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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -29 BOX 33 ry N1 � T 1- if f kip m re , . 207-03m- PUTNAM COUNTY DEPARTMENT OF HEAL. CERTIFICATE OF CONSTRUCTION COMPLIANCE F ATMENT SYSTEM PCH3D CONSTRUCTION PERMIT # P V Located at Ki2AMefzS PoPb T}oHD To or Village ?V'TN!9M Cot Z P, Own Applicant Name 3-1 CRS 1 o� 1,►`�I ly �a Tax Map Block Lot Formerly Subdivision Name t?y T N A. 1 C NAS OF Subd. Lot # Mailing Address .3-7 '& W Nll✓ RS Pa AD V. PuT-J t1 r1 Vi4 L C E `d . /J . `�. Zip Date Construction Permit Issued by PCHD 'Sy PJ r— 19 f 10191 .2-7 C12o ; � � IAA i'`'t 1'2 o A9 Separate Sewerage S, sy tem built by 3�CRo ion b�►n Ra+�o C ®iZP, Address 0S S I *Q 1 fV C N, Y 1 d s-6'2 Consisting of Gallon Septic Tank and 6 0 L, F o PE 12 F o1? A T En PVC p1 Pc Other Requirements: Water Suooly: Public Supply From' Address q PuTiJAvin A•✓EtJue or: x Private Supply Drilled by F F Seig t � Smi, i N c— Address 1312E W s , E n', ni: Y. I o z-0 S � i l-3ing Typea� Cite- ):A eh-completed ? -- Number of Bedrooms Fo u tz- Has I certify that the system(s), as listed, serving the built plans (copies of which are attached), in plans and the standards, rules and regula ' n of Date: Z 3 —S 5 Certified by Address *7-00 arbage been installed? /O 0 N�Wyo ive� *emises wee tructed essentially as shown on the as- Fe - ssued Construction Permit and approved Putty Cd'ty D ent of Health. P.E. J R.A. License # D 6 V) kV 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 revocati , modific 'o r is n cessary. By Title: — Date: 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi nal Form CC -97 PUTNAM COUNTY ]DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT-;::. e1116cititin Street Address: Lot #16 Kratters Pty Pd, Putrm Chase Subd. TownNillage: I Putnam Valley Tax Grid # 84 -1 -29 Map Block Lot(s) Well Owner: Name: Address: V.S. Corporation, 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 HDrilling 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 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot i9 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 50 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 220' Depth of completed well in feet 365' Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface 5 Drilli 4 in ove burden clay and boulders 5 Hit ro at 5' 32 365 Drillin in roc ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub -- Capacity 1OL Depth 240' Model 10GS10412 Voltage 230 HP 1 Tank Type WX302 lume 86 al Date Well Completed 8/26/99 Putnam County Certification No. 002 Date of Report 11/3/99 Well D ' e ign . Nu'rz: rxact location of wen wttn atstances to at least Well Driller's Name P. ns r. Signature: White copy: HD F permanent lanamarxs to tie proviaea owa separate sneevpian. Address: 4 Put rw Ave., Vaster, NY IM Date: 11/3/99 Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY CT Cert PH -0404 LABS 39 MILL PLAw ROAD - DANBURY, CT 06811- NY Cert: 1��`ll' (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT- VO• PT. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 DATE SAMPLE COLLECTED: 11 /3/99 TIME COLLECTED: 9:00 A.M. COLLECTED BY: R. DeVALL DATE RECEIVED @ LAB: 11 /3/99 TESTED BY: LAB #11471 REPORT DATE: 11 /8/99 SAMPLE SITE: V.S. CONSTRUCTION, LOT #16, PUTNAM CHASE SUB DIV., PUTNAM VALLEY, N.Y SAMPLING POINT: TANK — HOSE BIB SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 15 Odor ND 3 Units pH 7.09 no designated limit Turbidity 0.24 NTUs . 5 NTUs CHEMISTRY: Nitrite N -50.005 mg/L as N 1 mg/L as N Nitrate N 4.98 mg/L as N 10 mg/L as N .Alkalinity 232.0 mg/L no designated limits ir&ess, a 2124;;0.:, ...rn�l.L- Z :A :- nd.desigaated Iiiniii l. Iron - 0.063 mg/L 0.30 mg/L Manganese 0.039 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6:2 mg/L 20 mg/L ** Lead <0.001 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: 11/3/99 SAMPLE, AS TESTED ABOVE: OPOTABLE or DOT 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 CRGNIN ENGINEERING PE PC The Lindy Building, Suite 200 PEEKSKILL, NY 10566. (914) 736 -3664 FAX (914) 736 -3693 T131 Adam E. Stlebeling Assistant Public Health Engineer Putnam County Dept, of Health Dept.. of Environmental Services R4 Geneva Road Brewster, N.Y. 10509 VE ARE SENDING YOU At tachad COPIES DATE ATTENTDSV ADAM STIEBELING 'P CRoT�J k 0Ar►l 12p Ca%ZP Pv —II -9� CERTIFICATE OF CONSTRUCTION COMPLIANCE PACKAGE 1'ilz o cll S P00-0 20190 - TOWN OF PUTNAM VALLEY COPIES DATE NO. DESCRIPTION 3 AS —BUILT SEPARATE SEWAGE DISPOSAL SYSTEM PLAN 3 CERTIFICATE OF CONSTRUCTION COMPLIANCE 3 GUARANTY OF SEPARATE SEWAGE DISPOSAL SYSTEM 1 FOUNDATION LOCATION SURVEY MAP 1 WELL COMPLETION REPORT 1 WATER ANALYSIS REPORT -5200% -0H CK, -FOR- APPLICATION ' FEE THESE ARE TRANSMITTED For approval �, M.! MIMIMIMIMIM? MsMIM/ M! M( MIMiMiM( M! MAM1M[ M/ MFl 1�IMtMiMtMI�11EM: M!!' �111MiMIM'. M4M ?M:MIMIMIMIM!MIAMMtM!M(MIMIM lip N., A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH S_ ERVICES �: ........a _ . - � = .... : ci`•ra.' ,.i 7' - r..m'•'r :q r .. i .♦ •.. :a?ne .cr - e, .. .. ., f 'f-' - .,.r,t.o •• ... �'• ..� of .:o �a -. (- i�:-F, ••ea».'Y_• ".�:YV. ,. n1P, ni .. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3'7 CRa•To;J 0,4lti1 -P6 pD C0 2P.• Owner or Purchaser of Building 977 cR6 totJ o4n J?o (-in co 2 r Building Constructed by I`izr9 A 6ZS P6,,�P Po nD Location - Street Building Type �5 4AV 1 2 � Tax Map Block Lot ow illage Subdivision Name 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 negligent act of the occupant of the building utilizing the _ .... •systems_ The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Ncus%e County Department of Health as to whether or of the f lure of the system to operate the by the willful or negligent act of the occupant'4f tqe b 'lding ktilizing the SyRtemk 'k j - N K R!! NIIa . 1�I e It Z Z Year /999 3-7 CROo• c� P1q� Root) cd2r Corporation Name (if corporation) Signature: Title: f'R C 0 b1-_,.►"j— 3-7 cT?y , a?i p% m c-aRe Corporation Name (if corporation) Address:.3? C_Rc; -n �J Diq r\ RO, 6 S-0,'J I.J C Address: 37 c2g7-ai .OAS Ra State /\i6�7 `W Yo i2 K Zip 10 -S�_6C_ State /JO �J ` OV K Zip 16 6`. Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONINIElTAL HEALTH SERVICES FINAL SITE nNSPECTION �ate:. 1 © .7. 6t c gtreetto �, 2a"k�x��. Owner �A{ Y. T Permits TINT Subdivision Subdivision Lot r 1. SewaQ27e Sv tem Area . a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Avo.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 ....... 1,250 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..... ... ...... ........................,/ enoth required �?7 Lenath inst 2. Distance to watercourse meas Ft.......... 3. Installed according to plan ..... ............ .................... 4. Slope of trench accep e 1 -1/ /foot ............. 5. 10 ft. from prope ine - - f- datio .......... 6. Depth of trench inches o s' ace ................. 7. Room allowed fo expansi ,1 .................. 8. Size of gravel 3/ - 1 %2" d' eter an .................... 9. Depth of gravel i trenc_ _2" .minimum ........: .......:.:. eape ............................................ : ._ CONNI tiTENNTS 11 jl_� t_� F,11 g. rum or llosect Jystern Size o pump c am er ............. ............................... 2. Overflow tank ......................... ............................... 3. Alarm, visual / audio .............. ............................... 4. Pump easily acce ' le, m ole grade ................. 5. First box baf .................... ............................... 6. Cycle witn sed by D.estimated flow /cycle........... III. House/Buildin a. House locatEd per,approved plans ....................... b Number of bedro .......................... .... ... i IV. Well a Nell located as per p ve 1 b. Distance from STS ar as ft ........... c. Casing 18" above grade .......... ............................... d. Surface drainage around 1 acceptable.......... . V. Overall Workmanshiti a. Boxes properly grouted .............................Y.. ..b. All pipes partially backfilled ........ ...................... c. All pipes flush with inside of box .................... = d. Backfill material contains stones <4" diamete .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... T - - - t /A, v .•L-....r.e ei .a - .. _. .,. .. ... _ fJ +Cr.'C... .. 'r• :� a ,. ,r �.. •iy -. •. .> ,.. ..• s.'.. . 'q�.o �w":nr•. .'.R.:$.•y >.. �.i PiJTKAM COUNTY DEPARTN" OF E MALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REM= FOR E Na INSPECTION For. Fill Trenches x PCHD construction Permit # PV- 11- 9 9 1 / Located Jj fziqMegS P6rJD I?r iqD . Q(V)�uT� �h ,qqg- y u jn, pphcantName.3j CR0TwJ Mgr j Tl6 . Cd TM& Block 1 Lot Formerly Subdivision Name Pv TN ►a m C MA S Subdivision Lot #' 16 Is system fill completed? tj kq Date Is system complete? _ y,_ Es -__ Dave 10-2C-59 Is system cons Mew as per pleas? SET _ Is well drilled? Is well located as per plans? C-s Are erosion control meagures in place? . w I cea* that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit . aMd__ j".and the Standards,, Rules and Regulations of the.Putu= .Coutity.Depknment : a Date: /0 26 S Certified hy_ PE-X—ItA "^ Design Professional i•� hU Address 2 �N�.1 i9trrt �[y� KrKr�t.�„Y Lic. # Comments: FOR KADAM L7 CBn 1 d 1 48LU 161 'ON M Form FIR 99 HllV3R AN3 AID WYM WY WL QHZ 66- 4Z -1�0 PUTNAM COUNTY DEPARTMENT OF HEALTH 194 _l —Z DIVISION OF ENVIRONMENTAL HEALTH SERVICES. CONSTRUCTION PERMIT FOR S TMENT SYSTEM I PERMIT # V I !'- 9 f M7 Located at W fjRl't'd614S f:>a,-J Wo4D cr SUSLUE Y OF P9ZoPt"RT Y fNt PA?Lt o Falk, Subdivision name DR. 14A Z`, sEtboi" Subd. Lot # S77 Date Subdivision Approved (�r Village PU i /Ji9 r"t 1,9LLE'r Tax MgBlock d Lot Renewal Revision Owne Applicant Name .37 cfWVtiJ -b iQ n. g0 w.0 Cost? Date of Previous Approval Mailing Address 39 Cl2OTW J b4vlq 120A 6 oSS1>OIJ64 A)Cw y'o��C Zip /dSC Amount of Fee Enclosed X380 spa &c r -AMIL r . Building Type KC-S 166;4 c 6�- Lot Area W.1 Ac-No. of Bedrooms I— Design Flow GPD 1010 O Fill Section Only Depth Volume Separate Sewerage S, sY tem to consist of SO gallon septic tank and SOV L, F Qe:Iii F Svc pd pc I 2r1L 612iq VE1 -- - rrzc?j cly Other Requirements: 3) C oTO �r"'-1 o To be constructed by 3'7 eRo-mJ fiAt- r 266b Address O,SS i lJ i i.1 61, N _ �_ 10.576'1 Water Supply: Public Supply From Address _ or:: ✓ PrivateSUpply Drilled by, F, l3tlrl� SO rJs: °i C,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 th ' -\ ccessors, heirs or assigns by the builder, that said builder will place in good operating condition any pas ent system during the period of two (2) years immediately following the date of the issuance of th 6f tfte G��y'fi * of Construction Compliance of the original system or any re rs thereto. Signed: Address '7 , J.A k.d, W,�, �d %� 1 APPROVED FOR CONSTRUCTION: This x W R.A. Date License # 0 6 Z c) �-V 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. Appro ed r is ar of domestic sanitary sewa a ply. .. �. f By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT ENT OIF HEALTH ➢➢BSI {OFd OF ENVIRONMENTAL HEALTH SERVICES APPLIIcCATRON TO CONSTRUCT CT A. WATER WELL q please print or type PCHD Permit # Well Location: Street Address: To illage Tax Grid #' 1C"rbEY X lod ® ?D. fu—, ipw,, VlgLLC7 Map Block Lot() �- Wen Owner: Name: 37 e Ro-r wJ DAB. Address: 3'7 c-nz Za j 1!�.A rtA fL.d A r, T401gb CORP. OS S 11J I� � tJ.. I OS�Z Use of Well: b Residential Public Supply Air /Cond/Heat Pump Irrigation I- pr°imairy Business Farm Test/Monitoring Other (specify) 2- secoadaryv. Industrial Institutional Standby Amount of Use Yield Sought 5"' gpm # People Served Est. of Daily Usage ECIO _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Da°aung ✓New Supply (new dwelling) Deepen Existing Well Detaaled ]Reason WIC TM SUPPLY . F-011 t CAJ IZ;C S 1 ,b CN C E- ff ®>r IIDAlln®g Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes a-� No Name of subdivisionbsuziC Y or Mi oT-Vitye PR ePpiEp F oa Pr,2. mq Y Sc - 6 i.-J, " Lot No. Water Well Contractor:f F. QCgZ � So'-3S 1t lC- ssWv pne't iwc RZGO-Cr r f ^J.y. NEW y. ...:Q.�a... Is Public .Water Supply available to site? . �` ............�. ,..`. ............... Yes No. Name of Public Water Supply: 1.) fF �Y , �y ` �� °N, illage N ire Distance to property from nearest water main:. Proposed well location & sources of contamin tl�o o b d on @p; ate sheet/plan. ..v., W Date - ;Applicant' Signature: E2980 'J� O F E ' S'0�% PERMIT TO CO1�tS'T - TIER WLLL 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 al e Permit Iss ' cial: Date of Expiration t Title: fi Permit As Non- Tirat<nsfferrra Ile White copy - HD file; Mellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH A DIVISION OF, ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL r-,) � LLplease print or typer « ;z::• 2: a�•._ - - = PCHI3�ei°iriit�:: °�- ;`.:�•:.:,• L 9 "I'_ Well Location: Street Address: Town/ Tax Grid # S aNli N Map g5,' Block I Lot(s)% Z, Well Owner: Name: 3-2 UzorO.4 Address: 37 cao-IoIU oA," r164P 60M I 05 �vltiC� /� 0 6 Z Use of Well: _X Residential Public Supply . Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �_ gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 1"Divi OUAL L for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes. No Name of subdivision BL.Y � CbkS15 Lot No. I Water Well Contractor: tar. A L SonrS Ad ss. �v C �5M-M &Q _R Is Public Water Supply available to site? ..:.... .. ....... ..... Yes No _ Name of Public Water Supply: o ; lage Distance to property from nearest water main. Proposed well location & sources of contami be pro vi a on s arate sheet/plan. fit-' FLAN r .. cant- atur . D ate: ....D1-; _?- 9... Appl . Sign e:�.. - 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. Date of Issue 5 N � 1 Permit Iss ' fficial: Date of Expiration _ o�f 1 o Title: of Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 0 FUT' TAM COUNTY DEPARTMENT OF HEALTH ...�.. SION.OF ENVIRON ENT'AL.HEALTH - SERVICES CONSTRUCTION PERMIT FOR S q TMENT SYSTEM PERMIT # Located at gyp, R M 674.S po t-j 4 a (�r Village..CCu.i 1119 r x V19 LCCY rrSuaVkFY or- Piko -ptWTY mePA?ztD P ^, Subdivision name DR, NaR I-t SECbi�" Subd: Lot # S77 Tax MapBY�Block I Lot Z_ Date Subdivision Approved Renewal Revision Owne Applicant Name .3 `7 cRa—, p/j _b iq n. 0 A D Cast - Date of Previous Approval Mailing Address 3 2 C'R o Thtj Dana t?o w o o -SS 14 i t- 6, N w �/o`ttt Zip I d-S 6- Z Amount of Fee Enclosed �3y0 Building Type VLSI bey iCe' Lot Area 7Y. -1AcNo. of Bedrooms Design Flow GPD Zd O Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 600 L ►"• " � SAY Qtti -F PVC PIPE: I P 2fZ 6Z11 V6-L. - rTzC?J c�f Other Requirements: To be constructed by 3% Cr?o -n^l Mr-4 R06b Address OSS 1;3 lr,� 6,, �0 _ Y_ l0S, ,Water Sunnly: Public Supply,From, - - Address- or: ✓ Private Supply Drilled by F, 66A L So I/J C, Address � f v i W P r-4 4Vc. =6P S-rim, ti .y. 1 d Sa 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.th, ' " uccessors, heirs or assigns by the builder, that said builder will place in good operating condition any, p f s��{ ent system during the period of two (2) years immediately following the date of the issuance of th df'tfie Ctg, 'fic of Construction Compliance of the original system or any re rs thereto. Signed: / / Address %, I I �,n W61-4, / 13 11 APPROVED FOR CONSTRUCTION: This z W R.A. Date 6-3-5? License # D 6 Z c) '�-O 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. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 F] 27. Is any portion of this project located within a designated Townes wetland ?_ 5 28: `Wetlands IIf Number ................ ............................... .................... P4:: 29. Is Wetlands Permit required? ............................. ............. ............................... O Has application been made to Town or Local DEC office? ............................... r.1 Ili 30. Does project require a DEC Stream Disturbance Permit? ... ............................... N 0 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 rJ O 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 e-5 DESCRIBE: 4,.,44 T}ft nT&Wraz 33. Is there a local master plan on file with the Town or Village? ......................... E S 34. Are community water and/or sewer facilities planned% be developed within 15 years in or adjacent to project site? ................................ ............................... I) O 35. 'Are any sewage treatment areas in excess of 15% slope? . ............................... i 36. Tax Map ID Number Map 8* S I$ g 2 .......................... ............................... , 0 Block 1 Lot 37. Approved plans are to be returned to ..... Applicant _je< Design Professional . - NOTE AH- applications"f6iire ,i&ww nndapproVa.l of a tlew °SSTS-t+o'be-located with nithe NYC )Mitet4tre&shaii 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 ofa 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. F NEW; I hereby affirm, under penalty of perjury, t' o g to the best of my knowledge and belief. F1eme a Class A misdemeanor pursuant to SIGNATURES & OFFICIAL TITLES: Grz0 Mailing Address: ................................... -r NEW Yn faded on this cue c;ro, ein are p nis le a aw. W 0 C, W i NJ `�' 62980 Z ! 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"t'+ 7 r -:11,1-1 ? 0! _ = '::.:. k ;;t ", 'C; .F, 4 t 1': :�! "r , •'Y- .. . ....,r,. .ra. . Y- t.' r' M y.. % . �: /_" j *: I ,+ to °: .. ,.. ,.,. .. ..... 1 ,..'.....::.. .f. r . , _.., . / t ,_*.-1, I.. . #: . , W. � . .. ..1. _. ,!. J .:. . $' a: .. .. .. _ - V. rr j,�' i . J.F, _,: i vY .', '1'i`' i" `. �h ,,,,YY,, yy9�W�f� •: r�.a YCr W A .: . 5:, :l ": �': :i 'i , `M1 , t i.i J. :' . i. t, J':.:.. h. -. .....�..'. h J. t _ yt -t ' r. y: . :i: i ": :: �`� ` - '': ,: :. 'i n' .Y-1.1 . - Zle.s'• .' iy i. \. J ;r . :a �'a ..,.. ..., : :. -Y: :i .. .. .. .> :\ , 1•,: t::. .. _ ... t ' 1 %f /• - c ;; 06/17/99 THU 15:25 FAX 914 736 3693 CRONIN ENGINEERING PE PC CRONIN ENGINEERING P.E.,P.C. 2 JOHN. WALSH ,BOULEVARD TAI` "E "'L "I`N]Dy BI:Z3G ,.9,u,1TE, 100 PEEBSBILL, NY. 10566 FACSIMILE TRANSMITTAL SHEET TO: FROM COMPANY: DATE: PGDH os• 17 -99 FAX NUMBER ^ 1 TOTAL NO. OF PAGES INCLUDING COVER: PHONE NUMBER d / SUN DEWS REFERENCE NUMBER a 7� � toll �s? RE YOUR REFERENCE NUMBER: �SDS & Road ❑ URGENT FOR REVIEW 13 PLEASE COMMENT O PLEASE REPLY ❑ PLEASE RECYCLE NOTES /COMMENTS: — prat* "r ya ovir e"o•ja cotiUtILlotna N y &Oe# -0 1 TELEPHONE (914).736 -3664 ■ FAX (914) 736 -3693 IA 01010 i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 3'7 cKoTd �J D (4 M go i'q D Co -1 Z- r' tsSS n�lN'6, ^J-Y- 10 56'7 - 2. Name of project: S S D -S 3.. Location(pV: FU-TW p M 1Vi3 L L 7 TNC L(fJb Y 7rL n 6 4. Design Professional:T-*to-r if.Y L. Address: Su -rG- 2 oo 2 ToK b.07 tvt, 6. Drainage Basin:PtEKs i<I L L Na z c o W SR 001< PE E KS K I L L, 1Q 56'6 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 (SEQR)? Type Status (check one) ........................ ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? . : ......:................ .J 0 10-."''Has-DE-IS been completed and found acceptable by Lead Agency? ............... 11: Name of Lead Agency, :12: Js.1 is_Pr. Ject. i i asp; a<•e ar- der. the..cou+rol of lopal..n & t7criing, .car_ other officials, ordinances? ... ......... ................. . ........... es 13. If so, have plans been submitted to such authorities? ....................... ....... 4 0 14. Has preliminary approval been granted by such authorities ?dA Date gi?anted: 15. Type of Sewage Treatment System Discharge ................. surface water ✓groundwater 16. If surface water discharge, what is the stream.class designation? .................... nJ 14 17. Waters index number ( surface)°::. .................. N , 18. Is project located near a public water s' upply system? ....... ............................... N 0 w 19. If yes, name of water supply, 114A Distance to water supply N ii 20. Is project site near a public sewage ;collection or treatment system? ................ N r ��� 21. Name of sewage system. PTA Distance to sewage system _ r' R AA r-1 22. Date test holes observed. 3 29 23. Name of Health Inspector S rrEg>= r. 24. Project design flow (gallons per day) ............. .................. ............................... 900 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N 0 26. Has SPDES Application been submitted to local DEC office? ......................... / A Vt. 2 27. Is any portion of this project located within a designa`ied�T6*h ;� 4 Statewetland? NO 2 8 -,.Wetlands ID-N ....................... ................ i 29. Is Wetlands Permit required? ........... ............ ................................... J► 0 Has application beenmade to Town or Local DEC. office? ............... 30. Does project. require a DEC Stream Disturbance,PermitZ.,,. ............................... 31. Is or was project site used for agricultural activJtyi,nyQlving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial . activity? ............... ....................... Yes/No X10 32. Is project located within 1,000 feet of existing or aba.ndoried landfill, hazardous waste site, salt stockpile, landfill, sludge . disposal site or any other potentially known source urce of contamination? ............................... Yes/No' tj o DESCRIBE: 33. Is there a local master plan on file with the Town, e? .......................... —YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................................................ Ji 0 35. Are any sewage treatment areas in excess of 15% slope? ................................ t3 0 r � I .. , Map 36. Tax Map ID Number .................. ....................... 8f, 0!';'Block I Lot Z 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All ppLii�q�!91►4 fqpeyjp� -i�cati4withft the N�YCVaterished shaill -yalidapproval of a n0w'SST8'f6*be n '16e sent to the Department, and need not be sent in I 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 p toj 6ct:,,suc, h-as stormwatetplafig 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.., . 3 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.jo comply with this provision may be grounds for the rejection of any submission. of NE C4 I hereby affirm, under penalty ofterjury, that thisform is true to the best of my knowledge and belief e ei are punishable as a Class A misdemeanor pursuant to, Se ao. 145 nal SIGNA TUPES & OFFICIAL TITLES.- Mailing Address: ................................... --rHG- L J.rJ i y C TMICIAJ d 0 Su LTC zoo 2 =-0tVJ Wiq , L K W Z_ VD 06/17/99 THU 15:28 FAX 914 736 3693 CRONIN ENGINEERING PE PC 0 003 2 27. Is any portion of this project located within a designatiAtown a wetland? : ,:, _; 28::. Wetlands iD Nt riiber ::.............................. .......................y..,,,• ...................... _ JJ 29. Is Wetlands Permit required? .............. .....................::.:.: :::::.......................... O Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? ................................... N 0 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 n14 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 ssS DESCRIBE: y.t-ST ka!!J '1}ir✓ rd?nat4? 33. Is there a local master plan on file with the Town .vr Village? ......................... E S 34. Are community water and/or sewer facilities planned1to be developed within 15 years in or adjacent to project site? ...... ......................................................... tj 0 35. Are any sewage treatment areas in excess of 15% slope? . ............................... i3 0 36. Tax Map ID Number .......................... ............................... MapB 6MBlock 1 Lot "l$ Z'% 37. Approved plans are to be returned to ..... Applicant v.--'_ Design Professional NOTE: All applications for review and approval of a n w'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 Eproval-of. the S §TS� p�'orV!nai a�c� l- by-.hI Dint:, eds':vrithiii ih -w it lso- = - - --! requue DEP review and approval of other aspects ofa 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 (Forth LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. SF" HEW I hereby apkn4 under penalty of perjuto the best of nV knowledge and belief. a Class A mkdemeanor pursuant to S AM SIGNATURES & OFFICIAL TITLES: �OF NEW,yo. on this f due cR J� �f' it are a n le aS G7z0 O f N 6� ~KUFESSIOV' Mailing Address: ................................... ti o c n16 �U r T 7, 2=,ONMw M wc,o- w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM 3� CRo'Ta� '-bArl ko A.N W' 4� Owner 37 C- 1?a-'01 J DA(n i�UpA CO'R Address 08Sjtjj V, ru,y JaS62 f; Located at (Street) VRAMER Po ,JD go AD Tax Map BtJfl3lock I Lot Z 7 (indicate nearest cross street) Municipality Tawra of PUTNmr, VA LE y Drainage Basin 1PEEKSKJ LL Ho LL -0 w I?RC)d K SOIL PERCOLATION TEST DATA Date of Pre-soaking A M i L- 190 19 9 9 Date of Percolation Test n PR 1 L- 2 0, 19 9 9 Bole No. Run No. Time Start - Stop Ela se Time tVim.) . De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate N in/Inch 1 100!3 1038 3� h 2 to",,- 11,0 I9 3/y 254 1( 3 1110— 11`' 19'/t 2VL I 'L 4 11 yo , ��' 9'/�. 2 I& 1 S .. -m--2 6Y3 111,3 3o Z 3`' 10 4 1`i6' 1115, 30 ZO I/'j,, 21/t4 I't S 1 2 3 NOTES:` 1. ,Tests to be repeated at same depth until approximately equal percolation rates are ootainea at eacn 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 measdrements to be made from top of hole. .A'�.> Form DD -97 TEST PIT DATA DESCRIPTION OFD SOILS ENCOUNTERED IN TEST HOLES DEPTH v:.:.._ ;.HOLE N0. G.L. �1 o'PS o 1 L . 0.5' 191]1 1.5' 2.0' 2.5' 3.0' 3.5'. 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 10.0' MUd 90;001( L o n r^x CRAY SgtJb& r MA IX 4- 2 HOLE NO. HOLE NO. 3 'PS o1L `moo sa1c_ fjd SAdtpY Cain $WWtJ SpNoY 4- 0 r4rLj Indicate level at which groundwater is encountered ps o /J E Indicate level at which mottling is observed nl a rJ C Indicate level to which water level rises after being encountered tV --r Deep hole observations made by: -r m oTH Y L. CK61i li =7::7 . Date Design Professional Name: Address: -rHE Y 6LD G, S U j 7'c 2 m.o Z So l L X H C4 V L �� t�. o. S• C6' Signature: Design Professional's Seal Uj coo` 62950 \ �� P/?OFESS�D�Py� / PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL..HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 39 022 i olJ ppn 720t-)b C0 /2t . Located at 1;& is M ER `P0 -'-) D 26 14 0 (k 1'o , A4' r, V%g t c e- Y Tax Map # 8 0, Block I Lot Z Subdivision of Subdivision Lot # 00 Gentlemen: Filed Map # Z7? Date Filed This letter is to authorize -1—IN o T H L. cRo/j 1,4 a duly licensed Professional Engineer ✓ 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 Healt nt, and to sign all necessary papers on my behalf in connection with this matter an , ' Y nstruction of said wastewater eat nt and/or water supply systems izi .con he"19f . ' s: of Article 145,and/or 14 o e ation >Law. -the Public Health I;aw; a d -f ' P____ _. out itary Code. z Very y y rs Countersi . ' 62 0 .aP`' ' Sine O� &%%& rt'He- Una b y 9'u 1 c, d 1,,(J Mailing Address S U 1. T°t 2 0 0 Z _S_O } {ri W r+ L' s if SL V-0 P£EKs W L L State 106 0 )/o rz K Zip I oS Kg- Telephone: _ 21 �) 7:X - 366" K Pn-F1 i E>E -wT- Mailing Address: 37 eAO-raiJ bi9 n noel 4b COO P. 3 7 c32 d'T'co-i A►9Y4 i`Zono 0SSIrj1'-J pi .,/, State NEW VogLI< Zip IV S6 L Telephone:' 91 '71' Form LA -97 PIJTNAM COUNTY DEPARTMENT OF HEALTH 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: S Civiq V W 'T-E- 1S45rl )19 G C, D I S tPO S A C S YST��i Lj I, NAI_ SratJTVCC I represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 3`7 C.Wo —ro/ J Dn m Kd n ts qW. Having offices at: 37 CieoTbd Dt9n 20191, 0SS11► 0-) G A)CO Yol K Whose Officers Are: President -Name: VP 1< S i9t-1 TO CC, d Address: 31 Cep -roig _bqM -Z3j41b 6 SS In# I eJ G' 14 jJ .) , Vice President - Name: VA L .S R a-F u c C I Address: le Secretary -Name: M l c HE Z c S19N T y c c- Treasurer - Name: i C tf 6 2 6- N?'u c c Address: and that I am and will be individually responsible for any to the approval requested and all subsequent acts relatin; Signed: Title: Sworn to befor me this day of ZoN4r th) 1 '75 (year) Notary Pu (No. x&923313 o Qualified in Westchester County Commission Expires March 14, -000 Corporate Seal Form CA -97 all�ctA §f tkk corporation with respect m A4r !\ ti i CV mitt's e a eo4 f- PROJECT I.D. NUMBER, PROJECT Appendix C State- EnAmnaffintal Quallty,iReview' SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I_DQftAF1%T INFORMATION (To be completed by Applicant or Project sponsor) SEAR 1. N30 �PO 2. PROJECT NAME z 7 c 12o T,&�) Dov-, 'R6 eq 0 C O'R P- ,- SWr46'e- 3. PROJECT LOCATION: T PU A ^ VALLEr County PU T-.-i A r%7 munwjwty o w d 6 F .4. PRECISE LOCATION (Street afte" and food Intemetions. I)fQm1nQnt I&ACIM1101M ate., Of PrOwMe M111)) Sou-rq "911& OF' K'R/4r46_a PO tj b 120 Ab S. is PRO "D ACTION: ZKow OExpanew ❑ Modilkationfaltw9lion 6. DEICRIBE: PROJECT BRIEFLY: 6F_ _jq Fiq r-1 ( L 4✓tj Cd-e SC W iq dC DIXpost9c SY-ST16M Ift /q.-j 17 7. AMOUNT OF LAND AFFEC71ED:. Initially Gem Ultimately — acre a. WILL PROPOSED ACTION COMPLY WITH OUSTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Xv. ONO if ft dwrft "fly 0. 1!g IWGPRNENT LAND USE IN VICINITY OF PROJECT? ltm. ❑ P&fflFoij$V0W' De24:rftw `77. 6 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR. FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, -STATE OR LOCAL)? tdYq ❑ No it Va. 1181 swe"s) and po"1111"Pt 8 "_o frp hii S Ly Sew .-j� 14 Po -x iq C F ., 11-. OM ANY ASPECTOF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yea Muo it ym 4al agency name and Pa duawavai 12. AS A RESULT OF PROPOSED ACTON WILL EXISTING pEFjMrr1Appft0vAL REQUIRE MODiFICATION7 0 y" I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE A90 C/20 1 Date.. low 4 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 js '%y PART 1111—ENviAONMENTAL ASSESSMENT (To be completed by Agen A. DOW ACTION EXCEED ANY TYPE I THRESHOLD IN III NYCAK PART 41i17."127 . IN review PFC041" and we Z-FULL EAF. 0 Yee 0 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN, S.NYCAR,PART 017.p it No, a negative declaration matrtms superseded by another Imfghf0d agency. ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOC*TED WITHINO" ALLOWING Q 3MGwera maybe handwritten, It Wglbld C1. Existing air quality, surface, or groundwater quality or. quantity, nolso levels,, sxlating ;" potlfma, solid waste I)Mductlon or dlspml, potential for erosion. drainage or flooding probl"i Explain brisfIr. C& Asellwile. agricultural, archaeological. historic, or other natural or cultural rGeburcooki.071000unIty W neighborhood character? Ex0laln briefly. C3. Vagetatlon of fauna, fish, aftillish or wildlife species, significant hablIalo, or tftrastene6.or endangavit! spaw? Explain briefly. C4. A community's existing plane or goals as officially adopted, or a chango In ueo.or Intensity of uto of land at other natural meaufcsol Explain briefly CS. Growth, submMusnt development, or related activities likely to be Induced by the proposod action? Explain briefly. CS Long term, short term, cumulativo, or other effects not Identified in C145? Explain briefly. C7. Other impacts (Including changes in use of elthw quantity or rM of energy)? Ezol4in briefly." D. 18 THF1111C OR IS THERE LIKELY TO SL CONTROVERSY RELATED To POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yee. No to yes. exp!atn WIV ...... p PART I1111— DETERMINATION OF SIGNIFICANCE (To IIIII19MUCTM& For each adverse effect ldmtlfWd above detiMnS wfttt,W, Itill SWMMtlw, W90, ImpCirtarit or othererlse signitticant. Each effect should be'"sessied In connection with Its (a) setting (I.C.,ulben of fur* (b) probability 011 occurring (c)'dursdon; (d) and M magnitude. 11'riecossally" add artachnients at: rolensi supporillngmaterials. Ensure that oxPlariallons contain sufficient detail to show,that all Dean k1snUfled and adsti"tely wWressed. 0 Check this box if you have Identified One or more potentially lags or significant adverse Impacts which MAY Occur. Then proceed directly to the FULL EAF an.dW propme a posift declaration. 0 Check this box If you have -.determined,.. bGS@d.:on -the:. Infointawn vw"iiin' 8"Itil Va" and any mpponing rau "ally adver" environ"Writel Impacts documentation, that the proposed action WILL, Not i " ' " itli 1 "' y. AND provide on attachments as necessary, this.reasons,supportIng th1s. detertifilInatim- Hama of LP Ar-V OFTVP@ hisaw Of ROSPOnsfilk Officer in Le;Z Apncv yith Cd RegM1610 officer Sormture oil Itanionable Offecer a Lead Agency —7-riPam 61, P;= (it differm from mvonnbl. ificerl D&ta 3 , 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEINIS REVIEW SHEET FOR CONSTRUCTION PERMIT . A , iA d O N, N E R .STREET LOC 2 L.` R-NI, GR, AS MB, BH Y pOCIIMENTS PERMIT APPLICATION PC -1 PER" - T PWS LETTER LETTER OF AUTHORIZATION ESIGN DATA SHEET (DDS) ORPORATE RESOLUTION SHORT EAF l I Irt;t — �C�BDiVISION kip LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED C RATE 7pfl, REQUIRED DEPTH TAIN DRAIN REQUIRED STANDPIPES 7- GENERAL CATED IN NYC WATERSHED NS SUBMITTED TO DEP EGATED TO PCHD EP APPROVAL, IF REQ'D P TEST HOLES OBSERVED RCS TO BE WITNESSED =APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) XTHERREQ'DPERMIT(S) ON DDS PLANS & PERMIT SAME 969 NEIGHBOR NOTIFICATION ER BI/LBA R. FLOOD ELEVATION AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE VIN FLOW Y SROSION CONTROL:HOUSE,WELL, SSDS ?ERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP p AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45o W /CLEANOUT FILL SYSTEMS CLAY BARRIER I FT. HORIZONLTAL;S PE 3:1 TO GRADE FILL ECS FILL NOTES FILL CI'R FIC ON NOTE DEPTH GA S FILL P ILE & NSIONS VOLU E TAX NIAP 4 zip tar tar �$2 LT IFILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED QN PLAN - FROM SSTS 7.10'TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 1-5'WELL TOPL . 100' TO WELL, 200' IN DLOD;150' PITS I00' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER l0' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS ONSTRUCTION NOTES J)ESIGN DATA: PERC & DEEP RESULTS ONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT lz OOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TMw"IPE/RA; NAME,ADDRESS,PHONEf DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %30'- 2 1/o,35' -10/0,100' - <I% 20'MIN to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION COMMENTS: I� L5. C . <ilAAa3 - cTs BIZ .� LP )6 0 te- S.-t> 75i''155 .00 14. s AA, w 0 ten CL I On 41 ce LIJ er cl ul We' co cz� / Y '. � !t �( �r 7. ����7� jS{ #4 3 s �4 �'� �'t'SS3 � �X � + `.n }�"� -� 'L - � .�.. , \U,�v JA :ty �cj Q CLI;k� �41 co P)