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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -39.2 BOX 28 r6 r I,` `, • I ,fir -� - I +� 03470 PUTNAM COUNT'S DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH- SERVICES ; F SUBSURFACE SEWAGE 'TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Location - Street Tax Map Block Lot Town/Vllage Subdivision Name Building Type SubdivisionLot# 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 thel'utxaain County Department o��i�ealth, and n a•:a 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 oithebuildinguti�iirngthe system.- _:r.:... , 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 ar negligent act of the occupant of th uXU%VL% u i n� n %t11�e system. /.-- -� Dated: Month — Day,�Le Year Si /—.1I. u f'A/ 0 �✓ � rv.S % � ��' Title. � 11 X� General Contractor (� wner - Signature �- orporation Name (if corporation) Corpoxation ,ame �if corporat�oZi Address: ���' Address: S ` . �d'` >� State Zip i J ' State Zip -L J ,p . F(3m OZS-91 ' YML ENVIRONMENTAL SERVICES 321 Kear Street o Heights, N.Y. 10598 _ ' Heights, Albert H. Padovani, Director � LAB #: 32.300551 CLIENT #: 56296 NON STAT PROC PAGE I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~°~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~°~~~~~~~~~ SABIT89 FRANK & PHYLL% 194 WEST SHORE DRIVE PUTNAM VALLEY, NY 10579 DATE/TIME TAKEN: 01/24/03 12:30 DATE/TIME REC'l}: 01/24/03 03:10 REPORT DATE: 01/31/08 PHONE: (518)-851-7851 SAMPLING SITE: 221 CHURCH RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE CQL'D BY: FRANK ORLANDO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/24/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01/24/03 LEAD (IMS) <1 ppb 0-15 ppb 9101 01/24/03 NITRATE NITROG 0.61 MG/L O - 10 9139 01/24/03 NITRITE NITR8G <0.01 MG/L N/A 9146 01/24/03 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 01/24/03 MANGANESE (Mn) 0.017 MG/L 0-0.3 mg/l 2037 01/24/03 SODIUM (Na) 8.72 MG/L N/A 01/24/03 pH 7.3 UNITS 6.5-8.5 9043 01/24/03 HARDNESS,TOTAL 148 MG/L N/A 01/24/03 ALKALINITY (AS 112 MG/L N/A 01/24/03 TURBIDITY (TUR <1 NTU 0--5 NTU CD r� COMMENTS: ca on --c. BACT THESE RESULTS INDICATE`THAT THE WATER (WAS NOT) OF A ^�c� SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATEN AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS / cn TESTED, AT THE TIME OF COLLECTION. an Pb/Cu LEAD limits for public schools are set at 15 ppb. co LA EPA Lead & Copper Rule for Public Systems requires that no mop o-{ than 10% of their distribution points have a LEAD value of moeV than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. ' Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet' a maximum of 270 mg/L of Sodium PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT �1U- �1C•4�`+dY1e`ir4'11°r -: w:i..� �r.r�ry„¢a~ i-,•, i��•J:�.`... {•. d :.fa i1uNc'T•�K . � ` �� +� i•+.�T;:.ii�..� :_ �- :n.�..: :.�i -: r'•.: �.n :.fw. �i ap` )hlock j Lots) ,z Well Owner: e: Add re Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing �' Open hole in bedrock Other u Casing Details Total length ,_ j r ft. Length below grade 'qft. Diameter in. �� Weight per foot alb /ft. Materials: Lf Steel Plastic _ Other Joints: , _ Welded �fhreaded — Other Seal: x Cement rout _ Bentonite Other g Drive shoe: Yes No _ Liner Yes ,<No Screen Details Diameter (in) Slot_ Size Length(ft) Depth to- Screen (ft) . Developed? First Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield -ZO gpm Depth Data Measure from land surface- static (specify ft) -36 During yield test(ft) - Depth of completed well r in feet 3 Well Log If more detailed information descriptions or sieve analyses are avatlabie, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5,vt -c- Capacity f Depth -3ng Model Vr©'? -i € Voltage - X3 o HP Tank Type 2- Ao L Volume Date Well Completed � It) Y" Putnam County Certification No. % Date of Report / . d 3 Well Driller (signature) 1 1, - �- s ---' � &• wI �i..l NOTE: Exact location of well with distances to at least two permaner�lanoarks to be provided on a separate sheet/plan. Well Driller's Name . Cam- Address: Signature: �_���.�,�, ---- Date: .� White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 a Ii A 6- '6 f N 0F3 c R/ y N a K 1 H CERTff FICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM Maggel,!"'� PCIIID CONSTRUCTI ®N PERMIT' # /� � %2 Located at �� `� r;/��'t Town or Vil ' Owner /Applicant Name �il Tax Map �° %� Block Lot372- Formerly Jel e Subdivision Names/ Mailing Address "Pa./3 / f5l, Date Construction Permit Issued by PCHD Subd. Lot # P'- 2 - Z-1 d 2- Selgarate Sewerage _System built by Address Consisting of Gallon Septic Tank and ,5 -Gy Other Requirements Water Supply: Public Supply From Address Zip 01°: �' Private Supply Drilled by e'" ae � 41c.,,-�,- gAddress �- t °�' �• �'' b�' crosinn , ^.� ,rni Pen , n.o fP ? 0 r' a� ... n`_ �'_. -, -- - ple. d. Number of Bedrooms Has garbage grinder been installed? W& 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 ed PCHD Construction Permit and approved plans and the standards, rules and regulations of the Pu (14 artment of Health. Date: 2— Certified by d` z'--� s� P.E. R.A. AdZlress License # '-5"� Any per��h occup}g prerruses served above s e ptly 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. Ass, 5-� �- Pub i; By; Title: ` e ex Date: Llq�o bt ite copy - 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 �;.. .4...m «,. ...,- .�.�.r• ✓° .- ..... n:..:' r::... r" �:%. r: a��.+ n�• r. �ne�..:.: r.: a' mwio-Ja '..n'�C:,:�:.e:- :.'.::':..i.,,; .. ... -.7�. . _ _ r. ...:.r�� ... •.il�j�:'�:�'w�t.�:;�.^ =• .: LETTER OF AUTHORIZATION . RE: Property of Located at T/V /✓ Subdivision of 1g, If Block Subdivision Lot # Z Filed Map.# Date Filed le/I9 12oe % Gentlemen: This letter is to authorize LGi�I� a duly licensed Professional ngineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers. on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health ,.•(lAl 't1Y1J • u�tlkill �131M�j' �.iia ►_J '�' wv." . � I.t .. . .. t. >.. .. Countersigned: r - -P;E., R.A., # ;9 -Y Mailing Address r Very truly yours, Signed: l (Owner of Property) r Mailing Address: d' A �SS- State a_5 State Zip Telephone: y Telephone: s- •sue' -����' T Form LA -97 Public Health Director L UR: i iii viol 11°, i..V., Associate Public Health Director Director of Patient Services DEPARTMENT CAP BEALTH 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 Fax (845) 278 - 6648 February 6, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 0 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Proposed SSTS - Rush, Church Road (T) Putnam Valley, Tax Map # 73.18 -1 -39.2 Dear Mr. Sullivan: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Design data sheets must be signed and sealed by yourself as the design professional accepting the work of others. v42. 100% of the required primary trenches (500 l.f.) Have not been provided on the SSTS plan. 3. Complete contour line 178' on the SSTS plan. Complete nli noie 2 on shed 3 reievarii to ROB depin and vuiuine. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj Vii. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES, iN CE SEWAdtWkATMENT SYSTEM UAL A: ft Owner Frank Rush III Address Church Road/Kramers. Pond Road Located at (Street). Kramers Pond Road Tax Map7.3 :18 3 lock 1 . Lot 39 (indicate nearest cross street) 4 Municipatity Town oi-: Putnam valley Watershed. Hudso=,,,---- SOIL PERCOLATION TEST DATA Date of Pre - soaking i 7.1 i 00 Date of Percolation Test '.47-1—.-, :Depth From G W 01, �;Tiercdla ot :> Time '-Z a se Time .:�,Surface:-:Q. W:, S' Milo Hole No.. }a eta Rate :::Rua No*". 4 1 9155- 10:3'5 40 172 204 2 3/4 14.5 2 10:36 -11:0 30 172 19 3 .2 ;4 13.3 3 p,N C 4 1. A 5 1 9.57 -10 -2, 17 20 3 2 10 17 20 3 9.7 3 4 5 6 1 9:139-10:06 7 17 3/4-20 3/4 3 2.33• 2 10:07-10:161 9 17 3/4-2.0 3/4 3 3 3 10:17-10:26 9 17 3/4-20 3/4 1 3 4 5 NOTES: 1. Test's to be repeated at same depth until approximately equal percolation. rates are obtained at each percolation test hole. (i.e. ig• I min for 1-30 min/inch, -5 2 mir, 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 Indicate level at which groundwater is encountered gone _ ... .........._..._._..--- -._.._ ____._....------ ._.__._. Indicate level at which mottling is observed None Indicate level to which w ter level rises after being encountered - Deep hole observations made by; Arthur D Angelo, P. mate . Design Professional NamL. , Gro h Lo it)3erwirth, P. ° Address: p Commonweal. Engineering 10 Lincoln Lane Si mature: dgef `eld,ACT 06877 Design Professional's Seal y' IS C. r�A' ' 48.40 . ,�� TEST PITT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES ° UEPTH HOLE M. ", C HOLE N0. n ,: r%„ ,'sy%v .r' -r:. r C;i�, � ... � 4���i � -'e.Cr1.. � v iJ y 1�:,.:1 r;.,' -r �%G•.,..w.- l- ., ti j�sC) p .�. U�3^i�.i` r n -...:.y....a.;.»..'.�:. ��+±.« °•�:•r!^�+'CC�• - ham. � �:' -«-� �...�::.....�.:.�.,'. 0.5' 811 Brown-Silty Loam 811 Brown Silty L.o4m 1.5' 2.0' i 24 Brown Coarse - Silt with Dearading 321, Brown Coarsg flock Silt with Decrr.��3�ng 351 r Rack 4.0' 4.5' 6 5.0' 5.5' of rts�;, G a . 6.0' co�P 7.5' mow. 8.5' 9,01 .. � ..i ��- t-t.��f V>_ -. .. ... ra.. c � - v. .. ✓�. _[ I - v _ -.. .. ... .. -. ... ... .: i. __e .s ... ... .e... .. .. ,. w..n° W -.�� � �...t.,, _.� .. >...... ..w Indicate level at which groundwater is encountered gone _ ... .........._..._._..--- -._.._ ____._....------ ._.__._. Indicate level at which mottling is observed None Indicate level to which w ter level rises after being encountered - Deep hole observations made by; Arthur D Angelo, P. mate . Design Professional NamL. , Gro h Lo it)3erwirth, P. ° Address: p Commonweal. Engineering 10 Lincoln Lane Si mature: dgef `eld,ACT 06877 Design Professional's Seal y' IS C. r�A' ' 48.40 . ,�� TEST PIT DATA HOLES - DESCRIPTION OF SOILS ENCOUNTERED IN TEST H - Dr'-_'P T H 7 G.L. Topsoil Topsoil Topsoil 81, Brown Silty Loam 811 Brown Silty Loam 8-11 Brown Silty Loam 1V 1.5` 2.0' 25 10; 3.5, 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 8.01 85 9.51 2 161, 'Brown Coarse-•Silt 241, Brown Coarse with Degrading Rock Silt with Degrkldi-)ig.. Rock 6011- Qkay Sandy Silt Loam !'Hardpan 6611 .......... . ....... ..... .... - ----- 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 Deep hole observations made by: Arthur D'Angelo, P.E. Dete Des ign Professional N aj e: Joseph L..Bierwirth, P.E. Address: commonweal Engineering 0 6-0 7 10 Lincoln Lane Signature: dggrield,ACT 06877 Design Professional's Seal 4'. 4,": 4 0 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST FILES ..pp '_�iibn!rnss.. v+.xK.r i .� °.. tC. �i4:�; F:'�� rv^eS -�.r- ro�S- ��•'.*' To Soil -- - TOPsoi1 0.5' 1.0' 8" Brown Silty Loam 8" Brown Silty. Lo Y AandY Loam 1.5' - aVe1 2.0 24" Brown Sand 2.5', -aV� ' 3.01 35 4.01 ZL Gray nd 4.5' Graver I 1 -- 5,0 60" Brown Silty Loam 55 with Ddgiading Rock 6.0' Hardpah 72„ 7.2,x, .ija:rdp.an 6.5' 7.0' 8.01 8.51 a <f 9.01 1� �.t 1ndic:ate 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 --- Deep hole observations rhade by: Arthur D' Angelo, P. E .. Date lo. /�`�.1 Design Professional Name e: L. Bi erwi rth, P.1E . Address: Commonweal Engineering / 3 10 Lincoln La- uc V. dgef ° 1d, CT 06877 74 � f:. x � Signature , . , _µ .r d Design Professional's Seal U Indicate level at which groundwater is encountered None Indicate level at wh.16h, rnottlbi is observed None Indicate level to.which wateflevel rises aft' -being encountered .. . _. . I., er Deep hole observatio-nOlmade by . Arthur, VAngpelo, P.E. Date 10/17/00 Design PfofeWonal N" .41np JQ5eRhL. B =with, P.E. Address: C im t I in a 1,0 TAinrri1r) g�dieXlca, CT 06877 Signature: 1 ,n 1A 4,'4} Design Professional's Seat TEST PIT DATA 2 DESCRIPTION OF SOILS V T_ DEPTH HOLE NO. I HOL NO HOLENO. G.L. To Tom 0.5 4' Sanly/Sitty Lq=_ 4" Sib L 1.01 1.51 18" QaAy Loam 2.0' 24" Silty Loam me Clay 2.5 3.0' 3.5' 4.0' 4E Silly Loa 4.5' DokzdWR R c 5.01 60" BrownU Lom 5.5 6.0' 6.5' 7.0' 4" INVP 7.5' 9,DNN C /,V 8.Q' V 9.01, 61 MWI 9.51 10.01 Indicate level at which groundwater is encountered None Indicate level at wh.16h, rnottlbi is observed None Indicate level to.which wateflevel rises aft' -being encountered .. . _. . I., er Deep hole observatio-nOlmade by . Arthur, VAngpelo, P.E. Date 10/17/00 Design PfofeWonal N" .41np JQ5eRhL. B =with, P.E. Address: C im t I in a 1,0 TAinrri1r) g�dieXlca, CT 06877 Signature: 1 ,n 1A 4,'4} Design Professional's Seat ` PUTNAM CO UNTY DEPARTMENT OF HEALTH A ' 01VISION OF ENVIRONMENTAL HEALTH SERVICES S 13 ICJOX. E SE'W'AGE TREATMENT SYSTEM Owner Frank Rush III Address Church Road /Kramers Pond Road Located at (Street) . Kramers Pond Road Tax Map73 :18 31ock 1 Lot 39, 2. (indicate nearest cross street) Municipality Town of Putnam valley Watershed Hudson SOIL PERCOLATION TEST DATA Date of Pre - soaking ► 4l d cx Date of Percolation Test i 2.11 ! fl d NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 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 Depth.t`o'Water. , ater F. om r n r G ou d -e L vel :: Percola ttan No. Time : ::E1a a Fime Surface:(Inches) DroppIn . . ate Hole Run No:::: Start :Sfop Min:) Start Stop %ncies MinfIncit . 4 1 9:55 -10:35 40 172 — 204 2.3/4 14.5 2 10:36-11:06 30 172 — 19 3/4 24 13.3 3 4 5 5 1 9: 57-10: 24 27 17 — 20 9 3 �pNC 4� sA 4 C N _ 0 5 ? 895 6 1 9:59 -10:06 7 y17 3/4 3 2.33 2 10:07 -10:16 9 117 3/4 -20 3/4 3 3 3 10:17 -10 :26 9 !17 3/4 -20 3/4 3 3 4 5 1 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 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 n TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 DEPTH HOLE NO. C HOLE NO. D HOLE NO. .s ;. w" �1.. �'.. �r�?'..,w rei•: ��:.t �,: �:..' �L�` Yi��i. 1' �i: qr: ��-. ��:. 4.: C' i�:::.: xd' vr�r��Lu�l�7 .�1�s'��:::.:L.:L�.�..�f ?.:�.d. .c= - .4%;<- .��':7:�_.::,:�. ...._..::���..w.:'�Y•,.�.•r 0.5' 1.0 8" Brown. Silty Loam 811 Brown Silty Loam .1.5' 2,0' 24" Brown Coarse 2.5' Siit with Degrading 3211 Brown Coarse 3.0' Rock Silt with Dearading 3.5' Rock 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7811 7.0' 84" 7.5' 8.0' 8.5' OF NEk, 9.0 ��P IN C s 9.5' w r 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 - =- Deep hole observations made by: Arthur D ! Angelo, P . E . Date (X/60 Design Professional Name: Joseph L. Mierwirth, P.E. Address: Commonweal Engineering �� -,�3 / -O5"S 3 10 Lincoin Lane Signature: idgef�ield y7CT 06877 :Design Professional's Seal I( n... ` f 48407 b� 4r q .k,: ��? •Kjf:, �$ T r SY. i,..' 4ii.; Y�l. �jy '4�.Y ;�.'!d';lf..,'.4.7�1t!X14. 1;'�• 11+ 7' i TEST PIT DATA DESCRIPTION OF SOILS ENCOUM ERED IN TEST HOLES 2 DEPTH. HOLE NO. 7 HOLE NO., A HO_ LE NO B p �V1 �•• �. - opsoil .. ai+lts- .- :i':j^T J:f� :an;r2 -O♦ tiGiwj: ?a \til;ri 4�.iis'::�- .'T-T :!nQ/4: .Y. ": a.Mb. -(YK.s 6c(i: -w> _. �. _i 1- -tt.W "aJ l> .i✓L i7h�. \�.= .ryii'Sl.. ;Topsoil Topsoil 0,5' 8" Brown Silty Loam 8" Brown Silty Loam.8" Brown Silty Loam 1.0' 1.5 16" Brown Coarse Silt 2,0' 24" Brown Coarse with Degrading Rock 2.5' Silt with Degrading 3.0' Rock 3.5' 4.0' 4.5' 5.0' 60" Gray Sandy Silty 5.5' Loam Hardpan 66" 6.0' 6.5' 7.0' 84" 7.5' 8.0' 8.5' _ 9.0' w� I 9.5' �. ' C o a .._.......� ..n .s ... �..� .h ..- .....� V. -. ._. ..F. ---, .... -.. � _�...�_'_ ^� .. �. ..- ._..,... .. � �.�-- �- •- -.+... ` ?4895 �-.S 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 - -- Deep hole observations made by: Arthur D' Angelo , P.E. Date Design Professional Name: Joseph L. Bierwirth, P.E. Address: Commonweal Engineering ( �� `Zv L3 0!570 10 Lincoln Lane Signature: RidaOfield,,,CT 06877 Design Professional's Seal �A \;;4u! II TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES N DEPTH HOLE NO. 4 HOLE NO. 5 HOLE.NO. 6 :a- .- ?�.�- __..._ :_ � ..�. G.L. _ r .'�1�i.T- i- •:6�:riri -.. ,.+- "...�i� a..�a`r _ '.. •....:.._v:..1r.- '�.._'.� - -,..� .,.-�. .� _.:: i`r ;S��:�. «�n`.. ..•...n.:...,.. ..r •. Topsoil Topsoil TnpGnil 0.5' 1.0' 8" Brown Silty Loam 8" Brown Silty Loam 8" Silty Sandy Loam 1.5' - _ 1H" arow„ Sabel gavel 2.0' 24" Brown Sand & 2.5' Gravel 3.0' 3.5' 4.0' 4811 Gray Sang] � 4.5' Gravel 5.0' 60" Brown Silty Loam 5.5' with Degrading Rock 6.0' Hardpan 72 7211 Hardpan 6.5' 7.0' 7.5' i 8.0' ". ".�.. 8.5' W� 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 - -- Deep hole observations made by: Arthur D' Angelo, P. E. Date 10/17/00 Design Professional Name: Joseph L. Bierwirth, P,E. Address: _ Commonweal En ineerinq dgefipld, CT 06877 Design Professional's Seal p ^rc� Cl e G TEST PIT DATA 2 Cpy- `. ♦`P.I ^:� ;1re .'U7 DEPTH IO]✓E NO. 1 G.L. To soil 0.5' 4" Sand Sil Loam 1.5' 18" ClayA Loam 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 60" Brown Sil Loam 5.5' 6.0' 6.5' 7.0' 84" 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' NO. 2 HOLE NO. 3 Topsoil M 48" Silly wi De ra c 84" 8" Sil Loam 36" Silty Loam with Degrading Rock and Gravel 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 Deep hole observations made by:_ Arthur D'Angelo, P.E. Date 10/17/00 Design Professional Name: Joseph L. Bierwirth, P.E. Address: Commonweal Engineering Signature I PUTNAb1 COUNTY DEPARTMENT' OF HEALTH DMSION OF ENVIRONMENTAL HEALTH L• MIVIDUALWATERSUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS n REVIEW SHEET FOR CONSTRUCTION PERLN117 STREET LOCATION: REVM7,'ED BY: M OR, AS, &ATE: TAX IYIAP': (CONFIRMED) q2 , b — ` — :? 7 - ^� Y Nk DOCUMENTS 'Y N (REQUIRED DETAILS ON PLANS CONT'D) U< (�PERtiIII APP LICATIO;i (_)HOUSE SEWER -'J." FT. 4 "0'; TYPE PIPE CAST IRON (of )UjNtiYLL PER= ORPWS LETTE (c::::fL)NO BENDS; BENDS 45° W /CLEANOUT C[)UP C -97 RENEWALS (,e)L )LETTER OF AUTH RIZ ON - U(_ jSIIE NoT t'0 CHANGE) �!(L)UDESIGN DATA S T DS)�� s`� LL S-yalEINTS L ORPORkTE RES Oi�i ie •, HO AL PAST TRENCH SLOPES 3 1 TO GRADE (f)(_JSHORT Ea (,/ _) (_)PLA`iS- THREE SETS (Z(__)HOUSE PLANS -TWO SETS U(_WARLkNCE REQUEST SUBDIVISION L,<)LEG_AL SUBDIVISION �SUBDIVISIO \APPROVAL CHECKED PERCRATE (l}(__)FILLREQUIRED C DEPTH L_)L,JCURTALN'DRAIiti REQUIRED GENERAL LOCATED Lr NYC WAIZPaHD L-) ff ff TO DEP (G) • "SPECS / FILL•'NOTES +=s o2 ^Y : ( FILL PROFILE ,& DwAggsi l S ! ` ©� (_)UFILL Di EXPANSION AREA FILL GREA TER FEET kY BARRIER /UJ 44 F L CER ION NOTE UUDE GES UUV N PLAN FOR RO.B.,UNCLASSIFIED & IMPERVIOUS (r j EPARA ION DISTANCE FROM TOE OF SLOPE � • RENC&PROVIDED�3 l 60FT 14IAX. PARALLEL TO CONTOURS t�(�100 °Jo EXPANSIONS PROVIDED: f���DEP APPROVAL, IF R @'D w (,- l"DETAWUST FREE CRUSHED STONE ORWASHED GRAVEL (:(�GEOTEXTILE COVER (_)DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM MS �(�PERCS TO BE WIII�SSED l �� UU10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL E - PROV? L SSDS ADJ, LOTS �)20 TO FOUNDATION WALLS _ (� TLANDS (IOWNIDEC PERMIT REQ'D ?)" " ' TO WELL, 200' IN DLOD, i50' TO PITS (•DATA ON DDS PLANS & PERMIT SA14LE /(� 100' TO STREAM, WATERCOURSE, LAKE Cm- ezpaa) (_ j( RE 1969 NEIGHBOR NOTIFICATION (50' TO CATCH BASIN, 35' STORNIDRAIN, PIPED WATER U)U TTERBUZBA 0C 'r0.WA'FFRLL?`n`(piG'20') . _.. 100 YR FLOOD ELEVATION w!i 200' . Ijai AGE COURSE (�C.0 - _..;...�::. -Sd'u: TES?' r`?: r:. i.C:S:•lO�fEi�Oi',D'....__...�- —•- 200' 1500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REOUTRED DETAILS ON PLANS (�(j10' NIIi`I TO LEDGE OUTCROP (_ . SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK U SSDS HYDRAULIC PROFILE uKJ10' FROM FOUNDATION; 50' TO WELL GRAVITY FLOW WELL (� CONSTRUCTION NOTES 1 -15 �-��LOCXTION DLNIENSIONS TO PROPERTY LINES -- ' -=- -' - -- -' _......_ DESIGN DATA: PERC & DEEP RESULTS OF SERVICE CONNECTION 2' CONTOURS EXL5TI�IG & PROPOSED - __ — 1IIY 15' TO PROPERTY LINE i DRIVEWAY & SLOPES, CUT _. SLLORyd /e jFOOTMG /GUTTERXURTAIN DRAINS ,U( _) IN SLOPE SSTS AREA 066 (920 %) (�tJUSDA SOIL TYPE BOUNDARIES • (,_ )(4 REGRADED TO 15 %, IF REQUIRED ((_)TITLE BLOCK; OWNERS NAME ADDRESS DOSE/PUMP SYSTEMS Tbi g, PE/RA, NA YIE, ADDRESS, PHONE E—JDATUM DATE OF DRAWING/REVISION Yl NOTES ( REFERENCE Si 75% OF PIPE VOLUME/DOSE VOLUME NOTED (, J_JLOCATION OF WATERCOURSES, PONDS IL FOR FORCE MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. ND D -BOX SHOWN & D ETAILED ( )PROPOSED FINISH FLOOR AND STORAGE ABOVE ALARM DRAIN BASEMENT ELEVATIONS CURTAIN ' Qt/�WELLS & SSDS'S WAN 200' OF SSTS (-- )L—)ST� S, S' BOTH SIDES, DETAIL )(__)PROPERTY 11ETES &BOUNDS UU15' NIIN CDS = >S %, 20'-4%,25'-3%,35'-l%, 100 %-�l% UU20' 141 to ISCHARGE/100' with 182 cons day discharge (_ jU10' h to NON•PERFORATED PIPE COMMENTS: �n �, ' a_�' - - (REVSHEET) PUTNA.M COUNTY DEPARTMENTOF HEALTH ° DIVISION OF ENVIRONMENTAL HEALTH SERVICES .:Wr. icj':'�z ....+irs:, :. .:rh. ,. ...•. e,F_ • :.�.•1'�r-...,t,,, .. .3':.„;,;., A'I MENT SYSTEM Owner Frank Rush III Address Church Road /Kramers Pond Road Located at (Street) Kramers Pond Road Tax Map73.'.' 18- 3lock 1 Lot 39.2. (indicate nearest cross street) Municipality Town of Putnam valley Watershed Hudson SOIL, PERCOLATION TEST DATA Date of Pre - soaking 1 l d CC') Date of Percolation Test i Z(12jfl 0 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 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 Depth to Water mater 3 From G ou d 1F om r n L eve e Percola i n ha Mole No No. Time Start Ia se Time Surface (16cbes) Start stop )EDrop:In Inches Rite. 1Viin/Incli ;Run n:) 4 1 9:55 -10:35 40 172 — 204 2 3/4 14.5 2 10:36 -11:0 30 172 — 19 3/4 24 13.3 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 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 3 4 5 5 1 9:57 -10:24 27 17 — 20 3' 3 - 2 10.26- 10.55 .29 17 — 20 9.7 3 5 6 1 9:59 -10:06 7 17 3/4 -20 3/4 3 2.33 2 10:07 -10:16 9 17 3/4 -20 3/4 3 3 3 10:17 -10:26 9 17 3/4 -20 3/4 3 3 4 5 T_ NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 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 TEST PIT DATA 2 DESCRIPTION OF SOILS IENC,- 01INTk;RFtI? 1!N T-ES'!!':uOL&'S,_ .,. :.: .. n & - DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' NO. 1 HOL NO. 2 HOLE NO. 3 To soil Topsoil I W 8" Silty Loam 36" Silty Loam with Degrading_ Rock and Gravel 84" Indicate level at which groundwater is encountered None Indicate level atwhich mottling is observed- None Indicate level to which water level rises after being encountered Deep hole observations made by: Arthur D.'Angelo, P.E. Date 10/17/00 Design Professional Name: Joseph L. Bierwirth, P.E. Address: _ Commonweal Engineering f� dge d, CT 06877 ► s Signature: Design Professional's Seal TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ..DEPTH . _. ve ^I-r_ . Ti •b'isC•+^ t�v r.HOLE.N.O. HOLE NO. .r.. 5 . ,•4tt h.r_ 'ty ,�.-. HOLE NO � .r la T ._ 71.E o - i_l.'S � a r + .,.�.. ^. �. �. ^C� C G.L. Topsoil Topsoil TopGOiI 0.5' 1.0' 8" Brown Silty Loam 8" Brown Si1ty.Loam 8" Silty Sandy Loam 1.5' - 1611 Brawn SahA 8 r_. -avel 2.0' 2411 Brown Sand & 2.5' Gravel 3.0' 3.5' 4.0' 48" Gray Sand & 4.5' Gravel 5.0' 60" Brown Silty Loam 5.5' with Degrading Rock 6.0' Hardpan 72" 72" Hardpan 6.5' 7.0' 7.5' 8.0' 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 - -- Deep hole observations made by: Arthur D' Angelo, P . E . Date 10/17/00 Design Professional Name: Joseph L. Bierwirth, P:E. Address: Commonweal Engineering 10-1 10 Lincoln Lane dgef ifld , CT 06877 4 �itUl Design Professional's Seal s o TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 DEPTH HOLE NO. 7 HOLE NO.. _ A _ _ __ HOLE NQ; B t'-'_ .. _.. �:.. _•. Z .-... }. .r- _rLT_ G^ _.�' -mac= -. ._. _ ... 'air. 'c. r::y; ..n _ .. . -. 7...y.:..b ... _ G.L. Topsoil Topsoil Topsoil 0.5' 811 Brown Silty Loam 811 Brown Silty Loam 8" Brown Silty Loam 1.0' 1.5' 161, 'Brown Coarse Silt 2.0' 24" Brown Coarse with Degrading Rock 2.5' Silt with Degrading 3.0' Rock 3.5' .4.0' 4.5' 5.0' 60" Gray Sandy Silty 5.5' Loam Hardpan 661, 6.0' 6.5' 7.0' 841, 7.5' 8.0' 8.5' 9.0' 9.5' �_. .. - 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 - -- Deep hole observations made by: Arthur D ' Angelo, P.E. Date /v Design Professional Name: Joseph L. Bierwirth, P.E. Address: Commonweal Engineering n Signature: 10 Lincoln Lane idcgoTield,,,CT 06877 Design Professional's Seal 4 4/� F TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES . DEPTH HOLE NO. C HOLE NO. D HOLE NO. �rops'oi -,T�: -�. LYR'T. II'S�'lJ .. i�.L~an >rT. M-s•i.- .'VY ". �.w _`L -.r3R. J. 1ops�oi`- 0.5' 1.0' 8" Brown Silty Loam 8" Brown Silty Loam 1.5' 2,0' 24" Brown Coarse 2.5 Silt with Degrading 32" Brown Coarse 3.0' Rock. Silt with Degrading 3.5' Rock 4.0' Q 4.5' 5.0' 5.5' 6.0' 6.5' 781, 7.01 84 7.5' 8.0' 8.5' 9.0' - '.y.,-° ..«e- �..e-, -.+ cz• =ss:.,.;..o .. -..,. .-._ >..._..... �.. .. a ..._ .._ v.._ .. ^.•y+.� ...- ....« - .ero.e...mc -e.. .. . 10.0' Indicate level at which groundwater is encountered - Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered - =- Deep hole observations made by: Arthur D' Angelo, P.E. Date <! i Design Professional Name: Joseph L. Bierwirth, P.E. Address: Commonweal Engineering 243'`�3i -aSS3 Signature: 10 Lincoln Lane dgef,Zeld OCT 06877 Design Professional's Seal J�� r, r.•.I�.v�`1Li co `\ .`4 4Vf PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OP' ENVIRONMENTAL HEALTH SER'VICES' °::.y.: = - =:- � "" `''.'rI✓CA'L'101�1 'OR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: " 7 2. Name of project: S 3, Location T ail 4. Design Professional:� 5. Address: 6. T„y e of I ro ect: 'rivate/Residential Food Service Commercial M_ Apartments Institutional Mobile Home Park �V Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? A/a Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required'? ......................... Mk 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10, Nance of Lead Agency 11. - Zfihis project is.ar� �t�� un�ier�tlie ot7'�ri1 �� ^l rl -rlan i g, 0 other r n ,� c . -mss , i ..._.. _ afficials,�ordinances? ............................ ............................... �-s •I 12. If so, have plans been submitted to such authorities? ....................................... ---> 13. Has preliminary approval been granted by such authorities ?, ��Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water i- ' groundwater 15. If surface water discharge, what is the stream class designation? 16. Waters index number: (surface) ......................................... ............................... 17. Is project located near a public water supply system? ............... I...................... 18. If yes, name of water supply ..-T Distance to water supply 19. Is project site near a public sewage collection or treatment,systern? ................ A 20. Name of sewage system 1. Date test holes observed of 22. • Distance to sewage system Name of Health Inspector QLe Form PC -97 e L 3. Project design .flow (gallons per day) .... yvv State�l'otfdidnt'Dischargt Elimination System (SPDES) Permit required ?... Ald 5. Has SPI -XIS Application been submitted to local DEC office? ......................... b. Is any portion of this project located within a designated Town or State wetland?—A-2 7. Wetlands l.D Number............ 8. is Wetlands Permit required? ................................. t........................................... 1010 Has application been made to Town of Local DEC office'? ... ... I. ... I ................... 9. Does project require a DEC Stream Disturbance Permit'? .. ............................... A1� 0. Is or was project site used for agricultural activity involving applicLtion•of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .. Yes/No 4 1. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfall, sludge disposal site or any other potentu l known source of contamination? . Yes/No 'Ale DESCR11:31 ": Is Cher: a local master.plan on. file ,vith the Town or Village`? ......................... AlU Are community watt ?r and/or sewer facilities planned to be, developed within 15 years in or adjacent to project site? ................................ ............................... "% ar-,y.stwage, treatmeyit areas in excess of 15 %s1l ope? .............................. Tax Map ID Nurnber .......................... ............................... MapV,. / ,FBlook / Lot 39 Approved plans are to be returned to ..... __ Applicant _ k-*4 Design Professional the application is signed by a person other than the applicant shown in Item l .,the application must accompanied by a Letter of Authorization (1 onn LA -97). Failure to comply with this provision ry be grounds for the rejection of any submission. Ihereby q/ under penalty of perjcrry, that injbrrnation provided on this form is true ro the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. :NATUR1,,;S' &, OFFICIAL TITLE,, : _ _ F71 c 44 id s .ling Address: ........ �• . __ -�- BRUCE R. FOLEY Piiblic Health Director LORETTA MOLJNARI R.N., M.S.N. Assecinte Public- Health Mrector Director 'of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914)279-6130 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 E911 ADDRESS VERIFICATION FORM OWNERS NAM E: - TAX AIAP NUMBER: E911 ADDRESS- TOWN: AUTHORIZED TOWN OF. (Signattwe) DATE: Ax 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. (Eq t I Vr-, lu'RNI) C3 A YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914). R45-2800. Albert H. Padovani, Director LAB #: 32.300551 CLIENT #: 56296 NON STAT PROC PAGE 2 SABITO, FRANK & PHYLLI 194 WEST SHORE DRIVE PUTNAM VALLEY, NY 10579 DATE/TIME TAKEN: 01/24/03 12:30 DATE/TIME REC'D: 01/24/03 03:10 REPORT DATE: 01/31/03 PHONE: (518)-851-7851 SAMPLING SITE: 221 CHURCH RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL`D BY: FRANK ORLANDO TEMPERATURE..: < 4C NOTES ... : COLIFORM METH-. MF -W --------- W-1— -----------������������ DATE FLAG RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE .CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L , DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY.H�RP. .I�ATEB-: 70-140 MG/L MG/ � ---IGRAH|P[R L ITFR ^ gra -in-/- L ga1 �on z--R- -n- b /� -> ' cz --�'`- -' r� SUBMITTED BY: Director ELAP# 10323 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ' Date: �.. •. •:... ..�.._�� Lam! -�y��° ..e .Ci• •+<•� -,�1: �i.- -�. _...,..�-- .�:1'i�.. ... -:i •c i•.�.ve` �} := �'+Y"J� . ..:a.�.'�.1:_.ae =..:.= ._- .-.... Street Location urn Owner / Lo, G, Town ev Permit # PV - (j -0 a TM -31. 9- Subdivision Lot # 8- S46VI j") 1. Sewaae Svsiem 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 ...... ............................... H. Sewage System a. Septic tank size -1,000 ......... 1,250 ... :other ................ b. Septic tank installed level' ........:............ c. 10' minimum from foundation .......... ....:.......................... d. istribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil,between box & trenches Junction Box - roperly set ....................... ........ ........................ 1. Lend required Length installed 2. Distance to watercourse measured / Ft.......... 3. Installed according to plan ......... ............................... 4. ,Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 1' /Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... g. Pump or Dosed sty ems 1. Size o pump chamber.... . .................... 2. Overfl tank . 3. Alarm, vis aud' ................... ............................... 4. Pump easily a ssible, manhole to grade ................. 5. First box b ed ..... ....:.............. ............................... 6. Cycle wi essed by H. stimated flow /cycle........... M. HouusseBuildui a. House located per approved plans ... ............................... b. Number of bedrooms ................:!%.. .........................:..... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft ........... c. Casing 18" above grade..... .............. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside -of box ... ............................... d Backfill material contains stones <4" diameter .............. Curtain drain & standpipes installed according to plan Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ....... O.:..:!n� h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 o�ST-3 � � I a . I ' ANAFUS � 1A� I[�Ii W ''1W. o�ST-3 '11/11/2002 A,TmzmqN at 06:47 9149624248 JOSEPH SULLIVAN 0 pVMAM COVM VZPATMaW Qjr MA&TR of MANTS 0XVM e, Aoe-z 0 Gin X3 Aubbl- (ioz For; .16 qsm coqpUU7 ps ollis.? is wou looted ss Per ,oa�tol gooms DoW. cu* tat the lwom(sl a 104 st do vlu 68 boa PM Come" odstd, IM10 04 wee appmved PIM BW Y'175 Yom FIR-99 PAGE 01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. CONSfi— ,"/ v "I'' �l \y��y${�'ti „�j��� <..j�: 7,/ ,�^yr i��w,jT q�s �'1- } %�° xnrv�• �`�"..�.l 74'aj.�"�:71, ..4'....` �.• , 1 PERMIT # f V-1 a- 0a- Located at e/4 a r- C4 a j Town or Village , wUw Subdivision name r6 ,r ,.� S f� Subd. Lot # Z Tax Map 73.1 d Block . Lot 3 9 2 Date Subdivision Approved ij/,Fzm Owner /Applicant Name �, .vh * f qw o' A Mailing Address %mod -4elX -,� A Amount of Fee Enclosed 300 Renewal Revision Date .of Previous Approval Zip Building Type%�-,-4i -d en ee Lot Area . i rNo. of Bedrooms _4 Design Flow GPD f'Ov Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1_2 el gallon septic tank and �E10 ,/. ,di z4,* W;je Other Requirements: 2”, ,Icy To be constructed by Address JQ/r, e Water Supply: Public Supply From Address Address w - .^��p... .........• .-� .r •i -. �.rTi..� �...:�" -ter+« I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sv tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P. E. k-' R.A. Date License # y %� G �4o� e s APPROVED OR STRUC al pires two years from the date issued unless construction of the sewage treatment system has been co spected 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 rmit. Approved for discharge of domestic sanitary sew a only. e By: "` Title: Date: .2-70--02- White copy - HD Fi e; Ye —o copy - uilding Inspector; Pink copy - ( er; C61ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OY HEALTH DIVISION Off+ ENVIRONMENTAL HEALTH SERVICES ._.'q, IIT �l?,A ' —b? .TJ:p'AT^a'?'�. �T4�'!rR' �, .g,. �ac�:'4` .`L,�.�EB JL please print or type PCHD Permit # / - V Well Location: Street Address: Town/Village Tax Grid # q O'Cr4 Map 7 ,1 /f Block / Lot(s)_3f, 2 Well Owner: Nga!!me:, Address: Use of Well: `Residential Public Supply Air /Cond/Heat Pump Irriga 'on I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �� gpm # People Served 4 Est. of Daily Usage ®v gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ef' Is well located in a realty subdivision? ...................................... ............ .................... Yes &-,0 No Name of subdivision ='moo. ��� Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Uigiiiati;ii'G: D`E:y�- c-�A!' / %d"di�'- sf / ,�`"_ �^.._• -• I � I 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 wa r well driller certified by Putnam County. Date of Issue Permit Issuing Official: Date of Expiration — Z0 -0 !J Title: Permit is Dion- Transfferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 is -16-t f=) —Text 12 PROJECT 1.0. NUMSER 617.21 , S - -- ApPAndtx.g_ ���- ay.' rz+•= n%;:'. �f.+• s` �_ e» c< :%r�i�^a:.id%:tai,.'.':'•;,a:: •w� -i:� °�•+o-�L'tL'�' `...o:•'fn�n �.arr., +. iii:;. 1. a'r.- .r.'- �:..w.�ive «6�'�w.•m. �i - ,....ri.e. �.� J°'.: a Quality Review =r- � ✓- SHORT ENVIRONMENTAL ASSESSMENT FORM . PART I— PROJECT INFORMATION o be com leted b For UNLISTED ACTIONS Only. i!. �t 1. APPLICANT /SPONSOR A y AAplicant or Protect sponsor) 2. PROJECT NAME 3. PROJECT t. PRECISE LOCATION (Street address and road Intersection , pr S. is PROPOSED ACT1- 0— ,y Neu C1Exaaesia 6. DESCRIBE PROJECT BRIEF LY: ❑ Mcditication/alteration vent landmarks, etc., or provide map) x 7. AtilOU ?IT OF LAND AFFECTEO: Initially acres Ultimately 6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING acr A es Yes . , No It No, describe briefly A OTHER EXISTING LAND USE RESTRICTIONS? WHAT IS PR---S :VT LANt) USE IN VICINITY OF PROJECT? sidentia! C1 Industrial ❑Connerciat. .. _..._.,..,.,.... ,._ ,_ ... _.., __ ... ,_. e: _ ..Agriculture _ •_ � •og:._, _ •.•.• .•_..- •..,• _.._,_.�.... _ .. -.._ >, _..r- <— ...- ...ti.� . >, ._.,... ,........ ..F_...�. -.. � �c ?�,irore.�flpen.s'P�e •a -..�• ...,�.� •v,�,.. r. OtTer 1C. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVc'AN— � STATE OR LOCAL)? Yes ❑ No II yes, Itst agency(3) and permltla royals AL AG_NCY (FEDERAL Dp 11 • DOES ANY AS OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Yes ❑ No 11 yes, list agency name and permlVapprovat ' 12. AS A P,ESULT OF PROPOSED ACTION WILL EXISTING PERMIT /gppROVAI REQUIRE MODIFICATION? Yes }�No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOVlLEDGE ADplkanUsponsor r Si0ature: Date: If the action is in the Coastal Area, and you are a state a en Coastal Assessment Form before proceeding with this ass a the s'srrlent nVFR PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION FXCEED ANY TYPE i THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑Yes No .T�On »_ a €�C� G4x��? E[ Fx?+ ti"� =r"`fiiivi�itD' J` n fi EL Ocil NS ly 6 NYCRR, PART 617.6? If No, a negative declaration may be superse eky another Involved agency.. . ❑ Yes o C. COULD ACTIOirRESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. 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: IUDr. CC. 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. AudL C6. long term, short term, cumulative, or other effects not identified in Cl—CS? Explain briefly. 0 C7. Other impacts including changes In use of either quantity or type of energy)? Explain briefly. . .... ,... .. - -. r �.. -.... �,. _.:>y ��.. �+. m ”' "`Far• �,�„•ss.r..v w""r� -- �•�'r•�^'. D. IS THER, OR I T ` LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? C1 Yes o if Yes, explain briefly PART ill—DETERMINATION OF SIGNIFICANCE (fo be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effec, t should be assessed in connection with Its.(a) setting (i.e. urban or.ruraQ;.(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. ❑ Check this box If you have identified one or more potentially large or"slgnificant adverse impacts which MAY ccur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. he 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 environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: 7-L CNAE1 13 X.DZIA)Lk I Piint or Type Nam"I Responsible O icer ,er in tead Agency Signature 'o reparer (It different from responsible officer) Date l z 0 4 X 74 Ak", -7k lo, 4i, zi. f a A:7 /D i 4 �,;Oe 'S" VA, POO w 1 4 5 R, - I ,y X r. R '�ThIE) 16 to pJS n I nd filet ftyctcm tip o Diu l:,!4 MO I- M, It war, over. P73tem 1;:m Pw: 6�j In enmozd.srce zdth all Sundaf'i rulsrz- Bnd ren i 1c,' ic,-nf; (if Dopnrimmit 6f, PUTNAM COUNTY DEPARTMENT OF HEALTH 0;f,4 DRAS.ION�F ENVIRONMENTAL HEALTH SERVICES, APPROVED AS N,XF�J'FOR CONFORMANCE WITH r. APP LiCA.KE I,'.U,!.ES AND REGULATIOtiS.OFTHE p NAM COUNTY HEAL (H DEPARTMENT. w, N UR r IT: NE yl e4b DAI lo .1,1392 ,S flty Y - S ^:��,; ., . a!i ^_i'a: - :.?,5; rr 85' °�r�i' f�' r rsr x. ��..y _�k,t ^'�- � �� .K7 � t-^ �"�'�c` . "L; •6�'� . e. , _ car._ inner` sC ;::?;is�:.e++�:Sati= .sj�.�'�..'§ •,��� .................. • -, •r Qq Via +u ate' s SAW AIN ..tiy,.a:. Q .xu,r. �. . � .eo - f - -• � Fr v TQ� , l dLl' j A ....: ''t�, ago %% Li A �'k'• =rti'x t�,.'- �.'i �r�? .^ �rTf..?,l �.. �`ypa'v f4- L.prakS. -� Pta.�!' . 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