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02674
T l / e Lot Mes S-3 FM Secdon pub, J Volume
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Number d Bedroema Dee p Flog. G P D r% D`O PCHD NodBtadm Is Requbed Wbm FM Is completed
Sepatage S&WM. - . syshm ee com" d[ � xam septic Twit 6 b i"'F" .w•dc
To be cm6neted by Addt"s
Water Sp¢:PdbBc SRpb FYop Addrenr »
on vt..a� g�opb; DdBod bi sea..,..
Otbair ltequhemeah
1 }r rose flat i am wholly and completely'responsible for the design and location 'of -the pro po at the se rate'saw di W. t stern
at►ove dest�ibed .will tie,MOgstructed is shown pn the approved amendment there to and in accord �i n iules a regu ons o. nam
County ,Depihmant Of =ItN" ;and that on completion thereof 4 • -Co ificate the Constructio AEG!..; to the Commissioner of Nwlthwill
be submitted "to,the Department, and a written guarantee will be furnished the owns, his 6qe s, heirs y the puilgar, that said buikW will
pike in good olte►apn/ condition any . part of silo sewage' disposal systerei' during the tely following the "to of the issu-
ance,of the appioral .of ttie Ce[tifloate ot,Constructlon Compliance of the oiiginal cyst r t the drilled weal dowibed above
Will be located as'sAUavn on the approved plan and that -sill well will be installed in, :accordan he da, : nd rgq ai-ESR of the Putnam
County O rtinnrt of Multh
Date 6 Spoed P.E. R..A, --
_ i-�• �-C . , �Wy X 93
APPROVED FOR CONSTRUCTION. TMs approval exP No
le{ two veal the .date issued u ass con of to building has been undertaken and is
revocable for ca 'or may arneneed or modified when consider n y by the C one► of Maalfn: Any Mange or teration of construction
squires a new mit p oared' for disposal of domestk`san ar and %o► pr wa ev supply only.'
Date By Title
8
4
PUTNAM COUNTY.DEPARTMENT.OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES ^�
Date—
Re: Property of
Located at ��� feo
(T) `,.kozj ��'- Section Block Lot 2�%
Subdivision of
Subdvo Lot #
Filed Map ,# Date
Gentlemen:
4� V l rY-0
This letter is to authorize /
a duly licensed professional engineer or registered architect
(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 provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned: `
G "JF
P.E. , e,
7-
Address
0'4f
Veiny) truly yours,
1 �
Signed
Owner of Pr erty
2% r'1.01 -Y) bnCI ITW . --
• Address
\ArkbL'—J� /V-V /L/a2f
• TO
� 51 Tele one
Telephone
1• %, •• Wowe WDIVII 1,401 I • .
DESIGN- DATA :SHEET- SUBSUFACE SE4d DISPOSAL SYSTEM = - .� FILE- NO.
Owner ✓® �/ r! �' �ti�% h eAddress
Located at (Street)4fi 0_4 1;1 O -eo . Sec% Block Lo
(indicate nearest cross street)
r7unicipality J` 4 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO HE SUBMITTED WITH APPLICATIONS
Date of Pre-Soaking �--f�% " Date of Percolation Test a
HOLE
NUMBER CIS TIME PEROOLATION PERCOLATION .
Run Elapse Depth to Water From Water Level
No. Time Ground Surface In Inches Soil Rate
Start-Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
9.0 V8
4
5
Z�L
4
5
1
2
3
3
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to'be suimitttd
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH.
HOLE NO.
HOLE N0.
_ .. _ ... G.L.
1'
2'
3'
4'
5'
6'
7'
'X-
HOLE, NO.
8'
9'
10°
11'
12'
13°
14°
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY / .!� DATE:
DESIGN
Soil Rate Used _ Min /1" Drops S.D. Usable Area Provided ®�
No. of Bedroans _ Septic Tank Capacity gals. Type Off.
Absorption Area Provided By � L.F. x 24" width trench
Other
SPACE FOR USE BY HEALTH DEPAR' ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
PC -1
PUTNAM COUNTY DEPARTMENT OF HEALTH
:. � :. •-..=,.;n . = n APRE30AT -IDN- FOR APPROVAL =..OF* ;PLANS' °FOR �'-A` •WASTt ATtR DISPOSAL'" SYSTEM"
1. Name and Address of Applicant:
2. Name of Project: ...5 /J
4. Project Engineer: �14 1�
/0 -11&6 if
License Number: 2Al'F Phone:96 >_ Vsyi-
1
3. Location T /V /C: �v 00V G/ C
5. Address: 2M���- r•
6. Type of Project:
Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)"
7. Is this project subject to State Environmental Quality Review (SEQR)? Ales
Type Status (Check One) Type I.. Exempt
Type II. Unlisted
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. Ale
9. Has DEIS been completed and found acceptable by Lead Agency? ...........
10. Name of Lead Agency
11. Is.thi,s project:.:.,n_an area. -under the control of .local. planning., zoning,
or other officials, ordinances? ......................................... ti es
12. If so, have plans been submitted to such authorities? ..................
13. Has preliminary approval been granted by such authorities? Date Granted:
14. Type of Sewage Disposal System Discharge...... Surface Water J00'00' Ground Waters
15. If surface water discharge, what is the stream class designation ?........
16. Waters indek number (surface) ........... ...............................
17. Is project located near a public water supply system? ..................
18. If yes, name of water supply Distance to water supply AN-0
19. Is project site near a public sewage collection or disposal system ?..... A10
20. Name of sewage system Distance to sewage system 4%•
21. Date test holes observed: 22. Name of Health Inspector:
23. Project design flow (gallons per day) ............. 190 ?...................
11/93
2.
24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?..` 10 _
25. Has SPDES Application been submitted to local DEC Office? ...............
26. Is any portion of this project located within a designated Town or State �,�
wetland ? ............. ................ ...............................
27. Wetland ID Number ..................... . ...............................
28. Is Wetland Permit required? .............. ...............................
Has application been made to Town or Local DEC Office? ..................
29. Does project require a DEC,Stream Disturbance Permit? ................... Alp
30. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal, Alp
landfilling, sludge application or industrial activity? ........ YES or NO
31. Is project located within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination? ..............YES or NO
DESCRIBE:
32. Is there a local master plan or file with the Town or Village? ............
33. Are community water, sewer facilities planned to be .developed within 15 years?
mod'
34. Are any sewage disposal areas in excess of 15% slope? ........................
35. Tax Hap ID Number . ....................: ...................
36. Approved Plans are to be returned to: ...............: Applicant eEngineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
% 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 Hisdemeanor pursuant to Section 210.45 of
the Penal Lau.
SIGNATURES & OFFICIAL TITLES:____
MAILING ADDRESS:
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET for CONSTRUCTION
" PERMIT
iCATN : Si tEE
'J. �; � ` �%f .:• z �... �_;:, A .
BY B. HEDGES R.MORRIS OTHER DATE �_/ TAX MAP # -
Y.N
DOCUMENTS.
.TION
WELL PERIVITI.1A J PW S LETTER
ERS AUTHORIZATION
DATA SHEET(DDS)
;ATE RESOLUTION
PLANS THREE SETS
HOUSE PLANS - TWO SETS
VARIANCE REQUEST
UBDIVISION
LEGAL SUBDIVISION
m SUBDIVISION APPROVAL CHECKED
m PERC RATE
m FILL REQUIRED DEPTH
m CURTAIN DRAIN REQUIRED mSTANDPIPES
V4
EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE
IF PUMPED PIT & D BOX SHOWN & DETAILED
- NO. OFBEDROOMS
& SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
ROPE METES & BOUNDS
OUSE SETBACK NECESSARY (TIGHT LOT)
HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE
NO BENDS; MAX. BENDS 45° W /CLEANOUT
FILL SYSTEMS
AYBARRIER
FT HORIZONTAL: SLOPE 3:1 TO GRADE
.L SPECS m FILL NOTES
,L CERTIFICATION NOTE
DEPTH GAUGES
PROFILE & DIMENSIONS
LJJ VOLUME
GENERAL LL IN EXPANSION AREA
&X-APPROVAL SSDS ADJ. LOTS AND (TOWN/DEC PERMIT REQ ?) TRENCH ON DDS PLANS & PERMIT SAME LF TRENCH PROVIDED m 60 FT MAX
969 - NEIGHBOR NOTII~ZFICATION PARALLEL TO CONTOURS
ER BI/ZBA 100% EXPANSION PROVIDED
m 100 YR. FLOOD:ELEVATION
i
SEPAKATION DIST°ANCBS SPECIFIED ON" PLAN-
REQUIRED DETAILS ON PLANS
SEWAGE SYSTEM PLAN - (NORTH ARROW)
SSDS HYDRAULIC PROFILE m GRAVITY FLOW
CONSTRUCTION NOTES (GRINDER NOTE)
DESIGN DATA: PERC AND DEEP RESULTS
TWO -FOOT CONTOURS EXISTING & PROPOSED
DRIVEWAY & SLOPES CUT
�OOTING /GUTTER/CURTAIN DRAINS
EROSION CONTROL; HOUSE,WELL, SSDS
EROSION CONTROL NOTE
PERC & DEEP HOLES LOCATED
REPRESENTATIVE OF PRIMARY AND EXPANSION
LOCATION MAP
10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL
20' TO FOUNDATION WALLS ffj 15' WELL TO P.I
100 TO WELL, 200' IN D.L.O.D., 150' PITS
100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (PITS -20')
50' INTERMlITENT DRAINAGE COURSE
200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS
45' MIN TO C.D. S=> 5%, 20'- 4% ,25'- 3 %,30'- 2%,35' - 1%,100' <1%
20' MIN TO C.D. DISHARGE A 00' WITH 182 CONS DAY DIS.
10' FROM FOUNDATION; 50' TO WELL
COMMENTS:
BRUCE R..3 F.OLEY,
Acting Public Health Director I
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130 October 16, 1996
Frank Sullivan
2972 Ferncrest Drive
Yorktown Heights, NY 10598
Re: Proposed SSDS:
Levine
Canopus Hollow Rd.
(T) Putnam Valley
Dear Mr. Sullivan:
Review of plans and other supporting documents submitted at this time relative to the above -
captioned project has been completed. - Comments are offered as follows:
"The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in this regard."
1. Well permit application has not been submitted.
2. Neighbor notification is requested.
Upon:receipt:of a -subri issiori i6 ei d`lo milect the --above, , this- applicati+ln v�i11- be considered w=
further.
Very truly yours,
i,) &�l 44014O
Robert Morris, P. E.
Public Health Engineer
RIWjp
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
•t•• '~ =- APP OATI6N'lT0 CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address Town Village City
Tax Grid Number
WELL OWNER
Name Mailing Address 1 ff(Private
0Public
USE OF WELL
1 - primary
2- secondary
O. RESIDENTIAL 0PUBLIC SUPPLY OAIR /COND /HEAT PUMP` OABANDONED
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify
0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY p
AMOUNT OF USE
YIELD SOUGHT c gpm /# PEOPLE SERVED 't /EST. OF DAILY USAGE al
EI REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION Q. ADDITIONAL SUPPLY
bldfEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
CIDRILLED
DRIVEN
DUG
GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES &` NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name /1.1' . � �c�.�c. %� Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: y TOWN /VIL /CITY
DISTANCE TO PROPERTY_ FROM .NRAREST.WATER..MAIN..... -.. .... - _...._.... _...._.._.. ..
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
Q ON SEPARATE SHEET `� a
(date) (signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of 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 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 attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well dril g operations be contained on this
property and in such manner as not to degrade or of s contami a surface or groundwater.
Date of Issue: j j� 19
Date of Expiration ( 19 Pe t Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
06
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