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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -69 BOX 33 04401 NN kc , ' ` tir - ' ,� NJ 04401 PUTNAM COUNTY DEPARTMENT OF HEALTH . ..e _a .. . •: �+ Ol.. =E.N �i00�i:\ M -N -T ,J .H•.R.d[ SAJT .�..I j't; A.1`+1:./E r. v `- �:..�4 ..:�,, •.I 7: CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # `�/ /�'�" 03 Located at 18 F4 F li SA N'r 'RUN J?pAP Town or Village ii A M Vi9 t L y' Owner /Applicant Name 3'7 CA"TyiJ OAM ROAD Tax Map Block CoiZr, Subdivision Name S T/2A ln) CE R R 1-( KJ o L L Formerly 2 Lot 6 9 Subd. Lot # 13 Mailing Address 39 C,R o Ta,IJ 0/4/11 /?U rq D O SS I A l JJ 6- tU % Zip 1 U 5C2 Date Construction Permit Issued by PCHD 2'9 C o i a:•1 PA 6, 126F9- Separate Sewerage System built by 3�7 cRoToh► oA^ goigp ca-P Address � 169,62 Consisting of 12S76 Gallon Septic Tank and SO 1� 4.r-, — 4 `12— /24Q2 Fo i2M T W EU C )N 2q` G )e1gVe4, T2��cy Other Requirements: `?u r`11 -fV rC/'h Water Supply: Public Supply From Address 0 rrJ/-IPi+ !� VENu�' orb_ _ Private Supply Drilled by if. f IT611 L J ,Fa j 'r 1 r-, Address E NJ &� WX 1 o So `j .Has - erosi-on-coi3gol--bezn-c'ompleted Number of Bedrooms r 0TL Has garbage grin NEW y I cifti fy that the system(s), as listed, serving the a re s c bu►lt.plans (copies of which are attached), in r \ the t?d plans and the standards, rules and regulat ns9 e P to �,Coi Date: Certified by (Design Pro "`" Address 2 »NN wALs'H 2n vtio essentially as shown on the as- lstruction Permit and approved )f Health. L W P.E. it Rte— 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 revoc ion, modificationt change is necessary. l M1. By: Title: �� Date: White copy - HD Fi e; Yello py - Building Inspector; Pink copy - wner 4ge copy - Design Professional Form CC -97 VJ U0115L1UUl.tvi& PUTNAM COUNTY DEPARTMENT OF HEALTH DIVIISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION- REPORT VvreIl Loc0i6h . ," Street� Stpvbarg Knollso Lot #13 Town/Village: 1?uttm Valle Tax -Grid # •: ;_ -Y' « ,, a... _ Map 84 Block 2 Lot(s) 69 Well Owner:. Name: Address: VS Construction Corp.,, 37 Croton Dam Road, Ossinin a NY 10562 Use off Well: 1- primary 2- secondary X . Residential Public:Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial. Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 42 ft. Length below grade `41 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded _ Other Seal: X Cement-grout- Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data . Measure from land su ace - static ?specIT 53 31.41 During yield test(ft) 201.2' Depth of completed well in feet 705' Well Log If more detailed information descriptions or are available, please att#ch. Depth ]Frown Surface Water Bearing Well Diameter(in) (Formation Description ft. ft. Land Surface 20 Drilling in oar den clay and boulders Hit rock at 201 �rilli it3. roc3c' set eaain e : . ,:.: 42 705 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type GUJD Capacity g Pm Depth 6601 Model 50515412 Voltage 230 HP 1 Tank Type Z�X302 ,- V,olume.8 lions Date Well Completed 11/10/01 Putnam County Certification No. 001 Date of Report 8/21/03 Well n e;.(sigpSiwc) g�.g;o Beal NOTE: Exact location oI well wim olstances to at le i LWO pU IIi liolll 1a11U111a1KJ W Ou plvviuvu ull a avpalaw oiivvvpiaii. Well Drillet's Name P. F.//B9al'. &- . , xnc. Address: 4 Rlb= AV8°o BrOwbBr, NY 10509 Signature: i' ,� ' Date: 8/21/03 Perry Lo Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 A.1 IMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD ,_CONN.E,CTIC.UT..o69og_ _NELAC, CT c o., •.;. :,i.'..: ; -.. .tea -:..c .s'•.'�'; -r. - .�� " - - '�' �x Mailing Information: Collector's Information: Name: PF Beal & Sons Client: VS Const. Name: Mike D. Address: 4 Putnam Ave Address of site: Lot 13, Strawberry Knolls City: Brewster City: State: NY Zip: 10509 State: Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: Date Collected: 8/21/03 Date Received: 8/22/03 Preservative: _ .HNO3 Time Collected: 12:30 Time Received: 12:00 Temperature: <4C Lab No.: J036116 Date Analyzed Test Name Result MCL Method 8/22/03 15:00 Total Coliform Absent 8/22/03 Chlorine Free Residual <0.1 mg /L 8/22/03. Color ND 8/22/03 Odor ND 8/25/03 Iron <0.03 mg /L 8/25/03 Manganese <0.01 mg /L 8/25/03 Sodium 8.26 mg /L 8/25/03 Chloride 19 mg /L 8/25/03 Hardness 76 mg /L SMWW 2130 B N/A -t:-38- mg/17----- 8/25/03 10:00 Nitrite <0.1 mg /L 8/22/03 pH 6.85 S.U. 8/25/03 Sulfate 33.9 mg /L 8/22/03 Turbidity 0.06 NTU 8/25/03 Alkalinity 68 mg /L 8/25/03 Lead <1.0 ug /L At the time of analysis the sample was acceptable for total coliform Absent SMWW 9222B N/A SMWW 4500CIG 15 Units SMWW 2120 B 3 TONs SMWW 2150 B 0.3 mg /L SMWW 3111 B 0.3 mg /L SMWW 3111B N/A SMWW 3111 B 250 mg /L SMWW 4500 Cl C SMVIM( 234; G 1.0 mg /L SMWW 4500 NO3E 6.5 -8.5 S.U. SMWW 4500 H B 250 mg /L SMWW 4500 SO4F 5 NTUs SMWW 2130 B N/A SMWW 2320 B 15 ug /L SMWW 3113 B N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. State #: PH -0218 Michael Lapman ELAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 20 961 9919 jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well- L6ca"66fi-, Street Kdd'r'6ss':"_ Strawbe M Knolls, Lot #13 I 0 iffage: Putnam Valle 7 IMap 84 Block 2 Lot(s) 69 Well Owner: Name: Address: VS Construction Co o, 37 Croton Dam Road, Ossinip ,NY 10562 Use of Well: 1- primary 2-secondary X Residential Public Supply Air cond/heat pump _LIrrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: -_ X Steel -Plastic--.,— Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours _�L Yield 5 gpm Depth Data Measure from land surface-static (specify ft) 31041 During yield test(ft) 201.21 Depth of completed well in feet 7051 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 20 Dril in r urden clay and boulders Hit rock at 201 '�42 -il-1-ing 4g .. set A 42 705 Drilling in rock cfranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity 5glm Depth 660' Model 5GS15412 Voltage 230 UP 1k Tank Type WX302 lume llons Date Well Completed 11/10/01 Putnam County Certification No. 001 Date of Report 8/21/03 Well rille I re NUT E: Exact location of well with distances to at leqAt two permanent lanamarKs to De a on a separate sneevpian. 1-1 A Z7 // 7� Well Driller's Name P. F Inc. Address: 4 g&mm Ave., nnmnbpx,, Ny 1 Signature: Date: 8/21/03 Perry al White copy: HD File; ellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 �W 7"1 l'W d 'J jell i c, � '' 4 �... ♦. „s'.x.,y� 'yam. " -. Y" h. `' { ,ter k x O� �?:c�a..� '- 3'a4�as �a�, �"�.`" t�k'?•.t�;- teu.;-i 7.�w _ 'mac. ;r .. .h.,n.tl7lk.:iJ ....d _.4K.... b:.dl�l.' J& G,se *V-6 A $yµ �e5..•� -.9-C :,,''gsy ,`'�','�_,n,.,.1. `7'A.a'M k� a'�''ry'e:� r k: "�` ,R iazdy "� ��-+( tr ,�{,`„` �,.. + '�'Ofr i'�74` -•� tYTnJ?.'�.+ ,.I r �l Z x � '� by � z�'�'.+�,a"^�e ..� rt: a N._......_.. _ I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W ..se1lLocatl2n. - :_ Streetflddress: _ - ::. Strawberry Knolls, Lot #13 Tewn/Village Putnam Valley Tax grid # Map 84 Block 2 Lot(s) 69 Well Owner: Name: Address: VS Construction Corp., 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter _bin. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 31.4' During yield test(ft) 201.2' Depth of completed well in feet 705' Well Log If. more detailed information descriptions or sieve. analyses _ are available; "" please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 20 Dri lin in ove urden clay and boulders Hit rock at 201 20 .42 ; _ Dri sPt easinr, coo lAted . . 42 - 705 Drilling in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5c[pm Depth 660, Model 5GS15412 Voltage 230 HP � Tank Type WX302 luTeAKL gfllons Lv \ Date Well Completed 11 /10 /01 Putnam County Certification No. 001 Date of Report 8/21/03 Well rille i re) r NOTE: Exact location of well with distances toat e�t two permanent landmarks to be prov d on a separAte sheet/plan. Well Drillees Name P. F s Inc. Address: 4 pt_*M Ave., Brajo+pr, NY 1fKfl9 Signature: Date: 8/21/03 Perry L al White copy: HD File; low copy - Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 LETTER TRANSMITTAL CRONR4 ENGINEERING P.E., P.C. September 2, 2003 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914-736-3664 Yax M-736-3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health I Geneva Road Brewster, N.Y. 10509 RE: 18 PHEASANT RUN ROAD "STRAWBERRY KNOLL" LOT #13 TOWN OF PUTNAM VALLEY 37 CROTON DAM ROAD CORP. THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X 14ASE REPLY W WE ARE SENDING YOU attached 1.) Three copies of as-built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) E911 address verification form 6.) $200 certified check for application fee 7.) Water Analysis 8.) Well completion report I 0% The information enclosed is submitted for review only the septic pump test will be witnessed by your department on September 5h. Respectfully, submitted, )Kenneth M. Murphy Design Engineer BitUCE� K"FOLEY Public Health Health Director — t ,QU TTA_ 49URAi - E: j I „.M: §,N + Associate Public Health 'Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fan (9.14) 278-7921 Nursing Services (914)279-6558 WIC (914)278-6678 Fax (914) 279-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 .6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX NIAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) 39 Uo ion iC>Ar� jZcAP cO-2P s� c Q4 -oLK 2 L-a T : 6C( FNC1 O Stgtkr Rom Ro � D k�:t ►"iJAI'Ll VALLF- 1/ DATE: �Igo,(9 .. -_ ti : -_S".. _. . ..._F... •�: . .�a' .. t.c�.rm i.e.- «c ,..... �.. __ .��'. _ _ ' -T.,•I The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRIvI) 7) JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET J m 5 STAMFORD, CONNECTICUT o69o5 NELAC, CT and NY State Certified Environmental Loborotor,- Mailing Information: Collector's Information: Blame: PF Beal & Sons Client: VS Const. Blame: Mike D. Address: 4 Putnam Ave Address of site: Lot 13, Strawberry Knolls City: Brewster City: State: NY Zip: 10509 State: Zip: Telephone: 845-279-2460 Fax: 845 -279 -6613 Telephone: Sample's Information: Site: Date Collected: 8/21/03 Date Received: 8/22/03 Preservative: HNO3 Time Collected: 12:30 Time Received: 12:00 Temperature: <4C Lab No.: J036116 Date Analyzed Method Test Name Result MCL 8/22/03 15:00 Total Coliform Absent Absent SMWW 9222B 8/22/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 8/22/03 Color ND 15 Units SMWW 2120 B 8/22/03 Odor ND 3 TONs SMWW 2150 B 8/25/03 Iron <0.03 mg /L 0.3 mg /L SMWW 3111B 8/25/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B 8/25/03 Sodium 8.26 mg /L N/A . SMWW 3111 B 8/25/03 Chloride 19 mg/L 250 mg /L SMWW 4500 CI C 8/25/03 Hardness 76 mg /L N/A SMWW 2340 C -� --° =L:8 TT5103_..._...__�.. ,.._`. Nitr Y ;Y- ;r .:._. _ 1.38 -n /L .:. - _:..7r�l..mg /L ......_....._. SMWW.;4500 NO3E 8/25/03 10:00 Nitrite <0.1 mg /L 1:O mg7L- _.. - - °`Sk1WW 4500 N ©3� --= - - 8/22/03 pH 6.85 S.U. 6.5 -8.5 S. U. SMWW 4500 H B 8/25/03 Sulfate 33.9 mg /L 250 mg /L SMWW 4500 SO4F 8/22/03 Turbidity 0.06 NTU 5 NTUs SMWW 2130 B 8/25/03 Alkalinity 68 mg /L N/A SMWW 2320 B 8/25/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform NIA =Blot Applicable mg /L- milligrams per Liter RID- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter s Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com OF ppp."7, # xe:J # 004d 0 0 z idl C3 CIO PHZ 4 SA NT RMV MA "56'36 74.73, 8022296ili6 2utAaAjnS pue-I RIIOUuOa e09:11 60 02 2nU PJTNAM COUNTY DEPARTMENT OF HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3`7 CRO -76�J PAM -90AD c012P. St a &Ci Owner or Purchaser of Building Tax Map Block Lot 3 % C RO ToA1 C)tq r) I ';k'0/9.D C672p, Iry }r�1 xq Nt Vq L L. Building Constructed by TownNillage PHCP sP�-7- Ru Aj V o ei L) s, rz►Q W Tf, RfN erg o L t_ Location - Street Subdivision Name SW CAE_ L 'r%�MI / 13 Building Type Subdivision Lot I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system sen-ing 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 :prapEriy_ s ca ed by tl e -« llft�l:or ne -aliapt act.-of oecipapnt ol'th .bull -ing uxili i. gY h� system. The undersigned further agrees to accept as conclusive the determinati Director of the Put l a County Department of Health as to whether o of to operate w j cau i�y the willful or negligent act of the occupan of 1 �,TJ4 Day �9 Year 200`2 General Vo"fittkor (Omer) - Signature 3? C 0 -7 -WJ DPr-I rZoA_D c o t Corporation Name (if corporation) Address: 29? C2y -foes OAM State D SS 1 r) J/,3 6- i-J .. Zip 10 5-6 2 the P " blic Health lur of the system ldi g utilizing the 0 Signature: Title: FRC_. j DLJ -F 3�) C2o —/6 � aAr.-I 120i40 Co12i' Corporation Name (if corporation) Address: _'P G1267-aN DArh 2O. State 0 S-f W 1 J C, NN/ Zip 10 5-6?- Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ...DIVISION..Or ENVIRONMENTAL IIEATLH SERVICES TiELD ACTIVITY REPORT Street Town State Zip PERSON IN CHARGE TEST 0 DOSE TEST T— o . /W- REQUIRED GALLONS ! T SPRrTOR • TRT Signature and Title RFp(1R1' RF .F I� .TVR RY: , I acknowledge receipt of this report: SIGNATURE: 02/96 Title: �O O O� REQUIRED GALLONS ! T SPRrTOR • TRT Signature and Title RFp(1R1' RF .F I� .TVR RY: , I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 09/29/2003 10:47 9147363693 CRONIN ENGINEERING 1 PAGE 04 BRUCE R. FOL,EY Public Hadth Dimctvp DEPARTMENT OF HEALIT 1. Geneva Road Brewster, New York 10509 Lb1LEi`Y'A MOL.BNAIU mod., M.S.N. Affada& publk 8e44h 1 &Vaar Dlroacv of Patient Severna P- P%ae.19 VAT , A77 ON: .'G o GENE REED AA information below must be f& completed prior to any scheduling. DATE: ]ENGEINMER OR k` H: P HONE #: MASON: DEEPS: C PERCS: r- PLC TEST TOWN T4T OAAk yAruC)f TAX SLiBDDISi ®N: 45y "Wc��'o:e*y l�tan4�. • n � A f ll LOTS: tom. 17ES NO ❑ �"� Proposed SSTS wirkin the drainage basic of West Bran or Bo®ds Corner Reservoim ❑ M"' Proposed SSTS within 500 feet of a reservoir, reservoir tem or control U-e. ❑ e"' Proposed SSTS within 300 feet of a watercourse or a DE C wetland. C3 M"", Proposed SSTS design flow greater than 1000 gallonsid v or SPDES Permit required. ® Proposed SSTS for a Commerical Project- $t is tie responsibility of the design professional to provide the above' ormatiou prior to soft testing. 'his Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered = to any of the questions, NYCDEP m witness the soil testing. This Department will coordinate a mutuaily suitable time for field testing; wfth the PGDOFL the Design PrzofessiooA and NYCDEP. If a project has been determined to be Delegated based on the above espouse nerd then subsequent information indicates NYCDEP is required to witness the soil testing, ' will be the sole responsibility of the design professional to schedule re- witnessing of the soil . testing. i INNYMEP. FOR C'Ot -%TV USE ONLY DATE: TIVE! CQtitiA1EPR5; 08/15/2003 08:38 9147363693 CRONIN ENGINEERING 1 PAGE 03 �. � -Y, �.- {a..i1�+ N�..dl it �- rr. .: kw/b .Y � __ _ +v - ... �... � va .. - .. _. . ♦ v�F� J' PU'X'NAM COUNTY DEPARTMENT OF VEALTH DMSION OF ENVIRO"IENTAL KEALT4 SERVICES -5a V- ATTENTION 13-m 0 GENE REQUEST FOR EINAT, INSPECION For: All information must be fully completed prior to any inspections being made. PCHD Construction Permit # "-9-40? Located: 1040A W. A11' f2011_ 12Q^D (T) Owner /Applicant Name: TP CRo'rGAJ A0A#) F242 C�71°. -TIM Formerly: Subdivision Name: Subdivision. Lot T Is system fill completed? yCT Date: Is system complete? y, Date: Is system constructed as per plans? t' Is well drilled? V%-' Date: Is well located as per plans? yc f Are erosion control measures in place? Fill TreochesX - y7.,An• VA LLGy Block !Z ._ Lot 0A 1J-W W %/ K tit oc.4 Qj 2 I certify that the system(s), as listed, at the above premises has been onstructed and I have inspected and verified their completion in accordance .with the issued P CHD Construction Permit and approved plans and the Standards; -Rules and,.Rmulatioas of the Putnam County Department of Health. _ ._. _..._ ._:':....._'...,.a Date: l-o- c, .i r 1_ F_ 2.0-0-T Certified by: Address: Z Comments: Form FIR -99 NN WALL, Kt�,,J kv? C�oN1F1 LNG' Design Pro LL LrC TL PE 'A' Rk Lic. # ] WS"EGN OIL IENWROIVMENTAL H EAL7 HI SERWCES �4 �l - . _ _ _ tom. . � p wr . -..� _.. - .�.. - .....E.,, ar,__ ...-a � >u.♦ _. _ CONSTRUCTION CTIION PE1181� IT IF 113' x - �?A�E� TREATMENT SYSTEM PERMIT # -P ! 4r0 Located at ?He.4 ,54,,V7- iZOAl /204q) Town eP Za r ,V.4 . Z- ZC � Subdivision name .9iT ,g�iwa y Ate Subd. Lot # / 3 Tax Map 64 Block 2 Lot —C . Date Subdivision Approved AlA y /�, ZOOZ . Renewal Revision Owner /Applicant Name �37 L'zom) J7A,,4 2tAp &e-P. Date of Previous Approval Mailing Address A7 02lyrprr PAM l2aA q , Ci55�N /wG jv y Zip 10.562 . Amount of Fee Enclosed -;36O p Building Type Lot Area ,Z, 7Z No. of Bedrooms _,y Design Flow GPD� 14 creel Fill Section Only Depth Volume PCHHD NOTIlIFICATIgN IS REQUIRED WHEN ]FALL IS COMPLETED Segarate Sewerag-e ftstem to consist of /19 7`7? gallon septic tank and t�-VC7 �-•/_• o' Other Requirements: ZZA0 CAS. PoAczeTr- ?Me> �H�� '� WV t1yoe0A1A77e ;5HCF 00 fUAP OZ z 044. To be constructed by 5-(&M4 ��M'e>,n-1) aL-�- . Address 3-10 w-vo,o mat ®ir Suu�pvs , Public From Address or: Private Supply Drilled by (Eris rive IE�L ) ^ 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 Compli�,h6e `sf,actory to the Public Health Director will be submitted to the Department, and a written guarantee wi1L�b 'fu . glfe- t•the Wffer, his successors, heirs or assigns by the builder, that said builder vil place in good operating cot 1-i n �y part 4" ai . se age treatment system during the period of two (2) years ,.immediately folloo thq' date of the i sua�e of tie approval' th Certificate of Construction Compliance of the original system or an r� airs 7reto. .;; Signed, '`) ' Y %� R - Date 0.3101. 0-3, Address ,2 a L, 0.1-A, License # 6, 2G,gC7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage matment 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 pxrmit. Approved for discharge of domestic sanitary sewage only. u�C r� AL403 By: s Title: Date: copy - HD File; Yellow copy - uilding Inspector; Pink copy - Owner; drange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH & DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEETT'OR CONSTEJCTION'P//E��TtNIIT NAME OF OW r NER: �� C 44 Ilk" STREET LOCATION: r►L"W& Vy -a-�� ' ASP • REVMWED.BY: RM, GR, h9, SRDATE: dK 0• TAX mAp*: (CONrwmD) Y N DOCUMENTS Y N fREOUIRED DETAILS ON PLANS CONT'D? ' ." 41101; TYPE PIPE. CAST IRON ((_)PERMIT APPLICATION S ( HOUSE SEWER - Y FT. �(� Wei �NO BENDS; MAX BENDS 45' W/C OUT (.UPC -97 (LETTER OF AUTHORIZATION . DESIGN DATA SHEET (DDS) FILL SYSTEMS j�" (�UCORPORATE RESOLUTION (�L ,10 HORIZONTAL; PAST T LOPES 3:1 T GRADE SHORT EAF : C__)(�FILL SPECS/ 1 -5 PLANS - THREE SETS (JUG II.E & DIMENSIONS U(_iOUSE PLANS - TWO SETS IN EXPANSION AREA j L j(VARIANCE REQUEST FILL GREATS 2 FEET N/ SUBDIVISION UU CLAY BARRIER !!! LEGAL SUBDIVISION (�(�FILL CER ON NOTE IUUBDVVISION APPROV CKED D E ( RC RATE L REQUIRED DEPTH (_U__)U . ON PLAN FOR RO.B., IJNCLASSiFIED & IlVIPERVIOUS (� SEPARATION DISTANCE FROM•TOE OF SLOPE (�UURTAIN DRAIN REQUIRED GENERAL LF TRENCH PROVIDED K —00 60FT MAX. Eco LF a bc 9�11 OCATED .INNYC WATERSHED CL PARALLEL TO CONTOURS ANS SUBMITTED TO DEP H100% EXPANSION PROVIDED LEGA TO F RE (��, _)DETAtILIDUST FREE CRUSHED'STONE OR WASHED GRAVEL ( D/ EP APPROVAL, IF REQ'D ( U— GEOTEXTILE COVER (__)�EEP TEST HOLES OBSERVED / SEPARATION DISTANCES ON PLAN - FIt01VI'SSTS (•� RCS TO BE WITNESSED :/ 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL C_) APPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS U ETLANDS (TOWN/DEC PERMIT REQ'D ?) , �A'X A ON DDS PLANS & PERMIT SAME 100 TO WELL, 200 IN DLOD,150 TQ PITS 1_ —_1(✓� 1969 NEIGHBOR NOTIFICATION 100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan). 50' TO CATCH BASIN 3 ' ST RMDRAIN PIPED WATER LLD ' = . - • 0 YIZ. D PY:80 ELEVATYON W1I 200' ( - SOIL TESTING LOTS >10 YEARS OLD REQUIRED -DETAILS ON PLANS SEWAGE SYSTEM PLAN-(NORTH ARROW) (� SDS HYDRAULIC PROFILE (,- Y-ZGRAVTTY FLOW CONSTRUCTION NOTES 1 -15 (�UDESIGN DATA: PERC &DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED C_OC_),DRIVEWAY & SLOPES, CUT ✓( �FOOTING/GUTTER/CURTAIN DRAINS C—ASLy USDA SOIL TYPE BOUNDARIES VJC_)TITLE BLOCK; OWNERS NAME ADDRESS ✓ TM #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE . U(_JLOCATION OF WATERCOURSES, PONDS (��LAKES,WETLANDS WITHIN 200' OF P.L. UPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S WAN 200' OF SSTS L�� & PROPERTY METES BOUNDS .(�(„ JEROSION CONTROL FOAMOUSE, WELL & SSTS, EROSION CONTROL NOTE COMB ENTS: nn MQ)10'T0 WATERLINE (pits'- 20') _ 50'. INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (�U10' MIN TO LEDGE OUTCROP , r// SEPTIC TANK U /U10' FROM FOUNDATION; 50' TO WELL WELL DIIVVIENSIONS TO PROPERTY LINES b ON UMIN 15' TO•PROPERTY LINE SL ( l' U OPE IN SSTS AREA (520 %) ' U GRADED TO 15 %, IF REQUIRED ' . DOSE/PUMP SYSTEMS PUMP NOTES . DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED L�PETAIL FOR FORCE.MAIN, (PIPE TYPE, ETC.) TT AND D -BOX SHOWN & DETAILED UUl DAY STORAGE ABOVE ALARM vUSTANDPIPES, 5' BOTH SIDE AIL U( -J15' MIN to CDS=>5 °/ %,15' -3 %, 35' -1 %,100 % - <1% L_X_J20' MIN CHARGE/100' with 182 cons day discharge U to NON - PERFORATED PIPE y 4 _ RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 .. TeL(914) 73G3664.� 7;3&3693. March 6, 2003 Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit Strawberry Knoll Subdivision — Lot 13 Pheasant Run Road, Town of Putnam Valley Dear Mr_ Paravati: The following information has been enclosed for your review, for the above referenced subdivision lot: 1. Three copies of the SSTS plan dated March 6, 2003. 2. Letter of authorization. 3. Affidavit Corporate Owner application. 4. Application for Approval of Plans for a Wastewater Treatment System. 5. Design Data Sheet — Subsurface Sewage Treatment. 6. .Construction Permit for Sewage Treatment System. i. Well Colnpletion`Report. 8. Short Environmental Assessment Form. 9. Application fee of $300.00_ 10. Pump / System Curve for the proposed pump. 11. Two copies of the house plans. Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matter. Respectfully Submitted,: Idw Luis H /iZ�andez Project Engineer cc: Val Santucci StrawbmyKnoll,Lot 13,PCDH,03- 06-03. doc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r aYt9,... -. r i+•va .v rs -N_:. -. . •n..ati= .- •[..eri'.: r ... ..�•::ro. ..'ivw w. ': .i. • +i,%:0. LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road Corporation Located at Mi 11 Street (CR #23) / Lover Is Lane -- /'H2�i45AA17" ZIV /00,40 TA-Putnam Valley Tax Map # 8�4 Block Lot �_9 Subdivision of Strawberry Knoll Subdivision Lot # / Filed Map # 2900A -6 Date Filed lq,4 Y i5, 00d•2 . Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer x 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 b half in connection with this matter and to supery t e n of said wastewater ea en d/or er supply systems in conformity w N d"_ le,145 and/or 147 th du tion L e Public Health Law", antfie Pu a ,ou' it 'de. �. �....... .. uounterslgned:,� VJ N 62980 P.E., R.A., # �• Koh! Very tr A;`" i Signed: Mailing Address 2 John Walsh Blvd. , #200 Peekskill N.Y. State Zip Telephone: (914) 736 -3664 10566 Mailing Address: State NY �L J--j 37 Croton Dam Road Ossining Zip 10562 Telephone: (914) 739 -7362 Form LA -97 PUTNAM COUNTY DEPARTMENT T OIF' HEALTH I�gV ISyON OF ENVIRON MEINTAIL EAILTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICA'T'ION FOR PERMIT APPLICATION SUBMITTED TO PUTNAiM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply r Val Santucci represent that I am an officer or employee of the corporation and am authorized to act for: - Name of Corporation: 37 Croton Dam Road Corp Having offices at: 37 Croton Dam Road, Ossining, NY 10562 Whose Officers Are: President - Name: Address Val Santucci (Same as Above) Vice President - Name: Same as President Address: (Same as Above) Secretary - Name: Michelle Santucci Address: (Same as Above) Treasurer - Name: Address: Same as Secreta (Same as Above) and that I am and will be individually responsible for any to the approval requested and all subsequent acts relatin, Sworn to efore me this °"day of (month) oW (year) Notary Pub KELLY M. LENT Notary Public, State of New York No. 01 LE6026834 Qualified in Westchester Count- Commission Expires June 21, 2 Form CA -97 I Sianc Title: all 44ts 4i the co oration with respect VS Gonst;ru= -01i ' PUTNAM COUNTY DEPARTMENT OF IfEALT9 - -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W ell Laeation Street Address: s� 1 i] Sl lr, TownNillabe: ITax Grid # .13. S :r vjbwry ztriplls Put lam Valla Map Block Lot(s) Well Owner: Name: Address: 'IS Cti?r..str-�I:.4'.t= cC..o.V. t 37 O rotcn D= Road, �Sdi.7�li j� 3� 1:05 Use of Well: X Residential Public Supply Air cond/heat pump Irrigation 1- primary Business — Farm Testimonitorin$ Other(specify) "secondary Industrial _ Institutional Standby Drilling Equipment it Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing 7: Open hole in bedrock Other Total length 42 ft. Materials: X Steel Plastic —Other Casing Details Length below grade 41 ft. Joints: — Welded X Threaded _ Other DiAmet =,r d in. Seal: X Cement gout _Bentonite Other Weight per foot 19 lb /ft. Drive shoe: _ Yes —No Liner:_ Yes X No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) iDeveloped? Screen Detail First Y'es lso Second Hours W ell Yield Test _ &tiled v Pumped ti Compressed Air Hours _ 6 Yield_ a gpm Depth Data ensure :Tom an su oce,stallC (.Deity tt acing yield tcsl(ft) Depth of completed well in feet 31.41 201.20 7n3' Well, Log Depth From Surface Water Well Formation If more detailed ft. ft. Bearing Diameter(in) Description descriptions or 2ir it ETC at 20, sieve analyses 20 42 Drill, lri sods s9b cc ana, g rout ad are available, ,1.. 705 Dzilll.ng I.a roc. !, ra a,ta please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type a- b Capacity daring drilling, Depth 560' Model5GS15412 list: -� Voltage 230 HP Tank Type Volume Date Well co:npletc Putnam ounty Cer4 cation No. wofXeport Well I er is►gpatu►c) 02 1/7102.1`Lr;L:�1 NOTE: _xact location of well with distances to at, east two permanent landmarks to a provi a m a separate s&eplin. Well Driller's Name r r.;i' - .St; , Yrzt~` _ Address: :� '` '•• �N a Ydf 1v:. 3. Signature: `. Date. "^ Parry . s. ZM—L White copy: EDP File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Well driller Fonn WC -97 -MGNIM- ENGINEERING (914).736-3664 Fax (9141736-3693 t CIEW1 _ W; 1' - '�Xaw .c e, DATE 6%316>61E) -3 INSPECTED BY r-A ee i) -.0v - -rc If 1, -- --------- . .... --------- H L 1� T e 0A 7% - - ----- ---------- T ------- --------- L _j r4 ! ..... . ... 4- ----- - �- yL .. I ` I , . it 7 b --- - -- --- - ----- . ....... ........... .... .......... .......... . ..... . ..... - ........... - -------- - --- - --- - ---- ............ ............ . ..... .... A 4_1 ell, Z 3. .......... 4 71 t. ... ... . . ...... - - - ------- -- ---- T fA Vf- . .... . .... ..... . ...... T T 4 t b , 2/f Pump Characteristics Pump /Motor Unit Submersible Manual Models (50) Ml M2 M3 M4 M5 Automatic Models Al A2 - Impeller Engineered Thermoplastic Horsepower 1/2 Full load Amps 14.5 17.6/7.113.2/3.11 1.6 1 1.2 Motor Type Capacitor Starti 30 R.P.M. 3450 Phase 10 30 Voltage 115 208 -230 208.230 460 575 Manual Model (100) — M2 M3 I M4 M5 Automatic Models 77 A2 - 1 55 42 Horsepower 1 Full Load Amps 13.0 /113 6.0/5.8 2.8 1 1.9 Motor Type Capacitor Start 1 30 RPM 3450 Phase 10 30 Voltage 208 -230 1 208-2301 460 1 575 Hertz 60 Temperature 140° F Max Fluid Temp. NEMA Design L F B Insulation Class B Discharge Size 2" NPT Std. Solids Handling 3/4" Unit Weight 58 lbs. (50) 65 lbs. (100) Power-Cord - -• - r .115V, 14 /3;5JTW- A;-230V,- 1a,t- All cords 20' std. with 30' opt. Materials of Construction Handle Stainless Steel Lubricating Oil Dielectric Oil Motor Housing Cast Iron Pump Casing Cast Iron Shaft Stainless Steel Mechanical Shaft Seal Seal Faces: Carbon /Ceramic Seal Body: Brass Spring: Stainless Steel Bellows: Buna -N Impeller Engineered Thermoplastic Upper Bearing Single Row Ball Bearing Lower Bearing Single Row Ball Bearing Bottom Plate Polyester Coated Steel Fasteners Stainless Steel Legs Engineered Thermoplastic Performance Data O 3 /16c Lcv ?' 30 90 25 30 70 N 20 m 60 iu o, E CID 15 CU 50 0) _ = 1/ 40 10 30 20 5 10 0 0 Capacity, US GPM 0 10 20 30 40 50' 60 70 80 90 liters /second 0 1 2 3 4 5 6 cu meters /hr 0 5 10 15 20 Total Head (feet) 13 22 40 50 55 63 70 80 90 GPM 1/2 HP 63 �l27 13 1 0 — — — 1 HP — 1=7 88 77 1 68 63 1 55 42 22 0 .. D.ime.nsional ,Dcst�a..:,:..., 1. All dimensions in inches. 2. Component dimensions may vary +l- 1/8 inch. 3. Not for construction purposes unless certified. 4. Dimensions and weights are approximate. 5. We reserve the right to make revisions to our products and their specifications without notice. 6. Float switch (automatic models only). --3- IS 16 - - -- --7 -, 16 ---- -- a1: v .-- l;:S^'::ti CISCHAROE 4' 3.1V16 .Y ]DISCHARGE _ "IPT I' " " "' -. t µ. DISCHARGE PIPE.? NOT INCLUDED i NOTwCLUDEC `i ic/ITCH ly � cyyliCH SHEF50 SHEF100 AURCIRA /HYDROMATIC Pumps, Inc. 1840 Boney Road, Ashland, Ohio 44805 (419)289 -3042 i n Q rn 0 0 0 W 2 Fr L s rn Q 'o 0 `o Q t 0 7 CL 0 o` 5 Q U a I ` , VELOCITY HEAD AND FRICTION LOSS IN FEET PER 1.00 FEEL' OF PIPE �J NJ 4 cL IRON / STEEL Schedule 40 PLASTIC Schedule 40 COPPER _ Typo M US GPM _ Vel. F./ Sec. Val. Hd. Ft. Mead loss Ft./ IMy Val. Ft./ Sec. Val. Md. Ft. Head Loss Ft./ 100' Vol. Ft./ Sec. Vol. Md. Ft. Head Lois Ff./ 100' 10 1.6 - 0.8 1.6 - 0.7 1.8 0.1 1.2 12 1.9 0.1 1.2 1.9 0.1 0.9 2.1 0.1 1.6 14 2.2 0.1 1.5 2.2 0.1 1.3 2.5 0.1 2.2 16 2.5 0.1 2.0 2.5 0.1 1.6 2.8 0.1 2.8 18 2.8 0.1 2.4 2.8 0.1 2.0 3.1 0.2 3.5 20 3.2 0.2 2.9 3.2 0.2 2.4 3.5 0.2 4.2 22 3.5 0.2 3.5 3.5 0.2 2.8 3.9 0.2 5.0 24- 3.8 0.2 4.1 3.8 0.2 3.2 4.2 0.3 5.8 26 4.1 0.3 4.8 4.1 0.3 3.8 4.6 0.3 6.7 28 4.4 0.3 5.5 4.4 0.3 4.5 4.9 0.4 7.8 30 4.7 0.3 6.3 4.7 0.4 .2 5.3 0.4 8.8 32 5.0 0.4 7.1 5.0 0.4 5.8 5.6 0.5 10.0 34 5.4 0.4 7.9 5.4 0.5 6.6 6.0 0.6 11.2 36 5.7 0.5 8.8 5.7 0.5 7.3 6.3 0.6 12.5 38 6.0 0.6 9.8 6.0 0.6 8.1 6.7 0.7 13.7 40 6.3 0.6 10.8 6.3 0.6 8.8 7.0 0.8 15.0 42 6.6 0.7 11.8 6.6 0.7 9.7 7.4 0.8 16.5 44 6.9 0.7 14.2 7.0 0.8 10.6 7.7 0.9 18.0 46 7 3 0.8 _12.9 14.0 7.3 0.8 11.4 _8.1 8.4 1.0 19.5 48 7.6 0.9 15.2 7.5 0.9 12.4 1.1 21.1 50 7.9 1.0 16.4 7.9 1.0 13.3 _8.8 1.2 22.7 55 8.7 1.2 .,19.7 8.7 1.2 16.0 9.6 1.4 _27.2 60 95 1.4 23.2 9.4 1.4 18.6 10.5 1 7 2.0- 31.8 _ 65 102 1.6 27.1 10.2 1.6 21.6 11.4 36.8 70 11.0 1.9 31.3 11.0 19 24.9 12.3 2.4 42.4 �tl6., .• 45.8 - 1'60 :' - 35:8 1'1.8" 16 40.4 14.0 3.0 80 12.6 2 5 40.5 12.7 2.5 32.0 54.2 85 13.4 2.8 45.6 13.4_ 2.8 35.3 39.5_ 43.7 14.9 15.8 3.5 3.9 60.5_ �90_ 14.2 3.1 51.0 14.2 3.1 67.3_ 95 15.0 3 5 56.5 15.0 3.5 16.6 4.3 74.3 1_00 15.8 3.9 62.2 15.7 3.9 47.9 17.5 4.8 82.0 97.5 110 17.3 4.7 74.5 17.3 4.7 57.3 19.3 5.8 120 18.9 260 88.3 18.9 5.5 67.2 21.0 6.9 115.0 130 20.5 _5.6 6.5 103.0 20 5 6.5 78.0 22.8 8.1 133.0 140 22.1 7.6 119.0_ 220 7.5 89.3 30.4 150 23.6 8.7 137.0 14.5 166.0 160 25.2 9.9 156.0 16.4 187.0 170 26.8 11.2 175.0 184 209.0 180 28.4 12.5 196.0 20.5 233.0 _ 190 129.9 13.9 218.0 1258.0 4 cL IRON / STEEL Schedule 40 PLASTIC Schedule 40 COPPER Type M US GPM Vol. Ft./ Sec. Val. Md. Ft. Head loss Ft./ 100' Val. Ft./ Sec. Vol. Hd. Ft. Head Loss Ft./ 100' Vol. Ft./ Sec. Vol. Md. R. Head Loss Ff./ 100' 20 1.9 0.1 0.9 1.9 0.1 0.9 2.0 0.1 1.1 22 2.1 0.1 1.0 2.1 0.1 1.1 2.2 0.1 1.3 24 2.3-1 0.1 1.2 2.3 0.1 1.2 2.4 0.1 1.5 26 2.5 0.1 1.4 2.5 0.1 1.4 1 2.6 0.1 1.8 28 2.7 0.1 1.6 2.7 0.1 1.6 2.8 0.1 2.0 (3N 2.9 0.1 1.8 2.9 0.1 Bl 3.0 0.1 2.3 35 3.4 0.2 2.4 3.4 0.2 2.4 3.5 0.2 3.1 r0 3.8 0.2 3.1 3.8 0.2 X3.1 4.1 0.3 4.0 45 4.3 0.3 3.9 4.3 1 0.3 3.9 4.6 0.3 5.0 50 4.8 0.4 4.7 4.8 0.4 4.7 5.1 0.4 6.0 55 5.3 1 0.4 5.6 5.3 0.4. 5.6 5.6 0.5 7.1 5.7 0.5 6.6 5.7 0.5 6.5 6.1 0.6 8.4 65 6.2 0.6 7.7 6.2 0.6 7.6 6.6 0.7 9.7 70 6.7 0.7 8.9 6.7 0.7 8.6 7.1 0.8 11.2 75 7.2 0.8 10.1 7.2 0.8 9.8 7.6 0.9 12.6 80 7.7 0.9 11.4 7.7 0.9 11.1 8.1 1.0 14.3 85 8.1 1.0 12.8 8.1 1.0 12.5 8.6 1.2 16.0 90 8.6 1.2 14.2 8.6 1.2 13.8 9.1 1.3 17.8 95 9.1 1.3 15.8 9.1 1.3 15.3 9.6 1.4 •19.6 100 9.6 1.4 17.4 9.6 1.4 16.8 10.1 1.6 21.6 110 10.5 1.7 20.9 10.5 1.7 20.2 11.1 1.9 25.8 120 11.5 2.1 1 24.7 11.5 2.1 23.5 12.1 30.4 _ 130 12.4 2.4 28.8 12.4 2.4 27.3 13.1 _2.3 2.7 35.1 140 13.4 2.8 33.2 13.4 2.8 31.5 114.2 3.2 40.3 150 14.3 1.5:3° 3.2 , 38..0. , 1_4.3...,3.2. 15.3' 16.3 - 35,7.- 15.2 -- �tl6., .• 45.8 - 1'60 :' - •-3.6 --43.0 ` 16 40.4 16.2 4.1 51.5 170 16.3 4.1 48.4 4.1 45.1 17.2 4.6 57.7 180 17.2 4.6 54.1 17.2 4.6 50.3 18.2 5.1 1 64.1 190 18.2 5.1 60.1 18.2 5.1 55.5 19.2 5.7 70.7 _200 220 19.1 5.7 66.3 19.1 5.7 60.6 72.4 20.2 22.2 6.3 77.9 93.1 21.0 6.9 80.0 21.0 6.9 7.7 240 22.9 8.2 9_5.0 22.9 8.2 85.5 24.3 9.2 110.0_ 260 24.9 111.0 24.9 9.6 99.2 26.3 10.7 127.0 280 26.8 _9.6 11.1 128.0 28.3 12.4 145.0 300 28.7 12.8 146.0 30.4 14.4 165.0 320 30.6 14.5 166.0 340 32.5 16.4 187.0 360 34.4 184 209.0 380 36.3 20.5 233.0 400 38.2 122.7 1258.0 3 i p./ EQUIVALENT LENGTH (FEET) OF STRAIGHT PIPE FOR PIPE FITTINGS I/Y (BASED ON HYDRAULIC INSTITUTE PIPE FRICTION MANUAL) PIPE DIAMETER .=�:., :.. -. �. �:.. -= PIflE'FIT7iNG� :'o-•.�..��= X14. -;1= f� %a '1 ^172 2± �� %z 3 4 5 6 SCREWED RETURN BEND OR (� REGULAR SCREWED ELBOW 4 6 6 7 9 9 11. 14 - - LONG RADIUS SCREWED ELBOW 2 3 3 1 3 4 4 4 5 - - REGULAR SCREWED 45° ELBOW 1 1 2 2 3 3 4 5 - - I SCREWED T -LINE FLOW 2 3 5 6 8 10 13 18 - - SCREWED T- BRANCH FLOW 5 7 8 10 12 14 17- 22 - - SCREWED INCREASER (1 PIPE SIZE) 1 3 1 3 2 4 10 - - - SCREWED GATE VALVE 1 1 1 1 1 2 2 3 - - SCREWED GLOBE VALVE 27 32 41 45 60 66 84 112 - - cCD3c@:; SCREWED COUPLINGS & UNIONS 1 1 1 1 1 1 1 - - - SCREWED SWING CHECK VALVE 9 11 13 15 19 23 28 40 - - SCREWED ANGLE VALVE 1 1 6 16 118 18 18 18 120 20 - - �-t INWARD PROJECTING PIPE OR -E SUDDEN INCREASE 3 4 5 t�6 1 11 14 20 26 33 REDUCERS 1 1 I 1 1 2 2 13 4 14 7 FOOT VALVE (- 3 I 4 5 I 7 9 111 116 121 26 �.� BELL MOUTHED INLET 0 0 I 0 0 I 0 1 1 1 1 2 �- SQUARE EDGED INLET 11 I 2 I 3 3 I -4 -I 5 I 7 10 113 116 1 ^, REGULAR FLANGED RETURN BEND _� [ :.. GR 'REGULARFLA'NGE'D'ELB01N"'"".' -zV -2.- 3µ1 3= 4 _fi '8; _ -9 LONG RADIUS FLANGED RETD. BEND OR LONG RADIUS FLANGED ELBOW . - 2 2 2 1 3 3 4 4 5 6 4 LONG RADIUS FLANGED 45° ELBOW - 1 1 1 2 2 3 4 15 5 FLANGED T-LINE FLOW - 1 1 1 2 2 I 2 3 13 14 -� FLANGED T- BRANCH FLOW I - 4 I 5 6 7 8 110 14 116 19 FLANGED INCREASER I- - I - 1 I 1 1 I 1 1 1 1 Q FLANGED GATE VALVE - - - 3 I 3 I 3 3 3 3 FLANGED GLOBE VALVE - 45 57 63 74 83 98 120 156 192 FLANGED SWING CHECK VALVE I - 7 10 13 18 221 28 40 53 65 FLANGED ANGLE VALVE - 16 18 181 21 23 130 39 53 65 BASKET STRAINER I - - 1 101 11 113 14_1 17 1 22 25 28 09/10/2003 11:23 9147363693 CRONIN ENGINEERING 1 SN G INEJ3 R e: .0 &0 N. IN! 2 JOHN WALSH BOULEVARD THE LINDY BLDG; SUME 200 FEEKSKffLL,, NY 1066 ro. Ti=c aNandh YROM: Ken COMPANY: VATB: RCHD. SEYM 10, 2003 FAX NUMBER; IWAL NO. OF PAW INCLUDING COVEL- PHONE NUMBER: SPNOWS REFER CE NUbMFA- Pheamt aRoad RE: YOUR REI%JtbN NUMBER: 37 Croton Dun Road Cotp. P.CDH.=t #PV-"3 PAGE 02 0 URGENT 13 FOR REVIEW 13-PLEASE COMMENT 11 Pl4sp, APPLY 0 PLEASE ItECYCLE Town of Putnam VaUey M'S Consd-= n Comphance Strawberry Kno% lot 13 GE I CONIMNIS 'buffs fa>� is VOU .Saatu oxapEggoe for &c above m(cmgdamgjjr& TEL. (914)736-3664 a PAZ (9g4)736-3693 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner D.FSIGDAr4,SI-IEET = �SUBSURFAEE SEiVAGE--TREATMENT S-YSTEItiI �' Y 37 Croton Dam Road.Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Located at (Street) �WeA. ,!i r -f'y'y -/z62#,0 Tax Map 8�4 Block 2 Lot (indicate nearest cross street) Municipality (T) Putnam yalleX Drainage Basin Peekskill Hollow Creek 1� SOIL PERCOLATION TEST DATA Date of Pre - soaking 05 - i6 --00 Date of Percolation Test Off- / T - 46 Hole No. Run No. Time Start - Stop Ela se Time 6Silin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinAnch 2.7 2 3 /� — /,Z ` —� 3v .2i —23.x. /'3. 4 5 -7,� - . 2 �,�_ ` /mil_ •��.� :,: r _. _..:..._ �i -- 235 d2 3 �� �_s _ Z r3 3�� 2 i - d3.5'. 2. 5: 12 4 5 1 2 3 4 ,. 5 n V 1 r.J: 1- bests 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, < 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES - -- _ - - 6;' _ .'Q <:- .� :�°�..re.- '^r',w.:.'«,.n',�a� ••,-s �s.:T,a-- d.•ti.,-;�e DEPTH HOLE NO. 25 HOLE N0. HOLE NO. G.L. A, o �a; L %aa 5� �' L 0.5' 1.0' 1.5 _1�417 arc 2.0' _ 2.5' 3.0. 3.5' 4.0' e r' e ��„ �'�,w �ve v 4.5' 5.0' 5.5' 6.0' 6.5' .;. 7.0' 4..-. 7.5' 8.0'..ry 8.5'+ >., �. r 9.5' 10.0' Indicate level at which groundwater is encountered eJ14 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered N /r4 Deep hole observations made by: _ Adam Stiebeling/ Keith Staudohaur Date PCDH Cronin Envineerinz Design Professional Name: Timothy L. Cronin III A Address: 2 John Wals-li-Blvd. #200 Signature: Peekslo/il, /NY 10.566 Design Professional's Seal ®\ °� 62980 ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR „ -WAS')<'EWA'T .c 7 Eg Tg1 ATNIEN.T SYSTEM....". - r r> •.� :,,p o. . .n ..d• Y* . _' o ♦• •= •• -- ...�+t ? °..a "r.Jra • :::• %y. �� 1.--Name and address of applicant. '37 Croton Dam Road Corp. 37 Croton Dam Road Ossining, New York 10S6 2. Name of project: Strawberry Knoll Putnam Valley . m 4. Design Professional: Timothy L. Cronin III_ 5. - Address: 2 John"'-Walsh-Blvd; 200 Lindy Bldg 6. Drainage Basin: Peekskill - Hollow Creek Peekskill,.. New York 1OS66 . 7. Tyne of Project: X 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 x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... NIA 11. Name of Lead Agency Town of Putnam Valley Planning Board 12. Is. this project in an area under the control of local planning, zoning, or other - officials., ordinances? .. _ .. • _. �............. ._ -• - • : Yes .. . 13. If so, have plans been submitted to such authorities? .. Yes 14. Has preliminary approval been granted by such authorities? Yes Date granted: Jan 2001 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ............:...:.......................... ............................... N/A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply NSA Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ......:......... NO 21. Name of sewage system N/A Distance to sewage system N/A 22. Date test holes observed Apriumay 2000 23. Name of Health InspectorAdam Stiebeling 24. Project design flow (gallons per day) ................................. ............................... 800 Gal /Day 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... NO Form PC -97 2 , 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number.: ...: ......................... .: N/A : . 29: Is Wetlands Permit required? ...... ... .. .......... ............................... No�. Has application been made to Town or Local DEC office? ............................... No 30. -Does project require a DEC Stream Disturbance Permit? :: ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops,'solid or hazardouswaste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 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: 3 -3. Is there a local master plan on file with the YES p e Town or Village? ............... ....... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............................... ............................... _ NO 33. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number .......................... ............................... Map &Z Block .2 Lot e!�g 37. Approved plans are to be returned to ..... Applicant x Design Professional - NOTE:, All applications_ for review and; approval of..a new :SST.S:w— heflocatea within.the.NVC-Watershed shall Tie 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 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 ti�s, provision, may be grounds for the rejection of any submission. I hereby afJ11im,- underpenalt}y ofperjury, that infbr to the best of my kno' wledge and belief. false staters a Class A misdemeanor pursuant to Section,210. 4,1 SIGNATURES & OFFICIAL TITLES. Timothy L. 'Jr N ti w, ro di&- Novi e 8 =as form BS true lrnaade,he i � n"able as Tie ��rgal, W.� il In F.62980 ; Mailing Address: ..................... ... . Cronin EngineeriT'g4,'?_j.:_P_ -,�'. 2 John Walsh Blvd; 200 Lindy Bldg; Peekskill,NY 10566 14.16-4 047} —Tut 12 PROJECT I.G. NUMBER att.�1 SEAR Appendix C State. Environmental.Awllty_ Review_ SHORT ENW ONMEN"fAL ASSESSMENT. FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsorl It 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 i . APPLICANT ISPONSOR 2. PROJECT NAME 37 Croton Dam Road Corp. Strawberry Knoll, Sublot # 3. PROJECT LOCATION: Munkipallty Town of Putnam Valley county Putnam County 4. PRECSE LOCATION (Stmt address and row Intersections, prominent landmarks, eta, or provide map) Pheasant Run Road S. is PROPOSED ACTION: ® New ❑ Expansion ❑ Modifkatlonialteration S. DESCRIBE PROJECT BRIEFLY: Construction of- Subsurface Treatment System to serve a Single Family House 7. AMOUNT OF LAND AFFECTED: ' Initially .Z� 7Z acres Ultimately Z, ; acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ZJ Yea ❑ No It No, descrR» briefly 9. WHAT Is PRESENT LAND USE IN v=Nrry OF PROJEC77 fRASeldential ❑ Industrial ❑ Commercial ❑ Agriculture C3 PvWlCorestUOpen span ❑ Otrw Describe: Surrounding Lands -are zoned Single Family-Residential 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCAy1 ®Yp ❑ No It yec list sgeneyts) and permlVapprovels , Town •bf Putnam Valley Building Permit ' 11. DOES ANY ASPECT OF THE ACTIC:1 HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ay. ❑ No h yes, list agency name and wwawova, Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESORT OF PROPOSED ACTION wiLL E=i No PERMRUPPROVAL REwRE MODIFICAnow ❑ Yea Elmo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE Cronin Engine C / Keith Staudohar Date: ,00P3 Signature It 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 PAItT II— ENVIRONMENTAL ASSESSMENT (TO be completed by Agency) A. DO(ES ACTION EXCEED ANY TYPE I THRESHOLD IN 0 MYCAR PART 017.127 It yoo. cowdinato tho ravt= pn=ea sind UW tho FULL E4F. 0 V., - No — I I WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN a NYCJ9R. PART 017.97 It No, a 11091111ve declaration may ba OuPMcded by another Involved agency. IC31 Yc=a 1516 THE FOLLOWING: (Anat-jara may bo hendwitten, it weltliwil C1. Exist" sit quality, aurfaca:w iroundwator quality or quantity, nola© lovolG, 0113111110 I(Olft Pattmno, solid rjacto production of disposal, potential for erosion, drainage of flooding problamt-Explain twial1r. C3 A03111t3tic, OgAtUltUral, &C110001091=11. 111010111C, 01 Other natural W Cultu(01 f0soul`Coa; of cOnlifflunitY Of "OlghbOMOW character? Explain briefl1r. CO. VcgololSon or fauna, fish, oMllflaft of rilldlito spodw, significant habitala, Of thfoalOnCd Of OndOn"ed ap=les? Explain baldly. M) C4. A commelity's existing plans or goaltl as Officially adopted, or a change In use or Intensity Of u00 of land or other natural roommm? Explain bfiolly CS. Gro"h, subacquont dovalogmint, or related activities likely to be Inducad by the proposed action? Explain Molly. M Long term. short term, Cumulative. or Other effects not Identified in C1-057 Explain bdolty. C7. Other impacts (Including changes In use of oltrw quantity or typo of onorgy)? Explain wolly. 0- 113 THERE OR IS IH g UDC12LY TO 9d. CQNTACV2RSY RELATED TO POTENTIAL AMME ENVIMMAWAL ItAPACT27 ❑ YC13 It Yee, explain b7salty .... ...... IN PART 110—DIETERMINATION OF: SIONIFICAMCE (To be Completed by Agency) IMMUCTM& For oiaich advww affect Wmtlflod above, determine wfttW It 10 sumnintial, law, inipwant 07 othawl" w9niqcWt. E-am effect should bo wwoold in connection with Ila (a) waing P.a. urban of furat (b) probability of occuffing;,(C) dunWon; (d) IfrOvionmbill2r. M 9wora0lic sew; and (Q magnitude. If necessary. add* attachmaints or rofwa= auipWunq mataisk. Ensure that GROzineltlans ciantain sufficient dotWi to aftow that all rolmmil advww Imposts MvQ b=n Idantifled wild adcquatak addre"ed. ❑ Chech this box If you have IdQntIfIed one or more potentially large or significant 1 r lmpa= which MAY occur. Than proc"d diroctly to ft FULL EAF andfor proparo a pcQlttw d2clamfi= ftck this box If you hwe - detwitnined, basW on the Information and ar-WyWa above and any suppoMng' docuimritation, that the proposiul -wtW WILL NOT result In any algrilileant advilwim. environmental Impacts AND pmvldQ on attachnionta as necesmary, tho rations supporting this dGtorminatiom r Typ4? Mania o► ARIJ40"SibIe Officeir in Load Lbm CK Responsicia UlItcor in C— D Title ol ResponsibLa C31fk:ar Sividium as Areparm (11 diffamm I — msamubiop ollicer) lag/a.� I Data K I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION f Date: Inspected by: �St' Street Location �,., J2 Town rf.�T Permit # ^j°// �► - a 3 TM # a —G `2 Subdivision Lot # $ig( /1 � 1. Sewage Svsiem Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course / wetlands ...... .............. :................ II. Sewage System a. Septic tank size - 1,000 ........... 1,250.... ..other ................ b. ' Septic tank installed level ..... ........... I...... .I........................ c. 10' minimum from foundation ................................ I......... d. Distribution Box 1. All outlets at same elevation -water tested....... ........... 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... b. renc ies 1. Length required'S-6� Length installed �;oa 2. Distance to watercourse measured Ft....- -.. 7//��' 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 314 - 11/2" diameter clean .............. .....: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends capped ............. .....................K ............ g. Pump or Dosed. Systems - = _ _.......1 Size of puflip� chamber ...................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio :.......:........:.. ........I..........I........... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans ......................... b. Number of bedrooms ..................... ..................... .Y......... IV. well Well located as per approved plans . ......:........................ b. Distance from STS area measured ft........... c. Casing 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan f Curtain drain outfall protected & dinto exist waterco g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. 12/02 COMMENTS T bc,� -�r . 7 k l-- r f 0 0 X r 1.26'° Gz. 661 _ ,� .. ►ib JL JL'J �I.1V �i��GCrJL 1L'1.Y1V !C ®1L� 1L' 11 II .1LJ JC L'iLW'-.:::..' -' •:. ,•�' .''. I., ::. _.• .. '. -�..� . Fill pad located per the approved plan Fill Pad Length Required Length Fill Pad Width . Required Width Fill Pad Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) _.Additional Comments: Reserved for Field Sketch if Applicable Required Depth Date: Inspected by: Aga-' � I] Vs. cuf CIO 0-1 tWE.T 203 - z r ..T a snag w RT..m u :m•c rv. 1 �= I t � 1 � ac •Tr,.:c •c. n. IT.r a.� n I - - - -- Mfl-- •r+l ,r o 0 0 6-17 1? Ayt :l: I _ 3 {t ; I IE PUT\AM COUNTY DEI'«PTIMFIIT OF HEALTH Q LEf �IJ Qi 1:= IiOUS rL ir;t. 1.1PUOP_':D FOR BEDPO! n'i COVITNT ONLY, TO THESE HOUSE ' n 11 (i t�f •1 t X7117 "1 Z L3Il:tl� � 't„� `�'L�S1vS sift �s .:,5'; ;.�s _ ai "1'i:D `,':!) Tt':'ls L'i.;,OII TC,It APPROVAL % /AIAX. 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L RISE ALL DOORS ]/P Y w%Yv H4MILTOV I zCLG GIRIILIt = G,RJ ff TD a. t -1 I /r.0 �� srrtrRroot n rTOS ./22'x24' GARAGr/ ELEVATMNS :Sit[RE TO PROVIDE wiw R -19 rLWR INSULATION PER TLT.S.CL.C. (717) i.. --- .,.,,. w R•m4 r na 9 SIt[ L"TtOA PUtwac va 1 re wt;. PufN rnaTT. ]e vv orw.. m• — - - - - • -- -- ' '- - A T `' ■ TJPUIWJ LIM DA1N 42 CLOSET (D "Coo"O" (; 45� CLO 'le4-a-P4. AJe, (:�m uz —?bs —I Allj� sm— /QN-990787 r------------------------------- --------J------------------------------- PAR r1`17) 4"-7"7 BUPA MJT) ID 3 , -8 if t1l -3- -3 4-101/2, L-A to xri -7- , • BEDROOM u3 DEAL .4 MOM- .1 CLO Z•• V2, lot MUTES. I. 2's ETIEVIOR WALLS e Iv O.C. 22.. MARRIAU WALLS Q 16. O.C. 3 81-0• CLG MT. 4. Rwr SYST EM TO BE 24• ar- E) Mv VI qwWS 61-30 3re RAISE ALL 0=3 V4' _ 1 4 .CLG CEAM OVER 040I III BE. 2-1 1/2'.12'.40• 0• KjL. CLO 'le4-a-P4. 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