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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 39. -1-4 BOX 19 02203 I LI , �ti ,� r ,, U76% r k,-I, , 02203 \16� PUTNAM COUNTY DEPARTMENT OF HEALTH ,z-, 2 HE. IMISERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWA SYSTEM PCHD CONSTRUCTION PERMIT # Located at 'Zlo z✓fe-D 1 Town c- illag®, R Tai, '^'l vac - Owner /Applicant Name IrV53e t ( ZX--'55e -t Tax Map $17 Block t Lot 4- - Formerly J&A;ut5 AS soft Subdivision Name Mailing Address x'19, fox 3 F Subd. Lot # A.) Zip 140 5-1 ,. Date Construction Permit Issued by PCHD 8 —1 d Separate Sewerage System built by 144011 i . oec,s Address Consisting of It 2aO Gallon Septic Tank and �� L 5� 'Z•`ar e 1aC. �.�..� %•ts Other Requirements: Water Supply: Public Supply From. Address or: ✓ Private Supply Drilled by (ft"tc k,-5� va 81-as, Address 12- t t 0. A, R lam. BWl&tTg Type- ` -5 r—. L. _.._... __ Has- erosion control-been completed ._ _. ` �S.. _ ......._...._ __ ...:..._.... Number of Bedrooms 4 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 County Deppment of Health. Date: l = a© Certified P.E. 41"� <l1c° Address 74- , i-2� =� �'©�i % , uu �l� License # 4166 2 r r�� a 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 a]pprovals are subject to modification or change when, in the judgment of the Public Health Director, such rev oc o modif ati n or c an s necessary. B� Title: +}-rte Date: 1111 o )Mite copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 a 1C 11.1T1VAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: To P -f L� Tax Grid # Map Block I Lot(s) 4- Well Owner: Nam • Address: Use of Well: D- 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 ft. Length below grade _Li o ft. Diameter in. Weight per foot J�lb /ft. Materials: / Steel _ Plastic _ Other Joints: _ Welded J Threaded _ Other Seal: _ Ceme t 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 Z 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 ° Joe) • 3/ ,t.r a ,,w Ll o N g3 —6 eK r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type_ L,)I Capacity i Depth is:' Model O)qh, Voltage MV IP Tank Type 0. Volume JIL Z Date Well �Cyompletead� Putnam County Certification No. Date of Report W I Driller (si tur NOTE: Exact location of well witfl distances to at least two permanent landmarks to be provided on a separate sheevptan. lI /1 d d 4L9AV , PCs i4d Well Driller's Ine � 1 %- Al i"oS Address: N N Signature: Date: Z White copy: HID File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 c Federal Id: Collected by: Inorganics Analysis Data Sheet Form I IN Client Name: RUSSELL. ROESSEL Project Name: STANDARD STL Sample Number: 211115.01 Client I.D.: 766 RT 301 COLD SPRING BATHROOM Date Collected: 13- DEC -99 Matrix: 1 DrinkH2O Date Received: 14- DEC -99 Comments: PAID Analysis Result Units Method Analyzed Alkalinity 70.4 MG /L 2320 B 22- DEC .99 ECOLI ABSENT /100 MLS 9223 14-DEC-99 Lron 60.0 U UG /L 200.7 23- DEC -99 Lead 1.0 UG /L 3113 16- DEC -99 Manganese 26.2 UG /L 200.7 23- DEC -99 Nitrate (N) 0.4 U MG /I_ 300 16- DEC -99 Nitrite (N) 0.01 U MG /L 4500 -NO2 B 15- DEC -99 Sodium 5.9 MG /L 200.7 23- DEC -99 -total Coliform ABSENT /100 MLS 9223 14- DEC -99 Total Hardness 76.6 MG /L 200.7 23- DEC -99 Turbidity 0.29 TU 2130 -B 15- DEC -99 PH 7.9 4500 -HB 14- DEC -99 Remarks: 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562.0890 17 .a a�....�.... ;._,. - plyis a. Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Pro gram. (ELAP)." i I IN .i:v \ %:ij :;. +:v: tii i. ti:..' {...:$::; } :::....:.:... . ,; }.....; ..:A n •`:iii• } %i•ti ::' wj. }: }: $: :.... ..h.. i;L :v v,'. {p ONTAMINANT MCL (1)(4)(5) C form bacteria Any positive result is unsatisfactory Le 0.015 mg/l (15 up Nitra s 10 mg/l as N 4ites 1 mg/1 as N I n 0.3 mg/1 anganese 0.3 mg/l I59n plus manganese 0.5 mg/1 Sodium No designated limit (2) pH _ _ .—No designated limit..'. a ness No designated limit Alk unity No designated limit urbidity 5 NTU (3) NOTES: (1) .Makimum contaminant level. (2) Water containing more than 20 mg/l of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Tur PUTNAM COUNTY DEPARTMENT OF HEAL' (4) mg/1 means milligram per liter. J DIVISION OF ENVIRONMENTAL HEALTH SERVIC: .(5) ug/1 means microgram per liter. y � ADAM S. STIEBELING ASST. PUBLIC HEALTH ENGINEER 4 GENEVA ROAD PHONE (914) 278 -6130 Ext.1 BREWSTER. NEW YORK 10509 FAX (914) 278-79 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION O F ENVIRONMENTAL HEALTH SERVICE'S' ' GUARANTEE: OF SLIBSURFACE.SEWAGE TREATMENT SYSTEM J v e- ss el 3r-t Owaci - Tax Map Block Lot _ D�IWLer- C_C Building Constructed b`° 1 TownA44a;e 7eo(0 3 e .Cold �� _ N y �.: k �-s s sack Location - Street 1155/6. Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and -ompletely. res- p._,nsible for the location, workmanship, material, construction and drainage of the selvage treatment %stem serving the above - described property, and that is has been constructed as shown on the appr, ed plan or approved amendment thereto, and in accordance with the standards, rules and regulation: of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heir,, or assigns, to place in good operating condition any part of said iystcrn constructed ,-by me wvh, :,:h fails to operate for a period ,of two years immediately follo%� in` the date of approval of the '"Certificate of Construction- Compliance" for the sewage treatment sv,ten ,, or any repairs made by me to such system, except where the failure to o erate ro erty is caused b� tYie «illtitl or rieeliQ�i� p p p •�• " i'act-of the occ :upant-of the building-utilizing-the- system. The undersigned further agreCs to accept as cot.Ju,ive the determination of the Public Health Director of the Putnam County Departn :, nt ot'Yle. :.ti; as to whether or not the failure of the system to operate was caused by th:: l!ti:! :... :.: ,1,,; ,,f the oecupant of the building utilizing the system. Dated: Month. _ Day Year' l Signature: ?,D • � -' � %;G� � • � :�,- Title: u — General Contractor (Owner) - Siyn, :tore Corporation Name (if corporatior Corporation Name (if corporation) Address: _ ��1 .. 4 Address: State _ /ip State /l) y Zip Fofm GS -97 7 FROM ° Putnam Co o Health Dept. LAWRENCE BELLUSC9®, P? E° Dv of Envrnm'tl H' lth Sv's 92 Perks Blvd. 1 Geneva Rd. Cold Spring, NY 10516 �fau49� &5;9342 Attn: Adam Stiebeling, A,P.H.E. Re: Roessel - Cer;tif of Compliance SUBJECT TM# 39 -1 -4, Putnam Valley DATE Jan 5, 2000 Dear Mr. Stiebelings Enclosed please find the support documentation for the above referenced. If you have any question or need clarification on any detail, please contact me at the above telo no00 very-truly yours, Lawrence Belluscio Inclso (1)- $200,00 Mo0, (3) GS -97 (3) As -built dwgso (1) CC -97 (1) WC -97 (1) Water Analysis Report cc: Rus Roessel, Applicant rs L._,.. _. ... ...- �._•-_._ ...._._.._...._�-- ,...._�.... -. _. 'y- -_. -... _. _..... ... _. ......._ _..... .. . SIGNED.._ -. ... .. ._.... _...._ _�.... _.__. .. - .. -.__.. _.... _. ... •- I PUTNAM COUNTY DEPARTiMENT OF HEALTH DIVISION OF ENVIRONI NMENTAL HEALTH, SERVICES FINAL SITE I1'SPECTION DLte: % �f Street Location nspecte Permit r v Tir�1 M 1 — Subdivision Lot r NA 1. Seivage System Area a. STS area located as per approved plans ........................... . b. Fill section - date of placement 3:1 barrier Loth. 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. Seivagge System a. !Septic tank size -1,000 :.. �1,250 other ................ ... ..... b . Septic tank installed level ................ ............................... c. 10' minimum from foundation ........ :................................ d. Distribtuion Box 1. All outlets, at same elevation-water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction. Boo. - ,properly set ...................... ................................ �-1. Lena required Length installed 2. Distance to watercourse measured Ft...'11 . 3. Installed according to plan ..................:. 4. Slope of trench acc wable 1/16 T foot ............. 5. 10 ft. from ged;.. - 0 ft. -, undaf ns.......... 6. Depth of trees o urfa .... 7. Room allow sio % ........................ 8. Size of grav di er clean...: ...... 9. Depth of gr12 �. `.. 10...Pij z ends cat' ............................ "D -ose.... , .. , ... �..._..... r. a. v14b V1 r/LL111y V11 CU.1LV V 1..... ..... ............................... 1 �� v'•v 2. Overflow tank. ... ............. 3. Alarm, visu io ............... 4. Pump easil acc ible; m ole to grade ................. 5. First-box baffled... ..................... ............................'.. 6. Cycle witnessed by D.estimated flowlcyc . . III. HouseBuilding a. house locatEd per appro d plans b. Number of bedrooms .................. IV. Well a7—Well located as per app ' ans........... ,,�,.... . b. Distance from STS area measured 2i .. c. Casing 18" above grade .............. d. Surface drainage around w a a' e.. ........... 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" diame r ............:. e. Curtain drain & standpipes installed accordi g to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area .............:. h. Surface water protection adequate ................................ :. LOOO 5Z i. Erosion control provided ............... ..............................„ Rev. 1197 N 10/18/1999 07 :50 t � J �C Is, Is Is Is Is At I ()t .Hr <r i' �Ay PUTNAM COUNTY DEPARTMENT OF HEALTH [VISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM vy Located at I tot V I I Town or Village Pw)LCV+� Subdivision name Date Subdivision Approved Subd. Lot # Tax Map 3A Block ( Lot 1f Owner /Applicant Name ' R NKed Renewal Revision Date of Previous Approval Mailing Address (4* R I " Zip 10 �Vb Amount of Fee Enclosed 4 goo Building Type 1-r- O At*6f Lot Area 8 .t 3 No. of Bedrooms �_ Design Flow GPD So u Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 17150 gallon septic tank and 14,g d 13 jglk ALL 7_S Other Requirements: To be constructed by - koos 4- So AJ 5 Address .WAX Water Supply: - aSupply.From Address or: Private Supply 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 system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. ` R.A. Date 116k Address 241 kx�. , Ne�ls`�v�+4 License # X3736 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 when considered necessary b the Public Health Director. Any revision or alteration of the approved plan requires a new it. jj7ed f r isc arg of domestic sanitary sew ge only. L By: Title: Date: e/to/93! White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 IFUTNAM (COUNTY DEPARTMENT OF HEALTH DRgSRON OF 1ENVRROIMlENTAIL HEALTH SERWCES APPLICATION TO CONSTRUCT A WATER WELL . 1.. qC� y- _r 1.1. — 1...... _ > 1 u3 please print or type PCHD Permit # � :) `� / / . , , Well ]Location: Street Address: Town/Village Tax Grid # Map v61 Block Lots) Well Owner: Name: Address: 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 u, S gpm # People Served 5 Est. of Daily Usage 2!g gal. Reason for Replace Existing Supply Test/Observation Additional Supply IlDrilling -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 No Name of subdivision Lot No. Water Well Contractor: •„ Address: Is Public Water Supply available to site? ................................... ..............................� Yes No Name of Public Water Supply: A� %r+' Town/Village Distance to property from nearest water main: Aj TA Proposed well location & sources of contamination to b rovided on separate sheet/plan. Date:..' .7. 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 .YOR 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 well driller certified b Putnam County. f Issue— Ba Permit Issuing Official: , Date o � g Date of Expiration $ ® Title: 4-W, Permit- is Non-TransfergabR4 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ APPLICATION FOR APPROVAL OF.PLANS FOR..._.. _ "� y. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: X554 ��et '_ ` to std _ 2. Name of project: e Q {leg; h�Y 3. Location TN: P�++aa -. � ��- 4. Design Professional: F J� - �2. 5. Address: 2,IZ. s�- 6. Drainage Basin: else►,s�"` "��`, °sr�� 7. T e of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision' Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ........................ Exempt Unlisted 0b 10. Has DEIS been completed and found acceptable by'Lead A enc g Y ................ 11. Name of Lead Agency 1�,1� 12. Is this project in an area under the control of local planning, zoning, or other v.. off icials, -- ordinances':-....;h.... ........� ...................... .......... ..........................::::: ...._ :p�,�, ...... , 13. If so, have plans been submitted to such authorities? ................... `� S 14. ;Has preliminary approval been granted by such authorities? Date granted: �1., .t �� 15. Type of Sewage Treatment System Discharge:.. .............. surface water --groundwater 16. If surface water discharge, what is the stream.class designation? .................... N ,0- 17. Waters index number (surface) ...........:.............................. ............................... �'% 18. Is.project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply ��� Distance to water supply N lA 20. Is project site near a public sewage collection or treatment system? ................ 0 d t 21. Name of sewage system P1� Distance to sewage system 22. Date test holes observed 2y 23. Name of Health Inspector /�`'��� 24. Project design flow (gallons per day) ................................. ...........:................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... �o o r' �d Form PC -97 '2 27. Is any portion of this project located within a designated Town or State wetland? PO 28. Wetlands ID Number - 29. Is Wetlands Permit required? ............ �o .................................. ............................... / Has application been made to Town or Local DEC office? .........:..... N l 30. Does project require a DEC Stream Disturbance Permit? .................................. /)0 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 v 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 /1�b DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ..:...................... VPS 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ............................ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /U 0 36. Tax Map ID Number ............................. ............................ Map _LL 9 Block Lot I 37. Approved plans are to be returned to ..... Applicant / Design Professional NOTE: All applications for _reyie�v-an�l. ppro al:of a ne - SSTS to be located within the-NY- C-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 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 l .,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 submitsion. 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 & '®Fp'ICL4L TITTLES. Mailing Address PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF' ENVIRONMENTAL. HEALTH SERVICES 'SHEET ` --SV4 SURFACE '99WA9 'T'WAT4fENTSYSTEW-'.--"•-'-"'?-'-'--,-'-� 1Z 5r, Owner e Address Located at(Strect) � pl 3:010 Tax Map 3 q Block r Lot (indicate nearest cross Street) Municipality � 'LtL4 I Watershed �j SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test WOO NO 't 1, 1--eq 446 M. , : I.."M i IlkIX r ;-N NOW "10 JrK •1 Iz- 5 3 .5-3 .2 f 3 17 S-9 ,-4 5 30 33 3. 3 30 33 3 4 2 3 .4 NOTES; 1. Tests to be repeated at SM040ffi UAtO approximately equal percolation mtes.are obtained at each percolation test bole, (Le, s I min for 1-30 minlincl ,;g 2 min for 3140 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of bole. Form DD-97 DER G.L. 05, 1.0' 1.5' 2.0' . 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' _..._.10.0' TEST.Rrf DATA DESCRIPTION OF .SONS ENC.OUN TERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which rnottling'is observed 0 Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Nance: ►�. zz Address: PIT Sipagure: ij 1Desflp professlogRal's Seal a I J of NEB R1G K A, 2�fY ��OG 214 '41 �FCJ NO' 43936 J Mr. A. Stiebeling P.C. Health Dept. Geneva Rd., Rte 312 Brewster, N.Y. 10509 . �- .r,.r.��., _.- .am.....ar.- +a- .w —,�.: .w..,..s .....,...rw.r_..a ..,..i. ,._.,r .er...�....o..,v...._... ..,.r RE: Roessel Residence, SSTS permit TM: 39 -14 Dear Mr. Stiebeling: Fred Zenz 292 Main St. Nelsonville, N.Y. 10516 August 8, 1999 I would ,like to officially request that percolation testing not be performed at full depth of the proposed pits at the above mentioned premises. This request is made in the interest of safety and it appeared obvious that there, were no changes in soil profiles as one went deeper in the ground. A note was placed on the plan addressing this issue. Topography was obtained by Mr. Roessel from NYS DOT mapping at the DOT office in Poughkeepsie. We also took some shots and made some changes due to the newly constructed drive. ' No excavation or filling took place in the SSTS area. Absorption area per pit was calculated based on an effective diameter of 8.5' and an effective height of 7.5'. This leads to an absorption area of 200 sq. ft. per pit. A flow rate of 800 gallons per day with an application rate of 1.2 gpd/sq. ft. leads to a primary area to consist of 3.3 pits, therefore 6.6 pits including the expansion. area. .These numbers -- were -then•rounded•upward too- pits•for the primary , area "and'3- moire-to'conViete-the - expansion requirement. These are the same figures used if the Northup SSTS permit issued a few months ago. I hope the preceding comments clear up any questions concerning the Roessel Residence application before your office. If you have any further questions please call at 526 -2377 (mornings) or 265 -1032 (afternoons) or 265 -1044 (fax). jF N 07 fJ s ed Zenz s z� �' FO /Vo 43736 AR0FEssjo% P M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATNIENT SYSTEMS REVIEW SHEET FOR ,CO1, T,RIf.CTI�� STREET LOCATION I NAME OF 01'NE REVIER'ED BY RNI, G AS, I IB, BH Z TAX liiAP # Y ROCUMENTS Y N EROSION CONTROL:HOUSE,WELL, SSDS �� PERC & DEEP HOLES LOCATED TTE REPRESENTATIVE OF PRIMARY & EXPANSION N LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE SUBDIVISION - °� NO BENDS; MAX.BENDS 450 W %CLEANOUT LEGAL SUBDIVISION 1 FILL SYSTELMS SUBDIVISION APPROVAL CHECKED CLAY BARRIER P RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE VL L QUIRED DEPTH FILL SPECS FILL NOTES ��,C,VRTArN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES L GENERAL FILL PROFILE & DIMENSIONS CATED IN NYC WATERSHED VOLUME s T-5 1tPITEST ANS SUBMITTED TO DEP FILL IN EXPANSION AREA LEGATED TO PCHD TRENCH P PPROVAL, IF REQ'D ]LF TRENCH PROVIDED 60 FT MAX. HOLES OBSERVED PARALLEL TO CONTOURS P CS TO BE WITNESSED 4� 1, 100% EXPANSION PROVIDED - APPROVAL SSDS AD]. LOTS SEPAkkTION DISTAN ES SPECIFIED TLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA..ON:DDS PLANS &PERMIT SAME 10' TO P.L., DRIVEWAY LARGE TREES, TOP:QF FILL:? .... ...._ ,: . o PRE 19'69 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS 15'WELL TO PL L TTER BI/ZBA 100' TO WELL, 200' IN DLOD,150' PITS 10 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) %R REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20) SEWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW CONSTRUCTION NOTES 15'MIN to CDS= >5 %,10'- 4 %,25'- 30/c,30'- 2 0/o,35' -1 0/*,100' - <1% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS �Y_ ELL SOIL TYPE BOUNDARIES ® DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET F_T_�PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: I PERbiIT LICATIO P jg)ERD4IT S L L 0 IGN DATA SHEET DS ORP TE RESOLUTION HOR EA PLANS - THREE SETS USE PLANS - TWO SETS VARIANCE REQUEST FEE PERC & DEEP HOLES LOCATED TTE REPRESENTATIVE OF PRIMARY & EXPANSION N LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE SUBDIVISION - °� NO BENDS; MAX.BENDS 450 W %CLEANOUT LEGAL SUBDIVISION 1 FILL SYSTELMS SUBDIVISION APPROVAL CHECKED CLAY BARRIER P RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE VL L QUIRED DEPTH FILL SPECS FILL NOTES ��,C,VRTArN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES L GENERAL FILL PROFILE & DIMENSIONS CATED IN NYC WATERSHED VOLUME s T-5 1tPITEST ANS SUBMITTED TO DEP FILL IN EXPANSION AREA LEGATED TO PCHD TRENCH P PPROVAL, IF REQ'D ]LF TRENCH PROVIDED 60 FT MAX. HOLES OBSERVED PARALLEL TO CONTOURS P CS TO BE WITNESSED 4� 1, 100% EXPANSION PROVIDED - APPROVAL SSDS AD]. LOTS SEPAkkTION DISTAN ES SPECIFIED TLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA..ON:DDS PLANS &PERMIT SAME 10' TO P.L., DRIVEWAY LARGE TREES, TOP:QF FILL:? .... ...._ ,: . o PRE 19'69 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS 15'WELL TO PL L TTER BI/ZBA 100' TO WELL, 200' IN DLOD,150' PITS 10 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) %R REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20) SEWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW CONSTRUCTION NOTES 15'MIN to CDS= >5 %,10'- 4 %,25'- 30/c,30'- 2 0/o,35' -1 0/*,100' - <1% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS �Y_ ELL SOIL TYPE BOUNDARIES ® DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET F_T_�PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: I BRUCE- _R . F.Q$Y, ..,_ ._ ........,.. Public Health Director - . LOU -17A .:MOLIN.ARI - RN., 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678. Fax (914) 278 - 6085 August 9, 1999 Mr. Fred Zenz, PE 292 Main Street Cold Spring, New York 10516 Re: Roessel, TM# 39 -1 -4 Town of Philipstown Dear Mr. Zenz: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. Documents • See Notice of Incomplete Application sent under a separate cover. 1. Insufficient expansion area provided for I - -4-pits-primary'-4 pits- expansion Provide source of survey and topo abel septic tank outlet line,: distribution box Please verify application rate of 1.2 gpd/sq. ft. -l-1 -(S Do i -J- This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, 6L Adam B. Stiebeling Assistant Public Health Engineer ABS:cj x -... •- ..BRUCE.:_R��.�EOLEYM�.•..;: _. -�.o: �._:.,�...�: �:.:.: ,.: v:�..:....,.:: -:.. Public Health Director August 9, 1999 �_v u...- ,....: LORETTA . MOLINAR.F.R N.,:.ME.S:N. Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH[ 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914)278 - 6678 Fax (9 14) 278 - 6085 Mr. Fred Zenz, PE 292 Main Street Cold Spring, New York 10516 Re: Application to Construct a Subsurface Sewage Treatment System Roessel Residence, Route 301 (T) Philipstown Dear Mr. Zenz: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on July 28, 1999 is incomplete. Please be advised that the following information is required before the Department may commence its /review Permit eslgn'Data Sheet, with completed testirig d;ifes _- Short Form EAF The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at ext. 2157. Very truly yours, Cif Adam B. Stiebeling Assistant Public Health Engineer ABS:cj �Xc© i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of �4e%4 Located at Rm.- ga k T/V J(,K ,,,. 4 Tax Map # 3et Block _� Lot Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize F-_ 4-- a duly licensed Professional Engineer for 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 an d 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 Health and-the Putiiam • - _,._.._. County Sxnitary�C�ode. Countersigned: P.E. # �f3�36 Very truly yours, Signed: 4.t �?� (Owner of Property) Mailing Address 2-42 LA t,, r.., Sr- I Mailing Address: Q - FLsavvi u.e State All-1- Zip 105'16 S Telephone: 2.6 5 — / 03Z R. �_ q State W, Zip 101,T16 Telephone: 265-3Y77 i� Form LA -97 c� 9 4.0 CONSTRUCTI ®N PERMITS Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Department; those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots Re ui ' e No fill or Fill Two -Feet Deep or Less. C nstruction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) . Application for Approval of Plans For A Wastewater Treatment System. (A,ppendix K) �- Corporate Resolution (if corporate ownership). (Appendix K) 5. Short Environmental Assessment Form (EAF).(Appendix K) 6. Design Data Sheet. (Appendix K) _.: -z-fr. __'tsr►�'._ ...' .......:: of NOTE: All submitted Department application forms shall contain original signatures (no photo copies). 7. Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall include, as a minimum, the following: a. Property survey with metes and bounds descriptions and major physical features. The plan shall make reference, by note, of the survey source and in the case of lots 'not subject to a filed map, a certified copy of a survey shall be provided. b. A datum reference is to be provided (i.e., National Geodetic Vertical Datum 1929, or assumed/other). ' 11 House location with proposed finished floor and basement elevations specified. d. Plan and profile of the SSTS, t i 100 percent reserve area, .construction details of absorption sy - tank, distribution or junction boxes, puit, osing siphon, etc. e Location of driveways. Location of well or public water main and hou a ection. g. Two -foot contours of the prope If ground is to be: cut or filled, both' existing and proposed contours mus Location of any watercourses, ponds, lakes or wetlands on, or within 200 ,eet of property. Accurate location of all deep test holes and percolation test holes. Omission of soil .testing on lots-in recently approved subdivisions will be at the discretion of the Department. Location of all existing wells and SSTS within 200 feet of proposed SSTS .dwells, or a note stating that none exist within 200 feet. Title box indicating name and address of property owner; parcel tax map identification number; property location, including street and municipality; name, address and phone number of Design Professional; date of drawing, ,�fc'luding dates of any revisions; and scale. and discharge points for gutter, footing, storm and curtain drains. t M. design criteria on plans to include number of bedrooms, soil percolation rate and deep test hole soil information, and sizes of SSTS components. 0,,0- n. Construction notes pursuant to Appendix C. AV <Space or Putna m County Health Department approval stamp (minimum 3" . eferably at the lower right hand portion of the design plan. 'Location map (minimum scale of 1" =2,000'). ��,^ L,�� :y q. rosion control measures for house, well and SSTS. r.. When a pump pit is proposed due to insufficient elevation for gravity flow or for dosing purposes, the pump pit design/de i shall include, as a minimum, the following: ake and model of pump to be use and operational characteristics. - 0 e -day's storage past the high -1 el alarm within the pump chamber. Che valve. - Gate v ve. - Unions - Operating an alarm levels for pump. - Means for pump moval for maintenance. - Pump curve should e supplied with the engineering report. The pump operating ra e should be indicated on the pump curve. 7. - Pump dose olume to be e , al to 75 percent of the volume available in the SS S pipe network. - Minim m velocity of 2 feet per se nd to be provided. in force main. - Baf d distribution box to be utilized SSTS. - Tr96ch detail for force main, specify pipe ty d rating, bedding and ote<stating;. ``A11. electr-ical.•work -and material, for-pu lip shall comply with the National Electrical Code. " - Note stating, "All pump power and control wiring shall be gpade directly to the control panel without any outside splices. " - Note stating, "The pump control panel, disconnects and alarms shall be located inside the house- " Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. 8. Two (2) sets of house plans with title block as specified in 7. k. above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality. Upon approval of the Construction Permit, the house plans will be. signed and stamped: 66Approved For Bedroom Count Only If water service is from a public supply or community supply, a letter from the _ ater supplier will be required stating that they will be able to supply the property with water at adequate pressure. j �.. _� �,...� .:._. �.....,._.., 13 10. ell Permit Application, if required.' (Appendix K) 11. Applications. for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question., A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notificatiori shall mean receipt by. each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. _ Transmittal of this notification should be sent to the contiguous property.owners.......; ..:...._ Y by the Design Professional. 12. Fee - See Appendix I. B. Construction Permit Submission Requirements For Lots Requiring Fill Greater Than Two Feet in Depth 1 -6. Same as Section 4.0 A. 7. Same as Section 4.0 A., except for d. d. Two separate plans will be required; the title box for both plans must contain the statement, "Preliminary Design For Fill Placement Only" . _ ... .44 i. Plan and Profile of Fill Section - Three (3) copies of this plan will be required showing the dimensions of the fill pad (i.e., length, width and depth top and bottom slopes of periphery of the fill) depth gauge locations, well. septic tank. house and driveway locations. This plan shall not show the design of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. All horizontal separation distances involving fill greater than 2 feet in depth are measured from the toe of the slope of the fill. The estimated volume of fill in cubic yards must be specified on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e., one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1) copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. This plan will be retained for the Department's files for future - reference. After a "Construction Permit" for the placement of fill is issued by the Department, a copy of the "Construction Permit ", one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building Inspector in the respective municipality in order that a "Building Permit" may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that the SSTS is constructed in accordance with the approved plans. If any significant departures from the approved plans are proposed because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Same as Section 4.0 A. 13. Fill must be stabilized in accordance with fill note # 1, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: 15. a. Results of a minimum of two (2) soil percolation tests in the stabilized, fill. b. Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on tLalje and does hereby certify that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is considered suitable for use in a subsurface sewage treatment system. The soil percolation rate in the settled fill based on percolation tests after stabilization is minlinch. " SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) years old, regardless of whether the same or a new owner is involved. a 5.0 CONSTRUCTION PERMIT RENEWALS The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: , 1. Letter of Authorization 2. , Construction Permit Application 7' 1300 GALLON ®RYWELL n 3 '3 ��0 4a ® ® ®® 00 ® 0 MM l ®000 ® ® ® ®® 8'5' 7' `L - - HUDSON O CONCRETE PRODUCTS, INCORPORATED Route 9 o Cold Spring, New York 10516 914- 265 -3265 3 '3 MM 0 MM l ® ®® M 7. 6" MOM Can= m mom Mmm omm= ® 3' 6' g' S. MEMO ��� m O MOO mm Im Cover MOM ® mom ��® Omm M3 ®mm ®� 2' MOO ��� b ®� �uE� SIDE VIEW `L - - HUDSON O CONCRETE PRODUCTS, INCORPORATED Route 9 o Cold Spring, New York 10516 914- 265 -3265 SEEPAGE PITS (CYLINDRICAL) - DIIVIENSlONS FOR REQUIRED ABSORPTIVE AREA (IN SQUARE FEET) DIAMETER OF SEEPAGE PIT (FEET) EFFECTIVE STRATA DEPTH BELOW FLOW LINE (BELOW INLET) t FOOT 2 FEET . 3 FEET 4 FEET 5 FEET '6 FEET 7 FEET 8 FEET 9 FEET 10 FEET 3 9.4 19 28 38 47 57 66 75 85 94 4 12.6 25 38 50 63 75 88 101 113 126 5 15.7 31 47 63 79 94 110 126 141 157 .6 18.8 38 57 75 94 113 132 151 170 188 7 22.0 44 66 88 110 132 154 1.76 198 220 8 25.1 50 75 101 126 151 176 201 226 251 9 28.3 57 85 113 141 170 198 '22' 6 254 283 " 10 31.4 63 94 126 157 188 220 251 283 314 11 34.6 69 104 138 173 207 242 76 311 346 12 37.7 75 113 151 188 226 264 3 2 339 377 Absorptive Area for C.v • -'- '- -_ --,' Absorptive Area for Re h = effective depth ( D outside diameter W = outside width in L = outside length it rr = 3.14 Page 1 co cn !. TABLE S SEEPAGE PITS - REQUIRED ABSORPTIVE AREA (IN SQUARE FEET) FOR HOUSEHOLD SYSTEMS RATE MIN /I MIN/INCH SEWAGE APPLICATION RATE GPD /SQ. FT. FLOW RATE (Gals /Day) 2 Bedrooms 3 Bedrooms 4 Bedrooms 5 Bedrooms 6 Bedrooms 220 260 300 336 390 450 440 520 600 550 650 750 660 780 900 1 -5 1.20 183 217 250 275 325 375 367 433 500 458 542 625. 550 650 750 6 -7 1.00 220 260 300 330: 390 450 440 520 600 550 650 750 660 780: 900 8 -10 0.90 244 289 333 367' 433 500 489 578 667 611 722 833 733 a 867 11000 11-15 0.80 275 325 375 413' 488 563 550 650 750 688 813 938 825 975'' 1,125 16-20 0.70 314 371 429 471' 557 643 629 743 857 786 929 1,071 943 1,114 1,286 21-30 0.60 367 433 500 550: 650 750 733 867 1,000 917 1,083 1,250 1,100 1,300 1,500 31-45 0.50 440 520 600 660 780 900 880 1,040 1,200 1,100 1,300 1,500 1,320 1,560, 1,800 46-60 0.45 489 578 667 733 867 11000 978 1,156 1,333 1,222 1,444 1,667 1,467 1,733 2,000 OVER 60 UNSUMAILE ... USE SPECIAL DESIGN PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL; HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A:-'.GENERAL INFORMATION Name of Project l (T)(V) County Site Location Building construction begun j Extent Is property.-MthinNYC Watershed ? ................. F_� .Yes No SECTION B. TOPOGRAPHY (Please c eck all appropriate boxes) 1. Hilly Rolling. Steep slope Gentle gope F_� Flat 2. Evidence of wetlands Low area subject to flooding EZBodies of water Drainage ditches R 3. Property lines or corners evident ....................... ............................... 4. Do water courses exist on or adjoin the property.? ............ .......... 5. Will these affect the design of the sewage system facilities ?.......... 6. Do watershed regulations apply in this development ? .................... 7 Will extensive grading be necessary? ................ ............................... 8. Will extensive fill be necessary for SSTS? ....... ............................... _.9.- .Do- filled-area exist - within the SSTS-area? . . ...................... . Yes EYes E; ' `s Yes Yes Yes -Yes No No No E 'to ' N . N.o. If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 'd ravel Lo;FBackhoe Clay Hardpan ture 10. Appearance of soil: L2 "� 11. Observed from: Borings Bank cut excavations 12. Soil borings /excavations.obseived by /4 . tiro zg"z on 7 9. 13. Depth to groundwater Ll ge_ t on t' 14. Depth to mottling �o�cAL on 15. Are test holes representative of primary & reserve areas ...... ............................... Yes F—] No 16. Soil percolation tests made by I_N04.-_C_XD on 17. Soil percolation tests witnessed by �t on SECTION D (on back) Form ST-1 �0 SECTION' D. DRAINAGE M18. �Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes a 19. Will groundwater or surface drainage require special consideration? ...........::........ Yes 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... � Yes ♦.�._._..._ -._ _ _... . 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... 0 Yes o Inspection data . 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Yes o 23. Additional comments I 24. Site observer /inspector and title . ' 25. Date(s) of observation(s)inspection(s) 71116 TEST PIT PROFILES Hole r Lot 4 r Lot--.' Hole r Lot r Depth to water 9�fl Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth-to rock/imp; -" !.- Depth to-rock/i'mp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 L 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 t� A -so -'A-;5 _43 U I'LT" FLA W -r.m. " 34-1- PV P&-A- r-AtA A, 4URIJ6'-,e r.3^08,y vVAITS_j f'! ruunas QQu"y7 VOPartmenT, or-aseasiL A716146ft of raviropmental Rea'Ith RAaVAVi kp. d &a noted for Conformanoo V&tb --.iIiCable Rules and Regulations of. t m C t Partment." 77Ti +1 This is•to certify that the sewage disposal system was!constructed as indicated -on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and. regulations of the Putnam.Co. Dept. of Health and the New York State Dept. of Health. AL 7eo& ro J. 3: .I SCALE: JV!-fd I'L-q I 0. P �jijs-r Ata1z, J441ZOGv Z-Vows- SACIAW) OU! Pir. No 49002 5 45 4• C4 0 3 44 ruunas QQu"y7 VOPartmenT, or-aseasiL A716146ft of raviropmental Rea'Ith RAaVAVi kp. d &a noted for Conformanoo V&tb --.iIiCable Rules and Regulations of. t m C t Partment." 77Ti +1 This is•to certify that the sewage disposal system was!constructed as indicated -on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and. regulations of the Putnam.Co. Dept. of Health and the New York State Dept. of Health. AL 7eo& ro J. 3: .I SCALE: JV!-fd I'L-q I 0. P �jijs-r Ata1z, J441ZOGv Z-Vows- SACIAW) OU! Pir. No 49002