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HomeMy WebLinkAbout1814DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -38.1. BOX 16 01814 496 me so 1=41 1 IN 'I I 01814 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVLSIQN_ OFENVIRnNMENTAL: HEAL.T.H_SERVICE,S_.._.,.:_.. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P 2-$ -66 Located at / 13a-r l W14 Town or V e /- 41�v.sn Owner /Applicant Name —T-7q e- )3,a v, )oW T o yVi Tax Map 3 Block 19- Lot 3 6, Formerly Mailing Address J 4 -i f_ p 2 Subdivision Name P4 r i. r e_ Subd. Lot # I W Zip /6 &U v , Date Construction Permit Issued by PCHD '5 " ; Q QC Separate Sewerage System built by %3v-r- Address Consisting of % Z 5 d Gallon Septic Tank and l� �� 11 r 1 z«, 7 _tl cl l r Other Requirements: Water Supply: Public Supply From Address or: 1/ Private Supply Drilled by Address 101 iD f fc- 311 .: -._ I3ui- 1ding..TYp ... x4.. - gn. - .... Has. erosion control. been com.pleled ?._ Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Cgqnty Department of Health. Date: 1 )L -.zG. ­00 Certified by Address P.E. l/ R.A. License # 57 ! 2-f Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat' dificatigil or change is necessary. By: AM2 Title: �� —Date:P White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a* / WELL COMPLETION REPORT elf Locatiiin " Street Address: "`° ` At (-- 6 TowiiNillage: ' "" Soh Tax Grid # Map Block Lot(s) Well Owner: Name: Address: & CL) . Use of Well:_ 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length alft. Length below grade ,ZO ft. Diameter -7 in. Weight per foot _7 lb /ft. Materials: V Steel Plastic Other Joints: _ Welded 4Threaded _ Other Seal: _ Cem nt grout Bentonite Other Drive shoe: Yes No Liner: Yes tl 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 —k- 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 j�� j ✓ 6 . (A eis If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5-, Capacity Depth 'j TO` Model 76 016-11 Z Voltage 230 ✓ HP Tank Typetux —,362- Volume 94,-,cj:zj, Date Well Completed oo Putnam County Certification No. ©a7 Date o/Re ort 6 a Well Driller (signature) %&^� NOTE Ex ct location of well with distances to at least two permanenf lar4marks to be provided on a separa sheetlplan. J Well Driller's Name Rllf6m Address: /®/ Signature: Date: � 3 d D White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598. Albert H. Padovani, Director LAB #: 32.008038 CLIENT #: 12956 NON STAT PROC PAGE -------------------------- ~M ---- N- N N ----- N N N N N N ----------- FARESE, JOE 10 COTTAGE PL. APT. BE WHITE PLAINS, NY 10601 DATE/TIME TAKEN: 12/12/00 12:00 DATE/TIME REC'D: 12/12/00 .12:11p REPORT DATE: 12/23/00 PHONE: (914)-659-1266 SAMPLING SITE: Lot #1, Sylvia Barlow Way SAMPLE TYPE—: POTABLE Patterson, NY PRESERVATIVES: NONE COL'D BY: JOE.FARESE TEMPERATURE..: NOTES...: COLIFORM METH: MF ~ ----------- DATE FLAB PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 12/26/00 MF T. COLIFORM ASSENT /100 ML ABSENT 1008 12/26/00 LEAD (IMS) <1.0 ppb 0-15 ppb 9101 12/26/00 NITRATE NITROG 3.5 MG/L 0 - 10 9139 12/26/00 NITRITE NITROG <0.01 MG/L N/A 9146 12/26/00 IRON (Fe) <0.06 MG/L 0-0.3 mg /1 2037 12/26/00 MANGANESE (Mn) 0.025 MG/L 0-0.3 mg/1 2037 1e/26/00 SODIUM (Na) 8.4 MG/L N/A 12/26/00 pH 6.3 UNITS 6.5-8.5 9043 12/26/00 HARDNESS,TOTAL 110 MG/L N/A 12/26/00 ALKALINITY (AS 140 MG/L N/A 12/26/00 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: -- STAT COMMENTS: ENACT THESE RESULTS INDICATE THAT THE WATER (WAS (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN160)THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. 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. 9. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights N.Y. 10598 -,�914 Y 245-280(Y-- Albert H. Padovani, Director LAB #: 32.008038 CLIENT #: 12956 NON STAT PROC PAGE 2 -- ---- -- ----- -------------- N N N- ------- N N N- ------- N ------ ----------- FARESE., JOE . DATE/TIME TAKEN: 12/12/00 12:00 10 COTTAGE PL. APT. BE DATE/TIME REC'D: 12/12/00 12:11p WHITE PLAINS, NY 10601 REPORT DATE: 12/23/00 PHONE: (914)-659-1266 SAMPLING SITE: Lot #1, Sylvia Barlow Way SAMPLE TYPE — : POTABLE Patterson, NY PRESERVATIVES: NONE COL'D BY: JOE FARESE TEMPERATURE. NOTES...: COLIFORM METH. .- MF -------------- N N N N N --- ---- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM.&..MAGNESIUM ..CQNCENTRA- CALMUM CARBONATE 4 'IN MG/L.' THE'' HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER% 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATERg 140-300 MG/L (1 grain/gallon = 17.2 MG/L) c- SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 7_�� scwrLw Cro 31, 30i I- - Owner or Purchaser of Building Tax Map Block Lot Sa, -,. z Building Constructed by ��'`/J Pir o �• Tow ge FrLVfiS Location"-. Street Subdivision -Name )q f,sJ " I Cf- l Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or. any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the .system. - The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building u ' 'zing the system. Dated: Month 12 Day 2D- Year CC) Gerill Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Signature: Title: Corporation Name (if corporation) Address: �� �� VC ?� �. C State W k APIE) Zips X) �� Form GS -97 BRUCE . -.R. - FQLEY .. - Public Health Director - LORE'ITA . MOLINMU.!: R N. -1 -- v&&N: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: 1-1i, Re_-t r_ L , (2, p �101 lSGtrlvti Luce \ fti 1.14 AUTHORIZED TOWN OFFICIAL: (Signature) DATE: Wou- The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e.; a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 — Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 December 27, 2000 Mr. Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance The iiar]ow Corp. -Lot #1 Sylvia Barlow Way Patterson, N.Y. T.M. #35. -5 -38.1 Dear Robert : Enclosed are the following: 1. Five (5) prints of Drawing SS -1, "As -Built Plan," dated 12- 15 -00. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 12 -22- 00. 3. Three (3) copies "Guarantee of Subsurface Sewage Disposal System," dated 12 -22- 00. 4:• -Well Completion Report, dated 6 -3 -00, - •:- 5. Laboratory Report , dated 12- 23 -00. 6. Application Fee in the amount of $200.00, payable to Putnam County Health Department. 7. 911 Address Verification Form. If there are any questions concerning the enclosed, pleas e call. Very truly yours, HaLyW7.N ic hols Jr., P.E. HWN:his 00- 096.00 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 14 0o... Inspecte �, Zit t� Str_ ` r S,�Ldw eetLocation5i`v�A RA -r ow �ay Owner T Town P1 rrE-Rso/y Permit # P•- 2 o v TM # -3 - s - 3 e, i Subdivision Lot #. / "FAmx:sE 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement, 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ............ ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic t .1 c size - 1,000 .......,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ....... ............................... d. Dist 'butiioon Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. TrencFes engt required / 9/,94 Length installed 2. Distance to watercourse measured •+ 1,9 v Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... . -9. Depth of gravel in, trench -12" minimum .. ; ................. ....w�.. 10. Pipe ends capped......... ................ ............................... g. PumR or Dosed Systems Size o pump chamber ................ ............................... 2. Overflow tank ....:........................ ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade. .. ............... 5. First box baffled ........................................ : ......... :...... . 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans ... ............................... b: "Number W%8_ rooms : ......................... `= IV. ..., a. Well located as per approved plans . ............................... b. Distance from STS area measured 4- i e 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. fpSurfike— water protectiOnzade irate, ` " q,:.� ._ ......................... i. p -E o ion control'provrded ........ Rev. 6/97 ie I ins ICS ICS IBM NO 6� ro .r O JY' BRUCE R. FOLEY Public :Health - Director- LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: /�I, Z 602 c ♦ ��</ Fax #: ;- 79 — el f_6 7 No. Pages 2- Includin cover sheet From: Gene D. Reed Putnam County Department of Health J .For your information - Please respond For your review Attached as requested As discussed Please call Notes/Messages In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. W wS ®d jenousa�osd , o� vv 7r a :dq pop ma 00-- -�/ :apa`f IRNH ;o bvawPdoa AIMOD wind atp p saoumn sal Po s3in fpnpms 044 Put smd paeoaddt po %Pm8 Qopae�sao� aid pomst sqj o Pso�a tai aopal6wa.► m�qi po�caon ptsa paa -jadm ®nVq I Dul 1a1or=o9 m q sgq somasd ®Aoga M as ` *Xq 0 Js)MWAu VW OR 4,0M 1 90 — —)/ :eaotl poald ol samnm tonvoo uopm w' mmid sa8 so Pamog eg LPSUU — Imid led oa'pwnn cw MGWJ 61 90- - :011q r I P Z®leldwoo mvAt el asaaldwas n3 =Pail # 101 UonNPgnS f yg . ml --:g- 40019 ±i4v V" --- :max m=gddVI.sumo Apo fii) /rl ..o :Po1wol go ®�, � # 03 Mod ' 'gP� �®A �copaeds�al eeq�aroag Am of iopd pouldwo ApV ®q iQnw uopmqp. IN IP.d :zo3 .° =Wig 10 JAZUNVJZCI AIR= wvufla T0'd L99V 6LZ V16 SlOHOIN M ANNOH WA SZ:SO OOOZ- LZ -AON PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # to-<9 Y- 0 W-29-OR . Located at .i L��� bmL' w irf Town or Village PArl Subdivision name FAg Subd. Lot # i Date Subdivision Approved x /11-7 1 16 Tax Map °b 6 , Block r2 Lot p Renewal Revision Owner /Applicant Name 1- 9: BAP —OW C-0?`?Q?- old Date of Previous Approval Mailing Address ,d "TM4F PLIXC Afr &F, W i4IT-E N " Zip ( 06-51 I Amount of Fee Enclosed 4 '7)d# W Building Type tZ46� 10'4 L10 Lot Areal-Al- No. of Bedrooms A' Design Flow GPD SOD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by -"- 13.0" Address Water Supply: Public Supply From or: Private Supply -Drilled by Address Address +)�o LF 405 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date -' / 4160 Address 'jll a0Wj Za�� COMVP.OAAD9 *y 14-' License # "2'417 4 Iv� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified WA considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe t. pproved discharge of domestic sanitary sewage only. By: Title:) y ✓ " Date: ,0-3 If White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design kofessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL .. .... ........ ..pimeprintortype._. P'CHD•Permit # Well Location: Street Address: Town/Village Tax Grid # `'J 1-04 13AfZWW WAY PAML=P!�?' / Map Block --2' Lot(s) Well Owner: Name: Address: T46 849",P (-/0"- 1a C-67ri.414E APF 9,G V1 4nV7 RA m7 NK(46ol Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ '� + gpm # People Served '91 °'S Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes JC No Name of subdivision r-kazela Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No ,e Name of Public Water Supply: "' Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided sheet/plan. Vseparat 4" Date:!_ Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and. waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water� 11 driller certified by Putnam County. Z J . AA Date of Issue Jai Permit Is 'ng icial: Date of Expiration o Z-- Title: c h1f" Permit is Non- TransArrable I 1 ' White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ..I BATH < BEDROOM 4 DRESSING- BEDROOM 3 WALK 131-0- x 10'-0' j IN CLOSET f J- r MASTER BEDROOM BEDROOM 2 OPEN 13' 0- 1 L'6 PUT:NL-A-'-,'I COUNT1\6EPARTNTEIN'T OF HEALTH 7i;, Ap-pgm'-m MR im (-()TTNLT SECOND FLOOR D E D R, 0 0 -.1"S 4828 =.-1344SF Tj FOR 4 DnDn't, AT 46 SIG- ) �A 77 fUREA TITLE - TE KITCHEN io )o I •I ORNIN43 AGOM DIN*IN*G MOOM, r M' 13'0** w 12'.0** 1p OPEN ABOVE LIVING ROOM FOYER FIRST FLOOR FAMILY ROOM 13' 0• x 17' o' * 4828 Harry W. Nichols Jr., P.E. 311 Clock Tower Commons Route 22 "Bf'ewstef; NY 10569. Telephone (914) 279 -4003 Fax (914) 279 -4567 April 26, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Sylvia Barlow Way -Lot #1, Farese Subdivision Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of SS -1, "Proposed SSTS," dated 4 -4 -99. 2. "Short EAF," dated 4 -4 -00. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System" dated 4 -4 -00. 5. "Well Permit Application," dated 4 -4 -00. 6. "Design Data Sheet." 7. "Letter of Authorization." .8. _ Corporate Owner-Application. 9. -'Two (2) copies of Residence FIoor Plan(s)'for "Bedroom Count Only 10. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Thank. you. Very truly yours, hf Harry W. N' ols Jr., P.E. HWN:JM:hls 00- 096.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS. - _. -- REVIEW= Sr'IEE' T F0R'CONS`I'RIICTIO°i "PERMIT „NAME OF OWNER: C') AS'I'REET LOCATION: W 1k REVIEWED BY: AS SRDATE: TAX MAP--':. (CONFIRM ED) Y�( DOCUIfENTS Y ti (REQUIRED DETAILS ON PLANS CONT'D) vI - PERi�ITT APPLICATION L)5 HOUSE SEWER - %" FT. 4 '0'; TYPE PIPE CAST IRON WELL PER,INIIT OR PWS LETTER �NO BENDS; NLAX BENDS 450 W /CLEANOUT PC -97 RENEWALS LETTER OF AUTHORIZATION ( e5C�')STTE NOTE (NO CHANGE) DESIGN DATA SHEET (DDS) TILL SYSTEMS C_JCORPORATE RESOLUTION ( x )10�HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT EAF L_)PLANS -THREE SETS HOUSE PLANS - TWO SETS UUVARIANCE REQUEST SUBDMSION ( /y/ )LEGAL SUBDIVISION SUBDIVISION A PROVr CHECKED PERC RATE ° (� FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED (�PLAINS SUBINIITTED TO DEP D LEGATED TO PCHD ( —) EP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED P E R C S TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D?) DATA ON DDS PLANS & PERMIT SAbfE PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100'YR: FLU'OD ELEVATION W/I200' SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS CA��SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2'CONTOUBJE2USTING & PROPOSED D AY & SLOPES, CUT OOTING /GUTTER/CLMWAINDRAI(S LE BLOCK; OWNERS NAME ADDRESS TMh, PE/RA; NAME, ADDRESS, PHONE' DATE OF DRAWING/REVISION DATUM REFERENCE (_)(_)LOCATION OF WATERCOURSES, PONDS We LAKES,WETLANDS WITHIN 200' OF P.L. (_PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS CObIMENTS: (REVSHEET) SPECS / FILL NOTES 1 -5 C_)CVFILL PROFILE & DIMENSIONS U FILL IN EXPANSION AREA FILL GREATER THAiV 2 FEET (A CLAY BARRIER L� FILL CERTIFICATION NOTE (� DEPTH GAUGES VOL. ON PLAIN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE TRENC C_er_)LF TRENCH PROVIDED 60FT MAX. (_eLJPARALLEL TO CONTOURS C_ LJ100% EXPANSION PROVIDED L� DETAMMUST FREE CRUSHED STONE OR WASHED GRAVEL �GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS L ( 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL ( )20' TO FOUNDATION WALLS d( �}( )_ 100' TO WELL, 200' IN DLOD, 150' TO PITS (T_X_J100' TO STREAM, WATERCOURSE, LAKE (inc. espan) CZ 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER �1I,0.' T'O.WATER•LLNE (pits - 20') 50' INTERMITTENT DRAINAGE COURSE ((___)200'/500' RESERVOIR, ETC. r 150' GALLEY SYSTEMS L Xy __)10' MIN TO LEDGE OUTCROP SEPTIC � TANK 10' FROM FOUNDATION; 50' TO WELL WELL. DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (520 1/6) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS L� NOTES (_) OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (__) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (� PIT AND D -BOX SHOWN & DETAILED (__) DAY STORAGE ABOVE ALARM CURTAIN DRAIN TANDPIPES, 5' BOTH SIDES, DETAIL (� 15' MIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %,100 % - <1% L� 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 0' MIN to NON - PERFORATED PIPE 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review -SKORT- ENVIAGN MENTAL- ASSESSMENT -FORM =..":.._u..__.._:_-.:._ _.. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 77070r. Tl+� DAP-WW r✓bP-F%1AV00 NAME, I 1 HDi v i DIIRi.. 3.. PROJECT LOCATION: "` �►jm Municipality T�taN County ' 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) S; LmN m-wq'i vJ � 5. IS PROPOSED ACTION: 5Q New ❑ Expansion ❑ Modificationlaiteration 6. DESCRIBE PROJECT BRIEFLY: i1- IflivIOJRi, �t-5 ' 7. AMOUNT OF LA140 AFFf�ECTED: �1 A ,. A � Initially p� acres Ultimately v acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Kyes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture tJ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)?�yy, ❑ 9No list Yes If yes, agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? El M Yes No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE'MODIFICATION? El Yes nNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �r'� "r �� jr" ��I A� J 1 Applicant /sponsor ame: Date: Signature: &.A4 A I If the action is in the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment I OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1•C5? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS. THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTST- _Q Yes- ... ..-.. - _.._.._ _..r._._.. ..., .;. .. -, ., , - ^•,- ❑fJo° _ ff Yes,:expialn briefly., : -• - _ PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (I) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name oTLead Agency Date E OS -*c lqd �,,Jitie of Responsible © t , r �T J�It:,, iJ ignature of Prepare /.(, 'dliffgjon'�,frpt{t,*io6nsible officer) � r] 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: TR� WL-OW UPPOWOH 10 GOr4AF, "L6- APr bl�-- V,) 4 1TF pc A-) H, , lei' lO&o i 2. Name of project: LOF l . JHJO/ V10 4L 6719 4. Design Professional: HAWY W - H16 0 S ; X PE 3. Location TN: 5. Address: X111 6. Drainage Basin: EST 6F -AN&b4 7. Type of Project: �( Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision M -11Fe40141 GLoo(- To+q7z colmaA� 99NE $9Ew6TEP- P) 10,r7uw Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR)? Type Status check one Type I Exempt Type II Unlisted �K 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... NA 11. Name of Lead Agency N A 12. Is this project in an area under the control of local planning, zoning, or other officials; ordinances? ......... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? 40 Date granted: MP N 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... �' R 17. Waters index number (surface) ........................................... ............................... NA 18. Is project located near a public water supply system? ....... ............................... NO 19. If yes, name of water supply NA Distance to water supply NA 20. Is project site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system N A Distance to sewage system N4A 22. Date test holes observed S -�a " q& 23. Name of AgAh4dslyFtQr. 0, in NylH 24. Project design flow (gallons per day) Ofl L3d0 25. Is State Pollutant Discharge Elimination System ( SPDES) Prtnriz+`d`.. NU 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. r „Wetlands ID Number...'............ ............................... _ . _.. , .� _ _ .. �.... . 29. Is Wetlands Permit required? ................................ ............................... .......... NA h4 0 Has application been made to Town or Local DEC office? NA 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Mo 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No �4 o DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... YE5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... NO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... N 36. Tax Map ID Number .......................... ............................... Map O'y° Block Lot *58.1 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE:.All applications for review and-approval_of a new.S.STS- to.be located within �:Vater -shed shall .. - -.. be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal,�Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... _ '�l I CULLL TWYL WINMCA OP E—= ROWS l �� VA` ' _P "1. ' COU�TI?X DEPARTME P OF HF.tA, I H DIVISION. OF ENVIROt,!,, T HEAL rrI,_.- SEPVIC -rS DESIGN DATA ;SHEE71- 7SUPSUFACE SEWP.GE DISPOSAL SYSTEM Der'ler JO:SEP}i f- /1MGe -G pddxeSs to CO TiH6T--?—L - WI-4t c P(.AtipSA* 10601 Located at (Stxeet) Sec. 35 . -Block S Lot 38 . (indicate nearest cross street) municipality ?s�-r7 r- t�So r.s Watershed L,4s-r $x . x SOIL PERCOLATION TEST DATA -REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date. of, Percolation Test. HOLE NIU\ME R Cl= TDIE PERCOLATION PERCOLATION Run :.._ Elapse Depth to Hater Fran water. Level Z\b. Time Ground Surface In Inches Soil Rate 'Start-Stop Min. Start Stop- Drop In Min/In Drop Inches 'Inches Inches Q 1 x:43 )0;0 Z4 E 3 8 7 2 'lo .lo W,4o 3o ZO z z3 z 3 1 ©,o _ 3 'l0 41 H: I I. 3.0 Z•1• .... � 1 9:34 9; 4b �.Z. �.�._ - - •�.�. '... - ._•.._.'_... 3: ... ..: _. ' .- fi;;Cj- n - - 2 9'• 48 I o:07 1 Z) ... z4- 3 6 3 3 )o',08 la t Z(. 18 Z) Zq- 3 o e 5 estS to re peat ed depth .until , aQp c)>. r,,ately . �.al -so? 1 •rat -° s a,-e oC'r!ln�� c?ti %'.Ci'. G ^_l "COIz ?o test hole. All da ta t0 }j- .Stl illt ice' i!Y_3S11'_'Cl? !1tS `O S ]rte_^? , ] ,1 LQJ O� ill * . — - ., 14, INDICATE LEVEL AT mdICfj C__RoU\q);.RTER IS a�COLNTEp _,ED INDICATE Lvqkm.,TO. 1,1**R1CH---+,T4TF_R�-LEVEL RISES AFTER B:-,-ING ENcbutq--rERM N e M. BLJDZIA1gK1, P. 6-0 -4) DATE: DEE-11 HOLE OBSERVATIONS MADES f- r-", M4c_1 DESIGN' Soil Rate Used 8 - j o rJjn/l Drop: S. D. Usab16 Area Provided No. of Badxccms 4 Septic 'Tan}. Capacity Z'S o gals ., Type C_,ONC, Absorptiori Area Pro'v"ided By 4 4 4. L.F. x 24" width' trench, Other. Signature e s S J L L_ FA Mcm W_ L=- pp-c-c- Q_mm:r(zG,1 Sa61 'J"'I"J'S SPACE FOR USE BY HEU.TH DEPAIPM Et T U.,UY: "fps W b gal. Q y iecke& - _-'JIbDate 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of TI45 16N�-UO CO-F* TI 0 H Located at 4:5 i LV i A T/V FPrITF- P -60 0 gNp-,ow W 4 Tax Map # 4) w Subdivision of 'FA PLE6G Subdivision Lot # I Gentlemen: Filed Map # Block Lot �-_I b5 Date Filed 10121110 0 This letter is to authorize 14AW W,, N M 0 L� ; J • P5 a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public H_ eal_th Law, and the Putnam County Sanitary Code. Countersigne P.E., R.A., # Mailing Addi 6fL6 w/I; 8'V.. State R Zip 1 0609 Telephone: 11q- Vq - q X12 Very truly yours, Signed: v Mailing Address: l�� ► -ice � \�� State 1� W g zip—ID g2 0 Telephone: 12�k l 'A C 'g G X5311 Form LA -97 " o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES....' AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 1—° I 'FP<P-eiE 6Ub1)1g1 5i off TM I, 3 0 5 �� �► � PR`,c 5� represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: r- \ o W Having offices at: Whose Officers Are: 10601 President - Name: cep_P V ,Z esc_ Address: 1C) PL A4 c:i�H uJr�A Vice President - Name: sckc,.e_ Address: Secretary -Name: --Address: Treasurer - Name: Address: SG�c, Y 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 thereto. r°\ Signed Title: Sworn to before me this '31 day of IU&14� (month) ao-o -o (year) Notary Public CAROL K. BAGEN Notary Public, State of New Yo(I orporate Se No.' 5003 B 1 4 Qualified in Putnam County Commission Expires 11/02/00 Form CA -97 Harry W. Nichols Jr., P.E. 311 Clock Tower Commons :.. Route22__- .-.. ... Brewster' WY 10509 Telephone (914) 279 -4003 Fax (914) 279 -4567 To: (I.KV Attention:��� Date:l�ii��Q Job No.: O ' Mt_ Ql Project F—PcQ —GCE- RSV l %i co' "R` (� pa v j -)O� Gentlemen: We enclose ( ) copies of- B/W Prints Reproducibles Reports Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. S 1a: ent ur Messenger Your Messenger Copy to Blueprinter First Class Mail Special Delivery Hand Delivery Very truly yours, Harry c ols Jr., P.E. DIMENSION CHART in feet , l NT A g 3 9S, (sl 44` r0 :5' 43, 52' . 7 RO` 1o2.S' • � 9 8�': 97.5' = . � -�; • _ 93' 131 1V :: , 13 ��j2e5 14Q' .. .. • � ► � 132:5' ". 13�' , � T F I •.ii /5 0 �t I ' • _ ,•j � — i - (•rnre 0.tOR .LL,n4.D .T.16rH „ lip 7U P+Z -P - fro P• `�gg I wl�dil. WNthi'"R'PS la CH d 11 r - � N . •:47 � i { s � 7711, .s • of ti :. ,. ,.: i ` ? !. kx � - w S r. A. �� , p. � .V'! ����blQ�LiV•G'. 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