Loading...
HomeMy WebLinkAbout3164DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. f- www.scanyourdocs.com 631- 589 -8100 72. -1 -19.2 BOX 26 03164 I fl + o I G a`�° ` NAM COUNTY DEPARTMENT OF HEALTH _ DIMTSI.ON OF T _. NVIRONMEN'�' AL �E A.�,.. H a�t.Vl:� ;'�C� CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE E o T T SYSTEM PCHD CONSTRUCTION PERMIT # SW- 2 6 - 01 0 . D Located at 15 Camp Collins Road Town or Village Putnam Valley Owner /Applicant Name Joseph Strauss Formerly Tax Map 7 2 Block 1 Lot 19.2 Subdivision Name Rose Property Subd. Lot # 2 Mailing Address 90 Cook Avenue,' Yonkers, NY Date Construction Permit Issued by PCHD 5/28%04 Separate Sewerage System built by United Septic System Consisting of 1000 Gallon Septic Tank and Zip 10701 311 Railroad Avenue Address Bedford Hills, NY 10507 30OLF Abs. trench 24" wide, W /endcaps, Curtain Drain Other Requirements: 3'6" fill 1200cy R.O.B. /400cy impervious berm Water Supply: X Public Supply From Norman Anderson or: Private Supply Drilled by R - si_cl_ential. Number of Bedrooms 3 Address Address I :lag C-!10910n control beer. coni"IetedY Yes 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%ouDV Department of Health. Date: 6/14/04 Certified by Address 113 Smith Avenue, Mount KP9 0�0W'Orlab54'0 P_ E. X R.A.. # 071226 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 revocation, modification or change is necessary. By: Title: lq-Pf Date: �� O ` 4i copy -'HD File; Yellow copy - Building Inspector; Pink copy -Owner; Orange copy -Design Professional Form CC -97 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Vi4 , ci, `Ucc'-j - / nfv'i iage:" - iax Grid if Map 76e Block / Lot(s) Well Owner: N e• Address: �m Vl 0 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond /heat pump igati n Business Farm Test/monitoring Other(specify) Industrial 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 —oL 11 ft. Length below grade Diameter / in. Weight per foot lb /ft. Materials: K Steel Plastic _ Other Joints: _ Welded X Threaded _ Other Seal Cement grout _ Bentonite Other Drive shoe: -4 Yes No Liner: Yes _XNo 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) e) During yield test(ft) --- ---�— Depth of completed welltin feet �'(p Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 0 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type [Q Capacity (f, 04, Depth Model 7,T541 3- Voltage it HP JL Tank Typef 220 Voluttfe t E 2 Ckk Date Well Completep Putnam County Certification No. Date of Report Well Dnl er (si ature) 7�1 turd rxar tocatton or weu wturatstances to at least two permanent /iangrnarxs to be provtnea on a separate sneet/plan. Well Driller's Name �(� ,.� eZj � RZ- Address: �Y Signature: 7 /1 /% �- Date: &� 16 '' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 EXISTING 4" WASTE LINE EXISTING 1000 GAL. SEPTIC TANK EXISTING 4" P.V.C. SOLID PIPE EXISTING CURTAIN DRAIN EXISTING DISTRIBUTION BOX �\ 0 38' 6 z. f 38 7 I 3 8 4 3g 0 ©38 _ �\ � � I i t 1' a i EXISTING 304 LF ABSORPTION 4 S' v. I n: •p Yi, STRUC7lON NOTES KI3TINC 3 BEDROOM DWELLING X|STING 1000 GALLON SEPTIC TANK 04 LF 2'—U"w ABSORPTION TRENCH, U'—O" o.o. PUTNAM VALLEY TAX MAP INFO. � ' � ` ^ � " � � . SWING TIES ^. . �^ .' \" �! � / .�| .' ., o` SEPTIC TANK 16 30. DBOX 68. 57.5 JBQX 1 70 58 J130X'4 83.5-65-:76 ^. . �^ .' \" �! � / .�| .' ., o` rnE r i` b`l� NAM COUNTY DEPARTMENT OF HEALTH ... .. VT - ION -1, d� -.FN `r .R. .1 1 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE E T T SYSTEM PCHD CONSTRUCTION PERMIT # SW -26 -01 0 Located at 15 Camp Collins Road Town or Village Putnam Valley Owner /Applicant Name Joseph Strauss Formerly. Mailing Address Tax Map 72 Block , 1 Lot 19.2 Subdivision Name Rose Property Subd. Lot # 90 Cook Avenue, Yonkers, NY Date Construction Permit Issued by PCHD 5/28%04 Separate Sewerage System built by United Septic System 2 Zip 10701 .311 Railroad Avenue Address Bedford Hills, NY 10507 Consisting of 1000 Gallon Septic Tank and 30OLF Abs. trench 24" wide, W /endcaps, Curtain Drain Other Requirements: 3'6" fill 1200cy R.O.B. /400cy impervious berm Water Supply: X Public Supply From Norman Anderson Address or: Private Supply Drilled by Address a+s:+.+.n r:: VZGiI flip, r Number of Bedrooms 3 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 Put oupty Department of Health. Date. 6/14/04 �� "7 . v R X Certified by Address 113 Smith Avenue, Mount KP§O;'`"IfiOT6540 License # 071226' V-14 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 revocation, modification or change is necessary. amm ILL.' rm'FAZWI��� _APff 2< Date: WYcopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT `V6'ell l,ticatitiri - et Add`re t'Ilage `' i ,U Grid 4 - Map 7W Block Lot(s) ICI. Well Owner: Na e- Ad ess: /0-' Use of Well: I- primary 2- secondary Residential. Business Industrial Public Supply Air cond/heat pump igati n 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 !�Z.1 ft. Length below grade rift. Diameter tn. Weight per foot lb /ft. Materials: Y Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Sealer_ Cement grout _ Bentonite _ Other Drive shoe: >/-._ Yes No Liner:_ Yes XNo 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 tin feet 3W /o Well Log If more detailed information descriptions or �>�•e_ana uses. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface t� 000 ,. - _ ... -- - - - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type LQ Capacity =7 v/-, Depth Model 7,'541 ,-- Voltage 2U U HP Tank Type r� Volume 62 C Date Well Completep Putnam County Certification No. Date of Report Q Well Driller (si ature) 7/ NOTY Exalt location of well with distances to at beast two permanenkz_ t /tanomarxs to De provided on a separate snccupimi. Well Driller's Name (.>��� Address: Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R- +FOLEY Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH. 1 Geneva Road Brewster, New York 10509 Eaviroamcntal 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 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: u- -i -1�� The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, ie., 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 VERiI2Ivn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF AL_ A 'TH E IC - _NVIRONM HE - E-NT GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Joseph Strauss Owner or Purchaser of Building Joseph Strauss Building Constructed by 15 Camp Collins Road Location - Street Residential Building Type 72 1 19.2 Tax Map Block Lot Putnam Valley Town/Village Rose Property Subdivision Name 2 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.negliau_,enL ct_o£the o c�tpantFoFthe_building itilizing 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. Dated: Month 0 6 Day l l Year 04 Signature: Joseph Strauss /owner . Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: Address: State Zip State Zip Form GS -97 FA KEANE COPPELMAN ENGINEERS, P.C. CIVIL & ENVIRONMENTAL CONSULTANTS 113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 (914) 241-2235 June 24, 2004 Mr. Joseph S. Paravati, Jr., Assistant Public Health Engineer Putnam County Health Department I Geneva Road Brewster, NY 10509 RE: Certificate of Construction Compliance Joseph Strauss Camp Collins Road, Putnam Valley TM# 72-1-19.2 Dear W Paravati: Pursuant to a telephone conversation with the owner, we are forwarding the following information as requested. 1. Swing Tie measurements for the ends of the trenches are provided. 2. Swing Tie measurements for the existing well are provided. 3. End I measurement from point B has been provided. Should you have any questions regarding the above, don' t hesitate to contact me. Very yo e t r/ . Greg WrGreg , P.E. YML E0UI NIAL SERVlCES d�l Kear btreet -�'�' ,`-�������� (914) 245-28O0 Albert H. Padovani, Director LAB 0 87.400109 CLIENT 1: 57527 NON STAT PROG PAGE NEWBY, CAROLYN DATE/TIME TAKEN: 05/19/04 10:3OA 15 MEYER DR DATE/TIME REC'D: 05/19/04 11:00A PUTNAM VALLEY, NY 10579 REPORT DATE: 05/27/04 PHONE: (845)-528-0677 SAMPLING SITE: 15 CAMP COLLINS RD : PUTNAM VALLEY NY COL'D BY: MICHAEL NEWBY NOTES...: OUTSIDE TAP ` ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE PUTNAM CNTY PROFILE z 05/19/04 MF T. COLIFORM ABSENT /100 ML ABSENT 05/19/04 LEAD (INS) 2.1 ppb 0-15 ppb 05/19/04 NITRATE NITROG <0.2 MG/L 0 - 10 05/19/04 NITRITE NITROG <0.01 MG/L N/A * 05/19/04 IRON (Fe) <0.060 MG/L 0-0.3 mg/] 05/19/04 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 05/19/04 SODIUM (Na) 4.32 MG/L N/A 05/19/04 pH 6.2 UNITS 6.5-8.5 05/19/04 HARDNESS,TOTAL 50.0 MG/L N/A 05/19/04 ALKALINITY (AS 46.0 MG/L N/A COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public sehools 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 Sbdium is suggested. IETHOD 1008 9101 9139 9146 2037 2037 9043 .��� YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 9 (914>-24-�- --`�`-�r�c Albert H. Padovani, Director LAB #v 87.400109 CLIENT #: 57527 NON STAT PROC PAGEg 2 NEWBY, CAROLYN DATE/TIME TAKEN: 05/19/04 10:30A 15 MEYER DR DATE/TIME REC'D: 05/19/04 11:00A PUTNAM VALLEY, NY 10579 REPORT DATE: 05/27/04 PHONE: (845)-528-0677 SAMPLING SITE: 15 CAMP COLLINS RD : PUTNAM VALLEY NY COL'D BY: MICHAEL NEWBY NOTES...: OUTSIDE TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM L-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. 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 O 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 H WATER: 70-140 MG/L MG/C = MILLIGRAM PERLlTER '6ARl} WATER:-1-4J-300 MG/L ' (i grain/�all�� � l7.L SUBMITTED BY: Director ELAP# 10323 KEANE COPPELMAN ENGINEERS, P.C. P, 113 Smith Avenue -MOUNT 500.,NEW YORK 10549,- (914) 241-2235 TO Putnam County Health Department 1 Geneva Road Route 312 Brewster, New York WE ARE SENDING YOU: r, Attached rJ- Shop drawings r� Copy of Letter r'11 Under separate cover via r--;' Prints ri Plans (� Change order ILIETTIER @IF UMMMOMM ATTENTION:. Joe Paravati, Jr. RE: Joseph Strauss 15 Camp Collins Road Putnam Valley, New York SSTS.As Built Rose Subdivision Lot 2 The following items: [7 Samples ❑ Specifications r_1 COPIES DATE NO. DESCRIPTION 4 As Built Plan 1 Certificate of Compliance 3 Guaranty Form I E911 Address Vertfication I Application Fee I rIF-OF- Ar1r- 1 rLMI-401VII 1 1 CU U5 GnOCK00 DelOW: For approval C7, Approved as Approved as A�OPYXAQC 68c. r - i'At proved as noted rj As requested rA Returned for corrections For review and comment FOR BIDS DUE REMARKS: COPY TO: ri Resubmit Copies for approval CQP;es 10j: " ovai rj Resubmit Copies for approval 17 PRINTS RETURNED AFTER LOAN TO US SIGNED: Keane Coppelman Eng 9142416797 06103104 01i89pm P. 001 KEANE COPPELMAN ENGINEERS, P.C. CWIL & ENVIRONMENTAL CONSULTANTS 113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 (914) 241 -2235 FAX TRANSMITTAL COVER PAGE OUR FAX NO. (9141 - 241.6787 DATE: TO: c�~ FAX NO: FROM: SUBJECT: . e -mot• -t iyv�i- t.- �I -../� �-c� a: 5L NUMBER OF PAGES: �-- (INCLUDING THIS PAGE) * ** *PLEASE CALL IF YOU DO NOT RECEIVE ALL PAGES * * ** Ti l. A -IMMA COT 4,1-47 TCI • QdE:Z- ?7R -74 ?1 NAME: PUTNAM COUNTY DEPARTMENT OF P. 1 Keane Coppelman Eng 9142416787 06/03104 01:33pm P. 002 BRUCE R_ FOL.EY Public Health Director L ORMA MOLINARI • R.N., M.S.N. Associate Public Health Dir+eettr Director of Patiew Services DEPARTMENT OF HEALTH I Geneva Road ` Brewster; New York 10509 REM.. F FOR FiE]LD TESTING ATTENTION: o ADAM STIEBELIM ❑ GENE REEI) , All information below must be fuLy completed p rior to any scheduling. DAM 06/04/04 ENGINEERORFIRIi• Keane Coppelman Engineers PHO� #• 914 -241 -2235 • Peter Gregory REASON: DEEPS: ❑ PERCS: ❑ PUMP TEST: a TO INSPECT SSTS X ROADISTREET: Camp Collins Road TOWN: Putnam Valley SUBDIVISION: Rose 'ES:.. - NO .- TAX MAPH: LOTH: 2 Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. F �. Proposed SSTS within 500 feet of a reservoir; reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 galludday or SPDES Permit required.. Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soli, testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based oti the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COU, i'TY USE ONLY DATE: TIME: CONDIENTS: TI W- d -aSM4 PPT 14:1-3 TFI : R49- 278 -7921 NAME: PUTNAM COUNTY DEPARTMENT OF P. 2 ❑ a a o a o a o .- TAX MAPH: LOTH: 2 Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. F �. Proposed SSTS within 500 feet of a reservoir; reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 galludday or SPDES Permit required.. Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soli, testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based oti the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COU, i'TY USE ONLY DATE: TIME: CONDIENTS: TI W- d -aSM4 PPT 14:1-3 TFI : R49- 278 -7921 NAME: PUTNAM COUNTY DEPARTMENT OF P. 2 iQ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ - ...... _.. ; I✓'lUiV S T U 7I;YUIY P 1Y'MIT- N'GTt SL VAGi "I'�Ai-I EN T SY 5°i'EM PERMIT # <S-w - �2& -- O ! T "N o ptoj Located at Camp Collins Road Subdivision name Rose Property Subd. Lot # 2 Date Subdivision Approved Owner /Applicant Name 7/24%86 Joseph Strauss Mailing Address 90 Cook Avenue, Yonkers, NY Amount of Fee Enclosed $300.00 Building Type Residential Town or Village Putnam Valley Tax Map 72 Block 1 Lot Renewal Revision Date of Previous Approval Zip Lot Area8.610 No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume Separate Sewerage System to consist of 1000 Trench, 24" wide W /Endcap, Curtain Drain gallon septic tank and 300 LF ABS 19.2 Other Requirements: 3 �— 6 ff r1 L L. /,9 0 O c -y /l..6 0 Cy v4p. Div a(-4-Cg To be constructed by United Septic ` Address 311 Railroad Ave. , Bedford Hills, Water Supply: Public Supply From Address NY 10507 �y C i -rriv Trill r 1 v :p�._�a i,- - :;n... 5 ;';' _ �!?:.�. , : ��U31aIR`Myellll ovate -..L r'1 , . C_L. �;_ s r. re.. Brewster, NY 10509 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the eoarate sewage treatment system 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 roa s dWM. Signed:. Address 113 P.E. x R.A. Av,pe'uj , Mount Kisco, NY 10549 License # 071226 Date 5/17/04 APPROVED FOR CON RytTION: This approval expires two years from the date issued unless construction of the sewage treatment system h *en 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 pe it. Approved for discharge of domestic sanitary sewage only. By: Title: / — Date: .S 0 Wh(t�opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNA.M COUNTY DEPARTMENT OF HEALTH D_ IVISION OF ENVIRONM1ENTAL._$IEALTI3 SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM __ Owner Joseph .Strauss Address 90 Cook Ave., Yonkers, NY Located at (Street) -Camp Collins Road Tax Map 72 Block 1 Lot 19.2 (indicate nearest cross street) Hudson River Municipality Putnam Valley Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking 5 -10 - 0 4 Date of Percolation Test 5-11-04 • Hole No. - Run No. _ Time - -- Start - Stop Ela se Time se Depth to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate b1in/Inch P1 l.,i. <, ". 9x`57- 10:.0,8 11 - 18 21 ,,3,,....,. 3..6 ---:-'LO: 12 18 21 __3....__ 4 ......... 3 0:20 -10:32 12 18 21 3 4 5 P2 1 10:01 -10:1 _ 11 18 21 3 3.6� 2 10:12-10:24 12 18 21 3 4 3 10:*24-10:3E 12 18 21 3 4 " 4 5 1 2 3 J11 4 KJE 5 Ch v ����• GIN Pe- NOTES: 1. Tests to be repeated at same deptti unto approxtmatery equai percotauvu .a«� a.- ��w•••� -- - -___ percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 • KEANE COPPELMAN ENGINEERS, P.C.. CIVIL & ENVIRONMENTAL CONSULTANTS 113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 (914) 241 -2235 May 18, 2004 Mr. Joseph S. Paravati, Jr., Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Application to Construct a Subsurface Sewage Treatment System Joseph Strauss Camp Collins Road, Putnam Valley , TM# 72 -1 -19.2 Dear Mr. Paravati: Pursuant to our telephone conversation, we are forwarding the following information as requested. 1. A completed Putnam County Health Department Construction Permit Form for the trench installation. 5 Ll':iIi Should you have any questions regarding the above, don't hesitate to contact me. Ve y s, Peter . Gr ory, P.E. LORETTA MOLINARI Public Health Director April 7, 2004 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Peter Gregory, PE Keane Coppleman Associates ROBERT J. BONDI County Executive 113 Smith Avenue Mount Kisco, New York 10549 Re: Field Inspection — Strauss Camp Collins Road, (T) Putnam Valley TM# 72 -1 -19.2 Dear Mr. Gregory: A site inspection was made for the above referenced project on April 5, 2004. The following comments must be corrected in the field. l " I ne I111 paaTaS n7t oeeIi Cua piele(i. irripelwu aye-L 110.) 7It5l UEeit Illy a iii, a���1LLU1� lU aim' '° " approved plan. All trees need to be removed from fill section side slopes. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157.. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Keane Coppelman Eng 9142416787 03129104 01:49pm P. 001 KEANE COPPELMAN ENGINEERS.- P.C. XM '-k 113 SVIM AWWA - MOUNT KASCO. NEW V(W 10549 (914)241-2235 FAX TRANSMITTAL COVER PAGE OUR FAX NO. (914)-241-6787 DATE: TO: P FAX NO: FROM: SUBJECT: 0 r NUMBER OF PAGES: (INCLUDING THIS PAGE) ****PLEASE CALL IF YOU DO NOT RECEIVE ALL PAGES**** ►^n 17M ^ MnA -1 1r • .. .- __1 - - --- --- I ­­_ __ - BRUCE R FOLEY Public Health Director Keane Coppelman Eng 9142416797 03t29t04 01:49pm P. 002 DEPARTMENT OF HEALTH I Geneva Road Brewster, New York .10509 a LORETTA MOLINARI •R.N., M.S.N. Associate Public Health Director Director of Patten Services REQUEST FQR FIELD TESUNG ATTENTION: ❑ ADANI STIEBELING a GENE REED , All information below must bell ycompleted 'griorto any scheduling. DATE: 03/29/04 ENGINEERORl:1R1�I: Keane Coppelman Engineers PITU�tE #. 914 -242 --2235 Peter. _ Gregory, REASON: DEEPS: ❑ . PERCS: ❑ PIMP TEST: a TO INSPECT-FILL X 4. . ROAD/STREET: Camp Collins Road , TOWN: Putnam Valley TAXIViAP #: ' SUBDIVISION: Rose LOT #: 2 OWNER: Joe Strauss lru.....,._.. �. ❑ ❑ Proposed SSTS within the drainage basin of West Braach or Bolds Corner Reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake, ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ ' � Proposed SETS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ❑ Proposed SAS for a Commerical Project. It is the responsibility of the desiga.professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status Qdint,or Delegated) based on the response. If you answered ►1,_,es to`any. of the questions, NYCDEP must witness the son testing. This = Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. MfIO_Zfi1 _'7rArild TI IC 1d•d7 TCI •OAC_070_'700� a.�nnnr. n�iTiinns l+e��n---- r.r—r.r.•r.•r. .T �+� .-+ •+ LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 218 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 15, 2003 Peter Gregory, PE Keane Coppleman Associates 113 Smith Avenue Mount Kisco, New York 10549 Re Dear Mr. Gregory: ROBERT J. BONDI County Executive Field Inspection — Strauss Camp Collins Road, (T) Putnam Valley A site inspection was made for the above referenced project on October 14, 2003. The following comments must be corrected in the field. ±i rLLr1 :nno ... - F 1,..n n l+raa•!: f •;i_ �'. �,.,J\ _._l. .....: -� he ll . ^C b. -,. � 1p.8�... �,; ill,: r4'iC1S .ayc� nG� �nS�uiicu). :u r 2. The fill pad quality appears marginal. A sieve test needs to be done in order to see if quality is adequate. 3. Based on a perc hole that was recently dug, it appears the depth of fill is much less than 3.5 feet. 4. It appears that length of pad area is ok, but the width,appears short. However, since the pad is incomplete, it's hard to measure the actual lengths. 5. Silt fence needs to be added and existing fence needs to be repaired. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. c4a f.•aw, P64ei- -3 Sincerel f1(!yy C�u�- 5Ji[o,�. �,.�i (,2 .i hk `s vlJr/n'.+r�My, ��" /'L'�+'to✓rN [� L� LL✓6/.l //-- �FIP W 'I � � 1 if li 'f' ! ✓1 � J ✓'�'L'C� ✓Y w� l l � I i �rv� M h l � itrcl '�" X-41 13 a- e„,urd c1,1 'Aew JSP:cj C'u., Y� Joseph S: Paravati, Jr. Assistant Public Health Engineer Keane Cappelman Eng 9142416797 c /' 1 1 I , I I 1 � r4ir► � K� / �G!'� .w / L 10109103 11:36pm P. 001 PUTNA,M COUNTY DEPARTMENT OF EMALTH DIVISION OF ENVIRONMENTAL HEALTI SERVICES ATTEN'T'ION JOSEPH d GENE REQUE,S_T FOR RNAL 1NSPF.CT[ON For: Fill All information must be fully completed prior to any Trenches ---- inspections being made. PCHD Construction Permit # SW -Z6-6% Located: CA /AQ C OLL.L_N S 0 (T) (V-) PUT Q A M XJ p LLB Owner /Applicant Name: ;YOS F A 1-4 7 AU.S .. T1V1 "7 Z Block Lot Formerly: SubdivisionNamC: (ZvsE Subdivision Lot,# 2 Is system fill completed? YES Tate: 04-03 Is system complete? Date: Is system constructed as per lans? Is well drilled? T �S Date: Is welt located as per plans? Y05 Are erosion control measures in place? Y (=S [ certify that the systems j, as listed. at the above premises has been constructed and I have .inspected :.. _ . _ _ �1'•d. e:°:ficd tI1�li S/C�Ll�ilv'e�_usi Ll 2 -;;cor ncc. with f le issut4 YCHD Cons±!vCti��..Pem�it, An'A approved plans and the Standards, Rules ap-d" - Regulations �of Rho Puti `County Depotttnent of . Health. Date. 0 Iu-03 Certified by: PE RA D 'gn tro fessi Adams: 113 .SKYE A 11 par kZ � L o Lic. # Comments: Oh Lz! a�p Lavmp COI I n S Z. 1 eL� otws&iALjinjr, 44 11 4iXU. Form FIR -99 .. v , - __ __ - _ — __ _ f9(^T_4C - ^?A17� rCIT f].`7A`• ^•Trl .f'lilt -_^�70 _70^_lA ^•— ^•, {�IF1MC. CI ITAIIIM !"fll II.ITII 1.1C11.11.1TMCLIT !lC —n _ __ o� PUTNAM COUNTY DEPARTMENT OF HEALTH NA) DIVISION OF ENVIRONMENTAL HEALTH SERVICES - (,Ul�l"� ��l�U't✓ t tUIV -Y�iu -ill l �r ti�" PERMIT # Located at Camp Collins Road 1 Town or Village Subdivision name Rose Property Subd. Lot # 2 Tax Map 72 'Date Subdivision Approved 7/24/86 Renewal Owner /Applicant Name Gail R. Gremse Block 1 Lot 19.2 Revision Date of Previous Approval Mailing Address P.O. Box 554, Putnam Valley, NY Amount of Fee Enclosed $300.00 Building TypeResidential Lot Area u. Fill Section Only Separate Sewerage System to consist of 1000 Other Requirements: Zip 10579 vo. of Bedrooms 3 Design Flow GPD 6 0 0 Depth r` Volume ?.00 el �ocyG I UIRED WHEN FILL IS COMP LET D ° gallon septic tank and To be constructed by Barnes Septic System Address P.O. Box 266, Bedford Hills, NY Water Supply: Public Supply From Address r _. _... - -. , ., .. "l ' K dress Putnam. Avenue. i Brewster, NY 10509 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem 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 aperRAl of the Certificate of Construction Compliance of the original system or any repair ereto. � �.a N o PP ` L PSI AN ENGINEERS. �O�tSSEGi3r:L C'ORPORATtON Signed: P.E. X R.A. Date 1A Address 1/3 S A, 44 Mr x-1 jCC, t--) y License # 0 7 1ZZ-& 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 new p i . Approved for discharge of domestic sanitary se a only. a By: Title: � �t Date: White copy - HD File; Ye low copy - Building Ins pecto Pink copy - Owner; Orange copy - Design Professional Form CP -97 Public Health Director DEPARTMENT OF HEALTH .1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 -6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 t a To: Engineers, Architects, Building Inspectors, Septic Installers, Construction Permit/Repair Applicants From: Bruce R. Foley, Public Health Director Dater August 8, 2001 Subject: Putnam County Health Department, Registered Septic System Installers Please be advised that on April 26, 2001 the Putnam County Board of Health adopted revisions to the Putnam County Sanitary Code requiring that the installation and repair of all subsurface sewage treatment systems (SSTS) be performed by installers registered with the Putnam County Health Department. This provision became effective July 1, 2001 and includes the installation of SSTS's for all new construction as well as repairs and replacement of any portion of existing systems. Please note that individual homeowners may construct or repair systems serving their residence without registering with the Putnam County Health Department. However, they must obtain a Repair Permit or Construction Permit from the Department. All work will be monitored by the Department. If you have any questions relative the registration process or to verify the registration of a proposed installer please contact William Hedges at (845) 278 -6130 ext. 2168. BRF /jP PUTNAM COUNTY- DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL r.l.si -..-.a -.•, -�.. ...e _._ �..c......- -.:.�. �_;'a-� '..`_- '� - -:_ �_- °+�wr; ::✓ i... e.::.=. ::. ^.:-�.�.'*f:.w';.w:�-•h;'..� •... --. r '�., .^,- '•.;.5:! -. `. ?..:.i• -� ;� Please print or type Well Location: Street Address: Town/Village Tax Grid # Camp Collins Rd. Putnam Valley Map 72 Block 1 Lot(s) 19.2 Well Owner: Name: Address: Gail R. Gremse P.O. Box 554, Putnam Valley, NY 10579 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ i__ gpm # People Served 3- 4 Est. of Daily Usage 6 0 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason To serve single family residence. for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision Rose Subdivision Lot No. 2 Water Well Contractor: P. F. Beal & Sons Address: 4 Putnam Ave. Brewster, NY Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: miles es Proposed well location & sources of contamination to be provided on separate sheet/plan. 'Cant: = 5n Da* e: l »tp 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 Di c r. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a ate well driller certified by Putnam County. Date of Issue SO 0 Permit. Issuing 0 ial: Date of Expiratio Title: Permit is Non -Trans erra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 M1 �. BRUCE R.. FOLEY Public Health Director NAME: ADDRESS: � d . )RETTA MOLINARI R.N., M.S.N. - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER SITE LOCATION: DATE: STAFF PRESENT sue- I/O � 0 ," 5-S-1 � q k y 1 o' C% SPECIFIC WAVIER REQUEST: 11,1.. C vlk rte i ( 3 70% .� we.. ...aw., -. �.....�... •. _...6 - -: "K. -- ..u>. -..- .rte..- �- r- ..�......r .. -u..• —.... .. ..p ... o-.---t -1.��. ..�...r- `�..- .-.rt- �. .. ...w .-• �..�..v.r �..r _- .....- �-- - -.-.. .0 DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIG FICANT HARDSHIP ?. YES .. NO DISCUSSION REQUEST APPROVAL OR DENIED ROVE REASON FAR DENIAL OF K)ALIC HEALTH (SPECWAIVER) DENIED DATE: EW YORK STATE DEPARTMENT OF HEALTH Specific Waiver ureau of Community Sanitation and Food Protection from Requirements of.Part 75 and Appendix 75- A,10NYCRR '-ia9: 1�'Iv ltr'L.�'1115ti iiv�J �"'v: ?Li4'yi�`''IIG� Lt:��C%`�CC�J"° rs .ar. r,tir Last Name Name of Applicant ' .Gremse Address Site Location Gail P.O.'Box 55.4, Putnam Valley, NY 10579 Camp Collins Road Putnam Valley 1. Reason why site does not meet 10NYCRR Appendix 75-A (check appropriate box(es)): Separation distance cannot be achieved. ] Excessive slope. E] High groundwater. E] Inadequate depth to bedrock or Impermeable layer. n Soil unsuitable. X her (explain) -- 2. Proposed design or conditions of waiver. 0 NY 10579 3. The proposed design may have the following limitations (check appropriate box(es)): U Increased risk of well or spring contamination. E] Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. [] Other (explain) E] Additional Information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with New York State Department of Health Administrative Rules and Regulations. Part 75.6 (b). a waiver is hereby granted. This waiver may be revoked by,lhg issuing. official for a change In conditions for which this waiver was granted. ORIGINAL - Local Health Agency COPY - Applicant/Design Professional kRT II- ENVIRONMENTAL ASSESSMENT ( o be t. DOES ACTION EXCEPdANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the - .i 3. WILL ACTION RE EIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED TIONS IN 6aNYG`R'1FSatAf'�:6 " %' negative declaration may be superseded by another involved agency. ❑Yes Wo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible.) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or, disposal, potential for erosion, drainage or flooding problems? Explain briefly: tV3�t t� C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly- 05. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or, other, effects not identified in C1-05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENV(RONMENTA CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT -OF A CRITICAL VNVIR4�kNM €NTAL AREA: (CFAj? ., � _ OYes )4o; If Yes, explain briefly: E. IS THERE, 0 S THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL. IMPACTS? ❑Yes tf Yes, explain briefly: Part III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise gignificant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; Ic) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part It was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then /proceed directly to the FULL EAF and /or prepare a positive declaration. �jeck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environme tal impacts AND provide on attachments as necessary, the reasons supportin this determination:' t hf�fi�, Name of Lead Agency Dat r 2,v c. trot_ ir-, �V2-- Print ype Name of Responsible Officer in Lead Agency T t of RePonsi e fic Stature of Respb1sible Officer in Lead Agency Signature of Preparer (If different from respon ible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Gail R. Gremse P.O. Box 554 (Mailing) Putnam - Valley, NY 10579 2. Name of project: Gail R. Gremse 3. Location TN: Putnam Valley 4. Design Professional: Keane Coppelman 5. Address: 113 Smith Avenue Engineers 6. Drainage Basin: Mount Kisco, .NY , 10549 7. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................:.. Type I Exempt x Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... - I L. Name of Lead Agency - 12 Is this project in an areK ur&r the rontxol of local planning, zoning, cr other. ._ _ Y _. -_ .._ . _ officials, ordinances? ....................................................... ............................... Yes 13. If so, have plans been submitted to such authorities? ........ ............................... No 14. Has preliminary approval been granted by such authorities? Date granted: No 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... - 17. Waters index number (surface) .............. - 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply - Distance to water supply - 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system - Distance to sewage system - 22. Date test holes observed 4/24/01 23. Name of Health InspectorAdam stebeling 24. Project design flow (gallons per day) ................................. ............................... 600 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... No Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVISION 'y-•' ��'n_ J k :'r+V' .P 7• _ � 1 ae_ V Of Ei� VIRO1�MES1'�AL +' trift LETTER OF AUTHORIZATION RE: Property of Gail R. Gremse Camp Collins Road Located at TN Putnam Valley Tax Map # Subdivision of Rose Properties 72 Block 1 Lot 19.2 Subdivision Lot # 2 Filed Map # 2152 Date Filed Gentlemen: 7/4/86 This letter is to `authorize Peter J. Gregory. 'P. E, , Keane Coppelman Engineers PC a.duly licensed Professional Engineer x 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 _rnly♦4P' ''s }/s %- �..a+ �[n..e i:.(� .:nne.�.rrw•�r �nw u, nF1M/i9y /Jn/ !�r.iro r_ tii��, {_ccZetnetac ._ r. MaV- �%V.liJ►►KV�,Cr r Vl Y V"�..4JVV .�1 {�t'V1 4 LLVk�11A\Ill� {4LW -`✓l .. At $�j.r as �, J�V�.�.I -. 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. FOR KERN^ COPPELMAN ENGINIEERS5, F'.C. Very truly yours, ek PROFESSIONAL CORP �.. y Countersigned. Sgne P.E., R A., # 071226 2 (Ownergf Propctty) Mailing Address 113 Smith Avenue Mount Kisco, State NY Zip 10549 Telephone: 914-241-2235 Mailing Address: P. 0. Box 19 State NY Telephone: Putnam Valley, Zip 10579 Fomi LA -97 KEANE COPPELMAN ENGINEERS, P.C. " 113 Smith Avenue MOUNT KISCO, 14EW YORK 10549 v m TO xot -mw► CovAt y DeA Q(v9,gAtAeA WE ARE SENDING YOU Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ d E-TUM OCP 4 ° e H@5M0VV �tK DATE 06 JOB NO. Stie RE: C3co� 1?d ?AV, \A/le ec zv; 4 o 3oa the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION ec zv; 4 o 3oa I NtSt ARE T RANSIV,i I TED aS cileukeli beiuJV: v ❑ For approval ❑ Approved as submitted ❑ Resubmit For your use ❑ Approved as noted ❑ Submit • As requested ❑ Returned for corrections ❑ Return _ • For review and comment ❑ ❑ FORBIDS DUE REMARKS copies for approval copies for distribution corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US �. V COPY TO SIGNED: If enclosures are not as noted, kindly notify us at Ice. e I i— .�....«.. _.... .'��4. .. .. . ..T � �rL wP-. _.- W:_I�.-.Y X11•. ... . •�b.nT7'.- BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 : 6130 Fax (845) 278 - 7921 Nursing services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Keane Coppelman Engineers, P.C. 113 Smith Avenue Mount Kisco NY 10549 June 19, 2001 Re: Gremse Camp Collins Road, Lot #2 (T) Putnam Valley, TM# 72 -1 -19.2. Dear Mr. Coppelman: The above regarded application cannot be processed. This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until a certified check or money order in the amount of $300.00 for a Construction Permit be mailed to us. Very truly yours, Theresa Nemeth Senior Typist e . KEANE COPPELMAN ENGINEERS, P.C. 113 Smfth Avenue MOUNT KISCO, NEW YORK 10549 .��_.. ,r.. �i� -.. rL .. ... -. .. cr is ... -s.- _ �`_ .•- __.,...a..ay.... (914) 241 -2235 TO Putnam County Health Dept. WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ITTERN OLJ V o e LIVMUVVLM DATE JOB NO. ATTENTION Adam Stiebeling RE: Gail R. Gremse Camp Collins Road Putnam Valley Putnam County TM# 72 -1 -19.2 E:k Attached ❑ Under separate cover via the following items: ❑ Prints 91 Plans ❑ Samples ❑ Specifications ❑ Change order 3] Forms COPIES DATE NO. DESCRIPTION 2 House Plans 4 Fill Placement Plan 1:. SSTS Plan, Profile & Details l Construction Permit 1 Well Construction Permit 1 esign Data Sheet 1 pplication for Approval of a SSTS 1 IShort EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints KI For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: _� e-..,- .....,.. ABRUCE� R. iFOLEY"p.::,�:•. ,- ...... -�_ . _.. .. ...� -. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road LORET{TA MOUNARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 July 9, 2OO 1 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 eKv Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Keane Coppleman Engineering 113 Smith Avenue Mount Kisco, New York 10549 Dear Mr. Gregory: Re: Gremse, Camp Collins Road Rose Realty Subdivision, Lot #2 TM# 72 -1 -19.2, (T) Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. Plan A. As noted on "Filed Subdivision Plat ", T -0" deep curtain drain required due to depth of groundwater. B. The following notes are to be stated on the plan. - Well and SSTS are to be staked by a New York State Licensed Land Surveyor prior to construction. - There are no other wells or SSTS's_within 200' -0" of subject property unless shown. Waiver(s) Required A. Due to the proposed depth of the f ll (greater than Y -6 ") a fill greater than T -6" waiver will be required to be issued. SSTS proposed is as shown on the approved Realty Subdivision filed plat. Pending receipt of the above stated comments prior to Thursday, July 19, 2001, this project will be discussed at the Departments next "Specific Waiver" meeting on Tuesday, July 24, 2001. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj PUTNk %l COUNTY DEPARTMENT OF HEALTH DIVISION OF EN'VTRON)IFNTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT _ REVIEWED BY: R,\1, G AS, RDATE: ;g!OCU"'E NTS RMTI APPLICATION )YELL PERMIT OR PWS LETTER LETTER OF AUTHORIZATION L,fflC_JDESIGN, DATA SHEET (DDS) #HOUSE RPORATE RESOLUTION ORT EAF AWNS -THREE SETS PLANS -TWO SETS UUVAR_0CEREQUEST �+ � SUBDMSION r EGXL SUBDIVISION SUBDIVISION APPRgVAL CHECKED pI I � ,� PERC RATE �'J • J 3,_0 LZCLJ L R PTH (� RT —IN DR�.L`i REQUIRED G (� CATED Di NYC WATERSHED (� NS SUBMITTED TO DEP (__ C_ZD ED TO PCHD 1,� ( )L EP APPROVAL. IF REO� V��APPROVAL SSDS ADJ, LOTS ANDS (TOWN/DEC PERbIIT REQ'D ?) (_)EZON DDS PLANS & PERMIT SAME � 1969 N- EIGHBORNOTIFICATION (� TTER BLIZBA 100 YR FLOOD ELEVATION W/I200' AGE SYSTEM PLAN - {NORTH ARROW) ; HYDRAULIC PROFILE LAITY FLOW ISTRUCTION NOTES 1 -15 IGN DATA: PERC & DEEP RESULTS 3NTOURS EXISTING & PROPOSED AWAY & SLOPES, CUT I' L1 G /GUTTER/CURTAIN DRAINS IA SOIL TYPE BOUNDARIES LE BLOCK; OWNERS NAME ADDRESS PE/RA; NAME, ADDRESS, PHONE# V,-OF DRAWING/REVISION IUAREFERENCE 6ATION OF WATERCOURSES, PONDS (CES,WETLANDS WITHIN 200' OF P.L. OP OSED FINISH FLOOR AND ,F INTENT ELEVATIONS `ILLS & SSDS'S WQN 200' OF SSTS OPERTY METES & BOUNDS COININIENL US: p (REVSHEET) TAX KNP =: (CONFUWED) iE SEWER -' /4" FT. 4 "0'; TYPE PIPE CAST IRON EN'DS;1LAX BENDS 450 W /CLEANOUT. RENEWALS NOTE (NO CHANGE) FILL SYSTEMS ORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS FILL NOTES 1 -5 LL PROFILE & DIMENSIONS IX IN EXPANSION AREA FILL GREATER TIM AV 2 FEET jAY BARRIER ;LL CERTIFICATION NOTE WH GAUGES OL.' ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS EPARATIOi i DISTANCE FROM TOE OF SLOPE TRENCH F TRENCH PROVIDED 60FT MAX. ARALLEL TO CONTOURS 00% EXPANSION PROVIDED. )ETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL TIQOTEXTILE COVER TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL TO FOUNDATION WALLS TO WELL, 200' IN DLOD,150' TO PITS r TO STREAM, WATERCOURSE, LAKE (inc. a =pan) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits - 20) L`iTERMITTENT DRAINAGE COURSE u sylllux : MTY TO LEDGE OUTCROP SEPTIC TANK FRONI FOUNDATION; 50' TO WELL WELL 1IENSIONS TO PROPERTY LINES iCATION OF SERVICE CONNECTION "TO PROPERTY LINE SLOPE PE STS AREA (S20 0/6) D TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS 5.rz:, T---> J( PU, IP NOTES J( DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED _) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC -) (�( PIT AND D -BOX SHOWN & DETAILED U( 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN UUSTANDPIPES, 5' BOTH SIDES, DETAIL to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<1% (__ C_J20' MIS( to CD DISCHARGE /100' with 182 cons day discharge (__-)( _J10' NIhN to NON- PERFORATED PIPE Sti0y vc KEANE COPPELIVIAN ENGINEERS, P.C. 113 Smith Avenue MOUNT KISCO, NEW YORK 10549 (914) 241-2235 TO Put . nam County Hpalth Department FUEUV[En W? V UHMUVVZM DATE I JOB NO. /j ATTENTION Adam Stiebeling RE: Gail R. Gremse Camp Collins Road Putnam Valley .Putnam County TM# 72-1-19.2 WE ARE SENDING YOU 10 Attached ❑ Under separate cover via the following items: > ❑ Shop drawings ❑ Prints X Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order N Form COPIES DATE NO. DESCRIPTION 4 Fill Replacement Plan 4 SSTS Plan,, Profile & Detail 2 Waiver Form Due to Fill Greater than 31-611 ESE ARE TRANSMITTED as checked below: N For approval ❑ Approved as submitted ❑ Resubmit -copies for approval ❑ For your use ❑ Approved as noted ❑ Submit - copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return - corrected prints ❑ For review and comment' ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. Apr -12 -01 04:01. Keane Coppelman En9v BRUCE R FOLEY Public Health Director P.03 . .. n<'v.F N P: ='l J cs.nh -:, ♦ —C• � Z' :.'vCf. r C. DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORS'Yi'A MOLINARI RN., M.S.N. Atiodeft Public Health Dlreetor Dinwer 4 Patient Sawces ATTENTION: rlADAM STIEBEL ING o GENE REED All information below must be fllllX completed prior to any scheduling. DATE: 64/12/01 ENGINEERORFIRM: Keane Coppelman Engineers PHONE N: 914-241-12235 REASON: DEEPS: 6 PERCS: PUMP TEST: a ROAD/STREET: Camp Collins Road TOWN: Putnam Valley TAXMAP#: 72 -1 -19.2 SUBDMSION: Rose Property L.OT#: 2 OWNER: Gail R. Grems NYQEP CRITERIA FOR JOINT REVIEW AND WITNFSSINr. i7F SOEL 'e'ESTiNd; YES NO 0 a Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. PrApnseti: S. whi�500jee >r�farerYO=r,:r,eser�ryir'�•.. irroposeaS'S�ivit>iiri 2t10 ieef of a watercourse or a DEC wdland. a la Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. C3 10 Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ya to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the POOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness .the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. _ FOR COUNTY USE ONLY -r DATE: TIME: (FIEWTEST) PUTNAM COUNTY DEPARTMENT OF HEALTH ' :..�: • >.+- ..+ua� .�ru ..- . ray. , i r 1 an . :- o...•a.sa a ��i° :�:0N�'ivNN 'Al, HEALTT� SERVICES . INITIAL INDNIDUALICOMMERCIAL SITE INSPECTION FORM SECTION A..GENERAL INFORMATION Name of Project /S " m County Site Location (ac Li. Building construction begin Extent Is pryrty within NYC Watershed? ...... I........... F__j Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1.. Hilly oiling ep .slope _ _ entle slope— -Flat -- -- 2. 0 Evi ence of wetlands Low area subject to flooding F-71 Bodies of water Drainage-ditches rock outcrops 3. Property lines or comers evident..; ..................................................... F_� Yes o 4.= Do water courses exist on or adjoin the property. Y No _ ? ............ ... .... 5. Will these affect the design of the sewage system facilities ?............ _ - Yes � No 6. -. -Do watershed regulations apply in this development ?........................ Yes o 7 Will extensive - grading be Hzs l extensive fill be necessary for SSTS? ......... ............................... . o No . - - -- 9. Do filled areas exist within the SSTS area? :....... ............................... Yes Q No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS - - - - - -- -- - -- - 10. - Appearance of soil: Sand pan- Mixture Gravel ; .- oam . Clay - 0 Hard 11. Observed from:' a Borings Bank cuN Backhoe excavations 12. Soil borings /excavations observed y t on 2- �_ _ Ir 11 Depth to groundwater o c 3 t on 14. Depth to mottling St on 15. Are test holes representative of primary & reserve areas ...... ............................... es F__j No 16. Soil percolation tests made by C04,fV on 17. Soil percolation tests witnessed by t on SECTION D (on back) Form ST -1 2 .�T. Y •. '• _T �AT..}O T"-�Zi .. � . : an ... �_ue r.. .... � :. « .. .a... - m- r �) .. . � ... � .. .. . v s _...e.. .. r.r ....r 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage require special consideration? ..................... es No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... O'Yes E] No SECTION E. REMARKS 21. • If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ........... ..................... Yes E2 o Inspection data - - -- - 22. Do adjacent. wells and/or sewage systems exist ? ........................ - 23. Additional comments ITS es -� No -- - - - - -. 24. Site observer /inspector and title P, - -- 2�. " Date(s) of otiservation(s)inspection(s) - TEST PIN PROFILES Hole # Lot # --Hole # _ . _ _ . _Lot # -Hole # Depth to water �' Depth to water De th p -- - �_... _. to water -- .._...._ _..... . . Depth to mottling -4 Depth. key M01-t! L"-9- - --- Depth to rockhmp.' � Depth to rock /imp. Depth to rock/unp. G.L. G.L._ G.L. 0.5 - = - -- .. .... . _...... 1.0 An 1.0 - _. 2.0 2.0 V 3.0 ..� r►, -fi 3.0 - ! 3.0 4.0� i- G- c 4.0:' r - 4.0 5k rt' 5.0 5.0 6.0 6.0 6.0 7.0 8.0 10.0 10.0 7.0 8.0 9.0 10.0 (- , o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 E�i 1V fo Iii Sri : = S n Lit �►c: ; SE h%AuL' i iKEA1 i �;[vT SYS r.i� Owner Gail R. Gremse Address P.O. Box 554, Putnam Valley, NY Located at (Street) camp Collins Road & Sprout Tax.Map 72 Block 1 Lot 19.2 (indicate nearest cross street) Brook Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA i Date of Pre - soaking o 4 / 2 6 / 01 Date of Percolation Test o4/27/01 Hole No. Run No. Time Start - Stop Elapse Time (Min.) De th to Water From Ground Surface (Inches) Start Stop Water Level Drop n Inches Percolation Rate Min/Inch 1 1 11:30 -11:37 7 18 21 3 2.3 2 11:40 -11:49 9 18 21 3 3 3 11:50 -11:59 9 18 21 3 3 4 5 2. 1 :10-1:1 :20 -1:27 1.8 .. 21 3.. .2 2 7 18 21 3 2.3 3 :30 -1:39 9 18 21 3 3' 4 :40 -1:50 10 18 21 `3 3.3 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootameu at eaa► percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. —� Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO.-' 2 HOLE NO. G.L.. -- Organics .Organics 0.5' If if 1.0' Red Brown Red Brown 1,5 Sandy Loam. Sandy Loam 2.0' W /Small to Med. W /Small to Med. 2.5' Cobbles Cobbles 3.0' 3.5' Ground Water If 4.0' Ground Water .4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered V-6' Indicate level at which mottling is observed NA Indicate level to which water level rises after being encountered 31-61 Deep hole observations made by: Keane Coppelman Engineers, P.C. Date 4/24/01 Design Professional Name: Keane Copt 1 man Engrs P.C. Address: 113 Stith Avenue Mount Kisco, NY 10549 Signature: Design Professional's Seal FOR KEANE COPPELMAN ENGINEERS, P.C. OrE-`SSiONH^L CiJRRORATIn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: � °� Inspected by: _i P E Street Location LM 0 Co t;kS (ca d _ _ Owned L-,i r x , :i w2i: w;, �;u t �`1`� hn `u,%•i�j "° • �•:- .... Permit # Gar TM #— _ i - t 4 -'2-- Subdivision Lot fZoS e— #.-2- 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 stripped ................. .. ............................... d. Stone, brush, etc., greater than 15', from STS area.......... e. 100' from water course / wetlands :.... ............................... II. Sewage System a. Septic tank size - 1,000 : ......1, 250 .........other ................ b. 'S eptic*tank installed level ........ ............................... ... c. 10' minimum from foundation .......... ............................... 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 ..................... - 6. renc eies 1. Length required , ;eQ 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, 100 % ......................... 8. Size of gravel 3/4 - 11/z" diameter clean ............... ' .... : 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capRed....... _ . .. ....:w JA .�'�.v,StP*i`tiS:...._...._.__._ 1. Size of pump chamber ....... ....... ............................... 2. Overflow tank .......... ....................... ... 3. Alarm, visual/a .............. ...............:............... 4. Pump ea ' accessible, manho a to gra e ................. 5. F' ox baffled .......................... ............................... yycle witnessed by H.D.estimated flow /cycle........... M. ouselBuildhig a. house located per approved plans .... ....................:.......... b. Number of bedrooms ....................... ............................... IV. Well Well located as per approved plans .......:............. ........... b. Distance from STS area measured --j- w o ' - ft........... 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 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. 12/02 r cr . b'.t I mom r cr . b'.t -SITE INo"ECIi6i F OR FILL PAD 10 Date: 1' �V Inspected by: Fill pad located per the approved plan Fill Pad Length _ Re uired Length /0 Fill Pad Width 7u Required Width q,2 . Fill Pad Depth Required,Depth Run -of -Bank Fill Quality �M airy,i t 6, Slope from Top to Toe Impervious Layer Installed trosion Control Installed Sieve Test Results (if applicable)J... OA -Additional, Comments:. Reserved for Field Sketch if Applicable , 1y �C' PROP _._ . - .. �;. ... .. ELL ._. 7. J E - ' E) Bfi0 Op0- - PROPOSED -- WATER - o co �. IK ._ - - _1 - _ - 'E - OSE ci NI 2: X340 , JF,p PROPOSED ROOF: & FOOTING DRAIN _ a D AN RPOSE Tf- TRACKING PAD PO a; , I :,t :7f . b� j tt 1 �