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02752
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02752
PUTNAM COUNTY DEPARTMENT OF HEALTH
- -?0 �,1�� _
�' E1RO'T'
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR
PCHD CONSTRUCTION PERMIT # __ *0P'.-- g9' V 11�t "-R
Located at/ r ,L- �- J / e d own r Village � d i 114 Iles
Owner /Applicant Name D. LQ ?eJ/%,q Tax Map Block �_ Lot �2
Formerly of. � �a Subdivision Name Th0Pzz?As;r r/
Subd. Lot # 02. R
Mailing Address sf �,� f e, �j' /% ��,�, /ori7�,r� /�� Zip d,f�
Date Construction Permit Issued by PCHD
Separate Sewerage System tem built by 4 /00 %/ Address
,TMENT SYSTEM
Consisting of 1,6,66 .Gallon Septic Tank and J"?✓e
Other Requirements:
Water Supply: Public Supply From., % — Address
e9'7'rS�*
or:` g Private Supply Drilled by P14- AJ ly , Address
.. ur.
/n��G,�° � /��° -� rIas erosion control been completed. ��
Number of Bedrooms Has garbage grinder been installed? //d
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 utnam Co CDartment of Health.
Date: tJ� Certified by _ P.E. 4 R.A.
c,� r 1 �� (Design Pro �I)
Address %� itJT�'e:��a� -� q( .� �- .0!C License # W����_
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
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner;
Date: I /C>
Orange copy - Design Profes ional
Form CC -97
- -.__�
PUTNAM COUNTY DEPARTMENT NT OlF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT M:
eHl Ti.® u>ti ®�'
Street Address:
Town/Village:
Tax Grid #
Map Block / Lot(s)�
Well Owner:
Name: Address:
aj-
Use off Weil:
I- primacy
2- secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion Compressed air percussion Other (specify)
Wel H Type
Screened Open end casing Open hole in bedrock _ Other
Casing Details
Total length &6 ft.
Length below grade ��ft.
Diameter Tin.
Weight per foot _1_7_lb /ft.
Materials: _ Steel _ Plastic _ Other
Joints: _Welded Threaded _ Other
Seal: _ Cement grout Y 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
Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet
-f e-41
Depth Date
Well Log
If more detailed
information
descriptions or
S
El.�y
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
96
�
,►
_
�
%� -.- �-
J
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type Capacity /a
Depth / 0 Model _�zS
Voltage? HP ° ?i
Tank Type 4o.%/�Z Volume 2 6A,
Date.Well Comp ete
3Wa
Putnam County Certification No.
007
Date of Report
3
Well Driller (signature)
A-Ztm?,� Aajt
NUIX: bxftct location of well with distances to at least two petmanenyland7larks to be provided on a separate /neeevptan.
Well Driller's Name Q Address: �fi,, /% roe - ®I�i,f• �O
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
PUTNAM COUNTY. DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
w. .a.n... w'sr�a �•n�.+t... e•. -.rs e.i:�acs x-�'.. .. .. '�r -. m v. ... �•.h: ...o. xv. ��x w�• e....'.. w .s.�- �_vrw.+aw•'a.'a�ea•:�ix':. �.�.�a1x. �. � .. .s �
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
151 / /r 2--
Owner or P baser of Building Tax Map Block Lot
Building Constructed by Town/Village
Location - Street Subdivision Name
&Z--o i1- ,Cr
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 conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Year 4 Signature:
Dated. Month Day 7 gn
/ C. Title:Q2�
neral ntractor (Owner) - ignature
Corporation Name (if corporation)
Corporation Name (if corporation)
Address: 148 k'04 �1las,.�/�j Address:
State /Jy Zip 16j-f % State
f'4�er,e-
Zip
Form GS -97
1
BRUCE R. FOLEYI
Public Health Director
-
Associate Pieblic Health Director.
Director of Patient Services
DEPARTNViEW OF BEALTH
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
®WftRS NAM:
TAX MAP NUMBER.:
E911.AIDIDRESS:
TOWN:
AUTHORIZED TOWN OF
(Signature)
DATE:
Do 06�24,5 tjL'-k!SE Le�
_ )
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 VERFM
` .
'
.. �p
' YML ENVIRONMENTAL SERVICES
'
321 Kear Street
Yo�ktown Heights� N.y, 10598
(914)'245-2800 -
Albert H. Padovani, Director
LAB #: 85.900174 CLIENT' #: 12530 NON STAT PROC PAGE 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CALANDRO, JOHN
13 WEST ST.
PAWL%NG, NY 12564
DATE/TIME TAKEN: 09/10/00 02:0OP
DATE/TIME REC'D: 09/12/00 10:30A
REPORT DATE: 09/20/00
PHONE: (914)-855-3319
SAMPLING SITE: 148 SUNNSET HILL RD. SAMPLE TYPE..: POTABLE
: PUTNAM VALLEY, NY PRESERVATIVES: NONE
COL'Q BY: JOHN CALANQRO TEMPERATURE..: < 4C
NOTES...: KIT TAP COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
PUTNAM CNTY PROFILE
09/12/00 LEAD (IMS) <1 ppb 0-15 ppb
09/12/00 NITRATE NITROG 0.35 MG/L 0 - 10
09/12/00 NITRITE NITROG <0.01 MG/L . N/A
09/12/00 IRON (Fe) 0.200 MG/L 0-0.3 mg/l
09/12/00 MANGANESE (Mn) 0.075 MG/L 0-0.3 mg/l
09/12/00 SODIUM (Na) 6~72 MG/L N/A
09/12/00 pH 7.6 UNITS 6.5-8.5
09/12/00 HARDNESS,TOTAL 78.0 MG/L N/A
09/12/00 ALKALINITY (AS .66.0 MG/[ N/A
09/12/00 TURBIDITY (TUR 4.7 NTU 0-5 NTU
^ CrjHMENTS:'
Pb/Cu LEAD limits for public schools are set at 15 ppb.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of their distribution points have a LEAD value of more
than 15 ppb and a COPPER value of 1.3 mg/L, else water
treatment must be undertaken to reduce the waters corrosive
potential.
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
Na No limits for Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted 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.
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.
9101
9139
9146
2037
2037
" '
. ' YML ENVIRONMENTAL SERVICES
321 Kear Street
(91*) 245-2800
/
Albert H. Padovani, Director
LAB #: 85.900174 CLIENT #: 12530 NON STAT PROC PAGE 2
~~~~~~~~~~=~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CALANDR8, JOHN DATE/TIME TAKEN: 09/10/00 02:0OP
13 WEST ST. DATE/TIME REC'lJ: 09/12/00 10o30A
PAWL%NG, NY 12564 REPORT DATE: 09/20y00
' PHONE: (914)-855-3319
SAMPLING SITE: 148 SUNNSET HILL RD.
: PUTNAM VALLEY, NY
C8L`DBY: JOHN CALANDRO
NOTES...: KIT TAP
DATE. FLAG PROCEDURE
'
—SAMPLE TYPF".: POTABLE
PRESERVAT%VESx NONE
TEMPERATURE..: < 4C
COLIF8RMMETH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RESULT NORMAL - RANGE
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
^
CONCENTRATION9 BOTH EXPRESSED AS CALCIUM CARBONATE, INMG&. THE
HARDNESS MAY RANGE FROM 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
MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER
HARD WATER: 140-300 MG/L (1 grain/gallon 17 2 MG/L)
- = .
\
'!
SUBMITTED BY:IA6,
Director
METHOD
ELAP# 10323
^ "
�.. ^
~�..
YML ENVIRONMENTAL SERVICES `
321 Kear Street '
Yor-ktown Hei N. Y.^ 10598—�
(914) 245-2800
Albert H. Padovani, Director
LAB #: 85.900165 CLIENT #: 12530 STAT PROC PAGE I
CALANDRO, JOHN DATE/TIME TAKEN: 08/22/00 04:00P
13 WEST ST. DATE/TIME REC'D: 08/22/00 09:00A
PAWLING, NY 12564 REPORT DATE: 08/24/00.
PHONE: (914)-855-3319
/
'
SA ' �- S, I����rE �n: SUNSET
S ET �HILL RD.
'
' S
PL�E
TYPE*,,.: � POTABLE
NONE
NONEP 6TN R�E*SPR» ATJ S�A�A �E' ��
COL'D 8Y: JOHN CALANDRO TEMPERATURE.'-- < 4C
NOTES...: HOLDING TANK COLIrORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
08/22/00 MF T., COLIFORM ABSENT /100ML ' ABSENT 1008
.�
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WAT OF A
SATISFACTORY SANITARY QUALITY ACCORDING-Tl�THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
~
SUBMITTED
Albert H. Padovani, M.T�(ASCP)
Director
ELAP# 10323
YML ENVIRONMENTAL SERVICES
' 321 Ke.r Street
!, �r�=��������,... ��. ..'��`������/.'��q�k��yvn'Heigh���
(914) 245-2800
Albert H. Padovani, Director |
LAB #: 85.900174 CLIENT #: 12530 NON STAT PROC ' PAGE 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CALANDRO, JOHN
13 WEST ST.
PAWLING, NY 12514
DATE/TIME TAKEN: 09/10/00 02:00P
DATE/TIME REC'D: 09/12/00 10:30A
REPORT DATE: 09/28/00
PHONE: (914)-855-3319
SAMPLING SITE: 148
SUNNSET HILL RD.
SAMPLE TYPE..:
POTABLE
: PUTNAMVALLEY,
NY
PRESERVATIVES:
NONE
COL'' | -Y! JOHN CALANDRO
TEMPERATURE..:
< 4C
NOTES...: KIT TAP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
C0-IFORM METH:
MF
DATE FLAG
PROCEDURE
-
RESULT
NORMAL - RANGE
METHOD
PUTNAM CNTY PROFILE
09/12/00
LEAD (IMS)
<1
ppb
0-15 ppb
9101
09/12/00
NITRATE NITROG
0.35
MG/L
0 - 10
9139
09/12/00
NITRITE NITROG
<0.01
MG/L
N/A
9146
09/12/00
IRON (Fe)
0.200
MG/L
0-0.3 mg/l
2037
09/12/00
MANGANESE (Mn)
0.075
MG/L
0-0.3 mg/l'o
2037
09/12/00
SODIUM (Na)
6.72
MG/L
N/A
09/12/00
pH
7.6
UNITS
6.5-8.5 '
9043
99/12100
HARDNESS,TOTAL
78.0
MG/L
N/A
09/12/00
ALKALINITY (AS
66.0
MG/L
N/A
09/12/00
TURBIDITY (TUR
4.7
NTU
0-5 NTU
`
. '. -'� .�-'
COMMENTS:
Pb/Cu LEAD limits for public schools are set at 15 ppb.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of their distribution points have aLEAD value of more
than 15 ppb and a COPPER value of 10 mg/L, else water
treatment must be undertaken to reduce the waterscorrosive
potential.
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
Na No limits for Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those ona
moderately restricted diet, a maximum of 270 mg/L of Sodium
is suggested.
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.
YML ENVIRONMENTAL SERVICES
' 321 Kear Street '
-
''V-ocktown � E}:��c�'���^���'
(914) 245-2800
Albert H. Padovani, Director
LAB #: 85.900174 CLIENT #: 12530 NON STAT PROC PAGE 2
CALANDRO, JOHN DATE/TIME TAKEN: 09/10/00 02:00P
13 WEST ST. DATE/TIME REC'D: 09/12/00 10:30A
PAWLING, NY 12564 REPORT DATE: 09/28/00
PHONE: (914)-855-3319
SAMPLING SI7E_f148 SUNNSET HILL RD. SAMPLE TYPE..: POTABLE
: PUTNAM VALLEY, NY PRESERVATIVES: NONE
COL . D BY: JOHN CALANDRO TEMPERATURE..: < 4C
NOTES...: KIT7AP COLIFORM METH'.- MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
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 THEA[MENT TO WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L
MODERATELY HARD WATER: 70-140 MG/L MG/L =MILLIiRAM PER LITER
HARD WATER: 140-300 MG/L .(1 grain/gallon = 17.2 MG/L)
SUBMITTED BY:
~^... . H. .~..,~..^,y.....~... .
Director }
ELAP# 10323
DANIEL J. DONAHUE, P.E.
pil -S
EER
-CONSULTINGENGIN
120 Breckenridge Road
Mahopac, N.Y. 10541
914.628-7576
May 15, 2001
Putnam County Department of Health
Geneva Road
Brewster, N.Y. 10509
Att: A. Steibling
RE: As Built SSTS
Lot #2 Sunset Hill Road
Putnam Valley TM# 62 -1-15.2
Dear Mr. Steibling:
Enclosed please find:
1. Certification of Construction Compliance
2. Well Log and Bacti Results
3. 9yrantee and two copies
4. FArcopies of the asbuilt plan
5. Filing fee of $200.00
6.- E911:1% at.- On'
By: Daniel J. Donahue, P.E.
Site - Sanitary - Environmental
S r: -!t Location
Town
1. Sewage Svstem Area
2. STS area. located as per 2pproved plans ...........................
b. Fill section - date of placement
3:1 ba:-rier Lctn. Width Avg.Dptn
C. \atonal soil not stripped .............. :....................................
d. Stone, brush,.etc., greater than 15' from STS area .........
e. 100' from Nvater, coursJ% vetlaads ...... ...............................
11. Sen•ace Svstem
a. ':ptic tank siz° -1,00 1, 250 ......... other ................
b. S"'ic ten'., irlit_ veal ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Distri tuion Box
-1. ollt le- at same elevation-water tested .................
2. Protected below frost .................. ...............................
3. tilinimum 2 ft. 0ri gin2l soil between box &ten ' es
Junction Box - properly set 600 ........................ .
— . Leng required Length installed
2. Dista_ce to watercourse measured Ft..........
3. Installed actor ' ; to plan ......... ........:..............4.......
a.- pe of tent cceptable 1/16 -1/32" /foot ............
f. o�� p er�y line - Oft . Vc-.. pth ftre <30 es fro s sa.........
om Ior pansion,100° : ....................:
e of a 13/; 1 %:" diameter clean. pth o: ravel in trench 12" minim pe ends capped ...................... ........................ :......
- -- - - 17
I AL HEALTR SERVICES
FI! AL SITE I\SPECTIOC
Owner .5 re
Permit r: _ -- _
} ,r
ti'etiloW tank ...................... .................
3. Al visual/audio....... ...................... {
4. Pu ily acc i o grade .................
5. First _ e ............. ............................... I
o. Cycle e ed y . .estimated floti=dcycle........... I
III. HouseBuildi `
P_ house ocate -per approved plans ... ............................... I
b. Number of bedrooms ....................... ...............................
IV. Well
a: Well located as per approved plans ................ ...... .......
b. Distance from STS area measured (rjft...........
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 conta'ms 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 ... ......................... :.....
L Erosion control provided'.. ..............................................
Rev. 1/91
i
r.
e
•
COM1 ENTS
t
I�
lO
1
DM3I N OF DEPARTWNT o!► MFALTH
HEALTH SERVICES
RFd�tJ�S1:,Fl�$p�ld��
per: v For: Fill
PCHID Conoucem pwrait
Located: r"Ai re7 [ C �p4r�n
Oww/Applicad Name:
Formerly: Subdivision Nam: e f�
Subdivision Lot N
Is System 1W completed? _ Date: ._..`..
Is system radiate? N'S Due: ea
Is system eamstruc wd as per plants? � -`
Is wep drilled? Date:
Is wall located as per pleas ?�_
Are erosion control measures in place?
I ce<dij► that the system(sl as listed, at the above premise+ has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Patmit and
approved plats and the Standards, Rules and Regulations of the Putnam County Depanuteat of
Health.
Dttte: ��,... Catiifled by: PE .!�, . RA -,.._
Design Professions!
- l
FOR )dADAM 17 GENE '3 --
(NAME)
Forte FIR -99
„� L` A Novi k m-ow .�
DIVISION OIL ENVIRONMENTAL HEALTJ11L.. SERVICES.
CONSTRUCTION PETRMI WAGE TREATMENT SYSTEM
PERMIT # /)G/ — J ,2 d2 )
D
Located at .jam. /teg q( Town or Village P/V
r
Subdivision name S' -r dy, ✓ Subd. Lot # i3 Tax Map .Z- Block _� Lot /� t..
Date Subdivision Approved -2A,)1f -T Renewal Z"'O' Revision
Owner /Applicant Name 416 L;> Date of Previous Approval ld- e fry
Mailing Address /-k 73 Ahye j jft4r,Y --t Zip Z6 -v
Amount of Fee Enclosed
Building Type4'"'�”' % Lot Area No. of Bedrooms Design Flow GPD 2c�
Fill Section Only Depth Volume
PCHID NOTIFICATIQN IS REQUIRED WHEN FILL IS COMPLETED
Senarate Sewerage System to consist of % 4grz) gallon septic tank and J? 61 --- /',
✓ .2 .4 "V -
Other Requirements:
C-'e;A
To be constructed by 1 j `%3y Address
Wz0 SUW1v: -_— Public Supply From Address
o1r: 'rte 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 s, s� tem described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P
� R.A. Date 3
.E.
Address &4Wj0Vc l License # -1-h l
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 newp rmit. Approved f r discharge of domestic sanitary sewage only.
By: �� Title: 1 Date: ►�'
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 °
.:. _ please print or type
Well Location:
Street Address: Town/Village Tax Grid #
iV Map Block/ Lot(s) /
Well Owner:
Name:
Address:
Use of Well:
_ Residential Public Supply Air /Cond/Heat Pump Irrigation
rimary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm d Est. of Daily Usage dal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
{New Supply (new dwelling) .Deepen Existing Well
Detailed Reason
,+E' ar, -0.'W' Vc-,E
for Drilling
Well Type
yG Drilled Driven Gravel Other .
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? Yes � No
...................................... ...............................
Name of subdivision S�',��i3.� Lot No. �.
Water Well Contractor: Address:
Is Public Water Supply available to site? .................................. ............................... Yes No L�
Name of Public Water Supply: % 14 TownNillage
Distance to property from nearest water main: &4E
Proposed well location & sources of contaminaVto rovided on separate shee Ian.
�
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.
Date of Issue d 12_ I Permit Issuin Official: at4v
Date of Expiration _ 1 101 Title:
Permit is Non- Transferr le
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
MUMME4 PMEM jdEI EMAM OMPG= sun=
d* 0*4
—IOD:4. a,-M 0 C2,42
Ae�/�o swuwo -j
Dab d 7MVhM. ARMOVd
8 -ex. 73 Pal, 4A.,
-Date Subdivision ADDroved /* Fee Enclosed t!r_:IA._*'
Dwbm WI= G 2 PCHD Fkagkad= b Mmmm4 wbm M 20 cmpbaa
swmb 20�,Zycg= b G=Ubg ell-0-40 Gam Soh T"& .a lor 6 0',00vo
w � 61 A
7aku Rflat sclkt ram Ad*=
M 299mb SOP* DRE29
represent that I am wholly and compl.olibly respansiblo.for tho design and location of the propolod system(s); 1) that the gbparate sswag0 di al astern
.bowo doscribod will-bo constructed as shown on the approved amendment there to and in accordance with the standards, rules aiR requ 07 Putnam
Wild of. Hm 621 % and that on coniplotien thereof a '*Cortific:ato of C . bristructiOn Corn I PHOMD" satisfactory to the Commissioner of . Hoalthwill
0a s�abwolttod 0 tho ft"mcni, qnd.q witton I 0jarontoo will bo furnisliod trio owner, his eucc6iezos�,holrsor awlanaby tho builder, . that a I OiS builder will
W= in o*W op=otlag coo6dition any port of said cot:taW disljowl s ystom 4urino. the P0710d Of ttUO (i) lmmOgiotaly, following the date of the I=u-
00M Of the OPpMDI of 206. Cortlflt026 of Construction COM"pil6nco,of the -11
i , lwtam Or 0 2, that the drilled. well -d6talWo e6om
in it
UC and rj
,ZHD Do tocotod on tho 000 plan and that old t%roll will be Installed rdonco %N o.. Of the Put..
County Depa"mgm 09 IN
Doto Sao Od
te, I �. P.E. PA.
n
dd7bgs— 14 100eip
A ;0001;
ey=�� Liconso No.
qppROVEO FOR CONSTRUCTION- This CIPPVOVD . I eupirOBAWO.VonrG fr rn q, data Issued u I st ctl . of the building .has boon undertaken and is
co. '=. Any chance or altwation of construction
-go., O'f
Ybuoicabla for ca to or m be mond or modified when can I" "IeNk ly IM Com
v supply only.
U it for diwozoi of dorriastictit.1y
Rev. -7 my Titlo
/ >-, t�aQo 10/88
X,
24
..;PUTNAM C0UNT-YDEPAXTMEW,-.6#tia!m
Y_ -E to toTTGA& Pernsit
eer
vinamen -N 10512e. ng
TE
:,',oi CERTIFICATE OF
Pok W`
U gRb='FOR SEWAGE D TEM i
-Z,
x , . 9owa or vulagi M.
_10
T
7
,Iibdivtsion Name
'Elk Msp. Block -
0
7A
Mind/ Name
Date of F*6*1 one 'Ak
1 A W
74
W ;Tows
P
1 3
PDepth Volume
Nambe of Bedrooms � ` Design Flow G P D `G' �1 � ` r •+ vP,CHD NotlBcad� IeRegalred�When_FW le completed
..SaaParote Sewerage System" of Gallon So-
pdC i
:0
To tie _Con9tmC4ed!b`
i"
Waitei'SUPP
Pub] elSuoplf From
J
"Y
Supply DiMed by; '04 !1��d&ili
-that I.arn,who!4� 1). . ..... f: so sa iyst eim
.,I: represent �-a. orno�eiei�: iesponsjb,le forjhodes!g�,j!�d,jlocat�jon -of.., the proposed A hat he separate. waga�dqpo i.
4t6io've des4,.ri6W'%�ilj 6�njtiucjb�61:is- shown' on the Approved ,ariericinnent f6iii:tci rules nd u!at ions .of. Jhe, Putnam'.
io`hstAult i�n`jCompliance'; r jit iiiiaory" to' the Cj"i"J.nif of Healthwill'
ounty Oeparirne�hi of that on pietjqjn ,thereo 'a,"Certif icate,� Tf,
t
e''submiti- lrneinti.�a6d'a . writtin'i6irantia4ili d;Aei.!!�ii,,iiAi6ssors;'helrs or -assigns by he',builder"Ahit said e'Oepa�l bCf urn isfi6d- the 'builder
-Y �-rhadiate Y� ollowing th
Place. on:96od,;operating elcohdition, any part of sand edate 0 thq,!"um,
ingAhe,per. cl,o.,�t 2
Q.) Par
—ance o the approve of Ahe of t well, cles�ribed i6646
th
d ki
dan�e.,Wit l��: 6 W u na rn
..will bel'o6tedii ik&" ad rules dtio;s, f-� 4he-
_#pproved,plari�and'f6i, W, �i
�v_,,a',t,� �ITI - - - _ , 'n
A
t
y?D a t f
�rna,n 0 GaItW.
gr - zp
"'Oth it goo.
Date
4
^ /W'
ZY License N
n!tr, ttl6n, of the b6ilding'14s,biee %qn,SrtSken.,an
APPROVED F R �'C i! a .15 W!
:reyocable or., m y, a o Ifi
f
d ed,when consider L$4ryk�y jh f HI angp or,ai,eia.l W 0 construction rr r. Ar 'iolv r� disposal rsan U
is'a X ny:cn
P
sa l!
iris., a:66
supply..qnly!',,�,�,
her,
W ,
87 1
Date "Tlitlel�&
0
4
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPI CAm10N `PO CONSTRUCT .A WA'i'Eit WELL—
PCHD PERMIT
WELL LOCATION
Street Address o Village City Tax
e? /� L �% 10 �lV
Grid Number
"_
WELL OWNER
Name Mailing Add ess
�- ,gig �a � mac=
�t'lvate
O Public
E OF WELL
Ot primary
2 - secondary
RESIDENTIAL ® PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
BUSINESS O FARM O TEST /OBSERVATION
® INDUSTRIAL 0 INSTITUTIONAL O STAND -BY
® ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT- gpm /41 PF D /EST. OF DAILY USAGEdd2) stal
® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 12-ADDITIONAL SUPPLY
&.NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLINfG
DETAILED/
REASON FOR
DRILLING
WELL TYPE
DRILLED
O
DRIVEN ODUG
O
GRAVEL.
-O 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 ®��' � ,� � �� �s /.ice ly Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES
NM E OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
r8cT aTr __0. pAnpER^v FFnM .P?Fti W T .WAFER' MAIN:.
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
SEPARATE SHEET
(` ate (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
thirt -y (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 drilli g peration a contained on this
property and in such manner as not to degrade or other: s ontam' a surface or groundwater.
In
Date of Issue: c � 19
Date of Expiration �2' S- 19 11F Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PC =1
PUTNAM
COUNTY DEPARTMENT
OF HEALTH
APPLICATION -_XQR APPROVAL. -OF -PLANS FOR A ,WAS WATE �1Z,SP !y, Y TAM.._„_. -_
R. Q� sWY.�
Name and ` ddre s of Applicant: .eI4-,A Oe4 f 1Y_0A0i0tf15(
Name of Project: �Sl Gc�id.�r V ._r° r / % .. �i
\ • ,D 3. Location J, V C:l�� � l!!�PZGi -�i
Project Engineer: /�iiilG'L !'GKi7�i 5. Address:
License' `Number,:_ Phone:
TY ie� of Project:
1C Private /Residential Food.S'ervice Commercial
Apartments Institutional, Mobile'Home Park
Office Building ,Realty Subdivision Other (specify)
Is this project'subject:to State Envronmental,Quality Review (SEQR)?
Type Status (Check One) Type I... Exempt
Type II. Unlisted X,_
Is a Draft Environmental Impact Statement (DEIS) required? ................ A/
Has DEIS been completed and found acceptable by Lead Agency ?.
Name of .Lead Agency
>,
Is this,,project in an area under the' - control of local planning, zoning,
_ .
or- othdr` -off a ci: a's; 6-d i.rrances?
If So,�have plans been submitted 'to such authorities? No
Has' preliminary approval been granted by such authorities ?�_ Date Granted: &//.2�_
Type of Sewage Disposal System Discharge.:.....: Surface Water Ground Waters
If surface water discharge, what is the'stream class designation ?........
Waters index number (surface) ...................
Is project located near a public water supply system ?�)
If yes, name of,water supply' _Distance to water supply-
Is project site near a public sewage ,collection or dispbsal'system ?...... do
Name of sewage 'system [Y-
+.�=- Distance to sewage system
Date observed: 23'` Name
of Health Inspector .
1
Project design flow (gallons per day).. ... ................. . C)
2.
5. Is State Pollutant Discharge Elimination System ( SPDES.) P._erm.i.t.,required ?.
. - __ ...D A . . 'w ., V�, - fL ..�- a -a... f'..:.... � ..c:.r.. - ....a) ...., n 5.+- -•-. _..s.s .. 4.D j, i ..
.6.. Has SPDES Application been submitted to local DEC Office? ...............
7. Is any portion of this project located within a designated Town or State
wet land?.......°........ ..........:'`.. ...................
/ ie' 1`
3. Wetland ID ,Number .. ... ...... ...
......: ...............
9. Is Wetland Permit .required? .... ..... :.. ...... . ............`. //IL-
Has ,appl,ication been made to -.Town or Local DEC',dff-i,cce? .:...........:.::'.
0. Does.pro.ject require a DEC-Stream Disturbance Permit? ..... .... .. /�f�)
i . Is or was project site used for agr cultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste dispos`�1,,.
landfilling, sludge application or Industrial activity? ........ YES or'. -.
�. Is project located'w.ithin 1,000 feet ,of"' of 'abandoned landfill;
hazardous waste site, salt stockpile, landfill, sludge disposal site or,
any other potential known 'source,-of contamin'atio'n. ... ..Y.ES or
DESCRIBE:
;. Is there ,a local master plan or, file with the 'Town or Village? '::......... �
Are community water,.sewer faci.liti.es planned to be developed within 15 years?
Are any sewage disposal areas in excess of �15� slopes -
_ . -
Tax Map ID Number . �. �.'f. �L %/v /fro
. ..... ...... ....
Approved Plans are to be returned to:. ................ Applicant ,Engineer
the application Is signed by�a person. other than the applicant shown in. Item 1, the
11cation must be:accompanied:by a Letter of._Authori'zation. Failure to comply with this
ovision may be grounds for the rejection�of any submission.
I hereby affirm, under penalty, of perjury,, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a '.Glass A Misdemeanor pursuant to Sect ion 210.45 of
the Pena I' Caw. `-
NATURES & OFFICIAL TITLES:
LING ADDRESS: �-
` +� ti
a � '33�
d
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
�.: ':..,. .a ,:.� - AF•PLIt;ATION''� -�C3"t;t33ss�'F�i7(:''Iy ��yuAiEk ''r�,I;• - a ..,. ;:-...... , .... .r.-
PC HD PF.RMTT llflj�� -/ 4J`'''
WELL LOCATION
Street Address
o illage City Tax Grid Number
WELL OWNER
Name Ma • ling
%� �� . O ` et
Address
lr . - /i
rpublic rivate
USE OF WELL
primary
2- secondary
RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
0 BUSINESS O FARM Q TEST /OBSERVATION
0 INDUSTRIAL b INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT_,rgpm /�� x U�V /EST. OF DAILY USAGE6ydgal
REASON FOR
DRILLING
13 REPLACE EXISTING SUPPLY
WNEW SUPPLY NEW DWELLING
O TEST /OBSERVATION Q ADDITIONAL SUPPLY
0 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
WRILLED DRIVEN
ODUG
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 &/V/1G /YC'A�y Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _1e1NO
NAME OF PUBLIC WATER SUPPLY: 4 TOWN /VIL /CITY
.DIS:'AYCE -TQ:: PROPERTY FROM .NEAREST wi;TER MAIN_
LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED A
ON SEPARATE SHEET #
ly t
(da e) (sign ure)
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 drilling operations be contained on this
property and in such a manner as not to degrade or oth7t'Ll 'contami ate surface or groundwater.
Date of Issue:_ 19 - /1/14/11L
Date of Expiration 19 �� Permit Issuing Official
'Permit is Non - Transferr ble White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVIkON OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHOMUT10W
RE: Property of RIC 4W 6 1*,,AP- -e>-D* Al
Located at —X&bf WW2:: A(Ae 4 J2 t432
TN oe
44�,*Jrax Map 4 (,-j Block Lot 1.,CZ
Subdivision of f ffffl PDO-V
Subdivision Lot # A Filed map # Date Filed
Gentlemen:
This letter is to authorize Q qaloz -4. Dd a 4#se
a duly licensed Professional Engineer &.- or Registered Architect to apply for the required
wastewater treatment and/or water supply permits) 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'D -attm*nt--- d-,to -sign allnecessaryp
ep on my behalf.in_Pormp;tipp,W4 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.
Very truly yours,
Form LA-97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of PIG 4W D T1— A) DO A'
Located at S 19 5,67' hQZ L �
T/V &1/y #01 jFax Map # flp X Block __ Z Lot /�.�
Subdivision of �S' ff 8 Pl7,04/
Subdivision Lot # J_ B Filed Map # Date Filed
Gentlemen:
This letter is to authorize Q ANi F e /. DdNR#Vf
a duly licensed Professional Engineer �- or 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. andwthc?1_ri-nam gggjmy �Apikarr� Gode.
Very truly yours,
r
Countersigned: Signed: GC`•
P.E., R.A., # (Owner of Property)
Mailing Address lojz M Mailing Address: rJ 73 4C
State --/V !l Zip ^ Z D ,rte/
Telephone: L-c�- F -) i G
Ala) b c-ine ,
State M
zip 1420 -4
Telephone: 94-23S-4496'
Form LA -97
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY &. SUBSURFACE SEWAGE DISPOSAL SYSTEMS
. Val w EET o ONSTk %aa(lN•�E I�Tj_
STREET LOCATION Yc�1a X jI
U'UI NAME OF OWNER
BY B. HEDGES R.MORRIS OTHER DATE _/� TAX MAP # -
DOCUMENTS.
Y YN
ERMIT AP LICA�TTf� m S ; GRAVITY FLOW, SUFF. SIZE
PC -1Jt IF PUMPED PIT & D BOX SHOWN & DETAILED
In T M PWS LETf E
m NG k ORIZATION [l)/WELLS & SOSDS'S W/IN 00 FT. OF PROPOSED SYSTEM
TE RESOLUTION
PLANS THREE SETS
HOUSE PLANS - TWO SETS
M. VARIANCE REQUEST
/ SUBDIVISION
GAL SUBDIVISION
SUBDIVISION APPROVAL CHECKED
m PERC RATE__�,jX.6. 4-kl
=FILL REQUIRED DEPTH
CURTAIN DRAIN REQUIRED m STANDPIPES
GENERAL 01
'EX- APPROVAL SSDS ADJ. LOTS °
WETLAND (TOWN/DEC PERMIT R & D)
DATA ON DDS PLANS & PERMIT SAME
RE- 1969 - NEIGHBOR NOTIFIFICATION
LMER
100 YR. FLOOD ELEVATION
REQUIRED DETAILS ON PLANS
SEWAGE SYSTEM PLAN - (NORTH ARROWYAs1'
SSDS HYDRAULIC PROFILE m GRAVITY FLOW
- CONSTRUCTION NOTES (GRINDERATE)
ESIGN DATA: PERC AND DEEP RESULTS
TWO -FOOT CONTOURS EXISTING & PROPOSED
DRIVEWAY & SLOPES CUT
FOOTING /GUTTER/CURTAIN DRAINS
EROSION CONTROL; HOUSE,WELL, SSDS
.EROSION CONTROL NOTE
PERC & DEEP HOLES LOCATED
REPRESENTATIVE OF PRIMARY AND EXPANSION
1
� '? r:
PROPERTY METES & BOUNDS
HOUSE SETBACK NECESSARY (TIGHT LOT)
FIOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE
NO BENDS; MAX. BENDS 45 W /CLEANOUT _
FILL SYSTEMS
CLAYBARRIER
10 FT HORIZONTAL: SLOPE 3:1 TO GRADE
,FILL SPECS m FILL NOTES
FILL CERTIFICATION NOTE
DEPTH GAUGES
FILL PROFILE & DIMENSIONS
VOLUME
FILL IN EXPANSION AREA
TRENCH
TRENCH PROVIDED 5 LL-J60 FT MAX
100% EXPAIIVSI( N
10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL
2O' TO FOUNDATION WALLS fti 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' INTERMITTENT DRAINAGE COURSE
200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS
15' MIN TO C.D. S= >5%,201- 4 %,251- 3 %,30'- 2 %,35' -1 %,100' <1%
20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS.
10' FROM FOUNDATION; 50' TO WELL
COMMENTS
✓Azte 6 --
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Dan Donahue
200 Breckenridge Road
Mahopac, NY 10541
t
gHUCE R'' F61-15Y, R.S.
Acting Public Health Director
October 21, 1996 .
Re: Proposed SSDS: Sheddon
Lot 2B
Sunset Hill Road
(T) Putnam Valley
Dear Mr. Donahue:
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. Standard note 1 is not legible
2. Plan is not legible in areas
3. Well detail, junction box, absorption trench and septic tank notes are not legible
=j-. , MaxiiTiUrt;-3o ' -.,1 X1:.1► i W-.1 ' 1 .l, . � •::; _ ..:._
5. All slopes in the proposed SSDS primary and expansion area must be reduced to a 15%
slope by the addition of ROB fill or the trenches designed 10' on center.
6. Soil data on plan is to note depth of the deep test holes
Upon receipt of a submission, revised to reflect the above, this application will be considered
further.
V truly yours,
'J
Robert Morris, P. E.
Public Health Engineer
RNVjp
Division
4 Genev
a
Dan Donahue
120 Breckenridge Road
Mahopac, MY 10541
Dear Mr. Donahue:
JOHN KARBI. Jr.. P.E. MS. , . I
Public Health Director
DEPARTMENT OF HEALTH
Of Environmental Health Services
Road, Brewster, New York 10509
(914) 278 -6130
August 30, 1994
Re: Proposed SSDS: Sheddon
Lot 2B Sunset Hill Road
(T) Putnam Valley
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."
The slope in the SSDS area is 20%. This slope must be reduced to the minimum
of 15% by the addition of ROB fill. Fill must also be placed in the
xpansion area.
r/1
Proposed contours for the fill must be shown on the plan.
100% area,
CJ .
Plan notes 50% expansion area, current codes require expansion
/revise
accordingly.
q1i.
. - 'L
ni. A ri C A J rlt.. F fa
E-ar�, _ opt - � r,.n.: le... -ar.� = to - -� y!?r�m . on... �h,: p'• � . _ - dss, �s.. liras ar e acceptable. . .
� -
_
A -
Provide current tax map number.
AK,r 6.
Referencing subdivision plat is not acceptable for questions 11 & 12 of the
PC -1 standard form.
!70
File map number and date has not been noted on engineer's authorization form
(enclosed).
14.
Design data sheet has not been completed. Complete design section and
resubmit (enclosed).
9.
SSDS plan is not clearly legible.
10.
Remove vote 6 or revise to current codes.
11.
House sewer is to note a minimum slope of 1 /4 " /ft. or 2%.
12.
Erosion control measures for the house, well and SSDS are to be shown on the
plan along with a note stating all erosion control measures are to be in
place prior to the start of any construction.
Upon Receipt of a submission, revised to reflect the above comments, this
application will be considered further.
Very truly yours,
P. &4v
Robert Morris, P. E.
Public Health Engineer
a�
KITCHEN
OI
DINING
BATH
».n
1
HALL
LIVING RM
N1.1]r
MRFD
RM 13
1.
nil :
CRESTWOOD 27x 8'
xyd -n t
BED.RM ' I
a.nu
L1
BED RM f 2
1.9.11
e�
BATH' 2 ..
0
DINING KITCHEN O
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GLENWOOD 27 x48' Sj�n4,t�:, S TTit-le
PENN LYON HOMES INC.
Old Trail Road, Selinsgrove Pa. 17870
Telephone (717) 743 -0111
LYNWOOD 27'x52'
s'
�PU'TNAM COUNTY nEPARTMEN'T OF' HEALTH
ARPLI;CATIQN. F�R,A °Pf ��AL .nr �?� :A I1�: M- GP0SAL- -SY,3TEM
_�....... _n..... -
Name,a'd ddress of Applicant: iGrAf
Name of Project: _bed 4MV6,T/OAd di s' fDs 3.• Location 10/6: Jf/l ggee-el'Y'
Project Engineer: 'Address:�C'G,r��w,�p�,oG,'.e�
License�Number:T f* Phone•
Type of Project: ,
Private /Residential Food Service Commercial
Apartment's' Institutional Mobile.'Home Park
Office Building Realty. Subdivision Other (specify)
Is this project - subject to State Env,ironmentaJ:Qua'lity Review (SEAR)?
Type Status.:(Check One) Type I'.. Exempt
Type II: Unlisted
Is a Draft Environmental Impact Statement. (DEIS) required? 25
Has DEIS been completed and found.acceptable by Lead Agency? ............
Name of Lead Agency
Is this project in an area under the control of local planning, zoning,
or ot:het•,offic.ials ordina'n.c¢ =� - - _.._ ._•. Y_
If ^so,,,,Kav9�.,plans -been -submitted to such authorities? ................... A/D
Has preliminary approval been granted b�( such 8uthorities') Date.Granted:
Type of Sewage Disposal System Discharge::..•:`. Surface. Water. X_Ground Waters
If surface water discharge, what is the stream class designation ?........
Waters index number (surface) .....:...::..:'..::..... :....:........... :..
Is project located near,a public water supply system? .................. A/10
If yes, name of water supply . Distance to water supply
_ _. .,
Is project site near a public sewage collection or disp6sal' system ?..... Nd
Name of sewage system Distance to sewage system
7 7_
Date observed: / IZ) �°�` 23. ` Name of Health Inspector:
Project design flow (gallons per day) ...... ............................... Ql%
• a i
z°
5. Is State Pollutant Discharge Elimination System (SPDES),.Permit required. ?,.e, .
c: �T ' tPU S AO'OIAcation' been submitted to local DEC Office? e ° ° . - e e e e
7. Is any portion -of this' -project located within a designated Town or State
wet 1 and? e e . °.e' e .. °
e, e'e e e e °- 9'O+Y :O�'o•°jti Ore.,e�e: a \e4° s'0 e e ° e ° e e ° ° ° ° ° e s e ° ° °
3. Wetland ID Number °..° e.nee...e` °.ece ::'o: o oa�o °e °e °. °ee ° ° ° °e ° °ee °e..° AIIAL
9. Is Wetland Permit required? ........
Has application been-made to Town .or Local,,DEC -1.06ice? o a . e e e e e a o
0. Does project require a DEC, Stream Disturbance Permit? eeeee
!. Is or was project site used. for agrcultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste,dispo
landfilling, sludge application or industrial activity? ee.eee... YES o,
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;contam1nation ?'.° °:e'..YES o
DESCRIBE: -
Is there a local master plan or file -with the.Town,or Vi1`lage? eeee. e
Are community water, sewer facilities planned to-be developed within 15 years?
Are any sewage disposal areas ,in excess. of 15X slope?.'. a Ln =- -'
3r- 0.f alp• u Number .`�YeK.f 9 e'e .. . .. e a e e e .,a e e e•a e e
Approved flans are to be returned t-o: ..e, eee. °e Applicant;_ Engineer
the application -is signed by a person other than the applicant shown in Item .1i -the
Alication must be accompanied by,a.Letter of Author.ization.'�FAiTure to comply with this
)vision, may be,grounds for the rejection any submission.
I hereby affirm, under Pena 1 ty of perjury, that information provided on ' th is
form is true to the best of -my knowledge and be 1 iefe Fa Ise :statements, made -
herein are punishable as a`.Class A kisdemeanor:pursuant'to Section 210.45 of
the Pena 1 :LaN:,
NATURES & OFFICIAL TITLES: I..
- --
er 4e
ING ADDRESS:,
.t .'
1-111
- RMFUI
, � �- I?
DESIGN SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM
Owner 141�101 rl) Address A,1-41 A7-olY -7' 44j-
Located at (Street) f&HfF - /
7 //.e Z 1P See. le.2- Block Lot /� a-
(indicate nearest cross street)
Municipality P U7-
s
Date of Pre-Soaking 14Z Date of Percolation Test
HOLE
NUMBER CI=
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water Fran
Water Level
No.
Time
Ground Surface
In Inches
Soil Rate
Start-Stop
Min.
Start stop
Drop In
Min/In Drop
Inches Inches
Indies
2a
3
-02 Z/ 2
j-
3216
43
20
f �
5
3
32 3
,,))
0 4/ C2, r
"?O
30
5
2
3
4
5
NOM: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained,at each percolation test hole. All data to' be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
TEST PIT DATA RBQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
1K)LE
G.L.
21
31 S 14
%I
51 1 �-r C 6 A7 10 A e 7 -'-
61
71
81
91
10,
ill
12'
13'
INDICATE is vEL AT WHICH GROUNDWATER is ENCOUNTERED 0 N
INDICATE LEVEL To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:D 4,--11 F Z- J, D oti x-i',,1u F DATE: /o4/ /
DESIGN
Soil Rate Used 3e) min/ill Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 1b00 gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other
Name jDAA//,,rz- J D,01V4A16,L Signature
'Z
)W, 37J 43 Md) SEAL
Address
'AN] 4c
AINI 1UJ V1 V N11 Id
THIS SPACE FOR US91-RA MMDEPARTMU ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
FU'T'NAM COUNTY DEPARTMENT OF HEALTH
_ ..... ......... ...._. APPL ICpT-I¢I� �R • 4P s OVAL ,.OF ..P.LA�'a,:POR:> AST_ . - R DISC ;SAL S�(STEM • - —
P
Name and Address of Applicant: �P.lG,i �i S� e d e ,
—P.O. Fo x 934
p�T�fiH �/•IGG�'r' ,v l ,�a.rr�1�
Name of Project: CaNSTRocT/aN OP SS C:S 3. Location T/V /C: elezo y
Project Engineer: , AIIiF4 I D-O)VIIfuF 5. Address: N,PFG,rF� R /o�F iPD
440109� Ali
License Number: Phone: .Z 199
Type of Project:.
_,) Private /Residential
__ ...Apartments
Office Building
Food Service Commercial
Institutional Mobile. Home Park
Realty Subdivision Other (specify) ,
Is this project.subject to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. T_ Exempt
Type II. Unlisted ,_Y_
Is a Draft Environmental Impact Statement (DEIS) required? ............. l D
Has DEIS been completed and found acceptable by Lead Agency? ...........
Name of Lead Agency
Is this project in an area under the control of local planning, Zoning,
or other cfficials, ordin.az.es ?.: ;.:: ...:...:.. ..:
�...
If so, have plans been submitted to such authorities? .................. /go
Has preliminary approval been granted by such authorities ?„ NIA Date Granted: A(Ig
Type of Sewage Disposal System Discharge...... Surface'Water _Ground Waters
If surface water discharge, 'what is the stream class designation ?........
Waters index number (surface) ......:.:. .............:.................
Is project located near a public water supply system? .................. A 0
If yes, name of water supply Distance to water supply
Is project site near a public sewage.collection or disposal system ?..... A10
Name of sewage system _ iu // Distance to sewage system Alt
Date observed:S'f.F S& &air.,.s/ov lv-a 23. Name of Health Inspector• fir FisF
Project design flow (gallons per day).......... . . ....................
2.
15. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. /i/0
6. Has SPDES Application been submitted+toW*local DEC Office? ........
7. Is any portion of this project'located within a designated Town or State
wetland? .......... ............................... .....................
S. Wetland ID Number ... ... ... .....................................
9. Is Wetland Permit required? ....................................... Has application been made to Town or Local DEC Office? ..................
0. Does project require a DEC Stream Disturbance Permit,
1. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disp -
landfilling, sludge application or industrial activity? YES o NO
Is project located within 1,000 feet.of existence of abandoned landfill, /0 /V
hazardous waste site, salt stockpile, landfill, sludge disposal site or -_
any other potential known source of.contami.nation? ..............YES o
DESCRIBE:
Is there a local master plan or file with the Town or Village? ....:...... _Y _r
,. Are community water, sewer facilities planned to be developed within 15 years? Al a
Are any sewage disposal areas in excess of 15% slope? ............ No
TaxMap ID Number ........................................................ e.2-/W-
Approved Plans are to be returned to: Applicant _ Engineer
the application is signed by a person other than the applicant shown in Item 1, the
:.lication must be accompanied by a Letter of Authorization. Failure to comply with this
Dvision maybe grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Pena 1 Law. ,
:NATURES & OFFICIAL TITLES: 110111 e
LING ADDRESS: 1.411 O
o