Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2452
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -15 BOX 21 02452 vh 1?� : 4 As 02452 PUTNAM COUNTY DEPARTMENT OF HEALTH - ............- _ -. -... _..DIVISION OF ENVIRONMENTAL CERTIFICATE OF CONSTRUCTION COMPLIANCE F ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # hy'* Z Oq Located at LU-,!:149 Town or e Villa % II Owner /Applicant Name MJeA& (2,JA f ny Tax Map_ Block Lot _ Formerl " i��� Y I� , Subdivision Name LJA,_ , K Subd. Lot # Mailing Address 1"4d, I kl As goA.Q _ 1� VQ \/A W , -V IJ X Zip 1,0151 Date Construction Permit Issued by PCHD %C) 4 Separate Sewerage System built by Aggoul �C" Address JrAg J IL,6 Consisting of I OPV .. Gallon Septic Tank and Other Requirements: -. tl u i e,2r ik r u, I ,pov Water Suppy: Public Supply From Address or: °/ Private Supply Drilled b � Address !� � PP Y Y 012RkI&J _ O&�1i7g46g � r ld,&W l /Al ,y �. Building Type r _ ! 'Has erosion control been completed?-,� Number of Bedrooms : Has garbage grinder been installed? ld-z7 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 Department of Health. Date: Certified by / ,, P.E. (Design Profession Address -r �� License # '-I q2 P ers� o cu PY g premise Nerve �ove sY sei(s shall promptly take such action as maybe necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocati , modifi atio e is necessary. By: ,fflo ° Tit le: Date: ll White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CC -97 X ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLE')ITRON REPORT Welf)l; ®e�tion treet Address: %17 pa Tax Grid # Map Block Lots) Well Owner: Name: Address: Use of Well: I- primary 2- secondary Residential V U Public Supply Air cond/heat pump Irrigat' n Business Farm Test/monitoring Other(specify) Industrial Institutional Standby )[Drilling Equipment 4- Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing 14 Open hole in bedrock _ Other Casing Details Total length ft. Length below graded . Diameter Zit in Weight per footIb /ft. Materials: teel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout — Bentonite Other Drive shoe: _I'es 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 _1_6 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well lL ®g 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 ff �✓ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type'_4 ,t tt, Capacity -5'— Depth !i-iTb ° Model 61 o 5 -- -3 Voltage 7-3 ° I/ HP ..�' Tank Typel/A Volufne A�4 �o Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) !o<(7, rout' u *: txAct location of well with aistances to at least two permanent lanalnarxs to ue provvi/iaea on a separate sneevptan. Well Driller's Name ��✓"f" Address/ Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 T ti Imminan Anderson Im May 1, 2001 Putnam County Department of Health Division of Environmental Health Services Dear Sir or Madam: 152 Barger Street Putnam Valley, NY 10578 Re: Michael Spiegel; 209 Bell Hollow Road,. Putnam Valley NY 10579 This letter is to inform the Department of Health, that the well on'the above property can be service as is. Sincerely, Norman Anderson President SERVICES 321 Hear Street ` �2 . 14)45-2800 Albert H. Padovani, Director LAB #: 32.102417 CLIENT #: 13299 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 1 SPIEGAL, MICHAEL DATE/TIME TAKEN: 04/17/01 11:30A 209 BELL-HOLLOW RD ' DATE/TIME REC'D: 04/17/01 12:20P PUTNAM VALLEY, NY 10579 REPORT DATE: 04/30/01 PHONE: (845)-528-1491 SAMPLING SITE: 209 BELL HOLLOW RD. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: SARAH ANDERSON TEMPERATURE..: < 4C NOTES... KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/17/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 04/17/01 LEAD (IMS) <1 ppb 0-15 ppb 9101 04/17/01 NITRATE NITROG 0.31 MG/L 0 - 10 9139 04/17/01 NITRITE NITROG <0.01 MG/L N/A 9146 04/17/01 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 04/17/01 MANGANESE-(Mn) <0.010MG/L -0-0.3 mg/1 2837 04/17/01 SODIUM (Na) 5.48 MG/L N/A 04/17/01 pH 6.7 UNITS 6.5-8.5 9043 04/17/01 HARDNESS,TOTAL 86.0 MG/L N/A 04/17/01 ALKALINITY (AS 58.0 MG/L N/A 04/t7/014-`-' TURBIDITY (TUR . -- 4"0 ' NTU �-��'0�5�NTU^ ' , ` - -- COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD ING -7�~E �HWAS NEW YORK STATE. AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic 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 mangahese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. ' ^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heigh 10598 � ' - '-' ', .- ' (914) '245�280\�-~ '`-~—~ Albert H. Padovani, Director LAB.#: 38002417 CLIENT #: 13299 NON STAT PROC PAGE 2 SPIEGA(, MICHAEL DuTE/TIMETAKEN: 04/17/01 11:30A 209 BELL-HOLLOW RD DATE/TIME REC'D: 04/17/01 12:20P PUTNAM VALLEY, NY 10579 REPORT DATE: 04/30/01 PHONE: (845)-528-1491 SAMPLING SITE: 209 BELL HOLLOW RD. : PUTNAM VALLEY, NY COL'D BY: SARAH ANDERSON NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/Lv DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L ~-~ 7�LL�G.Rf�M PIFER SUBMITTED B ,,Albert H. Padovani, T.(ASCP) Director ELAP# 10323 Public Health Director 0 Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (9,14) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Nkl -,#A &Z- Atv,-J TAX MAP NUMBER: 2 o 9 E911 ADDRESS: TOWN: penlom AUTHORIZED TOWN OFFICIAL.,: Aca-rul?,' (Signature) DATE: Z/ z 3 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form, is to be submitted with the application for a Certificate of Construction Compliance. (E91 I VERFRND v 05/08/2001 22:31 9142487557 DRK CONSULTING ENGIN PAGE 01 8 - ' ORES CONSULTING ENGINEERS 2 DALE AVENUE, SOMERS, NEW YORK 10589 a (914) 248 -7726 May 8, 2001 Pubram County Heahh Depmbmd Geneva Rood, Route 312 Btawew, W 10509 RE: 30%el. 90 Hdm Rood, PV, NY PCMD Pw" No. P V 5a0 Dow Mi. Adnn 80ebkV. I iuspected the pwnp and electrical panels at the refrmced property and found than wired cor reWy. Please refer to the attached photos. Adam, appam ly the electrician had wired the alarm circuit through the bighting circuit, sorry for the problem you had with hao. o °���Q A �y'0 05/08/2001 22:31 9142487557 DRK CONSULTING ENGIN PAGE 02 1007-'e lkvw jawdaijpaja laBoids alm D Q� CL 0 N Lo IV II 05/08/2001 22:31 9142487557 DRK CONSULTING ENGIN PAGE 03 IOOZ 'B �ldW ai hand dwnd �a ds 4 A -ORK Consulfta Enaheem - 2 ale Avenue, Somers, NY 10589 914-248-7726 TO: Putnam County Health Department Geneva Road, Route 312 Brewster, NY 10509 Att-n--.- Mr:: Adam B;tleb6407 We are sending: 13 attached _ plans l3 specifications 13 shop drawing — reports COPIES DATE 13 under separate cover 13 FAX E3 approval of subcontractor a order on contract 13 samples NUMBER DATE: 5/3/01 1 JOB NO. RE: Spiegel Bell Hollow Road, PV, NY PCHD Permit No. PV-5-00 E3 photograph 13 copy of letter 13 FORM 0 DESCRIPTION I Well test results I VX-97, Well completion report I Norman Anderson well service road letter I Survey 5 As-built Septic Plan. 1 E911 I foffn I CC-97, Certificate of Construction Compliance C] Continued on the attached sheet THESE ARE TRANSMITTED AS NOTED BELOW: for approval 13 no exceptions taken 13 resubmit copies for approval for information 0 note comments 13 resubmit copies for distribution for action 13 for correction 13 return corrected print [3 as requested 0 for review and comment 0 E Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly: and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for . a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as co. nclusive 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 utilizing the system. Dated: Month ,,5 Day Year r General ontr or (Own Signature Corporation Name (if corporation) Signature: Title:- Corporation Name (if corporatio Address:. e Address:,LR -/" t- G.c.s' 41,0056a,-,5e 1- 3 Lf. S State . fie✓ �,� �L . Zip eZ_ State Zip r_km Form GS -97 p 11/01/2000 23:43 9142487557 DRK CONSULTING ENGIN E„ � . T ^ti .� "� I l Cyr f . �, r ,:A l'; I • kl� "*W T icy F ��� ►� :1 I� T ►1 U'I`•I�1«�'� t1;lI i''�� a�.';1 ° ° <�rl_�..i.'t.1 a;�.:°�l I l: �FE'Z1 Ci h -ti ry' � i`n�� a.f,:'za a.i:e�>t.�.:I� _' / �.wtrvr,•:F' "t°,i�- ;1.^+$ PCHD Constmcdon Permit 0 PAGE 01 .�iC r+'S.Ss,�.;4 •�l_`. • Ali "P.' !r '� -- --- y+ xk'�;,g I wffy that the mss), as listed, at the above premises has bow constructed and I have inspected and verified their completion in accordance with -the issued PCM Construction Permit and approved plans and the Standards, Rules and Regulations of the Putown County Depa =ent of Heaahh. Dam Certified by: DONALD R. I� PP PF h �1' y?i:1.1 T__.:.1 T Doran FIR 99 f� 05/01/2001 22:34 9142487557 DIRK CONSULTING ENGIN PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E"MONMENTAL HEALTH SERVICES PAGE 01 94/- RW ST FOR FiN L n t p , ION For: Fill Date: 1 -5 /z °y4 Trenches PCHD Construction Permit #� ~� Located: 6"4L A&ZLe7trl �'.���. Tom- (T) M me'' j VIWZda �k Owner /Applicant Name:/�jrJ�'.�d' A 4 b4 . 1.-- Block �_ Lot Formerly: Subdivision Name: N4- Subdivision Lot # Is system fill completed? 0-1-V ES: 1 NO: Q NA Date: � Is system complete? Es: o No Date: Is system constructed as per plans? Es: a No 1 Is Well drilled? Es; OF . NO Date: f Is well located as per plans? YES: o No; o APPROXIMATELY Are erosion control measures in place? WIES: O No I certify that the gstem(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the. issued PCHD Construction Permit and approved plans and the Standards. Rules and I, Vgations of the Putnam County Department of Health. Date: A" Certified by: 1� E Design ProfessiW. _. •......___ ...-:_._ ...... ` —DONALD R. KNAPP, P.E. .. Address: 2 DALE AVENUE, SOMERS, NY 10589 Lie. # TELEPHONE/FAX: (9141248 -7726: fax .(9141248 -7726 Comments: FOR & ADAM D GENE a (NAME) Form FIR 99 !" t Ie A '} I ((1) °, ! II) I I" A !'t I l I l I (D I III A ! ! I I 111 l ON t I i' (1 11 I 11F.12 I I i ! •� I .III `� I CONSTRU CTffGN P EIl Mff IE TREATMENT SYSTEM I PERMIT Located at b,.1.L BOGGvW go Ar • Town o'r ViRage- Fz_r1-A1A1,;i 11-efz4A_1_X . Subdivision name Nfl Date Subdivision Approved A114. Subd. Lot # A14 , Tax Map 57 Owner /Applicant Name ► /��G -ivY �i�'/ Mailing Address Amount of Fee Enclosed Building Type� 1D Block / Lot 15 Renewal M,+V Revision Date of Previous Approval '� 2 v® :u iiif Zip OF .4 Area o. of Bedrooms'_ Design Flow GPD r ]Fill Section Only Depth 0�&- "/ VoRume rE D PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COPT + Sepairnte Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by Address __...:._. dyatenr_Sanl�:_, ,- Public_Supply From ____ . Address. - o1re ,!( 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 seuara, to _ 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: Address 19 P.E. v--' R.A. Date At Ae�w_ ' A/,VA25�License # 12 V APPROVED YOR 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 &y the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Appr ed d char of domestic sanitary sewag only. By: Title: I Date: 1116 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 Date _,- 7 -�9 ._,....v ......._...._ . , ._... Re: Property of Y S ah o�cP�iP+qY Located at -rft Map 1 (T) i 15Section Block t Lot Subdivision of Subdv. Lot Filed Map Gentlemen: This letter is to authorize Donald R. Knapp a duly licensed professional engineer . (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated.by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf.in, connection with this matter and to supervise the construction of said system or systems in conformity with the " "prbvisions- of --Asrtie16 14� o� 147, Education Law, the Public Health Law, and the - Putnam County Sani -, tary Code. Very truly yours, Signed. Countersigned: Got, r'acf fri e� P. E . , R . A. , # 072770 -- /it Uj --- Address 2 Dale Avenue, Somers, New York 10589 &LviQ141' Vel a-pli Address Town J (914) 248-7726 FAX (914) 248 -7557 -3 -z' Telephone Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH II) I i S i ON OF W RON, i a l HEALTH i RVI (m PIERMsUT # U► a; M i c 1 1(1) `• 12 M 11 1 I, +!:' '• ,, �. -` 111� ` I 1 I\ I 1 I I e 1 Located at Town or Village F111A6d VALLM7-- , Subdivision name Subd. Lot # _4A, Tax Map �_ Block �_ Lot 9f2 Date Subdivision Approved 4 ®, Renewal Revision Owner /Applicant Name Date of Previous.Approval Mailing Address Amount of Fee Enclosed 0,yo , 0 Building Type %6:?gV TCAMdLot IFBIl Section Onfly 74 No. of Bedrooms P" Design Flow GPD��G� ](Depth lV -4f" VoRume Sepanrate Sewerage System to consist of 16 gallon septic tank and f5'j � Other Requirements: To be constructed by Address ten Su fl Public Supply. From Address _ 02- 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 sysr during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of nstruction Compliance of the original system or any repairs thereto. Signed Address WOR WE 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 by the Public Health Director. Any revision or alteration of the approved plan requires a new ppR JIN Ap v f r di harge of domestic sanitary sew ge only. By: - Title: Date: 2,1 00 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 APPLICATION TO CONSTRUCT A WATER WELL print or type s . .,_ -�... <..: <.,. : ",PC- H&Peftni -f# ; 5 Well Location: Street Ad ess: Town/Village Tax Grid # o d Map Gj Block Lot(s) �? Well Owner: Name ; K,�I�t" G � t li Address: /fi� n , Use of Well: esidential Public Supply A /Cond/Heat Pum Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought�� gpm # People Served jd Est. of Daily Usage Aovogal. Reason for ace Existing Supply Test/Observation Additional Supply Drilling ew 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: : - - ---r Is Public Water Supply available to site?.. ................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamina ion to be provided on separate sheet/plan. Applicant Signature:. _ __ ._ e., ,.. _ . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan re uires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue W,?/ 0 Permit Issuing fficial: Date of Expiration 1 oz, Title: bid Permit is Non - Transfer bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ._:'.J r' a ®EPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. 3 HOLE NO. 4 G.L. 4 °' TOP SOIL 6" TOP SOIL 6" TOP SOIL 6" TOP SOIL 0.5' 1.0° 1.5' Roots to 18" Roots to 18" Silty clay loam Silty clay loam to 32" 2.0' Silty clay loam to 26" Silty clay loam to 26" 2.5' 3.0' 1 Roots to 38" Roots to 36" 3.5' Sandy /gravel loam Sandy /gravel loam Sandy /gravel loam Sandy /gravel loam 4.0' some cobbles 5.0' 5.5° 6.0' Ledge Ledge Ledge 6.5' 7.0' T'-6" Ledge 7.5° *No groundwater *No groundwater No groundwater No groundwater 8.0' No mottling No mottling No mottling No mottling 8.5' Consistencv-very hard Consisten cy-ve ry hard Consisten -very hard Consisten -very hard 01 ._ '' ' 28' to water on:3/25/99 32" to water on 3125/99 q9. *INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED: See comments for test holes 1 & 2 INDICATE LEVEL AT WHICH MOTTLING IS OBSERVED: NA INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED: NA i DEEP HOLE OBSERVATIONS MADE BY: DONALD R. KNAPP, P.E. DATE: 12/12/98 10/15/99 DESIGN PROFESSIONAL NAME: DONALD R. KNAPP, P.E ®RK CONSULTING ENGINEERS ADDRESS: 2 DALE AVENUE SOMERS, NEW YORK 10589 914- 248 -7726 F FAX 914 -248 -7726 I � I DESIGN PROFESSIONAL'S 0 ... ,......_, ....,.PUTNAM- CODN�,DEPARTMENT OFMHEALTH,,... ,.... -PAGE 2 OF2..... ........� DIVISION OF ENVIRONMENTAL HEALTH SERVICES TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DATE OF DEEP HOLE TEST: 12/12/1998,3/25/99 test holes inspected by PCHD see attached data sheet, 10/15/99 for test holes 6 & 7 DEPTH HOLE NO. 5 HOLE NO. 6 HOLE NO. 7 HOLE NO. G.L 6" TOP SOIL 6" TOP SOIL 4" TOP SOIL 0.5' 1.0' Silty loam 16" Silty loam Fine silty loam 1.5' 2.0' Sandy clay loam/rocky 2.5' Roots to 36" Roots to 33" 3.0' Grev San loam/ 3.5' Stone 4.0' Roots to 48" Led a Ledge 4.5' Grey sand. loam/ 5.0' IStoney 5.5' 6.0' Ledge 6.5' 7.0' 7.5' No roundwater No groundwater No groundwater 8.0' No mottling No mottling No mottling -8.5' Consisten_ -ve _hard Qonsistenq-very hard Weathered led a " 9.0' consistency-very hard 10.0' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED: NA . INDICATE LEVEL AT WHICH MOTTLING IS OBSERVED: NA INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED: NA DEEP HOLE OBSERVATIONS MADE BY: DONALD R. KNAPP, P.E. DATE: 12/12/199E 10/15/99 DESIGN PROFESSIONAL NAME: DONALD R. KNAPP, P.E DRK CONSULTING ENGINEERS ADDRESS: 2 DALE AVENUE SOMERS, NEW YORK 10589 914 -248 -7726 FAX 914 - 248 -7726 uCalun rmurCO01UNAL.0,CAL B F _ COUNTY D i M N G- H EQ UI i O- ENVIRONMENTAL H r _ T N SERVPCES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM OWNER: Michel and Joyce Spiegel ADDRESS: 29 Hiawatha Road, Putnam Valley, NY 10579 PROPERTY DATA LOCATED AT: Bell Hollow Road TAX MAP: 51.4-15 BLOCK: 1 MUNICIPALITY: Putnam Valley Section: 15 LOT: 15 DRAINAGE (BASIN: Husdon River DATE OF PER - SOAPING: DATE OF PERCOLATION TEST: HOLE NO. RUN NO. MIME START STOP LAPSED TIME (MINUTES DEPTH TO y11AYER START STOP (INCHES) (INCHES) WATER LEl9EL DROPINCHES (INCHES) PERCOLATION RATE MIN /INCH 42:40:00 8:00 AM 10:01 AM 121:00:00 10 7.00 3.00 40:20:00 43:40:00 .2 10:01 AM 12:11 PM 130:00:00 10 7.00 3.00 43:20:00 46:40:00 3 12:11 PM 2:35 PM 144:00:00 10 7.00 3.00 48:00:00 46:40:00 2:35 PM 4:59 PM 144:00:00 10 7.00 3.00 48:00:00 38:00:00 3 9 8:02 AM 10:10 AM 128:00:00 10 7.00 3.00 42:40:00 2 10:10 AM 12:21 PM 131:00:00 10 7.00 3.00 43:40:00 3 12:25 PM 2:45 PM 140:00:00 10 7.00 3.00 46:40:00 4 2:35 PM 4:55 PM 140:00:00 10 7.00 3.00 46:40:00 5 2:49 PM 1 4:43 PM 1114:00:001 10 1 7.00 3.00 ji 38:00:00 3 1� 8:04 AM 10:08 AM 124:00:00 10 7.00 3.00 41:20:00 2 10:08 AM 12:14 PM 126:00:00 10 7.00 3.00 42:00:00 3 12:14 PM 2:35 PM 141:00:00 10 7.00 3.00 47:00:00 4 2:35 PM 4:59 PM 144:00:00 10 7.00 3.00 48:00:00 5 2:49 PM 1 4:43 PM 1114:00:001 10 1 7.00 3.00 ji 38:00:00 1 1� 7:30 AM 9:35 AM 125:00:00 10 7.00 3.00 41:40:00 2 9:35 AM 11:40 AM 125:00:00 10 7.00 3.00 41:40:00 3 11:40 AM 1:45 PM 125:00:00 10 7.00 3.00 41:40:00 4 1:45 PM 3:49 PM 124 :00:00 10 1 7.00 3.00 41:20:00 5 2:49 PM 1 4:43 PM 1114:00:001 10 1 7.00 3.00 ji 38:00:00 NOTES: 1. TEST TO BE REPEATED AT SAME DEPTH UNTIL APPROXIMATELY EQUAL PERCOLATION REATES ARE OBTAINED AT EACH PERCOLATION TEST HOLE. (I.E. LT 1 MIN FOR 1-30 MINIINCH, LT 2 MIN FOR 31-60 MIN1INCH). ALL DATA TO BE SUBMITTED FOR REVIEW. 2. DEPTH MEASUREMENTS TO BE MADE FROM TOP OF HOLE. Signature: License Number: 72770 o Putnam and Westchester Counties, New York .n.em.. +,r -..s :.....�,.- ,._.� -.., .. ... v..,t ... n..r ., -.s. ca- ._ra... _.s. ....• ..w >. u. an, ......a...wr a-. n.an.. .. x. --. w. r. as .�.n. . ...,n .....,. mss,.. cr..rc�.. w..,w. .. .. .. ->. .. included areas and the nearby soils are better suited to Erosion hazard: Slight recreational development. Depth to bedrock: More than 60 inches The ca abilit subclass is Via 25 p y Many areas are wooded. Other areas are used for CIB— Charlton loam, 2 to 8 percent slopes, very community development or for recreation. A few areas have been cleared and are used for farming. stony. This soil is gently sloping, very deep, and well No major limitations affect the use of this soil as a drained. It is on hilltops and parts of hillsides. It formed site for dwellings with basements, for septic tank in glacial till derived from granite, schist, and gneiss. absorption fields, or for local roads and streets. During Stones cover 0.1 to 3.0 percent of the surface and are construction, minimizing the removal of vegetation, al areas are irregular in about 3 to 25 feet apart. Individual mulching, and quickly establishing a plant cover help to shape and range from 3 to 30 acres in size. control erosion and sedimentation. The typical sequence, depth, and composition of the layers of this soil are as follows— This soil is not suited to cultivated crops because of stoniness. It is only poorly suited to permanent pasture Surface layer: because of the stoniness. Maintaining an adequate 0 to 2 inches, very dark grayish brown loam cover of sod is the main management concern. Overgrazing also is a concern. It decreases the extent Subsurface layer: of desirable pasture plants. Rotation grazing, 2 to 8 inches, dark brown loam applications of fertilizer, weed and brush control, and Subsoil: proper stocking rates increase the quantity and quality 8 to 24 inches, dark yellowish brown sandy loam of feed and forage. The potential productivity of this soil for northern red Substratum: oak is moderate. Planting seedlings early in the spring 24 to 60 inches, dark grayish brown sandy loam reduces the effects of summer droughtiness, which that has thin lenses of loamy sand increases the seedling mortality rate. Establishing Included with this soil in mapping are small areas of logging trails across the slope reduces the hazard of the well drained Paxton soils, the somewhat excessively drained and well drained Chatfield soils, and the erosion. Surface stoniness is the main limitation on sites for moderately well drained Sutton soils. Paxton soils have recreational development. The slope also is a limitation a firm, dense substratum. They occur as scattered on sites for playgrounds. Land shaping and grading areas- throughout - the- maplunit: Chatfield soils: at& - -- ao overcome -the slope_ Removmga a stones may.. be necessary in intensively used areas. Recreational -'- moderately deep over bedrock. They are adjacent to areas of rock outcrop, which are mainly at the summits areas are susceptible to deterioration as a result of . of hills and ridges. Sutton soils are in swales and midsummer droughtiness. Irrigation reduces shallow drainageways. Also included are areas of droughtiness during these periods. -. Riverhead and Knickerbocker soils on terraces adjacent The capability subclass is Vls. to large perennial streams, areas of Charlton soils that have an extremely stony or bouldery surface, and areas CIC— Charlton loam, 8 to 15 percent slopes, very of rock outcrop. Riverhead and Knickerbocker soils are stony. This soil is strongly sloping, very deep, and well more sandy than the Charlton soil. The included drained. It is on hilltops and parts of hillsides. It formed Charlton soils are commonly in the western part of in glacial till derived from granite, schist, and gneiss. Putnam County. Included areas make up about 15 to 25 Stones cover 0.1 to 3.0 percent of the surface and are percent of the map unit and are as much as 2 acres in about 3 to 25 feet apart. Individual areas are irregular in size. shape and range from 3 to 30 acres in size. Soil properties— The typical sequence, depth, and composition of the layers of this soil are as follows— Water table: At a depth of more than 6 feet throughout the year Permeability. Moderate or moderately rapid (0.6 -6.0 in/ hr) throughout the profile Available water capacity: Moderate Reaction: Very strongly acid to moderately acid throughout the profile Surface runoff. • Medium Surface layer: 0 to 2 inches, very dark grayish brown loam Subsurface layer: 2 to 8 inches, dark brown loam Subsoil: 8 to 24 inches, dark yellowish brown sandy loam 1�. Y' TICYAWOFFUTNAM CHAPTER 1414: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New Fork. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under. SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANT/SPONSOR: December 6, 1999 December 6, 2000 Michael & Joyce Spiegel 29 Hiawatha Road Putnam Malley, NY 10579 PROPERTY ]LOCATI ®N: Bell Hollow Road TAX MAP #: 51 -1 -15 SIZE OF PARCEL: 6.037 acres ZONING: R -3 PROPOSED ACTION: Construction of single family residence, driveway, septic system within Watercourse setback area MATERIALS REVIEWED: 1. Site Plan and. Proposed Sewage Disposal System Plan, prepared by D. Knapp, P.E., dated 11- 10 -99. 2. Site Alteration Permit Application forms, file # WT -312, dated 08/19/99. CONDITIONS OF PERMIT: 1. All erosion control measures shall be implemented as shown on above referenced plan. 2. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 3. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place.until final site inspections for compliance with conditions of permit have been completed. Pw i oft := a 0 4= ":Th6.P•lanning: Board;. Wetlands. Inspector; - and /or-Bui ding Inspector,sball have. th.. J. ht. to, inspect the project from time to time. 5. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: December 6, 1999 cc Page 2 of Applicant Building Inspector Planning Board Environmental Commission Stephen W. Coleman Town Wetlands Inspector "'PUTNAWCOUNTY-DEPARTM .' O i n L ff DIM10 MES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM OWNER: Michel and Joyce Spiegel ADDRESS: 29 Hiawatha Road, Putnoth Valley, NY 905,_79 PROPERTY DATA LOCATED AT: Bell Hollow Road TAX MAP: 51. -1 -15 BLOCK: 1 MUNICIPALITY: Putnam Valley Section: 15 LOT: 15 Septic fall from Lyons, quality good Compaction good DRAINAGE BASIN: Husdon River DATE OF TESTING: November 1, 2000 DATE OF PERCOLATION TEST: PF 2 1 6:18 PM 6:29 PM 11:00:00 10 7.00 3.00 3:40:00 320° 2 6:29 PM 6:42 PM 13:00:00 10 7.00 3.00 4:20:00 3 6:42 PM 6:56 PM 14:00:00 10 7.00 3.00 4:40:00 _ 6:56 PM- 7:11 PM 4&00:00: ..- 7-.::10 ., , - 7.04. .3.00 5:00:00 5 7:11 PM 7:26 PM 15:00:00 10 7.00 3.00 5:00:00 NOTES: 1. TEST TO BE REPEATED AT SAME DEPTH UNTIL APPROXIMATELY EQUAL PERCOLATION REATES ARE OBTAINED AT EACH PERCOLATION TEST HOLE. (I.E. LT 1 MIN FOR 1-30 MIN/INCH, LT 2 MIN FOR 31-60 MIN /INCH). ALL DATA TO BE SUBMITTED FOR REVIEW. 2. DEPTH MEASUREMENTS TO BE MADE FROM TOP OF HOLE. Signiture: License Number: 72770 DIRK Consulting Engineers 2 Dale Avenue, - .Somers, NY. 1058.9 . s �x -.. .c:. +. .:: .�,, :. .... .- ... ..,,., w....=. ,.-+� �«c .... .....�. ...,.... ..... ,�- ...,..... -.. ..- ...... -.m^ sr.•,a �c:' .r.:.:..�..�... ... ... - ....w.+...... �.. .a.,..a. .rn ..... ...._- ...w ....� - .....e.n . 914 - 248 -7726 LETTER OF TRANSMITTAL TO: Putnam County Health Department Geneva Road, Route 312 Brewster, NY 10509 Attn. Mr. Adam Stiebeling We are sending: X attached p under separate cover p FAX _ plans p approval of subcontractor 13 specifications p order on contract CI shop drawing p samples reports p COPIES 1 1 3 1 1 1 ' 1 EACH 1 1 1 DATE NUMBER p Continued on the attached sheet THESE ARE TRANSMITTED AS NOTED BELOW: DATE: 2/8/99 1 JOB NO. RE: Spiegel Bell Hollow Road, PV, NY p photograph p copy of letter E3 FORM O DESCRIPTION SURVEY SEPTIC PLAN PRELIMINARY SEPTIC FILL PLAN WP-97, APPLICATION TO CONSTRUCT A WATER WELL CP -97, CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PC-97, APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM ADJOINERS NOTICICATION LETTERS WITH COPY OF.RETURN RECEIPTS ENGINEERING REPORT PUMP DATA PARTIAL TAX MAP WITH ADJOINERS X for approval p no exceptions taken p resubmit copies for approval E3 for information 0 note comments 13 resubmit copies for distribution . p for action p for correction p return corrected print p as requested 0 for review and comment p COPIES TO: FILE i I SENDER: COMPLETE A V ® Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. n Print your name and address on the reverse _ 4 ORK CONSULTING ENGIIV � so that we can return the card to you. Attaph this Gard to the back of the mai�iecE N.; � ,...; .:.. � .r,.... - -T .,._ ,:._.�, •. ,,... ... „ ., or on the fronf`if `spa "ce permiti"" .:. _ .: , 2 DALE AVENUE, SCIMEf 1. ArticleZdressedto: January 28, 2000 AA6147°®G& �/d r7 I AAp",- 49 07'> Clarence Fahnstock Park Staatsburg, NY 12580 2. Article Number (Copy from service label) Tax Map 40 -1 -11 �,o�� 0,4 ¢,p j;'� PS Form 3811, July 1999 Re:.: Putnam County Dep System for Property - -- A. Received by (Please Print Clearly) I B. C. Signatur l a ❑. Agent. C3 Addresse D. Is delivery address diffet Item 1 ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandis ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes Domestic Return Receipt 102595.99 -M -t7e: • : Name: Michael and Joyce Spiegel Address: 29 Hiawatha Road Town: Putnam Valley, NY 10579 Tax Map: Tax Map 51 -1 -15; Property Location: Sell Hollow Road, PV, NY Dear Sir: Please be advised that an application for a construction permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of ..the - latest site -plan ... y. - If you have any questions, concerns or information that may bear on the health department's review of this application, you may call the Health Department at (914) 278 - 6130. Very truly yours, By: Donald R. Knapp Title: Professional Engineer Received by: Clarence Fahnstock Park Address: Staatsburg, NY 12580 Tax flap #: Tax Map 40 -1 -11 2 DALE AVENUE, SOME SENDER: I also wish to receive the follow- t s p Complete items t and/or 2 for additional services. ing services (for an extra fee): m . 1 12 Complete items 3, 4a, and 4b. O Print your name and address on the reverse of this form so t t we can return this 4b. Service Type Certified t a, DRiK CONSULTING �NGiiV "m: card to you. a Attach this form to the front . of the mailpiece, or on the bads 1 pace does not . - ' - - 1— ` . . , ........°,.. -Z-0 1 • ❑ Addressee's Address Restricted-Delivery. m O Write 'Return Receipt Requested' on the mailpiece below the article number. ' Q ?�� a The Return Receipt will show to whom the article was delivered and the date i o delivered. 2 DALE AVENUE, SOME d 3. Article Addressed to: 4a. Articl b �o Town: CL E M��• A <<F� Tax Map 51 -1 -15; Property Location: Bell Hollow Road, PV, NY 4b. Service Type Certified January 28, 2000 � / �� 0 Registered ❑ Express Mail ❑ Insured iG ' Q ?�� Return Receipt for Merchandise ❑ COD i Date of Delivery 5. ecelved By: (P t Name) 866, 8. Addressee's Address (Only if requested and fee is paid) Patrick and Patricia Macgt o n ure ( r see or Age PO Box 259 I H Putnam Valley, NY 10579 PS Fo 3814, December 1994 102595.99 -e -0223 Domestic Return Receipt Tax Map 51 -1 -16 - - - - - -- - - - - -.. .:.- - ----- ___,,.�- - - - -- __ - ---- _�__-- __- �_--__ z. Re: Putnam County Department Of Health Review of Proposed Sewage Treatment System for Property Name: Michael and Joyce Spiegel Address: 29 Hiawatha Road Town: Putnam Valley, NY 10579 Tax Map #: Tax Map 51 -1 -15; Property Location: Bell Hollow Road, PV, NY Dear Mr. and Mrs. Macquignon: Please be advised that an application for a construction permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concems or information that may bear on the health department's review of this application, you may call the Health Department at (914) 278- 6130. Very truly yours, By: Donald R. Knapp Title: Professional Engineer Received By: Patrick and Patricia Macquignon Address: PO Box 259 Putnam Valley, NY 10579 Tax Map #: Tax Map 51 -1 -16 .9._...., -_ ..._ ... DRK,CONSULTIN.G.ENGINEES - ' - - 2 DALE AVENUE, SOMERS, NEW YORK 10589 - (914) 248 -7726 January 28, 2000 Ritasue Siegel 2411 West 55" Street New York, NY 10019 Re: Putnam County Department Of Health Review of Proposed Sewage Treatment System for Property Name: Michael and Joyce Spiegel Address: 29 Hiawatha Road Town: Putnam Valley, NY 10579 Tax Map #: Tax Map 51 -1 -15; Property Location: Bell Hollow Road, PV, NY Dear Mr. Siegel: Please be advised that an application for a construction permit relative to the construction ".:.. of;a sewage system and /or well. propose , or-the=captione property has been made . to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information that may bear on the health department's review of this application, you may call the Health Department at (914) 278- 6130. Very truly yours, By: Donald R. Knapp Title: Professional Engineer Received by: Ritasue Siegel Address: 24t1 West 55th Street New York, NY 10019 Tax Map #: Tax Map 51 -1 -14 Public Health Director January 18, 2000 ~M� LORETTA MOLINARI' R.N; M.S.N. . •. > Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 WIC (914)279-6678 Fax (914) 278-6095 U&S" Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 DRK Consulting Engineering 2 Dale Avenue Somers, New York 10589 Re: Application to Construct a Subsurface Sewage Treatment System at Bell Hollow Road, Spiegel (T) Putnam Valley Dear Mr. Knapp: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department is incomplete. Please be advised that the following information is required before the Department may commence its review. Do mentation Complete Form CP -97. _ ... _.. __ -• -. -- Submit Form PC -97-. Submit certified copy of survey. Well permit must be signed. Provide neighbor notifications, as required. Planes) Provide datum referencing elevation on plan. Provide access way to service well. Show location(s) of deep test holes and perc test holes on the fill plan. Show locations of existing wells and septic systems within 200' of proposed SSTS or state none exist within 200'. Provide in Title Block - parcel Tax Map #, property location including street and municipality. Locate discharge of roof and leader drains on the fill plan. Leader drains and curtain drain discharge to be piped in separate pipes to the point of discharge. Provide construction notes pursuant to PCHD bulletin ST -19, Appendix C. 8� Provide information as required in Bulletin ST -19, Section 4, Letter A, Number 7R, regarding pump. b G FA Knapp /Spiegel January 18, 2000 Provide "fill plan" as described in Bulletin ST -19, Section 4, Letter B, "fill greater than two feet in depth.." 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 New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EN•VIRONNIE \ ?AL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS �,,� / L_ REV1ENN HEFT FOR CONSTRUCTION PEIMMITf :4TUFeTJLQ I10\ RIi : 1 =I��� �: ✓. _.. NMME�OF OWNER .�, .., REVIEWED BY PUN 1, G , AS, IB, BH DATE TAX MAP 4 y N "IENTS Y N EROSION CONTROL:HOUSE,WELL, SSDS �fl PWS LETTER E ER OF AUTHORIZATION GN DATA SHEET (DDS) . ^ORPORATE RESOLUTION 3' 6RT EAF PLANS - THREE SETS FIUUSE PLANS - TWO SETS ' , ARIANCE REQUEST .r va FEE r fi SUBDIVISION LEGAL SUBDIVISION 00 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) OAS REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS u PER.. & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/N 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LINE (pits -20) 50' INTERMITTENT DRAINAGE COURSE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MN to CDS= >5 0/o,10'- 4 0/*,25'- 3 0/*,30'- 2%,35' -1 0/0,100' - <1% to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION ]NO M20,mrN S DIVISION APPROVAL CHECKED CLAY BARRIER ERC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE L REQUIRED DEPTH FILL SPECS FILL NOTES URTAN DRAM REQUIRED': FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS LOCATED N NYC WATERSHED VOLUME PLANS SUBMITTED TO DEP lflFILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED 60 FT MAX. DEEP TEST HOLES OBSERVED PARALLEL TO CONTOURS PEECS TO BE WITNESSED 100% EXPANSION PROVIDED EX- APPROVAL SSDS ADJ. LOTS SEPARATIONDISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DDS PLANS "& PERMIT _ ME 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 1969. TI • 20' TO FOUNDATION-WALLS _15'WELL TO PL __._ .. ... J;D4kai L . _ _ _ <. 7....100' TO WELZ , 200'1N'DLOD;1'SO' PITS TM�,PEIRA; NAME,ADDRESS,PHONE9 DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mPROPOSED FINISH FLOOR AND BASEMENT EL. COJI�IEIvTS• � ,. � 1 m f___ , 1�_C_ . r-, , 0 u r 00 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) OAS REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS u 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LINE (pits -20) 50' INTERMITTENT DRAINAGE COURSE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MN to CDS= >5 0/o,10'- 4 0/*,25'- 3 0/*,30'- 2%,35' -1 0/0,100' - <1% to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION M20,mrN [__Fj ® TM�,PEIRA; NAME,ADDRESS,PHONE9 DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mPROPOSED FINISH FLOOR AND BASEMENT EL. COJI�IEIvTS• � ,. � 1 m f___ , 1�_C_ . r-, , 0 u r 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. n rT— Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet )Deep or ]Less 1. Construction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) 3. Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) Corporate Resolution (if corporate ownership). (Appendix K) .5! Short Environmental Assessment Form (EAF).(Appendix K) Design Data Sheet. (Appendix K) 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, they following: a. Property survey with metes and bounds descriptions and major physical features. The plan shall make reference, by Hate; -ath survey ourE d in the case of lots not subject to a file 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). /.House location with proposed finished floor and basement elevations sp ifed. Plan and profile of the SSTS, to include 100 percent reserve area,. construction details of absorption system and components including septic t ;distribution or junction boxes, pump pit, dosing siphon, etc. Location of driveways. po,.i 117 Location of well or P ublic water ma' and house service connection. ' Q Two -foot contours of the roe If ground is to be cut or filled both property. rtY t o existing and proposed contours must be shown. Location of any watercourses, ponds, lakes or wetlands on, or within 200 feet of property. i. 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 �,G �v discretion of the Department. j. Location of all existing X1.1- s- an`dSSTS within 200 feet of proposed SST - - and wells or a note�statngtv�nec�st_vrct ir2$0-..fe�e ._.__.._....._...__ ..._.._. _.._..�:.- .._ ._.._ ..,_ _ .. k. Title box indicating name and address of property owner- arcel tax map identifcation number; roperty location, including street and municipality,; n me, address and phone number of Design ro essiona ; ate o drawing, including dates of any revisions; and scale. Location and discharge points for gutter, footing, storm and curtain drains. m. Design criteria on plans to include number of bedrooms, soil percolation L,qg rate and deep.test hole soil information, and sizes of SSTS components. r n. Construction notes pursuant to Appendix C. 1 S- ���' _\ o. pace for Putnam County Health Department approval stamp (minimum 3" x 5 ") preferably at the lower right hand portion of the design plan. p. Location map (minimum scale of 1" = 2,000'). /Erosion control measures for house, well and SSTS. r. 'hen a pump pit is proposed due to insufficient elevation for gravity flow or for dosing purposes, the pump pit design/detail shall include, as a minimum, the following: - Make and model of pump to be used and operational characteristics. - One -day's storage past the high -level alarm within the pump chamber. - Check valve. - Gate valve. - Unions - Operating and alarm levels for pump. - Means for pump removal for maintenance. - Pump curve should be supplied with the engineering report. - The pump operating range should be indicated on the pump curve. - Pump dose volume to be equal to 75 percent of the volume available in the SSTS pipe network. - Minimum velocity of 2 feet per second to be provided in force main. Baffled distribution box to be utilized for SSTS. Trench detail for force main, specify pipe type and rating, bedding and cover. _.-. - .:. w _ _ .•...�..__.._ Note'stating,' "A11 electrical work and inaterialorpump instatlatiot� shall comply with the National Electrical Code. " Note stating, "All pump power and control wiring shall be made htI directly to the control panel without any outside splices. " Note stating, "The pump control panel, disconnects and alarms shall be located inside the house. " 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: "Approved For Bedroom Count Only' If water service is from a public supply or community supply, a letter from the water supplier will be required stating .that they will be able to supply the property with water at adequate pressure. e 10. Well 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. Notification 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 by the Design Professional. • h:: 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" . ff 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 cvi - e -reta�inett- or" e �partmerif's i{es - or future' reference. After a "Construction Permit" for the placement of fill is issued by the Department, a co!1t3 py 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 -1he 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: 0 a 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 6Late 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 min inch. " 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. 5.0 CONSTRUCTION PERMIT RENEWALS fitl 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 1 CHAPTER 144: 10 'x " MIT ifs, € M � i '1 Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under. SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EMPIRES: APP]LIECANT /SP ®NS ®R: PROPERTY LOCATION: December 6, 1999 December 6, 2000 Michael & Joyce Spiegel 29 Hiawatha Road Putnam Valley, NY 10579 Bell Hollow Road TAX MAP #: 51 -1 -15. SIZE OF PARCEL: 6.037 acres ZONING: R-3 PROPOSED ACTION: Construction of single family residence, driveway, septic system within Watercourse setback area r... .a _MATERIALS REVIEWED. 1. Site Plan and. Proposed Sewage Disposal System Plan, prepared by D. Knapp, P.E., dated 11- 10 -99. 2. Site Alteration Permit Application forms, file # WT -312, dated 08/19/99. CONDITIONS OF PERMIT: 1. All erosion control measures shall be implemented as shown on above .referenced plan. 2. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 3. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. Page I of2 ; W . .. _: 4:.� ;The Planning .Boardr W�tlads �pspector,nor Building. Inspector, shall, have the right inspect the project from time to time. 5. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: December 6, 1999 Stephen W. Coleman Town Wetlands Inspector cc: Applicant Building Inspector Planning Board Environmental Commission Page 2 of2 { 1 S PACE 1 ®F a ....- ,PUTI�AM 00UN DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES DATE OF DEEP HOLE TEST: 12/12/1998.3125 /99 test holes inspected by PCHD see attached data sheet. 10/15199 for test holes 6 & 7 DEPTH ROLE NO. I HOLE NO. 2 HOLE NO. 3 HOLE NO. 4 G.L 4" TOP SOIL 6" TOP SOIL 6" TOP SOIL 6" TOP SOIL 1.5' Roots to 18" Roots to 18" Silty clay loam Silty clay loam to 32" 2.0° Silty clay loam to 26" Silty clay I to 26" 2.5° 3.0° 1 1 Roots to 38" Roots to 36" 3.5' Sandy /gravel loam Sandy /gravel loam Sandy /gravel loam Sandy /gravel loam 4.01 some cobbles 4.g° 5.0° 5.5° 6.0° Ledge Ledge Ledge 6.5° 7.01 r -6' Ledge 7.5° "No groundwater "No groundwater No groundwater No groundwater 8.0° No mottling No mottling No mottling No mottling 8.5° Consistency-very hard Consistency-very hard ConsistenR�-very hard Consisten -very hard 28" to water on 3/25199 32" to water on 3/25/99 .. .... , .,.. -. _ V...n. .�... - _ .. �_ .. _ .... .. INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED: See comments for test holes 9 & 2 INDICATE LEVEL AT WHICH MOTTLING IS OBSERVED: NA INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED: NA DEEP HOLE OBSERVATIONS MADE BY: DONALD R. KNAPP, P.E. DATE: 12/12/98 10/15/99 DESIGN PROFESSIONAL (NAME: DONALD R. KNAPP, P.E DRK CONSULTING ENGINEERS ADDRESS: 2 DALE AVENUE SOMERS, NEW YORK 10589 914 -248 -7726 FAX 914 -248 -7726 DESIGN PROFESSIONAL'S SEAL .. .. ._P.U.TNAM,.CO.UR.TY— DEPARTMENTnOF- HEALTH- .-- :. --; -.~ -PAGE 2 OF-,2,- L - -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DATE OF DEEP HOLE TEST: 12/12/1998.3/25 /99 test holes inspected by PCHD see attached data sheet, 10/15/99 for test holes 6 & 7 DEPTH HOLE NO. 5 HOLE NO. 6 HOLE NO. 7 HOLE NO. G.L 6" TOP SOIL 6" TOP SOIL 4" TOP SOIL 0.5' 1.0' Silty loam 16" Silty loam Fine silty loam 1.5' 2.0' 1 Sandy clay loam/rocky 2.5' Roots to 36" Roots to 33" 3.0' Grey san loam/ 3.5' stone 4.0' Roots to 48" Ledge Ledge 4.5' Grey sand. loam/ 5.0' stone 5.5' 6.0' Ledge 6.5' 7.0' 7.5' No groundwater No groundwater No groundwater 8.0' No mottling No mottling No mottling 8.5' Consistency-very hard Consistency-very hard Weathered.led e 9.0' Consisten -ve hard 10.0' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED: NA . INDICATE LEVEL AT WHICH MOTTLING IS OBSERVED: NA INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED: NA DEEP HOLE OBSERVATIONS MADE BY: DONALD R. KNAPP, P.E. DATE: 12/121199E 10/15/99 DESIGN PROFESSIONAL NAME: DONALD R. KNAPP, P.E DRK CONSULTING ENGINEERS ADDRESS: 2 DALE AVENUE SOMERS, NEW YORK 10589 914 -248 -7726 FAX 914 - 248 -7726 �pF NE{v * o v # DESIGN PROFESSIONAL'S SEAL I DI,.`i IO °ti OF ENVIRONMENTAL i A! rr.:. ;,L T! -I `EViCE -S DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM OWNER: Michel and Joyce Spiegel ADDRESS: 29 Hiawatha Road, Putnam Valley, NV 110579 PROPERTY DATA LOCATED AT: (Bell Hollow Road TAX MAP: 51.4-95 [BLOCK: 9 MUNICIPALITY: Putnam Valley Section: 15 LOT: 15 DRAINAGE BASIL: Husdon River DATE OF PER-SOAKING: DATE OF PERCOLATION TEST: HOLE RIO. RUN NO. TIME START STOP LAPSED TIME (MINUTES DEPTH TO WATER MATER LE�9E DROPINCHES (INCHES) PERCOLATIOi� RATE RAID /INCH START STOP (INCHES) (INCHES) 8:00 AM 10:01 AM 121:00:00 10 7.00 3.00 40:20:00 3.00 2 10:01 AM 12:11 PM 130:00:001 10 7.00 3.00 1 43:20:00 10 12:11 PM 2:35 PM 144:00:00 10 7.00 3.00 48:00:00 4:55 PM 4 2:35 PM 4:59 PM 144:00:00 10 7.00 3.00 48:00:00 c�. 2:49 PM 4:43 PM 114:00:00 _...,._ -: 1 7.00 - .. .. 2 1 8:02 AM 10:10 AM 128:00:00 10 .7.00 3.00 42:40:00 2 10:10 AM 12:21 PM 131:00:00 10 7.00 3.00 43:40:00 3 12:25 PM 2:45 PM 140:00:00 10 7.00 3.00 46:40:00 4 2:35 PM 4:55 PM 140:00:00 10 7.00 3.00 46:40:00 c�. 2:49 PM 4:43 PM 114:00:00 _...,._ -: 1 7.00 - .. .. 38:00:00 3 1 8:04 AM 10:08 AM 124:00:00 10 7.00 3.00 41:20:00 2 10:08 AM 12:14 PM 126:00:00 10 7.00 3.00 42:00:00 3 12:14 PM 2:35 PM 141:00:00 10 7.00 3.00 47:00:00 4 2:35 PM 4:59 PM 144:00:00 10 7.00 3.00 48:00:00 2:49 PM 4:43 PM 114:00:00 10 1 7.00 . 38:00:00 4 9 7:30 AM 9:35 AM 125:00:00 10 7.00 3.00 41:40:00 2 9:35 AM 11:40 AM 125:00:00 10 7.00 3.00 41:40:00 3 11:40 AM 1:45 PM 125:00:00 10 7.00 3.00 41:40:00 4 1:45 PM 3:49 PM 124:00:00. 10 7.00 3.00 41:20:00 2:49 PM 4:43 PM 114:00:00 10 1 7.00 3.00 38:00:00 NOTES: 1. TEST TO BE REPEATED AT SAME DEPTH UNTIL APPROXIMATELY EQUAL PERCOLATION REATES ARE OBTAINED AT EACH PERCOLATION TEST HOLE. (I.E. LT 1 MIN FOR 1-30 MIN/INCH, LT 2 MIN FOR 31-60 MIN1INCH). ALL DATA TO BE SUBMITTED FOR REVIEW. 2. DEPTH MEASUREMENTS TO BE MADE FROM TOP OF HOLE. Signiture. License Number: 72770 VPutnam and Westchester Counties, New York included areas and the nearby soils are better suited to Erosion hazard. Slight recreational development. Depth to bedrock: More than 60 inches The capability subclass is Vle. 25 Surface layer: 0 to 2 inches, very dark grayish brown loam Subsurface layer. 2 to 8 inches, dark brown loam Subsoil. 8 to 24 inches, dark yellowish brown sandy loam Substratum: 24 to 60 inches, dark grayish brown sandy loam that has thin lenses of loamy sand stoniness. It is only poorly suited to permanent pasture because of the stoniness. Maintaining an adequate cover of sod is the main management concern. Overgrazing also is a concern. It decreases the extent of desirable pasture plants. Rotation grazing, applications of fertilizer, weed and brush control, and proper stocking rates increase the quantity and quality of feed and forage. The potential productivity of this soil for northern red oak is moderate. Planting seedlings early in the spring reduces the effects of summer droughtiness, which increases the seedling mortality rate. Establishing Included with this soil in mapping are small areas of Many areas are wooded. Other areas are used for CIIB— Charlton loam, 2 to 8 percent slopes, very community development or for recreation. A few areas stony. This soil is gently sloping, very deep, and well have been cleared and are used for farming. drained. It is on hilltops and parts of hillsides. It formed No major limitations affect the use of this soil as a in glacial till derived from granite, schist, and gneiss. site for dwellings with basements, for septic tank Stones cover 0.1 to 3.0 percent of the surface and are absorption fields, or for local roads and streets. During about 3 to 25 feet apart. Individual areas are irregular in construction, minimizing the removal of vegetation, shape and range from 3 to 30 acres in size. mulching, and quickly establishing a plant cover help to The typical sequence, depth, and composition of the control erosion and sedimentation. layers of this soil are as follows— This soil is not suited to cultivated crops because of Surface layer: 0 to 2 inches, very dark grayish brown loam Subsurface layer. 2 to 8 inches, dark brown loam Subsoil. 8 to 24 inches, dark yellowish brown sandy loam Substratum: 24 to 60 inches, dark grayish brown sandy loam that has thin lenses of loamy sand stoniness. It is only poorly suited to permanent pasture because of the stoniness. Maintaining an adequate cover of sod is the main management concern. Overgrazing also is a concern. It decreases the extent of desirable pasture plants. Rotation grazing, applications of fertilizer, weed and brush control, and proper stocking rates increase the quantity and quality of feed and forage. The potential productivity of this soil for northern red oak is moderate. Planting seedlings early in the spring reduces the effects of summer droughtiness, which increases the seedling mortality rate. Establishing Included with this soil in mapping are small areas of logging trails across the slope reduces the hazard of the well drained Paxton soils, the somewhat excessively erosion. drained and well drained Chatfield soils, and the Surface stoniness is the main limitation on sites for moderately well drained Sutton soils. Paxton soils have recreational development. The slope also is a limitation a firm, dense substratum. They occur as scattered on sites for playgrounds. Land shaping and grading -areas throughout.the. -map -unit. Chatfield soils are :...,.... help .-to- overcome.-the _slope.. �empvingTthe. stones may moderately deep over bedrock. They are adjacent to be necessary in intensively'used areas. ecreat'ional areas of rock outcrop, which are mainly at the summits areas are susceptible to deterioration as a result of of hills and ridges. Sutton soils are in swales and midsummer droughtiness. Irrigation reduces shallow drainageways. Also included are areas of droughtiness during these periods. , Riverhead and Knickerbocker soils on terraces adjacent The capability subclass is Vls. to large perennial streams, areas of Charlton soils that have an extremely stony or bouldery surface, and areas of rock outcrop. Riverhead and Knickerbocker soils are more sandy than the Charlton soil. The included Charlton soils are commonly in the western part of Putnam County. Included areas make up about 15 to 25 percent of the map unit and are as much as 2 acres in size. Soil properties— Water table: At a depth of more than 6 feet throughout the year Permeability: Moderate or moderately rapid (0.6 -6.0 in/ hr) throughout the profile Available water capacity. Moderate Reaction: Very strongly acid to moderately acid throughout the profile Surface runoff. • Medium CIC— Charlton loam, 8 to 15 percent slopes, very stony..This soil is strongly sloping, very deep, and well drained: It is on hilltops and parts of hillsides. It formed in glacial till derived from granite, schist, and gneiss. Stones cover 0.1 to 3.0 percent of the surface and are about 3 to 25 feet apart. Individual areas are irregular in shape and range from 3 to 30 acres in size. The typical sequence, depth, and composition of the layers of this soil are as follows— Surface layer. 0 to 2 inches, very dark grayish brown loam Subsurface layer: 2 to 8 inches, dark brown loam Subsoil. 8 to 24 inches, dark yellowish brown sandy loam PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH aSERVICES Date I e ° 7 Res Property of. Gentlemen: This letter Is to authorize ®on& it Knapp a dully licensed professional engineer andicate to apply for a Construction Permit for a separate sewage, system, to serve time above noted property in accordance with the standards, rules or regulations as promulagated. by the C6i�assioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf.in, connection with this matter and to supervise the construction of said system ' or systems in conformity with the provisions of Airticld 145 or 1479 Education Law, the Public Health Law, and the - Putnam County San!-, tart' Code. �'-tia- Very truly yours, Signed. p Countersigned: 4,on rack- PoEo y RoA. 9 # 072770 w Q'� rl Addreas 2 Dale Avenue, Somers; New York 10589 illA.-d Address Toxin l (914) 248-7726 FAX (914) 248 -765 Sf :2� Telephone TelePh ®ne P BRUCE R. FOLEY Public Health Dirict6r May 31, 2000 LORETTA MOLINARI R.N., M.S.N. Associ6ii Public' Health Director ' Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Irving Sevelowitz Building Inspector Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 Re: Spiegel, Bell Hollow Road TM# 51 -1 -15, Town of Putnam Valley Dear Mr. Sevelowitz: This. letter is to verify that a construction permit to construct a sanitary sewage treatment system and water supply system was granted for.the above referenced lot on March 2, 2000, by this office. Approval was such for a SSTS and Well for the issuance of a building permit for a three (3) bedroom house. Please feel free to. contact me at ext. 2157 if any questions arise, or I can be of any further assistance. ABS:cj Very truly yours, &L �• Adam B. Stiebeling Assistant Public Health Engineer 116 F W' A~! 4,{ a .` '€ 4 {I. 4, U B _ & T 01F HEALTH Ii➢ J[ FZISION. OF. ENVIRONMENTAL-HEALTH .SERV-1 C S CONSTRUCTION PERMIT e ri IiBEATMENT SYSTEM PEST # _ D Located at 2 (1, ol�k�Ll A r Town or Village Fl 'N Subdivision name Subd. Lot # _A Tax Map _ Block �_ Lot Date Subdivision Approved 4A Renewal Revision Owner /Applicant Name k IgI_ ,��,���G�- j�Date of Previous Approval dA- Mailing Address Amount of Fee Enclosed 1 J,o , 0'0 Building Type )8(1 J ft Mt `Lot Area Fill Section Only No. of Bedrooms P) Design Flow GPDG,� Depth ' -60" Volume Separate Sewerage System to'consist of gallon septic tank and T pI Other Requirements: To be constructed by Address Water;Sua lam: :- Public Supply From - Address. or: Private Supply Drilled by Address rte' 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,, stem 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 syst during the.period of two (2) years immediately following the date of the issuance of the approval of the Certificate of nstruction Compliance of the original system or any repairs thereto. Signed: Addres NA R-a & 1 M i AIPIPROVIEID FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system htis 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 pe Ap v f r di harge of domestic sanitary sew ge only. By: Title: Date: 00 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION -TO CONSTRUCT A. WATER WELL - ,.. p. P_... __.tyP ,.....,. PCHD Permit # P 1% 5-0,3 lease riot or e Well Location: Street Ad ess: TownNillage Tax Grid # �7 c7 eo Map Lj Block Lot(s) F5 Well Owner: Address: Use of Well: 7residential Public Supply Air /Cond/Heat Pihnb Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought> gpm # People Served %1 Est. of Daily Usage A�ogal. Reason for ace Existing Supply Test/Observation Additional Supply Drilling 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 PS Lot No. Water Well Contractor: Address: - Is Public Water Supply available to site? ..:........................:... ............................... Yes No Name of Public Water Supply: T. w. Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. 1 Applicant Signature: 1 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. Any revision or alteration of the approved plan re wires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Z 0 Permit Issuing fficial: Date of Expiration 3 1 i OZ.- Title: "�fl Permit is Non- Transferr bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form , WP -97 r' Performance Submersible. Effluent Curves Pump ,METERS FEET ... .. 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM l i I i 0 10 20 30 rn'/h CAPACITY ' p p GOUL ®S PUMPS, INC. SBECA FALLS PEW YORK 13148 METERS FEET 120 fl nnr-1 -qRRr, - 9C 25 80 100 30 70 x 20 25• J F 60 0 80 F- 50 15 x 20 40 J 10 P0-,. 30 60 20 5 I- 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM l i I i 0 10 20 30 rn'/h CAPACITY ' p p GOUL ®S PUMPS, INC. SBECA FALLS PEW YORK 13148 METERS FEET 120 fl nnr-1 -qRRr, 0 L 0 01985 Goulds Pumps, Inc. 10 20 30 40 50 60 1 10 70 80 90 100 110 120 GPM I I 20 30 rn'/h CAPACITY Effective July, 1985 11ooe 35 100 30 90 25• 80 70 x 20 J P0-,. 60 0 I- 50 15 40 10 30 20 5 10 0 L 0 0 L 0 01985 Goulds Pumps, Inc. 10 20 30 40 50 60 1 10 70 80 90 100 110 120 GPM I I 20 30 rn'/h CAPACITY Effective July, 1985 11ooe PUTNAM COUNTY DEPARTMENT OF HEALTH D.I.VISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER T,REATWNT, SYS, 'EM - 1. Name .and: address of applicant :� 2. Name of project: j*n �_U 4eg 3. Location TN: rNA. 1 Ups, 4. Design Professional: l2�1, jCS. Address: (,F A��„ 6. Drainage Basin: al J 0!ez�L alv �' - 7. Type 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 Exempt ✓ Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ...........:............. 10. Has DEI• been completed and found acceptable by Lead Agency? .::............ Lev 11. Name'of Lead Agency _ LI,- 12. ,Is this project in an area under the control of local planning, zoning, or other officials;. ordinances? 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities ? , Date granted: - ..� 15. Type of Sewage Treatment System Discharge ....::........... surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... "Ar 17. Waters index number (surface) ........................................... ............. ................... Ar 18. Is project located near a public water supply system? ....... ............................... 6-- 19: If yes, name of water supply �� Distance to water supply — 20. Is project site near a public sewage collection or treatment system? ................ 21. Name•of sewage system Distance to sewage system 22. Date test holes observed 23 Name of He�Insector 24. Project design flow (gallons per dad) ....................... ..: 1E 2' ' ........... ..°... .... gS 25. Is State Pollutant Discharge,Elimination.Sgstem (SPDES)`Permit required ?I.. • to 26. Has SPDES Application been submitted'to local DEC office? . � Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? . Has application l een.made to Town or Local DEC office ?�! 30. Does project require a DEC StreaiWDisturbaritce- Permit?':.. :................................ 31. Is or was project site'used for agrtcultural'activity, involving application of pesticidesao ..orchards,,oz;other crops, solid or hazardggs:vuaste disposal;. landfilling, sludge application or industrial activity? Yes/No 32. Is,,prplect 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? ............................... YesNo DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 9a 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? . ............................... -p 36. Tax Map ID.Number ........................... ............................... Map_ Block_j_ Lot 37. Approved plans are to be returned to ..... Applican X— Design "Re sional -A10TE All applications for;review,and approvalo a�ri+ew SST beldc t ,vin e _ ;.:.� e� s DE IT �be sent to the Department; and need- not-betsent 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 submission. .1 hgrepy affirm, under penalty ofperjury, that in ®rTation provided on this form is true � to the best 9f my knowledge and belief. False statements made herein are punishable as a Class A rn'isdemeanor pursuant to Section 210.45 of the Penal Law. A SIGNATURES & OF. Mailing Address:... ..... V�O Q /off ao ®�� I 07,-,70 1 L.- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONM NTAL HEALTH SERVICES FINAL. SITE INSPECTION r_1 L` IT ' t6 Co Date: - - - .Ins ect ... �...,...... "St`ree"t`�oc , .Owner k Town V `4 TM# si -l" 1. Sewage System Area a. STS area located as per approved plans ... .:: ........ .......... .... b. Fill section -date of placement 3:1 barrier Lgth. t f O Width Avg.Dpth3 c. Natural soil not stripped ..................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. SeWage System a. Septic tank size -1,000 ......... 1, 250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... c�....d. ist 'but on Bo __.... outlets at same elevation -water tested ................. 2. Protected below frost .................. ....................... ......... 3. Minimum 2 ft,Original soil between box & trenches e. Junction Box -properly set ........... ............................... f. Tr—enches T_.T_e_ngtn required &.67 Length installed % 2. Distance to watercourse measured Ft.......... _.._ 3. Installed according to plan .. ............................... t.... �► 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations........:. 6. Depth of trench <30 inches from surface.............. Z 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1 Y2" diameter clean .................... 9.-Depth of gravel in trench•1.2 "-m nimum;:u:: _ .�..y 1(). Pipe ends capped ......................... ...... . .. .:.................... =� g. Pum or Dosed Systems ize o pump c am ec ...... :.......................................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. ox b 5. First baffled.... 6. Cycle.witnessed by H.D.estimated flow /cycle ........ III. ouse/Buildin a. House located per approved plans .......................... .. b. Number of bedrooms ........ ............................... IV. Well a. Well located as per approved plans ............................ ... b. Distance from STS area measured * ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ...................... V. Overall Workmanship a. Boxes properly grouted.......... \r ...., b. All pipes partially backfilled ........... ...............:............... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dir.to exist watercour g. Footing drains discharge away from STS area .............. h. Surface water protection adequate .. ............................... L Erosion control provided ................ ............ .I.................. Rav F /07 Permit # 1 ri) V - S —CtD Subdivision Lot A Ad //1 ' 'R "Y PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. Yes ❑ No _B.-WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by anothdr 1hyalVea agericy: ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced..by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. g� i; TyEE3E, 9Ei.lSJFtFRE.LLt LY.70 -BE, CONTROVERSY RELATED'TO POTENTIAL .ADVERSE ENVIRONMENTAL IAAPACTS? ❑ Yes No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreverslbility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately'addressed. ❑ Check this box if you have identified one or more potentially large or'slgnificant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis. above and any supporting documentation, that the proposed action WILL NOT result in any significant_ adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: c -a Name of Lead Agency .Print or Tyke Name o Responsible Officer in Lea Agency `^ =.t _' ^ 1.' . Title of Responsible Officer rr.�..a� _' '-:.Signafure of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date 2 ,...q . r .... 14.16.4 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 SEOR k Appendix C State Environmental Quality Review - SHORT'. ENVfKC NMENTAL ASSESSMENT• FOK f' " For UNLISTED ACTIONS Only PART I— PROJECT INFORMATIONffo be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR Mirht-1 and Toyr_e SDeigpl 2. PROJECT NAME. FS i n g I P fq mi I y rt-.q i'd t-n r-t-0 'RP I I 14n 1 1 n% 3. PROJECT LOCATION: Municipality • P It t n a m Va 11 P y County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) West side of Bell Hollow.Road, 2 miles from Canopus Hollow Road 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Development of well and septic system 7. AMOUNT OF LAND AFFECTED: Initially —1 , n acres Ultimately —1 - n acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial U Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) and permitiapprovals Wetland variance form the Town of Putnam Valley 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes • ❑ No If yes, list agency name and permltlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Y s 13 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Donald Knapp Date: November 23, Signature: • 1 T// If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 R 1999 PART II— ENVIRONM9ENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATE AS_PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR; PART617.6? If No, a negative declaratlon..� . _ . may tre'superseded b an6thar'10614,..... . y ed' a�eni:y. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or "wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be Induced.,by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1 -05? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. _ tI..ISSFiSRE,•AR•IS -T #ERE— W1(ELY= TO-BE; CONTROVERSY RELATED -TO-POTEf4TFALADVERSt-ENVtR6N ❑ Yes ❑ No . If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural);. (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately'addressed. ❑ Check this box If you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a' positive declaration. L7 Checl his box if you have determined, based on the Information and analysis. above and any. supporting ;_.- documentation, that the proposed action WI6L NOT result in any significant adverse environmental Impacts ;:,..AND provide on attachments as necessary, the reasons supporting this determination: . ...._ Name of Lead Agency frirrt r Tyb'e]Name of Responsible Or icer in Lea Agency Tit e o Responsi e O ice, Signature of Responsible Officer in Lead Agency Signature o reparer (If different f rom responsible officer) Date 2 tY�b, ra -s Yfiy� � �Cq � 1 c0� x HPh :jyVohs Phase(Max Am 1( RPM {( � 1r,;. 115 � j ` '`` ��• 9 4 :� �` �' %3 .� 230 u lK � mot,° } •, A� kgFr- d ATU� R�. y - s Gou ld S 1:Imp�ller - -17 isa ,y dt k_ , Submersible 2 Casl�g '.4 �'t if i'"1� e} i� •} 1� it jyvh, .�:{ai}�{�.5,,�$.c�y�.,;�kt:'rL dr..,.:e uka�",�•i ..a :s: � ..,u�rm^.. - 1 � . "t hx 9`oi �t i r 3 . Atleclaadcal �a Seal ' r� Ot T_ t: T 6 Bearings— F P U, U PPer & Lower t >r } t 7. Powor ble a .,... Y • , _, 8 .0_ Ring 4 LJ . . tY�b, ra -s Yfiy� � �Cq � 1 c0� x HPh :jyVohs Phase(Max Am 1( RPM {( � 1r,;. 115 � j ` '`` ��• 9 4 :� �` �' %3 .� 230 u lK � mot,° } •, A� kgFr- d o o V �e'r.E it r 1, r3 y �.�•''�µf d}Fa, \ 4"�'' �+i t +; -n t� i s t 3JEGi'FIWS NEW 1DRK olaa SPECIFICATIONS ARE SUBJECT TO,CHANGE WITHC � "uS WE0511HN1 k� m .I (t ,s, H WE10i2H WE1612N- WE0512HHI WE151211HI H 411E103Y WE1692N WE0592HH1 WE1692HH1 01, Y{E1 u W 534 WE6651HH WE1BS¢Hfl ':,f 3500 j 3500;'] '3500'af _3500' f 11 X100 •: (( 108 'f l , 53 .Q 82 II r`•jl 95 't ;( 105:��j� ,z 48 ``.I( r7,1:'.'•� �� ,a •., Il'' 91 '� M(( 4100'�,'�(r 45'. -'ai 75':.f ;( :;•�' �, ' ijt 85 jl 96 ,s jC`'' 40 ri'IP ;72..• j is 79 Fjj4 92 _ 35' jh 70 it jjr� ,72 ll 86 :7' 30 :ll 67 ! �� 7 <0$ 4`air :,({ X18, J, `60 J( AZ 65 , jf s 12 (.",",58"r 30s`nh . 54 a� �� �z c n, g" 340 i ,� � •'� is o -: {15 P �CI sYwF �'!? }j� ,''?� iF�'1�'�t� "an`l � ���jj '..';l b{ T i.i`'•� 'o 9'. 1 t 5 ^1a1 L e 4`�� 2r NPT ' `•, � � 3'/. La iel WE0712H & VNE1012H ,18 JI Itleatlaru Canadien,8tendeMs Aaoeletlort r 4 i je flnO taboretoriea c °1 , NOTICE �,' PRINTED. IN U.S.A. -17 isa ,y dt •.�•• t� u�tt '.4 �'t if i'"1� e} i� •} 1� it jyvh, .�:{ai}�{�.5,,�$.c�y�.,;�kt:'rL dr..,.:e uka�",�•i ..a :s: � ..,u�rm^.. - 1 � . "t hx 9`oi �t i o o V �e'r.E it r 1, r3 y �.�•''�µf d}Fa, \ 4"�'' �+i t +; -n t� i s t 3JEGi'FIWS NEW 1DRK olaa SPECIFICATIONS ARE SUBJECT TO,CHANGE WITHC � "uS WE0511HN1 k� m .I (t ,s, H WE10i2H WE1612N- WE0512HHI WE151211HI H 411E103Y WE1692N WE0592HH1 WE1692HH1 01, Y{E1 u W 534 WE6651HH WE1BS¢Hfl ':,f 3500 j 3500;'] '3500'af _3500' f 11 X100 •: (( 108 'f l , 53 .Q 82 II r`•jl 95 't ;( 105:��j� ,z 48 ``.I( r7,1:'.'•� �� ,a •., Il'' 91 '� M(( 4100'�,'�(r 45'. -'ai 75':.f ;( :;•�' �, ' ijt 85 jl 96 ,s jC`'' 40 ri'IP ;72..• j is 79 Fjj4 92 _ 35' jh 70 it jjr� ,72 ll 86 :7' 30 :ll 67 ! �� 7 <0$ 4`air :,({ X18, J, `60 J( AZ 65 , jf s 12 (.",",58"r 30s`nh . 54 a� �� �z c n, g" 340 i ,� � •'� is o -: {15 P �CI sYwF �'!? }j� ,''?� iF�'1�'�t� "an`l � ���jj '..';l b{ T i.i`'•� 'o 9'. 1 t 5 ^1a1 L e 4`�� 2r NPT ' `•, � � 3'/. La iel WE0712H & VNE1012H ,18 JI Itleatlaru Canadien,8tendeMs Aaoeletlort r 4 i je flnO taboretoriea c °1 , NOTICE �,' PRINTED. IN U.S.A. Goulds Submersible- Effl- loumna ® Ig ®� -n21 .38185 ETL LISTED SUBMERSIBLE . PUMP CLASS I AND 11 DIV. 2 AND G1086131480 CLASS III DIV. I AND 2 ETLTESTING LABORATORIES, INC. CORTLAND. NEW YORK 13045 : r PUTNA I COUNTY DEPARTMENT OF HEALTH h11114 c 1'► DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 'Date: Ins ecte I 4(/0( it 16 /Cv Street Loc iFt Owner I Town Permit # 0 V 5 —00 TM # �^ l - (� i Subdivision Lot - 1. Sep` ale System Area a. STS area located as per approved plans....: ........................ b. Fill section - date of placement 3:1 barrier Lgth. t I O 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. SeNlage System a. Septic tank size -1,000 ......... 1, 250 ......... other :............... b. Septic tank installed level ......................... I..................... c..., 10' minimum from foundation ..... ............................. � - a ` i All out etas at same elevation -w ater tested ................. 2. Protected below frost ........................... 3. 'Minimum 2 ft,Original soil between box & trenches e. Junction Bo - properly set .......................................... t• Len requifed �J I;erigtl Ifi' talied COOT 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ............................... ...� 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations........:. 6. Depth of trench <30 inches from surface ................ :Z.. 7. Room allowed for expansion, 100% .. ........................ 8. Size of gravel 3/4 -1 %s" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .......:........... ......... ....... ................. �y g. PumR or Dosed Systems 1. Size o pump chamber .....:.......... ... ..................... ....... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 0 4. Pump easily accessible, manhole to grade ................. `4 5. First box baffled ... ............................... 6. Cycle.witnessed by H.D.estimated flow /cycle ......... III. HouseffluildLng a. House located per approved plans .......................... .. b. Number of bedrooms ........ ...........................:.:. IV. Well a. Well located as per approved plans .............................. b. Distance° rom STS area measured ' ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable .......... ::........... V. Overall Workmanship a. Boxes properly grouted..........:........: b. All pipes partially backfilled ....... ... ............:.................. c. All pipes flush with inside of box ... ............................... ..,.d. Backfill.material contains stones, <4'! diameter,:::.::::: e. `Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercour g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate .. ............................... i. Erosion control provided ................. .............................. , Rev. 6/97 0 ';? L-)Oo age �.l . Z �5 ,C�r��� IZ p _. 1 . . . . . .................... cp I �E�itRtR E :mac-17 _ 7a ihwf j � J AAP PROP o ' I . j - �'.. •. ` , ♦t "fir 4LoR = '� - --•t •�• tygtre 041: ON LIT -0 ---- - - - - DEEP M0.G'M • ♦`♦ \,`. .� - �l' l OCK ♦♦ y — LIZ' -0 I ♦_ ♦♦ .._ : • r -' ,. ! : "� �•1..., C �, "� ' �:. r: ` ♦♦ ♦�i i s�,_ -tea�',•- • �,•' i;, • '[ 'i+ � , t • .. LOCATE IN CENTER OF FI tt�- ll''tt R ••.�S P DI b F - DEPTH CAJGE ,♦ % r -' t eA :;. , , r }; ; 9 " �� Q - ^ D RnOAAED TYPICAL L, -TOP(,V SLOPE TOP OF SLOPE _ -- ♦` , N PR! SSO AREA . "` `" '` T" •Sj� ------- - ------------ ---- -- -_ -�_ - J , s s�•;•.t]. * r. �' y l .ti� -- ---- - - - - -- -------------- - - - - -- - -- kis# .l./ r � 16� VOLUMES PTION APPROX CUBIC 1 1500 262 100 let _- - -- _- -- -- -- ---- -- - _ -- -- --- -- ,�.'' - :.r _•`• _;�'�. - �,: _4. g,. }.[y... .� :i ,w. - - 100% RES: - - -- - - c ' - 97"-0- - -- -- -- - -- - - - -- - - -- - -- .. - 3 ---- - - - - -- �- -..:s= --- -• -- -- _ _,, ._... — .:.�...!. • F. PROPPED 1500 GALLON - - - -- - -- - nn umu mnnnmm� unn vnnm,mm�u,vmmrammmm •�-- -�' --� nnZciuimni :,7uinimwin�iniuiun,i,ium nmu6nunmm�ounnm,y}Ij�� "- - - 200 �- S 2 46. 40 -)N 153.Of - OBSERVATION PORT W)TH — ��'A�NFORTSA ?(•0 =— OBSERVATION PORT CAP TO FINISHED GRADE 12 REQUIRED) RANDOM DATUM AC 126' CURTAIN DRAIN SEE DETAILS _._ '- — = - -- — SCI I {JAI 1 nw ROAD DA DTI A 1 DIV= nil A u t 111 ^W '{ 190 BEDROOM SEPTIC TANK SI14GLE FAMILY RESIDENCE FIN. FLOOR EL 190.0 10' -0•' BASEMENT FIN. FLOOR ELEV. - 181.5 PROPOSED GRADE — FINISHED GRADE vs xw ® ®cc� ®� i .. 1 N Cf Ff0 3 f Hfp p fsi�E IF 21 l7p,H a "^-----Na.i� y0�1 20` MA rYPICAL ol 112' -0 `• "�` ROCK ` —0��� ' [ }. -•.. ..:y D4 n �°`, r `.' ` ,, . "."r�.r�.!u.. :.,� r; _ '' ,77 4•. .,��: �j `ii \ /E LOCATE I IN 9 CENTER O F ,F,I,LL J0bS P2 l,,•. _ h7-7r �'''.;.,_,ii'r F h' 3, / ,s ( �` .�'• ICI DI �--- -- FILL DEPTH EAUGE , °• - .r !• ?� .y: '- i,.,'y �,r r f { \ -0' ti. v Q n 8 RtQJIRED TYPoCALI ____TOPff SLOPE 02 �t rYf .. • is , 'lI :4.' c' ' �; : w' ? V PI '�- TOP OF SLOPE - --._ �' ., •i• -:. %• rr; ? n- ,�,y�'J;1 ,.'�: a' �: h - ``.__y,_a- - PRIMARY 3$D ARE/-- - - - - -- � p Zr. r,ry�, o � ::r. .}c \ •,.i 1 '.f a r, . I `b- �-- 8--- - - - - - -- I 11 Z y� n.4,',7 •!J., . _� ' i J� - �----- -� - - -- -------------- - - - - -� - - -- -F- -_ -� rR,' `r' - p�x •r d .;.....�►.d,,•�c6� r ,y 1, - - - - - -- ------ --- - -- ------------- ``' -- -- - - -- ---- --- -- - - -- - - - - - - - - -- -- - - -- •. i:. i. •� r 1.� - - -- -- - - - - -- -- - - - -- - - - - - -- !;.'' :' m` - -PROPOSED 3 I5C0 C • --------- -��an..ec- = - - -�-g• S- - EPTI. _ - 3�. - - - -- nununulm un r unnnnimumlumuu......... +/+= --� ""` 2 -� - -- - - -= �mnmttiunim ---- -m np mu i i w u0nmummmniniri im °mama - _. 5 00 ,. ,. ....... ,._..,��..�: BEDROOM S SINGLE FAMILY 46' 40" V1 1 3.01' RESIDENCE _- s•_ 190 EIN. FLOOR EL 190.0 10' -O" OBSERVATION PORT WITH �seRVATwNroRT A O =— OBSERVATION PORT CAP TO FINISHED GRADE 12 REQUIRED► BASEMENT FIN. RANDOM DATUM _ 126' CURTAIN DRAIN SEE DETAIL y' ___ - - - -- TLOOR ELEV. 1915 —`� :k NF.RSIIir AND USE UE IN LJAI :N IS IONS A_S INSTRUMFI+IS Of SCRYICE ARC ANn SIIAI,1. REMAIN :SUI.l,NG CNOINFSRS. TI(P.SC OOCUMCNIS ARE NOl TO DG IOR ANY OTf1ER rRO1ECIS OR rURrosrs OR BY ANY OTHER rRLY AUTIIORmn R1 NT CORACT WMIOU- ME SrECRlC 'K Mwan „w: rwrrr.Tre� I� .4 BELL HOLLUW Humu PARTBAL 36TE PLAN SCALE: 1= 20'_ 0" IT IS A VIOLATION OF-THE PROFESSIONAL LICENSE LAW FOR ANY PERSON TO ALTER THIS DRAWING IN ANY WAY, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER /ARCHITECT AS APPLICABLE• THE ALTIERING ENGINEER /ARCHITECT SHALL AFFIX HIS/HER SEAL AND THE NOTATION •A] TcaFn nv- rni I 1 t f } ? t v// rti U I- \% fir. + � °�' �,.�.. � s • c� _ _ __ f � A�\ "iri /q : C.rA ^fit /C � \ •`; Ae Err G%,o w Cr X%S a _ � ioa �d!•'Q P...bP � �. - `� Ive odc .��tC //y Tr /�C � =f �! � eal[•� -�' .•a.t� - `�rY� �. 4.�L'`�.%+e '�fG� %.Y�J' - / %•y�*�... � \. %v � 4/J d✓/J i�� S 1 /L�cS. `-� 0 � -r- � i /3�s • �v+. - - -�- -- -- . 'k� - fi- >..'�,' , Y, �, �' �"it ° _�: � - Ot/1C � / ` � : � l �$ I __�� »S K � � � � �.1 r - J�t3�rti b V•'fs'a�� "• Q r Box Y 1 - 7rNEr T C %Oti o Qr:� � "av�l�%.,� 3%� ;;t ..y. .,' �, ro-"r "% t ---- S •>W �. i- �• 15 ' � + +ate �` \ \ \t c tc - l - =.4•. r'%8��:0�., A 1lyh. -`Y:,. ro �� I �7 Oii6'i -no / 'v �J / /'� N.. ✓U YY N es i' .� � . :/�!'�� ®fiJ �: . r '_�- / ✓O2�CI I'YJ ���sraP t/ CDGfY�iG: �•�"'.. ,' s.: � -. ��� ` G � >t �� .. 50i � :� '` 'wil �un9�r•.na Tip,• .``- -.. _ � =' ..:.: .S p �'P! ��?�� _C.�cPe.k�;��B �-. ®LPN, �' �►, °� w p I l cX r�Ce,dcaf _ - _ _ _ ._r 9 � :' l� .f . - �:�! ' .� " � ' • `, _,• '-.� wo v - -- �+- %Ij L� I'11? f io v+n C} ly i 1 F o4' h h &r VLX 'r A . - ~ � a a JJ, i ,/ � '' ]I � O � { 'y �Q " /il`j r °q _ ��% `' �Y �ol G ?%r , �r�} .�•� .:���„:� .'<• t - � - -- . vo ,= J ! '•ii -..:J �^ , t i t �'�"ar, _.._yf% O J ; ? J /d'IY • 4-rBtR G- 6 t i ..c, .: i.o.,!'ui noP {iii _ _ 1 � a3' �:, � ��vtsanisY' Heeilth S®sel000 .fit+ bdC ....•k.l- Iti%� Q :/ SG- �f .✓ ' .O' y� ¢ od ed r.88�8'Yor ooafos€�sao ©' vita ��! —� my .►. help „• �� .�y�,iia�b�� -`pies �aa �egnimeioZ a le _ _ � •7 `. � �� ' § �m�s s off_ � ,' - _ • i i i, . ..... ... ... . VAP A SA,oSEO,, IP t • UV /g y F�Oo C 4, % % --------- . .. I 20r IAA P4 (A 00. DELP tlQU CRIPTION APPROA PER 4F4 - _t: VOLUMES "fit M6',_ 112' -O CUBIC) ry 1500 P5 Fq ED a 262 U4 S 100 rD 05 mof Ir Li LOCATE IN n CENTER OF FILL p7 P2 DEPTH C�AUIEL DI 5 RtQ-qRED TYPICAL ♦ T '14, X j , T2 D2 I. -TOP LOPE SLI TOP OF SLOPE Pi 4 D3 PRIMARY 88D AREA -- - ---------------- -------------------------- ------------ ----------- - --- ---- . . . . . . . . . . . . . . . .... ow, ------------ ------------- . . . . . . 100% RES: -- - _71k --------------- ------- - -- -- 1500 GALLON - -- ------- PROPOSED 3 SEPTIC TANK ------- BEDROOM SINGLE FAMILY .............. RESIDENCE n., W 153.or EL 190.0 46" 40'" 190 FIN. FLOOR 10'-0" ERVATION-PORTS5 It OBSERVATION PORT BASEMENT FIN. OBSERVATION PORT WITH CAP TO FINISHED GRADE t2 REOUIRED) RANDOM DATUM i FLOOR ELEV. A L126- CURTAIN DRAIN _SEE DE_TA'L:6___ PROPOSED GRADE FINISHED GRADE nw nnAD n A 13 T I A I QllrC 101 A V y. z 2 Y c 3 J M i 0 1 t 1500 GALLON SEPTIC TANK 1000 GALLON PUMP CHAMBER 2- SDR35 — ISA - v 44' -p•• 15 � THIS IS TO CERTIFY THAT THE SEWAGE T 1GA THE SYSTEM WAS INSPECTED BY ME BEF 53•-0•_ WITH ALL STANDARD RULES AND REGUU 13A 14 - 52'-0•• A STATE DEPARTMENT OF HEALTH: 12A �. 6 ., 53-0^ -- _ IIA -' 50•.0- 12 -S - u S 5• -p.. I0A tp_ < 0 52'.0.. 10 9A I 3 SA 38' -0.. 2 .- S1, 0.. 22' -0" _ � 32•_0.. N l- k7• _;} OI BY 4 �I CURTAW DRAW O � n S 32' 46' GO" W ............... -7 153.01' r f i I f 0 t r s, i 13 i •A •i -4W: 6A •SA 6t, k 4 ' Y1 •a 1 1 J WALM f C 2W — ORL HCUU tiv UeWD r - v n THIS IS TO CERTIFY THAT THE SEWAGE T DATE THE SYSTEM WAS INSPECTED BY ME BEF WITH ALL STANDARD RULES AND REGUU DATE STATE DEPARTMENT OF HEALTH: :Y DATE i; ,BY DATE I BY I I 3 B 2 _;} DATE.. BY 4 DATE BY f 6 -. +� 1 4. mcrcm I U I MC I AOLC UIV i nc MO-outL i ui M mnu rwm Oar i n, o i O1 -we i DIMENSIONS. AS BUILD TIE -IN DIMENSIONS NODES A I B 13 1 118' 123' 1 A 132' 126' 2 116. 2 A 134' 123' 3 105,41 109, 3 A 136' 120' 4 98*-7" 102' 4 A 132' 115' rj 92' -5A 129' 110, 8 86' 88' 6 A 126- 104' 7 120*-9" 130' 7 A 121'-1" 139' a 1 114' 122' 6 A 114'-7" 135' 9 109* 116* 1 9 A 107'-2" 129' 10 104,-2, -:109:.. .10 A 125' 11 97'-7" 102' 111 A 96'-3-. 122' 12 92' 96' 12 A e8--5-- 115' 13 89' 13 A 80'-4- 107' 14 80" 83' U A 73--4- 102' is 68' 73' 15 A 65--l- 96, C 45*-5, p DI3 121'-7- , 7N 0R. : '1,4, � - L,% 1 Ll, f vouats ►vextIment of AmAtIL Avislon of bivirommenW Health Service. approved as rioted for conformance with applicable Rules and Regulation of the Putzq Cc t Departamt. L rn GG >> CD C= C3 C-) O Cii DATE �27 ..... ..... . y /f !a.•:lry heel e 'If ref Ao, yw Ao Cr i i/S< i I �%av J� Q� y d✓i1.,%..SG�S 0 �� .. � o I►7. 3,ac it Al � lu ,+ r ' � 1 3 i F 't Ir :v r� i .r� • ,. I �1 GAY ,� �P 20 154.17 AC. AL I I 10 AL I % �� JOE � .i� o s• 9 �9 i i i i w �Piµ�1T r' 178.89 AC. CAL. ;� .0 AC 1 I5 6.54 AC. ` CAL. ,� 7 s . I � uWA IN ois�ure 14'' AC. t,• A' , sl 10.3 Ac ,--S6 \ °,.ems ti�\°� CQtscgml2 r tr h I1 ° lil t 8.39 AC. �3 g _ 22 4 e41 • �Q?6 10 3.02. AC. 8'= X23 „�Z� 8.23 AC. �ssea g +$ 8.38 /Ac. WSW ` �p,�y i 9 8 8 4J+ rorRy2 w 10 1 2.26 AC. 3.00 AC. 0�9 25 +�u . 3.00 AC. 59 tr ' 26 +sau 42.53 AC. ra n r . 1cr `� e �r��' 3.00 C. �.> M 5 Je lco+� 27A* s ti 56.97 AC. • „ 3.01 AC. LOU G \ �. k29 *� , g .4.27 AC. vt V AL 3.04 -AG. 8 . � � � •PK9wl� 3.03 AC 8 iS ISSu ^Pr ✓ Kla 19.23 AC. r 3246 ,� r