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HomeMy WebLinkAbout2752DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -15.2 BOX 23 02752 No . P. J IL I ' %vvm Ami r ' 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 BA I BED RM' I • � O ' o HALL LIVING RM BED RM'2 11.1.r BED RM +3 00 4r? BED RMzI FL' KITCHEN DINING d v. i! BED FW 2 BED RM' 3 LIVING RM r ¢,.m weau nran d � 6 b ELMWOOD 24'x46' } •i NODK /. o BATH Y DINNG. 61'al ' o' 0 0 BED RU'I m.iza + KITCHEN r.ar n.¢v ]()BAT /1 /� HALL a m In OP HEATH I LIVING RM BED RM 2• �{ zor.¢r 1 -- ' BED i2Mv 3 rru+ 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