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Home My WebLink About2094DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.56 -1 -13 BOX 18 02094 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W.ell_LoeatigA - -- Strr:et Address: = Tawn/Village: - - - TiVGrid #` iMapo.,4BIock % Lot(s) Well Owner: Name: Address: kLI'—t11 Aeg 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 aft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials: YSteel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: 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 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 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type ezmdl,% Capacity 1 Depth Model ' Voltage 22,0 - HP Tan Type Volume _jhgaW o 20 2A4 Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prov' d on a separ ate heet/plan. Well Driller's Name Address: Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ._.,. -. ..... .y,, c \ ': . ? ^cK'1 1. fig.. q. .. ... „ ... ...... •7''; +{K'. -" :41 " .. ,.yr K "' 1'.t a t`J..rv-Ti y, h• Tu _ .S1O,N ® E V1R CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREAT1bSF;IV'I' SYS'I'EIdI _1PCHD CONSTRUCTION PERMIT # Located at 1. -A1-a Town or. Village Owner /Applicant Name �Zv 15 �� (141.1 ,•1 NI O Tax A�Iap i. 6 Block 1 Lot t � Formerly Subdivision.IVame �S 004 Subd.. I,ot. # Mailing Address °l 4 @�Lp qtr � %W r_ �� s �` Zip �. Date Construction Permit Issued by PCHD 101 4_ Separate..9e erage System built by 0 mo .1v1t ' Address ` Consisting of 1 �S D Gallon Septic Tank and . �� L f� , ,k16 9 -�1G•y Other. Requirements:Si1 -�(a. �IQ.1.1oa -9 Water'Sup l : - Public SupplyZOb�r`% Address m�a Private Supply Drilled by W 'El t. Lo, I0(, • Address 195 4 '�'S7 (, �(tt 1'05'!2.! _Biuldang. Type. _._., ..ipl -! Has erosion, comp YE Number of Bedrooms A- Has garbage grinder been installed? � 4 I I TI I I TAI ' 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 regulation's of the Puuiam CountibePartment of Health. Date: +1 VJ Certified by Address '�D e o K %I- P.E. )4 R.A. Profe�sigpal) �% ; License # Any person occupying premises served by the above systeM(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from Isueh 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 pf the Public Health Director, such` revocation, mo catio r change is necessary. Date: B Y Title• V % S � l�-- l� White copy - HD File; Yellow copy - Building Inspector; Pink. copy - Qwner; Orange copy - Design Professional Form CC -97 Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed Compliance: Marino 8 Rose Lane, Lor #7 (T)Patterson, TM# 36.56 -1 -13 Dear Mr. Nichols: May 20, 2002 Review of plans and other supporting documents submitted at this time relative to the above- regarded project has been completed. Comments are offered as.follows: _ 1. Final as-built inspection indicates that there is no silt fence for the well. 2. D -box requires a 90° elbow. 3. Well Completion Report does not note the duration of pump yield test. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Vey yours, v Robert Morris, P.E. Senior Public Health Engineer RM:tn Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 ' " "' • `_ 'Brewster, NY 10509 —" Telephone (845) 2794003 Fax (845) 2794567 April 30, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance - Marmo 7asperwoods, Lot # 7 8 Rose Lan e Patterson, New York Dear Robert : Enclosed are the foll owing: 1. 'Five (5) prints of Drawing SS -7, "As Built SSTS," dated 4/30/02. 2.. "Certificate of Construction Compliance for Sewage Treatment System," dated 4/30/02. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated ... _.. , _..41301 0 .._ 2., _.�.._._._. ^..4:... __.Lafioiafory Report's; 'dated`4 /18/02. - - _ _ • . - -- -_... _._ - - - -..... __.._ __ - �.._._ ...._... _ . _ _... _ � . _ . _ . 5. "Well Completion Report," dated 3/27/02. 6. Application Fee in the amount of $200.0 ayable to Putnam County Health Depart ment. 7. "E -911 Address Verification Form," dated 1/3/02. If there are any questions concerning the enclosed, please call . Very truly ours, r Harry W. Nich is Jr., P.E. HWN:JM:jmm 01 -0 41.00a BRUCE R. FOLEY * �.�►. liAltl. �.N,, 1�i.�.N•� k _ . AaroMeu PuNk NoaM' Dbvcra Dfrnra q/ -PO" &rikU DEPARTMENT OF HEALTH .1 Oereva .Road Brewster, -New Y,9 ,w 10509 z0*9oossnW,He4&h (914)`278 • gi39.1.1&410. 278.7921 Norsla6 Servlca (910278.63 {i WIC (911)278.6678 .F#X(914) 279.6013 Early'lo—kriWr6o'(914) 278%, 6014 '\Presabool (9L4)279-6082 Fa (916) 27r• 6648 E91.1 ADDRES§ VERIFICATION FORM OWNERS NAME; vos or) '11... . TAX MAP NUMBER:' E911 ADDRESS: TOWN: AUTHORIZED TOWN OMCIAL: (Signature .. ,DATE;'- - Piifnam" "County Department of Health will not' issue a Certificate of 'Construction Compliance unless the above form is completed;..i.e., alegal E91 -1 address is assigned by an authorized town official. This forbris-to be subtaitted' ." with the application fora Certificate of Construction Compliance. (E91 I VERFR _ PUTNAM. COUNTY DEPARTMENT OF HEALTH, I�IVISI0N _�Fxl� ' RONMEN-TAL HEALTH- �SER'�ICE =Sn � ^s. ,..• : v. .GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM. Owner or Purchaser of Building Building Constructed by Location - Street Building Type Tax Map Block Lot TownNillage 5 Pte- Vjoop� Subdivision Name Su.bdivisi6n 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: �_.:_.. operar..e_properly_is caused -by t ie- wi-llfW- or-negi- gent-act-bf 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 uti-liz -iirg the System. Dated: Month Day � Year �02 G neral Contractor•(Owner) - Signature Corporation Name (if corporation) Address: State /V. Zip Odd Signature: Title: PA �El /�l�G�' L-d�LY �c�.C7L I ►� 9 Corporation Name (if corporation) Address: PC, 16-0,k, �5-'3 State / y K..... Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . . FINAL SITE INSPECTION Date,4;' 98i- o I s ecte'x .�, _ tr acation- w- ....... - I ° y .- ,�,. � ma c =.- G- : i` m. ,2.� <�.- -, `0wrier Town Permit # 7f — 3 7!5 ^Q( TM € 3 G, S! - / —/ Subdivision Lot # 77 1. Sewage Svstein 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. SeN aQe System a. eptic t�an.k size - 1,000 ......:.1,25 .........other ................ b. Septic tank installed level ................ ............................... c. J0' minimum from foundation .......... ............................... _..- - 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches T Length required 8 pp Length installed ita) 2. Distance to watercourse measured -f- t Do Ft.......... . 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1 116 -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: Pipe a �PF d.....:...:.. ............ ............................... g. umn o ose stem ize mp 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.esfiinated flow /cycle............ III. HouseffluildLng a. liouse located per approved plans .............. ..... b. Number of bedrooms ...... .........................'�..,. . IV. Well e.< a: Well located as per approve plans.......... ... ..... 70-6,0M b. Distance from STS area measured -f- i d� 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 & dirto exist watercourse g Footing drains discharge away from STS area 4h Surface `water:protection'adequate; ....... :... :_ ........ i 'i.�Erosion control provided ......................... l� COMMENTS 1 V, -:� -i EMMI,��® TIMU", I/�FW I N" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IJEATLH SCR ICES. -:. T�x� FIELD ACTIVITY REPORTu� NAMF� OSTW7. ADDRESS: Z-A f Street Town State Zip PERSON IN CHARGE OR TNTFRVTF /a �q2 E] PUMP TEST 91,50SE TEST (D ° -Y REQUIRED GALLONS® S' 4 oel 6-x >c 7, V-0 :-- 3.8 g - EL. START _ oa A EL. STOP Signature and Title RF_PORT RFC'.FTVFT) RY, I acknowledge receipt of this report: SIGNATURE: 02/96 Tit Rev. APR -19 -2002 01:45 PM HARRY W NICHOLS - - -- - 914 279 4567 P -02 ... pUT'NAM CQUPIx7! WARTUM S � IDTMMN 01 ZNVMON> MAL SALT 4TTEN ION O ADAM GENE For: ,Fill AII Wormation MUlt be WYOmplctcd pdar to my Trtnchat .. -- Wspecdons Was gads, - Loceted, F-059 0"er /ApPUMtNerve; SubdMgon Nwu: '° = w� -L--- porcculy; — - 7 Subdii slop Lot # Is rystun fill complatad? Date: is sys<isn compute? Date: _ - �►,,.�_.._._.. is "cm conswotod.aa pec piRO? Is wendrWW? Y- Data:. + t6- - 02' Is wcU basted SS per plans? Are Croft control mmums in puce? i ca* tbat the sygem(sl as paced, at the above pct:mises has boa GOW Mtod aW i biv* i ?Mfd sad vcriLcd theft camnplation in wosdanee with the issucd PCHD Construction Permit cad spproved:plus* sod the Standards, Ruics sad Regulations of the Puttum County btpwment Of Diu, °�� ` — Certified by: PE . L e RA '' D Ptofcysioaal Address' ie - ,....._._..�,,. _, Cotumcati: • r ' Form Fitt -99 APR -19 -2002 FRI 00:58 TEL:845 -278 -7921 NAME: PUTNAM COUNTY DFPAI?TMFti-r nc o -, Public Health Director April 26, 2002 __ = LOREIT4 :�iC)L11�TARi R.N., M.S.N. " Y Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Marmo 8 Rose Lane, (T) Patterson Lot # 7, TM# 36.56 -1 -13 Dear Mr. Nichols The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. I., The distribution box inlet pipe need a 90° elbow. 2:. Silt fence is not installed below the well area. All silt fence must be properly installed prior to the start of any construction. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, E ll Gene D. Reed GDR:cj Environmental Health Engineering Aide �_.:._. BRUCE R. F4I,$X� Public Health Director April 26, 2002 DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA- MOL- INARI R.N:, -M.s.N. ; Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Marmo 8 Rose Lane, (T) Patterson Lot # 7, TM# 36.56 -1 -13 Dear Mr. Nichols The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: • , Silt fence is not installed below the well area. A formal notice of hearing may be issued if the violation is not corrected within 5 days. It is truly hoped that the above violations are corrected without having to take legal action. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR: cj SENDING CONFIRMATION. DATE : APR-28-2002 SUN 21:00 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE : 92794567 PAGES : 2/2 START TIME : APR-28 20:58 ELAPSED TIME : 01'13" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. 9wc1a IL FOLZV LORMA MOW wu &N., msX. AM& RwM Dei,ea. A.—J1 P.M. Y-M D&v�ear 1*. S.W- DEPARThMNT OF HEALTH I Geneva ROM BIW3101, New Yak 10509 mma.ea R.M ("s)"A - 6110 P.(445)271-7P21 wfC(B0)2M-6S7J P-(W)M-6M 1---r- (6/3)271.6014 6a (N3)271.6614 ft.d.d a" W-5912 F.(940212-6111 April 26.2002 HarryNichoL%PE PattemaPar1r. Suite 106 2050 Route 22 Brewster, Now York 10509 Ret - Field Inspection -Malmo 8 Rose Lam M Pattmon Lot 0 7, TIM 36.56 -1 -13 Dear 1&. Nichols The following item arc in violation ofArdetc lZ Section 2C of the Pumam County Sanitary Coda: • Silt ftee Is not installed below the well area A formal notice of eazing may be issued if the violation is not corrected within 5 days. It is truly hoped that the above violations no corrected without having to take legal action. very truly yours. Gene D. Reed Envirommental Health Engineering Aide GDP--cj ° SENDING CONFIRMATION DATE : APR -29 -2002 MON 01:08 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 2/2 START TIME : APR -29 01:06 ELAPSED TIME : 01'13" MODE : G3 RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. BRUCE R. FOM LORBTTA tv MWAw am., xs N, P.bfh Hra" Db— Apo= hMk NtalN nY'.ruar Deverw of ParlsN Sa.rav DIPPAR hEgNT OF HEALTH 1 0*Ma Road Brewahc, New York 10509 Lm— wa,w mw (a/s)1n -elt0 P4(45)171 -M1 nmq.a strolW l 27=-051 W[C(113)171 -[s78 F«(a1e)"s.eat grg Atenmeapeslln•es" ae(w)rn.eew Pr.a.d(a(5)21a -9911 1.(":n-et() April 26, 2002 Harry Nichols, PH Patterson Pgdt, S,dte 106 2050 Route 22 Browgter, New York 10509 Re: Field Inspection - Matmo 9 Rose Lane, ('I') Pattason Lot N 7, TMK 36.56.1 -13 Deer Mr• Nichols 17re following items are in violation of Article 111, Section 2C of the Putnam County Sanitary Code: Silt Gnoe is not IOVA ed below the well area A formal notice of hearing may be issued if the violation is not corrected within 5 days. It is ttttly hoped that the above violatians are coneeted without having to take legal action. Vcry Only yours, Crew D. Reed Bnviro=MW Hcabb Roginc=ing Aide ODR:cj YML. ENVIRONMENTAL. SERVICES 321 kear Street: Yor k:town H;i9tlt,, N.Y. 1059FI ( 91'4) 245-2Qi: 0 ' " _ Albert H. Padovani., Director LAD #a 93.200984 CLIENT #: 55391 NON STAT PROC PAGE 1 MARMO,. LOUIS DATE /TIME. TAKEN; 04/10/02 t:a:_ytOOP 20 BLOSSOM LANE DATE /TIME REC ' D :; 04/11/02 12:15P BREWSTER, IVY 10509 REPORT DATE 04 /18 /02 PHONE n (845)-490-0907 SAMPLING S I TE g 0 ROSE LANE. , BRE:WSTER , NY SAMPLE TYPE ..4 POTABLE n WELL- PORI' PRi- GERVAT I VE S a NONE COL ' D -BY,. LOUIS 141AR110 TEf' PERATURE i . ; `: 4C NOTES ... g COI_. I FORIyI MI :'1"H n III:- DATE FL_AS PROCEDURE RESULT NORMAL -- RANGE: METHOD PUTNAM CNTY PROFILE ()4/11/02 MF T. COL. I FORM . ABSENT /100 iriL ABSENT 1008 04/11/02 LEAD (IMS) 1.5 ppb 0 -•15 ppb 9101 04/11/02 NITRATE N I TROD 6.70 MG /I__ 0 - 10 9139 04/11/02 NITRITE: N I TROD <0.01 MG /L. N /A 9146 04/11/02 IRON (Fe) 0.066 MG /L 0-0.3 mg/1 2007 04/11/02 MANGANESE:: (Mn) •=:0.010 MG /L ( 7 -0 . , 3 mg / l 2037 04/11/02 SODIUM (Na) 6.61 MG /L_ N/A 04/11/02 pH 7.5 UNITS 6.5 -8.5 9043 04/11/02 HARDNESS , TOTAL 140 MG /I__ N/A 04/11/02 ALKALINITY (AS 118 MG /L N/A 04/11/x2 _.TURBIDITY (TUR <1 NTU 0-5 NT_t.l...._ COMMENTS BACT THESE= RESULTS INDICATE THA"f THE WATER (WAS) ( WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD I rHC:: 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 he potential.. _b l ic: 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 d:i et, the water should contain no more than 20 mg /L of Sodium. For those can moderately restricted diet, a maximum of 270 mg /L of Sodium / YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Y o�n ��!�wtLc�.,~r (914) 245-2800 ' Albert H. Padovani, Director LAB #: 93.200984 CLIENT #: 55391 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MARMO, LOUIS 20 BLOSSOM LANE BREWSTER, NY 10509 DATE/TIME TAKEN: 04/10/02 05:00P DATE/TIME REC'D: 04/11/02 12:15P REPORT DATE: 04/18/02 PHONE: (B45)-494-0987 SAMPLING SITE: 8 ROSE LANE, BREWSTER, NY SAMPLE TYPE..: POTABLE : WELL PORT PRESERVATIVES: NONE COL'D BY`: LOUIS MARMO TEMPERATURE..: < 4C NOTES...:' COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE' FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH ]S 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 CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, 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-�0MG/L��' VERY`HARD WATER A 300 MG/L-'' - ' MODERATELY HARD'WATEK:' 4 .'��G7(- - '�`| .~IG- AM PER LITER `----^' --^ SUBMITTED BY: Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 66NSTRuftic N'PERMIT ;rM- A- TMENT:SYS -EM= -�.�,., -- .. - PERMIT # 3 3 -O Located at s P 66 L xH 5 Subdivision name J_AA5V— VtiWJ 05 Date Subdivision Approved Subd. Lot # /(z/ eje Town or Village NTTEQ Tax Map Block ) Lot Renewal Revision Owner /Applicant Name �Q AS 4 KANLE_tW / W"O Date of Previous Approval Mailing Address 10 6146,6 I vin L/I N IF Zip 10 5 D 1 Amount of Fee Enclosed ' J� l�� Building Type �E4 @EM L-6 Lot Area No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of (Z�o gallon septic tank and � /`_ Lf- M5 Other Requirements: 00511,,P/► 5 (P f nt) To be constructed by Address Water Supply: Public Supply From Address Supply __ .. - , Pnvhte . Drilled by: _ _ ; ... _ . . _. .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 s, sti tem 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. X R.A. Date 6 t z-� I Address '7®�I F"� 2 `2- p"`l ZF.(Z l� j l�-2QiLicense # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage tr e t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modifieVte onside r essary by the Public Health Director. Any revision or alteration of the approved plan requires a new ppprov f discharge of domestic sanitary s77� By: Title: Date: A 0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location `' Street Address: °" ' "" ° Town /Village: Tax Grid'# Map oo Block tot(s) Well Owner: Name: 'Address: �14 019 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 Length below grade ft.' Diameter in. Weight per foot - 49 IbIft.: Materials: Steel _Plastic _Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other - Drive shoe: Yes _No Liner:_ Yes yNo Screen Details Diameter (in) Slot Size IL ength(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed _Pumped 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 sleye.artalyses�_ ^:. are available, please attach. De' the From Surface Water., . Bearing Well Diameter(in) Formation Description - ft. ft. Land Surface :' ` _ :.- jib. r _ . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type egadlA Capacity (h_ Depth Model Voltage 226 HP TatType Volume 9,j Lzlz 2- o Date Well Completed Putnam County Certification No. ' .. Date of Report well Dnl. r (signature), _ NOTE: Exact location of well with distances to at least two, permanent landmarks to be prow d on,.. separate sheet/plan. Well Driller's Name Address: Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ please print or type PCHD Permit # ' w� Well Location: Street Address: . TownNilla a Tax Grid # �j Ht-- I 0 E- L-N Map )b /� LBlock Lo t(s) Well Owner: Name: Lout ,5� Address: &05iom [-hi-t5 8 T -W 105ol 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 4- Est. of Daily Usage bgC gal - Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No No Is well located in a realty subdivision? ...................................... ............................... Yes Name of subdivision ) k QQ- \,fW 0S Lot No. Water Well Contractor: D Address: '--- -- Is Public Water Supply available to site? .................................. ............................... Yes No 'A Name of Public Water Supply: '-- Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separat sheet/plan. Date:_: _ Applicant. Signature: - v 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el driller certified by Putnam County. Date of Issue Permit Issui }ci�al: Date of Expiration' Title: (,,� %r"" Permit is Non- Transfe ale White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 APR -29 -2001 11:45 AM HARRY W NICHOLS "A BRUCE -k-1 Public &CDkwoor 914 279 4567 P.09 l =Ift PuNk H9M Amotor DEPARTMEW OF HEALTH 1 Geneva Road Brewster, New York 10509 % G. RM MOR EXAM ATTEN'T'ION: o ADAM S$'IEBELING ENE REED AN Information below must be fift completed prior to any scheduling. DA`T'E: J -2-7 - G ENGINEERORFIMI: :200 REASON: _PEEPS: . PERCS: MR' TEST: .o ROAD STREET: YES NO Proposed SSTS within the drainage basin of West Eranch or Eoyds Corner Reservoirs. Proposed SSTS within 500 feet of a reservoir, reservoir stem, or control lake. o ML Proposed SSTS within- 200_feet of o wstercourse-or a DEC Yy tlarl(L._ - � - P : Zi- 'Proposed SSTS.-desiiti flow greater than 1000 gallons/day or SPDES Permit required. o Proposed SSTS for a Commerical. Project. It is thi responsibility of the design, professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered j= to any of the questions, KYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witneso the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR CoUM USE o.4Nt.Y DOE: NAM: L 03 TV S=11M IMLOTEST) MCA - - 4 - - - - - - - - - - Mal Z078 NAM CO. " LAFAYET Hats tats mats ooroo� ;FIELD CO. NEW FAIRFIELD,CT Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 July 20, 2001 Harry Nichols, P. E. Patterson Park Suite 106 200 Route 22 Brewster, NY 110509 Re: Proposed SSTS: Marmo Rose Lane, Lot #7 (T) Patterson TM #36.56 -1 -13 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. 1. The minimum of 0.5 feet of fill is to be provided for the pri mary and expansion area: The fill is to extend 10 feet horizontally past the edge of any trench and slope 3:1 to grade. Upon. receipt of a submission, revised to reflect the above comments, this application will be considered further. Very tru ours, r ��tsL✓ Robert Morris, P. E. Senior Public Health Engineer RM/jp —S.. BRUCE - R.�._� eQ .._..a....., Public Health Director . ,._ - -� b��-t�1v10i;INARI •R.N.; R�I:S:N: .: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva • Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 July 20, 2001 Harry Nichols, P. E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Marino Rose Lane, Lot 7 (T) Patterson, TM #36.56 -1 -13 Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 6, 2001 is complete. The Department will notify you by August 10, 2001 of its determination. The Project has been delegated to the Putnam County Heath Department for review pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my .:attetuion.at theaabove. address._: This. notice :must -i'ik tide:Yddr'ti6rhie, the. location. of the - .project; - the' --. office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental s Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2166. Ver ly yours, Robert Morris, P. E. Sr. Pubic Health Engineer. RM/jp Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 ' Brewster Telephone (845) 2794003 Fax (845) 279-4567 June 26, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road ' Brewster, New York 10509 Re: Individual SSTS Jasper Woods - Lot # 7 Rose Lane Patterson T.M. # 36.56-1-13 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS-7, "Proposed SSTS," dated 6/26/01. 2. Short EAR 3. "Application for Approval of Plans for a Wastewater Disposal System," dated 6/26/01. ---:4-,--------"ConstructionPemlitfor Se, 4wd. 6126/01 -wage Qi.sppsal, System 5. "Application to Construct a Water Well," dated 6/26/01. 6. 'Design Data Sheet." 7. "Letter of Authorization." 8. Two (2) copies of residence floor Plan(s), for bedroom count only. 9. Review Fee in the amount of $300.00. If there are any questions concerning the enclosed, please call. Very truly yours, Harry WI.i c h o Is Jr., P.E. HWN:JM-jmm 01-041.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION „0XE )URONMNTAL HEALTH.SERVICES APPLICATYONYOR AIPPROVAL OFPLANS�'OR ��tV_ A WASTEWATER .TREATMENT. SYSTEM 1. Name and address of app cant :. 2. Name of project: 3: Loeatton T/V: 4. Design "Professio Address: P60 6. Drainage Basin: ■;.. a .. . 7. J, aey, of ProjM; Private%Resideotial Food Service Commercial Apartments „ Institutional .. Mobile Home Park ' '" Office Building Realty Subdivision Other (.$pccify). 8. Is. this project subjcct,tg StatedEnvironmsntal Quality Review (SEQR)?,'•? Type Status (cl}eck one)....,,.....,;......., ..• ................,..:......., , Type I Exempt Type II Unlisted:•” 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed "and found acce table b Lead Agency? ..............,.. .." .. P Y 11. Name of Lead Agency = f 4A • •• .111 .. , •:ir�' _ �_1,2 :�'Is:this.project"m an area under the control -o flocal-plannmg, zoning, of officials, ordinances ? .......................... ........... .......•........,......,....,.. 13. If so, o hate; pleas <beeasubraitted i'such ..c . ., . •,�• - ,- „:'. .... X14 14: Has preliminaryDp ;oval beeii'granted by such authorities? (� Date granted• ' [J 15. Type of Sew age_Treatment System Discharge:: : :::::.::.::;_,_, surface water A ” groundwater 16. If surface water dischar a what s,tho :stream class designation? :::;.. : ::..: „ 8.,.. �. 17. Waters older number (surface) .,.:::..:: � .:..:.:.:.:.:...:............:::: :::.: :.................... :.... . Iv 18. Is project located near a public water supply system? ........ ...........+..........:...•...� 19. If yes,.name ofwater supply` ` l Distance,to water supply (� 20. Is project site`near a publiC' ewage collection or treatmenfsystem? 21. Name of sewage system N Distance to sewage-' system N C 22. Date test holes observed-` 0 23. Name of Health Inspector 6 &H5 READ 24. Project design flow(gallonsper :.......................... .......................:..::... �•� . 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES 'Applicatiaa been subnutted to 'local DEC office? .:.- .....::.:.:....:.:... -P� 2 2 7. Is any portion of this project located within a designated Town or State wetland? 0 28. Wetlands ID Number _ n _ �4 ,. ,r.r. .: .. 0?! eyy, ��.. �g0, }�O,..i.r�eea,e.�.o...osf.. eoote eoo. e000PO'0'OVOado'00o'O0O000oo6ob 00di'oo /'0'o 80eoo so.o�i'.' "'' �� " 29. Is Wetlands Permit required? .:: .:......:.::............ ........ ............ :.......................... a Has application been made to Town of Local DEC office? ........................... 0 3 0., Does. project .require a DEC- Stream Disturbance Permit? ............................... 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'Mustrial activity? .: .. ......................... Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................................ Yes/No DESCRIBE: 33. I s there a local master plan oa file with the Town or Village? ....... .. .........:..: by 34. Are community water and/or, sewer facilities planned to be developed within. - 15 ye rs-M or adjacent to project site? ................................ ............................. .1. IJ\D 3 5'. Are any sewage treatment areas in excess of 15% slope? ........... ......,..........�... NO 36. Tax Map ID Number .......................... ............................... Map &,` .t Block Lot 37. Approved plans are.to_be returned to..,..., Applicant "NOTE: All applications for ieview and a'p' proval of a new SSTS to be located within the NYC, Watershed 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,Deparunent. :Projects within: the watershed may.also require DEP review and approval'of other aspects of a project, such as stormwate.r plans or the creation of impervious surfaces, and the projeet"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 OM. the applicant shown in Item 1.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to eomply'with this provision may be grounds for the rejection df any submission. I hereby affirm, under penalty of perjury, 1/1 at information provided on this form is tree to the best of my knowledge,and bellefe False statements made herein are punishable as a Class A .misdemeanor pursuant to-See l n 2210. -S-of the Penal w. r1 SIGNATURES & :OFFICIAL TITLES: ` Mailing Address, ..... .: �� ...................... 2�� =,L, 2�- - PUTNAM COUNTY DEPARTMENT OF HEALTH - -- DIVISION OF ENVIRONMENTAL EALTH . L �� H E.R'V. ,ICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM � Owner Louti� ` Ft�M . Address m B ," 1 Located at (Street). Ljc� `.1 JMQeg-R,�D, Tax Mape��15� Block Lot (indicate'nea.rest cross street) Municipality �ATI J�FR_, Jc) H Watershed SOIL PERCOLATION TEST DATA 51 %0 0" Date of Pre-soaking � - � Date of Percolation Test:. _. .. . .! . .. . . {. .. . Y : : yr V . •i + ^.'•yi + +. ..'..` ::;�y3u�.{'Y . .I:{•✓ XT':i�:� ;� <:r. ' ��y'1"��/1t[. :�1) : :,,yv,�s+ X �}� { P erctila �: Hole No i 2 2 h his bo 4 . . _. .. 2 t tool_ � ` o o -� 3A . .... 1 140 ( 4 S 2 4 5 N 0TT'.0 1 T Tc is t bo c s o repeat at same epth until approximately equal percolation rates e.re obtained at each percolation test hole. (i.e. s 1 min for. 1-30 mWinch, s 2 min for 31 -60 rniii%inch) All data to be submitted for review. '.. Depth measurements to be made from top of ho1c. TEST PIT DATA DE SCRiPTiON•O..F'SO,ILS ENCOUNTERED Y.KTES'T HOLES DEPTH, 1-IQE;:NC �l iL.E-NO..: - �._ HOLE NO.. _ - - _.. - - tu 'tip MeD 1.5' 2.01 SR - 3.0' _ ;.5' Y, 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' Ell - " , I nuin - T Indicate level at which groundwater is encountered Ind-icate level -at which mottling is observed 'rzt--lb ' Indicate level to which water level rises after.being encountered Deep hole observations made by;r N�o��, ; �' Lro Date Design Professional Name: RAWTJ, N�Udbt.s Address: Signature: Design Professional's Seal NJ Clio s �z Uj C1 , W No. 66124 �oA�OFESStO�P`• 11.164 WW)—T- *4 12 PROJECT .IA. NUMIBEA:. �SEQR Suite lEnvironmental Quality Review] . . SHORT ENVIRONMENTAL ASSESSMENT FORM For UNL18T -EP �1CTIQNS.Only, PART 1— PROJECT INFORMATION fro be completed by Applioant or. Project sponsor? ` 1. APPLICANT )SPONSOR f, L EEC - dip Z. PROJECT NAME Lo-r . -1 _ 4,7t?l"�..: S. PROJECT LOCATWIk F' + 1 1''� P HA M MU11101pift . . 4 : Coon 1. PRECISE LOCATION .0 addraN and road Interaeottona, prominent Iandmarla, eto., or provide map) .... �,. N. ❑ Expanalon ❑ ModllloatloNalteratbn 6.' DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF D �— InIWIy aces UIUM091Y acne 8.: WLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING MND USE RESTRICTIONS? Ja lrea ❑ No If N% dworibe brlally . '` ..o , • : ;, :;. , 9. WHAT 18 PRESENT LAND USE IN VICINITY OF PROJ#Ci7 Qoinmerclal Park)FareattOpen•spaco- - Q Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCALV • [1Y" No If Via, )tat apenoM and pem VeWovale .. . 11. DOES ANY AVWOF THE ACTION HAVE X CURIMMY VALID PERMR OR APPROVALt ;., :. .. Yaa No �,�. �ri1' Wt,.,�►ay � ar►d WtmlUapProvy.. .. ,:, , u. As A RESULT OhF� PRO?dBED AGTION,WILL EXISTING PEAMRIA!'PR0IIAL REQUIRE MODIFICATION? DYa '. �TNo h . : -. 1 CER'TiIFY THAT THE INn�FOiRMATnION PROVIDED'ABOVE IS TRUE To THE BE/1S/T OF MY KNOMJLEDGE.. , ' ' " ` ' + "1 ' J ✓a 1 ' J V P E t 1 7 t t�1,eHr . )►DpllcanNaponacr natm�c oat« Slpnatur« If the action Is in the..Coastal Area, and you are a..stgtt agency, complete the . Coastal Assessment Form before proceeding with -'this assessment. AVER. PUTNAM COUNTY DEPARTMENT. OF HEALTH LETTER OF AUTHORIZATION RE: Property of Located at LAS � TN Tax Map # '�J (� � �y �O Block Lot Subdivision of Subdivision Lot # r Filed Map # '�� Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect _ to apply for the required wastewater treatinent and/or water supply permits) to serve the above-noted property In accordance with the standards, rt les or r gWations. as promulgated by the Public. Kaalth Director of the Putnam �C.9tatLty: Health .DGpar tea :.and: io_ Igit -all . necessar _ y.- papers ion my behalf in-coamection with this maser 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 1-iealth Law, and the Putnam Co_�__unty Sanitary Code. / of NEW r 9 NICHp�� Countersigned P.E., R.A., # ..: Mailing Ad Very truly yours, Signed: L _ (Owner orpmPC y) r State Zip Telephone: (�� " Mailing Address: 20 BL-05s w\ \ CR9L-- State \Ay Zi p `Osoci Tcle P hone:64"� 1 61-1 - :•II. tip•: r•�lH : •;r•r r/ I• r BATH ~ ' BEDROOM A \ .,• ')I. DRESSING• BEDROOM J. �. WALK' 17' -0" x 1 0' -0" "� 1 ..IN \ CLOSET _ aL MASTER BEDROOM BEDROOM 2 OPEN N 17'-0 a 16,.8** 11' 0' • x 15..8 1 quTlAkM COUNTY DEPARTMENT H F HEALT ROUS L� APPROVED FOR BEDROOM! COUNT ONLY, - - -- _ _.__...�.L.�. -- SECOND F L O.O R BEDROOMS 4828 =. •13 4 4 S F ALL SqrkEQUEN RI TiONS TO THESE HOUSE 12CIn011 FOR 4 PPROVAL i _ 0. r - - Si -aft •IT E DATE Cj(- �. �• •• KITCHENK•��/ DINING ROOM p MORNING AGOM ~� 1.7 07 w 12.,0•. IN • ', /� mil" • —' Lam. !i r.. •.. � .� - \ . �. .. _ -t OPEN ABOVE - LIVING MOOM FAUILY PIOOM 17 0 • x 1 i'•0" 17' 0" a 17' 0- FOYEM �• FIRST FLOG fi PUTNAM COUNTY DEPARTNIE \Z OF HEALTH DIVISION OF ENWIRONNIENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SENVAGE TREATDIENT SYSTEiNIS NAME OF O7Y. R: REVIEWED RM, DOCUI• i'TS PERMIT APPLICATION STREET LOCATION:w4 AS, SRDATE: TAX 1`LAPe: (CONFIR%iED) �� l ELL PERMIT OR PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAT ((__)PLANS -THREE SETS (U(UHOUSE PLANS - TWO SETS (_)(_)VARLANCE REQUEST l / SUBDIVISION Z UULEGAL SUBDIVISION UUSUBDIVISION APP AiV C hED L,(�PERC RATE ' U(__)FILL REQUIRED H UUCURTAIN DRAIN R IRED GENERAL L)LOCATED IN NYC WATERSHED ( / u )PLANS SUB�ITTTED TO DEP / DELEGATED TO PCHD ( .. DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED . LPERCS TO BE WITNESSED . (0, )EX- APPROVAL SSDS ADJ, LOTS LJ(WETLANDS (TOWN/DEC PERMIT REQ'D ?) (� DATA ON DDS PLANS & PERMIT SAME L:_:':�JPRE 1969 NEIGHBOR NOTIFICATION L LETTER BUZBA. - _.- .- ....... - . •..�...' ,�- ��100 YR ..FL'OODE%;RVATYO'`t i" //i20`J'- �`:—�:.:: 1' (REOUiRED DETAILS ON PLA \S CON'T'Dl /(�(6HOUSE SEWER -' /l' FT. 4"0'; TYPE PIPE CAST IRON UNO BENDS; DIAX BENDS 45o W /CLEANOUT 1110'- . RENEWALS 10' HORIZONTAL; PAS RENCH SLOPES 3:1 TO GRADE EILLSPFZSF- OTES 1 -5 FILL PROFILE & DIMENSIONS IN EXPANSION AREA FILL GREATER TITAX2 FEET CLAY BARRIER CERTIFICATION NOTE 'TH GAUGES .. ON PLAN FORRO.B.,UNCLASSIFIED & INIPERVIOUS ARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED (� DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL C_ILJGEOTEXTrLE COVER SEPARATION" DISTA`i CES ON PLAN - FROM SSTS )10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' 0 FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS L X100' TO STREAINI, WATERCOURSE, LAKE (Inc. espau) (__) 50' TO CATCH BASIN, 35' STORRtiIDRAN, PIPED WATER 10'TO.WATERLINE (pits -20') _....,.� ....t._,•--- .:..__._ ._ _ -. 1 LJ50 LN TER�tii�i ?Ei�T DRAL`IaGE COiIR$E � -~ ' ^ �ry -• �r TOIL TESTING LOTS >10 YEARS OLD L_)( _)200'i500' RESERVOIR, ETC._ 150' GALLEY SYSTEMS tEOUTRED DETAILS ON PLANS 10' tiILY TO LEDGE OUTCROP SEWAGE SYSTEM PLAN - (NORTH ARROW) U SEPTIC TANK SSDS HYDRAULIC PROFILE (�( 10' FR0�1 FOUNDATION; 50' TO WELL GRAVITY FLOW WELL CONSTRUCTION NOTES 1 -15 DIMENSIONS TO PROPERTY LNES DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION 2' CONTOURS EXISTING & PROPOSED U MLN 15' TO PROPERTY LINE DRIVEWAY & SLOPES, CUT ' SLOPE FOOTING /GUTTER/CURTAIN DRAINS o (USDA SOIL TYPE BOUNDARIES SLOPE IN SSTS AREA (520 /o) ITITLE BLOCK; OWNERS NAME ADDRESS UUREGRADED TO 15 %, IF REQUIRED TMn, PE/RA; NAME, ADDRESS, PHONES DOSE/PUh1P SYSTEMS )DATE OF DRAWINGIREVISION (/ )KJDATUM REFERENCE L� LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (�V )PROPOSED FINISH FLOOR AND / BASEMENT ELEVATIONS WELLS &. SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS L _)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE CONINIENTS: (ItEVSIiEET)09 101 /00 L j( _JPUjiP NOTES U( _JD,OSE 75% OF PIPE VOLUNIE/DOSE VOLUME NOTED L� ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED LJ(U1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN (�( STANDPIPES, 5' BOTH SIDES, DETAIL Lj 15' D1L`4 to CDS= >S %, 20'A%, 25'-3%,35'-1%, 100%-<I% Lj 20' Nn. 'N to CD DISCHARGE /100' ivith 182 cons day discharge (�( -10' INIIIN to NON - PERFORATED PIPE PUTNAWCOUNTY. DEPARTMENT OF HEALTH ,DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner AfAjrl ow Address C Block'- Located at (Street). t7,ofsp,53Z Tax Map 36,576 Lot 3 (indicate nearest cross street) Municipality B4:ff gjjz5,28Z Watershed 61¢, i 131Z#Ale,14 SOIL PERCOLATION TEST DATA Date of Pre-soaking 5 3oz-n I Date of Percolation Test Z -5 ....... . . . a............ ........... .. .......... . . . . ... ...... .... ..... . . .... I . . .................... . 4 .3 4 F-1 5 NOTES: 1. Tests to be repeated at same depth until approximately equal, percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made. from top of hole. Form DD-97 /091 1tv 2 3 11;17 - 11;47 o 10 4 5 . ...... A0 T- 7/ !!7 7,7 4 .3 4 F-1 5 NOTES: 1. Tests to be repeated at same depth until approximately equal, percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made. from top of hole. Form DD-97 3 TEST PIT DATA r .2. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH �� HOLE N0. HOLE NO. HOLE NO. G.L. 1.0' 2.0' -1 1m�wi 2.5' 3.0' 3.5' 4.0' :._ . ......... .. . . . . h . 6.0''. 6.5' ry.E 70 ate, x, 7.5' _.. :. - - -- -- - -- :8.5' - --- - - - - -- - - - -- --- ._._ -.. -- - - - - -- - - -- -: -... - --------- -..... - - -- - - - -- - - - - - - - -- - - -- -- - 90' _..:._.___... - -- _ . ...__ -.. _.__..__ — - - -- - -- -_ - _ _...._._..._. 10.0' Indicate level at which -groundwater is encountered - - -- -- - - — Indicate level at which_ mottling is: observed_.. -__ Indicate level to which water level rises after being encountered . Deep hole observations made by: C, -F F- C n j—,,!::--, D, H . Date. S 31 o Design Professional Name: Address: Signature:. Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH., -D SION OF ENVIRONMENT AL,'HEALTH SERVICES INITIAL I OWMAL /COMMERCIAL SITE INSPECTION FORM SECTION A.,,�GENERAL INFORMATION - - - - Name of Project _ 11-jzIA-Al (T)(V) _7>41'rEizS,oAZ County PaLV¢ Site Location 'Zcx,- g5 G,* ,y&— Building construction begun A10 Extent `-- Is prorty within NYC Watershed ? ................. Yes No SECTION B. TOPOGRAPHY (Please check all appropria bones) 1.. _ illy Rollin Steep slope.. e_-_ -Flat 2. F__J Evidence of wetlands a Low area subject to flooding Bodies of water Drainage-ditches Q Rock outcrops L�l y v c e- 3ovlt(e rS 3. Property ' 0 Yes No lines or corners evident .:..................... ............................... - 4.--Dowater courses exist on or ad'om the roe a Yes No 1 P P rty? ........... ...... 5. Will these affect the design of the sewage system facilities ?............ a Y s No 6.--Do watershed regulations apply in this development ?.:�.::::::: :::� -- Yes F IR6 7 Will extensive grading be necessaryT. —. -, : _ Yes_ .N _ . _ .._ :__._..... -7 Will extensive fill be necessary for S STS? ......... .... .I.......................... 0 Yes No 9. Do filled areas exist within the SSTS - area ? ............. F__J Yes No If _yes, what is the condition of the fill? SECTION C. SOIL OBSE VATIONS - -10.— Appearance of soil: Sand _0 Gravel a Loam F-_� Clay. Hardpan Q Mixture 11. Observed from: 0 Borings F__J Bank cut Backhoe excavations .12. Soil borings/excavations observed by. 461 %� EEt� };C ,1j, j/� on 13. Depth to groundwater on 14. Depth to mottling n/oeV� 62,1ryD on 15. Are test holes representative of primary & reserve areas ...... ............................. ... 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by G, Tzo�, -h J'�� G� ij�H, on SECTION D (on back) Form ST -1 9 v PA SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 s No 19. Will groundwater or surface drainage require special consideration? ............... Yes F-eN 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes SECTION E. REMARKS 21. • If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? .......................... ............................... 0 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist?; ::::::.............. .......... .................. ... Yes � No 23. Additional comments •t 'Ro -posE_:"p 24. Site observer/inspector and title -- - ' 25.JDate(s) of observation(s)inspection(s) 3.0 TEST PIT PROFILES - -- - Hole # Lot # " :_ --Hole # _. _ .----Lot #. : -..- -_Hole # Depth to water _ - Depth to water - Depth to water - - - " - - -" -- - Depth to mottling Depth to mottling, - Depth to mottling ` Depth to rock/imp. 'Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 7.0 0.5 - - - -- . -..- 0.5 7.0 1.0 . _- _._ 1.0 .:.1.0. 2 0 - ------ 2 0 3.0 3.0 . 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Sheet i of - PUTNAM COUNTY DEPARTMENT OF HEALTH VIRONNl�11WI L HEEL) .L11 S..i�, IC FIELD ACTIVITY REPORT NAW., TPl• AmRESS: ro545 L. 7'477- s ^,J /f-11 Street Town State Zip PERSON IN CHARGE nR INTTFR VIFWRT). .41, / /� /!oL S i� ,E T)atP -30101 Name and Title TYPE OF FACILITY: S, S, j S e FINDINGS: AJ01--- .z z,— v'7a r.. -... }.,. p... �__ •..- w+ �:. �-...^. �... >_....- ...- .r...- .- .....•. -..-. ...e.....- .. - -.. �. -� -.�- . »_. .. -... � -.P • �.+. r.... i.� .q. .. —_._. ..._�..- .�.... � •�.r -.._. w...._. 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