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HomeMy WebLinkAbout3979DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.58 -1 -38.3 BOX 31 or. lug I 03979 PUTNAM COUNTY DEPARTMENT OF HEALTH _- DIVISION -OF ENVIRONMENTAL HEALTH.. SERVICY�$.. .. CERTIFICATE OF CONSTRUCTION COMPLIANCE FO6r) ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # } Z_ off- �L,j3lJz Located at `:J G 11 8F FAT LANE Town or Village Owner /Applicant Name pr tbM'E5; 1_.a, Tax Map a7-)- 'j8 Block I Lot X113 Formerly g )')- Subdivision Name gD%- `AA-Qjf- `• M�OtML i l •1S -l�u_ �t1�[ t..En.E Ic.� Subd. Lot # -S Mailing Address Zl 1 t1-� -- l - 'J ,]J 3'^� u' u- "r'.'°�, lQ ` � Zip >C3 :(-9 Date Construction Permit Issued by PCHD oz- Separate Sewerage System built by R � , 11\ c Address '\v N A*"l �i1 �', 4L/ ) L'1649 Consisting of z`�O Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From. 510 a tc*- Z4 iu CJ 1D & Address or: 'A' Private Supply Drilled by Address A,\ :B_u W—ftl - Type _ -? Li)-. L. _ _ Mlles. erosion control been comPL -t.b l? 'iz .,....... . Number of Bedrooms `i Has garbage grinder been installed? 90 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: fZru�c�Z Certified by k&J-0., P.E. R.A. Address ' �, ���(7�es�osy nab License #� 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 revocatio modification o change is necessary. By: Title: 1 n Date: White copy - HD Filo; Yello'*Aopy - Building Inspector; Pink copy - 0,4} er; (Qradge copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT 'Well Location - S reetAddress: ,��- � - � n/Villa e: Tax Grid # cc-)/fS3. Map . Block3g Lot(s) 3 Well Owner: Na f. Address: 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 /K Open hole in bedrock _ Other Casing (Details Total length 6'0 ft. Length below grade ST ift. Diameter in. Weight per foot /G lb /ft. Materials: -c Steel _ Plastic _ Other Joints: _ Welded _,V Threaded _ Other Seal: - c Cement grout _ Bentonite Other Drive shoe: � Yes No _ Liner Yes ­2�. No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Field Test Bailed Pumped ---'-`Compressed Air =Hours-) Yield 1p gpm )[Depth Data Measure from land surface static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or ievf analyses are available, please attach. Depth ]Frown Surface Water Bearing Well Diameter(in) Formation (Description ft. ft. Land Surface 6 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 34*i, ,Z Capacity Depth 25'0 Model �uS Voltage 2.31' HP i Tank Type &1Y lJ a Voltimr 0 Date Well Completed Putnam County Certification No. q Date of ReportW7ell Igh / /0 Driller (signature) Ny'i'1N:: rxact location of well with distances to at least two permanent/landtnarks to be provided on a separate sheet1plan. U3,ZC- Well Driller'sName �� fi Address: Z Signature: Date: / :� / % 06 + White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Cr J a BRUCE R. FOLEY * � LORETTA MOLINARI R.N., M.S.N. _ ... .: -, ,.-�1'soli?I:...:,r::�•i�•����: � _:;.- . _ -;� :;- :�;..- .�rh� -. - ...�.� �����'.,.. ,.. ,_.= ���_,�_ .-.:, ���s��# at�l' a6'li"c-I���ltli-DgPe;;t��r� _ .::�,::,= Y Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 ' V Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Musing Services (914) 278 - 6558 1 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 NAME: TAX MAP NUMBER: E911 ADDRESS: I Greencliff Homes, Ltd. 83.58 -1 -38.3 Putnam ( 1 11v ..'r AUTHORIZED TOWN OFFICIAL: I'f� �: (..� : �'�SC 1t (Signature) DATE: .0 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E91 I address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. " (E911VERFRM) PUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEA]LT H SERVICES e A I�`�+.l�g cGreeneliff Homes, Ltd.- 83,58 1 38,3 Owner or Purchaser of Building Tax Map Block - Lot Greencliff Howes, Ltd. Building Constructed by Location- Street 7 Gilbert Lane. Residential I utlianfl Valley Town/Village ][lose Marie & Michael Burns and John 1Lenich Subdivision Name Building Type Subdivision Lot #. 3 I represent that I am wholly and -completely responsible for the location, .workmanship, material, construction and drainage of the sewage treatment system serving the above = described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health; and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or, any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act: of the. occupant of the building utilizing the system. The undersigned further agrees to; accept as conclusive the determination of.the ,Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent- act of the -occupant of the building utilizing the system. Dated: Month 12 Day 3 Year 02 Signature: Title: president General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Greeneliff Homes, Ltd. Corporation Name (if corporation) Address: 21 Peekskill Hollow Road, Putnam Valey Zip State ICY - Zip 10579 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Hei ht , , ^ �. N.Y 10598 Z'9 ^'' Albert H. Padovani, Director | LAB #: 32.209064 CLIENT #: 4507 NON STAT PROC PAGE LEA-ROME INC DATE/TIME TAKEN: 12/04/02 11:00 P.O. BOX 687 DATE/TIME REC'D: 12/04/02 11:20 PUTNAM VALLEY; NY 10579 REPORT DATE: 12/09/02 PHONE: <914>-424-4326 SAMPLING SITE: CONTE RESIDENCE, PUTNAM VALLEY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D 8Y: JAMES SCHMIDT TEMPERATURE..: < 4C ' NOTES...: COLIFORM METH: Ml--' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 0-15 ppb 9101 12/04/02 MF T. COLIFORM ABSENT /100 ML 12/04/02 LEAD (IMS) 1.5 ppb 12/04/02 NITRATE NITROG 0.71 MG/L 12/04/02 NITRITE NITROG <0.01 MG/L 12/04/02 IRON (Fe) <0.060 MG/L 12/04/02 MANGANESE (Mn) <0.010 MG/L 12/04/01 SODIUM (Na) 6.67 MG/L 12/04/02 pH 6.5 UNITS 12/04/02 HARDNESS,TOTAL 64.0 MG/i 12/04/02 ALKALINITY (AS 52.0 MG/L 12/04/0E_ TURPIDITY'1TUR`, /1 .NTU, ABSENT 1008 0-15 ppb 9101 0 - 10 9139 N/A 9146 0-0.3 mg/l 2037 0-0.3 mg/l 2037 N/A 6.5-8.5 N/A N/A 0-5'NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD! HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese he 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 r6stricted 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 9043 -~ � \ YML ENVIRONMENTAL SERVICES ` 321 Kear Street `. (914) 245-2800- ` Albert H. Padovani, Director | LAB #: 32.209064 CLIENT #: 4507 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ LEA-ROME INC DATE/TIME TAKEN: 12/O4102 11:00 P.O. BOX 687 DATE/TIME REC'D: 12/04/02 1100 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/09/02 PH[NU : (914)-424-4326 SAMPLING SITE: CONTE RESIDENCE, PUTNAM VALLEY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JAMES SCHMIDT ' TEMPERATURE..: < 4C NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: MF DATE FLAG PROCEDURE 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. .-SO7TWATERx,�0~70�MGfL�- .''����� ` VERY HARD-WATER `ABO�E='3 'MB/i�-``'` �� ^ --~~----- H-- -----'--R':- - -^ --'--T-=------[ -� ---''�7--------'-' HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: , a`u� Albert H. Padovani. M.T.(ASCP) Director ELAP# 10323 BRUCE R. COLEY LORETTA MOLIN ARI RN., M. . Public Health.. - Director.. .. - Hc» +tk.l�fra�;r.. +s . �' . �'� Y . :4eSD C�iCr�e2 c r of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road - Brewster.,. New Ytirk .10509 Environmental Health (845)278-.6130. Fax(945)278-7921 Nursing Services (845) 278.- 6558 WIC (945)218-6678* Fax(14S)278.6085 . Early Intervention (845) 278 - 6011 . Preschool (845).278-6082 Fax (845) 278 - 6648 Date: To: J G�Sv'y1 Fax. #: 41 i No. Pages- b (Including cover sheet) . From: :)`©se-Ph 'S, Par*y^- h- Jr, Putnam County Department of Health For your information Please respond VFor your review Attached as requested As discussed Please call Notes/ Messages' 6tti e, �rlU !'iN✓@ d+ny o qv` 4lbrij.� q/12 me, a e"d - In the event of transmission/reception difficulties, please contact this office at (845) 278 -6130 ext.- 0115-7 e 9 O O m It N co O O O rn It x w 0 z _U a Q c� O w 0 6_.: 10 a AS -BUILT RELOCATION - DIMENSIONS 1A 15.0' SEPTIC TANK 1C 30.6' SEPTIC TANK 2A 13.8' SEPTIC TANK 2C 38.3' SEPTIC TANK 3A 27.3' DROP BOX 3B 44.1' DROP BOX 4A 32.7' DROP BOX 4B 47.1' DROP BOX 5A 37.8' DROP BOX 5B 50.5' DROP BOX 6A 43.5' DROP BOX 6B 54.7' DROP BOX 7A 49.2' DROP BOX 7B 59.2' DROP BOX 8A " 54.1► 'DROP O. X` 8B 63.3' DROP BOX 9A 59.8' DROP BOX 9 67.9' D OX 10A . 34.4' LATERAL END 1OB 79.9' LATERAL END 11 39.1' LATERAL END 1 B 82.2° LATERAL END Q2AZ 44.4' LATERAL 12B 85.1' 13 0. LATERAL END 13B 14A 88.9' 55.0' LATERAL END LATERAL END 14B 90.8' LATERAL 9.3' LATERAL END 15B 92.5' LATERAL END r• PIAKLS PEEKS6' ILL. (FILED ON 5128129 AS M. Pole LAKE RESERVED STRIP AS 0 SHOl'.'V CA' 4.44P 785 (Width Vcries) 0 CONSER VA TION to 1� °la. v �--�{, 0 6B 5 54.7' D DROP BOX 7A 4 49.2' D DROP BOX 7B 5 59.2' D DROP BOX X X. 8B AIZ RESER VEL SHOWN O t7' coNSEI e .o 10 ,0 i(o,0 t� 76,ol d BADEY & WATSON LETTER ER ®ff T RA" SMET'T'AL M�; � h .. Vr .. �N 1. n..•'1il a,- i. �p ..N- ' ^(i4 ry .R..'VC -r ,r 3063 Route 9, Cold Spring, New York 10516 Date: 03 Jan 2003 File No. 02 -165 W. O. # 15497 RE: TO: Gilbert Lane Mr. Joseph S. Paravati, Jr. Rose Marie & Michael Burns and Subd. Lot No. 3 Tax Map 83.58 -1 -38.3 Putnam County Department of Health Permit/Title/P0 # 1 Geneva Road (Brewster, NY 10509 Sent via: — US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GRND We are sending: UPS -COD ❑ copies date description of document 3, 103- Dec -02 —❑ ISSTS "As- Built" 7 Gilbert Lane ❑ 7 F_ _ . �i'• -�. -.: - _�`�..:... _ � _ - ... - _ "- ,,�ra� , -'L-.. _ "• Yi _ ;;Pry ` ' ^ � - ❑ J REMARKS: Copies to: )File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey - watson.com 40-05 490400 624800 20529 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION at ....q ected 6 ��..Street�,ocation (9 l •�iL►'�.I.a -v1G� ..- .,`... Y�_... -,. YTSP Owner tgr aAc l (-k.: -s L�ro Town p✓� r,. ip b" tl&44 Permit # p v -.2 - TM # S . Se - t - 32(4 Subdivision Lot # 3 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 ........................... j'tr- H. Sewage System / a. Septic to c size - 1,000 .........1,250..: ..other ................ b. Septic tank installed level ..................................... :.......... c. 10' minimum from foundation...... .... ................... ............. d. Distri tuio Box /V % %'f 1 outlets at s e�eil vation -water tested ................. 2. Prote o'w frost .................. ............................... zn mum 2 ft.Original soil.between box & trenches Junction Box - properly set. ............................ ..... . 1. Length required Length installed � o 2. Distan ce to watercourse measured A-J//rrpt.......... 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 ................... 1.0.. Pipe:enslus: upped; .....:...:..........- ..:........................... _. or g. ize5- of pump c am er .............. c .......... 2. Overflow tank......... ..... `......... ..... 3. Alarm, vis audio .................... ............................... 4. P asily accessible, manhole to grade ................. first box baffled........................... ........... .............. r° 6. Cycle witnessed by H.D.estimated flow /cycle........... M. ouse/Buildm' a. House located per approved 4"el.................. ..........................:.,.. IV. a: l 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" er:.......... %�i e. Curtain drain & l mst led according to plan` f ,,,__G ain out protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 DEC -03 -2002 12:38 BADEY & WATSON, PC P.02/02 .DIVISION OF ENVIRONMENTAL IH[EAIL'II'H SERVICES REQUEST FOR FINAL - INSPEM�Ri Date: 12/3/2002 PCID Construction Permit # Located: Owner/Applicant Name: _.. -- ]Formerly: PV -3.02 Gilbert Lane _ _ Greendiff Homes Ltd._ n/a For: Fill Trenches _ CTK4) Putnam ram Va91 ®y TM 83.58 Flock I Lot 33.3 Subdivision Name: Subdivision Lot # Is system fill cormpleted.? n/a Is system complete? _ yes Is system constructed as per plans? ...._.--- ,- Yom.____ -.... Is well drilled? .... _... ... - Y !k._., . _ .- ..........._..._- ..... _ Is well located as per plans? generalay Are erosion control measures in place? s9.... . [BUIrns 3 Date: n/a Date: 12W002 Date: 11/27/2002 I certify that the system(s), as listed, at the above penises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. -- - -- Design. Professional Address: Badey i WoLgon, P.C. 3063 Route S, Cold Spdng, NY Lic. # Counamts` FOR.- ® ADAM 0 GENE ® Joe Paravatu (NAME) 062505 Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV -2 - J y Located at L 6c-tz'r 1.144 G (91 or Village girt rA11*.A_ V A LA. � � Subdivision name Subd.. Lot # Tax Map 93. 55 Block I Lot 3 9-3 Date Subdivision Approved _ 7%zC, /01 Renewal Revision Owner /Applicant Name (?RE 1-b, i CS. LTD : Date of Previous Approval ,S U'j.- Mailing Address �2 1 PECLSM cL, Fkr Lz)­! (20 ✓,4LLEJ Zip I cS- 7 Amount of Fee Enclosed I So Building Type Sc ,J �-LC Fa-,. «A Lot Area A L, A-c- No. of Bedrooms �_ Design Flow GPD oo Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewera ge System to consist of )2S-0 gallon septic tank and Syo LF or r2q Qa 6 FILL- i GU(2,rA(.) -Drm.0 Other Requirements: To be constructed by LEA -P..vr tf, 2jL.. Address V4L -LCY Water Supply: Public Supply From Address Trivati'Suply Dri�led;y .�_. _ ; ... x__,_. ti�u; ... _ Address '- �c ,✓� - >�,_ �;�r i I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage'treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate. of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed:: P.E. ✓ R.A. Date � C_ Lle_ Address 12n (S P,e cLMA tt PwG Q9 - M'4 ttt A+C- of 4 License # 6/91/ gl APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approve for discharge of domestic sanitary sewage only. By G I , Title: - f/ Date: Z White copy - HD Ale; tel w copy - Building Inspector; Pink copy -40 er Orange copy - Design Professional Form CP -97 IPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISI ®N OF ENVIRONMENTAL HEALTH SERVICES ._...`-•_.... -`7�+ :� A,Q_1's_.z-�.-'ORRIFG_R:A .,0�, It�.'QT3ti• C.`- u�`ar�e o�.'c['�i S Av= '•::•= z'.•.- :.;.c:�:z,�7�.. ...._. :: ..: e.. .... ,n•.. -.• i.y..�. moo_. ..... FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In, the matter of application for: Consrtuction Permits for Sewage Treatment Systems & Water Wells I, Steven ILea*irdi represent that I am an officer or employee'of the corporation and am authori zed to act for: Name of Corporation: Gireendiffff Homes Having offices at: 21 Peekskill Hollow Road, Putnam Valley, NY 10579 Whose Officers Are: President - Name: Steven ILeairdln Address: 21 Peekskill Hollows Road, Putnam Valley, ICY 10579 Vice President - Name: DankI Roma nello Address: 21 Peekskill Hollow Road, Putnam Valley, NY 10579 Secretary -Name: Address: Treasurer- ~Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: n Title: ?iresident I� to before me this day of (month) el ca,� �d a Notary Public MARIANNE B. DINATALE . . Notary Public, State of New York No. 01 D i 5020567 Qualified in Westchester County Commission Expires Nov. 22. ap- Form CA -97 cCon prate sl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 6-O c= .�j G L- ► �= 44o � c-S LTV, Located at (,-i L (?2M -T' �_v4 T/V V ALLY y Tax Map # S-1 5e Block l Lot 3 0- 3 Subdivision of GO%eAJ s Subdivision Lot # 3 Filed Map # Date Filed Gentlemen: This letter is to authorize �0 J t CL- 7. Do.4A riLt C a duly licensed Professional Engineer y- or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations -as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law., the Public Health Law, and the Putnam County Sanitary, Code. Very truly yours Countersigned: Signed: P.E., R.A., # �- -y�� (Owner of Property) L �ECkA&L Fr' hbrMt �o LTP• . Mailing Address/ � r �c�QR�; o%jc/�� Mailing Address: �I rOEW L ttoc� 2D. / a State Zip /u ` i State NJ Zip hots Telephoner ,�� Z ��� G Telephone: - 5-144 Form LA -97 CONSULING ENGINEERS -- ___ -•- �7___ _ ❑ Detucl 7. Donahue, P.E. 230 Breckenridge Road 914 -628 -7576 TO WE ARE SENDING YOU ��3D C Att parate cover via 71M 0)7 ❑ Shop drawings ❑ Prints r r, - -u ,.t fetter (—j Change order Cl- Plans r __the following items: ❑ Samples ❑ Specifications 1iI SF- ARE: TRANSIT!!'TED as, chocked .helo? For approval ❑ Approved as submitted ❑ Resubmit --copies for approval ❑ For your use P. Approved as noted ❑ Submit copies for distribution --- As requested ❑ Returned for corrections ❑ fern oorrected prints ❑ For review and comment i=! ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO-- SIGfdED: It ancloaurv$ era not as noted, kindly notity, u& at once. V, I, DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS ` ' 6137 Y2 rec6n'rldge oa Mahopac, N.Y. 10541 .845-628-7576 e, f C=) rn N ='b < rn cn CD N C-) CT CJ� Site • Sanitary • Environmen, tal ]PU TNAM COUNTY Y DEPARTM ENT OF HEALTH IDffVffSHON OF TENWRONM ENTAIL HEALTH STERWCES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT -SYSTEM iC ER1v1L111L # V V—� " a c-;)� "_ r a Located at Gi�,�j'" �i� c Subdivision name ✓/'/1 f' Subd. Lot # �l . Date Subdivision Approved / s�1 ,0/ Owner /Applicant Name ,2 !-C &0,, < Mailing Address &' offer ,f/,& 117, 4 /Y .1 Y S;DVillage 004,4-4 ,*" " ✓�� Tax Map -lock _/_ Lot 9 Renewal Revision Date of Previous Approval /,�'y Zip Amount of Fee Enclosed��` Building Type /-' " l% Lot Area & ^No. of Bedrooms -!Jr- Design Flow GPDP`0 II MII Section Only Depth V®Iume _ II IPCHIID NOTIFICATION IS II81A;OII IARIB:IID W1Hf1 N 1F' I X . A6 (r'ct MIN .tFTIM Selpan•ate Seweirage System to consist of Other Requirements: /C ato '-' "At a )e4tj 44V gallon septic tank and To be constructed by r /3 P Address WateLSuIID Ry- Public Supply From Address Private- Supply Diiried by _ _ -- v :.v . ....: - Address'. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approved/fqr discharge of domestic sanitary sewage nly. By: /%W Date: Z 2- White copy - HD Fil `; Ye o copy - Building Inspector; Pink copy - Ow ; Oran py - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL PCHI YeTmlt Well Location: Street Address: o illage Tax Grid # 10, 1 ' "G`i Z Mapa al3lock Lots -� Well Owner: Name: Addjess: acjx /Y. r Poo -f1� /a� ,l��Gy�,��o ` U e of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling !/view Supply (new dwelling) Deepen Existing Well Detailed Reason vg ,V 'A) for Drilling Well Type yDrilled c Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No !i Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Rtr'@ AJ Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No 4, Name of Public Water Supply: At l/f- TownNillage Distance to property from nearest water main: A f/3 Proposed well location & sources of contamination to b rovided on azate sheet/plan. Date: � �.� Applicant Signature: _ ....:.._ _ .. _ _ . . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. A Date of Issue /— 74 "o-z— Permi Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 14•164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appondlx C .. Rfavi `SFiOR�''ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION !Ta be comnlatAd by Annlira„t .,r Drm.m i. APPLICANT !SPONSOR 2. PROJECT NAME J 3. PROJECT LOCATION: fhmicipality jat, ' fi�� /: County t. PRECISE LOCATION (Street address and road Interaection},promittent landmarks, etc., or provide map) /v S. IS PryRyO�� POSED ACTION: 00 New ❑ Expansion 0 Modificationlalteralton 6. DESCRIBE PROJECT BRIEFLY: C,0, jI -1'' V C7f 4'v '6'v SS f f 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. W,�4,L PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? zYes ❑ No If No, describe briefly 9, WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT.? zResidentIst G Industrial u Commercial ❑ Agrieutturs ❑ ParklForestiOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE R LOCAL)? � ! Yes C3 No It Ilat agency(s) and permiUapprovas I (c+ yes, 1t. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes lJ No If yes, list agency name and permll/approval 12. AS A RESULT OOFF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Oyes IFJ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEOGI: v fe Date: Appiicantfsponsor name: Signature: If the action Is in the Coastal Area, and you are a stale agency, completerthe Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONM ,ENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION Ex EED ANY TYPE i THRESHOLD iN 6 NYCRR, PART 017.12? It yes, coordinate the review process and use the FULL EAF.. ❑ Yes _ 91 r ,40 _ 4 B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYORR, PART 817.61 It No, a negative declaration may be superseded by another invltved agency. ❑ Yes Nb C. COULD ACTION. RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: tAnswets may be handeaitten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briellq: C2. Aesthetic, oyricullural, archaeological, his torle, or other natural or cultural resources; or community or neighborhood character? Explain brlofly: , C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangorod species? Explain briefly: At 0 N/ cam, r1"� C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resourcttpiain.brietly /V CS. Growth, subsequent development, or related activities likely to be Inducad.0y the proposod action? Explain briefly. Ne.(v c C6. Long term, short term, cumulative, or other oflects not Identified In CI-057 Explain brieffy. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes O No If Yes, oxpisin briefly PART III— DETERMINATiON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS:. For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessdd In connection with Its (a) setting p.e. urban pr.rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. if necessary, add attachments or refamnee supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts ?live been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significlant adverse impacts which MAY occur •Then proceed directly to the FULL EAF and/or prepare a positive declaration. • eck this box if you have determined, based on the Information and analysis above and any supporting documentation, that ti proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: f hw% Dame of ea Agency A espoTint or Type game R nst t Officer in Lead Agency Tole el Itelp"Sible officer I 1 _ IL _ � e • i/ .� �• :erin Lead A$erty atu►a of rvparer ®rent frorn responsible o ieer L Date rl V V/ 1 Qj&- jow a f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , TREATM EN - ,T YS Owner Address la' 2#44.4gab Located at (Street) Tax Map jj, Block Lot,.?r (indicate nearest cross street) Municipality,__ A,*M'VA-11,ev Watershed bLrg SOIL PERCOLATION TEST DATA Date of Pre-soaking 1*3 13 Ald Date of Percolation Test f 5 ej Ho e N 0 No Time Start Stop 14 Time n.) . D Start Stag ev . . er aches Percolation :'. kt M" C' Re 1 1 it a. 2 3 V0 1 4 1,0"3 -Z 2 5 X01_' p=! .12 3a 1 3 10 !� o G 4 2 3. 4 5 NOTES: I 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 q TEST PIT DATA 'f M ®Ib®,Y ESC ' ION OF SOMS ENCOUNTERED IN TES's' MOLES 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' 8.01 8.5' ti 9.0' fQL NO. 4 9.5' ..... _e _ x,.10.0' ........ - . _.... a0, sl 0 OF NEB Indicate level at which groundwater is encountered _ n As Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 3 a aal k" Deep hole observations made by: Dd gA6fj0tX ' x"• ALL0 L Date Design Professional's Seal r ESS! pp� 4 7 PUTNAM COUNTY DEPARTMENT OF HEALTH � � N�l DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES APPLICATION FOR AP PRQVAL OF. PLANS FOR r.A.WAMWA` E TI A' 'I I I�7C`SYSTEM -.� 1. Name and address of applicant: & ! 2. Name of project: f' mlt, r d r- r 3. Locatigov: C700F. ► B 4. D Design Professional: &,v &_ J. c c)oM ,4NaaG 5. Address: 1plo , ,pip 6'.r- N 0,e, -V0 6. D Drainage Basin: 6J' wd n n f fyv✓ `. M Mil,'edAde- 'Col t►. Private/Residential Food Service Commercial Apartments Institutional Mobile Horne Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (check one) ............: ' r....... ............................... Type I Exempt Type II Unlisted _L._ 9. Is a Draft Environmental Impact Statement (DEIS) required? ...........::............ �t /1 10. Has DEIS been completed and found acceptable by Lead Agency? ............... W 11. Na i of Lead Agency All f. J2.As this p;ojict in an area under the control of local planning, zoning, or other officials ordinances? ............. ..... .... .....,...., ,... ... :....... ,.,............,............� 13. If so, have plans been submitted to-such authorities? ........ ............................... No 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number ( surface) ..................................... ............................... ; AI 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply ,- Distance tgwater.supply 20. Is project site near a public sewage.cbllection or treatment system? ............ ... ... ' ` /1/D s 21. Name of sewage system ' " Distance to sewage system 22. .Date test holes observed j�Z DZ) 23. Name of Health Ins � P ector G %tip 24. Project design flow (gallons per day) .....................°....... U ..... ............................... 1 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?... �o 26. Has SPDES Application been submitted to local DEC office? ......................... ^l //f Form PC -97 ­2 ,27. Is any portion of this project located within a designated Town or State wetland? Ala 28. �-W_edan_ds,JT)_Num_ber._ 40 Ef"Zv* 29. Is Wetlands Permit required? .................................... ..................... ....... Al e.) Has application been made to Town or Local DEC offite? ............................... 30. Does project require a DEC Stream Disturbance Permit? ........... I ..................... 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? ............................ Ye 32. Is.project located within 1,000 feet of existing or abandoned landfill, .'hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes&— DESCRIBE: 33. Is there a local master plan on file With the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within IS years in or adjacent to project site? ........................................... ................... a 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Ala - 36. Tax Map ID Number ......................................................... MaRI2.a Block Lot2L—,? 37. Approved plans are to be returned to Applicant Design Professional NOTE :-All applications for review and app.-oy.al.,ofa.ne.u!SSTS.tobeI hall: be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed'may also require DEP review and approval of other aspects of a project, such as stormwater for lans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1.,the applicatifig Must be accompanied by a Letter of Authorization (Form LA-97). Failure to comply with this P&W may be grounds. for the rejection of any submission C..) I hereby affirm, under penalty ofterjuryo that information provided on this form is true to the best of my knowledge and belief. Fake statements made herein are pun ishable:& a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. rya SIG NATURES do OFFICIAL TITLES.- 2) 4 Mailing Address: ................................... ae te.A-'e 6L A I'd) is A .-mil • PUTNAb1 COUNTY DEPARTZIENT OF HEALTH /O 1 F ENIVIRON�IENTAL HEALTH LNDWIDUAL'WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT ........ �A1E OF 0';�;fIR. � .. ' STREET LOCATION: REVIEWED BY: PAK OR, AS, ATE: � °'� TAX MAP': (CO�IRNIED) 0 3, Y N DOCUMENTS �L . PER:ti1TT APPLICATION (--)Nti'ELL PERNKlT ORPWS LETTER UUPC -97 (Zj(_JLETTER OF AUTHORIZATION i)(_JDESIGNDATA SHEET (DDS) L-)(�CORPORATE RESOLUTION (,G)USHORT EAF (�L _)PLANS -THREE SETS (,/JL )HOUSE PLAINS - TWO SETS (_J(/)VAKkNCE REQUEST SUBDMSTO i i (L_)LEG,4L SUBDIVISION LPL )SUBDIMION APfP YAL CHECKED (�UPERC RATE LIJL )FILL REQUIRED DEPTH (/JUCURTAIN DRARi REQUIRED GENNERAL LU( _JL TED Pi NYC WAT D (__)( _)PLANS 0 DEP UUDELE T.... (-J( APPROVAL, REQ DEEP TEST HOLES OBSERVEDA -S U PPRCS TO BE WIIIISSED ( E - APPROVkL SSDS ADJ, LOTS ( J(,::!5%VETLANDS (TOWNMEC PERMIT REQ'D ?) ��DATA ON DDS PLAINS & PERbIlT SAME (_ )2rPRE 1969 NEIGHBOR NOTIFICATION U( ,)LETTERBUZBA 'Y N (REQUIRED DETAILS ON PLANS CONT'Dl HOUSE SEWER -'/," FT. 4 "0'; TYPE PIPE CAST IRON LUL_)NO BENDS; NL4X BENDS 45° W /CLEANOUT RENEWALS LUpE NOTE (NO CHANGE) FILL SYSTEMS (L )10' HORIZONTAL; PAST TRENCH :1 GRADE LULm-,�FILL SPECS/ FILL NOTES 1 -5 UUFILL PROFILE & DDALENSIOi S (..e FILL LN EXPANSION AREA FILL GRE Yz FEE77 UU CLAY A RRIE UUFILL CE rATON OTE UUDEPTH G S UUVOL. 0 PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS UUSEPAR TION DISTANCE FROM TOE OF SLOPE TRENCH ULULF TRENCH PROVIDED ML -i) 60FT MAX. �PAR4LLEL TO CONTOURS - UU100% EXPANSION PROVIDED.- FREE CRUSHED STONE OR WASHED GRAVEL OTEXTILE COYER SEPARATION DISTANCES ON PLAN -FROM S L.L 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL ( J20' TO FOUNDATION WALLS _ J�100' TO WELL, 200' LN DLOD,150' TO PITS LU 100' TO STREAM, WATERCOURSE, LAKE (inc. eipan) �50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (U(y%j1B0.YR.. FL00D ELEVATION W/I ?.00' (( 10' TO WATER LINE, tts -_20.' .: TL'S'f G t S >40 YEARS OLD 50' L�Ii TER;/fiTTTEi DRA3iiAGE'COD12Sr - REOUTRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) �jL .JSSDS HYDRAULIC PROFILE (/1r )GRAVITY FLOW :UCTION NOTES 1 -15 DATA: PERC & DEEP RESULTS OURS. G & PROPOSED.. / OPES,CUT °G /G R/ TAIN DRAINS (f(,JTTTLE BLOCK; OWNERS NAME ADDRESS TNI91 PE/RA; NAME, ADDRESS, PHONE �DATE OF DRAWING/REVISION JDATUIZNI REFERENCE J LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. _)PROPOSED FINISH FLOOR An,, - , BASEMENT ELEVATWO (§ (WELLS & SSDS'S WO 200' OF SSTS (PROPERTY lv1ETES, &'BOUNDS 6?tvs COtiIMENTS: (REVSHEET) (,��200'500' RESERVOIR, ETC. _,150' GALLEY SYSTEMS Jcf!5(—J10' NILNTO LEDGE OUTCROP SEPTIC TANK (ZLJ10' FROM FOUNDATION; 50' TO WELL WELL (�tUDDYIENSIONS TO PROPERTY LINES - - - - — — - (1 OCATION OF SERVICE CONNECTION _ 77. ,.. 15' TO PROPERTY LINE SLOPE L—)SLOPE IN SSTS AREA (S20 1/6) L -JL--yfCGRADED TO 15 %, IF REQUIRED DOSE/Pump SYSTEMS UUPUMp NOTE UUDOSE 75% OF IP OL EMOSE VOLUME NOTED UUDETAIL FOR F E IN, (PIPE TYPE, ETC.) U )PIT AND D- X SHO N &,DETAILED LUL JI DAY ST GE ABOVE ALARM CURTAIN DRAIN Lr -_) STANDPIPES, S' BOTH SIDES, DETAIL (/ 15' bIIN to CDS= >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -Q% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE z. . +. ..r c , � . -. ... _.-. ,......•e .' c�c:••i- :. .,_ " -n.:. "..r_: ..� -� . ai_.•,r,�- .,.�i. - � � '.: L: ..._. .... - ...t... _, (ic sn ,y ::e �...:o- .. �: ,e.%. - LETTER OF AUTH®RYZA' RON RE: Property of Located at /i.9 -//E Tax Map # dock / Lot -3 Subdivision of �� S Subdivision Lot # 3 Filed Map # ' Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer _for 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, males 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 Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., Mailing Address /h/ / ?i,4 state All zip le Telephone:. �1._..�� �� "G" �� �� _. __ Very truly yours, Signed: �, (Owner of Property) Mailing Address: /110-� State Zip Telephone: %l c %- Fonn LA -97 CO UL IN ENGINEERS - :a •::c"; :Y - .. - Q,- nan;e11::AonAhue,:P.E. f ZOO Btecleeiuidge ROi d .Mahopac, N.Y, 10541 lrrt —s'* 914.628.7576 I D�i•�/� TO rx of POW 449-0001%, WE ARE SENDING YOU 01 Attached O Under separate cover via —the following Items: O Shop drawings O Prints O Plans O Samples O Specifications O Copy of letter D Change order O 0004ts DATE NO. OESCRIMON THESE ARE TRANSMITTED as checked below.' b�for approval O Approved as submitted D Resubmit coplas for approval O Fpr your use 0 Approved as noted O Submit copies for distribution -- O As requested O Returned for corrections v Return corrected prints 0 For review and comment Cl _ O FOR BIDS DUE " 19 O PRINTS RETURNED AFTER LOAN TO US REMARKS --- COPY To SIGNED: ..�....,,..e aro net of rtotod, AN►dy MUy 90 , ff� Daniel J. Donahue, P.E. 200 Breckenridge Road _ ................. 914.628.7576 TO WE ARE Stiff DING YOU I Attached 0. Under separate cover via --the ..._.,the following It ®ms: G Shop drawiflP G Prints 0 flans ❑ Samp108 l7 Specifi'catims a Copy of letter ❑ Change order y Q i COl91QS DATC 098C019710M i _ 7 G S 111 ?4I V/ .,THESE Ag3E- TRAM MiTTED` _.am FOP .approval D Approved as submitted 0� Retsubmi¢ _ .. for apprwial Q for your use C7 Approved as noted ❑ Submit copiota for distribution G As requested C Returned for corrections 0 Raters comected prints Q For review and comment C':- Q FOR BIDS DUE 19 D PRilbTS RETURNED AFTER LOAN TO US REMAI�EtS��� -��.- � �`'`� Jr y/��c/ � yy G �ti'i rr� �.>'� , �G�1� e��<P COPY TO.,r..__..._.. R$It3fdREt}: .r . +.r.uuroO Oro fW 05 AWOd, WfWfy hC410P u0 OFl6Q. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES,, L • � � � .._.� v c'�Di ��Jiacnt L 03'' 3 DESIGN DATA SI4EET - SUBSURFACE SF WAGE TREATMENT SXSTFM .'.2.,•. a... � � .� •: P' c .. ... A`.1 ...r _ .r .... .. rY.. ate........- nl.... tw I t ... �-: +� C- �- <P "'ec. �..'. . � /��%,�et. n d Owner 9(j IP tq S Address G/G Q C—se-r- L 9 •v if Located at (Street) 14PP*V'7- 1,.f 4f Tax Map Block Lot (indicate - nearest cross street) Municipality PGTA/ !tZ ygL.4,oz9!- Drainage Basin •t`�t%e C SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test �►,�_y,�d 1 ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole.. (i.e. s.I min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be submitted for•review... 2. Depth measurements to be made from top of hole. Form DD -97 I Depth to Water Water From Ground Level Percolation Hole No. Run No. Time Start Stop Ela se Time Min.) Surface (Inches) Drop n . Rate - Start Stop Inches Min/Inch IP 1 0 fD 3 .29 S? A 2 / © "k � 30 _ /S` 1 30 a it oz 4 .z s`.$ a.j - 5 . 1 2 3 4 , e L c sFO 3 • G, %� �Y � ?•• N T _ !ti.��,•� l •:. ;till �'t`'I: ��' A� r� O� �o. 48 •1 ��� a 9N�� • fiY 4 5 1 ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole.. (i.e. s.I min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be submitted for•review... 2. Depth measurements to be made from top of hole. Form DD -97 I N3Y0'00"' N7 ,5v000rw A 6 94.15' stow (97.07' per Deed) oOtoo ' �XCut • Fnd. ON EA SEMEN T N •••�- 186.73' S1 O'30'00 "E 1.650 Acres (77,858 S. F.) �..7 .. ... -... J 51.48' C D 4" CIP 2 St. Fr. Dwg. (Foundation Under Conet.) Top Fndn. 360.3 1 A 50.52' B 50.74' 1000 GAL. — SEPTIC TANK rye• .:w SDR 35 510 LF OF ABSORPTION CLEANOUT TRENCH w 6" SDR 35 39.9 L.F. 40.0 F. 7 0 40.1 L 3 40.1 8 1 40.3 L.F 4 40.0 L 9 1 40.4 L 5 39.9 L. . 1 38.6 LF. 6 38.8 L.. 1 4 37.2 7 38.2 L. 36.2 L.F. .-. LATERAL (TYP) f�00000000 Wall I', 0 100% EXPANSION o AREA R.R. Tie � wall N DV v LD EXlet. N Well 3 O O tD i 0 O O rn v x w 0 z U_ 2 CL 0 0 w U IA...;:. M 14 I 0 00 U') cp I N 0 6 z w J a r m a RELOCATION- DIMENSIONS 1A 15.0' SEPTIC TANK 1C 30.6' SEPTIC TANK 2A 13.8' SEPTIC TANK 2C 36.9' SEPTIC TANK 3A 27.3' DROP BOX 3B 44.1' DROP BOX 4A 32.7' DROP BOX Q 47.1' DROP BOX 5A 37.8' DROP BOX 5B 50.5' DROP BOX 6A 43.5' DROP BOX 6B 54.7' DROP BOX 7A 49.2' DROP BOX 7B 59.2' DROP BOX 8A 54.1' DROP BOX 8B 63.3' DROP BOX 9A 59.8' DROP BOX 911 67.9' DROP BOX 10A 37.4' LATERAL END 10B 83.8' LATERAL END 11A 42.1' LATERAL END 11B 85.9' LATERAL END 12A 46.3' LATERAL END 12B 87.9' LATERAL END 13A 51.4' LATERAL END 13B :90.6 LATERAL END 14A 55.7' LATERAL END 146 92.0' LATERAL END 15A 60.1' LATERAL END 15B 93.9' LATERAL END 16A 65.0' LATERAL END 16B 96.3' LATERAL END 17A 61.0' LATERAL END 17B 21.7' LATERAL END 18A 64.0' LATERAL END 186 23.1' LATERAL END 19A 66.8' LATERAL END 19B 33.6' LATERAL END 20A 69.9' LATERAL END 20B 39.4' LATERAL END 21A 72.4' LATERAL END 21B 44.9' LATERAL END 22A 75.7' LATERAL END 22B 50.6' LATERAL END 23A 23.5' CLEANOUT 23B 43.5' CLEANOUT WC 91.9' WELL WD 64.2' WELL r .3� .z �, ,. •'6� �. r,--^. `r �'�, r; �. _, .-.n_ '•c -. �.- �.`c�s. ....c.-t,.r. � -ti �.... 1r ., �4c�'.._:`w• "LAKE PEEKSK /LL - SEC77ON A " (F /LED ON 5/28/29 AS MAP No. 1115) O Pj Pole LAK777 N775 00 W RESERVED STRIP AS SHOWN ON MAP 185 17 (Width Varies) N a E CONSER VA TION N a 510.30'00 E .._. .._.. .. a •-� w r, •p 9.,' _L'r,... ��p..�t� .I '.. �C .. -M �- � . •• i 4' CIP 1000 GAL SEPTIC TANK 2 6' SDR 35 0 39.9 LF. • 40.1 L 3 1 40.3 40.4 L. 38.6 LF. 4 37.2 7 36.2 LF W 101 0 N