I-• f11 t - u r�•((� n I1 rr n I� 1 I• h In 1.1 p, I'I' , t I I••• u'1 U 111 111 �t rr I• I' rn to ,) rn I w. �t h n CI Irl lu ( f7 1 1 1. t� r 1 c) t o I 1; I' t(1 �' fl ,:, n1 , 11 11 I t. (l, (I �� I tf), in rl �1 <i r1 r 1 :.1 {�. ly i'I. [n I1 r It! `11 IIJ r rn I, I n u Ib c7 1 1 n rn u t 1,1 n (li I' • rn l I 1 ft' // I 11� tl 1 111 S, (1 • .. ly , C) I' I 111 (:. ti, 1 '1' 1�• ( +. 1 I •• Ill ill l:- 1 "I I j Ill Il 1, tl I:1 1 I11 rf It , -1 ill t' 1 I I� (1 ICI I'I' , �1 III fl 1..1 1' 1 r \I 1-1 �} L t'1 .. 11 1 1' (n I ( 11I , I tlt 1 •. 'I ' �' �' I I fP I* (n f) 1 • ;.t �.,. (D In /. l• 1••I lu � 1 l 1 !�• It h (l,. ll1 Iii I •�' IU - n Itl IU (I' I11 IU I- ;''II' 111 UI rl1 I'• u r , C) ;:{ tll 1� I �• (, I(I In :3 .. (11 , �, / U 1 t Li l'1 r1 to n ( cl r,• d yy rr I -l. 1(j �; tlt 0 1b to Ili r -I I ' U111.1 In (It In r) t.l 1�• 1, 1�, ,r jIj !7+ •�, tyl IrI IU IU (� 1s ly Iy y I ,.,. t l,t�t Iti Irt {u I� t•1tt1 I'• u1 i� Hl �� n ,;,, P m 11 ul II'; In r 1 u �1 ,., (;' i, u I 111 In 11. r� 1 ,• (:..:. C Iti s 111 rrl 1.1. `,, "1 I. �• G • 1 (I In ( ,J 1 ( � 27 1 u 1'1 I I { 1, 1' • 111 '\ l I �( I:1 fl Ill (') 1 f(i a rl 1 It n ri 't ' n rl 111 , in a -• r, I I,. I! I u. I ' I r r (S l.. C1 lu (_ a fl I•• III N• t11' N r Ir)' i 1 1' 11 t] �T1 „ Irl 1 I •• i't I il, n 111 1'1 III, In I 1 I I 1 111 I..I. 1 • '1 Ilt lI ,J It ; -) mil•• ,� I 111) I, III ,;1 111 , t t'I 11 y I• � l 1� III C] 111 r1 I j 1. tl I Itl , •• t.,• I IIl :I � 1•I 111 d� ,tom I' 1 I' I nt I( , •• I ill n 1-I t) a to f 7 I n - .. lu 1 111 ['t .III I ::1 III I 1 ; , i,l L.• I i ,. I- , II _, „ I n rn .; a 1, I ( i rb ;7 ►:, . I r (t ip r Ci I•. to I uI u I iii f' 1 1 I' 1 I I :.i I '• I ( 111 ri if 1 1 ., , , 11 (�;� ,.... I 1 I1: iI ,l) Ill• •(• (Ut:U t7 If1 I , n 11 t;: III jil R1 1 I'1 fit 11i I, li, ,., rlt Irr 11 Ili, rl ,, -t U IU I:J (i��• 1'I 1 h PII 'I _ t[1 I t ( :' I I Il {ll, , 1 r l 1-I rt L 11; 1-• /, (t, 1..1 ; ,, 1 , ( 11 l�l , I (, 1- • I I 1 l.7 1 -• ` IL ~ , ) I� ,1 (1 ( °• { I•• 111 DI U - 1 ! 17t �•' 1-• 1 i �!� 1 n i t r-1 r, I1 �,. ; i t 1 lt1 I • 11 � I,!. tl �1. l7 (11 cj II; t[i jl 1i� t1. its 111.„ ,I'1 In } n �1 III I( '1.1.111 I 1. jlil iI ('1 111 f j t3 Iv 1'1 IU 111 I ' I'll ill IIl ItI no rr 1fl (1 Il>1 (1t I •• ti ( Ilj C- I!� rn I In n n1 1 . Iitu ri r: lil II. II' nl :: i In nl ' � W j trl !'7 t! h• i= IIt l i,l I r I J RI 11• RI 11 { �r (7 t.i I -• f U I• I. 11 j j i' ;U 111 ,l 111 III 'a h •tl 1-• rl' I ; I 1 (n 1 •• l 7 t-1 In 1' IIl 14 rfl hI 1 :.1 ICI to in (11 .0 rn I -• r fl' I ry ril 1� (... ,.I• r 1 , •p I.,. I p I•,• Il r�i ri yj 11 Irl n �, I-•I 171 f II w 1�I � 1r1 �• 1 ri N <� lam' Ilt n' nn. ±4 to IJ Fit rJ 1' t• 'U II: C,� rJ 3 PUTNAM COUNTY DEPARTMENT OF HEALTH Date p A(9 /9' -GJ Re: Property ofl/Y� Located at (T) Section /9 Block / Lot S/ Subdivision of 3CYe D 0"?t '� V`Iez� cloS/'-vtiroS Subdv. Lot Filed Map 05 *4- ?46 '5/i Date c9 -10 -S' Gentlemen: This letter is to authorize a duly licensed professional engineer X 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 connection. with. .. this:: ma t:e:r� :�rid.::to :s.up -.,, V sP the . co-nstriactkop._.�f..5 -a.:!.d,�� system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. QF NEw Y� P ,�1• NfClyp �� �� c d <-,. f 6tnk3 &V �I =II Very Sign Countersigne '�QFESSIONP P.E., R.A., # 73 Fairfield Drive Address Patterson, N.Y. 12563 914 - 278 -6108 Telephone of Proper,-,, Town Telephone Putnam County Department of Health jDivision of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION • � ^ - FOR PERMIT. APPLICATION SUBM?TTED- TO > ... PU!rNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for ' I, _ DAV I ©_ GtbCGo��tiJY (_ _ _ _ _ ` _ 7 _ _ , represent. that .I am an offi er or em loyee of the corporation and am - authorized' to act for. _ _ �P�(_L�V�_ -�_ M k 21L�T �5�'A -rq _ _ (name of corporation) r 1 having offices at _�?.T Y S(MPSdnJ_ ROA.p_ _f?D. 6o�c.�7 7o ` e-- A 9Arr L. � _N'" _ _ O.S[ Z _ _ _ _ _ — _ Whose officers-are President _�-� 1,._ ( fame an Kddress)_ — ' Vice- President �Av��.v� OC -4--c Ad a� = — (Name and dress) — Secreitary _ _ ` O� CL 0 C C-ID G�. (A --------- (Name and Address) --- - — Treasurer ' -- — — _ -- - — _ - X42 se _ -- - - -- — — - -- and Address) and that I= am-and• will be' individually' responsible fo�n any or all aetp, of.the- corporation with respect to the approval equested and - all.sub- ( . sequent acts. relating - thereto. . Sworn to liefore me this 'xday Signe of 19 Title Notary, Public- ,. EDWARD J. CRFSCFMTA Notary Pbblic. sw- r. tier, Yo- • QLallft� in Putnam Ccun;y 7 Grin A AMS )*we" 30. • Corporate Seal =: 1 1 . Specifications Capacities Heads Solids NPT Motor _ _ Controls � Construction 45_gpm 21 feet 518 -inch 1- 1 14•inch 114 Auto or Man Cast iron or Bronze' 'Pump case, motor cap, support foot and baffle are cast bronze 85 -5 -5 -5 metal on bronze pumps. Shaft is stainless, steel. Lifting handle and-outside,assembty °screws 18.8 stainless steel on both cast iron and bronze models. Trouble -free ®In1enSIOnS Diaphragm Switch Diaphragm type pressure op- erated level switch sealed into watertight housing. - Switch diaphragm is isolated by oil ' retained by a second dia- phragm. Solids cannot affect, ; switch operation, and switch will continue to operate even if exposed diaphragm is punc- tured' —an exclusive HYDROMATIC feature. Standard switch setting is 8 inches but can be furnished special for levels to 30 inches. 4„ 4x Power Cord: Automatic model (SP25A) furnished with � vented power cable with molded plug in 10 -foot. length as standard. Other lengths available. Manual models furnished without plugs. 4sa 0 1% sm. PIPE Performance h W W LL 2 O Q W 3: Q O F I 1 SP2S.- MAX S!0L! V'S .5!p "SP-NEF,Z t:,r -,a RPM iiniiiiiiii MENOMINEE OEM No OEM XENON 00 FULL LOAD OEM No—AMPS AT I 15V. MEMEME "M 0 10 20 30 40 50 U.S. GALLONS PER MINUTE Bulletin 110.2 New 4/84; Supersedes 210.1 LITHO IN U.S.A. 60 NOTE: CASTING DIM- MAY VARY ;1/8" Distributed by: A1AaLEY THE MARLEY PUMP COMPANY ' ns �;;� HYDROMATIC PUMPS so. 317, AsNand. ONO 44WS 14191189-042 to Canada — V4 4n Canada Ltd ltee, 126 East d •&amPton, Ordaw L6T iC2 tme.nat.onat Saks — Asntand. ONo Tetra 987432 MODEL: ; SOLIDS .. ■ ■ ■ ■ ■ ■ ■t ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■t ■■ ■. c '] HEAO ■ ■ttt ■tt ■ ■ ■ ■ ■tttt ■ ■ ■ ■ ■■ • • - - ■������ st.t.ts.■tettt■tt.t■■■■ ■■■t■■�■ ■ ■n ■ ■ ■tt ■ ■ ■ ■ ■tt ■ ■ ■ ■tt ■t ■t. ■■ ■ ■t ■tt ■t ■■ IN FT_ ■■.■■ tt■■ ■■■■tt■tt■t■ttttt■■■tt■t■.t■■t■ 1 te� f? ■■■ ■■tom■►. ■■■■■■■■ ■■� 14 moommommom ........C... .. u ... �... t .V .......... ■■un.�t■u■ �ttttttt ■ ■ti ■ttttt.�ttttt�at■ttt■■■ti ■■ttt■.�■■nut�uttttt■� t■tttt.�tttttt.l�itttH ■ ■1 ' ■ ■� ■ ■i��NHtt ■ ■►1 ■■tt ■ ■ ■1 u t1.�tt■t ■tttt \ ■ttt ■tl ' t ■ttN.�Nn ■ ■ ■tt►� • • . ■■ut■.uNn■■ ■t■■ ■tu■■■'u■■■■■tt■ 0 10 20 30 40 50 60 1-7 Ifrv+ U.S. GALLONS PER MINUTE MODEL: SP.25A �._.�.._ �.. >� :... a._........ .. �7 41/e 4V4 61/4 4% O 1'/4 STO. PIPE 534 1 7' /a t _� ��'� • 61/4 NOTE: CASTING DIMS. MAY VARY =' /a tO WIZ k'O, 14 S.P25 _Submdrsible' Pump. fqt.,.�'I Residential and .Industrial Sump and Effluent Service HYDROMATIC : PUMPS A Maday Pump Company' Feattire S: Outstandinc i I 011-filled ball bearing motor provides life,-.Ipng'_ " j i single phase. 1750 rpm with built-in automatic reset overload protection. 2. Exclusive single rotor and shaft aresupported by one long bronze sleeve bearing, lubricated for life with oil in motor. Applications 3. Non-clog cast iron impeller, threaded to steel .shaft, allows all ordinary sump deposits, includ- •Septic tank effluent ing washing machine lint, to be pumped without eFlood control units binding. No suction screens to clean. oAir conditioning condensate 4. Mechanical shaft seat, carbon and ceramic faced. aindustrial circulators super lapped for perfect sealing. Buna N rubber. *Transfer tanks brass and stainless steel used in seat parts. eBasement sumps ,Elevator pits 5. Choice of cast iron or bronze construction. eWater coolers 6. Designed for field serviceability. Motor stator winding, mechanical seal, or level control switch can be replaced quickly without the use of spe- cial tools. 7. Each unit given a complete operating test before shipment to assure exacting specifications will , be met. ,,.•;:.:.:..:.. Jtmm CXXJNIY DEPAIMIMNT . of BEI. .OF:- HEALTH •SERVICES.'. - * DESIGN t i'ATA - SHEE�SUBSOFACE S gN3E:-V1SPOSA.L' SYSTkti r :FILE NO Y- 1 Located -at•-tStreet) ~_ A p . Sec. ^_� Bloc3c Lot e (indices - nearest cross street) Municipality To to N OP P a-t-t r't _1Zo N Watershed Som CO=CIN %TEST, DATA RDQOIRED TO I3E SUBMI = W= APPLICATIONS _Date' of Pre - Soaking 5¢l S d Y ~ Date of Percolation yTest S`I HOLD, NdiaER -.... C1= TIME Run IElapse Depth to Water From Water Level . • r': Nd.- - !Min. Ground Surface In -Inches - •.-- - --._• _:..:Soil Rate. -:- t Star Stop ,Min. Start Stop Drop In Min/In Dr .. _ ...... ... .,.. .. .. .. .. ..... 1 .ii:� �: ...:. inches ..:.. • � . _ • . Inches •-_Inches - •- . _ .._ _ , .. - NOIES: 1. Tests to be• repeated at sam depth until. approximatiely equal soil rates are obtained .at each percolation test hole. All data to' be subni.ttkd for review. ' 2. Depth measurements to be pie fran top of hole. rev. 9/85 ej- AL 3 lo�3r — Ir;o ;32. �¢..... Z -z �5 3 11 30 1 5 5 35 2431 3 (W30 -- IV, 0 0 30 2 2-4- �L 4 _ 5 ' i1J I T L K 4i k rC i3 o G 21 (88 r NOIES: 1. Tests to be• repeated at sam depth until. approximatiely equal soil rates are obtained .at each percolation test hole. All data to' be subni.ttkd for review. ' 2. Depth measurements to be pie fran top of hole. rev. 9/85 TEST Pr; SQB�LCTgD*.-R APPLICATION 'FERED IN 171' E -EOLS- DESCRIPTION.:OF SOILS 'COON DEPTH HOLE NO.'- HOLE., NO... "....HOLE Nb. G. No. of BedroaTs Septic Tank Capacity - 1, Z)p,2 gals. Type -Coyor-- Absorption. Area Provided By L.F. x •24" width trench Other -7 D6rvo C)() a-CA-I.Ai MIT Name LAoP-o4-r PC- Signature I')- jlkPl 1� 4-11 E-19t,P D21 v ,- SML- 4SL -Address 73 ff A-1 r L 'M m) IS66,3 Tf 0 Ir CE zz� THIS SPACE FOR USE BY HEALTH DEPARIMENZ MY: Soil Rate Approved sq.f•gal. Checked by*. Date s o. 1, 21 3 t 41 A -7. GI 71 8 91 CI 10, No. of BedroaTs Septic Tank Capacity - 1, Z)p,2 gals. Type -Coyor-- Absorption. Area Provided By L.F. x •24" width trench Other -7 D6rvo C)() a-CA-I.Ai MIT Name LAoP-o4-r PC- Signature I')- jlkPl 1� 4-11 E-19t,P D21 v ,- SML- 4SL -Address 73 ff A-1 r L 'M m) IS66,3 Tf 0 Ir CE zz� THIS SPACE FOR USE BY HEALTH DEPARIMENZ MY: Soil Rate Approved sq.f•gal. Checked by*. Date s o. 1, N -7. IVT No. of BedroaTs Septic Tank Capacity - 1, Z)p,2 gals. Type -Coyor-- Absorption. Area Provided By L.F. x •24" width trench Other -7 D6rvo C)() a-CA-I.Ai MIT Name LAoP-o4-r PC- Signature I')- jlkPl 1� 4-11 E-19t,P D21 v ,- SML- 4SL -Address 73 ff A-1 r L 'M m) IS66,3 Tf 0 Ir CE zz� THIS SPACE FOR USE BY HEALTH DEPARIMENZ MY: Soil Rate Approved sq.f•gal. Checked by*. Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at, Am P> (T)� Section Block Lot Subdivision of..1�ON'� Subdv. Lot # Filed Map t . MP '54'Z40�A Date 4 1,0-61 Gentlemen: This letter is to authorizeI��Y 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 connection with this matter,-.and to supervise. the construction of said - sy stem •er systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign P.E., �., h� Address - r--� Jr ' ;r No. 56124 e ze f n 8 Telephone Very truly yours, Signed Own- er of Property Address Town Te ephone tt« DROPS t ■IIIIII All IRAN InIIIIII®Ia Ago AI I Ian amago an INaA sit a ago ' 2112111a all AaAnRINI AIR AHKABINAMAK IN 1111.111 SRI Affordable 1'erief TWO Stor' 2740 CONTINENTAL III 1ST FLOOR 1000 SQ.FT. 2740 CONTINENTAL III 2ND FLOOR 1060 SQ.FT. 0- v [Ut DIPS ,f IIIII AIR III IIIIIIAIAIAaAIAIIIIIII IRAN Ill IN Ill 1IIICIA212 1l 31SIRIRABIARNEARRIRAIRRRAIAQAALAEIRI ERIII9 Affordable � "erief Two Story f 00 CLO DINING ROOM KITCHEN O U.UNDRY BATH 97 PAN t CLO 2740 CONTINENTAL III 1ST FLOOR 1080 SQ.FT. 2740 CONTINENTAL III 2ND FLOOR 1080 SQ.FT. LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 (914) 278-6108-(FAX) 278-2658 HARkY W.NIGHOLS, J4., P RANDOLPH W. LAURENT, PE. mff��w ry q��a T CONSULIN . G SITE . ENGINEERS PE. ' October 5, 1993 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Ice Pond View Estates - Lot #3 Renewal and Name Change Andrea Place Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS-3 "Proposed SSDS Lot #3"q .dated 10-5-93. 2. "Application For Approval of Plans For a Wastewater Disposal system". 3. "Construction Permit for Sewage Disposal System", dated 10-5-93. 4. "Application to Construct a Water Well". dated 10-5-93. 5. "Design Data Sheet". 6. "Letter of Authorization", dated 10-3-93. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". We have changed the SSDS to a conventional trench system for three (3) bedrooms. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nicols, Jr., P.E. HWN-.bd 8685-3 enc. cc: Mr. & Mrs. Donnelly w/enc. PUTNAM C OUNTY D E PARTMEN T O F H EA L TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: 3.._. Lo ion TN /C: �q AleAge-j-\- 4. Project Engineer: 47Gli1- �16 - ac% �/S ��' S. Address: Fz?irl,"dd Z�-, License Number: Phone: 9 _&/ 6. N Private/Residential of Pro ect: Food Service _.Commercial , Apartments Institutional Mobile Home'Park Office Building, Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) . Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. A)O 9. Has DEIS been completed and found acceptable by Lead Agency? ........... A)14 10. Name of Lead Agency A)11" _ �t •i.,...T.v.�th•is- ��3jQ� ±..i.�. a�...ar- Qa- urde•r she - cor„- ro ►..of- iv�^.ai 'j�tl4iii�iir�j`- ,....2a7iiiy; __ :.. __ .. _ -. .. -.. or other officials, ordinances? ......... ............................... /) 0 12. If so, have plans been submitted to such authorities? .................. A)A 13. Has preliminary approval been granted by such authorities ? A4 Date Granted: 14. Type of Sewage Disposal_ System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ A)1�' 16. Waters index number (surface) ........... ............................... Dt1l� 17. Is project located near a public water supply system? .................. 4) (9 18. If yes, name of water supply A)A Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... A) U 20. Name of sewage system AM .. Distance to sewage system 21. Date observed: a7 23. Name of Health Inspector: 24. Project design flow (gallons per day) ...... ............................... SD Z 2. J•c:. r. . : °S 1-1t ! i,t -Vi._tCharga 7 ' ..i s . .n .'o t10 S.Pyrr.3 : n .�: y. J d4 n ... ..:2 . .GY'v�4 t•FV "P V�.-t:.:-tJ a: .. .... .. ''1 "n. ,�:3 �.:v -'J'3'�J'l. i..iTi` �J c; c:.'j� •rc�'1•t -". -� ij f'1 'i: �i.. [i ✓,t�. . -..._, .. .. _._._� 26. Has SPDES Application been submitted to local DEC Office? ............... N% 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... A)0 28. Wetland ID Number ....................................................... A)lg 29. Is Wetland Permit` required?............................................... I A)o Has application been made to Town or Local DEC Office? .................. A)A 30. Does project require a DEC Stream Disturbance Permit? ................... A)O 31. Is or was project site used for agricultural activity involving application of pesticide$_ to orchards or other crops, solid or hazardous waste disposal' landfilling, sludge application or industrial activity? ........ YES or NO No 32. Is project located within 1,000 feet of existence of.abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... `DES 34. Are community water, sewer facilities planned to be developed within 15 years? ADO - -3::. -:.r_ any...:..w3ge •'d . s,..:.,..1 -a: i`•3� �.. ::Y...e:.a °..: 1..90 � f..rG ................. -..... - - ' ' - >.�.- - - ._ ._ ti 36. Tax Map ID Number 37. Approved Plans are to be returned to: ......... ..... Applicant 'En gi nee r`s rf 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: Failure to comply with this;" provision may be grounds for the rejection of any submission._; -` Ui I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 7 DESIGN ' tM -S -SUtSMCE *S&gAM °DTSPOSAL SYSTlM Ar3dreSS Located -at Street " � - -f : 2 yj_ Sec.: - _-Block- Lot Zg -- (indicate nearest cross street) - �(l o -r 4-3) . - MmiciPa1•itY — w'N OP., PA77 ri-rZ so,� watershed GYLo(o tJ SOIL, PF12O0mmm `TEST DATA --P )0U= 2U " 3E su&mr 1ED WITH APPIICATIO(�IS { _Date of Pre - Soaking.~ 4' 5- . s: �'$ $ Date of Percolation Test •.� l�!' SB ROLE .. _ _.• - PEi2CQLATION Run l Elapse Depth to Water - rom Water Level ; iIo: - i Time' Ground Surface In Inches ____....:_:Soil Rate' . Start-Stop r Min. 3 - 1.67- . ........ Start Stop ' -- :....:..:- Drop In Min,/In Drop - :03 2 Inches ruches Inches - ' -- - •---- - -. -.. - 3 l(;30 — (2:0 0 ; 30 2 Z4i. 6th 2 jO:0o -•- (o :30 :30 2�6' .. —VA _3.!� ........ ...... S 'WI T4 4 -F-SS Ch tax M r, L K-6-IL 10G 40 14 Co '2_(106 r 4.... .. _... - #�� 2 (o .S - I(.. Zg 2 8 �. 3 . II :30 - I2 o `Z+i� %Z 1pO 4 - 5 'iE 1 q;�{Z -Io:4L �o z 25 13% 35 :03 2 los42 - t(: 11 ; 4S 2 4- 2�-3 - 3 l(;30 — (2:0 0 ; 30 2 Z4i. 6th S 'WI T4 4 -F-SS Ch tax M r, L K-6-IL 10G 40 14 Co '2_(106 r NOTES: 1. Tests to be repeated: at sam depth until approximately equal soil rates are obtained at each percolation test mole. All data to' be s-ubmittbd for review. ' 2. Depth neasurements to be made Fran top of hole. TEST P �'A RDC2DIItID `.'TO 13E SUBMITTED :R . APPISCATION DESCRIPTION OF SOUS ENCOUNTERED IN: TEST -HODS • ° J-JEPM HOLE NO, ` I 49tiROLE � l`N,. � . r . .. HWJL'/ No. v .ti ... .a n -c _....<�)•.'.•5..:i +iw 1M"_'L•. _.tiruw.w+c -•� �.: r.. M. - �i ��•.._., ,..... .a. . c_�. -.-.. .. ...__ .y.. .. "."L"- _:.1�.•. .u._.._ _..•..a_..r.,.- G.L. ro pso r t. TL sr� 2' -`. .. �:.F:�. .1: • :'= 1��.�•r:G1y.1W \t..�.i• ....�Jr•.!- �i}:.li.. t 39 • t. :3S! t -t. i.:: '.i ✓.e/ -j•'y U y t'-r.. i :li � ..f •./.f..� y.i!.�.� .. N .: , r 49 :1 •:�.♦ sh !' f• �Y .'. ,M�� li. �4:. \rI WS�/�-f t JN.. i..1.i. 10, •2i 3-3' 149 , mm-IC am i •ram- C•u-av0v..t°"v�"�'i2' I.S' 0'- =. `- �- C�' °. _. .. .- - -.• , , _...._ -.. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING i33JOO T RID i 0 DEEP HOLE OBSERVATIONS MADE BY: LML V-le� P G. ID, 0! 14. bATE: 5 2 h5 g DESIGN Soil Rate Used o' Min/j° Drop: 0,45' S.D. Usable -Area Provided • No. of Bedrooms Septic Tank Capacity - l25-V gals. Type -CeAtC Absorption Area Provided By . 0 L.F. x•24" width trench Other CAJ OC -1 N v 0 A i (0 IUI? Q10 Name. I,AUP -"-r 9 (- gtAJ6l2lN6a AS4oc P (!C. Signature Address 73 ri4.1 m F/ 9LP D 21 WE SEAL. THIS SPACE FOR USE BY HEALTH DEPAREMU ONLY: Soil Rate Approved sq.fVgal. Checked by Date AS- 8U /L T DIMENSION CHART Il/NfTf N-° A B / 49.0 35.0 No B C 2 51.0 85.5 3 495 62.5 4 49.0 79.0 5 49.5 76.0 6 50.5 73.0 7 52.0 7/.O 8 54.5 99.0 9 58.0 68.5 l0 61.5 68.0 l/ 66.0 68.0 l2 24.5 670 13 22.0 62.5 14 2l. 5 58.0 22.5 54.0 16 23.0 49.0 17 25.0 44.0 18 29.0 39.0 19 34.0 34.0 20 39.0 320 21 86.0 //6.0 22 870 115.0 23 870 //3.0 24 870 / / /.0 25 875 /10.5 26 88.5 //O.0 27 9/.0 /09.0 28 'i4:0 /09.0 29 93.0 106.5 30 99.0 / /0.O x41 ti �I i� ti t 1 A -e 4 x Y/ ,�1 �, ,� IL A., L 71 0,7T 1. 171`vvlrrry woe 12A1A -fAv-etj p Imr, wj r ^4 -1,14-1 MAT' 4 flitrP 91J 4 "le-^L 17AfA, 'f^re-W freM ftrVEY 14. 0,A*rC7 C / EXISTINC> GRADE PF-IOFI 5190T Gf-AD rlk2r DRAIN 4 FOOTING rii'KC. TEST LOCATI, i6T PIT LOCATION weli- r—�-M -'5v5 -R,IJE� PROPOSED SSD CL'EN, 'bHAL% 1, � NOM VO 40 CA,LIRENT- ' ENGINE ASSOCIATES. I 73 FAIRFIELD DRI PATTERSON. NEW YORK 914.278.6108 CONSULTING SITE EN( DRAW,11,:..". PROPOSED SSD S: SCALE DATE 9 I tl_ DRAWN BY - V-T CHECKED BY.FlWtj J08 No t6t DRAWING No S: VERMIN. flKlwr SANITAKY WELL CAP CONDUi FOR ELIECTNIC CABLE -FINISH GRADE -- L- �1 11 IL, . IT OI A .z &KAcr- < CONCRETE SEAL O Z TPMFVF •AMY CASING - MAY U WITHDRAWN AS Gt'.;IU7 15 PLAGr-D L11"I OVf F'IF6 t"AKeK F'ITL,51,5 UNIT 2'01CCHARGe LINE GREC'< VALVE DRIVE SHOE WELL CA51MG ALLORi 5VFFiCIVNT CLEARANCE Fok" (;,KOt)j. q OVERFILL FOR SeTTL-esAMNIT I F,Ntt5HeP I-OLAPE: C,L,C-.4kN FILL rAmeIc. riL.YeK 4`0 f19KrO?_A're0 PIPE Ime! r-r-u6"50 5TOmr-_ OR WASHED C+R-AVP-L- P PIPE AP ENO YW/FT �_-F S LATERAL %bf,'145TAL- TRENCHES 14 WLT 501U. RAKE �"r? w"\ 5 - I 5 VIA. KWA-KOUT 7 GLEANOUT II BOTTOM OF TK6Nr_P PRIOR III n III TO VGI.. 6R05 OF ALL t2IST,,¢IE)UT0F_- 1 ilk III .'x 9, 1 Imsfer-710 RrINF�9 C.N64 COVER 5'01A. XKOUT SU13M•R51CLe PUMP 5.Alt- •., ,. - TYPi be-A1350RPTIOW TF,04tK 'TO SCALE NOT TO 5CAL_E rK w"\ 5 - I 5 VIA. KWA-KOUT 7 GLEANOUT II Covelz III n III 1 ilk III .'x 9, 1 Imsfer-710 RrINF�9 C.N64 COVER 5'01A. XKOUT I.-.),x 14, 1 A156OKPILoN SECTION �A-A Wsper'nom TRENCH cover— -PLAN JUNCTION BOX DETAIL- rrouND--) LOCATION 5TA K r, NOT TO 56ALe• I'TAF'f I? D Y MMKOUT LA. ov 7- JUNCTION Dox ON 1 WVADLe COVEF_ •., ,. - LATERAL Z,MIN. TGHTjOINT _—V Yr.) OLITI`Lovv 60KC:FOOTING M, 1 TO I.-.),x 14, 1 A156OKPILoN SECTION �A-A Wsper'nom TRENCH cover— -PLAN JUNCTION BOX DETAIL- rrouND--) LOCATION 5TA K r, NOT TO 56ALe• I'TAF'f I? D Y MMKOUT LA. ov 7-