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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -13 BOX 22 02627 Rio i r , .� • f T . 16 i I it . 4'� 02627 PUTNAM COUNTY DEPARTMENT OF HEALTH ....a .:.,..:.:D Y IO =0E ENVIRONMEN�'I'�= -HEAL'T'H SERY CE =r :. CERTIFICATE OF CONSTRUCTION COMPLIANCE FORS TMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at' o "__0 e-e &4C> Town or Village Owner /Applicant Name �p 6 , a 6o L - � Tax Map 62— Block -3 Lot Formerly Subdivision Name 0 /Cc C) gf � Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD Zip , d Separate Sewerage System built by Jem iuo Address Poo j6a iaS. c 14, Consisting of ZOO Gallon Septic Tank and 4CO c4 2 R_ yifoa— `�/Z,6i4& iei' Other Requirements: 0 Water Supply: Public Supply From Address or: ✓ Private Supply Drilled by _ Address _e— 3i O Building Type 6a /3 1 JA � ` Has- brosion control been completed? Ho ' Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatio of �e am C unty Department of Health. Date: d L3 Lo Certified by �-�-. P.E. ✓ R.A. Address �j4 "'� fj signof¢ssi ��� __ V. �L— License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from 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 subject to modification or change when, in the judgment of the Public Health Director, such revocati m difica ' or change is necessary. By: ��" Title: Date: 6J •o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUT NAM COUNTY DEPARTMENT OF HEALTH TH 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUC ff6N PIERMMIT FOR A .GE (TREATMENT SYSTEM I PERMIT # — %� I -00 ti L d vy it, -Ci7 Ev,.. � T r Villa e ? ��►1 `/A i� ocate at Subdivision name � �; '._. 2 Subd. Lot # 10 Date Subdivision Approved own o g Tax Map :? Block 3 Lot 1-3 Renewal - Revision Owner /Applicant Name ZI-66+n Mi p.- j e �Lj ct, Date of Previous Approval Mailing Address l 1�-i �1 e�.�►d (10A Amount of Fee Enclosed Building Type dem Lot Area .� Zip No. of Bedrooms 4 Design Flow GPD_60 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED UIRtED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12-S-0 gallon septic tank and Other Requirements: 125D GOAL PU-j Tr 19r-J tc To be constructed by d f� Address Water Su 1 : Public Supply From Address mr: Private - Supply Drilled by 'T- Address ,y I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date q License # S 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 whe sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new per 't. A roved f ischarge of domestic sanitary sewage only. By: Title: Date: 11 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 WELL COMPLETION REPORT . Well Location Street? Address: �i 2 e R , Town/Village: P� �, e, Tax Grid # Map 6'^Z Block3 Lot(s) j' Well Owner: Name: Address: C Use of Well: .1-primary: 11' econdary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion _y_ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length _,a=.Lft. Length below grade oZ6 ft. Diameter _7 in. Weight per foot / 7. lb /ft. Materials: JZ Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner:_ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test Bailed _ Pumped _ Compressed Air Hours Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses .. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft.. ft. Land Surface Land/ CL21 /d j j ✓ (S '�° a �" .. �... - ... _._ . .... :... . • . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typeo�i�� Capacity ._._. Depth Model Voltage ;ZO HP Tank TypeLx Volume , Date Well Completed 0p Putnam County Certification No. 007 Date of Report ��S ao Well Driller (signature) lap &;' ''N V YE: txact location oI well wim aisiances to ai leaSi two permanent ia[unuarnb w vo Yivviucu vu a OuFa` "', ..vF+.+a.. •Well Driller's Name N111144;17, % o; Address: /D/ f t !2 31 lc i-o", /V •/ ' Signature: Date: l�D –�— White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 BRUCE R. FOI.EY Public Health Director LOREITA = MMINARi -R.N., M. &K Associate Public Health Director Director of Patient Services DEPART 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 Interventlou (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUIYIBER- E911 ADDRESS: TOWN: Orly INS"I NUN-1 AUTHORIZED ORIZED TOWN OFFICIAL,:, U (Signature) DATE:` The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERB" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES v, ... ...,�,... g-r^r. Y' -�� ^ +exe+- ttrnx�:,e. zi'. -t -:W 4� .fr...rs..v: �..vt:L Ana- 'l�+•L.ay.:iYa:rs «..'��..ea : —xT' x- .A...... . trrrr +rteCnY::�•�..• v rt.- r..vwva- �. A-N :_sr..sza. --�u� LETTER OF AUTHORIZATION RE: Property of. Located at T/V /P, Tax Map # Subdivision of 2-hp m,-p- b Subdivision Lot # % Gentlemen: �g¢Q /LD 5 Z. Block 3 Lot / :CpQe'L F--S L%�Ed�iS. Filed Map # Z 116 E Date Filed 3L,3166 This letter is to authorize 1& Y rgero lu <Se f`f a duly licensed Professional Engineer ,�-'o_r Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in :conformity with:the- provisions-of Article. 145 .and/or. 147 of.the Education Law,,the_Public Health. Law, and the Putnam County Sanitary Code. . Countersigned: P.E., R.A., # Mailing Address box 9�5-y t�v State �zip C C)S4- l Telephone: iDoi� - 0 37(v Very truly y rs,. Signed: ner of Property Mail Address: etcl meted 144'1D State Zip Telephone: 4-11 - 5� 4 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH - -- _ . . .. . ........._.. DIVISION _OF- _ENVIRON ENTAE_.HEXLTH SE V-ICE.S. _, . _ .._ _.__.- _ -. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by 0 B Pee.- Location - Street CD 10VII 1 Building Type 5Z .5 /.5 Tax Map Block Lot FJ 4, VId Ae Tow illage V% <2CD$�s�'�y Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the "system.-" _ _... ... _ .. .. .. _. �....... . The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the buildn utilizing the system. A Dated:,iontV / I D -,,Dav 3 ) - Signature Corporation Name (if corporation) 00 Signature: Title: Corporation Name (if corporation) Address: Ryc�moa� l .d P k s-L State Zip State 4 Zip 1 ZGo Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street .. _...._ -- ------- ...------ �------- .___..... _.._.- xc�rk• -t�w.� .,Hei.gh�.�,. ;�_�;Y. >..;�c��±98,. - -- - - - ... _-y - (914) 245 -2800 Albert H. Padovani, Director LAB #:.32.005754 CLIENT #: 11705 NON STAT PROC PAGE 2 NNNN N N N N N N NNNNN NNN N N --- N ---- -- N -------- N N N N N N N ---- V- N--------- N--------------- MIRABILIO, JOHN i RICHMOND RD. POUGHKEEPSIE, NY 12603 DATE /TIME TAKEN: 09/08/00 09:OOA DATE /TIME REC'D: 09/08/00 O1:30P REPORT DATE: 09/20/00 PHONE: (914)- 471 -5199 SAMPLING SITE: SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COL'D BY: JOHN MIRABILIO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF N N N N N N N N N N N N N N N N NNNN N M N N N N N N N N M M M N N M N N N M NNNN N N N N N N N M N N N N NNNN N N NNNN N N N N N N N N N N N N DATE FLAG PROCEDURE 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 /L, DEPENDS ON THE. SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L �MODEhATELY HARD„ WATER : _ -74 -140 . -MG /L_ _ ..__: _MG /L -° _M I-LL� E GRAM PER LITER HARD WATER: 140 -300 MG/L (1 grain %gallon.= 17.2 MG /L) SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 lc`v PUTNAM COUNTY DEPARTMENT OF HEALTH �P DMSION OF ENVIRONMENTAL HEALTH SERVICES L FINAL SITE INSPECTION T.�a� +:.s++� a: :.z.. c.�..ar- r.:,..a:.. �.v.z. n.r., �.arr • ocr= ea,.`^s„can. .w•c.....•r. -rs :.-.� -. ... ... ar:..•a.� ... e Ins ecte Street Lo 'on t czry ��c.. Owner 2 a; L CO) Town Permit # TM # Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. SeNtage System p a. Septic tank size - 1,000 ... ..12 other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... f. Trenches 1. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8., Size of gravel 3/4 - 1%" diameter clean .......:.........._ 9.. Depth oil- gravel in trench 12" minimum ................... p10. Pipe ends capped ................................... :.................... g PPum�or _Dosed Systems 12,50 1. Size o pump pump c am er ................ ............................... 2. Overflow tank ............................ .. . ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible'," ccessible, manhole to grade ................. 5. First box baffled ............................ ............ ;.........i........ 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans ... ...............................I 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 ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box... ... .. ........................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... I- G'L d4 Y� ✓ V� C 'Tel. Street Town State Zip PERSON IN CHARGE' R .. Dste OR XffF_WPT Name and Title TYPE OF FACILITY FINDINGS: S ,. - �-- :• t r fly , �4 Po w =J , t� 1121�Q LJ�.P4L� %c4 v rriTQR' TFT Signature and Title nVnnnrr n1 OUT.ArVn RV!' = ► t �' _ I acknowtedge receipt of this report: SIGNATURE: Title.,-.' . f �'3 - .... Goulds • .:•rsei.,n '� rx: sms:w•..... .. ... ..... - _ . .. - .. rs ... r- .-a .. - K� 5 .- "Y .. '.•sY +,sY .R .i9-••.nF._ '= i'z:a:rvd' e wage. PS:. u . _. 3887i APPLICATIONS ,Motor. t�,�, t;:FE►TI�RES �'j"r;4afr,� " c t Single Phase 'A HO" 115V brlt'12, �y ,1.� 34.. 3 , 230V 60 1 1760.RPM 1 HP' 'j 1 For Homes , L + ,i 230Vt 60 Hz 1750 RPM,`1. HP, r t Impeller: Cast,lron semi Farms. +' , !�f, , opennon clog with pump out t1 , 230V, 60 Hz; 3500 RPM 'Built In 1 r 1 u,,�11►,�� ;vanes for'mechanical seal pro-,( Trailer courts rt �', overload . with adtomatlC_�eset °� k , tection: Balanced for smooth �, 3a, Motels ry dt!'�' �,}�i Three Phase: 1/s .1 HP 208/230 Schools f ; s' f,�'' v� �', hr460V, 60 Hz;17%RPM; '��`1 t :Cesing Cast iron volute•typeT s SeWag_e systems ` � , i Y ryr h 208/230'460V,`60 Hz, 3500 RP'M�u. + i doh mazlmilm efficiency 2;; Overload protection must. be a,z�7, al, {,^ lscharge adaptable for Hospitals rovided m starter urnt. f d P yr Industry , ., l�jy+ I syst @m$ t r , Shaft Threaded 400 series f ' t+ y1` Dewatenn9 stainless steel Mechanical Seal: Ceramic vs `1V . carbon sealing faces, stainless, a: ahr anyv�i here waste or dramage'tnust y, l Bearings Ball bearings upper ��$lg;,, yhsteel:'metal arts, Buna N o��r;; be disposed of quickly, quietly ana ' and lower + , �' rf nary}„ h r r v <tu" iT 0 V elastomer efficiently. w�a Pswer G`ord: 15' sCandacrd (optio „ l Corrosion resistant Shaft k lengths available) li* „y j 15 r• T ti stalnlessateel. Threaded d6§196. rSPECIfICATIONS ` 4, Single pha ..t %i HP, t6/3 r'}Pl, i #gt �x : Locknut on three phase Ho' dll to SJTO with three. prong plug; 3/a and,,1,''guard against componentdamage Pump + ` { 1; HP, 14 /3_STO with bare leads 7:' k` 'z on accidental reverse rotation , r r Three Phase. �/x 1 HP 14/4 STOP l cry t salt, Solids Handling Capablllt�es , , j �f,Motor Fully submerged with bare leads 2" maximum grade turbine oil Capacitles..Up to 180 GPM; r? =, , `. ;On CSA listed models 20' Jengtti ��+W$ ; ;�u6ncation'and efficient ,:. SJTW or STW are standard �; �':,�'at, Y To tal'Heads: Up to 49 feet TDH y la ` Discharge types available Designed for continous operatis�rL -'2" NPT threaded casing . ,1 All ratings are within,the working 2" NPT threaded companion limits of the motor. F - 'flange "BF" or " BHF units Bearings: Upper and lower' Optional 3 NPT threaded -' Y Y 9 1 p-' heavy dut � ball bearin s ; .*j ; ', ' companion.flange- ''BF;'or construction.. c "BHF" units, must order (A1 -3) Power..Cable: Severe duty,,..,,,.,, companion. flange separately rated, oil and water resistant Mechanical Seal: Carbon rotary/' Epoxy seat on motor -end ceramic stationary, 300 series provides secondary moisture stainless steel metal parts, barrier in case of outer jacket _ BUNAN elastomers. damage and to prevent oil V _ a Temperature:.160 °F (71 °C) w wicking.' maximum. TP and THP Models have. Ri : _ O- ng Assures positive Fasteners: 300 series stainless 2" companion Flange: sealing against contaminants. and steel. oil leakage. _. Capable of running dry without.:.. ....., _.._.• damage to components. ': .�... .. ._ -P ., _ >.... .. -`*. .� ��u3 .:: c Fk ,._,,sur ,_, .. ,�� w„Yu,w .n„ ....�. ','�_,.. ,'., fro-. `"' —_ BRIJCE_ .R_. FOLEY- Public Health Director 0 Roy P.O. DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public' Health ` Direcctor Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 orrI5 October 24, 2000 Xsen, P.E. 950 NY 10541 Dear Mr. Fredriksen: 0 Re: Proposed SSTS: Miribilio Wiccopee Road, Lot #6 (T) Putnam Valley, TM# 52 -3 -13 A field inspection was conducted by the Writer and Gene Reed, Environmental Aide on October 23, 2000. The following was noted: The SSTS has been relocated without a revised Construction Permit for a Sewage Treatment System. _- - - �- The house appears to be occupied. Furthermore, the septic tank is spilling sewage onto the surface of the ground through the outlet pipe. Both of the items noted above are violations of the Putnam County Sanitary Codes and notices of violation will be sent. A review of the file and plans for the project has been completed. Comments as follows: W Design Data Sheet has not been submitted. � There is no record of a Putnam County Department of Health Representative Irea QT,H DATA witnessing percolation tests in the revised area. Construction notes 1 -15 have not been provided on the plan. l� Name on the SSTS permit application and the SSTS plan differ. Revise accordingly. Erosion control measures for the house has not been shown. Pump curve has not been submitted. Pump pit detail is for a 1000 gallon tank. Plan view shows a 1250 gallon tank. � Revise accordingly. ;C Wd ICI-3000 ,0 Check pump size. SOAI S 1 -SIT" 3W AN3 ,1KOO ;gVNInd I Letter to: Roy Fredriksen, P.E. - October 24, 2000 -2- Dose volume is not correct. The minimum of 800 gallon of storage is to be provided. Standard pump pit notes have not been provided. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RMAn cc: Bruce Foley Adam Stiebeling Very Robert Morris, P.E. Senior Public Health Engineer NAME OF OWNER: REVIEWED BY: RM, PUTNAM COUNTY DEPARTZMENT OF HEALTH DIVISION OF ENVIRONN ENTAL HEALTH .TE�t.�.�.P�s�'•:.. ss�s�?JF�.Q�...SF�ACrE TR�ATNLEN`1r SYSTEMS,�� pV.. �.- :,�p.:�z- .r.:- .�..�......r -,�., b REVIEW SHEET.FOR CONSTRUCTION PE HT # / T LOCATION: tLC �ti� G�& SRDATE: Y N 8 TS (_) ' � MTI APPLICATI,, L)U�' L P PWS LETTER UUPC -97 �IGN IER OF AUTHORIZATION N L —)(_)SHORT EAF U(_JPLANS -THREE SETS L—)C--)HOUSE PLANS - TWO SETS C--)C—)VARIANCE REQUEST SUBDIVISION UULEGAL SUBDIVISION �) SUBDIVISION. APP OV CHEFKED U D UUCURTA 4 D D GENERAL C --) CATED IN NYC WATERSHED ( IANS SUBMITTED TO DEP (�( LEGATED TO PCHD (--)je±jtlEP APPROVAL, IF REQ'D gj (_)DEEP TEST HOLES OBSERVED (_)C_JPERCS TO BE WITNESSED (___)(_JEX- APPROVAL SSDS ADJ, LOTS (__)(_JWETLANDS (TOWN/DEC PERMIT REQ'D ?) � (� D TA ON DDS PLANS & PERMTT SAME _ U 1J(LETTER BI/2BA . U(__)100 YIL FLOOD ELEVATION W/I200' TESTING LOTS>10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) 3 HYDRAULIC PROFILE .VTTY FLOW _...- - - - - -- -- - - -- v STRUCTION NO . um- TOURS EXISTING & PROPOSED WAY & SLOPES, CUT NG /GUTTER/CURTAIN DRAINS (ERS NAME ADDRESS ADDRESS, PHONE#_,,,;, (.a DATE OF D (,)DATUM REFERENCE (-)(__)LOCATION OF WATERCOURSES, PONDS AKES,WETLANDS WITHIN 200' OF P.L. ROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS UPROPERTY METES & BOUNDS t Kn COMMENTS: 1 TAX MAP#: (CONFIRMED) ---:S Y (REOUIItED DETAILS ON PLANS CONT'Dl HEO'USE.SEWER -' /V FT. 4 "0'; TYPE PIPE CAST IRON \0 BENDS; SiAX BENDS 450 W /CLEANOUT RENEWALS (-J(SIIE NOTE (NO CHANGE) FILL SYSTEMS (__)(___)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE C—J(—J L PRO E & DIMENSIONS (__)(_)FILL IN EXPANSION AREA CLAY BARRIER NOTE UNCLASSIFIED & IMPERVIOUS EPARATION DISTANCE FRt M'fQZ.Oj SLOPE TRENCH T TRENCH PROVIDEDZi 60FT MAX. ARALLEL TO CONTOURS 00% EXPANSION PROVIDED (__)UDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL ( )( ),CEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 'TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL TO FOUNDATION WALLS 0' TO WELL, 200' IN DLOD,150' TO PITS 0' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) >TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER vT0 WATERLINE (piis - 20') �'-I`ITERMITTENT DRAINAGE COURSE `- X200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS Y10'FROM 0' N11,i 1 TO LEDGE OUTCROP SEPTIC TA FOUNDATION; 50' TO WELL fir✓ 2 WELL CZDIMENSIONS TO PROPERTY LINES �. ATION OF SERVICE CONNECTION 15' TO PROPERTY LINE SLOPE IN SSTS AREA (520°/x) RADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS P NOTES iE 75% OF PIPE VOLUME/DOSE VOLUME NOTED .-AIL FOR FORCE MAIN, (PIPE TYPE, ETC.) AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN (L) STANDPIPES, 5' BOTH SIDES, DETAIL (_J( 15' MIN to CDS = >5 %, 20'-4 %, 25'-3%,35'-l%, 100%-<I% (� )20' MIN to CD DISCHARGE /100' with 182 cons day discharge (__)( )10' MIN to NON - PERFORATED PIPE (M. ct2tC3� tL�o %G� f GGV - • .i1 .;.:vL ... .� _ � .- :.�..��.!� ��_.. �....�- y wwY ♦ r N- . � J 1. .. 5..+. Tr^ .. a. ... ._• ..._ .c•. r —a: Y .,.._n F. ". v. �L �PC•'c..a - - - -- " /LAJ j� rU1LV!!L•1 .1�JU1Y1S 11C�iLlA Lr+i� DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Camnissioner of Health FIELD ACTIVITY REPORT - Sheet of % INSPE7CTION Jam- — NAME Orig. Routine Orig. Canplain ADDRESS �� C �!�� d N�� Orig. Request No. Street Town TM No. — Canpliance Complaint Camp MAILING ADDRESS Final P.O. Baas Post Office Zip Code Group Illness _ Construction TELEPHONE • 34• • • H.5 Name and Title DATE TYPE FACILITY TIME TIME LEFT FINDINGS: '7� Reinspection Field, Sampling Only Field Conference Other Explain '- Z; � .rte -& INSPEC'T'OR: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION 1COMPLIANCE TREATMENT SYSTEM , PCHD CONSTRUCTION PERMIT # P /© X D Located at _( A GGa 02-c-e— iz 4i--5 Town or Village J 114 //n Owner /Applicant Name �p X1,7 O 'C46„ L.� L Tax Map Block _ Lot i3 Formerly Subdivision Name Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD Zip 06110 Separate Sewerage System built by iLi-r' Address P o+ � y4 aS 14. Consisting of Gallon Septic Tank and 4CO r�4 2 R— qn)F - Other Requirements: Water SUDp1V: 0 Public Supply From Address a or: Private Supply Drilled by t/r�' i Address �e— 3i Building Type %i� �� h r' Has erosion control been completed? � Number of Bedrooms Has garbage grinder been installed? Lb, 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 regulatio of the =Lunt, Department of Health. Date: i d A /06 Certified by P.E. L/ R.A. (Design R Of ssional) Address 9 U �X 9S l�I A a9-�, 7 X03 of License # SUS D S' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Un Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design'Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Location Street)Address: /C ee R� Town/Village: �t G Tax Grid # Map 37.Block3 Lots) Well Owner: Name: Address: C Use of Well: 1- primary 2- secondary _j_ Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion _x Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length �2 (_ft. Length below grade 5& ft. Diameter 7 in. Weight per foot �7 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded — Other Seal: Cement grout_ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours Yield-6— gpm Depth Data Measure from land surface - static (specify ft) / Ee-t During yield test(ft) Depth of completed well in feet 396 �t Well Log If more detailed information descriptions or... sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type ! ac o 141 Capacity Depth Model Voltage 200 HP Tank Type q ej -X Volume 2e) (A. Date Well Completed 7 LO p Putnam County Certification No. 007 DaLz-ort Well Driller (signature) /ap/� NOSE : Exa(ct location of well with distances to at least two perman6nt lanatnarKS to be provided on a separate,4neeuptan. Well Driller's Name I 0 Address: /De 31 Signature: Date: GD White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 1. Sheet i of * - PUTNAM COUNTY° DEPARTMENT' OF HEALT -11 }q� -�(' rc+� a 'g'vi- rw �c :- e�gr�-+�-�,y T F'r�.7� r' � r .r^��y� �.. ilJf "Ld i �� lit 1 i'Y 1'f "1 KE"HEA L SER 1 .I:+J.. `n r.a a' ate. �.r•r .. rs- . »t '� ' s : W ri y0_ TIEi,D ACTIVITY REPORT Ann q t L.Gfp tom_ . �oG . 5T. l 10 Street,. a Town State PERSON IN,CHAROE 3: + Name: and rTitl TYPE OF FACILITY a FINDINGS: -. , ti 4 - LUe go 4;1 'r, � �". `ter � ✓`� V.� �.�L% _ - - 2 y tr :rte Y GCw m _ l o TRT Sigriature:.and Tide- � - � - - Apm im.rF RY' I acknowledge :receipt' of thisefeporv. SIGNATURE. 02:/96 Title, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH ... - ' SERVICES.-.,. I CES... t -%:,. .c :_ .� :.. 7: tiv. ti .:r - a'.tn:•" CONSTRUCTION PERMIT F :S W GE TREATMENT SYSTEM PERMIT #-�Y �� Located at %le Town or Village Subdivision name W Il LtiFs E 5L ubd. Lot # 1 Tax Map � Block 3 Lot Date Subdivision Approved 1/1 C) /P,(, Renewal Revision Owner /Applicant Name G ZA L 6 C, 7V,- iZ E- Date of Previous Approval Mailing Address 111 1--( 045 L— Lj MSTf�IP Zip of °� Amount of Fee Enclosed ot�� Building Type 61 L 4e jFg Lot Area g37-% No. of Bedrooms Design Flow GPD__COOO Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 000 gallon septic tank and Z Other Requirements: To be constructed by Tb BF, Address ,,Water Supply: Public Supply From , Address -or: >( Private Supply Drilled by M F- Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs ther o. f -� Signed: P.E. _Z_ R.A. Address Date -7- I License # fa'a-744 Lo 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 per)". Approved for discharge of domestic sanitary sewage only. By: Title: f �2� Date: Q Q White iopy - 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 please print or type PCHD Permit #� F 1 Well Location: Street Address: Town/Village Tax Grid # "7(v W tuopg RD• Pp,+JqA,4A VALLF_ ap Sa- -Block Lot(s) , Well Owner: Name: Address: GP_/ -I(� GfLr_, ,:J G-T. fb Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served - EA I LyEst. of Daily Usage QQQal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........................... .................. ............................... Yes No >-:f- Is well located in a realty subdivision? ......................... ............................... ......... Yes No Name of subdivision \AJ Lt✓pFEe 4j-�o5TAT 5 - - Lot No. Water Well Contractor: V-) I3'F- -p er? 1 ,-1 %Z�D Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: _P„ c,4,,ti, TownNillage 1'11A Distance to property from nearest water main: 6 & _ TJW 1,,;A.0 Proposed well location & sources of contamination to be proy i o irate- sheet/plan. Date. i - _A licarrt gig' pi' - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 1 Date of Issue �[ �� Permit Issp'n Official: Date of Expiration at Title: �c, Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NAME: ADDRESS: SITE LOCATION: DATE - STAFF PRESENT: SPECIFIC WAIVER SW.:.1Q -99 BRUCE. R. FOLEY, R.S. Acting. Public -Health Director DEPARTMENT .OF..HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER Cecere, Craig 19 Noel Ct. Brewster, NY 10509 76 Wiccopee Rd. Putnam Valley, NY 10579 April 9 1999 BF,MB,ABS,RM,BH,GR,SR REQUEST: Required 3H:IV Slope To Proposed 2H:IV Slope DOES. THE PROPOSED- VARIANCE REQUEST POSE A .HEALTH .HAZARR-D .,CR__ ENVIRONMENTAL,..... _.- CONTAMINATION PROBLEM? YES NO WILL DIS.4kPPQOVAL RESULT IN A SIGNIFICANT HARDSHIP? +_X + + - -+ YES NO DISCUSSION REQUEST APPROVED OR DENIED APPROVED DENIED XX REASON FOR-DENIAL DIRECTOR' OF% PUBLIC HEALTH DATE: - _ —. r SW 10 -99 !NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver :Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR �r� rY,n ....,.r..- ..... ,..:, ... �— .... — _ - r lndi : :, qo vidtrHodtioid Stiaga Ttisatrriertt °Sytams <.:. -_ Name of Applicant C e c e r e Craig No. Street Cityfrown State zip Address 19 Noel Ct. Brewster New York 10509 No. Street Cityfrown State Tip Site Location 76 Wi ccopee Rd. Putnam Valley New York 10579 r 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ......................... .................................................................................................. 1............................................................................................................ ..........................._... ............................................................................................................................................................................................. ............................... 2. Proposed design or conditions of waiver: ............. ' ....................................................................................................................................................................:....... ............................... Waiver From-Required 3H:JV Slope to 1 Fro.P.o.S:ed....?H.. I.�.......?... Pe ............... .....:......................... ............................................................................................................................................................................................................................................ ............................... . : 3. The proposed design may have the following limitations (check appropriate box(es)): E] Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) .. ............................... .............................................................................................................. ............................... NONE ............................................................................................. ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. DOH -1326 (7/92) ........... ............................... F;EPFiESENTATIVE �OF�COWI M ISSIONEFt �OF�FIEALTH .................................................................................. ............................... DATE ORIGINAL - Local Health Agency COPY - Applicant/Design Professional (GEN -152) UTNAM E NGINEERIA PLLE ----------------------------------------- Eng/neers and Planners February 3, 1999 Mr. Adam Stiebeling Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Cecere Wiccopee Road Putnam Valley Dear Mr. Stiebeling: Enclosed, please find a submission for an individual septic approval for the above -Should--you have any questions or comments, please-feel. free- to contact this office.._ - - -- , Very truly yours, PUTNAM ENGINEERING, PLLC By: KH:rk Enclosure (File 990153) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225-3060-FAX (914)225 -2955 DIVISI ®N OF ENVIRONMENTAL HEALTH SERVICES _r... _ LETTER OF AUTHORIZATION RE: Property of G4Z-6- 1 Located at i 6 W i CCOPE-C Rory p %JUTI,-'/-H U14-&L& --11 T!V t _; VA-u-r--Y Tax Map # Block _ Lot Subdivision of Subdivision Lot # Gentlemen: W i ao -P1=G E si7;T 0 Filed Map # -� >« /3 f C Date Filed ,JAN i 0, This letter is to authorize Es (2 a duly licensed Professional Engineer V or Registered Architect to apply for the required wastewater treatment and/or water supply ermit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to su ery set , •tum of said wastewater treatment and/or water supply systems P /�.a�G�r� PP Y Y in conformity with the, p off : n�}� ©f tcle,\145 and/or-44a of-the Education Law; the Public_Health r.. _- Law,•and'the Putnam, ou " rotary o e. Countersigned: P.E., R.A., # _ Mailing Address 102 State Zip Telephone: Very truly yours, igned: (Owner of Propertq Mailing Address: 19 NoF_L (!�z:r0(Z1 F-5 R CU.) STETZ,. State Zip X)5019 Telephone: 2_41+56,5`i- (.Lc 219 - 7 L -7 H 6- Form LA -97 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel "NY "IU512 914 - 225 -3060 Fax: 914 - 225 -2955 LETTER OF TRANSMITTAL. Date: ...'2-13 RE: G 15�&f�-V a \Aj 1 C,C_.Q F'ai✓ X7-0812 (ItAA) 52 3 -►3 We are sending you attached under separate cover, the following items: Shop drawings _),e Prints Specifications Copy of letter Plans Other: fain of rf%nice nacrrintinn RMIRMT001 ME _. These are trsrnittec# __�Frar approval . .....:.__.:� .., _. _Approvectsubmitted°� _ For your use _ Approved as noted _ As requested _ Returned for corrections For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Copies to: SIGNED: If enclosures are not as noted, kindly notify this office. Public Health Director ....ORETTA M_ OLINARI -,RN., M.S.N. Associate Public Health Director Director of Patient Services . DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 ®rfao,!� Environmental Health (914) 278 -,6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 March 2, 1999 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Re: Cecere, Wiccopee Road TM# 52 -3 -13, Town of Putnam Valley Dear Mr. Ken Hurley: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. D cumentation Please submit a letter from a Putnam County Certified Well Driller that location of proposed well is both feasible to drill as well as to service in the future. Clarify profile. Profile shows "trenches" in fill. State depth of fill required. i Septics requiring fill greater than 2 feet in depth requires a fill plan; certification of fill as outlined in PCHD Policies and Procedures Bulletin ST -19. Fil etail Please edit detail to reflect request for waiver of transition slope 3: 1. Detail. should call out requested slope 2:1. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj k TNAM GINEERM.EEFPLLC. Engineers and Planners. - March 10, 1999 Mr. Adam Stiebeling Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Cecere Wiccopee Road Wiccopee Estates II - Lot 6 Putnam Valley Dear Adam: This office is in receipt of your latest memorandum and we offer the following comments: 1. A well access drive has been proposed at 15% maximum, on the .plan. 2. The plan and profile both state that 6" minimum fill, placed at 15% slope maximum, is required for'the fill section. -3. The, fill section detail calls for .a 2H. V side slope. - - - As you are aware, the current septic location is the flattest and largest area available on the lot. This area was field inspected by Gordon Young and yourself to verify this was the best possible septic area on the subdivision lot. At this time we would request your continued review and/or approval of this application. Very truly yours, PUTNAM ENGINEERING, PLLC B Y• Ken Hurley KH:rk (File 990230) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 -PHONE (914)225 -3060• FAX (914) 225 -2955 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _ - __. REVIEW SHEET FOR CO \STRUCTION PERMIT-: STREET LOCATION 6 � 1 LC b I-0 NAirIE OF OWNER r 4— REVIEWED BY RINI, GR, AS, MB, BH DATE TAX MAP # SUBDIVISION :GAL SUBDIVISION IBDIVISION APPROVAL CHECKED IiC RATE � ° �►4- 1 :L REQUIRED DEPTH WTAIN DRAIN REQUIRED ANDPIPES GENERAL ICATED IN NYC WATERSHED ANS SUBMITTED TO DEP ;LEGATED TO PCHD ? APPROVAL, IF REQ'D rEP TEST HOLES OBSERVED_ RCS TO BE WITNESSED :APPROVAL SSDS ADJ. LOTS :TLANDS (TOWN/DEC PERMIT REQ'D ?) ,TA ON DDS PLANS & PERMIT SAME .... E' 1969 NEIGHBOR-NOTIFICATION TTER BUZBA 00 YR. FLOOD ELEVATION ITHER REQ'D PERMITS) EWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS / SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/R.A; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION ATUM REFERENCE LOCATION OF WATERCOURSES, PONDS AKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: 'EROSION CONTROL:HOUSE,WELL, SSDS 4)ERC & DEEP HOLES LOCATED PRESENTATIVE OF PRIMARY & EXPANSION ION MAP AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED, PIT & D BOX SHO TAILED 'HOUSE - NO.OF BEDROOMS 9 J WELLS & SSDS'S W/IN 200' OF SED SYS. PROPERTY METES & BOUNDS HOUSE SSARY (TIGHT LOT) *MSE S - 1/4" FT. 4 "0; TYP NQ,B NDS; MAX.BENDS 45° W /CLEANO FILL SYSTEMS � v CL�Y BARRIER FT. HORIZONTAL;S PE 3:1 TO GRAD 2 - I FILL SPECS TES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH 63RENCH PROVID 60 FT MAX. 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY ,LARGE_:_TREES,.TOP,OF:FII,L -- - ,... -- 20''TO FOUNDATION WALLS ' 15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS -100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER A' TO WATER LINE (pits -20') SO' INTERMITTENT DRAINAGE COURSE 1,,0,07500' RESERVOIR, ETC. _150' GALLEY SYSTEMS IYMIN to CDS= >5 %,10'- 4 0/o,25'- 3 0/o,30'- 2 0/o,35' -1 0/o,100' - <I% 20 'MIN to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION V, DOCUMENTS RMIT APPLICATION. - I LL PERMIT �WS LETTER TTER OF AUTHORIZATION DATA SHEET (DDS) RPORATE RESOLUTION SHORT EAF PANS - THREE SETS OUSE PLANS - TWO SE S 3 ARIANCE REQUEST FEE Y §..,DESIGN SUBDIVISION :GAL SUBDIVISION IBDIVISION APPROVAL CHECKED IiC RATE � ° �►4- 1 :L REQUIRED DEPTH WTAIN DRAIN REQUIRED ANDPIPES GENERAL ICATED IN NYC WATERSHED ANS SUBMITTED TO DEP ;LEGATED TO PCHD ? APPROVAL, IF REQ'D rEP TEST HOLES OBSERVED_ RCS TO BE WITNESSED :APPROVAL SSDS ADJ. LOTS :TLANDS (TOWN/DEC PERMIT REQ'D ?) ,TA ON DDS PLANS & PERMIT SAME .... E' 1969 NEIGHBOR-NOTIFICATION TTER BUZBA 00 YR. FLOOD ELEVATION ITHER REQ'D PERMITS) EWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS / SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/R.A; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION ATUM REFERENCE LOCATION OF WATERCOURSES, PONDS AKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: 'EROSION CONTROL:HOUSE,WELL, SSDS 4)ERC & DEEP HOLES LOCATED PRESENTATIVE OF PRIMARY & EXPANSION ION MAP AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED, PIT & D BOX SHO TAILED 'HOUSE - NO.OF BEDROOMS 9 J WELLS & SSDS'S W/IN 200' OF SED SYS. PROPERTY METES & BOUNDS HOUSE SSARY (TIGHT LOT) *MSE S - 1/4" FT. 4 "0; TYP NQ,B NDS; MAX.BENDS 45° W /CLEANO FILL SYSTEMS � v CL�Y BARRIER FT. HORIZONTAL;S PE 3:1 TO GRAD 2 - I FILL SPECS TES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH 63RENCH PROVID 60 FT MAX. 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY ,LARGE_:_TREES,.TOP,OF:FII,L -- - ,... -- 20''TO FOUNDATION WALLS ' 15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS -100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER A' TO WATER LINE (pits -20') SO' INTERMITTENT DRAINAGE COURSE 1,,0,07500' RESERVOIR, ETC. _150' GALLEY SYSTEMS IYMIN to CDS= >5 %,10'- 4 0/o,25'- 3 0/o,30'- 2 0/o,35' -1 0/o,100' - <I% 20 'MIN to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION V, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEWSHEET FOR CONSTRUCTION PERMIT_ = :.•:: •.. -..,. :..�: .._,. NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAP #: (CONFIRMED) Y N DOCUMENTS (_J(_)PERMIT APPLICATION ,(_)(_)WELL PERMIT OR PWS LETTER UUPC -97 L_)(—)LETTER OF AUTHORIZATION (_)(_)DESIGN DATA SHEET (DDS) U(_)CORPORATE RESOLUTION (__)L_)SHORT EAF (__)L_)PLANS -THREE SETS (_JUHOUSE PLANS - TWO SETS UUVARIANCE REQUEST SUBDIVISION (_)(_)LEGAL SUBDIVISION (_)(.JSUBDIVISION APPROVAL CHECKED L_)L_)PERC RATE (_)(_)FILL REQUIRED DEPTH (_)(_)CURTAIN DRAIN REQUIRED I GENERAL (--)(--)LOCATED IN NYC WATERSHED (_)(_)PLANS SUBMITTED TO DEP (—_)L_)DELEGATED TO PCHD (__)L_,DEP APPROVAL, IF REQ'D L_)L_)�DEE T Fi6L'_ SERVED C--)C--)P SED. U(_)EX- APPROVAL SSDS ADJ, LOTS LJL_)WETLANDS (TOWN/DEC PERMIT REQ'D ?) C__)(_JDATA ON DDS PLANS & PERMIT SAME (_)(_)PRE 1969 NEIGHBOR NOTIFICATION - -_;�_ = (�(•- �I,ETTER•$UZBA;.: . L_) 100`YIV FLOOD ELEVATIONWA20V ...... (_) SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS SE AGE SYSTEM PLAN - (NORTH ARROW) ) DS HYDRAULIC PROFILE ( )( GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS �; CONTOURS EXISTING & PROPOSED (DRIVEWAY & SLOPES, CUT YFOOTING /GUTTER/CURTAIN DRAINS . (USDA SOIL TYPE BOUNDARIES P�TTLE BLOCK; OWNERS NAME ADDRESS #, PE/RA; NAME, ADDRESS, PHONE# ►DATE OF DRAWING/REVISION ►DATUM REFERENCE KOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ►PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS YWELLS & SSDS'S W/IN 200' OF SSTS )PROPERTY METES & BOUNDS )EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 Y,,--g (REQUIRED DETAILS ON PLANS CONT'Dl L__) OUSE.SEWER -' /" FT. 4 "0'; TYPE PIPE CAST IRON . .0EjNO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS (_)SITE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( N61FILL SPECS/ FILL NOTES 1 -5 (FILL PROFILE & DIMENSIONS (FILL IN EXPANSION AREA FILL GREATER THAN FEET L� CLAY BARRIER L_) FILL CERTIFICATION NOTE (_) DEPTH GAUGES (_) VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (� EPARATION DISTANCE FROM TOE OF SLOPE E C F TRENCH PROVIDED 60FT MAX. ARALLEL TO CONTOURS 00% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL L� ,EOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD, 150' TO PTI'S 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 47)IVTQ7WATER. LINE ( p!0 ;Q'). 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (1)10' MIN TO LEDGE OUTCROP SEPTIC TANK L_)( 10' FROM FOUNDATION; 50' TO WELL WELL � WC� DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION M IN 15' TO PROPERTY LINE SLOPE L_)(__�)SLOPE IN SSTS AREA (S20 %) (_)(_)REG RADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS L_) U E VOLUMEMOSE VOLUME NOTED FORCE MAIN, (PIPE TYPE, ETC.) AN OWN & DETAILED (�L �1 STORAG A OVE ALARM CURTAIN DRAIN (__)(__)STANDPIPES, 5' BOTH SIDES, DETAIL L_)L_)15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -i %,100 % - <I% (__)C__)20' MIN to CD DISCHARGE /100' with 182 cons day discharge LJ(__)10' MIN to NON - PERFORATED PIPE 14.164 (?/871 —Text 12 PROJECT I.D. NUMBER SEOR if' Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM -For UNUSSTEED ACTIONS Only' PART 1-"PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR PROJECT NAME. g- ' F-P f �.L 6 17Ge C-F-P7 3. PROJECT LOCATION: Municipality (,lac- 1�4A^,l L-L- County to VA14 M 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) S r_!5 S M-E-- t-A O-Fj P LAXq 5. IS PROPOSED ACTION: �aNew ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 4}At AWP...OVI65T7 7. AMOUNT OF LAND AFFECTED: G,-Z-2--T G3 Initially acres Ultimately .-2--Z7 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? $aYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ 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 BNo If yes, list agency(s) and permif/approvals OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 11. DOES ANY AI�SSPP ""E��CT ❑ Yes ,ENo If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes 13No . i CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / Applicant/sponsor name: ���- �' Y�G ' - • Date: Signature: 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 PANT 11— ENVIRONMENTAL ASSESSMENT (ro 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? It No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No _ .. d. COULD'ACT0t 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 brief 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. Q. I, S. TH. EREo-00:!S.Ti-1ERE- LIKELX- TO =t1, tiDN TROVEIaSY-REL-AFED-TO POTEN;TiAL ADVERSE- ENVIAUNMENTAL'IMPACTS ? "' ❑ Yes ❑ No If Yes, explain briefly PART 111 — 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. Cl Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Leatl Agency Print or T Name of Responsible Offiter in Lead Agency Title of Responsible O ficer idati:14 of R risible officer in Lead Agency Signature of Preparer (it different from responsible o icer) s Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RSURFAC �E AG iREATIE�T S YSiEM =.�: - , :_:..,:I N,.DATA SHEET = SJ .; .:. . Owner Address I!9 Lot✓L cjj r050� Located at (Street) -7 (-,o W i LL6 Pe F-- rOD. Tax Map Block'3 Lot 1-3 (indicate nearest cross street) Municipality Drainage Basin Hu.7150nl SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Bole No. Run No. Time Start - Stop Ela se Time Min.) De th to Watei• rom Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch 1 2 3 4 N 5 1 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ` DEPTH HOLE NO. G.L.. 0.51 HOLE NO. HOLE NO. 1.5 2.01 2.5' 3.0' 5ANIZ( 3.5' 4.01 VAJ/Cq EAV 01— 4.51 5.01 5.5' 6.01 6.5' . 7.0 7.5' 8.01 8.51 9.51 10.01 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered AIA Deep hole observations made by: .40AA 6ThS-,W" Date ^b6 Design Professional Name: 'Pt4:j-jqA,#,4 �7 & &jr:oe Address: to-;— Signature: Design Professional's Seal , �jF PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS. FOR =A WASTEWATER TRL+ XirML+ NT'SrYSTEIV •, ' _,.. , .- . 1. Name and address of applicant: CF- ,4 I G C L�- Ktr 19 NoFL L1. -o p-ow s TF,�p- t4,11. r o.5n-1 2. Name of project: C f -tV - 3. Location T(V: PC /MV -/ VA LLE y 4. Design Professional: 2 G W4' f� ia6 lEAddress: I Off- F�:4 PA A4:F 6. Drainage Basin: ++ O/q 7. Type of Project: _G Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park 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? ......................... /VD, 10. Has DEIS been completed and found acceptable by Lead Agency? ............... � A 11. Name of Lead Agency 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? ....................T 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... b 19. If yes, name of water supply 1'Y111A Distance to water supply�`�e 20. Is project site near a public sewage collection or treatment system? ................ AID 21. Name of sewage system V -A Distance to sewage system yv%A� 22. Date test holes observed ��' 1':2-I lqq 23. Name of Health Inspector f1PPM 5�'�'�`f3ct.rnlC 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 27. Is any portion of this project located within a designated Town or State wetland? IIVD 28. Wetlands ID Number ............. ............................... .................. ............................,�1 29. Is Wetlands Permit required? .............................................. ............................... /l 0 Has application been made to Town or Local DEC office? ............................. 30. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .......................... A0 34. Are community water and/or sewer facilities. planned to beAeveloped:within - 15 years in or adjaceiifto project site? ..:............................................................ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... YE 5: 36. Tax Map ID Number .......................... ............................... Map Block__ Lot J 37. Approved plans are to be returned to ..... Applicant L Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the 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. d hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant tc SIGNATURES & OFFICIAL TITLES: ........... s .........::.::: � ......... r .'q rZ Wt C' r. ly_t{. l Del PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE I iSPECTION SECTION A. GE ERAL INFORtMATIOi\►'' �� ° Name of Project XV) County Site Location Buildina construction begun Extent - ' Is property «ithin NYC Watershed ? ................. F-I Yes No SECTION B. TOPOGRAPHY (Please ch ck all appropriate boxes) I. F-� Hilly F--J Rolling Steep slope F--J Gentle slope Flat 2...F--1 Evidence of wetlands Low area subject to flooding Bodies of water Drainage ditches Rock outcrops �es Yes Yes Yes Yes F��Yes 7 Yes 3. Property lines or comers evident ....................... ............................... 4. Do water courses exist on or adjoin the property? .....................:... :.. 5. Will these affect the design of the sewage system facilities ?..:......... 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? ................. ............................... 8. Will extensive fill be necessary for SSTS? ......... ............................... 9,.JD.o filled areas exist- iiidiin the SSTS area? ..:...: .:.::.:.::::... ::..:...... ....�` If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: E rSand.D'16ravel P'� No No LJ "° Eja�No 0 No No �ANo Doam Clay F--� Hardpan lixture 11. Observed from: ' F--J Borings .0 Bank cut 12. Soil borings /excavations observed by 13. Depth to groundwater 14. Depth to mottling 15. Are test holes representative of primary & Backh excavations on ( Z 1 9 0 144 on on 4 areas ...... ............................... es E] No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 t SECTIONT D. DRAINAGE .. :.,... .. ,v.v . f ,_ . ..� _. �......... ill'proposed'grading materially alter the natural drainage in this or adjacent areas? F� Yes 19. Will groundwater or surface drainage require special consideration? ..................... Yes o . 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .............:........... Yes SECTION E. I RE.N ARK5 21 If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? .............................. ............................... Yes Inspection data No 22. Do adjacent wells and/or sewage systems exist? .................... ................. ............... F__J Yes F__1 No 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) 12 2 TEST PIT PROFILES Hole t Lot 4 Hole # Lot r Hole 9 Lot r Depth to water \41zW C Depth to water 4C Depth to cater Depth to mottling Depth to mottling 1 Depth to mottling - Depth to. tocklimp. C .. Depth to rock/imp. e p. b De th to rock/imp. G.L. G.L. G.L. 0.5 �" �? 0.5 �n_ `` 5 0.5 1.0 - c-� 1.0 2.0 ``=f� �S2 2.0 3.0 3.0 2= 4.0 4.0 �o 5.0 C (aL4' A 4944, 5.0 W CAAvs �. 6.0 4 6.0 7.0 7.0 8.0 Z 8.0 M 10.0 9.0 10.0 1,0 20 3.0 4.0 , 5.0 , 6.0 7.0 8.0 9.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA r >' Date of Pre-soaking Date of Percolation Test 1 2 3 4 5 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES DEPTH HOLE NO. HOLE NO. HOLE NO, G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0 3.5': 4.0' 4.5' ` Xrn 5.0' 5.5' cn 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name: Address: Signature: Design Professional's Seal Date CIE Ntw y y i " df' �: UE HEALTH T DIVISION OF EN"VIRONNME \TAL HEALTH; SERVICES FINAL SITE EMPECTION Date: �d Od I s eeted by: Su:etL 'ion dCC-0 i�. 1 O�rner U"lli2�lLl� Totitin Pe _ "tinit r - - TIM Subdivision Lot r �� 1. Sewage SS•stern Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Avg.DpCn c. \at oral soil not stripped ................... ............................ :.. . d. Stone, brush,.ete., greater than 15' from STS area ......... . e. 100' from water courseAvetla_- ids ...... ............................... II. Sei•age Svstem a. ;ptic TEE size - 1,000 .1,25 other ................ b. Septic tan's installed !eve ................ ............................... c. 10' minimum from foundation:: ........ ............................... d. Distribtuion Box .. All outlets at same elevation -water tested ................. 2. Protected below frost ............ ............................... .. 3. Minimum 2 ft.Original soil between box & tenches Junction Box roperly set.. : ,L`j�Leng required Len?th installed �� Q�'1 Dista_ce to �tratereours- measured Ft........ �l t�3. Installed according to plan ......... ........ :...................... ^:. Slope of tench acceptable 1/16 -1/32" /foot ............. 5. 10 f. from property y lm e - 20 ft foundations �........... \� 6. D-2th of trench <30 inches from surface ................. 7. Room allowed for expansion, 1006/o ......................... 8. Size of gravel 3/i -11/2" diameter clean .................... �(JID 9. D-1 en of gravel in trench 12" minimum ................... 10. Pipe ends capped ....................................................... Gt - Fume onDosed Svstems ....._ . gib• .. Rum of pump c am er ............................................... 2. Overflow tank ............................. ............................... 3. Alarm, visuall audio ................................. I................. ' 0 4. Pump easily accessible, manhole to grade ................. ". First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow/cycle........... HouseBuildin z. house located per approved plans ......................... Number of bedrooms ...................... ............................... Well located as per approved plans . ............................... Distance from STS area measured ft ........... Casino 18" above grade .................. ............................... Surface drainage around well acceptable .. .. .................... Boxes properly grouted ................... ............................... All pipes partially backfilled ........... .... :.......................... All pipes flush with inside of box ................................... Backfill material contains stones <4" diameter .............. Curtain drain & standpipes installed according to'plan.. Curtain drain outfall protected & dir.to exist watercour: Footing drains discharge away. from STS area.....:.. ........ Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 11§7 n _ s, cr T11 c c(:f ? it-174-5) z ` �J Cam- _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 'ohs 1�1.A31L: n 'Address J %�cG��oThv pv. �0 �C��s�e,4 ly Located:at (Street) /C1C_0 ee-_ Tax Map 52 Block _3 Lot !3 , (indicate nearest cros re t) Municipality f e Watershed Nd D ]2 � y— SOIL PERCOLATION TEST DATA f' Date of Pre - soaking 9ems Date of Percolation Test 17 / 9 / /rQ /b%7 ROTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. . Form DD -97 2 lt>30 1042 l2 19%4 3 - - 4 - -- - 3 o-4.3 iazs5 14 / zz�i 3 4. 5 - 2 A-A i0.5& 15- 1812 '2112. 3 s 3 D: Z 15 l `7 2, X_Z 4 3 4 5 ROTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. . Form DD -97 d TEST PIT DATA 2 DESCRIPTI0N OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. f HOLE NO. HOLE NO. Design Professional Name: — &� Address: -Po- an x 4c-0 Signature: cv Design Professional's Seal -, 9 LIN- ' r t t:' L C,/Hl. 7 -71 e3� 01 rQ a. V�7\ lo oil 17- M': ?ILI 1 Q- L A 'i . r'- 1—==� A 7 -T6pq� - l' '.'J I 46 TH#17 TOE— Sg�--A4,t;– A" lli'W- OF -Rtf— Y"'ATf49 :l i I pf-1 L� , r"4T' putnem County Department of-Health Division of Environmental Health Servioes Appr d as noted for conformance with ep r u "" noted ' io le es and Regulations Of the I'll c Cl- ty Health Depart— Title at OJ RD/ PO e'rc' x So P40 A 4 ori L 1,)c 10" y ( I c LO pe P 20 A Owr4 C);:- F,ht-41 VAik'l vj'�e- goo, -Z 1,54 2 Z- 1&4 7 -T6pq� - l' '.'J I 46 TH#17 TOE— Sg�--A4,t;– A" lli'W- OF -Rtf— Y"'ATf49 :l i I pf-1 L� , r"4T' putnem County Department of-Health Division of Environmental Health Servioes Appr d as noted for conformance with ep r u "" noted ' io le es and Regulations Of the I'll c Cl- ty Health Depart— Title at OJ RD/ PO e'rc' x So P40 A 4 ori L 1,)c 10" y ( I c LO pe P 20 A Owr4 C);:- F,ht-41 VAik'l vj'�e- tigh joints ;7 "n --femova0e coyer 14 to masonry, 6 "or 8 concrete nt asbestos pioe,,;Cuf to ad concrete lop BOX V U P p 86 J 114 U %; irls-CS WFAs M PER MAL LA- V�, 7 I tnz- A ern I-i A I f- 40 80.73 AC. CAL. r� i63 2- WO6 NO LOT 3-50 54 63.9 63.88 AC. CAL. 30.1 , r l �I � � J h / E /I AC. r 9 110 y / .C. ! 10 X11 10 II II 1 REVISIONS SPECIAL DISTRICT INFORMATION YInl.we SCHOOL •SCI• PuINAM VALLEY IENTRII SCM0. DISTRICI•••STIlW STATE LIRE DISPUTED 1W VAAI wo CFl(fR4 10-1" • -• 372002 WPM LIME -- I/eM IIIE VUAGi�LI1 - -_� BLOM LIMIT — — — PRIORITY LIT2 ORIGINAL LOT LIVE CONf IIUgOP ROAD 0.0.1. 'a1Rf. llfA SPECIIL 0130 SOgOL DISO MIT a PNO eP/Pe PTY _ FIRE {. NIMM.Y4UC.T 6124 fFA u•!YR S1.Iltt; 9 4 7 \I AC. fr a 28 6.87 AC. AC 27 31.25 AC. CAL. 63.3-7 DISPUVED ARM COUTIMgUS ONRI911P ROAD 0.0.m. 9ECIIL .110111 LIRE SCHOOL DISIRHCT LIRE PMT 6 FIIEL Boom I.h. IN/,. cement grout a'a", casing solid r"Ok into rock Proposed —127. 53 Note: No grove /we //s permitted N37"L-50' -50"E 14.08' 12 c^v, DKRICA L WELL N48--251'00"E LOt N25 S-0,01C area SOO off • of E.O.P. ..,48.34 zz '6040 D /within 50 a #,jSMffA pee bt 5 wi-caps. Xtaf'.N9 r I N51--08'-30- At 77' 0 NS6 N47-t-29- 00 "E a. fie a 7ppr 77 36' E.O.P 10 o Proposed we// ..... Ot i I No '9 N 9306' P6 •:el M NO'L22LIOt jowl off . .•.3ZZ2 . . //-0/ Ns 7 Zot lve8 wo/k le"Ir — /000• A Off of E. 0. P ' O \\ \ \ \�, y40°.37- a . 99.34' 36' - -20 I N570 - 58, Z if \ \ \ \ \ R OV 'Lz '15.25 Able For driveway grading, drainage and rh �lh� dyey TFUCIMn 7101?g #AV1nffrM9 defaile see cons of plans on file with the Putnam Proposed V01149Y Planning Board. as required N54- 10 Q e4 73 \N dw -j" Court AJ N 13164'- N/3 °-05'39 "W N -!i�O ;ir ♦ ��\ �\ \ \\ _ \� \ Tyr 9O SrN28°53'3Q'iY'NOS °- Lr't V�� +•2 00' 11H, • -jam MIA-f 01 Lot N-9 -90 DIS .857 N. Ji I 61 40'0" �._ j :, t BREAKFAST BATH 3 FAMILY ROOM 9'fi1h' X 12'11' y 12'10" X 12'11' —' — KIT: CHEN ,4 10'2" X 12''1" c 26'9 "112'11" UI° DW1-I i�+ii�l LIVING ROOM i DINING 10'10" X 12'11' 12'3" X FOYER G�. 101" X ?,,I • 4 . j 'i . t t .i f• , 40'0" i ._: !: BATH 1 BATH 2 " F111" ROOM 3 y 8 0" X t 1'3'h" X 9-7' X,10.7" 9'�" r �� "4 . i ! BEDROOM t SEDR ©OK 2 t2'9" X 16'6" i2'SYi" X 13'0" OPEN To _ FpYEH PUTF ?A.M GOUItTY ,)EP i'Il0,TT OF HEALTH HOUSE PI-FS . U! "Xi °D FOR 3 P ✓7:Uu ? ✓5 yx 4, 3 q Si�„aturc & Ti U e ate :V I.Crr Co L-4NF7INISF-PL�1� x m I G I I I NS AND R YOMES OF ALL CFESEA NaDIHJIp FI0.4E5 ARE COPYWO M WE WLL OFORCE ALL CCPYWC M TO PROTECT Ow CONSEEME PM7UBR W DEVRXI M THESE PLANS AAA EIEYATIONS ODULAq HOMES RESERVES THE RIpHT TO MAKE MWOR CHANGES IN DDNENSIONS AS REOLNUM BV MODULAR CONSTRUOTTON METHODS, BUILDER: SITE L(]G ---�E J�pt j P6L1G7 Z ADDRESS: ® 4 SHEET # A -3n Li DWN. BY: PW ti PROD. ID #! C666 , APP. BY: > 06/07/96 MY SERIAL #: - - -- I DATE: 05/29/96 l I PLANS AND ARCHITECT'S STAMP VALID UI&Y FUR MODULAR f{ CONSTRUCTION BY CHELSEA MODULAR HOMES, INC ® MANUPACT1CiER 0FORMATON CHELSEA MODULAR HOMES, INC. P.a BOX 1108 ROUTE 9V 14ARLEORM KY. 12542 914- 236-3311 ©L'OPYRIGHT 1996 CHELSEA MODULAR HOMES - All TIGHTS ZCSCRVE, TIE ARp11YCCTIRAL UDRM EaTAUED ,CAROM IS PROTECTCR UMUCR SEC. rM :� w K� C®Y.�d; KT. 17 U^ SL w5 Ar("Co 22".. C MT-� ,H .., - --