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HomeMy WebLinkAbout2833DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -6, 7, 8, 9 & 10 BOX 24 rm JL rV -h 02833 V PUTNAM COUNTY DEPARTMENT OF HEALTH "', . DTYTCTON f1F ENRIM1''.A�1:.H:F CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Pi/-<o -'6t� Located at Town or Village 'BD+JM VALt.l-r- V Owner /Applicant Name Tax Map eZ� W Block 1 I Lot (6-10 Formerly 94%- Subdivision Name t..41�A- Subd. Lot # NA Mailing Address 440 i -7&1 Ain 5TZ(-= r WeW Y®� : NY Zip 1© ©2 d Date Construction Permit Issued by PCHD : I zo q �- T Separate Sewerage System built by �5- r- -y e- Address 'K.t-t M.4 il/4A9�� Consisting of 000 Gallon Septic Tank and p� fl"f Cpl 0,C— LO J e-12-0,0,5- RiZ-- Gig o QC, Other Requirements: Water Sunaly: Public Supply From Address or: ><' Private Supply Drilled by WZMA4 l Address FuCrNJA-M YA i•:'at: ding i�� ;�.w�.a+'��'v� � � A.� . iius viv$i3rJL c3rMii v��.ii �.viu�l�ifd� Number of Bedrooms Has garbage grinder been installed? NO 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 the Putnam County Department of Health. Date: Ito Certified by P.E. >4 R.A. (Design Professional) Address rCoLt> spzI Kifa " License # C, 2 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 revocati n, modification or change is necessary. By: Title: Date: -4- t7d White copy - HD File; Yellmk (�ppy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562-0890 NYSDOH 10142 NJDEP 73015 CMOHS PH-0654 EPA NY049 Fax: (914) 562-0841 � ` ANALYTlCAL K[PU8T ' � 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562-0890 wYSDOx1m*e wJDs mmx v"DOn ,H-055" EPA NY049 Fax (m4)o62-0841 Severn Trent Envirotest / ' � s ANALYTICAL REPORT e NYSDOH 10142 Severn Trent Envi-test NJDEP 73015 CMOHS PH -0554 315 Fullerton Avenue Newburgh, NY 12550 Tel: (914) 562 -0890 EPA NY049 Fax: (914) 562 -0841 From : JOEL TRACE ARCHITECT PHONE No. : 914 562 5611 Mar.23 1998 11:57AM P01 rederal Id: Collected by: Inorganics Analysis Data Sheet form I • IN Cliont Maim; PATRICIA K. PERLMAN Project Name:. STANDARD ETl- Sample -Number: -.183444-01 "Cl iefit'1.0. -. * 170 (1. '.Ij DR. KAMN VALLtY 4dS[_ 610 Date Collected: 11•MAR•98 Matrix: I Drin)W.0 DaLct Received! .11-MAR•9A commts; PAW Analysis Result Units Method Analyzed COOL 1 1. .* ­...... . :... . :. . . :_ .. /100. KLS. '211MR-90 T til C101 i form ASENT'' 1100 KS 9223 11 • MAR48 Remarks: Sample passes NYSDW drinking water standards. 315 FWI*non Ave" Nm*mh. NY 12650 TO. (914) MMM wresuowrcnu NAVP 7W IS eyo" PO4" CPA WOO ftr (014) 562.bmi From JOEL TRACE ARCHITECT PHONE No. 914 562 5611 Mar.23 1998 11:58AM P02 I J JOEL TRKE REGIST(R(D ARCHITECT 51 SOMERSTOWN AORD OSqNIN(',. NV IOS62 -OFFICE. (914) $62-5611 RESIDENCE - (914) 762-2482 FAX TRANSMITTAL DATE: 81 PAX THLEF110NE NO. I SENT '1'01. cOMPANY: _BP Z- R_; "0, Or PAGES (INCLUDING COVER PAGE) COMENTSt PLEASE CONTACT SENDER IF TMSREIS 4 PaOSLEM WITH RECEIPTION 914-562-5611. From : JOEL. TRACE ARCHITECT PHONE No. : 914 562 5611 Apr.10 1998 12:02PM P03 Federal Id: Collected by: Inorganics Analysis Oats Sheet rarm I • IN Client Name: PATRICIA K. PERLNIW Project Name: STANDARD Ell- Sande Number: 183444.41 Client I.D.: 170 N. SHW DR. PUTNAM VALLEY NOSE BIB Date Collected: 11- MAR -98 Matrix: I DrinkM Date Recvivad: 11 -MAR-98 Comments: PAID Analysis Result Units Method Analy. -od MAR ..',: -. MI. ::gB Iotai COliform ABSENT 1100 MLS 9223 11- MAR -98 Remarks: Sample passes NYSDOH drinking water standards. MNAOiS ruhdcm Avmw NW*Uq n, NY 12iN 1 d (M) DW-00u • M MYO rota Ma N,DEP TMO CTOO PW4W CPA W049 FaX (014) 5W-06ii From : JOEL TRACE ARCHITECT PHONE No. : 914 562 5611 Apr.10 1998 12'00PM Poi JT JOCL fkk� Af('76T6AED RACHITECT 51 SOAACASTOLUN K)AD OSSINING, NY I0569 OFFICE - (914) ;69-M-11 • !�SIDENU • (914) ?82.2482 PAX TRKNSMITTAL DATE 9 Iq fl P TELEPHONE NO.: — A _--7 AX SENT TO; COMP hwy-. SUNDER: NO, or PAGES (INCLUDING COVER PAGE) COmMENTS; 0 PLEASE CONTACT SENDER IF THEREIS A PROBLEM WITH RECEIPTION Date Collected: 33•MAR-98 matrix: 1 Drift1wo ,$ Date Received: 13 -PM-98 c=wnts: PAID Remarks: (•)Parameter fails NYSDON drinking water standards Nam, NY UM rr (6141 6624lAO YON" M742 KIDe 71016 C700i1a qM SPA W41% M-MYOW Foe (OU) OHM Analysis Result Units Mettwd Analyzed Alkalinitty. ' . ::...:::...:::' :':::::::`::.'': 2a2o�....... ,::.: xa- wuz.�a. Iron 8750 (G /L 200.7 03•Ak -98 ..: : :......:i:'i a f4 :''.. .. .:. 5111.' {':''pp��':...i'yll: Manganese 89.8 Una 200:..:.:.•. .1 ... 03- •98 (llti`et:e:a(Al ;:: 'rC ::::::::..:.::: .::a:30`.r::::.:::'r::.::::.:: '.::. :::'.i:,::.:.':i 11 .:'; .: d` �.. 11- NitMte (Nl 0.01 U MG /L 0 NO2 0 MAR -98 Sodii ii ::....... i:".: ri':!: ::::.c29'y9:':i:(':;::'.:.::... :.:: .....JV-L:...... 7: '. :.;' ; .AP$98. lot aI mardncss 31.9 MG /L 700.7 03- APR -98 Yti+iii litY . c:::':.:.: .:,<.;:i5�'r:i::.::.r..r:::'::: :::;... 71►:...: 23..70;e.::.i':i'13- W-.98: PM 7.5 3500 -N -8 16- MAR -90 Remarks: (•)Parameter fails NYSDON drinking water standards Nam, NY UM rr (6141 6624lAO YON" M742 KIDe 71016 C700i1a qM SPA W41% M-MYOW Foe (OU) OHM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM PA-MCC AA 1C . M—i7 -WA 4,.1 Owner or Purchaser of Building PA tie A Tr- MA-Kl Building Constructed by �NFSTsi -k�R� L^1Z K/i: Location - Street Building Type &Z -10 I G -to Tax Map Block Lot TownNillage !,I-A- Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the i system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year tMO e (Owner) - Signature Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: 440 6T ��( -�bt Ste. QgW 2 " Address: 3�UND5A, L . RA-i ,bw VA it P State 1 �Jm,L _Zip I Oo 21 _ State N �o�>� Zip _ Form GS -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION( OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Y Well Locat oei _ Stree Address: - n/Village: P';a� 22"27 Tax Grid # 06z -oiv- 000 / -006 Map Block Lot(s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond / heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length a? 3 ft. Length below grade P; . Diameter" in. Weight per foot /G lb /ft. Materials: XSteel _ Plastic _ Other Joints: _ Welded >. Threaded _ Other Seal: x— Cement grout _ Bentonite Other Drive shoe: >!t- Yes No Liner _ Yes Y, No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped 'X Compressed Air Hours Yield __,� gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet ry0 0 Well Log If more detailed information descriptions or sieve ana m5es . are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface / 3 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity '- Depth 3F0 Model 1611b- 4!/a4- Voltage 2313 HP Tank Type Volume �4S . G,zr�l. X T1� vL Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) . NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheevplan. Well Driller's Name c`i��� ��a Address: Signature: At o A 111 A N i4 N`9 Lr%a N Date: !/ 7/f 14*wj . g White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 6� II 3. The Design Professional shall provide a note,on the submitted plans indicating present site conditions with respect to the well and SSTS area are comparable to those at the time of the original approval (i.e., site conditions have not been altered). B. Construction Permits being renewed by a Design Professional other than the one who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization 2. Construction Permit Application 3. New plans signed and sealed by the new Design Professional 4. -Soil Data Sheet (if applicable) 5. Same as Section 5.0 A. 3. C. A complete new application for a Construction Permit, including plans signed and sealed by a Design Professional, will be required as follows: 1. Where the Department determines that the SSTS design, as approved, is no longer adequate due to altered site conditions or revised standards. 2. If the number of bedrooms proposed is increased. 6.0 CERTIFICATE OF CONSTRUCTION COMPLIANCE___._ -. Before a Certificate of Occupancy for a dwelling is issued by the local Building Inspector, a Certificate of Construction Compliance for the SSTS must first be issued by the Department. The Department must be notified before the system is backfilled in order that an inspection of the completed system can be made. Open work inspections may be omitted only at the discretion of the Director or his designated representative. In order for the Department to issue a Certificate of Construction Compliance, the following must be submitted: (Note: All submitted Department application forms shall contain original signa --(no photo copies)). ertificate of Construction Compliance. (See Appendix K) Foam C6 -97 Three (3) copies of a two (2) year guarantee, signed by the installer, and/or general contractor, or the owner. (See Appendix K) f OeV4 G'Sr97 3. If the water supply is from a drilled well: Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (ELAP)." CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/l (15 ug/1) Nitrates 10 mg/l as N Nitrites 1 mg/1 as N Iron 0.3 mg/1 Manganese 0.3 mg/1 Iron plus manganese 0.5 mg/l Sodium No designated limit (2) pH No designated limit Hardness Alkalinity Turbidity No designated limit No designated limit 5 NTU (3) NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/1 of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Turbidity Units. (4) mg/1 means milligram per liter. (5) ug/1 means microgram per liter. a• r 18 A Well Completion Report signed by the well driller, including the results of at least a 6 -hour pump test (See Appendix K). r �G -q , oIZ:� A minimum well yield of 5 gpm is required. For yields less than 5 gpm see Appendix F for procedures on performing a 24 -hour well pumping test. The results of the 24 -hour pump test are to be submitted to the Department for review and a determination will be made regarding utilization of the well for supplying potable water to the dwelling. If the new well is found acceptable, then the procedures for determining the minimum potable water storage requirements, located in Appendix G, are to be utilized. If the water supply is from a public water supply, satisfactory results of a coliform bacteriological analysis of a water sample taken from the service connection, performed by a laboratory approved by the NYS Health Department "Environmental laboratory Approval Program." �3 Three (3) sets of "as- built" plans, signed and sealed by a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (mini . (minipeff 1 inch to 30 feet horizontal) and shall include: Surveyed house location with respect to property lines. The plan shall make reivietes ference, by note, to the source of survey. ' a uuuilus (1CJ111�l11Uli uCliiii MLY I IlUb`. Actual locations of installed SSTS and water supply improvements. �.The distances necessary to locate the septic tank , distribution boxes , J unction boxes, ends of the SSTS and well from two fixed points, preferably the corners o e building. e. The plan must include a legend, which reads as follows: "This is to certify that the sewage treatment system was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health. " t _.... ,. ._The .The "as- built" plans ..must also include a title. box,, giving the information ' required on the original design drawings. Minimum size of "as- built" plans S o - Id be 11 inches by 17 inches with a minimum scale of 1 inch to 30 feet. Space for Putnam County'Health Department approval stamp (minimum 3" x 5 ") preferably at the lower right -hand portion of the plan. Fee - See Appendix# After the Certificate of Construction Compliance Permit is issued by the Department, a copy of the Certificate of Construction Compliance Permit, Well Completion Report and approved "as- built" plans should be brought to the local Building Inspector for processing the Certificate of Occupancy. The local municipality should be contacted for their particular requirements for a Certificate of Occupancy. 7- PUTNAM C01 T JMDEPARMENTOFIVALTS X n F Z _ 6= COL FOR SEWAGE DEPOSAL SMM Tox4n of Puthdffl*Vdile�y -wes,t' Shore Drive VM Tosm 0; SdIlIN11161111111 mum 'N SwIlL W 0 at Relmewd-0—Res,Mm—o oww/AffoamKimise PaLrIcla K. Perlman Daft of Pir*vbw Approval Mdbg A"M 440 East 79th St. TOWONY my z6j 0021 M Date Subdivision Ap,,roved, Fee Enclosed LZ -Anr,, rr '300 � z, esidential IM Asm 2.973AC Sectim 0* ;-Vobww Nvilimbeir of Bedireasine I Dap now G P D H n C1 PCHD Nooficidois is Req%dred Whey M III completed Sept ,0 Smmo Symm to m" dj..jj �00 %low Septic Tent and 336 L of absorption trench To be amovicten! by Addwas To be determined water SOP*. PA& Sup* Fitesit Addna X FdW&b SW*L DAM by sad.w. To be determined Met represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate F_dl!UlFg� r XOT above described will be constructed as shown on the approved amendment there to and. in accordance with the standards. rules anTragu County Department of Health, and that on completion thereof a "Certificate I of Construction Compliance.•' satisfactory to the Commissioner of Heafthwill be submitted to the Departrisent, and a written guarantee will be furnished the owner. his successors, heirs or assigns by the bulkier, that said builder will place in good operating 'condition wiftion any port of said seva-S,disposol system during the period of two (2) years Immediately following th*date Of the issu- gr4a of jh9'approval of the Certif"te of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above WHO bwoocatod as shawii on the,apprqved plan and that said wall I will be Installed in accordan with the standards, rules and rag–uST10—nSof the Putnam County bWrtpheid of H"Ith. Date - ' 1- ` .. I Signed P.EX RA. d�& Watson 'Rt9 CS, NY Llc.. No 6 2 5 0 5 'APPROVED FOR CONSTRUCTION.- This approval expires twoyearClipm the date Issued unless construction of the building .has been undertaken and is xible for cause 0 may . be amended er necessary by the Commissioner of Health. Any change or alteration of construction few or modified when consid a pr FiV mires a no oermi Approved for disposal of domestic iian V-'sawage. and V&te Water Supply Only. Rev. By Title 10/88 Do Go DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number est Shore Drive Putnam Valley 62010 -1- 6,7,8,9 & 10 WELL OWNER Name Mailing Address atricia K. Perlman 440 E 79th Private St. NY, NY 10021 Public USE OF WELL 1 - primary 2 - secondary PRESIDENTIAL O PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL 0 INSTITUTIONAL p AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify, O STAND -BY AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED _ /EST. OF DAILY USAGE al REASON FOR DRILLING O REPLACE EXISTING SUPPLY O TEST /OBSERVATION GL ADDITIONAL SUPPLY E1 NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING In supply proi age residence 7. WELL TYPE DRILLED ® DRIVEN ®DUG O GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name To be determined Address: `iS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN" N/A LOCATION SKETCH & SOURCES OF CONTAMINATION -, ON SEPARATE SHEET P9 5F (date) PROVIDED 61 (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in suc a manner as not to degrade or L_6e of Issue: 19 Date of Expiration 19 Permit is Non - Transferrable White shall take appropriate action to assure that drilling operations be contained on this othe'xRise contaminate surface or groundwater. Permit Issuing Official copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. .Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION - _._ �• Date; ����/ .cam L,��._.• .� ,-,.� - _ ,�{ Inspeted_by: _.w�tr:;et L ,ew; � r: �.-. ,. ,� �� �r4 % - . � . �_ �Y : �_. , . :.owner Jj' Town Permit # ..:v y TM # Subdivision Lot # .y -- 1. Sewage System Area a. STS area located as per approved plans ............. :............. b. Fill section - date of placement 3:1 barrier Lgth Width Avg.Dpth c. Natural soil not stri ppe' d ................... ....:.......................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands., ..................................... II. SewaLye System a. Seftic, ze - 1,000 , 250 ......... other ................ b. Septic tank !�n el ................ ............................... c. 10' minimum from fouridation ......................................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches i' TZegth required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface... ............... 7. Room allowed for expansion ... 8. Size of gravel 3/4 - 1F/ i eter cle w 9. Depth of gravel in trench mrmmum ................... 1-0..PiYe end=^ �YYeu .:............:...::.:. .:.:...:.....................:. VM g. Pump or Dosed Systems 1. Size of pump c am er ................ ............................... 2. Overflow tank ...........................: ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade. ................ 5. First box baffled .................................................. :...... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Build' c-- a House located per approved plans .......................... t b. Number of bedrooms ... ............................... ...� IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfrlled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area. .............. h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 Form ST-3 PUTNpa_M COONTY DEPARTMEN'r Oi, HEAL111 APPENDIX K DIVISION OF ENVIRONMENTAL H.EAtTll SERVICES _Date �December _1,4, 1995 . 'Re: Proper -ty of Patricia K: Perlman_ Located at West Shore Drive (T) Putnam Valley Section 62.10 Subdivision of N/A Subdv. Lot 1 Gentlemen: Block 1 Filed Map # This letter is to authorize John P. Delano, P`.E. Lot 6, 7, 8, 9, & 10 Date a duly licensed professional engineer X or registered architect` (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department; of Fieal.th, and t:o sign all necessary papers on. my behalf in connection with this matter and to supervise the construction of said system or systems iiii COI1fOrRi].ty W7 t`I1 t17 jiT'Ovi °3a.vtts' lia A-r 147, Education Law, the .Public Heal.t1i Law, and, the Putnam Comity Sc1T:i- 'tary Code_ i Coun.tcrsigncd: :. ivar P.E. , IXXX. , 62505 Badey & Watson, P.C. Address Very truly yours, Sign d Owner of i r. operty Route 9 Cold Spring _ ng - N .914- 265 -9217 Telephone 440 East 79th Street A d d r' e -s New _York, NY 10021 T o w'n 212 - 744 -7070 Telephone xpCYl' PUTNAM COUNT T OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER�DISFOSAL S1'STEM"- 1. Name and Address of Applicant: Patricia K. Perlman 440 East 79th Street New York NY 10021 2. Name of Project: Same as Applicant 3. Location T /VX- Putnam valley 4. Project Engineer: Badey & Watson, P.C. 5. Address: US Route 9 Cold Spring NY 10516 License Number: 62505 6. Type of Project: Private /Resident Apartments Office Building 7. Is this project subject Type Status (Check One) Phone: '265 79217 ial Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) to State Environmental Quality Review (SEAR)? Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. NO 1. Has DEIS been completed and found acceptable by Lead Agency? ........... N/A 10. Name of Lead Agency Putnam County Department of Health 1.; 7s- till - .�rr�.�e,�i_,_�n d ^._ cep... =n�l�r i h8 .^Q�"trnl ti;?.. �^.��1 Plaini,-a!elr, or other officials, ordinances? .................. YES 12. If so, have plans been submitted to such authorities? .................. NO 13. Has preliminary approval been granted by such authorities? N/A Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters. 15. If surface water discharge, what is the stream class designation ?........ N/A 16. Waters index number (surface) ........... ............................... N/A 17. Is project located near a public water supply system? NO 18. If yes, name of water supply N/A Distance to water supply N/A 19. Is project site near a public sewage collection or disposal system ?..... NO 20. Name of sewage system N/A Distance to sewage system N/A 'fate observed: 23. Name of Health Inspector: 24. Project design flow (gallons per day) ...... ............................... 600 25. 1'5" jt�dte'-PJl'IGtdI'Il: i7 i Yiil'aC`vi �ovuC�) r' -� i'ii i't' "riC{J i id�i 26. Has SPDES Application been submitted to local DEC Office? ............... N/A 27. Is any portion of this project located within a designated Town or State NO wetland ? .............................................................. 28. Wetland ID Number ........................ ............................... N/A 29. Is Wetland Permit required ?. ................. NO Has application been made to Town or Local DEC Office? N/A 30. Does project require a DEC Stream Disturbance Permit? ................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, .solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or No NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or NO any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... YES 34. Are community water, sewer facilities planned to be developed within 15 years? NO 35. Are any sewage disposal areas in excess of 15X slope? `.....:....: . :.:.::.:.:: yp.11; 36. Tax Map ID Numb 62.10 -1- 6,7,8,9 er .......................... ............................... d & 10 . Applicant x_ Engineer 37. Approved Plans are to be returned to: ......... ...... If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. 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. SIGNATURES & OFFICIAL TITLES: P1kyL,1 —W ]§(adey & Watson, P.C. BAILING ADDRESS: Route 9 Cold Spring NY 10516 • h •Y • 81• • • CM • • • •' OF •• •' ' 1E Y• 1 �• •19� DESIGN DATA SHEET- SUBSUFACE SS PGE DISPOSAL SYSTEM FILE. NO -- �r .� •P . ®y.... -. v..�`/n..-�i�� : .. . i.. -. _ >.Yr o•W^wr4 9.wr•� -. Vf. -r._. .an .i:.� -, m w.rw . cS i.w. ':..Wltr 4:T.t.i �._.. ..-:t ..�...: e•n•. .. .....L' ..1` :•.. �l u..- uu�.."Y.wM �..'Sy'...�"•: .ate.. -r :.^. .r. .. . -- e�ni.'w j Owner Patricia K. Pq,rlman Address 440 E 79th St NY NY '10021 Located at (Street) West Shore Drive Sec. 62.10 Block .1 Loth, 7, 8, 9, &10 (indicate nearest cross street) Municipality Town of Putnam Valley Watershed Peekskill Hollow Brook SOIL PERCOLATICN TEST . DATA REQUIRED TO BE SUBMITTED WI'I'fi APPLICATIONS Date of Pre - Soaking 4/22/95 Date of Percolation Test 4/22/95 HOLE NUMBER CLUCK TIME PERCOLATION PERCOLATION Run. Elapse Depth to Water Fran Water Level No. Ground_ Surface In 7.Yiches Soil Rate Start -Stop Min. Start Stop Drop In. Min /in Drop Inches Inches Inches A.1 10.51 -11.06 15 19. 1/8 .22 1/8 3 2 11:06 -11:24 18 19 1/8 22 1/8 3 6 3 11:24 -11:47 23 19'1/8 22 1/8 3 8 "'. 4 11:47 -12:11 24 19 1/8 22 1/8 3 8 �.. 5 12:12 -12:36 24 19 1/8 22 1/8 3 8 B-1 10.53 -11.00 7 21 24 - 2 _.�,....-- 2-- 1�1.� ^00- 1.1_...088: 21�_.. - -._- 24 3 3 11:09. -11:19 10 21 24 3 3 420 -11:30 10 21 24 3 3 5 11.:30 -11:40 10 21 24 3 3 1 2 5 soil rates to, be- - repeated' at same - depth:- anti.]. - apprmcia�ate3.y .er3ua..1 are obtained at each percolation :test hole: All data :,to' be 'surm? ttl, for review. 2. Depth measureTents to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DFSCRIP`.PION OF SOILS ` ENC00 'EZED IN TEST HOLES DEP'T'H HOLE NO. 1 HOLE No. 2 & 3 HOLE NO. 4 ' . "'.U:T ..: .... T�r� -_� J -�.-.4 t�. .. _ ... "'.r -'`J" `�.:.: L'.L... . _•��..- .-.. T oT'.c,r'.ti L 4 ]' Loam .Loam Loam to 1811 21. 11 tt Sand 3' " is Trace ~ - Sand with Silt 4' 51 Sand with Silt Gravel " 61 Some Stones Few Sand with 71 End Cobbles Stones 81 1. End 91 End 10' ` 111 ' 12' 13' 14' II?DICP,?'E_ Lar' Y ! ,; : AT WHICH GROU MM --'- - < - . __. �. - - - _I5 c =UC .1 -,--MD .. None -. =r.. - . - INDICATE LEVEL TO WHICH .WATER. LEVEL RISES AFTER BEING ENMUNTERED N/A DEEP HOLE OBSERVATIONS MADE BY: Bad e y & Watson, P.C. DA'Z'E: 4/22/95 - -- DESIGN . Soil Rate Used 8 = 10Min /1" Drop: S.D. Usable Area.Provided 51000 SF No. of Bedrocros 3 Septic Tank Capacity 11000 gals. Type P C conc. Absorption Area Provided By '336 L.F. x.24 "width trench Other Provide .1' -0" min R.O.B. fill and a finished grade ,of: -.,l.5% max. Name Badey 7 Watson, P.C. Address Route 9 Cold Spring NY 10516 THIS SPACE FQR .*USE "BY 'HEALTH DEPAR21E -:: ONLY.: - ����0o Soil Rate Approved sq.ft /gal. Checked by Date Soil Rate Approved sq.ft /gal. Checked by Date APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES -INDIV):DUAL WATER - SUPPLY & SUESURFACE ._$EWAGE_DISPOSAL.SYSTEMS.. . - . -.ne ..w a-.. -.. v: ca v. .:^L^c ._- .:wv+rs. i. a. ...e .--- •.a...:r -...�... _�._+c 6r... +F Y'.av- ^{ Y'[+. _ •t .nn �. .ri-x r. . -ss .: �w-.Vt. .n.a.>ctWw.- .- ..uays� v. R- VIDW STREET LOCATION U✓� ` NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE �? / `i`/ 0 �1 TAX MAP # - - DOCUMENTS. I Y PERMIT APPLICATION PC -1 WELL PERMIT m PW S LETTER m ENGINEERS AUTHORIZATION m DESIGN DATA SHEET(DDS) M CORPORATE RESOLUTION M PLANS THREE SETS M HOUSE PLANS - TWO SETS E7 VARIANCE REQUEST SUBDIVISION FM LEGAL SUBDIVISION m SUBDIVISION APPROVAL - CHECKED m PERC RATE m FILL REQUIRED DEPTH m CURTAIN DRAIN REQUIRED mSTANDPIPES APPROVAL SSDS ADJ. LOTS Y EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS �OLAY B ARRIER FT HORIZONTAL: SLOPE 3:1 TO GRADE ILL SPECS m FILL NOTES ILL CERTIFICATION NOTE EPTH GAUGES PROFILE & DIMENSIONS OLUME ILL IN EXPANSION AREA TLAND ( TOWN/DEC PERMIT REQ ?) TRENCH to ON DDS PLANS & PERMIT SAME ®,,LF TRENCH PROVIDED m60 FT MAX 1969 -NEIGHBOR NOTIFIFICATION Z PARALLEL TO CONTOURS nr rr wrn r+N =,(M r..; 1 TL`Ii Dl/LD[=1 •.... -. _-- ....•• -• `a •.. •..•- .. •-. __......< ._ °K -i=+' ll'iv'�U �}1.C't�VJll'%1'�1 1`:lli YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS VAGE SYSTEM PLAN - (NORTH ARROW) IS HYDRAULIC PROFILE m GRAVITY FLOW JSTRUCTION NOTES (GRINDER NOTE) ESIGN DATA: PERC AND DEEP RESULTS LL�fwo-FooT CONTOURS EXISTING & PROPOSED ® EOjD�WWAY & SLa ^L�S CUT OOT G ROSION CONTROL• OUS LL S FREPRESENTATIVE OSION CONTROL RC & DEEP HOLES LOCATED OF PRIMARY AND EXPANSION SEPARATION DISTANCES SPECIFIED_ ON PLAN F LDS 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS ffJ 15' WELL TO P.L 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, ETCH 150 FT. GALLEY SYSTEMS 15' MIN TO C.D. S= >5 %,201- 4 %,251- 3%,301- 2 %,35' -1 %,100' <l% 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL BADEY & WATSON Surveying and Engineering, P.C. Route 9 —00id -00i Spring, Ny. 65r6- _ (914) 265 -9217 739 -3577 628 -1800 FAX (914) 265 -4428 TO: Putnam County Department of Health 4 Geneva Road Brewster, New York, 10509 We are sending you: Attached Via: Hand Conies Date No. Description 3 3/8/96 S.S.D.S. Plan These are transmitted: For your review. Remarks: Revised per your comment Copy to: LETTER OF TRANSMITTAL, .Date: March 8, 1996 Attention: Mr. Robert Morris, P.E. Re: Patrica Perlman S.S.D.S. Permit West Shore Dr. Town of Putnam Valley TM # 62.10- 1 -6 -10 Signed: Kurt Schollmeyer, P.E. BADEY & WATSON Surveying aoEngineering, P.C. Cold Spring, NY 10516 (914) 265-9217 739-3577 628-1800 FAX (914) 265-4418 Robert Morris, P.E. Putnam County Department of Health 4 Geneva Raod Brewster, NY 10509 Copies Date No. Description LETTER OF TRANSMITTAL Job No: 95-114 Re: Proposed SSDS PERLMAN West Shore Drive Putnam Valley TM 62.10-1-6,7,8,9 & 10 Sent By: 2 US Mail ❑ UPS ❑ UPS Overnight 1 02/14/96 188 $300.00 Certified Check 1 12/14/95 Construction Permit for Sewage Disposal System 1 12/14/95 Letter of Authorization 1 04/22/95 Design Data Sheet 12/14/95 Application to Construct a Water Well PCDH Form PC -1 2 12/14/95 1/2 Floor Plans 2 12/14/95 2/2 Floor Plans Remarks: For your use. For your approval. Signed: John P. Delano, P.E. Copy to: File ❑ Fed Ex ❑ Messenger ❑ Pick-Up AS -BUILT RELOCATION - DIMENSIONS Al 23.2' SEPTIC TANK 81 24.7' SEPTIC TANK A2 17.7' SEPTIC TANK 82 30.4' SEPTIC TANK A3 35.0' END LATERAL 63 63.6' END LATERAL A4 90.2' DROP BOX 84 106.1' DROP BOX A5 113.9' END LATERAL 85 126.0 END LATERAL A6 115.9' END LATERAL B6 133.8' END LATERAL A7 84.3' DROP BOX 87 107.5' DROP BOX A8 39.2' END LATERAL "E3� � 76.7' �F END LATERAL / I ; I { { { fQ � tJ { a y �o !� I Nil i Wei O 0-