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HomeMy WebLinkAbout1769DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -108 BOX 16 01769 A 1 ' .i dr 4 A. .;, Ir 1.41 Loy 01769 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES WELL COMPLETION REPORT Well Location - -. Street Address: :, _.. Town/Village: = .Tax.Grid.. #.- - •.: - - Map -Block Lot(s).. Well Owner: Name: Address: Use of Well: 1- primary 2- secondary _y Residential Public Supply" Air cond /heat pump Irrigati n Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length ft. Length below grade �ft. Diameter _�in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: 'c Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed Pumped Compressed Air Hours _ Yield _�5 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. 1W 1 Depth From Surface Water Bearing Well . Diametcr(in) Formation Description ft. ft. Land surface L — - -) 7 i c7 r •. CD CD If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type <'•. Capacity Depth Model �h�5��a Voltage HP Tank Type4+uGOJ Volume i B �j } ' %o W Date Well Comp eted Putnam County Certification No. Date of Re ort Well Driller ( ature) NOTE:- Exat;t location of well with distances to at least two permanent landmarks to be provided oyt1a !(Oftat6 sheetlean. `,� ��y�.41� jl%ir- ',/tip -Ce, �,�L� /"� ��O� / Well Driller's Nam 61:%A_ -� x//17 Address: �A ,C% 'L., k2 Signature: White copy: Date: File; Yellow copy - Building Inspector; Pink copy - Owne(; copy - Well driller Form WC -97 _ -- -� iA 2006 -01 -24 15:51 BRUCE It- FOI.Y 8452792332 DEPARTMENT . OF IVALTH i Cftm Road Bmw, ow, Ng► York lose wM P (/11 LORETTA MOUNARi• 132. MS.W. VIFWW of pd&W SVv(eira 1E WIk (994)278.6UQ FOV.IQ M- 7% 1 Hadma fie® QIg2U -058 VIP. (914)278.608 ,FU 014) 378 - 6:1164 >la" kkne®11a 014)1".6014 Ynselod (914)172401sa 1w (914)278 - GW lu Putnam Cry Dement of Heath will not !same a Certificate of Construe don Compriance unless the above form is completed, l.e., a legal E911 address is assigned by an aulberized tom offs iaL 'This form is to be submitted with the appUmdm for a Cerfficate of Consftuction CempUme: (s911j/ELFY K AM COUNTY DEPARTMENT OF HEAL X OF ENVIRONMENTAL HEALTH SERVICE.,. _` CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # F-0'3 -D 5 Located at Kp� A I L LA t� F_ Town or Village PA--TE R5C2N Owner /Applicant Name "AA m HoMC� 1�K� Tax Map Block 4 Lot Formerly NIA Subdivision Name �� d2SQ 2 W DQr1S Subd. Lot # Z I Mailing Address l a" &lrp, _31Z�5)ITE 30I A b2 EWSTT_E P= Zip f�0� Date Construction Permit Issued by PCHD 11 WrSeparate Sewerage System built by It4ddress 124 P-TE 22 PAW LI tk �� 1 Z56* Consisting of ZOO Gallon Septic Tank and Dd L, p 1 A A Other Requirements: 6) -1 9.0 13 F 1 LL Fo D1 PU 12 jqSJ Water Supply: Public Supply From Address or: >< Private Supply Drilled by b-,r c)AI?re-51AiJ LL Address [05 +- V-i I; 5ZCAe WIE L �. c� ►J.Y. I o512 Building Type(A�- 1=A .JE,'7'J2E as. erosion. control boon completed? Number of Bedrooms SUPHas garbage grinder been installed? NO I certify that the system(s), as listed, serving the above remi. built plans (copies of which are attached), in acco tfi Tans and the standards, rules and re u io ,ie'Putriarri't P g Date: 17 1 O(o Certified by Y i Address were constructed essentially as shown on the as- ,issued PCHD Construction Permit and approved Department of Health. P.E. R.A. License # Q �L 4:fl t4�3 Any person occupying premises served by the ab &y;t) 1 promptly take such action as may be necessary to secure the correction of any unsanitary conditions r g from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat'on, modificationpr change is necessary. r By: Title. Date: v White copy - HD Fi e; Yell opy - Building Inspector; Pink copy - Own r Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WAIL : - -- -Street Address­_- - . - TownNillage::.- --.. -- .:,, n Tax Grid # Map -j Block If Lots) Well Owner: Name: Address: �QiQq Use of Well: b- primary 2- secondary Residential Public 9upply Air cond/heat pump Irrigati n Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion __X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Screen Details Total length ft. Length below grade Diameter _in. Weight per foot lb/ft. Diameter (in) Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: Cement grout — Bentonite Other Drive shoe: Yes No Liner: Yes No Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours Yield � gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface L. / If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ,�, Pump Types Capacity Depth Mode ll– ��'ll�� /a Voltage HP Tank Type r Volume Ab'4410w k /ogpe =Well eted Putnam County erti ication No. Date o Re ort Well Dri ler ( afore) NOTE: Exa t location of well with distances to at least two petmanen lan arks to be provide o a driat6s sheet/ an. j Well Drille Signature: White copy: Address: Date: 7 l File; Yellow copy - Building Inspector; Pink copy - Owne ; 56 ty'&Iler Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DPVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Yl j a " H o 4- 1 Off') Owner or Purchaser of Building Tax Map Block Lot Ow14-ep, PATTE2SC*j Building constructed by TownNillage Location -': Street Subdivision Name N r,-eAi j IL`((I Building �ype Subdivision Lot # I represe t that I am wholly and completely responsible for the location, workmanship, material, construetipn and drainage of the sewage treatments stem serving the above - described property, and that is hash been constructed as shown on the approved plan or approved amendment thereto, and in accordande 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 tieatment system, or any repairs made by me to such system, except where the failure to operate ptoperly is caused by the willful or negligent act of the occupant of the building utilizing the system. The and rsigned further agrees to accept as" conclusive the d`eteriniiiaf on 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. the system. Day j-:l Year O(o Signature: ever 1 Contractor (Owner) - Signature Corporation Name (if corporation) Address � V-rt 3fz 0 rf- kfo' State i ydf e Zip / 0 f 6r q Title: Reg)( LAM y &,PSGAA1a Corporation Name (if corporation) Address: j) Y &rf 22 PAWI.�ab State NOV We Zip 845 - 878 -off 1 Form GS -97 RALPH G. MASTROMONACO, P.E., P.C, Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 . - (9) 4) 273.74.762. _, _ (9.14) 271 -2820. Fax ._ . Mr. Robert Morris, P.E. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: SSTS AS -built for Wyndham Homes, Inc. 64 Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 108 - R.S. Lot 21) Dear Robert: Please find enclosed the following materials: January 19, 2006 Via UPS 1. Five (5) signed and sealed copies of the drawing entitled SSTS As -Built Plan R.S. Lot 21 of Deer Wood Subdivision (Map 35, Block 4, Lot 108) Prepared for Wyndham Homes Inc., Located at Quail Lane, Town of Patterson, NY, dated January 17, 2006 2. Four (4) signed and sealed copies of the Certificate of Construction Compliance dated January 17, 2006 3. Four (4) signed copies of the Well Completion Report dated January 12, 2006 4. Three (3) signed copy of the Guarantee of Subsurface Sewage Treatment System dated January 17, 2006 5. One (1) copy of the Well Water Analysis - 6. One (1) copy of the New York Board of Fire Underwriters Certificate for the septic pump and alarm We are requesting your review and approval of the completed works. Please call me if you have any questions. G. Mastromonaco RGM /jl Enclosures Cc: Joe Darnell � 8452792 WM PAS Z%5 n5 1 nn '3�,a m E1_EC7RIC INC Zq`2i05 �OYI� 16: �I" � `203 ?300318 — — BY THIS CERTIF.ICA'` t ''oj :ib6MPL1A WdE' THE - .. BUREAU OF ELECTRICITY 40 FUL.TON STAEEi — NEW YORK, NY 10038' CI= RTIF1Er? THAT Upon the'applicatiafi of KEELER ELECTRIC 4 51 •GRASSY PLAIN STREET G1 BETHEL; M Mi, ' Located at 64 QuAiL LN,BREWtTER, NY 40809 upon premises owned by WYNDHAM 440MES • 8tOLLJwwoob Dk BREWSTER, NY '10559 Application Number: 2079738 Certificate Numbers . 209738 Lor LOT, Section: 35 Block: 4 -108 R,5►Lot: - 21 Building Permlt:1597 -05 SDC: W164 • Destribed as a Residential occupancir, wherein the premises electrical system consisting or, i eledtrical-devices and wiring, described- bel6W. Iocated in /on the premises at: B Chrtside, . A. vlaual inspection -of the premises el eLdcal system, limited to •electrical devices and wiring* to the extent detailed herein,' was conducted In adcordance with the requirements of 'the . applicable , node and/or standard piumulgated by the 3fate of New Ybrk, Department of State Code Enforcement. and Administration, or other 8uth6tjiy having•jurisdictioh, and found f s be in compliance3)ierewith on the 29th Day cf Rovember, 2005. = R& 9Mk 1= • 1Vllfsceltancoos __ SEPTIC 2'ANRPUMS Abrm acid Emergency Equipment PaaN 9oerd 1 0 SEPTIC Alarm A.ppuaates and Acca9eories Pump ltitoior 2 0 SEPTIC Waling and tlevaires Motor CDMM1 Cciaftr I O SEPTIC Special l Of 1 cerhfit�t locaon incicared. e may nobe aeren any" and ismalidated only bthe pmence of a raised seaft The YML ENVIRONMENTAL SERVICES, 321 Kear Street _Yorktown Heights, `50.1105q8 '1 (914) 245-2800 Albert H. Padovani, Director LAB #: 1.600174 CLIENT #: 57197 NON STAT PROC PAGE: I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLlNWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 SAMPLING SITEu 64 QUAIL LANE : BREWSTER COL'D BY: JOSE W. QUlCENO NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TINE TAKEN: 01/10/06 04:00 DATE/TIME REC'D: 01/10/06 05:00 REPORT DATE: 01/13/O6 PHONE: (845)-279-2022 SAMPLE TYPE..: POTABL.: PRESERVATIVES: NONE`. TEMPERATURE..: < 4C CDLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/10/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01/13/06 LEAD (INS) 1.0 ppb 0-15 ppb 9003 01/12/06 NITRATE NITROG <0.2 MG/L 0 - 10 9052 01/11/06 NITRITE NITROG <0.01 MG/L N/A 9162 01/12/06 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 9002 01/11/06 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 9002 01/12/06 SODIUM (Na) 11.1 MG/L N/A 9002 01/11/06 pH 7.7 UNITS 6.5-8.5 9043 01/12/06 HARDNESS,TOTAL 74.0 MG/L N/A 01/12/06 ALKALINITY (AS 82.0 MG/L N/A 9001 01/12/06 . TURBIDITY (TUR <1 NTU� 0-5NTU ' COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE T) OF A SATISFACTORY SANITARY QUALITY ACCORDI� HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECT[ON., Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be pntential,, ublic 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 Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Hei ht N Y 10598 ^ g s� . . (91/�1 '245-�80C-/' Albert H. PadoYjni, Director .� LAB #: 1.600174 CLIENT #: 57197 NON STAT PROC PAGE: 2 WYNDHAM HOMES DATE/TIME TAKEN: 01/10/()6 0%00 8 COLLlNWOOD DRIVE ` DATE/TIME REC'D: 01/10/06 05:00 RALPH TEDESCO REPORT DATE: 01/13/06 BREWSTER, NY 10509 PHONE: (845)-279-2022 SAMPLING SITE: 64 QUAIL LANE SAMPLE TypE,,: pOTABLE : BREWSTER PRESERVATIVES, NONE COL'D BY: JOSE W. QUICENO TEMPERATURE..: < 4C NOTES...: KITCHEN TAP CDLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE 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 :'COR jSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hal TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSEDASCALCIUM CARBONATE. IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO qyyq,EDS OF MG/L, DEPENDS ON THE SOURCE AND-TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED, SOFT WATER: 0-70 MG/1 VERY HARD WATER: ABOVE 300 MG/1 - ' MODERATELY-NOD -WAlER:'7O-f40'MG/L'~ MG/L'=-MILLYGRAM-PER- LITER - °--'~---~ HARD WATER: 1400300 MG/L ­(1 grain/gallon = 17.2 MG/0 ^' SUBMITTED BY: �~ Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF REALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: i,,T Street - Location C'�v. j1.1,•.�,�: - _ . v - "Owner Town Permit # d 5- TM # 3 Subdivision Lot # r'T V 1. Sewage Svstem 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 ... ............................... IL Sewage System a. Septic tank size - 1,000 ...:....1 25.4 ......other ................ b. ' Septic tank installed level ................ ...................... .......... c. 10' minimum from foundation .......... ..............................: d. Distribution Box 1. All outlets at same elevation -water tested ............:...: 2. Protected below frost ................... ............................... 3 Nlinimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... . 6. Trenches 1. Length required 5rnc:> Length installed 5.a 2. Distance to watercourse measured 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 - 11/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... 10. g, dyd...........i Pump or Dose stems ..............,...,... ..............r......r.�....... 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................ .............................:. 3. Alarm, visual/ audio ................. . ............................. ..... 4. Pump easily accessible, manhole to grade .................. . 5. First box baffled .......................... ..............................: 6. C�yycle witnessed by H.D.estimated flow /cycle........... III. HouseBuilding a. House located per approved plans............ b. Number of bedrooms .......................... .... .. ................ IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured ft ........... . C. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... -� V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box.... ......... ...................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ......:........ h. Surface water protection adequate .... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 YLS NU ff COMIVVIENTS �, ,: 7 b/ 100 ri ��al'.� c #�� {j . iJ •b Q. c'.4 f' ) r C Form -3 rv3�, Jan -12 -06 04;16P Ralph G. Mastromonaco PE 914 271 4762 P.01 mss. 278 -79 Z ( PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH XGENE REOUESI FOR FINAL INSPECTION " For: Fill A„(R.�M�"(,_ All information must be fully completed prior to any Trenches X inspections being made. PCHD Construction Permit # Located: V 1.. Owner(Applic Name: i Formerly: Is system fill completed? Is 'system complete? Yra (T)MB D TM-3-05 Subdivision Name: 12f Subdivision Lot it Date: iNLA Date: l f Is system constructed as per plans? Is well drilled? `Y15or2 Is well located as per plans? Are erosion control measures in place?� Date: _ 0.0 I certi fy that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance.. with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam 'County Department of ..Health. ; . .. . Date: Certified by: RA Design Professional Form FIR -99 j) I-0 i Jan -12 -06 05:06P Ralph G. Mastromonaco PE 914 271 4762 P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH )(GENE REQUEST FOR FINAL INSPECTION For: Fill A 1 �•�. All information must be fully completed prior to any Trenches____, inspections being made. PCHD Construction Permit # Located: oAi L L- A. (T): (V) Owner /Applic Name: D o TM Block Lot Formerly: _ Subdivision Name: Subdivision Lot # Is system fill completed ?Q Dater t Is system complete? YES Date: i O Is system constructed as per. plans? Is well drilled? "1'LG Date: Is well located as per plans? - i E:!�! Are erosion control measures in place? I gertify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved ,,mans and the Standards, Rules and Regulations of the Putnam County Department of Date -,, 2 Certified by: RA Design Professional Comments: Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLTI SERVICES FIELD ACTIVITY REPORT NAMF—f AnngF.y,s: Street Town State Zip PERSON IN CHARGE PUMP TEST DOSE TEST I •i REQUIRED GALLONS E2 - --- ---- --- fl -7-f- L - REQUIRED GALLONS E2 - --- ---- --- fl -7-f- b, AN A . . EL. START AN, 'Ve EL. STOP TN.0,PF-(`-T0R, :2 TRT! Signature and Tit le R F P QR T TZ F-C RWRT) RV. I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Z 11"Z b, AN A . . EL. START AN, 'Ve EL. STOP TN.0,PF-(`-T0R, :2 TRT! Signature and Tit le R F P QR T TZ F-C RWRT) RV. I acknowledge receipt of this report: SIGNATURE: 02/96 Title: SHERLITA AMLER, MID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 19, 2006 DEPARTMEiNT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Mastromonaco: ROBERT J. BONIDI County Executive Re: Field Inspection - Wyndham Homes Quail Lane (T) Patterson, Lot 21, T.M. 35. -4 -69 The above referenced separate sewage treatment system can be backfilled. The following comment must be corrected in the field. ® Grading around the well needs to be completed to ensure proper surface drainage away from well casing. - - Upon inspection,.it.was noted -that erosion control - measures had not been installed: -.For. - -- -. future reference, please note that all erosion control measures must be properly installed prior to the start of any construction. Failure to do so will result in legal actions taken by this Department. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # �"O3 -0 �SS Located at P VA I L L A N E Subdivision name Pee Z WOOO Subd. Lot # z Date Subdivision Approved - �>/oz f Owner /Applicant Name �`(jJ12 - Ao Homesp Ttv,. Town or Village PA— P- 50� Tax Map 35 Block 4 Lot Renewal Revision Date of Previous Mailing Address n(�tbLL1 hIWcop �J�l�l R1= W�TE�L . N.T. Zip 105cq Amount of Fee Enclosed 4-oa Building Type ( FAh . ( _ Lot Area4. :35 No. of Bedrooms -4—Design Flow GPD_BCO Fill Section Only Separate Sewerage System to consist of Depth Volume gallon septic tank and 'f;. Other Requirements: To be constructed by O W N E 2 Address A ��� Water Supply: Public Supply From Address ___.. or: Private, Supply .Drilled -by &o-jr-P- P?- Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operat' dition any part of said sewage treatment system during the period of two (2) years immediately following the 0 of the approval of the Certificate of Construction Compliance of the original system or any reps tie w `pSGE MAST, ?,, 'Q+ P-ANIZEEMMUR Signed: Address l � e APPROVED FORNS Uflf'!E1 is approval expires two years from the date issued unless construction of the sewage treatme s tk- as, been completed and,inspected by the PCHD and is revocable for cause or may be amended or modified whe con dered essary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. A roved o discharge of domestic sanitary se age only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 .(914) 271-4762 (914) 271 -2820 Fax Mr. Robert Morris, P.E. Senior Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Proposed SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 108 - R.S. Lot 21) Dear Robert: Pne 2005 Via UPS Please find enclosed four (4) signed and sealed copies of the drawing entitled SSTS Plan R.S. Lot 21 of Deer Wood Subdivision (Map 35, Block 4, Lot 108) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated March 8, 2005, last revised May 15, 2005. Your office has already approved this SSTS plan. However, the approved plan does not reflect revisions requested by Rich Williams the Patterson Town Planner. Based on his review, we have made the following revisions to the drawing: 1. Tax lot number has been corrected to reflect the Town designation as lot 108. 2. The Swale behind and to the north of the house has been adjusted to reflect the same location as shown on the approved subdivision plan. - In order that everyone is working off the same set of plans, Rick is requiring that the plans be re- signed by your office. All future submissions to your office will be pre- approved by the Town in an effort to avoid this situation. Please review and re -sign these plans. Please call me if you have any questions. Thank you for your help in this matter. ly, G. Mastromonaco RGM /jl Enclosures PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: Y N DOCUMENTS (__)(___)PERMIT APPLICATION " "WELL PERMIT ORPWS LETTER C--)C--)PC-97 (_) )LETTER OF AUTHORIZATION (_)(_)DESIGN DATA SHEET (DDS) U(__) CORPORATE RESOLUTION (_,(_)SHORT EAF UUPLANS -THREE SETS ((_)HOUSE PLANS - TWO SETS UUVARIANCE REQUEST SUBDIVISION ((__)LEGAL SUBDIVISION UUSUBDIVISION APPROVAL CHECKED L_)C_)PERC RATE ((_)FILL REQUIRED DEPTH (_)(_)CURTAIN DRAIN REQUIRED GENERAL (_,(_)LOCATED IN NYC WATERSHED (_J(__)PLANS SUBMITTED TO DEP )(_)DELEGATED TO PCHD ' UUDEP APPROVAL, IF REQ'D (�UDEEP TEST HOLES OBSERVED C_) _) PERCS TO BE WITNESSED C__)(_)EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) j DATA ON DDS PLANS & PERMIT SAME + PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA 106•YR. FLOOD ELEVATION W/I200'. ( 1( .)SOIL TESTIN G LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE V1TY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES U(�TITLE BLOCK; OWNERS NAME ADDRESS / TM #, PE/RA; NAME, ADDRESS, PHONE# ` DATE OF DRAWING/REVISION . DATUM REFERENCE (�ULOCATION OF WATERCOURSES, PONDS (ZLAKES,WETLANDS WITHIN 200' OF P.L. ( ._)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (_)/ WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS (ZL}EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: . (REVSHEET)09 /01100 TAX MAP #: (CONFIRMED) (Y (REQUIRED DETAILS ON PLANS CONT'Dl �HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS SITE NOTE (NO CHANGE) FILL SYSTEMS , ( )y )•10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS/ FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS (_)FILL IN EXPANSION AREA FILL GREATER THAN 2 FEET I CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES VOL. ON PLAN FOR R O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE E C LF TRENCH PROVIDED 601FT MAX. PARALLEL TO CONTOURS ,,100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD, 150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER Y 10' TO WATER LINE (pits - 20') 50' -INTERMITTENT DRAINAGE "COURSE ' 200' /500' RESERVOR ETC. _ 150' GALLEY SYSTEMS (_)L_)10' MIN TO LEDGE OUTCROP SEPTIC TANK (_,) 10' FROM FOUNDATION; 50' TO WELL WELL bIMENSIONS TO PROPERTY LINES (_) LOCATION OF SERVICE CONNECTION (MIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (520 %) (_) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS �) PUMP NOTES DOSE 75% OF PIPE VOLUIVIE/DOSE VOLUME NOTED __)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (_)(SPIT AND D -BOX SHOWN & DETAILED Lam(_ )l DAY STORAGE ABOVE ALARM CURTAIN DRAIN Lam(_ )STANDPIPES, 5' BOTH SIDES, DETAIL MIN to CDS =>5 %, 20'4 %, 25' -3 %, 35' -1 °/6, 100 % - <1% (_)L)20' MIN to CD DISCHARGE /100' with 182 cons day discharge C__)(_)10' MIN to NON - PERFORATED PIPE U PST NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ ...APPLICATION TO CONSTRUCT A WATER WELL_ please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 00AI L LA, 1 E PA � Map 35 Block q-- Lot(s) 49 Well Owner: Name: Address: 105 Use of Well: >< 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 A— Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply. Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason \/ipF-�/� D L 1✓ L OU for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision t-- n k A lo6c> Lot No. — Water Well Contractor: E� P_ I1,LF Address: Is Public Water Supply available to site? .....:............................ ............................... Yes No Name of Public Water Supply: Town/Village PJA Distance to property from nearest water main: JA Proposed well location & sources of contamination Vb trovided on separate sheet/plan. Date: - ��j��J Applicant Signature:. _ IA PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. evision or alteration of the approved plan requires a new permit. Well to be constructed by a water well ller ified by Putnam County. a . Date of Issue 0 Permit Issui 0 Date of Expiration Title: Permit is Doan- Transfer fie ' White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914) 271 -2820 Fax Mr. Robert Morris, P.E. March 8, 2005 Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: Proposed SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 69 - R.S. Lot 21) Dear Robert: Please find enclosed the following materials: 1. Four (4) signed and sealed copies of the drawing entitled SSTS Plan R.S. Lot 21 of Deer Wood Subdivision (Map 35, Block 4, Lot 69) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated March 8, 2005 2. Four (4) signed and sealed copies of the Construction Permit Application dated February 25, 2005 3. Four (4) signed copies of the Application to Construct a Water Well dated February 25, 2005 4. One (1) signed copy of the Corporate Affidavit dated January 5, 2005 5. One (1) signed and sealed copy of the Letter of Authorization 6. One (1) signed and sealed copy of the Application for Approval of Plans for A ...Wastewater. Treatment-�System ...._..,..:........:....._ _.. __..... _................_ :....._ .............. 7. One (1) signed copy of the Short Environmental Assessment Form dated February 25, 2005 8. One (1) signed and sealed copy of the Design Data Sheet 9. One (1) copy of the original Design Data Sheet for the subdivision approval 10. Two (2) sets of architectural plans for a four - bedroom house 11. Check #448713 payable to the PCDH in the amount of $400. 12. Pump design information and pump curve chart We are requesting your review and approval of the submitted materials. Please call me if you have any questions. rely, Ralph G. Mastromonaco RGM /jl Enclosures Cc: Wyndham Homes w /copy of plan PUTNAM COUNTY )DEPARTMENT OF HEALTH _... -. DIVISION OF ENVIRONMENTAL. HEALTH i"' S AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PEPMT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: AKA WW0509- WOdCS represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Havin; offices at: Whose Officers Are: President - Nam`e�-R,,<:I�x::�S kL Vice President - Name: Address: - Secretan, -N Add riess Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating the to. Signed: Title: Sworn to before me this 't) . day of _(month) (year) lic Corporate Seal Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH.'.. DIVISION, OF ENVIRONMENTAL HEALTH :SERVICES LETTER OF AUTHORIZATION RE: Property of�� c�c�►hc�.c�c-� �-_� �N� . Located at �� /.��,,rva� �t��— --R42rw EI N .4 061 TN RATTER -am.l Tax Map # ���JT Block _Lot Subdivision of wL4 % o- S %,TL- ft,) S Subdivision Lot # Filed Map # ��_ Date Filed..- 3-14-62- Gentlemen: This letter is to authorize RALPg Gi , MA`STeo MC+JAC o - a duly licensed Professional Engineer �_ or Registered Architect to apply for the, required wastewater treatment and/or water supply permi(s) to serve 'the above -noted property in accordance •.. .:.:.:.. with the standards, rules or regulations as promulgated by the Public Health Director of.tbePutiiam 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 tretment and/or water supply systems in conformity with the prq C ons.Qf ArticleJ4.5_and/or...147.of the Education.Law,Ahe Public 'H'ealth Law, and the Putnarr�`��b6 „ , t: - 1" ode. - Countersigne P.E., R.A., # Mailing Add State 45vi *4. Zip 1057 Telephone:(9 j4) Z7.1- 4762 Very truly yours, Signed. (1v11,111 wn of Property) Mailing Address: State jQR Zip Telephone: g R�_> - 2']1Z3_ 2-C), Form LA -91 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address, of applicant: 2. Name of project �Y�C)�A M i—I O 6. Type of Project: Private/Residential Food Service Apartments Institutional Office Building Realty Subidvision Commercial Mobile Home Park 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? ............ .............. <D 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency 11.. If this project is an area under the control of local planning, zoning, or other . officials, ordinances? .................................................. ............................... 12. If so, have plans been submitted to such authorities? ......................................... d/A 13. Has preliminary approval been granted by such authorities? 4 Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water, groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) .......................................... ............................... I Q 17. Is project located near a public water supply system? ....... ............................... tiles 18. If yes, name of water supply ia�A Distance to water.supply 19. Is project site near a public sewage )I O collection or treatment system? ................ 20. Name of sewage system N A Distance to sewage system &A 21. Date test holes observed 22. Name of Health Inspector .I Form PC -97 2 23. Project design flow (gallons per day) ................................. ............................... ° 24. Is State- PollutantDischarge Elimination System ( SPDES) Permit requiredT t4 b 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? �p 27. Wetlands ID Number .:......................................................... ............................... 28. Is Wetlands Permit requited?.. ......................................:....:. ............................... Has application been made to Town' of Local DEC office? . .................... ............ 29. Does project require a DEC Stream Disturbance Permit? ....... .................. p 30. Is of was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No N 0 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ...........................:... Yes/No .DESCRIBE: 32. Is there a local master plan on file with the Town or Village? 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ......... :........................................................ 34. Are any sewage treatment areas in excess of 15% slope? . ............................... `5. Tax Map, ID Number .......................... ............................... Map 22 Block Lot w� E� O plans are to be returned to ..... Applicant e�< Design Professional It -& appfiication is signed by a person other than the applicant shown in Item l.,the application must beActompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may �e unds for the rejection of any submission: r Li © ' 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 misdem suanii Section 210.45 of the Penal Law. of N. h�P� URGE MA . g SIGNATURES Mailing Addy � pROFE5S10Np�' 14.164 (9!981 —%xt 12 , PROJECT LO. NUMBER 617.E SEOR Appendix C _ State Environmental Duality Review SNORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--- PROJECT INFORMATION (l o be completed by Applicant or Proiect sponsor) 1. PLl NSOR I- • 1 �� Z. PROD ME• . o I> o 00 3. PROJECT LOCAMpliq MunLclpaft Coutny R QTO&� 4. PRECJSE LOCA71ON (Street address and road inWeectlons. p =rJnent Iammatia, eto., or prowde map? 6RO Ai L L.Avv e. I/Z H1 LE- w Ems' °F RTE. Z?,.. `9 FF Af PL-p— HILLDRIVID S. IS PROYOSED ACTION: 0 Eganslon 0 Modifloadon m Waflon .6. OFCRIBE P ECT BRIEFLY: 5'r q_ t� �4 M L`i T� >> F • 9 '5F AI-IO tA?1r=rJe:-m'PA CA W I C --- 7. A ibUNT OF LAND SCIM �.. Inittally acres Ulurnateiy _._.L:. acres 8._WILjL PROPOSED ACTION COMPLY WITH E)=NG ZONING OR QTHER FASTING; LAND USE RESfR=WNS? `j^",'O 0 No If No. deudw brlefi/ e, 13 PROENT LAND USE IN VICINITY OF PROJECI7 ,Masi trial ❑ htduat w . ❑ Commerow . ❑ Agriculture . _... 0 PaWForesiJOpen space 0 Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY aMER GOVERNMENTAL AGENCY VEOSW, STATE 9R L.00AI37 1Y`g,^,_"_ 0 No It res, Itst a6ency(ai and permitrappmwe 11. a ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? A; es 0 No it M ad agency name and petmWapppmvW TOWtjoF ?a�� _��4>J�IZPx:A p.::>- '5V v15101 AFF? -ovAv 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PER101APPROVAL REQUIRE MODIFICATION? ❑ Yea I CERTIFY THE INFORMATION PROVIDED ABOVE IS TRUE TO THE HEST OF" WY XNCWLEDGE Applicantibponsor Hemet f Date: r 3tpnalnre: If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Farm before proceeding with this assessment OVER 1 PART If--- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and lase the FULL EAF. ❑ Yes ❑ No B_ WICL.ACTION_RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS H NYCRR. PART.B17.fi?..<_ It No; a negative declaration may be superseded 6y another InwNved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) 'Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic panams, =00 waste production or dteposal, potential for erosion, dralnage,or flooding probleaW Explain btieft C2 Aesthetic, agricultural, archaeological, Mstoric, or other natural or cultural resources; or community or net tjbcrhoW dw' acted Explain briefly; C3. Vegetatkm or farms, fish, sheilflsh or wllditfe species, significant habitats, at-thmatened auandangbrW sondes? Explain briefly:. C4. w community s existing plans or goals as- ofndauy adopted, or a change In use of Intensity of use of land or other natural resources? Explain briefly, C5. Growth, subsequent development, or related activities IUcehl to be indurred by the proposed action? Explain briefly. C6. Long term, short teen, cumlativn, or other effects not Identified in Ct-057 Explain briefly..' W. Other broads (fnduding changes In use of either quantity or type of energy)? Explain briefly. 0. MALL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL THAT CAUSED THE ESTABLISHMENT OF A CF.A? ❑ Yes ❑ INo E- IS THERE, OR ISi- THERE-LIKELY TO BE, CONTROVERSY REiATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACT ❑ Yes ❑ No I Yes, explain briefly ` r POTENTIAL S? _ _ _........._ , . _.. -. _. _. _._ ... _ .. PART ![i-- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) iN MUCnONS: 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 mralk (b).probability of occurring; (c) duration; (d) irteversiblifty; (e) geographic scope; and M magnitude. If necessary, add attachments or reference supporting materials. Entire that explanations contain sufficient detail to show that all relevant adverse Impacts have been Ideniffied and adequately addressed, if question D of Part ll was checked yes, the determination and significance trust evacuate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ 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 andfor 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 Agency a, la n t SQ. Print or ype Name er Respomilile Officer In l Agency CNficq }} ore of Responsible Officer Ar Load Agency Slanawme (I l sent +!4 xb le afkaj L PUTNAM COUNTY DEPARTMENT OF HEALTH' DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner C,. Addres&8.4 I 1 wvo'p D2- e Located at (Street) _ A I I- LA S Tax Map Block Lot (indicate nearest cross street) 12.5.LOT Municipality Watershed ,>Cj5n arm jt, Date of Pre-soakin SOIL PERCOLATION TEST DATA . Date of Percolation Test 8 p �BE I -a: 111 T20 9:34o �x 0 223/4 2.5-/4 3 15.3 2 7:37 9•*55 v3 223/ 4 25314- 3 (o-o 3 :56 10 :1¢ JB 223%4 25 Y4 ' 3 (,:;.•C) 4 10,.,54-11:19 Z5 2Z3/4 25#4 3 8.3 .5 8:22 11:51 29 ZZ34253/4- 3 9.1 1:15 1:5212:21 Z11 -51 2Z 314 2 4� -3 9-T 2 4 :38 260 -3 04 40 /01*08 28 2*31i4'Z*(0'Y4 3: 9.3,, 13 -10:09 /0:37 2-8 2 31/4.2(10 /4 3 9.3 14- 10,-5811,-28 30 231/4 2(a 2-114 10.9 25 P.029 11:5q 30.- 231/4.263/4 272 12.0 12':03 2,33 30 2-3 25 Yz Z. 15.0 1 '47 12:34 1:04 30 23 Vz 25/Z Z 15.0 5 1'1%JAJaj0; L. LCSES 10 De repeatea at same aeput unfit approximately equal percolation rates are obtained at each percolation test hole. (i.e. -< I min for 1-30 min/inch, -< 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2* DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES .DEPTH HOLE NO. I I HOLE NO. HOLE NO. G.L. 7-opso,L I L. 0.5 6PS"dSAJPY P-F-p a to�q�,sAtJc>-r LoAA 1.0 1.51 2.0 2.5 \0VjS0jdESjLr 3.00 3.5 L-1C -IT TAW f I a 4.0 4.5 5.00 53 6.01 6.5 7.51 8.0 8.5 9.51 10.00 THE 114roRMA I D tJ 5 0,0W14 p-E01eJHA5'5*mj pp-ovicao B-r Indicate level, at which groundwater is encountered tj 01-1 P, Indicate level at which mottling is observed Indicate level to which water level rises after being encountered LA Deep hole observations made by:, M. QQ12A I �'SJW - PC-014 Date -7 1 o Design Address: Signaturt Design Professional's Seal of New MAST- 0 "0 0 '090FES !ALL. PUTNAM C-,OUNTY-I)E-PAR K-T,.OF,,�HEAU DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA. $HEE.T. SUBSURFACE SEWAGE TREATMENT SYSTEM OWner G;e6r;L'r.E MAeEtz Q.s�w Y Located 'at(Strcci) _o 4o goAo Tax-Map 3 5. Block 4 Lot 6 5 (indicate atarik cross street) Municipality (-r)- PA-rTEMSON' Watershed— 8 oq._5Root& Rr--s. L c S.01L. PERCOLATION .TEST DATA Date,-of Pre - soaking' -8 18) -oo- --Date of-Percolation Test lal 9100 Per�qokdodtest hole. (i:0. !c I min for .1 -3:0 m figifich 4 2 min for311-60 min(in6h) to be sUbmitted'for review. 2..' Depth measurements to be made from top pf hole. Form DD-97 ffiffi. _0501 Hole NA. ch. Z5 2 '9:37 9:55 2Z -4 is 0 3 9:56 1o: 14 1 8 tz 4 Z 6.0 4 + es.& -4- zt a X. 4. 4- 9.7 zz 36 '46 4 8.7 9..40 10.08 z.8 ra a Z4 10,3r 7.3 4- 30 -Z3 10.9 it: Z9 11 :59' 30 Z's 2:. 12.0 11'4G jZ- t Z i5.4 11 -7 NOM! 1. TiLvA •tn ioni-atoA of c-arn m- Aoml% tn#;l Per�qokdodtest hole. (i:0. !c I min for .1 -3:0 m figifich 4 2 min for311-60 min(in6h) to be sUbmitted'for review. 2..' Depth measurements to be made from top pf hole. Form DD-97 6.5' 7.0' 8.0' 10.0' Indicate level -at which groundwater is - encountered N o K( F Indicate level at which mottling. is_ observed Indicate level to which, water level rises af%r being encountered- ! A Deep hole observations made by:..a. Buvz►,.► -1c% P. E• H. w. >,stic I.1 L.� �a. P.t�Date ai. Professional Name: Address: .. .. _. . of NEW: 70�� iri�ZF,' Z Z - -- gYeWSTEL V6 -4 j&g c 0 `p � Nlly CO Signature: � ....�.. .. , ... � ... >: ...: I ..: . , ::�.;� �. �* x�Q. Uj AA- Uj v� Na6612s Design Professional's Seal \ 10 c, \ OFrsstioJ limmommo1 /i' iimiiaamia: ■ ■■■ ■o® ■■gym Pump Model CSHEF8:094 Nameplate Horsepower .50 ; Pump Model Classification SubmersiblO Service High Head Effivent Phase Single Voltage 115 200 230 R.P.M. 3450 Starting /Locked Rotor Amps. 57A 29.1 29.1 Full Load .Amps. 14.5 7.6 7.1 Winding Resistance - Range Start 7.8 -7 7.6 -7 7.8 -7 Run .66-.69 2.56-2.32 2.56-2.32 Locked Rotor Code H Class Insulation B Noma Code Letter L Maximum Water Temp. 140° F. Power Cord Size 14/3 16/3 Motor Manufacturer Emerson Type of Motor Split phase with centrifugal switch and start capacitor Motor Features Automatic reset thermal overload protection Pump Operation - Automatic Pressure Switch No t Float witch Yes Pump Operation - Manual Yes Yes Furnished as standard equipment. Optional' NOT furnished as standard equipment but the manual pump model can be equipped with. Three 230 460 575 22 11 8.8 3.1 1.6 1.2 4.91-4.45 20.5-17.7 F t3 16/4 29.7-27 Polyphase Overload protection in control panel No No Yes ,' i 0 PUMP MODEL Nameplate Horsepower Type of Service MATERIALS':OF SERVICE Motor Housing Pump Housing Impeller Pump Shaft External Fasteners Lifting -Handle O -Rings Mechanical Sea] Upper Bearing - Radial Lower Bearing - Thrust Bottom Plate Legs APPLICATIONS Solid Size Type of Oil Oil Re -fill Quantity Power Corn Size Diameter Amp. Rating Type SHEF50 .50 High Head Effluent Cast Iron ASTM A - 48 Class 30 Cast Iron ASTM A - 48 Class 30 Thermoplastic Stainless Steel Stainless Steel Stainless Steel Buna N Carbon Ceramic Single Row Ball Single Row Ball Polyester Coated Steel Engineered Thermoplastic 3/4 Inch Dielectric SE40 Single Phase 70 Fluid Ounces Three Phase 63 Fluid Ounces. Single Phase 14/3 16/3 .375±.01 .388±.005 15 13 SJTW STW -A Three Phase 16/4 .424 ±.005 10 STW -A Separate Wires Black Power Power White Power Power Red — Power Green Ground Ground PAINT Painted after assembly before testing. Dark green, water reducible alkyd enamel, one coat, air dried. YBMN ~unit w^L�.puMp 1S TECHNICAL DATA SHEF50 ;q 10-28 -1998 11:03AM FROM SUPER — TURBINE SALES 914 769 6756 T®� ._._.�.__ _ _ 71- . 16 16 54 316 p SIDE VIEW 147 P.2 S Pump Model- 5HEF'50 Nameplate H.P. ® Boxed Weight 58 Lbs. 2'° N T Discharge' goen9p �:;7, 1 9. M dons hr In I . vary uo ba. 3. Nw for oOnaAxron PUq=ee urde" CWdorc d. Dknenslorts land Wg#ft "OPPICOM11. S YUe n W" the r1w W Hake rWASIOM ro ow Produtas and tr,au 'Peemca s wlftut room IL Crb= anal gl a*un O WhOn ftftd vdrh awlde W4O FbW SwWL b�scharge Height If the pump is ordered for AUTOMATIC operation; a FLOAT SWITCH and TIE BAND are shipped loose with the pump. When installed as shown, the TURN ON and TURN OFF height is approximately the same as the float tether length. If this is 8 inches, the volume of water pumped out each time the pump runs is: 24 inch tank diameter 15.0 Gallons 30 inch tank diameter 23.8 Gallons 36 inch tank diameter 34.6 Gallons 48 inch tank diameter 62.0 Gallons , O 3I e• m. ' 1 3I N• WI t KI a rc• TIE POINT 'A' 4" PVC SCH 40 h M W N 0 N LOT 22 1250 CAL CONC. DUAL COMPARTMENT SEPTIC TANK 4' PVC SCH 40 — — ROOF DRAIN = 24_ HDPE..___ / 20 WOE DRAINAGE EASEMENT -� N N DMHW3 i - / i F 4' PVC SOR35 SLEEVE b ti n •� 4' SOLID PVC (TYPICAL) (y / 15 OBI I y I 8• I ml ml ml vl ml I I I I J2 � I I I I I I I I I I I I I I ?oq SSTS AREA 10, lot ml ml ml ml I I I j I I / 7.000 ai. I I I I I I I I pI I I I I i I I I I I 11 t'l Xp11 07g�1 I I IE lR 0q I 7R I I II I 1 1 I I I I I I I I I I I I I I I i l l l l l 1 I I I I I I I I I I I I C LIMITS OF O' -1' R.O.B.'I I I I I I I I I I I I IR GRADING PURPOSES I I I I I I I I I I I I I I I I I I I I I I i 4' PERF. PVC LATERALS L1 L2 L3 L4 LS LB CAPPED ENDS (TYP.) S 89'49'09' W 260.00' LOT 22 THERE ARE NO SEPTICS LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE OF THE EXISTING WELL LOCATION THERE ARE NO EXISTING OR PROPOSED WELLS LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE OF THE EXISTING SSTA AT DRAIN CROSSING 1250 GAL. CONC. PUMP PIT W/ ACCESS MANHOLE TO GRADE 24' HDpE �� _ DMH 2 I EXISTING WELL 55.1'. u Al O N 57 0', rqJ EXISTINGt LOT 2 49 / I; oI43�1° �" DRIVEWAY , 189,499 s.f.`•' 4.350 acres Qp: i Y / ko N W O = a / TIE POINT 'C' 1 I j — — _ _ TIE POINT '8'' T FOOTING DRAIN ----I Tq TIE POINT 'A' 4" PVC SCH 40 h M W N 0 N LOT 22 1250 CAL CONC. DUAL COMPARTMENT SEPTIC TANK 4' PVC SCH 40 — — ROOF DRAIN = 24_ HDPE..___ / 20 WOE DRAINAGE EASEMENT -� N N DMHW3 i - / i F 4' PVC SOR35 SLEEVE b ti n •� 4' SOLID PVC (TYPICAL) (y / 15 OBI I y I 8• I ml ml ml vl ml I I I I J2 � I I I I I I I I I I I I I I ?oq SSTS AREA 10, lot ml ml ml ml I I I j I I / 7.000 ai. I I I I I I I I pI I I I I i I I I I I 11 t'l Xp11 07g�1 I I IE lR 0q I 7R I I II I 1 1 I I I I I I I I I I I I I I I i l l l l l 1 I I I I I I I I I I I I C LIMITS OF O' -1' R.O.B.'I I I I I I I I I I I I IR GRADING PURPOSES I I I I I I I I I I I I I I I I I I I I I I i 4' PERF. PVC LATERALS L1 L2 L3 L4 LS LB CAPPED ENDS (TYP.) S 89'49'09' W 260.00' LOT 22 THERE ARE NO SEPTICS LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE OF THE EXISTING WELL LOCATION THERE ARE NO EXISTING OR PROPOSED WELLS LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE OF THE EXISTING SSTA AT DRAIN CROSSING 1250 GAL. CONC. PUMP PIT W/ ACCESS MANHOLE TO GRADE 24' HDpE �� _ DMH 2 TIE DISTANCES TRENCHES REQUIRED = 500 L.F. TRENCHES PROVIDED = 500 L.F. PUMP TEST 'PERFORMED 1 /13/06 PUMPED VOLUME = 248 GAL./CYCLE - 6 1/2" DROP/CYCLE A B c Tl 31.5' 19.2' 26.6' T2 42.0' 13.9' 18.8' T3 45.7' 13.1' 17.8' T4 57.4' 16.9' 13.7' DB1 129.6' 105.0' JB1 126.2' 102.8' J132 121.3' 99.0 JB3 116.4' 95.2' J84 112.1' 92.2' J135 107.7' 89.0' Ll 193.3' 178.5' L2 190.7' 176.7' L3 188.1' 175.5' L4 184.8- 172.8' L5 181.2' 170.3' L6 178.1' 168.3- TRENCHES REQUIRED = 500 L.F. TRENCHES PROVIDED = 500 L.F. PUMP TEST 'PERFORMED 1 /13/06 PUMPED VOLUME = 248 GAL./CYCLE - 6 1/2" DROP/CYCLE