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HomeMy WebLinkAbout3168DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -23.2 BOX 26 03168 2 Ll Nil T ' � 1 1 IL ILL a 03168 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL / ? Please. print or tyke . -- P.CHD Perxnl Well Location: Street Address: 1'ownllage Tax Grid # 14 VeM�3 j ©L- �.t��:} ��, f ViNfl �i�1i.i. Map 7Z-.Block Lots) 23,.` Well Owner: Name: Address: &I N'; it, Coe► s l I 1>6U `( PLAc< L.A M PEEXso< i LA ,, OY t�s3 7 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 gpm # People Served ___(o Est. of Daily Usage (Q c, CU gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason PE-cv i PcrfPa C.6 W#�TC2.,S'O t-Y Fvk- IJEyV Rte7e. i for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No _ Is well located in a realty subdivision? ...................................... ............................... Yes 'X No Name of subdivision Y1f ,mac tLE C-1 I= P__1+0 4 j, 60 , Pf}�c6� Lot No. 'Z. Water Well Contractor: (3 R_v S , Address: • 4 IAP�2 ( SO tira 0. y Is Public Water Supply available to site? .................................. ............................... Yes No y Name of Public Water Supply: N Pu TownNillage Distance to property from nearest water main: > i m i L E Proposed well location & sources of contamination to be provid d on separate sheet/plan. 9 Date: 06/2,T/Ot Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well dril er certified by Putnam County. Date of Issue 6t 2 r� . Permit Issuing cial: Date of Expiration Z� ® Title: t Permit is Non- Transferrab White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _._..._. CERTIFICATE OF CONSTRUCTION COMPLIANCE F1'REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ,Y - Z: CA Located at 3� i � �(� Town or Village IA4M VAL L `/ Owner /Applicant NameC.qO AA C0C�M Tax Map 4Z- Block I Lot Z vZ Formerly �4JA Subdivision Name LLJ �s"Y{Z j%-,Q Csc>. �AQCEL I Subd. Lot # Z Mailing Address Ji PEjge_q LANCE (%F- EV- 1j L , )V q Zip 105 Date Construction Permit Issued by PCHD Separate Sewerage System built by 4 l- coe� -(Wa Address V'' w:'-Ts- , wq /u-�fi° Consisting of l , Zoo Gallon Septic Tank and L-F oFE Z� " cJ iOf ,Aa5bF-P�!1)0J 1 MIJUAI�5 SQ,p�(30 AT 6 -rl- ac, Other Requirements: Water Supply: Public Supply From. Address - or: Private Supply Drilled by NAW AmTpfSu.t JX/ Address D- ilvAo-x V, -( Building Type . ' )N, t I i_ _ . Has erosion.,control.been completed? i Number of Bedrooms Has garbage grinder been installed? P�y 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 Co ty Department of Health. Date: /0 05 C z Certified by P.E. )C R.A. i (Design Professional) Address' tn1 ' C'd.� Q L, Cou-') `. J License # )05iG 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. AS, `s public By: j Title: _ c `n eer- Date: 1 J I Wheecopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALT H SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Cynthia Coombs 72. 1 Owner or Purchaser of Building Tax Map Block Westchester Modular Homes Building Constructed by 33 Horton Hollow Road Location- Street Residential Building Type Putnam Valley TownNillage 23.2 Lot Westchester Holding Co. Inc., Parcel II Subdivision Name Subdivision Lot # 2 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 system. Thy ander�tgned further agrees t pt . s ��'�?''' . e ation of the -Pub is �alth.::��. ::... - o ac.,e �. J ..t�,..,ive th �dc� �rz`i�in r ......� -.i v. .. .... - 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 10 Day 8 Year 02 General Contractor (Owner) - Signature Westchester Modular Homes Corporation Name (if corporation) Address: P.O. Box 900, Dover Plains Signature: �-�2 Title: Septic Installer -r) . Corporation Name (if orporation) Address: State NY Zip 1252 ,.�i 0, �`� /�/ Y Zip /DSV Forrn GS -97 PU T'NAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLE'T'ION REPSD,RI, e Well Owner: Use of Well: 1- primary 2- secondary TAX Cz rid,#_ T MapZ Block Lot(s)�3, J e, Address: �!y �Lac,+� -, _4�4LL Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Well Type C Rotary Cable percussion Compressed air percussion Other (specify) Screened Open end casing _�< Open hole in bedrock Other Casing Details Screen Details Total length k" r 'ft. Length below grade `W Diameter in. Weight per foot alb /ft. Diameter (in) Materials: Steel _ Plastic _ Other Joints: _ Welded >dhreaded _ Other Seal: Cement grout _ Bentonite Other _ Drive shoe: iCYes No Liner Yes -- No Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours Yield /d gpm Depth Data Measure from land surface -stab (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are avaliabie, please attach. If yield was tested at different depths during drilling, list: Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 3 " 9 d ye 5— 1 � Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity f t' f% % -•- r,� r >r Depth IYZU Model Voltage V HP Tank Type olumet3 ,f Date Well Complee�ted Putnam County Certification No. Date of Report Well Driller (signature) NCVTE: (Exact location of well with distances to at least two permanent ]Xndn) rks to be provided on a separate sheet/plan. Well Drillees Name c Address:/ Signature: 4, Date: Y e fs White copy: HD File; Yellow copy - Building Inspector; Pink copy,- Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 -8 r` Hl�ert H. Pa�ovani, Director LAB #: 32.208876 CLIENT #: 56161 N0N�STAT PROC PAGE COOMBS, CYNTHIA DATE/TIME TAKEN: 11/24/02 05:30P 11 PERRY PLACE DATE/TIME REC'D: 11/25/02 10:35A LAKE PEEKSKILL, NY 10537 REPORT DATEz 12/02/02 PHONE: (914)-528-1809 SAMPLING SITE: 33 HORTON HOLLOW RD. LOT#2 PUTNAM VALLEY : SAMPLE E O BLF. COL'D BY: CYNTHIA COOMBS NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/25/02 ~MF T. COLIFORM ABSENT /100 ML ABSENT 1008 11/25/02 �LEAD (INS) 1.2 ppb 0-15 ppb 9101 11/25/02 -NITRATE NITROG <0.2 MG/L O - 10 9139 11/25/02 -NITRITE NITROG <0.01 MG/L N/A 9146 11/25/02 ~IRON (Fe) 0.605 MG /L^ 0-0.3 mg/l 2037 11/25/02 -MANGANESE (Mn) 0.819 MG/L7c 0-0.3 mg/l 2037 11/25/02 -SODIUM (Na) 3.22 MG/L N/A 11/25/02 -pH 7.1 UNITS 6.5-8.5 9043 11/25/02 -HARDNESS,TOTAL 156 MG/L N/A 11/25/02 `~ALKALINITY AAS 148 MG/L N/A 11/25/02 -TURBIDITY (TUR 2.1 NTU 0-5 NTU COMMENTS',': BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINI 1 THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet the waff should contain no more than 20 mg/L of Sudiu a moderately restricted diet, a maximum �CkZf�'- / �Sodium is suggested. ^` `�' fML ENVIRONMENTAL SERVICES 321`Kear Street Yorktown Heights, N.Y. 10598 _ - Albert H. Padovani, Director COOMBS, CYNTHIA DATE/TIME TAKEN: 11/24/02 05:30P 11 PERRY PLACE DATE/TIME REC'D: 11/25/02 10:35A LAKE PEEKSKILL, NY 10537 'REPORT DATE: 12/02/02 PHONE: (914)-528-1809 SAMPLING SITE: 33 HORTON HOLLOW RD. LOT#2 PUTNAM VALLEY SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: CYNTHIA COOMBG TEMPERATURE;.-: < 4C -- NOTES...: KITCHEN TAP COLIFORM METHv Ml::' DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Q pHSCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY, WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. 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 HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER. SUBMITTED BY: Alypr Pty1ni, M.T:(ASCP) Director r� ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Ynrktown Heights, N.Y. 10598 _(914)-245 LAB #: 32.300393 CLIENT #: 56161 NON STAT PROC PAGE COOMBS, CYNTHIA DATE/TIME TAKEN: 01/17/03 10:00 11 PERRY PLACE DATE/TIME REC'D: 01/17/O3 12:00 LAKE PEEKSKILL, NY 10537 REPORT DATE: 01/21/03 PHONE: (914)-528-1809 SAMPLING SITE: 33 HORTON HOLLOW, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: CYNTHIA COOMBS - _ TEMPERATURE..: < 4C NOTES...: COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE 01/17/03 -IRON (Fe) 01/17/03 -MANGANESE (Mn) COMMENTS: Fe/Mn If both iron and manganese ar combined shall not exceed 0.5 RESULT NORMAL - RANGE METHOD <0.060 MG/L O-0.3 mg/l 2037 0.017 MG/L 0-0.3 mg/l 2037 R ore , their total value mg/L�� SUBMITTED BY: MAD Direttor 10323 � BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. :� ". r-;S -,. .a"5c�ui:E+ � �•3siii'� ^!'fC4:::i•' L:i �,�::vT � •` �� _° _. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914).278 - 6130 Fax (914) 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 '__ 1 9 / WI OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) `.i V. BADEY. & WATSON LETTER of TRANSMITTAL Surveying & Engineering, P.C. . 3063 Rouse 9 Coil S- TO: Joseph Paravati Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 File No. 98 -105 W. O. # 15172 RE: Certificate of Construction Compliance Coombs, Horton Hollow Road Westchester Holding Co Parcel H Subd. Lot No. 2 Tax Map 72.4-23.2 PermittTitle/PO # PV -23 -01 Sent via: copies US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX UPS -GRND ❑1 We are sending: UPS -COD ❑ copies date description of document ❑1 12 1- Dec -02 JA lication Fee - $200.00 F-11 08- Oct -02 Certificate of Construction Compliance for Sewer Treatment System . 51 101-Auiz-23 E911 Address Verification Form 03 08- Oct -02 Guarantee of Subsurface Sewage Treatment System 7l 02- Dec -02 lWell Water Test Results - two 2 pages ❑1 12 1- Jan -03 Well Water Test Results ❑1 07- Dec -02 Well Com letion Re ort T1 , ❑1 11 0- Oct -02 IDesign Data Sheet El I REMARKS_ Copies to: File h A Yours truly: Jason R Snyder, Jr. Engineer Tel: (845) 265 -9217 ext 13 Fax: (845) 265 -4428 Email: jsnyder @badey- watson.com 40 40 -05 500538 624458 20722 .,UL, i - Va3-dee,2 15:,54 BADEY & WATSON, PC BRUCE R. t: OI-E Y P.01/02 LORETTA MOLINARI R.N., M.S.N. .. _.. _. ._. :z-s •:J±Y.`.I ✓'G:_CS,.A.^'fitie�i :�� UytfiD;7.�VYCy Director of Patient. Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REQUEST FOR FIELD TESTING ATTENTION: ❑ ADAM STIEBELING P1 GENE REED All information below roust be fully completed prior to any scheduling. DATE: 1013/02 SADEY & WATSON, ENGINEER OR FIRM Surveying &Engineering, P_C. PHONE # (845) 265 -9217 REASON:.. ROAD /STREET: DEEPS: ® PERCS: ❑ PUMP TEST: o Norton Hollow Rd. TOWN: _ M _ Putnam valley TAX MAP#: SUBDIVISION: Westchester Holding Co. Parcel II OWNER: Cynthia Coombs 72. -01 -23.2 - LOT #: NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ m Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. Proposed SSTS within 500 feet of a reservoir:-resen!oir stem or con7_ol_ la e,- - ` ~'Proposed SSTS withln 200feet di watercourse Of a DEC wetland. ❑ ® Proposed SSTS design flow greater. than 1000 gallons /day or SPDES. Permit required. ❑ P 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 3Lev to any of the questions, NYCDEP must witness the soil 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 testmg, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE: COMMENTS: (FIELD TEST) FOR COUNTY USE ONLY TIME:.._._— _..._ / tq OCT -3 -2002 THU 15:27 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 1 Q ,! -A- i —L' —died 15:,.54 BADEY & WATSON, PC P.02i02 10/03/02 _ ..v, >c ,.- �.o .. + :, -t9- .-.a -i. a-- c>.x�;::.v.za -n. _...,. �: Z:`"�'a- `.:w•. - ss�..- .:_e'. ... .. .. _. o.o. -.::s �= ,..n :i..: `�; 4;= ..c�:::�'o'>,- :';..ate. �v ..r. - fs't�x :_.w -�. vi.-•�q,...:. . ... _..: Ann: Gene Reed R$; Request For Field Testing of Property of Cynthia Coombs sent 10/03/02 The previously sent deep hole inspection request is per your request for an additional deep hole inspection. Robert Van Pelt - Cathcart Badey & Watson. P.C. TOTAL P.02 OCT -3 -2002 THU 15:27 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 Crd Cc .'�LLADER/ FOO • IP OR APP&OV VA ED EQOIE T., 4* PUR FT. MIN...'PITOW x % 1250 CAL. PRE( CONC. SEPTIC 7 B 4" PVC. 0 1 /8" 40 FT. MIN. PITCH 50 FT. O.C. MAX. CLEAN—OUTS ..... ..... OP Box Ro) (SEE. DETAIL) X a PROVIDE LF. OF .0. .' �FAWW ri x PU"TNAM COUNTY DEPARTZiENT OF HEALTH DIVISION OF ENVIRONNIENTAL HEALTH SERVICES FINAL SITE MSPECTION Date: 5J Street I ocation Town Permit # TM #- -7,?- — / — 2, 3 , Subdivision Lot # �1- . 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 ..:.....1,25 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bo 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. ren' nc es -" TZength required 40o Length installed 2. Distance to watercourse measured o o 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 -1 %:" diameter clean ..........::........ 9. Depth of gravel in trench 12" minimum.:.., .....:........ e:er� ei - ............. ............................... g. Pumt) or Dosed Systems - Size ot pump chamber ....:.......... ............................... 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 /cyele ... ...... III. House/Buildin a: House located per approved plans .................... ....... b. Number of bedrooms ............................ 1 .................. IV. Well a. Vell located as per approved plans .............................. b. Distance from STS area measured 't / 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 plat f. Curtain drain outfall protected & dir.to exist watercoi g. Footing drains discharge away from STS area............ h. Surface water protection adequate .... .........:........... :.:.., i. Erosion control provided........... :..... 1-\V C,117- AUG -26 -2002 16:36 BADEY & WATSON, PC P.01i01 I a - PUTNAM COUNT'S DEPARTMENT OF HEALTH .�'IN•,_..�.!_s" Ism ,- _�L�JT'Maz+...nrl «n.J'inlc. +v YJ �n��V���'�V����. ����- `al��I•aLNRf ■AI��(1����,�r . REQUEST FOR FINAL - INSPECTION Date: = &*00? PCHD Construction Permit # PV -23-01 Located: Horton Hollow Road For: Fill - ..:. Trenches MM Putnam Valley Owner /Applicant Name; _ ... ,._.Cynthia Coombs TM 72• Block 1 . Lot 23.2 Formerly: WA Subdivision Name: Westchester Hotding Co. Inc,I Pareel It Subdivision Lot # 2 Is system fill completed? Yea _.. Date: Is system complete? -... ___ Yes Date: Is system constructed as per plans? Yes Is well drilled? Yes Date: Is well located as per plans? Generally Are erosion control measures in place? — Yom_.__ 8/26/2002 7/25/2002 7/25/2002 i certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion 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: 8126/2002 Certified by: John P. Delano PE X R A _ t�jr eSl lf S5' Address: Sadey & Watson, P.C. 3083 Route 9, Cold Spring, NY Lic. # 062505 Comments: FOR: 0 ADAM ® GENE 0 (NAME) Form FIR -99 TnT04 P. 01 AUG -26 -2002 MON 16:30 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P- 1 BRUCE R. FOLEY DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York. 10509 LCT,T 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/Preschool (845) 278 -6014 Fax (845) 278 - 6648 September 3, 2002 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: Field Inspection - Coombs Horton Hollow Road, (T) Putnam Valley Lot # 2, TM# 72. -1 -23.2 Dear Mr. Delano: The above referenced separate sewage treatment system can be backfilled.- The following comments must be corrected in the field. 1. It appears the expansion area has been cut. A deep hole test is required in this ^area to. _ - ..... ....._ Prns.irA prope€� dep-tl� Please Call m ;to_ -!Vma, es t�;is If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide SENDING COMMON DATE : SEP-3-2002 TUE 09:35 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 92654428 PAGES START TIME : SEP-03 09:34 ELAPSED TIME : 0012111 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. 0. BRUCE R. FoLsy pwi. AWN DkW, LOn=A MOM=% ALSY. N A—*b A" bN- DEPARTNIENT OF HEALTH 10000V6RO-d. BMwstW.WawYarkl0$09 UO—...ad 8.fth ($45)272-6130 P-(945)276-792 Nonly 3.01 (443)273-GSU W1C(34S)772.66n September 3, 2002 JohnDelano, PE Bad; Y*.W"n 3063 Route 9.., Cold Spring, Now York 10516 Re: Field hwaction - Coombs Horton Hollow Road, M Putnam Valley Lot 0 2, TbO 72.-1-23.2 Dear W. Deism: The above refisrencad separate sewage treatmerit gymern can be back0ed. The following comments =at be corrected in the fidd. 'It appears the expansion area has been cut A deep holitest is required in this area to ensure proper depth. Please call me to discuss this matter ilartiter. If you have any Ruther questions, please contact Me at (845) 278.6130 W. 2261. Sincerely, Ocao D. Read GDR.1 Environmental Health Engineering Aida PUTNAM COUNTY DEPARTMENT OF HEALTH N �'DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # T Y -c) 3 C� Located at w pr-T'po vV6- <� ; C44 BIZ Subdivision name MvL-b- i at G 'IrSubd. Lot # 2�- Date Subdivision Approved MAMCA 10 ZDC10 Owner /Applicant Name C"i N TH I A COOMi&S Town or Village Po-riJ PA V Tax Map -?Z o Block 1 Lot 23. '1- Renewal Revision Date of Previous Approval Mailing Address 0 i FeM �i A ce. LAKE DE�ICSItL hJd , Zip 0 Amount of Fee Enclosed y Cad Building Type (2cS:; 1,F-N°fj At_ Lot Area2z.. , No. of Bedrooms + Design Flow GPD S O V Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I i -e-g-0 gallon septic tank and 400 L • F. a6= -2,4 WOE ARIOP-PI-totJ 117?-E�caEss 92ace-A 4b 0, Other Requirements: Z.0 . f6. F J w Fb(Z Ca to D P ?-t � VA's ES IRAW 01 -TV 2 � To be constructed by RA L Y D nos' ¢ S'o . ,,Address FT. � ; C ot-b -CFPJ a1 Caj aXy Water Sup"I : Public Supply From Address Private Simply Dr�1ed by Ems, � {�Ot•) � •, - address:_ �ti-cc t �o I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment 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 repairs thereto. Signed: P.E. Address R.A. Date License # ato 2,r-V. r 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 anew pe 't. Ap ov discharge.of domestic sanitary sew; a only. By: -� Title: _ tl Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ LETrI ER OF RE: Property of Cynthia Coombs Located at T/V Philipstown Tax Map # Horton Hollow Road 72 Block 01 Lot 23.2 Subdivision of Westchester Holding Company Inc. Parcel H Subdivision Lot # 2 Filed Map # 2824 Date Filed 03/10/00 Gentlemen: This letter is to.authorize John P. Delano 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 matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. 'l Countersigned. . /u� P,E,, 062505 Mailing Address Badey & Watson, P.C. 3063 Route 9, Cold Spring State New York Zip 10516 Telephone: 845- 265 -9217 Very truly yours, Signed: (Owner if Property) Mailing Address: 11 Perry Place State NY Lake Peekskill Zip -10537 Telephone: 914 - 528 -1809 Form LA -97 BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, AC. C ' Date: 05 Sep -2001{ ep 2001 (845) 265-9217 (914) 62;-1800 (914) 739-3577 File No. 98-105 (845) 225-3312 FAX (845) 265-4428 W. 0. # 14343 RE: Coombs TO: Horton Hollow Road jAdam Stiebeling Westchester Holding Co, Parcel 2 Subd. Lot No. 2 i — Tax Map 72.4-23.2 Putnam County Department of Health Permit # I Geneva Road Brewster, NY 10509 Sent via: USMAIL ❑ UPS-NIGHT MESSENGER UPS-2 DAY ❑ PICK-UP ❑ UPS-3 DAY FAX ❑ ups-GRouN E) UPS-COD Cl We are sending: copies date description of document F_ 1 131 -Au -O I A lication Fee Ell Construction Permit for Sew F-11 I FL—etter of Authorization :at 2jfqr Approval of Plans for a Wastewater Treatment System Ell 23-Aug-01 [Short Environmental Assessment Form Ell 9__ Design Sheet 2 —3-, k u _1icatio_ � _to Construct 4 Water Well - ---- ----- - — ------ L____ I jFloor Plans F-4] Sewage Treatment System Sheet I of I REMARKS: Signed: John P. Delano, P.E. Copies to: File i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Cynthia Coombs 11 Perry Place, Lake Peekskill, NY10537 2. Name of project: Cynthia Coombs 4. Design Professional: John P. Delano, P.E. 6. Drainage Basin: Hudson River 3. LocationTN:. Putnam Valley 5. Address: Badey & Watson, P.C. Rt.9 Cold Spring, NY 10516 7. IyM of Proiect: X Private/Residential Food Service Apartments _ Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? TypeStatus( checkone ) ------------------------ - - ---- . Type Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? --------------- 10. Has DEIS been completed and found acceptable by Lead Agency? _ - - _ _ _ _ _ - _ 1 L. Name of Lead Agency Putnam County Department of Health Exempt Unlisted X No N/A 12.Ts'this project in an .area -under the control of local.planning, zoning, or other 13. If so, have plans been submitted to such authorities? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ No 14. Has preliminary approval been granted by such authorities? No Date granted: N/A 15. Type of Sewage Treatment System Discharge-------- _ _ surface water X groundwater 16. If surface water discharge, what is the stream class designation? ------------ _ N/A 17. Waters index number (surface) --------------- _ ------------ N/A 18. Is project located near a public water supply system? ------------------------ No 19.. If yes, name of water supply N/A Distance to water- supply >1mi 20. Is project site near a public sewage collection or treatment system? _ - _ _ _ _ - _ _ - No 21. Name of sewage system N/A Distance to sewage system >1mi 22., Date test holes observed 06/1.0/99 23. Name of Health Inspector A. Steibeling_ 24: Project design flow (gallons per ay ) -- ----------- - - - --- 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? --------------- N/A Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? Yes 28. Wetlands ID Number_ _ _ _ _ _ ------ NSA _' ... �_... ..y .�....... .. .- - -_ - -� - _ -- -�.... ..— -... alt. • <.�., -�.G' 2-Ra n�'it T'��..w. -_'T:� Permit 29. Is Wetlands 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/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ----------------- Yes/No No DESCRIBE: C) rn 33. Is there a local master plan on file with the Town or Village? --------------- 34. Are community water and/or sewer facilities planned to be developed within = 15 ears in or adjacent to o'ect site. ra''i Y J Pr' J �- - � ----------------------------------- 35. Are any sewage treatment areas in excess of 15% slope? `' 36. Tax Map ID Number ---- ---------------------- ---- -- Map 72 Block 1 Lot 37.3 37. Approved plans are to be returned to _ _ _ Applicant -X- Design Professional NOTE: All applications for review and approval of a.�new STS .to be jocatedwithiii . the NYC Watershed shall._. h scup to ire D ara incur,- auu need no -be seni in'aupi date co the DEP, aithWgh tine lkdject may require D P T approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from, DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant .shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA-97). 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 W. SIGNATURES & OFFICIAL TITLES. (Z Badey & Watson, P.C. Mailing Address: ------ -_ _ _ _ _ _ _ _ _ _ _ _ . 3063 Route 9 Cold Spring, NY 10516 PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..�.... _ w ... DESIGN DATArtSHEET - S �..�.� IJBSURFACE rSE'VVAG I RI,A7lv31 I" Y "��Ii2 11 Perry Place Owner Cynthia Coombs Address Lake Peekskill, NY10537 Located at (Street) Horton Hollow'Road Tax Map 72 Block 1 (indicate nearest cross street) — Municipality Putnam Valley Drainage Basin .Hudson Riv SOIL PERCOLATION TEST DATA Lot 23.2 Date of Pre - soaking 01/07/99 Date of Percolation Test 01/08/99 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water' Level Drop In Inches Percolation Rate Min/Inch A 1 10:21 10:41 20 19 — 22 3 7 A 2 10:42 — 11:02 20 19 — 22 3 7 A 3 11:06 11:27 21 19 — 22 3 7 4 — — 5 — — 1 10:24 10:44 20 19 — 22 3 7 ' 2 10.44- - ' -R:65- 2 1' 3 ... ;r. . J. 3 11:07 11:28 21 19 22 3, 7 4 — — 5 — — 1 _ _ 2 — — 3 — — 4 — — 5 — — NOTES: 1. „< Tests'ta bp,,"ed at same depth until approximately equal percolation rates are obtained at each Y� .ei; — r , yrco M101 est hole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be submitted.. 4 feview. 2. Depth eaiiiXeinents to be made from top of hole. Form DD -97 ;y. TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -_ ajP %_G r.. A.F'%Z G.L. 'topsoil Topsoil 0.5' V V 1.0' Sand & Silt Sand & Silt 1.5' V V 2.0 V V 2.5' V V . . 3.0' Sand & Gravel Sand & Gravel 3.5' V V 4.0' V V 4.5' V V , CD �''l 5.0' V V co') FM 5.5' V V 6.0' V V ` 6.5' V V S-1) �= 7.0' V V . a� 7.5' V 8.0' V 8.5' V 9.0' 10.0' Indicate level at which groundwater is encountered not encountered Indicate level at which mottling is observed not observed Indicate level to which water level rises after being encountered. n/a Deep hole observations made by: John P. Delano, P.E., Badey & Watson, P.C. Date 06/10/99 witnessed by A. Stiebeling, P.C.D.H. Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: va, P' Design Professional's Seal Cc �A 14164 (11/95) — Ted 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRC)NIVI1'�1E /�SiVli�l'iili: ° _ �_ �:: For UNLISTED ACTIONS Only PART 1— I*ROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT /SPONSOR 2. PROJECT NAME Cynthia Coombs Cynthia Coombs 3. PROJECT LOCATION: Municipality Putnam Valley County Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) See Map Provided 5. IS PROPOSED ACTION: ® New , • O Expansion O Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Single family residence, SSTS and well 7. AMOUNT OF LAND AFFECTED: Initially >1 acre acres Ultimately >1 acre acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes O No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential F-1 Industrial Commercial Agriculture O Park/Forest/Open space O Other Describe: Single family residences on 2+ acre lots 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMA i EL" i' Fitf�t5i `Ai�Ff'JTrici�^70:EF'.t; ?lEf T^el "GEtLr1' (FC! GEP�L,__. STATE OR LOCAL)? ®Yes O No If yes, list agency(s) and permit/approvals Putnam Valley building & driveway permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes NN. If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Oyes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: John P. Delano, P.E., Engineer for Applicant Date: Ln S Signature: ' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - ENVIRONMENTAL ASSESSMENT (To be completed by Anencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No - - - L'U`r:t�A FirGi� RECEifi L00r7�iF�71`r�cfFfL'ViENfAS F tOVIli 3 Ft�k`UIgL157� Ci°A TI ' IN 6 N fidR�PAR'f 617.6? If No, a negative declaration may superseded by another involved agency. ❑ Yes ❑ No 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: 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 C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. ® f r2 C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly. Y g� CZ 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 ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMEN A ? ❑ Yes ❑ No E: IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ' ❑ Yes .- .....r,J:No: - If.Yosrexplain- br'sefy 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 significant. Each effect should be assessed in connection With its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) 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 fart II was checked yes, the determination and 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. ❑ Check 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 siggnificant.adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Pint or Type Name of Responsible Officer in Lead Agency Tale of Responsible Officer- Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES __......,.....a .. DESIGN DATA SHEET - SUBStWACE SEWAGE w: .: - .•.- ::. -:. _ t , ' TREA`Y'7VI�C� f SYSTTi l' Owner Cynthia Coombs Address 11 Perry P4 lake Peekskill, NY 10537 Located at (Street) Horton Hollow Rd. Tax Map 72. Block o1 Lot 23.2 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 — — 2 3 — — 4 — — 5 1 — — g 3 —. — 4 — — 5 — — 1 — — 2 — — 3 4 — — 5 — — NOTES:. 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1 -30 min/inch, < 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 - TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G.L. Fine Sandy -Silty Loam 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' y 4.0' Fine Sandy Loam w/ Gravel 4.5' I 5.0' . 5.5' 6.0' I 6.5' 7.0' I 7.5' I 8.0' v 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered None Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered N/A Deep hole observations made by: RAY - Badey & Watson, P.C. Date 10/3/02 Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TTt Al'1V1L1V 1 •S YSUVIVI Owner Cynthia Coombs Address 11 Perry P1 lake Peekskill,. NY 10537 Located at (Street) Horton Hollow Rd. Tax Map 72. Block o1 Lot 23.2 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin.. Hudson River of Pre - soaking SOIL. PERCOLATION TEST DATA Date of Percolation Test Hole No. Run Time Start - Stop Elapse Tim a (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches /ermciolation e ch 1 — — 2 — — 3 — 4 — — 5 1 — — 3 4 — — 5 — 1 — - 2 3 4 — — v. f " '•.t NOTES:••,• l]' :ts to`1ie reputed at same depth until approximately equal percolation rates are ob ed at each xcolation testlole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All to be 4` x" h't • .F y ' s iikteil for:Tenew. b 2,?ept1 f}ieasuerients to be made from top of hole. * °• Form DD -97 JEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ;,. C IT-T -",r:^ DFF�T H T E, ern 3 G.L. 0.5' 1.5' 2.0' 2.5' 3.0' 3.5' .4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.51 8.01 8.51 9.01 951 10.01 R.O.B. Indicate level at which groundwater is encountered None Indicate level at, which mottling is observed None Indicate level to which water level rises after being: encountered N/A, Deep hole observations made by: Rav , B&W;J. Paravati - PCDH Date 10/10/02 Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: Design Professional's Seal I LIJ. f4i i A S I