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Home My WebLink About2830DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -3 BOX 24 IN X0 I U ,- ,� ' Ir _ P. 02830 OWNER'S NAME SITE LOCATION MAILING ADDRESS PUTNAM %.X"W11. HEALTH DEP9U%IIWA1r I:,, . DiV?SIT? QF ENVIRMAL-- T_ -ll? -1 91 -Vi 'EIS 6Q r /0 -/ 3 k 2 s-7-re PHCNE TO S �e Je K gd&-k 11,, g, / e Ile I.- PW CaVlaint # Name & Relationship (i.e, owner,tenant, etc.) TYPE FACILITY ! Is " PHONE REGISTRATION # /7 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. v Proposal approved �L Proposal Disapproved -�-7 _7_ DiXe roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Su)mission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street.Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE TITLE LATE VIES: Wiite (PCED); YeUc w (Ttkn BI); Pink (Applicant) r. to a % aha--V. dh 4v, �� { �,,��•# ,, y.,�oe:o. lion • ,H , i a 3wa ��ri, H4 PUTNAM COUNTY DEPARTMENT OF HEALTH Rey.-.3186. Division of Environmental Health Services, Carmel, N.Y. 10512 f Engineer Must Provide . . \ P.C.H.D. Permit ll -- \VX CERT Located OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM � - - _. uWa / - ` /� - 1 % _ Ta: Map �� /y Block Z Lot Owner /applicant Name'tJ mama Address Subdivision Name Sabdv. Lot # Date Permit Issued. Separate Sewerage System built by / l Address Consisting of /d ® l/ Gallon Septic Tank and O L '00 d // Z 0' Water Supply: Public Supply From Address or: f Private Supply Drilled by 41 /rn0121 k,Sza . c Building Type r/gG� ly�J'i.� ife Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were constructed eseentiall plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulat no, i acc ttfpe a ►�rj pl , and the permit issued by the Putnam County.De))pa/rtment Of Health. Oats f�11 � Certified T �✓✓✓ 2— ' `�/� �d�� License No. Address / t(y re the correction of any unsanitary Any person occupying premises served by the a sy,9. s) snail pr� tak6 no conditions resulting from such usage. Approval of the separate sewera em shall become s a pub((: sanitary sower becomes available °and t e approval of the private water supply shall become null nd v when a p 11 me$ available. Such approvals are subject to mar ificatfo or change when, in the Judgment of the Co I r of Healt re w i flcatlon or change Is necessary. Title L-� Date By PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF EWIRO Ar-..HEALTH SERVICFB Owner or Purchaser of Building Section Block Lot Building Constructed by Location - Street 14v/ Municipality Building Type Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SE4MGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 _. _. _ ._ � ye, Y y f i �a�-c? _ ryf':.Cryncts -_: ; �. ► .Comr.�_!Ja.nc�e °' ;.for .t.he_ sPa�ae 6i scoseI yst -Qr; any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the sy g�nn to operate was caused by the willful or negligent act of the occupant of th p�lding util Wing the system. c� �/ Dated th' da of 19 <`! Signatur,� 1� Title Ge eral Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 •' ( 914) 245 -2800 Albert H. Padovani, Director LAB-#:-87.302768--CLIENT-#:--5651 GAMBINO,.SAMUEL 15,8 WEST SHORE DR PUTNAM VALLEY, NY 10579 NON STAT PROC . PAGE 1 DATE /TIME TAKEN: 11/02/95 11:00 DATE /TIME RECD:.11/02/95.11:20 REPORT DATE: 11/07/95 PHONE". (914)-526-2197 SAMPLING SITE: SAME. SAMPLE TYPE...:. POTABLE MAIN FLOOR GARAGE SINK TAP PRESERVATIVES: NONE COLD BY: FRAN GAMBINO TEMPERATURE..: <.4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL —RANGE 11/02/95 MF T. COLIFORM . ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WA ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING Q THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF- COLLECTION. SUBMITTED BY: Albe t H . Padovani, , M . T . (ASCP ) Director ELAP# 10323 WELL UVr1rLtT1UW CkEXURI DEPARTMENT OF HEALTH . . ......... "Z4rV'jxU#KkW6&tt:&i.' Hew.,"! PUTNAM couNTy DEPARTMENT OF HEALTH Office Use Only WELL LOCATION 7—TREETADURESS: WNIVIMELICIly TAX GRIO NUMBER: Qs S e „� ffe, lv� WELL OWNER NAME* ADDRESS-. tt4 C i 1 401 'Ar 1C M 4'7� a , V� Ilee Q�PBIVATE I 0 PUBLIC USE OF WELL 1- primary 2 - secondary QAESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP ❑ ABANnOkED 0 BUSINESS ❑ FARM 0 TEST/OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE r. YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY (NEW SUPPLY (NEW DWELLING) [] DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH STATIC WATER LEVEL � _Oft_ DATE MEASURED* YA-AL/ DRILLING EQUIPMENT —ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT. ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED Q-&EN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH ft MATERIALS: STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE s ft. JOINTS: 0 WELDED Q'tHREADED 0 OTHER DIAMETER in.. SEAL:- QP61ENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT lb./ft.. L DRIVE SHOE.O YES NO I LINER:0YES 9910 SCREEN DETAILS _j DIAMETER (in) "SLOT SIZE LENGTH (it) DEPTH TO SCREEN (IQ DEVELOPED? FIRST . 12:90 HOURS n -1-0-YES GRAVEL PACK OYES 0 NO GRAVEL SIZE: DIAMETER OF PACK — in. TOP DEPTH _ft. BOTTOM DEPTH _ ft. WELL YIELD TEST If detailed pumping METHOD: 0 PUMPED tests were done is in- O'COMPRESSED AIR formation attached? 0 BAILED 0 OTHER :OYES ONO it more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE lgear. Water Well Oil- Meier In FORMATION DESCRIPnGN CQUE fL ling WELL DEPTH IL DURATION hr. min. DRAWDOWN IL YIELD OPM. Land Surface L4 9 WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAI4. PUMP IXFORMATION TYPE MAKER MODEL CAPACITY — DEPTH VOLTAGE — HP WELL ORI NAME OATS RTLr t ADO d a) K G +Y\ CLw 1,j(e, _A J/ 13V ---I i\ I. _ _ roe �ew�as �ro�aL in_ :� - - �_ � r�•� :I i�a�'Nf�t' r.e.,.. shin •� f • s. ..nt �� '�_.. � .rte � ✓ , w�d� , �1 1 DIAi'd A�prvtal cm ri t' atiAubd io Fe - ;.Enclosed_:= LAI Pim"Ar i Number Number 1 !; � NeG P D U� aYMi.� To M + W k V w -r 1'nOrMMt'.that 1 �ei;wheNY aM eanPMtNY �a!bohtibN fog tM deft �h0 lotatioe of tM WoVOwd systeinlgi.11 't aOgirN�ertbad wlll ",1i O"s!rueue all s"n oh;tM ap*owd atnNnelnMnt.Ehwa ' to and igac�o Aanu OdIMttY bmimo" oik of fIMR11 and [hit 4h toe�OMt10n tfwnof' 'C�ti1,iC�b a Colatrtid en; M "VAOW tdd to th ONarl hwK and a writti" awwwtaa wlp;0a tumNhW thi ownM his: a# w0a YI good :NariI14,'401841don. W'w part ,_o<F YId ,tariraN QbpM -- l4lklirn duriii tho oa .d9► �wei 01 the a/ rolve xd,,tM!CwtNleiN o/ Cowstructioe Coi�ipNnq' of iM or1�Mi1 sysbn Ott N -- IORaRM as tlldirw ow tM som" p`and that Yid waN wfll ba Inttal oordN�w' zCMIMY'Ogattttlam'. IIMKQ. j IM Oob , at s Si�Md ✓ ANROVEO 1'0 CONST.AtJCT1pNl T aPp►0W1 aaOka two s h tM daft ittuad� NSr� tit IS for 461rM Or nyY a e< nwdtfiad wMn oo by tM iriipion�^ nNU1na a p►m ' A to IispOYi of domalk y swMSM, and/ to,watw PUPPiy"8eY Ree oa .F a-1 � z> w � �• s C ......�= ._n...;�....- .- Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 18, 1993 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Gambino West Shore Drive (T) Putnam Valley Dear Mr. Sullivan: Review of,plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: As per our discussion in April, please revise the above captioned plan to show the proposed septic tank location on the right side of the building. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very--truly yours, Robert Morris Assistant Public Health Engineer RM /jp � •• • � r •• � i� v •e �• Kati � w.: • ..r �.+w• v+w- r 171 ��!'i`Li'�►SSl�SC7t35Ji�'t�l ........ � � } r ..axrwacw•.•..•or �t .. r. 4: __..e .. s� yr n� .- •yy,Ky - -..v4- •� n. .� �_ �+ ' '' 1ti1;C+` 1% LSi�Li5,�/ �'` Owner �� d _ %� r `/ '!C/ Address HOLE g'1;" Located at (Street) {'f1%�/ �r % �� Sec. ,6�'2, i4' Block / (indicate nearest cross street) [Municipality a �/ � Watershed SOIL PERCOLATION TEST DATA REQLT= TO BE SUBMIT= WIM APPLICATIONS Lot L3 Date of Pre-Soaking -�` f �- Date of Percolation Test HOLE 2 NUMBER CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water EYom Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 4 5 c 4 5 1 2 3 4 5 NOTES: 1. Tests, to be repeated are obtained at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately eq ual soil rates Percolation test hole. All data to'be submitted be made fraxn top of hole. 2 3i�' 4 5 c 4 5 1 2 3 4 5 NOTES: 1. Tests, to be repeated are obtained at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately eq ual soil rates Percolation test hole. All data to'be submitted be made fraxn top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO HOLE. NO, G.L. M. .2 31 41 51 61 -71 -d LL! 12' 131 14' INDICATE LEVEL AT WHICH GROUNUATER. IS ENCOUNTERED INDICATE LEVEL To WHICH WATER LEVEL RISES AITER, BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: LVIZI DATE: DESIGN Soil Rate Used S Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By 4161 L.F. x.24" width trench Other Name Signature Address Ce MS SPACE FOR USE BY HEALTH DEPARbRM ONLY: W4. V Soil Rate Approved sq.ft/gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMI WELL LOCATION StreeteAddress T own V llage City Tax Grid Number WELL OWNER Name r Mailing Addr ss r e— Private O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP D ABANDONED O FARM - O TEST /OBSERVATION 0 OTHER (specify' O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# ❑ REPLACE EXISTING SUPPLY &NEW SUPPLY NEW DWELLING PEOPLE SERVED --/- /EST. ❑ TEST /OBSERVATION 13 DEEPEN EXISTING WELL OF DAILY USAGE �G x.Sal 13. ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING _ WELL TYPE ,MDRILLED aDRIVEN ODUG OGRAVEL 00THER IS WELL SITE SUBJECT TO FLOODING? YES A---' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: G Lot No. WATER WELL CONTRACTOR: Name ��/.�✓! %I� /��?�G�d i� Address �o< IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. YES R"�' NO NAME OF PUBLIC WATER SUPPLY: �' TOWN /VIL /CITY �.. to any is +nr� q�A DTV FROM- "L .6 L'C Tr� FA a.�1�,1J'• Z, a 'Z R-PER a -z ROM :yo..�c� _�T ATE. .- .. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED. .ON SEPARATE SHEET —� (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3! (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 dr ing operations be contained on this property and in suc a manner as not to degrade or a her i e contaminate surface or groundwater. Date of Issue: y Z 19 L: Date of Expiration 4( 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller .REGISTERED NAIL. Coil � RETURN RECEIPT REQUESTED / Date 5� -- - .'....,..Building Inspector�^.X ._ _._�.. - ,. - -. - _ �..� �...: _ , ..�.,...,.,�..: ,•..... ......�- � ...�. .r_,� .......�.. - . • . _:.. _________ ___ _ _ __ Re: Construction Permit for single .family residence Applicant _Q`!%% _- Street Torn z. �W -/ - 3 Dear --------------------------- �-r� . -- - This Firm (I aa) submitting an application to construct a sewage disposal system serving a.single.family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for any variances? yes-- - - - - -- No --- - - - - -- B) Is any portion of the parcel located within a regulated wetland or its control area, and if so is a wetland permit required? yen -------- No --- - - - - -- C) Is any other local permit or approval necessary? Uri. --- - lip. _ If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone. 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Very truly yours, Name------------------ Health Department Inspector JK /jp vetland bh r Engineer, Architect, Owner 0 • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of`ri�� Located at ��' /- ..�1 ✓� �r�� 6' __g--IS tion Block Lot Subdivision of SubdV. Lot # Filed Map # Date Gentlemen: _�,) -�-• This letter is to authorize ✓ 4`'_� • � j to / I've Vy a duly licensed professional engineer' • or registered architect___ (Indicate to apply for a Construction Permit for a separate. sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulaga.ted by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code,.. Countersigned: POE* ,"'�.A., # wgareas �. 0 Very truly curs, Signs �-' Owner of Property Address may/ Town Telephone REGISTERED MAIL 'RETURN RECEIPT REQUESTED Date Building Inspector ------------ - - - - -= - ----------------------- Re: Construction Permit for single family residence �^ Applicant Street �� ' �.J o �c r i ✓� Tom _?_✓_�i!YJ_�%_al /C �! - -- Tlf - - - - -� �_ /d --/ - 3--- - - - - -- Dear /K. 6 11-1// - -- This Firm (I am) submitting an application to construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the folloving information be obtained from your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for any variances? Yes - -- - -- NO --- - - - - -- B) Is any portion of the-parcel located within a regulated vetland or its control area, and if so is a wetland permit required? Yes-- - - - - -- No - -� <* C) Is any other local permit or approval necessary? Na If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Name --------------- - -- Health Department Inspector JK /jp wetland bh Very truly yours, Engineer, Architect, Owner LE C L Q r n� E- _ 'I PC-1 C'- c3 u -r -y— ) ✓` � �'n`r M =-!- -r, C:� r° y-1 u -4,, 1-r- `r M APPLICATION- FOR -APPRiDVAL OF PLANS. FOR -A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: %GAG ST ��1 ✓'� �% � � /� 5-'7 2. Name of Project: c/t%nfP' �: G 3. Location. T /V /C: . N–�—' f t • ;Z/ % �e°r.� 4. Project Engineer. aS��' /�i ✓� 5. Address. r License Number:-5 �'� Phone: / 6. Type p', Project: 1/ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? A, Tyoe Status (Check One.) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental- Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... A� 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, y other. o"r"icia's. . _ �o- 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........................................... 17. Is project located near a public water supply system? .................. A10 18. If yes, name of water supply Distance to water supply 19. IS proieCt Site near a public sewage collection or C'.spOsc' syster:?..... Ale lG� 20. Name of sewage system Distance to sewage system' 21. Date observed: 23. Fume of Heal+ Inspector: 24. Project design flow (gallons per day) ... ............................ 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. /V c> 26. Has SPDES Application been subm ttedto local Uff*bTfice�' ::............. �... 27. Is any portion of this project located within a designated Town or State wetland ?............ .. ................ ............................... v 28. Wetland ID Number .....:.................. ............................... 29. Is Wetland Permit required? ........ A-- Has application been made to Town or Local DEC Office? _ 30. 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 disposal, A10 landfilling, sludge application or industrial activity? ........ YES or NO 2. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or ,/ any other potential known source of contamination? ..............YES or NO /l U DESCRIBE: >�. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? /✓o 35. Are any sewage disposal areas in excess of 15% slope? ........................ %� U - -36. Tax Map. ID Number .......... ......�. ............ ......... ........ 37. Approved Plans are to be returned to: Applicant Engineer :f the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this )rovision 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 Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. _ ;IGNATUR.S & OFFICIAL TITLES: � IAILING ADDRESS: APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS _.._........ _ _ _. H for:-CONSTRUCTION. P I = NAME OF R L%0- � 0 1 r I o STREET CA ON BY DATE 1 O I& jq 2— TAX MAP # 62— t 0 DOCUMENTS. Y I RNIIT APPLICATION -1 ELL PERMIT; PWS LETTER GINEERS AUTHORIZATION SIGN DATA SHEET(DDS) EP HOLE LOG NSISTENT PERC RESULTS (3) RC HOLE DEPTH RPORATE RESOLUTION ANS THREE SETS USE PLANS - TWO SETS VARIANCE REQUEST E6/ GENERAL 'LEGAL SUBDIVISION m SUBDIVISION APPROVAL CHECKED m PERC RATE FILL REQUIRED C2] CURTAIN DRAIN REQUIRED MSTANDPIPES m EX- APPROVAL SSDS ADJ. LOTS m WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE- 1969 - NEIGHBOR NOTTFIFICATION ,m LETTER Bl/ZBA SEWAGE SYSTEM PLAN - (NORTH-ARROW) SSDS HYDRAULIC PROFILE M GRAVITY FLOW D/ J BOX CSI TRENCWGALLEY m P- PTT DETAILS SEPTIC TANK - SIZE, DETAIL WELL DETAIL, SERVICE LINE IF OVER CONSTRUCTION NOTES (GRINDER RATE) DESIGN DATA: PERC AND DEEP RESULTS ISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION I EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE ffIF PUMPED PIT & D BOX SHOWN & DETAILED _1HOUSE - NO. OF BEDROOMS WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM ® PROPERTY METES & BOUNDS OUSE SETBACR��Y (TIGHT LOT) _OUSE SEWS 4" " 0; TYPE PIPE BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS mCLAYBARRIER m 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE M FILL SPECS CTIDEPIH GAUGES m FILLPROFILE & DIMENSIONS m VOLUME TRENCH M�LF TRENCH PROVIDED C� 0 FT MAX PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL TO WELL, 200' IN D.L.O�, INY PITS E LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' INTERNIITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.[I] 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS DRIVEWAY & SLOPES CUT It101 FROM FOUNDATION: 50' TO WELL ® FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: WELLS 15' WELL TO P.L. s-ui I,- I i vu-. -rpv-) . 0 l/t "Vfr z"o I) , Sl0(x DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 March 16, 1993 Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Proposed SSDS: Gambino West Shore Drive (T) Putnam Valley Dear Mr. Sullivan: Public Health Director 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: 1. Neighbor notification is required. 2. House sewer is to note a minimum slope of 1 /4 " /ft. 4. Standard Form PC -1 has not been submitted. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, ;?'&2 A 4"u, Robert Morris Assistant Public Health Engineer RM /jp _ , _..:�._..... _ �.,...m..� Im I Tom . . . . . . . . . . . . ti OWN . . . . . . . . . . - Av if, TRY- w—w tb MP by MOO A A t4bX -A th" lwoz�ms' WN 4 A"Al Q- M POW W-0 -7 �77-7. a