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HomeMy WebLinkAbout3478DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -50 BOX 28 r ' r 3'� �r I� go r tin 1. 1 �cr� 1'6 I 6 ,1 r ' 6 J i fd/ FOTMAll[ COUNTY DEPARTAU l' OFEr1LTH f Dhblm d BaebenAeitd Hadlb saealoea. Casttret. N.T.10M Elttblew to p" W Ftafastt / . ORCERZRWATE OF PROW FO=R SEWAGE DISPOSAL SYSI®11 Ftlslt r, .e i..iNc r i r f Let r Ts o...siA�..tN...L11�C�iz Dt= �i�_s'�_ ME -1�t' CO. , �_❑ � o Daft of previous Awroval Mllft Aa w., i Li uffluf&E EMFJ' t4d i7[ai:13 Mate Subdivision d I q Z�. Fee Enc osed .CO Type RES►DE L 4215 /G► n, FM Seaton 0* Lj Depth veh me Nlumbar of , //�� �,, Design Flow G P D � PCHD Notlgatba b Yega4at wbes FSI b aupbted Sepaeab Sewaaep Satan to am" d16o.�GtiUoa sq* Tent .,d FUME PI rt AMD V4 bM DI,4, EQ� f - 44 G,F; �IL�I.QS To be g.assR.cOeli by UNKNOWN .dilivess UNMDWrIl Watao• S"Vi 1 p a Is Supply Fmlo Afkbeaa get x Pth.te So* DttW by UJICiAMN .ddism ev. 0/88 Otbr 1 represent that 1 am wholly anCeompletely responsible for the design and location of the proposed system($)= 1) that the separate aawage diva am above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rpu ns o m p County Department of Neagh, and that on completion thereof a "Certificate Of Construction Complian" sotisfactOry to the. Commissioner of NYnhwill be submitted to the Department, and a written %WMtee will be furnished the owner, his sucassOrs. Mks Or assigns by the builder. that sold builder will piece in good .operatics condition any Pert of raid sewage disposal system during the period Of two (2) years Immediately following theate of the laau- ana of the aPPMOI Of the Certificate of Construction Compliance Of the Original system or any repairs thereto= 2) that the drilled well deforibed above wW be located as shown on the approved plan and that sold well will be installed in accordance with the standards, rules and rpu MMns pf the Putnem County Deg of Neelth. Date 43. Signed_ 4 � P.OL RA. Address M'M 1QG1tAEF_ V_+-1 hiciAl APPROVED FOR CONSTRUCTION: This approval expires two revocable for cause or may be amended or modified when cons= requires a no Approved for disposal of domestic i t 7/�` h Ns b il�fng has been' undertaken and Is Y change Or alteration Of construction Title FORUM court BNAEIMM OF EMalH lia �M� OWAM 411811, w�rW H�IIr St VWL Co" JR.T.116U �� m Fttfa iratttlt w CUTMR AU OF COMPUM CE TOM- N... G /A/CAR 9T�A- -rt'S SWW 1a 0 Z o� �APPRe�tNaide j /&4f D €V&0)Pj- n,5ktr Tor: MOP - 3/' i f 4 M'k Lek 7'C� Ra wad_ (- s "MM o Date d Ft,l a s AwmW 6— / 4– CrZ Tmrn L/r14e / W'Zy. iy S, � 171v 4�3 T— Fee Enclosed[L Amnttnt Exit Tfp FS i hE TI , i Fm Secttna Ottly > Vatute Nrber d pa=eans Dadp Flow G P D GQ FCHD NMdeNMn b Rgg�e't wbw t� b eatnFfeted Sapaeaw Sewwep 17etna is gams dl ' GgRw Sepw Tw* 1E 1� �S'r ��1� L f� To be -by GlNIS.JG c✓,J Adheaa ce ej&nJu�,J�� waw S"*, raft %P* Fran Adher 4111 l i Spp(y Defea bl u'i/Ka O-E�W Ada een Odw R.INIa.a.a 1 rpresent':that 1 am wholly and completely responsible for the design and location of the proposed system($)= 1) that the karate snra�e disposal stem above described will be constructed as ~non the approved amendment there to and in accwdo with the standards, rules anR'iagufaTiOns —oi� County cep stmant of 'HORN, and that On eOmpletkrn.thereel a "Certificate of Construction compliance satisfactory to the Commissioner of Meenhwill be submitted to the Delpertnwd. and a written "grantee will be tumid" the owner. his successors. heirs M assigns by the bulkier. that sold builder will g>~a in pea Operating condition any Part of sold sawaN disposal system during the period of two (2) yews Immediately following thedate of the Now hap of the approval of the Certificate of Construction Compliance of the original system or any repairs theretol 2) that the drHNd Well desalbW above will be located as shown On the approved pin and that said well will be Installed In aceoran Ith the sttlrda►a. rules and regu s of the Putnem County O of ""Ith. F Oats / ! q � . Signed P.E.�jR:A. _- (f! Address i V �� i2 v �: License No f • � L APPROVED FOR CONSTRUCTION, This approval expires two yea ro the dab i can con ru n Of t building has been undertaken and Is revocable lOr cause or may M amended or mOdilNiO when con ed ry by the C fuioner of Health. Any charge or alteration of construction Mulm a nn^ew per iil.. p �prov}d Ior disposal of domestic son e, and/ ter ppty only. . °V • X /�`l. 1 By Title �__ /." _ CWe --. -� v� PUTNAM COUNTY DEPARTMENT OF HEALTH _ - I y.'-' �. N! � ,!±T.�.0��- T,a.',1.\T�� �?1�TI' ���l' �, 11F :r � CERTIFICATE OF CONSTRUCTION COMPLIANCE F EATMENT SYSTEM PCHD CONSTRUCTION PERMIT # i U - h zo4Wv�-t ��lkP own Villa e v tn��►� Located at C ��• g Owner /Applicant Name 37 Cttoi—vO 17Atm PZ CORP. Tax Map ?31 lS Block l —Lot —15:4-D Formerly ��� E��!" r 60,4 / "Je'• Subdivision Name Subd. Lot # Z Mailing Address '31 C Rc-1V-x3 i--Av"t t2 P, o 5.5 9 roc.,%, , li'( Zip 10562 — Date Construction Permit Issued by PCHD Separate Sewerage System built by 51 alu're-0 pR'm RD, C-0 e0, ddress S ,ec—(-- Consisting of /� ZffCl Gallon Septic Tank and 4 c L� 2'41a,ag- ?rze"c H (F5 Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by e F . eatt, , r � Address 0g� sT-e , %) V r o;09 CIC 1 --'- til i1i111i Y y�1G `� °� licw 31V11 Number of Bedrooms Has garbage grinder been installed? nJo I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: (a-V - -ci Certified by P.E. ✓ 3: (De 'gn Profe i al) Address %r € PC, License # 61 131 CP 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 r ch e i necessary. By: Title: Date: Z' White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 9 V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -.-W-.]FL -COMPLETION REPORT' Well Location Street Address: Church Street TownNillage: Putnam valley Tax Grid # Map73,10--Block- t Lot(s) 11 _<6 Well owner: Name: Address: V. S. Co ration, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: I-primary 2-secondary X . Residential Public Supply Air cond/heat pump Irrigation Business — Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment. X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel Plastic Other Joints: Welded _X_ Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air-, Hours 6 Yield 10 _ gpm Depth Data Measure from land surface-static ?specify ft) overflowing During yield test(ft) 1401 Depth of completed well in feet .2051 Well Log If more detailed information. descriptions.or .:Z are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 20 Drilli I na in o-y-e airden clay and hWIdpra 20 Hit ro= at 20, 42 205 IDrilling in rock ciranite If yield waslested at different depths during drilling, list: Feet Gallons Per Minute PUMP/Storage Tank Information Pump Type sub Capacity 2gpm_ Depth 160, Model 7GS 5412 iVoltage 230 HP ',, Tank Type WX302 Volume 86 58,W—we-111 Tompleted 4/30/99 Putnam County Certification NO'. 002 Date of Report 6/9/99 Well DA NUTZ: Exact location or well with aistances to Son7 two permanent ianamarKs to oe p7peu on a separatt; snuoupikul. 4 Putnam Avenue Well Driller's Name Inc. Address: Brewster, NY 10509 Signature: Date: 6/9/99 Pe White copy: HdKle, Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 NORTHEAST LABORATORY OF DANBURY CT Cert: PH- 0404' ..7- ... '.::?y:► "�.r!- ..:e�l:},�.:;aaii.T' a.a- 1 .. M _ - ass �'M, QTY ..:::.%;�cY: i.Y...r. < ern ut.�+ +e+gt.- (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: 5/27/99 TEVIE COLLECTED: 4:30 P.M. COLLECTED BY: CHRIS B. DATE RECEIVED @ LAB: 5/28/99 TESTED BY: LAB #11471 & 11301 REPORT DATE: 6/3/99 V.S. CONSTRUCTION, LOT #2A, CHURCH RD., PUTNAM AVENUE, N.Y. HOSE BIB WE ,I:,- INTONE NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor ND pH 7.44 no designated limit Turbidity 0.26 NTUs 5.NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N 11301- Nitrate N 1.0 mg/L as N 10 mg/L as N Alkalinity 230.0 mg/L no designated limits w.. .. .._.����..::�. Er�ltiy. ;;4.`�.:T i;�k�y Iron 0.034 mg/L 0.30 mg/L Manganese 0.012 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 14 mg/L 20 mg/L ** Lead 0.008 mg/L 0.015 * ** m1= milliliter mg/L = milligrams per Liter ND = none detected. NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: SAMPLE, AS TESTED ABOVE: MOTABLE or aOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 TALL TEKSER-1-1-f GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 37 GRo -'ott1 DA,n� LZOt�D C ©iZp Owner or Purchaser of Building 3 7 G R &I n. i--, CC) Building Constructed by C"u tZL 4 IR ©A-D Location - Street R ES i DE NT-►A� Building Type .7 3.18 S C>- Tax Map Block Lot �crrrvl�� �a�E✓ <�illage L INc aR ES`rs�TSS Subdivision Name z Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material; construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or neglient act ofthe- occupant of.the buildingutila�.ing the - The undersigned further agrees to accept as conclusive the determin io oft ublic Health Director of the Putnam. County Department of Health as to whether r n fa' ;re of the system to operate was caused b the willful or negligent act of the occu t o 7 bui utilizing the Y P ,} g system. , Dated: Month Day (C Year '�'t `� Signature:­, Title: otJNER DES. General Contractor (Owner) - Signature 37 --12o'[ -0K 9Ae-A tzVAp GoRP, Corporation Name (if corporation) Corporation Name (if corporation) Address: 3 -7 c Raro N4 QA tA 17% ° t -ID Address: State d SS 1 N 1 rvc - , 1j r Zip lose-2 State Zip Form GS -97 0 ,41 /NS/ T E ENGINEERING, SURVEKING& LAWSCAPEARCHITECTURE, P.C. LETTER OF TRANSMITTAL ,r i 2-2i �4 Brewster, New York 10509 (914) 278-6392 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Date: 6-23-99 —Job No. 92127.302 Attn: Adam Stiebeling Re: SSTS As-Built for Lincar Estates, Lot 2 #204 Church Road, (T) Putnam Valley TM # 73.18-1-50 i WE ARE SENDING YOU Z Attached ❑ Under separate cover via ❑ Shop Drawings 0 Prints ❑ Plans ❑ Copy of Letter [:1 Change Order ❑ the following items: [:1 Samples ❑ Specifications COPIES DATE 6-16-99 NO. A13-1 DESCRIPTION ----,--.--.---- As-Built Drawing —4 1 6-22-99 CC-97 Construction Compliance 3 —1 1 6-16-99 5-24-99 6-9.r99 S-97 WC-97 Guarantee $200.00 bank check - #289687 Well Completion Report 1 6-3m99 Water Analysis Report THESE ARE TRANSMITTED as checked below: -DV%p r 'submitted q �bL it.." -cop fq ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment F­1 REMARKS: COPY TO: Lot98.dot PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE iN'SPECTION Town TN\Ir Q- 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. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ..................... ............................... I . Length 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,,,.,.._........ X. g. Pump or Dosed Svstems 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin� a. House located per approved plans ................ I................. b. Number of bedrooms ....................................................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured to 0-'�' ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... R ev. 1171 Owner Permit 9 Subdivision Lot r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �% .:- 'a rr} .. _: :� f:. �. u: J �: +.. blTi.v �•�. :... f — r% .,, : ��: fit; o`.-. . «. .r .. .. . - �..-. .:.i ..::$ -. = .�J .'� .. „n a ,.... .:-i .. f`.ii•.. CONSTRUCTION PE AGE TREATMENT SYSTEM PERMIT # Located at G.Id y /—' CH A04 D own r Village A179111 94 Subdivision name ai Ncf} R e!;74 Subd. Lot # 2- Tax Map 4-3.18 Block ( Lot 5 O Date Subdivision Approved 0 7L Renewal Revision C,,&.vT A A-G'T v £.vorE 4)w= /Applicant Name 3 -7- ��tcv rv� 0,9 -% e-v x oO. Date of Previous Approval " 3 Mailing Address 3 7 c RmTc,.v 041-1 Ro,JO sS3N -% � �U� Zip Amount of Fee Enclosed j 3 d7f, , O -- Building Type 6f�iWti79aL Lot Area No. of Bedrooms J-- Design Flow GPD 96Z9 16j ,PAC&/-t v Fill Section Only Depth Volume Separate Sewerage System to consist of /�- i C� gallon septic tank and Other Requirements: To be constructed by3 :i�cAmrmA-,1 p ,4eLi ArA9' G®n1f, Address cAtr7w 4--1 ra-m-o-v S 7-f -Ir v &-- _ Ae V 16? 66 2— Water Supply- Public Supply From Address _ ..,or� - .l'nvate Supply Drilled by %r Br9L� a �s i it,%.G_' .` Address. �..: iiv r;.t. ;f C �. d /iC- I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sY 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 -f} l) P _.� P.E. �k r: , ,ts ��iRTT.�Yv s a A w,0'Y1 /v°!�- 4- 1- 40JAU40,,C License # 611 3 1 I q 0 22— 6 "r'SrF- Pk , ko' y ,a'Q? �j APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. A proved for discharge of domestic sanitary sewage only. By: " ~ Title: Date: 41 % White copy - HD File; Yellow cop - Building Inspector; Pink copy - Owner; Orange copy - Design P ofe sional Form CP -97 Date 3 — I — T1 / y PUTNAM COUNTY DEPARTMENT OF HEALTH IIDII gSffON OF ENVIRONMENTAL HEALTH S ERVRC}ES APPLICATION TO CONSTRUCT A WATER-WELL. pleas. e print or type Well ILocaflow Street Address: o illage Tax Grid # " fdVAG1� A ©fo viNf M VfJ4, Map g%ig Block / Lot(s) grQ Wen ,owner: Name: 3 7 c Ae9 o---? ss: S e- R, c rm A", 0,4 r► r: o � p 190f f"t Ce9 g P, e755TA-- 11L>6- Al l U 5-6 ->— ff Use of Wefl: Residential. Public Supply Air /Cond/Heat Pump Irrigation Qrlmary Business Farm Test/Monitoring Other (specify) 2- secoadalry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served __Y_ Est. of Daily Usage Reason ffon° Replace Existing Supply Test/Observation Additional Supply RDrflnmg K. 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 Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision' tJti c-/7 10-1 T-,ES Lot No. �- Water Well Contractor: Ar ,60,41,5 �s�.vs .�.� -�, Address: ct Pa;rtvAm AvC , 60ece, ITA Is ]Public Water Supply available to site? ............................... ............................. Yes No k Name of Public Water Supply: M /} Town/Village N' �- Disteace to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. nv9�.; ^6 " =q;_ - — — Win._........_. u PERMIT T® 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 vithin 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 requiements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form prowled by the Putnam County Health Department. During all well drilling operations, the applicant and/or well iriller shall take appropriate action to assure that any and all water and waste products from such well frilling operations be contained on this property and in such a manner as not to degrade or otherwise contsninate surface or groundwater. APIROVIEIID_IFOR CONSTRUCTION: This approval expires two years from the date issued unless corastuction of the well has been completed and inspected by the PCHD and is revocable for cause or may be almeided or modified when considered necessary by the Public Health Director. Any revision or alteration i of th approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam COUV. Datcaf Issue 7 9 Permit Iss 922-r- g O al: 6� -PN Dateaf Expiratio c� Title: �-; E>L 1 a✓ Peirrantt is Moan- T>rannsffe lb e i Whit copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 k ""V I II Sete • FUTNAM COUNTY DEIPAIRTMIENT OF HEALTH HOUSE PLANS APPROVIED r7j BEDROOM COUIir-lf' Cip T E D R 0, 0 3' � Of Title— Da e AW*f, Shown with optional two-car garage padcage and circle top window over front door. * As k-j ESTCHESTER MODULAR HOMES, INC. s j5 n J . HE'SCARS ®ALE Second Floor �1 27'8" X 48' e 2656 Sq. Ft. t 48' First Floor 00 L--_1 010 I ' 0I0 KITCHEN i i BREAKFAST 1 12' -0 "x 13-0" I 8' -5" x 13' -0" I I � i I j I 13'- 9" x 13= 0" FAMILY ROOM 20' -0 "x 13' -0" I i ® 4- Spacious Bedrooms 0 2%2 Baths ® Open Two -Story Entry Foyer ® Formal Dining Room o Formal Living Room ® Spacious Country Kitchen with Breakfast Room and Pantry o "Cottage- Style" 3056 Lower Level Windows with Architraves on Front 18'- 9" x 13' -0" 27.0 ppO� 1V 8' 0 r� O I-1 s� =" O F Q W L� 0 0 W x W V47 • Framingham Pediment on Front Door • Fireplace Options Available • 'Boxed -out" and "Angle Bay' Options Available • Consult an Authorized Westchester Builder for a Complete List of Options o Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract No oral conditions. W Cd Q r-I H N Fa cd bb.0 .,I EQ PUTNAM COUI,;IT DEPARTMENT OFIZALTH ..y HOUSE PLANS APO"3OVED FOR BEDROOM COUNT (.)[.ILY; 3"'s Z. at KA CON57TWOTION NOTr—: -P TO THE 5UILPIN0 IN5PE0TO.R.',',.NHr=N A COPY OF HOUSE f�T.ANS SUE3MITTE THE PUTNAM ODUNTY -MUST BE SUE3MITTEr> TO A UILN PIC FILIN& FOR 5 HE 4T Td,�._VERIFY THE 5EPROOM COUNT- ALTH P EPARTME� FEB -23 -1999 10:09 I NS I TE ENGINEERING 914 278 6392 P. 07 IFUTNAUI COUNTY DEPARTMENT GIF HEALTH ID S40 N W ENVXRONMENTAL HEALTH- SE VIC S. . AN 10DAWT e CORPORATE OWNER APPLICA' 101 FOR FERhGT APPLICATION SUBlyff= TO PUTNAM COUNTY HEALTH DEPART To: Public Health Oirrecc or In the matter of applicat on for: 5,515 -5-7 �► �u. 7 :,?f4 represent that I am an o 1 or employee of the corporation and am authorized to act for: Nam of Corporation: '57 Caw 7'&d PA-vm c�osz-p: Having offices at: � G��'�✓ �� a�.�, vas �� �,,,�� !� �e � ® � President - Name- Address- /ice President - Name: Address: O,q �4M Rd I /v LNG ,1Vgiasc. Secretary -Name: Address: I .. Treasurer - Name: Address: and that I alas and will be ' dividuaily responsible for an an 'all a is o� a Ga ration with g P Y ,� to the approval req'uestedand all subsequent acts relating t cret:j Sworn, to before me this (month) 40tary Public it AMY L. KLEIN NOTARY MBIjC, STATE OF N QUALIFIED IN PUTNAM CC NO.OIKL5065476 MY COMMISSION EXPIRES )Form CA -97 day of _ (,year) W Corporate Seal FEB-2:3-1999 10:08 INSITE ENGINEERING 914 278 6392 P.04 'P I T.rrr*.Ti M rnrn%TTV nVp A j?rrAXjpW-r OF UW A ylryJr DIVI810 OF ENVIRONMENTAL HEALTH SERVIiCEL LE) MR OF AUTHORIZATION Property of Located at (5)v 1 P-Wo V0 t Subdivision Subdivision C140-01d I Tax Map # 7 3, 16 Block Lot # Filed Map # Date Filed 7 Geiatlemen: This letter is to author nnite 9, 9=mm & imesca e P.C. 299ft J. -p a duly licensed Profess naI Engineer x (xJkg*s=otAndd=xxxxxto apply for thi requ wastewater b=itnent d/or water supply.permit(s) to serve the above-noted. property in accord; with tkstandards,rul or regulations as promulgated:by the-Public Health Director of thl put Coq'ntyHealth D ep artment, and to sign all necessary papers on my behalf in connection' with matter and to supervise the construction of said wastewater treat men and/or water supply syst in conformity with the .1 rovisions of Article 145 and/or 147 of e A ation, w, the Public Hc j La* and the Putnam County Sanitary Code. Ir Very truly urs, # Mailing Address kwt &,Un Pbute Stato Telephone: Archil s"t -, P.C. im - Signed: Mailing Address: *57 C907M DA" '57 Coca State AJ -7 -7 36 Z Telephone: Form C P. ..,�;•a.w�f;.i.w- .'.•7'pra'v '•:'js�.r•:F:'.4., . _ + �. iti��' S~''.. y�- �i�fif���i�d 's�LT�On�..G.�'.'�j�,� �vwr,S..�• �> �:.wy+.i —iwar� > LA NDSCA PEA RCHITECTURE, P.C. April 1, 1999 Mr. Adam Stiebeling Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 RE: Lincar Estates Lot 2 Tax Map No. 73.18 -1 -50 Dear Mr. Stiebeling: Enclosed please find the information you requested. o A copy of the Town of Putnam Valley Wetland Permit Waiver for the subject lot has been enclosed. Two sets of modular house plans have been enclosed. Should you have any questions, please feel free to contact our office. Very truly yours, �. _ .. _ .,.. :...._..- � .i � IV�a I � .-�� �.-� :.� •r.. -�-3i� "�`P �- 1.�.�:r _T.LjFFiE° P- ;Q^ a�- ._�M,i-- ..- ..>y.�,..�,_, -._s s _....... ..- ..-w -. .,r w. La -.., ...... .... � r - .r. -..• -� .r- ..n• +•- �.o�.�'• -ve �....a.w:. . -.... .- ....rr .... �. - � • ems.. " ..._ _ -- .-..._ By: KEng ff - Enclosures Insite File No. 92127.302 9f 1485 Route 22, Brewster, New York 10509 (914) 278 -4990 Fax. (914) 278 -6392 ❑ 7 DeLavergne Avenue, Wappingers Falls, Now York 12590 (914) 297 -1742 w ww! insite- eng.com •'.��c:..r4s.wi i :- .�..±t. =: ".'�;.c.Y -. ;viec�3 � r :. � a�'v•. . -c`; ;° 'K �r T � - �l.,. ��,',T� jr 'i ._. �6. �' >3� r � : �.. .. _ ...: .. .. ,I 'r: .�a •,:�Y..t�....c:. l �%�� J � t�l "l' V Y 1"'a a c+ .k. ..�;+�y �y....r:,r ..emu::.. ..,;'::wa..::.. i -•wd. aC�� i� �:w.^ t. 4I PERMIT WAIVER CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANT /SPONSOR: March 17, 1999 March 17, 2000 37 Croton Dam Road Corp 37 Croton Dam Road Ossining, New York 10562 Insite Engineering, Surveying & Landscape Architecture, P.C: (agent) 1485 Route 22 Brewster, NY 10509 Attn: John M. Watson PROr._P_.E.. RTY LOCATION: 1riCaI .S... t a - ..., ., .a. ,. ... �R ir.oad TAX MAP #: 71- 18 -1 =50 SIZE OF PARCEL: 4.265 acre ZONING: R -2 PROPOSED ACTION: Construction of Single Family Residence, Driveway, SSDS, and Well within wetlands buffer area MATERIALS REVIEWED: 1. Application Materials, file # WT -289, dated 2 -8 -99, referred 2- 18 -99. 2. Construction Drawing for Lincar Estates, Lot 2, as prepared by Insite Engineering, dated 2- 19 -99. DATE OF SITE INSPECTION: March 05, 1999 CONDITIONS OF PERMIT: All work to be performed in accordance with the above referenced plans. Pagel of 2 �mestdes2pw • o� $;FoYr�ttd �Guitfll�rtr�ci Bois -sh'a bY°'dWplcri€'f"n1`�ia'�tf; construction/grading work. Erosion controls to be inspected by Building Inspector prior to commencement of construction activities. All erosion controls must be maintained properly throughout. the construction process, and remain in place, until final site inspections for compliance with conditions of permit have been completed. 3. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 4. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 5. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the officd of the Building Inspector (914) 526 -2377. Date Permit .Wage -P L p .199 aL T ._. .r n.e•.+... �,..� . at.. � ..._ a -.W ,:. ... ..N......w. ..... .,...- ..�—o-a ® .— ,_....s�.�.@... -. .�4T°.�V,....,�. P/", U.- 66'al'— Stephen W. Coleman Town Wetlands Inspector cc: Applicant/Agent ✓ Building Inspector Planning Board Environmental Commission Page 2 of 2 Un—e"esVw i �ii IN S TE :. ENGINEERING, SURVEYING & ...r. ",..: :.-•u.�S:.�16:7. •+r. ...w�. mt: °s..o•.M: -�� .Lcc .�. -t <u� :i�.f'.'.� -.c4- __�C s*pp�yy L?.'.... %1'y a, , .. .. Ire�''r I�7► GJB`� �'� iY11 Ak 1485 Route 22 (914) 278 -4990 Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 Date: Job No. �2j 02 Attn: 140% , I sT.Z�B� �G Re: L,X"r, WE ARE SENDING YOU O'/�tached ❑ Under separate cover via the following Items: ❑ Shop Drawings Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ THESE AR E79ANSMITT EDiAs c` ec- -=d•below �or approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: Lot98.dot IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE j PUTNAM COUNTY DEPARTMENT OF HEALTH j DIVISION OF ENVIRONMENTAL HEALTH ...INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TR_F,ATMENI T SV,c r,En.rS. . b -.� , . , • tiE(V1�Ew'SFII i;'1' r 0t2 C0 'STRUCTION PERMIT tll-fc*z� , STREET LOCATION C ( y)zc H '" n N; r L� i Ai IE OF OWNER l ! REVIEWED BY DATE Iz Y pr pQCU�iEM S ERNIIT APPLICATION PC -I WELL PERMIT PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) 9ORPORATE RESOLUTION SHORT EAF - TWO SETS SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED ERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL L CATED N NYC WATERSHED PLANS SUBMITTED TO DEP tEp l EGATED TO PCHD APPROVAL, IF REQ'D r:�MPERCS WITNESSED, IF REQ'D TA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA t00 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) i F2EOUIRED DETAILS ON PLANS &WAGE SYSTEM PLAN - (NORTH ARROW) ,S&DS HYDRAULIC PROFILE_ GRAVITY FLOW e6NSTRUCTION NOTES SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED itIVEWAY & SLOPES, CUT )OTNG /GUTTER/CURTAN DRAINS COMMENTS: Y TAX N.up EROSION CONTROL:HOUSE,WELL, SSDS �RC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOC TION MAP E AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED, PIT & D BOX SHOWN & DETAILED E'- NO.OF BEDROOMS ELLS & SSDS'S W/IN 200' OF PROPOSED SYS. 7 KOPERTY METES & BOUNDS Z S� HOUSE SETBACK NECESSARY (TIGHT LOT) f1!OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE r p© NO BENDS; IviAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER T. HORIZONTAL;SLO :1 TO GRADE FILL SP FILL NOTES FILL CERTIFI OTE I VOLUME VF N EXPANSION AREA T. KCH PROVIDED 60 FT MAX. LEL TO CONTOURS 100%E XPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS: TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 0' TO FOUNDATION WALLS 15 -WELL TO PL 00' TO WELL, 200' N DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATERLINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 0'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4Vo,25'- 3 1/o,30'- 2 0/o,35' -1 %,100' - <I% 9 10 2 'min to CD discharge /100'with 182 cons day discharge SEPTIC TANK O' FROM FOUNDATION; 50' TO WELL & DIMENSIONS FORM ST -2 u Ulv 1• Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM L _ "511. ?% WC•'R r,.•+✓..iP � ���� _. - �„�:�:.. e =• -� - AddressL Ik( ^tAn _L Located at (Street) G Ta Map�3 8 Block I Lot So ir►dic to nearest cross street) &1unicipality Drainage Basiri SOIL PERCOLATION TEST DATA Date of Pre - soaking Zd 231 Date of Percolation Test Z-2j) 99 DOTES: 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 minlinch) All data to be submitted for review. ; 2. Depth measurements to be made from top of hole. Form DD -97 De th to Water rom Ground Water Level Percolation Hole No. Run No. Time Start - Stop Ela se Time Arlin.) Surface (Inches) Start Stop Drop In Inches Rate Min/Inch 1 to:zL ! 2 l0' f7 �� •� �3 �i rt 2 3 10 3 3,,0 46't� 3 r 4 .5 r to � n 001. �► � •� Iig 1 0�5Z 4,0 � � �� � , •3 2 -. �:.. _...Y ..:. 3 4 5 1 • 2 3 4 DOTES: 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 minlinch) All data to be submitted for review. ; 2. Depth measurements to be made from top of hole. Form DD -97 o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.. r .. .Yap �+ _ '�.•. v .:,i.- s..a�:a•q,, v. _ Kt-r. ... .. _ .x.... _. ... .. .f :r �, d`..pi,.ti.'vsa. -osa. '+ -i.', ; .. •2' ... ... ... Date 3 3 Re: Property . of Lit - G'Ng 4 Located at (T) ANAP'\ \,/ALLe-�'Section Block __j Lot �CO Subdivision of IN�'•%�� ���/�Q� Subdvo Lot # Filed Map # 24 Date i2 0-7 Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this... matter. and to supervise the construe tion .._..of...s.a.id._,. system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours Signed Countersigne P a E o , RMo , # Cfli° s!j " �FF��'� � . coiv-f� -r�o, P•� Address q 1 A - Z10--s- - Telephone 0 ess rty Li L-f-- P - - 1-16A --Zs Town Zca f - �6$ o - 47e-� Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services v. .. ...5 ... .�... .-.. .. :C+`.a.•e3 >.,-..- ti 'fl`i i` iuk�.'�''i vCZC: vi%lr" :.ter. i�....... : ;�� T _� : :v- ti.a...:'. "�sL•gv;L r.� . . FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: �Q tNU G��l✓ represent that I am an officer or employee of the corporation and am authorized to act for ame of Corporation) Navin; offices at Z�j L.1�- y Whose officers are: W-1 t i0"'.0 � President: DONALD NUCKEL .281 Libetty - Street Little Ferry, NJ 07643 (Name and Address) Vice - President: (Name and Address) ' (Name and Address) Treasurer: (Name and Address) and that I am and will be individually responsible -for any and all s of the corporation with respect to the approval requested and all subse Vacts y�l thereto. / Sworn to before me this day Signed: o•f . •Not —arT.� P..;ub?. is „ ARLENE FAUSTINI NOTARY PUBLICOF NEW JERS8Y My Commission Expires June24; 19M $; $_ Title: Cornorate Sea Onsi$e Engineering A Design, P.C. 1849, Rt. 6 Carmel, NY 10512 Phone: (914) 225 -6200 Fax: (914) 225 -6438 TO t` 1`�IVi�P'\ �►PJ �i ��GIi�F� l V\e4Q > WE ARE SENDING YOU Attached ❑ Under.separate cover.via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order p L IE U LI EM OF MrV SOMOVUL DATE JOB NO RE: O NO. DESCRIPTION qS -t� . 4A the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION qS -t� . 4A e L p 1P ovvl�l► o`er �. a9 A ©/A. (c G it--J _ A eJA vF � 3 '� �3 ,. � o � ,�. r2 I✓ L, TI l_SE A?F_ T�:AtdSl�iiT i ED' as" i hpi kcal fiylny;; ZFor approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑. FOR BIDS DUE 19 REMARKS • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS SHEET for C N ..,. � PERMIT REVIEWS O STRUCTI�1 �✓O( . 9'N• yp�'. .Y• L.• Y NAME OF OWNER .�(�i` sIFFnI iu -i�- .' "v. - F•. d °: e.o:sw. -.:: r BY 492— DATE (J 7 TAX MAP # L� 2— DOCUMENTS. Y (� PERMIT APPLICATION [ C -1 100 /o o EXPANSION PROVIDED LL PERmrr;M PWS LETTER SEPARATION DISTANCES SPECIFIED ON PLAN ENGINEERS AUTHORIZATION ESIGN DATA SHEET(DDS) (� DEEP HOLE LOG E CONSISTENT PERC RESULTS (3) 100 TO WELL, 200' IN D.L.O.D., 150' PITS Q PERC HOLE DEPTH E CORPORATE RESOLUTION El PLANS THREE SETS 10' TO WATER LINE (PITS -20') HOUSE PLANS - TWO SETS 50' INTERMITTENT DRAINAGE COURSE VARIANCE REQUEST 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS GENERAL SEPTIC TANKS -LEGAL SUBDIVISION - SUBDIVISION APWOVAL CHECKED PERC RATE FILL REQUIRED CURTAIN DRAIN REQUIRED mSTANDPIPES EX- APPROVAL SSDS ADJ. LOTS DISCHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S W/LN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HO SE SETBACK NECESSARY (TIGHT LOT) HO SE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE N BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME TRENCH TRENCH PROVIDED 7 7 WETLAND (TOWN/DEC PERMIT R & D) F, 060 FT MAX 'DATA ON DDS PLANS & PERMIT SAME PARALLEL TO CONTOURS PRE -1969 -NEIGHBOR NOTNIFICATION 100 /o o EXPANSION PROVIDED LETTERBI/ZBA SEPARATION DISTANCES SPECIFIED ON PLAN DETAILS ON PLANS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL JRUIRED SEWAGE SYSTEM PLAN �- (NORTH ARROW) �20' TO FOUNDATION WALLS SSDS HYDRAULIC PROFILE m GRAVITY FLOW 100 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX M TRENCH/GALLEY m P- PTT DETAILS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER MWELL DETAIL, SERVICE LINE IF OVER 10' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) M 50' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS ffEfTWO-FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS ISRTVEWAY & SLOPES CUT ,FOOTING CD10'�FROM FOUNDATION; 50' TO WELL /GUTTER/CURTAIN DRAINS 7 WELLS m 15' WELL TO P.I- COMMENTS: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York.10509 (914) 278 -6130 ass, P►PPLICA'TT�N PCHD PERMIT # WELL LOCATION Street Address e-4-11196H D D Town/Village/City Tax Grid Number PUTWAD9 VA-LL6V i3. i8 -- 6 — 5-0 WELL OWNER taa3Nce nc'V��riPrh�Mailing ac Zg6ieu:3��ry 5 usr[rRt'�j N S private O Public 1�SE OF WELL - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY Cj AIR /COND /HEAT PUMP O ABANDONED ® BUSINESS ® FARM O TEST /OBSERVATION ❑ OTHER (specify ® INDUSTRIAL 0 INSTITUTIONAL 0 STAND -BY AMOUNT OF USE YIELD SOUGHT s gpm /# ® REPLACE EXISTING SUPPLY IINEW SUPPLY NEW DWELLING)- PEOPLE SERVED _+ OF DAILY USAGE _ gal O TEST /OBSERVATION 12. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ®GRAVED ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES -_ �A-_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 44414412 ES -rATEs Lot No. k1ATER WELL CONTRACTOR: Name Address:�%r�u� -Jr� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _NO HAMS OF PUBLIC WATER SUPPLY: "IA TOWN /VIL /CITY N 1A 'N!T �'T'. , ... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (Tate)" ,(si )nature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;• (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to ,degrade or oth w conta ate surface or groundwater. Date of Issue: 19J Date of Expiration 19� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller INSI 1 &NDESIGN ENGINEERING P.C. P _. ^.^,:v,r.. :.. ��a', �- a. �r. r= ae< �' c•-.-• rsv '��°'�.:;•�'y�'�.'.,r,i:�'��. _. "'n.. r�'- `e�..y;.+�?%rvM ti' .....'• t^: i::: w:::,' �. rrc4r .:czo�.:syxv'.,.:�a- •s: -�'�� ��•r:..� .. x. +� Pump Pit Design for SSDS for Lincar Development Co., Inc. Lot 2 of Lincar Subdivision Design Flow = 800 gallons per day Use peak hourly flow 10 times average daily flow Qpeak = 1,800 (101 = 5.6 gpm (24)(60) Static Head = ± 12 feet C = 150 d= 2,. L = ± 80 feet GPM = 35 gpm Equivalent L (Bend & Valve Losses) _ ± 50 feet Total L = ± 130 feet R f35 Hl = C .44 L)(GPM) = 3 feet i. Total-Dynaznic Jfleud. ( -].2 feet 1_S.feet ,• - .. Use Gould Pump model # 38714/10 HP (or approved equal) This pump will pump 35 GPM with a total dynamic head of 15 feet Ct 1849, Route 6, Carmel, New York z05r2 1 7 DeLavergne Avenue, Wappingers Falls, New York r2590 Fax: (914) 225 -6438 March 4, 1993 (914) 225 -6200 (914) 2971742 Goulds et le -'Sub., Vir P�jt&A J. , r �MI" � I na/I FEATURE SPECIFICATIONS MOTOR P eller Th 6 r m6plastic Semi- Pump: Single Phase: 0.4HP, 115 or `230 Vortex design'With pump out vanes for Solids h6ndling capability:. Volt, -6011z, 1550 RPM, built in over mechanical seal protection. 3/4"Maximum - load with automatic reset. TC"ing and Base: Rugged O.Capacities*,ppto 55 GPM Power Cord: 10 foot standard thermoplastic design provides ssuperior °Total Heads: Up to 24 feet length, 16/3 SJ.T0 with Ne.ma 5 -1 5P strength and corrosion resistance.. 0 Discharge Size: 1 '/2" NPT. 3.prong grounding plug. Optional Motor Cover: Thermoplastic cover Mechanical Seal: Carbon-Rotary 20' length, 16/3 SJTW with Nema with'integral and float switch 'Head/Peramid-Stationary Seat, 5-15P 3 prong grounding plug. , att achment po ints. Buna N.Elasto.mers. Fully submerged in high-grade 'oil. ot Temperature: (600C)'I.,, turbine for lubrication and efficient Power Cable: Severe-duty rated .`Maximum . heat transfer., oil an water iresistant . d Stainless :.� F astener$: 30.0. Series .i ,i'Ne— seal 09. tee,. 7 7 •7 .';Nb`daskets to replace during Capable running dry without Available able for autom ati c an :maintenance ' damage jocomponents manual o peration. Automatic I ainle' s s steel fasteners. j models include Mercury Float S wi c, it h assembled and preset the fact -at ory 00 ,,41CAT!P,NS.. " Specifically designed for the 11 Wing Us66` 0 0' Effluent sys, ems d "o -Homes o o; Heavy duty 'sump Pmp Water transfer )6VVatedng.,. . ... .... _7 7- --6 8- 6- 9 5 4 Goulds —:j l k MODEL' . j ar r DIMENSIONS 1 Impeller (All dimenslclns, 16 inches. Do' not use 'for cbnstruction purposes .): rt doged th&.m601astid base -:--,3.`-,,`-�Rugged thermoplastic plump A� VlephanicaCsea a. rings 5;'.,,BaII'be Rings 27 Cnrd "-0iffill6d 'W X. W: iron hibtbe-'h6using/stator . ........ .. --, 1 Q.Thermo lasticmotof.coVer .p. 6,11, I F �v -- 14 L ...... ...... 3S PERFORMANCE RATINGS ------ ----- Power Cord is ...,',,Series its RPM Gallons -Solids 'W is Total He HP Phase :"' .;'." � ­ ", , . Handling 1,- .1 1u . Per 'Arrip Length (lbs (FT of Water) Minute 01 15 -.� 01 1550 1/4 2 0. —_,36 `4 2 '�O Y" 15 EV041 1 �,;I 2 3 EP0412!:` 5 7 5 46 tP641)A "0 5 0 -.20- `2 2 20 1 U0412F 230 24 .0 -7,12 20' 21' EP041 1 AC 4: S-F:rlcrinATV,)!:c f. me F1.1-- lrr�T,Tn 07HWCZI W7PTIT NOTICF MODEL: 3871 0 c rc- c--ir 1r: I - UN S'r et SIZE: 3/4" SOLIDS RPM: 1550 Fi-7EF METERS FEET i F, F, 1 .1 0 10 20 30 ul 6 0 5 2 4 .6 z 10 4 CAPACITY 3 O 2 0 F, F, 1 .1 0 10 20 30 40 50 GPM 0 12 M3 /h 2 4 .6 8 10 CAPACITY G OU LDS PUMPS, INC. W`5 M! G W*CA FAUS WW YOW (3148 Efc---!ive Octobe. r. 190,' f, ipp" G^lui& PUMPS, Inc. SPECIFIVIIOINP AFF SLJE,.'rCT TO CPtN'3F WrTPOUT I\'.OTICF PRP�171FD It: U.S I t�I• \ rZi �l. Illy- - ..... . ........ I F1 �jj jr P ........... . ......... .. 111-MM �M ANN11111FIA-111 1 tl I.ry Al NP A 'IRSDALE If THE Vtwd -a Second Floor 27'8" X 48'o 2656 Sq. Ft 27'8ff 48' First Floor 001 010 J :0 KITCHEN BREAKFAST FAMILY ROOM L 12'- 0V-e X is-cr 20'-0 X I3' -0 pill 27'80 -D!M1NC- 190-1, 1 1360M 13'- Sr x I:r- 6., - L . . - • - I jV up 48' STANDARD S DALE 11 FEATURES ® 4-Spacious Bedrooms o Framingham Pediment on Front Door * 2V2 Baths o Fireplace Options Available * Open Two-Story Entry Foyer o "Boxed -out" and "Angle Bay' Options * Formal Dining Room Available * Formal Living Room o Consult an Authorized Westchester Builder * Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry 0 Ardsrs renderings and Floor Plan Dimmsions are approximate. All specifications must be Witten In the * "Cottage-Style" 3056 Lower Level Windows Contract No oral conclitions. with Architraves on Front --H- WESTCHESTER ODULAR 0 MES. INC. P.O. lur Box 900 Dover Plains, NY 12522 (914) 832-9400 0 (800) 832-3888 O ' INSITE ENGINEERING SURVEYING, P.C. Route 22 _ _ (914 278 -4990 .,:4' -. �.'.� �� .Y.;e:a pa. i.N ..1!+•'. X . . "wnnr q L: jj,' ^�rw' 7 Del-avergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: P&y b LETTER OF TRANSWTTAL OAT a 110B NO.. .., .,, . _... ATTEN110N RE: L�JiJJe�rR E�T`fFTcS wT' Z WE ARE SENDING YOU jf= Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Copy of Letter ❑ Prints ❑ Change order ❑ Plans ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as checked below: rVor approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN. TO US REMARKS: DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A.WATER WELL PCHD PERMIT # ' TELL LOCATION Street Address e,-Hu Town/Village/City Q Pu PA Tax Grid Number ALL OWNER Name Mailing Address C*_/CLo iNG ,Zoe Ll ��Q4► -� rivets . t1 >> rkA O Public USE OF WELL J2_ primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY ® AIR /COND /HEAT PUMP ® ABANDONED 0 FARM ❑ TEST /OBSERVATION ® OTHER (specify O INSTITUTIONAL ® STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. ® REPLACE EXISTING SUPPLY O TEST/ OBSERVATION KNEW SUPPLY NEW DWELLING 93 DEEPEN EXISTING WELL OF DAILY USAGE 00 fag C:ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE —ffRILLED DRIVEN []DUG [:]GRAVEL ® OTHER YS tYL ,SxT...SJEC._T,�TQ FLOODIPTG? ,� YES .. NC IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: [,ir Lot No. HATER WELL CONTRACTOR: Name Address: t✓LP-)KrJCDery t-5 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: e--'% TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON.. SEPARATE. SHEET (date (si ature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt } *. (30) days of the completion of water well construction,.the applicant shall:, 1. Pump the well until the water is clear... 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dr7er g operations be contained on this property and in such manner as not to degrade or ots� conta to surface or groundwater. �:w.. ti TVs �j /� v U= `'1"L'is �.c i`V .. .... a Date of Expiration 19 Permit Issuing Official Permit is Non-Transfer/able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 44 e CA7G 6r?q�'S PUTNAM"- COUNTY DEPARTMENT OF HEALTH ,y DIVISION OF ENVIRONMENTAL HEALTH SERVICES T y- - /`rTr . +. TY rye e± -r A'Tr!• -�._ '1 4S,..�,�'..�.�.r�.�r� - �.0 ET- �"�.u��3S1 Y *--'F;: L ��s�AO' E' �����s.7C-i�lc.1�'t���'►.,T�i�fi . 4�V7/1'01 CT - v�NGJ�L> 4; _11 � r3 C"' rV ,oar, 0 1 o c ©oel�, Address -?;z c�r�ro -✓ o f ^n Apr oss�RQ's✓� v � Located at (Street), !{���/! p . _ Tax map r45 Block C Lot (indicate :inearest cross street) Municipality Drainage Basin qv IsTv6'� r SOIL PERCOLATION TEST DATA Nte of Pre - soaking Date of Percolation Test Hole No. R No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches P olation . Rate Min/Inch 1 2 3 4 .. . 5 1 .... «w �. -.-.y .- -.a.c: «. - � -n... ..' r .,�s. - ..> :=a - _ � -..-. .r- ` -*:+v •.«.•+.. .. .. ........per ..... .-.. oy. 3 4 5 1 + 2 3 . 4 F7715 iv u mb: 1. 1 ests 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 2 TEST PIT DATt� DESCRIPTI0. ®F:S®ILS,ENCOUNT1ERlED IN TEST HODS : :raa�ri.:.�da'.M��.�P�;- . -� "�wn DEPTH HOLE N0 Q2-3 442, HOLE N0. HOLE NO. G.L. 0.5' E . 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' low 4.5' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered A.A&" Indicate level at which mottling is observed Indicate level to which water level rises after being encountered ev, Deep hole observations made by: j p y,� ,,,_,- sm a� Date g Design Professional Name: Jeffrey J. contelmo, P. E. Address: snsite wring, Surveying & Lmxl -gcape Architecture, P 1 -4B75.Route 22 Brewster, New York 10509 Signature: Design Professional's Seal OF NEW yp A. '0o��ss�ori PUTN AM „COUNTY• DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �:�.�� ;,:....ter �,w..:zrr�.I�:::.��t r” ?�.. �i-:$►; �? �i• r�� ,��T~".,.�.w�s�.�;u��c�,'I✓�L�i �C�iS' �. '`""1���A�lii�+,N7i''B��i'L�i'. .. • @*Mer- 37 -Ao m� ate ' �o Aso c mR //. Address 3,7 coy®T©•�okM too, Y/ 10s6 Located at (Street) , V ,5w cHv,ec'q Z U"AXs�. o.A�V Tax Map X3.1 Block Lot CJ '(indicate nearest cross street) Municipality fvT;yi3w" vAj..; Drainage Basin Alva es, SOIL PERCOLATION TEST DATA Date of Pre - soaking z�a 3 /9 Date of Percolation Test �- a .414 °Z Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 /0 3 k3 ' %z yG l� 3 % 2 /x.34 -fa 5;° - ,3 q3 411 3 3 /0S 50 – 10.1" 14X '41, !l- 3 lit -461y 5 rvoa$- loaSy 4e 31q 3 1 - «r �. ...... '%. _ . i V .. - .v � - .-. tS+ ....... a - 1...w...,. ... ' - ..-..a ......r � .... -..-� .. .-.... Z...... w . -.. �.. 4 . .,I .�. ter...... •�y'T++ .. 3 4 y 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. :5 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 �T• ca•.±axrra �q'o�TiFc+cr�c'twv non 2 TEST PIT. Dti T _ DESC TION OFSO S ENCOUNTERED IN TEST MOLES ri yx.*+r. r «rtyv S �ry�1;rsaa"mS3y` "sk` �+++ rmmw�xr:tanra`.;.saa. + ":n^.Lyv S ^.siv.i�r's°.. H HOLE NO. HOLE NO. HOLE NO. . 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' nn8.5' 9.5' 10.0' I1,0I _ �.. - _.. y,. .. air:'. rsi '.'.Z.C/..'..'.•t...a�.m�'^s3° Indicate level at which groundwater is encountered Indicate level at which mottling is observed,�,� Indicate level to which water level rises after being encountered Deep hole observations made by: CA^,k Date Design Professional Name: Jeffrey J. contelmo, P. E. Address: rnsite Engimming, a veying & ?escape Architecture, P. 1:54$5=Route 22 Brewster, New York 10509 Signature: Design Professional's Seal 61931 ��ESSiCP� 8RZ <k /OFe,�s w�7Yf Ra�� � • 1 sA�a wS74 A&4% TTI �.. - _.. y,. .. air:'. rsi '.'.Z.C/..'..'.•t...a�.m�'^s3° Indicate level at which groundwater is encountered Indicate level at which mottling is observed,�,� Indicate level to which water level rises after being encountered Deep hole observations made by: CA^,k Date Design Professional Name: Jeffrey J. contelmo, P. E. Address: rnsite Engimming, a veying & ?escape Architecture, P. 1:54$5=Route 22 Brewster, New York 10509 Signature: Design Professional's Seal 61931 ��ESSiCP� PU`1'NAM COUNTY DEPARTMENT OF HEALTH.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1F uJ9 �s r INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM 5 �, �irii�e'. r":.: nti' Sr :ii,iY%•` "w°'��:cr- ;,:F.y;e.u- .,°... .'i.:�we�a ^ +•� .. 1 `C,"I�iOP 9. � GENERAL. INFORMATION Name of Project ProJ ' L I 4o,ri: Z T � G )�) County. Site Location GN�rzc,�t Building construction begun Extent • Is property within NYC Watershed? ................. Yes R�o SECTION B. TOPOGRAPHY (Please eck all- appropriate boxes) S S I. ❑ Hilly ❑ Rollinal Steep slope gentle slope F1 Flat 2.1 ❑ Evidence of Ni etlands ❑ Low area subject to flooding ` E�Bodies of water ❑ Drainage ditches ❑ Rock outcrops 3. Property lines or corners evident ..................... ❑ Yes . Io 4. Do water courses exist on or adjoin the property? :........................... Y s ❑ No 2 '� 5. Will these affect the design of the sewage system facilities ?............ No S L�rO"J 6. Do watershed regulations a 1 in this development ........................ a.Y's �o app l' _. 7 «'ill extensive radin' be necess �--� g ary .................. ...................:........... Yes No 8. Will extensive fill be necessary for SSTS? ......... ............................... ❑ Yes [ZNo 9. Do filled areas exist Ny.ithin.the S.STS area? .. n' Ye( r 7. ((�'''•�'9l'� 1{ �� p, ......,...........' If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand Gravel �oam . Clay Hardpan Mixture E ❑ ❑ , 11. Observed from: ❑ Borings ❑ Bank cut. ❑ Backhoe excavations 1 Z17 12. Soil borings /excavations observed by on Z 13. Depth to groundwater , 1 o on 14. Depth to mottling on l 15. Are test holes represen tative of primary reserve rve areas :.. ............................... ... es No 16. Soil percolation tests made by �� \ U on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 t SECTION D. (DRAINAGE %`+ 1a •C/f'.�+W.L'�.�.��Kx.v.�+...vY. J� _ i ..�� W)o •ri'��'J.day.v M.h v +�Si n . 'i: _ �g;� � i ratl7n�` natenaliy alter he natural drainage in this or adjacent areas? Yes o . 19. Will groundwater or surface drainage require special consideration? .............. Yes o 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F-1 Yes - .: io SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ... :............ ............................................... F-1 Yes EK0 Inspection data �f 22. Do adjacent wells and/or sewage systems exist ? ........................................ es No 23. Additional comments 24. Site observer /inspector and title. ff -116 25. Date(s) of observation(s)inspection(s) j % z� (�`� _ _ _ _- ? TEST PIT PROFILES. 3 L Hole P -1-Lot A _ - - ole # Lot f H Hole 3 9 Q 9 Depth to water K0 D Depth to water D Depth to water Depth to mottling ''b K4_ D Depth to mottling '°� D Depth to mottling Depth to rock/imp. . D�t'� Yo`�r�.clufitiln. -= �:. J Jeu, Yi��ro�`xi�rri: - 1.0 2.0 6 r vZ J�e S 3.0 Low 4.0 5.0 -bi' ' CVAy SAOb 6.0 w Rociez- 7.0 8.0 .l 10.0 1.0 2.0 3.0 ':�Pyu®� %off. 4.0 rwr l 5.0 6.0 7.0 8.0 9.0 1.0 W 3.0 ri 4.0 5 6.0 ? Z a 7.0 8.0 M1 10.0 10.0 SiEIe r i i i 7 PC -Y1 f PUTNAM COUNTY DEPARTMENT O F HEALTH c •6Ta_" �.w .A.... -Sn . . - . ' ^C-y�p•y T. . ;`s lX'•t1 •ate _..iR. ..r^f .� ,r _.P.ar M Fr �� epr *4 •'o^�4Li•�'. .. •A ! ,g—! � . z. I _•.; x+ M �Yw... •y �S i •r-'..- 1.: Name and Address of Applicant: 2. Name of Project• `�- -� � l.i �.� p :/F -I.vP_ 3. Location T /V /C: �btPAr� \/A-L116-V11 • Go• � NG• ha�Nt 4. Project Engineer: C�5. Address: 1ep-49 e<z---�Ae Go .G„ License Number: ldIQ'?� i Phone: LZG -6vZ<� 6. Type of Project: private /Residential Food Service Apartments Institutional Office Building Realty Subdivision GA�r�I� , N •'C• X0512 Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR) ?. Type Status (Check One) Type I.. Exempt Type II. Unlisted _ 8. 9. 10. 11. Is a Draft Environmental Impact Statement (DEIS) required? ............ Has DEIS been completed and found acceptable by Lead Agency? .......... Name of Lead Agency Is this project in 'an area under the control of local planning,. zoning, 12. If so, have: plans been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? r' A Date Granted: D--'/A 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ............................. 17. Is project located near a public water supply system? i-JCD 18. If yes, name of water supply Distance to water supply i` 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system ►- a�,1�, Distance to sewage system 21. Date observed: LJ JVN-io iJ0 23. Name of Health Inspector: 1\3 24 -. Project design flow (gallons per day) ...... ............................... ti. 'iR4:-.T1W' � TI c�E, 2. 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... Na 28. Wetland ID Number ....................... ... ......................... N JP' 29. Is Wetland Permit required? .............. ............................... PC) Has application been made to Town or Local DEC Office? .................. 1-�1pt 30. Does project require a DEC Stream Disturbance Permit? ................... tic 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or.industrial activity? ........ YES or NO No 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? `�C> any sewage - disposal areas- iw—exces's o"T' i5,6 s is p6' ................ 36. Tax Nap ID Number ..................... ........ ..........................13 ►18 37. Approved Plans are to be returned to: Applicant ;� Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as•a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES HAILING ADDRESS:. t r DIVISION OF.ENVIRONHaML HEALTH SEWICES ,r'SIGN LYE iA�'SHr T- 568-5, 7rAC E 5EW ,11_IPC8 iL byS_ ,1Ui ` ` , FI:LE NO. H Owner Z_1"C_RR_ 00,i22oAn8k/rCry. J,C..Address 281 4j8a42_7* S7Ag'T' 4./Mg FWAR' A/Zk/ TS)eSar Located at (Street) e_,'{/UR.GH 2D,4D Sec: 73• jg Block / Lot (indicate nearest cross street) Municipality 8a1A, y1 VAI_Lcs � Watershed 1Ctgk54yLC AbLIC041 41200 k SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 'Date of Pre- Soaking — Date of Percolation Test HOLE NUMBER CIDCR TIME PERCOLATION PERCOLATION Run Elapse Depth to Water F-ran Water Level No. Time Ground Surface In Inches Soil Rate Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 3 .4 5 1 2 '. 3 4 ' , NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 F._.-. .,.. - TEST PIT DATA I TO BE SUBMITTED WITH APPLICATION IS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. Z, HOLE NO. _ . ..: , . �. _ . _ _ ... , ... ., _ , . - , ...... ,� ..,� . _.. � , . = >—w:._ � _ -• — . # ::. _. „ r, h . ., ...:,:. a _, . _ , . , .., ..$ • : F, -.. - ,:,,.� = �..;..;: G.L. 2' 3' 4' 5' 6' 7' 8' g' 10' 11' 12' 13' 14' u+D= Cr�ir, 10vM AT MISIOaT: GPOUNDPOO R TS. ENCOUNTERED. INDICATE LEVEL TO WHICH MTER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: RALAL„1v 9� 10-x,,vzz -t a5 A6 DATE: DESIGN Soil Rate Used x-10 MW1" Drop: S.D. Usable Area Provided No. of Bedrocros Septic Tank Capacity /2.S® gals. Type t o - Absorption Area Provided By 44+ L.F. x 24" width trench Other Al on P A) 7- - _ ,� Name j Signature -4.e 12' Address A.S i'7-a �R�lrr� �7 5 /car✓'✓ Ael . SEAL e412 ?7z>'> to ' /t,-7V Z-- Z-- 63931 4 THIS SPACE FOR USE BY HEALTH DEPARD1ENP ONLY: Soil Rate Approved sq.ft /gal. Checked by Date