HomeMy WebLinkAbout4309DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
84. -1 -16.1
BOX 33
16
LI . ,..
04309
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # b ` a 5 " ��
Located at 4"t , W-X-WV J WMV Town or Village PLIT�JA4 VAitjW
Subdivision name-
7m 5 fit" Subd. Lot # 1 Tax Map Block I_ Lot I t'v. j
Date Subdivision Approved SU Nf— W 1 41610 Renewal Revision
Owner /Applicant Name �A+ -E.S 'DPJIIFLDFIM�'i'lCc'¢' Date of Previous Approval
Mailing Address RO W D51- 45 i1A2RZ2r:vr New �- 0(',449 (��i Zip
Amount of Fee Enclosed 4 9,40 � 00
Building Type IAt, Lot Area AC No. of Bedrooms Design Flow GPD GOO
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of i , seo gallon septic tank and 500 LF —
?A tt lCho W %Vr-, AP-6olZrl"lotJ ITZ- l`6CAtom SPAS A-T- co ;:--T. 0 •C-.
Other Requirements: 2�V l2l'?.P� 6LL ° 1160 GAL.. NOAP-jatk �PWl&P Ai s?-M
To be constructed by 5T DD ,S lL Address RkT JW VA'L.L f
Water Supply: Public Supply From Address
_-Private-Supply Drilled by f32R�- 6Z i G. AAddress
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatmentsystem 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 # 00
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 a t. App 7d f r isc rg of domestic sanitary se age only.
By: Title: Date: ZQ
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr essi nal
Form CP -97
i'
11
PUT NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELIL.
please print or type PCHD Permit
Well Location:
Street Address: Town/Village Tax Grid #
VALL fo gakD KAfiVAM � Map 94 Block i Lot(s)
Well Owner:
Name:
Address:
Use of Well:
)<' Residential Public Supply Air /Cond/Heat Pump Irrigation
I- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought _ gpm # People Served (41 Est. of Daily Usage600_gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
W New Supply (new dwelling) Deepen Existing Well
Detailed ]Reason
VIM P0 'I AbLF WAIVO- 1 DRKCF-
ffor Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No .
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision TW LL ES�15 GA5T- Lot No.
Water Well Contractor: No?V'1AtJ �(I tN , Address: 5A9GE4Z ST- NTW*J 1S
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: �J �k Town/Village W/,A
Distance to property from nearest water main: `7 F tM l L-F -
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date: O O,4 .� .Applicant. Signature:
PEST 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.
Date of Issue Z S Permit Issui& Official:
Date of Expirati Z Q Title:
Permit is Non-TrgansferWabRe
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
DIVISION .OF Er- tIR.ONMENTAL HEAT. 'H SERVICES
: APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
Naive 'and address of nplicant`: '$1iAct -l.S l�E%Pi1�tJi- Qorzf'
n11 �c 1 obi
2. Name of project: $.V.Co2P- tom- Q 3. Location TN: �;LTNA1+�1
4. Design Professional: -FaJ P . DECJO.i?�. Address: 5� �� -`p(�, PG.
6. Drainage Basin: �k tD�orJ 12ty R4 -a1. CbLD 5PR- KA kW
7, X PrivAte/Residential Project:' '
Food Service Commercial
Apartments Institutional-. Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review- (SEQR)?
Type Status (check ... ............................... Type I Exempt
Type II .. Unlisted .
9. Is a Draft'Environmental Impact Statement (DEIS) required? ......................... K30
10. Has DEIS been completed and found acceptable by Lead Agency? ...:...:.......
11. Name of Lead Agency PUS N
12. Is tliis project m" an area under. the control'of local planning, zorang, or -other
Adials' ordinances? ........... :................................................................................
l�ta *e plans been submitted-to"sue ........................
14. Has preliminary approval been granted by, such authorities? -ADate.grWed: KVA
15. Type of Sewage Treatment System Discharge ............ ....y.. °surface water groundwater
16. If surface. water, discharge, what is. the stream class designation? ....................
17. Waters index number (surface) ............................. ..
18. Is project located near a public water supply system? ....... ..............................: N3
19. If yes, name of water supply Distance to water supply
20. Is project site near a public sewage collection or treatment system? ................ Na
21. Name of sewage system', N . Distance to sewage. system
AIA
22. Date test holes observed . 23. Name of-.Health Inspector A .5- n EW-INA
24. Project design flow (gallons per day) ...........................:... ...............................
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... -t4o.
26. Has SPDES Application been submitted to local DEC office? .........................
Form PC -97
27. Is any portion of this pi".. ct located within a designated Tow r State wetland? X40 '
28. Wetlands ID Number ::::.....................
Wetlands Permit: required? .................... ............................... ... ... .... _ . -
_.�
Has application been made to Town or Local DEC office? ............................... 0
30. Does project require a DEC Stream Disturbance Permit? .. ............................... N4
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application•or industrial activity? ........... ................. Yes/No p
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes/No NO
DESCRIBE:
33. Is there a local master plan on file with the Town or Village? .......................... i S
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ...............................
35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO
36. Tax Map ID Number ......................................................... Map g!!� Block J_Lot
37. Approved plans are to be returned to...... Applicant ._ Design Professional
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approv'& -o therm prtor-to fffla[°�pproval_by%the Department: -Projects, within-t6 -i ershed,may. °also-.
require DEP review and approval of other aspects of a project, such as stormwater lans or-the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms or such activities from
DEP, and submit those forms to DEP for'review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this. provision
may be grounds for the rejection of.any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true
to the best of my knowledge and belief ` False statements made herein are punishable as
a Class A misdemeanor pursuant A
SIGN�T�4TU ES & OFFICL4L TITLES.-
k
Mailiq Address :.... ...............................
r v I.1r AIVt CU U N'1' Y IMPARTMENT OF HEALTH
=DIVISION OF ENVIRONMENTAL. HEALTH SERVICES
4
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT ,SYSTEM .....
"c :44...6.. � . y.: .. .. .1 —.w ' •f.. �•. 1_ �.-� .... ..MF'.t s ... t � .? ♦ :}Y: __
1. Name and address of applicant: �kllS DFJr/�.L�P� Cof�P
2. Name of project:'0 +�.CoW t-cjC' t 3. Location TN: PtTNAf A A l l
4. Design Professional: Q , DE-(.Jo. f e5. Address: ft
6. Drainage Basin: *t%56N My e�(&" (21 -1 LLD 5P94 IJC�T
7. Type of Project:
Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEAR)?
Type Status (check one) ... ........................... .................... ,..... Type I Exempt
Type II Unlisted
9. Is a Draft Environmental Impact Statement (DEIS) required? ........................: M0
h
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. ' Name of Lead Agency
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? ......................
"T3 Tt so, have plans been submitted to such authorities? ..........................................
14. Has preliminary approval been granted by such authorities ?' �1%� Date gr nted: ' .
7".
15. Type of Sewage Treatment System Discharge ................. surface water groundwater
16. If surface water discharge, what is the stream class designation? .................... tA 1A
17. Waters index number (surface) ................
18. Is project located near a public water supply system? ....... ............................... Na
19. If yes, -name of water supply �J%A- Distance to water supply t, JIA
20. Is project site near a public sewage collection or treatment system? ................
21. Name of sewage system' � A/ Distance to sewage system
22. Date test holes observed IQeb 23. Name of Health Inspector M. RUD2Jk6ji 4
24. Project design flow (gallons per day) ................................. ............................... 8co
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... NO
26. Has SPDES Application been submitted to local DEC office? .........................
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? NO t "
28. Wetlands ID Number ......................................:................ ............................... A
'29. Is Wetlan ds Permit required?`:.....:...: .:................................ ............................... �0
Has application been made to Town or Local-DEC office? .................
30. Does project require a DEC -Stream Disturbance Permit? .. ............................... f-JO
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landf llirig, sludge application,or industrial activity? ....................... ...... Yes/No �-Jp
32. Is project . located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? .............. Yes/,No,N
DESCRIBE: .
33. Is there a local master plan on file with the Town or Village? ...................
::.. :.. `(�S
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? .......... ...............................
35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO
36. Tax Map ID Number .......................... ............................... Map ! Block _ Lot
(O.
37. Approved plans are to be returned to ..... Applicant Design Professional .
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
sent to - Deparfeat,- an4eesdiqet > e sent in•duplicate-to the DEli, although°tke project nay requht.-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 plans or the creation of
impervious surfaces; and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown-in Item l.,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
1 hereby affirm,, under penalty of perjury, that information provided on this form is true
to She best of nay knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45 of the Penal ]Law.
cos �. FN& ,f�PPUG4JT-
Sd11'S & ®Fp'lC� TITLES.- .
1.t4 C7 .:.r. PC
-9 V
lg Adairess :......... ..........................'3�T� �1
COL 5Pizte j G laS 1
0-3 :�
,w cr,
' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director �-
In the matter of application for: � C w ,t.� t. - Seta D. L07*
I, Dth1O fit. 5C4+wAfZA""Z
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: tZC0V_f:i'N1 -i-S DE7PPsli.JT Cb 2P
Having offices at:
J30 W. 1�1 ST - Q i t H 100-3>&
Whose Officers Are:
President - Name:
Address: W elS- 7y S7` /t-
Vice President - Name: flg yL
Address: 23O G,J c/ S7 A4K % ®O Re-
Secretary -Name:
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: �
Title: t/'
Sworn to before me this (> day of
.Q1
Form CA -97
Corporate Seal
pp k 1y
NEW
I 10)
LETTER LJR ®Y' rLUTYb ®RI6JATI®1V •c_ c .. .: V.-- n - , ..• f.. � ^. - Nv <
RE: Property of BQOOYSA 5
Located at Pn-eK-S IL( U -* -NOLI yVJ P-DA-D
T/V Tax Map # M Block - t Lot l G < i
Subdivision of i U, F-55 i 5 15*S i
Subdivision Lot #
Gentlemen:
Filed Map # 24-11
This letter is to authorize �T_o4111 P � Df—=LA4_3o , _R ,
Date Filed 0Cj W iq O
a duly licensed Professional Engineer _>c- or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
L.aw,_gtad the..P- utnam.Cotinty.Sanitary Code;,::,,. .
Countersigned. '
P.E., W 062-5o5
Very truly yours,
Signed:
(Owner of Property)
Mailing Address P-,A 4 WAr_5or,).fC:. Mailing Address: b � -,t,S P '> --UPMe*jT'
3Q� Foxf__q CO LX-.-) SPru N (?
State Zip 1013 i;lo
Telephone: q 14 - Z_rorj - `i 21-1
State Nj y Zip t W? &
Telephone: 2,(2— 26 - &i
Form LA -97
1 ¢16.4 (2/87) —Text 12
PROJECT I.D. NUMBER 611.'11 SEOR
1t' Appendix C
- ,- •. _
State Environmental Quallty. Review
- - ^�- • + y • �� M' SHORT . ENVIRONMENTALASSESSMENT�FORM V+ -• _� �� �� -� -'�
Ftr UNLISTED ACTIONS Only
PART.1— PROJECT INFORMATION (To be completed by Applicent:or Project sponsor)
1. APPLICANT /SPONSOR _ ;
. akow t t3� wk0swipmeNIF COOP.
2. PROJECT NAME.
mil' 5 W� &"ems" cow WF I t
3. PROJECT LOCATION::
Municipality l I:tT At-j County t vkT14A-0-1
4: PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map)
5. IS P-ROpOSED ACTION:
mew ❑ Expanslon ❑ Modiflcation /alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
4 '4-co 1 t! �"�
Initially • acres Ultimately'':--- acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ❑ No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
SI Residentlal ❑ Industrial Commercial ❑lAgriculture ❑ Park/Forest/Open apace ❑ Other
,l❑ _
Describe: �i ��,�, F•�,M_�.�`L . E�C� -� ;V•i�• � � - - - - .... , -
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
i §Yes D No If yes, list agency(s) and permlUapprovals
W Cc1c t 'r* -- cgat vi✓� A'y ant
11. .:DOES'ANY ASPECT OF THE ACTION HAVE A CURRENTLY.VALIDTERMIT OR APPROVAL?
Dyes, 1d�NO .:.If,yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
❑ Yes No
I- CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE'SEST OF MY KNOWLEDGE
Applicant/sponsor name: P. ^2 Pub_ Date:
Signature:
V
If the action Is in the Coastal Area, and.you are a state.agency, complete'the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration
may. be superseded by another Involved agency. •° ~ ° -
❑ Yes ❑ No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE' FOLLOWING: (Answers may be handwritten, If legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion, drainage or flooding "problems? Explain briefly
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural. resources; or community or neighborhood character? Explaln,briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly
C5. Growth, subsequent development, or.related activities likely to be Induced gy the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly.
C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly.
D; 13 THERE"OR IS THERE ZIKELY TO BE,:CONTROVERSY. RELATED -TO POTENTIAL- : ADVERSE'ENVIRONMENTAL IMPACTS?
❑ Yes ❑ No If Yes, explain briefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed.by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or-otherwise significant.;
Each effect should be .assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; .(c) duration; (d)
Irreversibility; (e) geographic scope; and (f) magnitude.-If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and. adequately addressed:_.
❑ Check this box if you have identified one or more potentially large or'significant adverse Impacts which MAY
occur. Then proceed directly to.the, FULL EAF and/or prepare a'positive declaration,
❑ Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on attachments as necessary, the reasons supporting this determination:
Name of Lead Agency
C®dnt or Name of Responsible Officer in Lead Agency Title of Responsible Off icer
CD
J.
ggitre of Responsi a O Signature o Preparer (1 different from responsible officer)
(2)
�>
ca_ = .-r. Date
n
b
r u i INA1V1 k, V UIN 1 Y 11LrAK 11V11'r•1V 1 VrAtiEAU114
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
- Owner .Ff�c(:t.S t•/�mCEV2d�r`ess?�d- �t\%`�r
Located at (Street) Sww 44oU ouD �bA Tax Map Block 1 Lot 1W
(indicate nearest cross street)
Municipality �t,17'6yA1 y►�tt.� Drainage Basin05c�;ty �LiJ
SOIL PERCOLATION TEST'DATA
A° . , DA i -
Date of Pre -s
15
p4s
Hole No.
Run No.
Time
Starf - Stop
Ela se Time
(P1VIin.)
De th to Water
1 rom Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Indies
Percolation
Rate
Min /Inch
A'
1
q:24- 9.24:-
2
Al
2
1:2B - 9 = 31
1 ZZ
3
1
AI
3
A `
4
q: - q,39
3
�� z2-.-
3
I
i
A
5
q-'41 - I,dg
3
M zz-
3
V
1
II=25- 1135
Iv
22-
3
3
2
3
11 =55 j2.05
to
.101 22
3
3
4.
12'0`1- IZ =1
1�1 22•
3
3
D
5
1210 - 1 Z'-33
15
I 2Z
3
S
1^
1
1
foCV
1 22
3
20
2
12: 20 — A., 20
(.0
) 22
3
ZC�
3
1'2(,- ),4(o .
20
10. 20
i
20
4
1! g"]- 2 :01
-0
I 20
1
2O
'0
p.
Z'2-E)
20
.
t °1 2
1
20
NOTES: A. , Tests;to'be`r,Eepe:Ated at same depth until approximately equal percolation rates are obtained at each
Tp reol;atiori test hole. (i.e. s I min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be
'L s�rb initted for rev <iew.
;Depth— as irements to be made from top of hole.
-97
Form DD
TEST PIT DATA
DESCRIPTI ®N OF SOILS ENCOUNTERED IN TEST HOLES
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being f
Deep hole observations made by-; �-l�At-3U �P F,
)untered .N ,fir .
k1�T5arv.P C. Date 62'
l�y ♦�,- s±v ✓cii ✓, ! \.. �.(l4►Vw�• --lad lf•
Design Professional Name: Yb+• r P. 6E CL
Address: 5AV6Y 4- WAT5o� , Pc-.
6(. COLD SMIJ6 l 1 tG
Signature: , OJYI,,,6--
Design Professional's Seal
ON
p Q . .r
^D E�.. ^K•� 9i LI
_
rw�w
R!'O F ESS���o���
HOLE N0.
.0
G.L.
PSca t L.
-MP50 t L- �2'> -PP50 L 3
0.5'
S tLi"`'� 5A-t.JD 5LL]2:� Lon W
1.0'
5ANt>\e LOA+A
2.0'
3.0'
3.5
w tw9 Aft
4.0'
4.5'
Low
5.0'
A tLAL
5.5'
cr-)
N
;..
IC-10j
D
cap
w
r�
9.0'
-...
-- _
10.0'
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being f
Deep hole observations made by-; �-l�At-3U �P F,
)untered .N ,fir .
k1�T5arv.P C. Date 62'
l�y ♦�,- s±v ✓cii ✓, ! \.. �.(l4►Vw�• --lad lf•
Design Professional Name: Yb+• r P. 6E CL
Address: 5AV6Y 4- WAT5o� , Pc-.
6(. COLD SMIJ6 l 1 tG
Signature: , OJYI,,,6--
Design Professional's Seal
ON
p Q . .r
^D E�.. ^K•� 9i LI
_
rw�w
R!'O F ESS���o���
a1 \11111 mil. 1 Ljcjr tin iiv1.L'nI Vl+' 11EALTH
a DIVISION Of i WIRONMENTAL HE, — ..TH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
-
0 wner P. =00K 4 ib1e- '� G�2P�... Address alJ�. 9 i It ►J ` dG; '
Located at (Street) Fft5i4u,140LWW P -cam Tax Map Block Lot
(indicate nearest cross street) `3U�D1Vi�lUA� UT �
Municipality I>tkTNfiM yp,,ig, Drainage Basin .44U0 btj P\1
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Qbj Z��24 �q9 Date of Percolation Test 09
Hole No.
Run No.
Time
Start -Stop
Ela se Time
(pMin.)
De th to Water
rom Ground
Surface (Inches) ,
Start Stop
Water-
Level
Dropp In
Indies
Percolation
Rate
Min /Inch
�'
1
�� {� -���5
I -
qq •- 22
.3
A
7A-
4
q
ZL
-
y
4
5
2
1
�i
3
i3
.4
.
5
INUIE6: 1. °;:.Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form D7.
TEST I'I'I' DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES s
HOLE.NO
C'o,MIPA�v�
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed `°t `- 0 %j 3'—Oq _
Indicate level to which water level rises after being encountered
Deep hole observations made by: (? �' Dpi. f E4W 10 Date
Design Professional Name:
Address: UjATrrx T.C_ ,
Signature:
Design Professional's Seal
ii/ i ii .
g DIVISION OPENVIRONMENTAL HEALTH SERVICES
1 .
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
0 - - - :A-ddress>
Located at Street P� c ��� �� �� Tax Map Block Lot
(indicate nearest cross street)
Municipality Drainage Basin
SOIL PERCOLATION TEST DATA
Date of Pre - soaking 1.3 14 1qq Date of Percolation Test
Form DD -97
Hole No.
Run No'.
Time
Start - Stop
Ela se Time
11'Iin.)
Deppth to Water
From Ground
Surface (Inches)
Start . Stop
Water
Level
Drop In
Inclics
Percolation
Rate
Min/Tnch
1
►t�� --
► o
► a,�
3
2
36 �'.�(�
10
.�
3
SS a
ID
3
4
2
4
5
1
1 1;16 -1 a,l
8
! .
20
2
_ ��
.60
y
3
_ 0'
ao
20
4.
-fZ
5
NOTES: 1. Tests to be repeated at same depth until approximately.equal.percolation rates are obtained at ea
percolation 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
IN
Sow 10,
0
FS
INV 00.0
M.
200
00.
L
plote 0 N
L% 55
\\\AG \A
0 A o
4 PEDK,
RESIDE'
FFc�:,
,2 O 2
!: PUTNAM COUNTY DEPARTMENT OF HEALTH
` DIN'ISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM
`y S TIO1 A. GEARA.L INFORMATION
Name of Project J J�Eh��S i� (T)(V} County
Site Location._ (i t
Building construction begun Extent N rz--
Is property within NYC Watershed ? ................. F-1 Yes No
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1. F_� Hilly F__] Rolling F-I Steep slope F_� Gentle slope Flat
2. F__J Evidence of wetlands F-1 Low area subject to flooding Bodies of water
Drainage ditches Rock outcrops
3.
Property lines or corners evident ....................... ...............................
F_� Yes
F_� No
4.
Do water courses exist on or adjoin the property? .......................:....
F_� Yes
F_� No
5.
4
Will these affect the design of the sewage system facilities ?............
F_� Yes
F__] No
6.
Do watershed • regulations apply in this development ? .......................
F__J Yes
0 No.
7
Will extensive grading be necessary? .................................. .
D Yes
[7 No .
8.
Will extensive fill be,necessary for SSTS? ......... ...............................
F� Yes
F-1 No
9..
r
Do filled as exist.N ithin the SSTS area?..-; .............
m... .. ...._._ _ ....._......
Yes__..a
-No-
If yes, what is the condition of the fill?
SECTION C. SOIL OBSERVATIONS
10. Appearance of soil: ❑ Sand F-I Gravel F-I Loam F_� Clay F-I Hardpan F_� Mixture
11. Observed from: F__J Borings 0 Bank cut Backhoe excavations
12. Soil borings /excavations observed by on
13. Depth to groundwater on
14. Depth to mottling
15. Are test holes representative of primary & reserve areas ... ...............................
16. Soil percolation tests made by
17. Soil percolation tests witnessed by
SECTION D (on back)
on
0 Yes E] No
on
on
Form ST -1
2.0 (orr'� �r�r �,�5�- 2.0
J.0 3.0
4.0 (,gar i t/ 4.0
!400" ' .� L o 1 5.0
6.0 6.0
r
7.0 _ 7.0
Z'r 36� 13�r�c� 2.0 3�` ��� ��r�� Lo,�►�
3.0 9 C,
r �
51 L- Y 5.0 2 `
r
(or,
8.0 GL 8.0. j► �" 8.0
9.0 r�rre .� 9.0
10.0 10.0 10.0
SECTION D. DRAINAGE
-- 8: - `'ill'proposed'gradi "nj irraterialiyalter the natuzal drainage m this or adjacent areas? ❑Yes F-] No
19. Will groundwater or surface drainage require special consideration? ...........::..:..... ❑Yes ❑ No
20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .........................
Yes No
SECTION E. -REN RKS
21. If a common grater supply is proposed, has an inspection been made of the
existing or proposed source and facilities? .........:...................... ............................... ❑ Yes ❑ No
Inspection data
22. Do adjacent wells and/or sewage systems exist? ..................... ...............................
Yes ❑ 1\10
23. Additional comments
Q
24. Site observer /inspector and title
25. Date(s) of observation(s)inspection(s)
TEST PIT PROFILES
i
Hole € Lot 4 Hole r Lot _ I
I
Hole 4 Lot r
_
Depth to water Depth to water
Depth to water
Depth to.mottling ��� 47-0 Depth to mottling err
Depth to mottlinc,
�l
Depth to rockhm f .. Depth to- rock/imp.. _ ��
Depth, o rock%iinpr
G.L. G.L.
G.L.
�r rr r
0.� O. 'r ��
e� %
O.S ►' o.
1.0 1.0 02( n� (�
1.0-
2.0 (orr'� �r�r �,�5�- 2.0
J.0 3.0
4.0 (,gar i t/ 4.0
!400" ' .� L o 1 5.0
6.0 6.0
r
7.0 _ 7.0
Z'r 36� 13�r�c� 2.0 3�` ��� ��r�� Lo,�►�
3.0 9 C,
r �
51 L- Y 5.0 2 `
r
(or,
8.0 GL 8.0. j► �" 8.0
9.0 r�rre .� 9.0
10.0 10.0 10.0
P U TNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM.. _
r Owner Mcpy- ..t~m..� C •V�t o�trvtE �r�-P, Address X30 ),45-Kl ST , y
Located at (Street) � kt1�(..4-F6LLW 120ND Tax Map _X Block Lot 1(,
(indicate nearest cross street)
Municipality PtTWW Vm.t,&q Drainage Basin - . 4AAc6uiJ 1z VSC
SOIL PERCOLATION TEST DATA
Date of Pre - soaking t 2/k � 'l Date of Percolation Test 12 \ F3-j
Hole No.
Run No.
Time
Start - Stop
El a se Time.
(P1VIin.)
Nth .to Water
om Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Indies
Percolation
Rate
Min /Inch
r
1
12i4d — V- r o
2t�
9 �, 3l i� 3/
3
9
A
?.
1'12- 1 -,.4 Z
'30
20 r2- 25
2-
17-
3
t : 45 — 2 -16
7�0
22 24 YZ
Z YZ
12_
4
5
30
3
10
2.�
-- _
3 -
1.52- 2122_
1>0
4
5
2
3
4
1VUTES: L, 'Tests 'ro6,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
subm:itted;for review.
r.,
2: +Depth measurements to be made from top of hole-.
Form DD -97
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN 'T'ES'T' HOLES
D -P-TH' .. 1 iC1 E- 0 ..:.::.:f.; 1 IDLE i�10.. ` .. _.. -01", -- }{}..�:.:��
Z�.<
G.L. 1�PSot L
0.5'
1.0' t Du .
1.5' 43 (1.:T—' WA+4 5tL:�— WjkM
2.0'
2.5' d
3.0'
3.5' �1
4.0' SMPY LoA+4 "
4.5'.
5.0' SAS t.Q AM
5.5'
6.0'
6.5'
7.0'
7.5'
8.0'
8.5'
9.0'
10.0'
Indicate level at which groundwater is encountered °11 -0ki
Inge lel at which mottling is observed --
i&6Wte l&el to which water level rises after being encountered *2
C�
e hoobsery tions made by: '�Z-f izfZMAJQ I,JAi>j Date ®S 27
Wi';kn go fessionaI Name:
esg. 5Rm� A w� ► P G:
�P C0)J Ip SPQ.@�1(9) Nj-� lo5I C
Design Professional's Seal
1V e
D O r t'• =s r�±�, ��;
17
iG) - Q
. . . . . . . . . . .
BfJlH
10
1-2/9
ED
FBI TC Hi
BED R M
D! T— I
10
0— B4 i H I
T— 0
fp R
0* 1 V A - '-16
7 12'° �a-If
Ito' -toye
l-':P,�-, -n
TAM qT OF HEALTH
�10VS.E UYDR CO 1NT 0 LITa
ON'ALTERATIONS TO THE�E HOUSE
ALL $VBlSZQ "
-
A
JTTED TO THE PCDOH FOR4 �
PP QYAL
NATURE & TITLE DAIW
3 BR
C:5:1 12-
C,�- i6rV.:ip e-LA5Aj. = 2.i*;5 -C)
pu vo p
(j tj
ZJ��5
o,S6 Go(�L.D5 ', &aS we- oc>4
Ca
4S 65, PM � 2"1 TD H
Order No.
HP Volts
Phase
Max. Amp.
RPM Solids Wt. (Ibs.)
WE031 1 L
115
single
9.4
Wt6jlL
WE0311M
WE0312L
230
A2-5 (115V), A2
Basin A7 -1801
4.7
1750
56
WE031 1 M
115
Order No.: SWA...,
9.4
SWE0311m,
TO: ":8
.Q
WE0312M
230
1
4.7
69 90 104 12
WE051 I H
115
13.0
50 76 92 116';
WE0512H•
230_
6.5
26 58 78 1102_
WE0538H
200
3.9
36 62
WE0532H
230
3
3.4
WE0534H
46_0
1.7
WE051 1 HH
'h
115
1
13.0
60
WE0512HH
230
6.5
WE0538HH
200
3.8
WE0532HH
230
3
3.3
WE0534HH
460
1.65
WE0712H
230
1
10.0
WE0738H
% 200
6.2
Y4'
WF:0739l4
208-230
3'
5.4
3500
WE0734H
460
2.7
70
WE1012H
230
1
12.5
WEI 038H
1 200
8.1
w
208 -230
3
7.0
WE1034H
460
3.5
WE1512H
230
1
15.0
WEI 538H
200
_208-230
10.6
E1532HF
-
- 3'
9-2
7
WE1534H
I Y2 466
__i3_01
4.6
80
WE1512HH
15.0
WEI5 8HH
200
10.6
WE1532HH
208-230
-
3
9.2
WEI 534HH
460
4.6
METERS FEET
120
MODEL: 3885
r
TIT
I
SIZE: 3/4' SOLIDS
110
0
30
25- 80-
70
20-
60
is- 50
40-
10- 30-
20
5 r if
Ka
0 10 20 30 40 50 60 70 80 90 100 GPM
0 10 20 M3/h
CAPACITY
WATER TECHNOLOGIES GROUP
SElECA MLS NEVV1PRK GAS SPECIFICA
AM
it
r-1
iF
Are In inches. Do not use for com
I HP = 15"
1,WE0712H and WE1012H =18';1
12W
F-ROTATION
" KICK-BACK
i-IFT
WE0511H
Order
rstem gME, Package Incli
WE0512H WE0712H WE1012H WE151 W&RUNH
No'
single
WE0538H WE0738H WE1038H. WE1538"..- Vk� hH
.0
Wt6jlL
WE0311M
WE0532H WE0732H WEI 0 32H WE1532H WED§??.,.
WtOiX WE0312M WE0534H WE0734H WE1034H WE1534K.'WE05 HWW6034HH
A2-5 (115V), A2
Basin A7 -1801
d and
1/2 Y4 1 11/2 li-' I" I
A_.
•750
1750
3500 3500 3500 3500,..: 35M.' . "'3500
Order No.: SWA...,
Ications.
SWE0311m,
TO: ":8
.Q
65
- - - A4
1*5 .;60.
57
69 90 104 12
45
60 83 98 122
25
50 76 92 116';
38 67 85 109
26 58 78 1102_
15 47 70. 941,
36 62
AM
it
r-1
iF
Are In inches. Do not use for com
I HP = 15"
1,WE0712H and WE1012H =18';1
12W
F-ROTATION
" KICK-BACK
i-IFT
WOR SYSTEM
rstem gME, Package Incli
irIng
Submersible EM
single
12L or WE031 11
pacifies
Mercury Level 0
[ designed
A2-5 (115V), A2
Basin A7 -1801
d and
Check Valve
and
Order No.: SWA...,
Ications.
SWE0311m,
SWE0511HH,tN.
,,'HANG4�.WITHO�t NR -Mkt.
s.
9P
R"
ridgy` -
Friction
LOSS
PLASTIC PIPE: - • . C�
FRICTION LOSS PER 100 FT.
2
2"
21h"
3"
4"
6"
8"
10"
GPM
GPH
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
Ft.
Lbs.
6
360
.10
.044
8
480
.17
.073
10
600
:25
.108
.11
.046
15
900
.52
.224
.22
.094
20 ,`
1,200
.86
.375
.36
.158
.13
.056
1,500
1.29
.561
.54'
.234
.19
.083
30
1,800
1.81
.786
.75
.327
.26
.114
i
2,100
2.42
1.05
1.00
.436
.35
.151
.09
.041
40 '
2,400
3.11
1 1.35
1.28
.556
.44
.191
.12
.052
45)
2,700
3.84
1.67
1.54
.668
.55
.239
.15
.064
50;`
3,000
4.67
2.03
1.93
.839
.66
.288
.17
- .076
60:'
3,600
6.60
2.87
2.71
1.18
.93
.406
.25
.107
70
4,200
8.83
3.84
106:
1.59
1.24
.540
.33
.143
80
4,800
11.43
4.97
4.67
2.03
1.58
.687
.41
.180
90
5,400
14,26
6.20
5.82
2.53
1.98
.861
.52
.224
100
.6,000....-
.:. _
7.1:1.....3.09
2.42
1.05
.63
- -:272
-.08 .
, -M6
125
7,500
10.83
4.71
3.80.
1.65
.95
.415
.13
.055
150
9,000
5.15
2.24
1.33 i
.580
.18
.077
.
175
10,500
6.90
3.00
1.78 .774
.23
.1C2
200
12,000
8.90
3.87 2.27 .985
.30
.130
250
15,000
i
,
3.36 1.46
.45
.195
.12
.051
300
18,000
4.85 ! 2.11 .63 i
.275
.17
.072
350
21,000 i
6.53 .2.84 84
.367
.22 1
.095
400 24,000
1.08' ,
.471 I
28
.121
j
500 ; 30,000
1.66 i 720
42
.182
.14
059
550
33,000 j i
1 1.98 I 861
.50 1
.219
.16
.071
600 I
36,000 I i i i
2.35 1.02
.59
.258
.19 1
.083
700
42,000 j j i
.79
.343
.26
.112
800
48,000 i i j
1.02
.443
.33
.143
900 ;
54;000 I i ; ` '• 1.27 554
.41 j
.179
950 !
57,000
46
198
1000
60,000 I i I i ! i ' i
.50
_
.218
2
a i�ncfion
._.. . �. - .. .. o-v a i'u'y _ 0-W,
i•_i- r'+•� - . ... : .. _ .:.rv- _. >tr. .�... M
EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS
Size of Fiftings, Inches
1 /z"
3 /a"
1"
11/4
1 Y "
2"
21/2"
3"
4"
5"
6"
on
10"
900 Ell
1.5
2.0
2.7
3.5
4.3
5.5
6.5
8.0
10.0
14.0
15
20
25
450 Ell
0.8
1.0
1.3
1.7
2.0
2.5
3.0
3.8
5.0
6.3
7.1
9.4
12
Long Sweep Ell
1.0
1.4
1.7
2.3
2.7
3.5
4.2
5.2
7.0
9.0
11.0
14.0
Close Return Bend
3.6
5.0
6.0
8.3
10.0
13.0
15.0
18.0
24.0
31.0
1 37.0
39.0
Tee - Straight Run
1
2
2
3
3
4
5
Tee -Side Inlet or Outlet
3.3
4.5
5.7
7.6
9.0
12.0
14.0
17.0
22.0
27.0
31.0
40.0
Globe Valve Open
17.0
22.0
27.0
36.0
43.0.
55.0
67.0
82.0
110.0
140.0
160.0
220.0
Angle Valve Open
8.4
12.0
15.0
18.0
22.0
28.0
33.0
42.0
58.0
70.0
83.0
110.0
Gate Valve -Fully Open
0.4
0.5
0.6
0.8
1.0
1.2
1.4
1.7
2.3
2.9
3.5
4.5
Check Valve (Swing)
4
5
7
9
11
13
16
20
26
33
39
52
65
Check Valve (Spring)
4
6
8
12
14
19
23
32
43
58
Example:
(A) 100 ft. of 2" plastic pipe with one (1) 901 elbow
and one (1) swing check valve.
900 elbow - Equivalent to 5.5 ft. of straight pipe
S- -wing_ 1
Check'- Equivalent to .,3O�ft;_�f �fra(ght pipe
• - -- -' �"
--T00 ff,df pipe - Equivalent to 100.0 ft. of straight pipe
118.5 ft. = Total
equivalent
pipe
Figure friction loss for 118.5 ft. of pipe.
A Assume flow to be 80 GPM through 2" plastic
pipe.
1. Friction loss table shows 11.43 ft. loss per 100 ft. of
pipe.
2. In step (A) above we have determined total feet of
pipe to be 118.5 ft.
3. Convert 118.5 ft. to percentage. 118.5 =100 = 1.185.
4. Multiply 11.43
x 1.185
13.54455 or 13.5 ft. = Total friction loss in
this system.
11
\ =2 .0 1
`1.,•,� �y INV i INV 00.0 1
Ff ttt
O� D MP IT 12 0 GALLON
s °O \ PRO SED SEP C TA EC ONC.
RESIDE OOM M1N
FF =202
IN
i
2
X CG X
N SFO S �9�
A
e
S ?°
1 �a
� p E
C7jB +
PR O POSED
Ora
N e 100 f `M�N�N
w t°`� of 3) o N
D N E lW A k L1 �x�st \NG s5�s NO �X\SPNG
KD
F 5 NO
I�
I INE PLAN
e
e A". SCALE 1"= ..30'
74.00' -
i`
r
t
u
\W"
1�
I <
l
� r
e�.
,
•j� VY�OY �Y9
r ALTERATION OE THIS �
' ANY WAY, BY ANY PERS
. THE DiRECT10N 11i ,
BADEY & WATSON
Surveying & Engineering, P.C.
3063 R_ oute 9, Cold Spring, New York 10516
914'265-9217; -7-39-357,7;.. 6284*800
FAX (914) 265 -4428
TO:
Adam Stiebeling
Putnam County Department of Health
1 Geneva Road
Brewster, NY 10509
We are sending:
LETTER of TRANSMITTAL
Date: 24 Sep 1999
W.O.# 12720
RE: Proposed SSTS
SCHWARTZ
Peekskill Hollow Road / Brookfalls Road
Foothill Estates East Subd. Lot No.
Tax Map 84.00 -01 -37
PCDH Permit #
Sent via:
US MAIL ❑
UPS -NIGHT
❑d
MESSENGER ❑
UPS -2 DAY
❑
PICK -UP ❑
UPS -3 DAY
❑
UPS - GROUND
❑
copies date description of document
El 123- Sep -99 Construction Permit for Sewage Treatment System. �
F-11 Application for Approval of Plans for a Wastewater Treatment System
❑ 115-Sep-99 IDesign Data Sheet
23- Sep -99 Separate Sewage Irreatment System Fill Plan Sheet 1 of 2
01 23 -Se -99 Separate Sewage Treatment System Sheet 2 of 2
REMARKS:
orms and plans revised to reflect recent test results. Bedroom count reduced from 4 to 3 BEDROOMS. I
elieve the applicant has previously provided the balance of forms, plans, fees, etc... in conection with this
pplication. Your timely conclusion is appreciated. Thank you.
Signed: John P. Delano, P.E.
cc: . File
PCDH 2486
BADEY : WATSON LETTER Of TRANSMITTAL
3063 Route 9, Cold Spring, New York 10516
914 265 -9217; 737 -3577; 628 -1800 Date: 12 Aug 1999
FAX (914) 265 -4428 Refer inquiries to:
Work Order # 12720
Project Director JPID
TO: Our. File Number 86- 198.11
Sent via:
US MAIL
❑
UPS -NIGHT
W
MESSENGE
❑
UPS -2 DAY
❑
PICK -UP
❑
UPS -3 DAY
❑
FAX
❑
UPS -GROU
❑
❑
❑
UPS -COD
❑
We are sending
number date of
copies document
description of document
final prelim
concep
.
revise
® 1 04 Aug 1999
JConst ruction Permit for Sewage Treatment System
❑
❑
❑
❑
❑
❑
❑
❑
Letter of Authorization
®
❑
❑
❑
❑
A lication for Approval of Plans for a Wastewater Treatment
®
❑
❑
❑
❑
Affidavit - Co rate Owner Application
® 04 Aug 1999
❑
❑
❑ .
❑
Short Environmental Assessment Form
E —111 14 Dee 1987
❑
❑
❑
❑
[Design Data Sheet
REMARKS:
Also enclosed; I SSTS Pump Design; 1 Application to Construct a Water Well; 3 SSTS'Fill Plan; 1 SSTS Plan.
You :need-to execute the Letter-of-- Authorizatiog 8� the A id�vitiffor; 6 �'pofkte!IDav erc Application,, ►dude 2�s is
-
off House lans and $300.00 Certified Check or Money Order; forward entire package to Adam @ PC1DH
COPIES TO: