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Home My WebLink About4457DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -13 BOX 34 04457 Ll Nor LT Y+. r J J. , 70 JW-jl 04457 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 20, 2009 Daniel J. Donahue, PE 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Addition — Eppner 43 Mill Street (T) Putnam Valley, TM # 84.15 -1 -13 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. o Please provide floor plans for review. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. Very- truly yours �r�G4�� -✓L�� dosep h S. Paravati, Jr., PE Assistant Public Health Engineer JSP /kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 DANIEL Jo DONAHUE, RE. CONSULTWG ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845 -628 -7576 September 15, 2009 Putnam County Department of Health Geneva Road Brewster, N.Y. 10509 Att: Joseph Pavaratti., P.E. RE: Proposed SSTS Mill Street Putnam Valley (T) Dear Mr. Pavaratti: Enclosed please find a copy of the revised plan for the above captioned project. The revision. reflects the comments noted in your review letter. As discussed, I need an "addition application" which you indicated you would forward to me. I advised the owner to prepare a floor plan for the house for filing with your office. I would appreciate if you would review the enclose plan and advise me if they are acceptable. If so, I will forward the remaining documents to you. Your prompt attention would be appreciated. Regazds, aniel J. Donahue, P.E. Site o . Sanitary o Environmental SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 4, 2009 Daniel Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J.BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS for House Addition Eppner at 43 Mill Street (T) Putnam Valley, TM # 84.15 -1 -13 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: -1: The topography.is faded and illegible. .2:` The expansion trenches need to be shown on the plan view. 3"' The pump tank cover is noted as 24 ft. wide. The trench detail has been crossed out. ,5" Silt fence needs to be shown below the septic and pump tanks. Proposed house plans need to be submitted for review. Please provide the addition application form. A ten foot separation needs to be noted from the septic tank to the house foundation.,, �P � �V / =` ""3 ,.6•'# 6 infihe P'CDH ii6tes should be crossed'out'or reir�oaed since t ie well is existing. r X0. The force main detail is to be labeled. Provide the outside height dimension for the pump chamber. 1-2"The absorption trench detail should note all pipes are to be laid level. A'f Pump chamber detail is to include a gate valve, check valve and union. Size of pump chamber is to be provided in plan, profile and detail view. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. GDR:kly Sincerely, ='` . n2"'J/ Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 .. w „ PUTNAM COUNTY DEPARTMENT OF HEALTH Di rIs'lo �i GF I;�YV k�Oi�lYlfiVTAL HE?,LTH'` INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWAIER: ,E)P _ ✓,5 STREET LOCATION: REVIEWED.BY: RM, Jai+; SRDATE: g4/3 Ay l TAX MAP#: (CONPIR=) IV, !S Y .�I�I. DOCUMENTS oj�� R= AP PLICATION ELL PERMIT OR PWS LETTER- 6XX�'3�- =97 TTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) L�CORPORATE RESOLUTION � )SHORT RAF )LL)PLANS -THREE SETS := - 'V'ARIANCE REQUEST SUBDIVISION (LEGAL SUBDIVISION ' L_)SUBDIVISION APPROVAL CHECKED UPiRb RATE _ FILL REQUIRED _ DEPTH TA IN DRAIN REQUIRED ✓/ GENERAL aCATED .IN NYC WATERSHED P S SUBM=D TO DEP ELEGATED TO PCHD DR, APPROVAL, IF REQ'D EP TEST HOLES OBSERVED PERCS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS _ TLAI�'AS ( . OWNIDEC PERMIT REQ'D ?)_ . DATA DA LA GN TADS• 1't.A:a & P%F�iY�i'. SA�1TE , r PRE 1969 NEIGHBOR NOTIFIC;ATI.ON . LETTER B=A 100 YEL FLOOD ELEVATION W1I 200' SOIL TESTING LOTS>10 YEARS OLD REOUIBED •DETAILS ON PLANS %GIRUAGE SYSTEM PLAN - (NORTH ARROW) VITYFLOW.— S HYDRAULIC PROFILE CONSTRTTCTION NOTES 115 i 7 DESIGN DATA: PERC &•DEEP,RESULTS CONTOURS EXISTING & PROPOSED Z • DRIVEWAY & SLOPES, CUT' FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM# PE/RA; NAB ADDRESS PHONE# — UIRED DETAILS ON PLANS CONT'D1 ' HOUSE SEWER -' /i" FT. 4 "0'; TYPE PIPE. CAST IRON "`�/ UUNO BENDS, MAX BENDS 4F.W /CLEA.NOUT RENEWALS SITE NOTE (NO CHANGE) % -6 , FILL SYSTEMS, 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS / FILL NOTES 1 -5 FILL PROFILE. & DnNWSIONS . (FILL IN EXPANSION AREA FILL GREATER THAN 2 .FEET CLAY BARRIER ' FILL CE NOTE DEPTH GAUGES. VOL. ON PLAN FOR RO.B.,.TJNCLASSIFLED & EyeERVIOUS i SEPARATION DISTANCE FROM'TOE OF SLOPE TRENCH' L_)f,_)LR TRENCH PROVIDED _S ®,e:) 60-FT MAX. LUi PARALLEL TO CONTOURS 100% EXPANSION PROVIDED UL_)DETAdIMUST FREE CRUSHED'STONE OR WASHED GRAVEL (_)UGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN : FROM'SSTS ( f(__)l0' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. (�.. 20' TO FOUNDATION WALLS 100' TO �f'ELL, ZOO!!! `tDL01 ,150'T Q P"T ( )0100' TO STREAK WATERCOM SE, LAKE. (Inc. ezpan). (_.::�)(__)50' TO CATCHBASlN, 35'.STORMDRAJN PIPKD WATER i� )10' TO WATERLINE (pits . 20') . l �11J50' INTERMITTENT DRA NAGS COURSE. ( ' k:: )200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS UUl0' MIN TO LEDGE OUTCROP. SEPTIC TANK -.,_(_„(__:_)10' FROM FOUNDATION; 50' TO WELL WELL UUD�NSIONS TO PROPERTY LINES (j(_ j LOCATION OF SERVICE COINNECTZON� '.�!S'¢le UUMIN 15' TO'PROPERTYLINE •SLOPE Opt IN SSTS AREA L—)L REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS DATE OF DRAWING /REVISION UUP.UMP NOTES . DATUM REFERENCE U )DOSE 75% OF PIPE VOLUME/D.OSE VOLUME NOTED UULOCATION OF WATERCOURSES, PONDS UU-)DRTAIL FOR FORCE',MAIN, (PIPE TYPE, ETC.) �Lp S,WETLANDS WITHIN Z00' OF P.L. L_JL_ )PIT AND D -BOX SHOWN &. DETAILED AJ (�(�I DAY STORAGE ABOVE ALARM UPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS CURTADi DRAIN. UUSTA�NPPIPES 5' BOTH SIDES, DETAIL ,_.)WELLS & SSDS'S WIMP 200' OF SSTS A oW4e UU15' MIN to CDS-- -S %, 20.' -4 %, 25' -3 %, 35' -1' %,100 % -<1% UPROPERTY METES. & BOUNDS �UEROSION CONTROL FOXHOUSE, WELL & --Z kc L_J(_D20, MlN to CD DISCHARGE/100' with 182 cons day discharge SSTS - CONTROL NOTE ' _ JL)10 MIN to NON' ERFORATED PIPE . ,EROSION • 5 kow . ��P ; Tr•e.�b+.as f�ovs �. ?14.x•s - jr�Pcr fs via!i6l,G� co ✓er Sla«.✓S- N'w�,�� PfvJ.�,` {Z 1:Xr. area. pk.ly6 eZ ✓H5f / PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # _ S-0q Located at g,3 �'1 /GL �S'� (S >r Village P�4 Subdivision name t/V Subd. Lot # Tax Map ffZ. _� Lot Date Subdivision Approved /lC/� Owner /Applicant Name V n "'l Mailing Address Renewal Revision Date of Previous Approval !'Q / ®y /J"g Zip a � Amount of Fee Enclosed A S°:% d ' Building Typer �V e G� .y/ of Are No. of Bedrooms Design Flow GPD d b Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and t o 1-,r o r 4 o, t? /v::7/ /-L G Other Requirements: pi/ or /-P fit T' To be constructed by /�.� Address Water Suoaly: Public;Supply From Address sdlod f- ®t••� -.... ,;...Tt'ri ate- €apply{- Vi-illed.b} ....... _ ::�'P �-s�` duress �- . _ .. _, �... _.a,. , • _ 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 Director /Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs the to. Signed: P.E. R.A. Date Address License # !}�� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. I: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 DIVISION F ENVIR ENT'AL_ ` A T' SERVICES � LETTER OF AUTHORIZATION RE: Property of Located at U0.1LF_-1 . Nj ' (3V J o, A'4' 110f Tax Map # S' Block _� Lot i? Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize 1)a �%' e A Dp KV-) vi e , P° s' . 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 Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in confornlitv:i?ith..the previsions of Article 145,and /or 1.47 of the Edz�cation:Law, the Public Health ' Law, and the Putnam County Sanitary Code. v C Countersigned: P.E., R.A., # Very truly yours, Signed: (Owner of Property) Mailing Address Qr� ,r .0&�, �s,z,�I Mailing Address: 4� fly ( SI-�I� i�� ,hle e- State Al-Ir Zip is Y/ Telephone:! ��- State C1I -W- Yo r k Zip 10S] 5 Telephone: Form LA -97 . i DANIEL I DONAHUE, P.E. L CONSULTING ENGINEERS T?;'�; -27 -2009 �. .120 Breckenridge Road Putnam County Department of He"OPac, N.Y. 10541 Geneva Road 845- 628 -7576 Brewster, N.Y. 10509 Att: Joseph Pavaratti., P.E. RE: Proposed SSTS Mill Street Putnam Valley (T) Dear Mr. Pavaratti Enclosed please fmd: 1. Applications for SSTS 2. PC -1 Form 3. EAF Form 4. Pump Calculation and pump curve 5. Design Data Sheet 7. Filing fee of $500.00 8. Letter of Authorization 9. Two sets of plans Comments: Mr. Eppiner plan to renovate his existing residence to a three bedroom residence. The existing septic system must be replaced which is the subject of this application. .. 'Your prompt attention would he apy e ,iated: _ = _ - r Regards, Dani J. Donahue, P.E. Site - Sanitary • Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PPLICATION FOR APPROVAL; OF. P LANE ti.• cL T c£i: z - -S_aa ynws... - i'•4. -. .sN . as - ..s.. -. -.. v A WASTEWATER TREATMENT SYSTEM 1. Name .and address of applicant: - l Y �2 em ° .O c� /W 11r 6 -e .e fl;42 ! .7 P'4- `1.Py x/ 2. Name of project: ,S,S"-%S 3. Locatiopov: ✓ ��7 �/4 /�� 4., Design Professional: &&4& A% .?ok a/%rc�i� 5. Address: A40 ? "e lo-Y 6. Drainage Basin: SSta dt4 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? ......................... A110 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency. /l /e 12. Is this project in an area under the control of local planning, zoning, or other officials 'ordin ces7 .' :....:........::..-...:..:.:..:.....:............:... :...:::...................:.... a° -h -� - �..: _._ .. 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 22. Date test holes observed /Jr 23. Name of Health Inspector �28 24. Project design flow (gallons per day) ............................................. ...... ............. C� 25. Is State Pollutant Discharge Elimination System.(SPDES) Permit required ?... _ p 26. Has SPDES Application been submitted to local DEC office? ......................... IM1114 Form PC -97 8/99 2 27. Is any portion- of this project located within a designated Town or State wetland? .. :28: VEletl r%ds 1D Nt mbe �.:... ................... ............ .... .....:......................... u , 29. Is Wetlands Permit required? .. .............. Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC, StreaniDisturbaince Permit? ........... 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 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 Aia DESCRIBE: 33. Is there a local master plan on file with the Town or Village?* .......................... �f 34. Are community water and/or sewer facilities planned to be developed within 15`years in or adjacent to project site? .................. ............................a.. 35. Are any sewage treatment areas in excess of 15% slope? ............................... 36. Tax Map Ip Number .......................... ..............................: Map fl.'/Mock_ Lot 37. Approved plans are to be returned to ..... Applicant _ Design Professional -=- -NO' :,A -,ll applicaficrosforreview -andlapprov al of a new SSTS'to °be locatetfi'witlun 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 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 tl�e application is signed by a person other than the applicant shown in Item I .,the application must ,,be;raccoTpanied by a Letter of Authorization (Form LA 97). Failure to' comply with this provision, gay be rounds for the rejection of any submission:; . f .. _ -:{ yfi p tyfp �ry9 I reb affirm, under en o er'u that information provided on,this form is true.• LL FJ ._. to:the best of my knowledge and belief. False statements made herein are punishable as ; a C7gss A misdemeanor pursuant to Section 210.45 of the.Penal Law. Z.0 SIGNATURES,& .OFFICIAL TITLES: Mailing Address • ..... . ........... .. ter PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ETSVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: Address: e.3 N))LG S% Located at (street): TM # Section:.— ock Lot,, � 3 Municipality: �d7- j dl 1%/�I.GEy Watershed: t�i%v7S -s ®.✓ I SOIL-PERCOLATION TEST DATA Witnessed by: Date.of Pre- soaking: Date of Percolation Test: Hole No. Run No. Time Start — Stop Elapse ' Time _ (min:) Depth to ' water from ground surface (inches) I Start - Stop.., Water level drop in inches Percolation Rate min /inch 1 2 4 5 1 2 3 4 . 5 1 2 3 4 _1 2 3 4 Notes: 1. Tests to be repeated at same.depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < I min for 1 -30 mini-'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, pe I of? TEST PIT DATA DESCRIPTION OF SOILS .- TNCO,UNTERED)JN TEST HOLES _ .. .� .. . DEPTH HOLE HOLE #- HOLE # HOLE # HOLE # G. L: 0.5' 3 �� S� 1.0' 1.5' S -v�� 5�. V--C 2.0' 2.5' 3.0' 4.0' �i Nl J/ KC Y 4.5' S �x `tea�wu c 5.0' - 5.5' .. � 6.0' 6.5''. 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered A/giy,. Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by:� 1 ��_ Date Design Professional Name: Address: Signature:: Design Professional = Seal PROJECT LD. NUMUA Sal. 1 SEOR Appendix C s State Envlronmentai Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS only PAP. * t ? ? x :?m T4 o. c lared s r ii ' i l j2 pa�t� -~ .' .,, "A a� sor) T"1. A!✓At.1CAri'r SFI�tiSOH 2. PM CT NAME �f �± PROJECT LOCATION, �� j� F &1lnlCio81iiy / .v '4 County h a. PRECISE LOCATION (Street address *ad road Inters one, prominent landmarks, etC., or pfovide mop) IIII' *3 S- iS PROPOSED ACTION: tdea � Es ^,dtlS�on I�.t MCdifiCaiidtll�IterStion e. DESCRIBE P90JECT BRIEFLY: 7. AhIOUNT pa LAN:A AFFECTED: r Initially, _ acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER WSTING LAND USE FIESTRiCTIONS" j jr Yas "I NO It 140, describe belefty �9. V /HAT I$ PRESENT LANG USE IN VICINITY OF PROJECT? Rafive tla' C�J sndustrtbl Commercial 0 Agriculture ❑ ParklForsovopan space Other Dourloe: IC. DUS ACTION INVOLVE A PERMIT APPROVAL, OR FUND14, NOW.OR ULTIMATELY FROM. ANY-OTHER GOVERhiME 'TAL AR §N Y (FEDERAL QY*el [a No H yes, list,egency(s) and permiVapprovats � .t-p rp DOES ANN ASPECT OF THE ACTION NAVE A CURRENTLY VALID PERMIT OR APPROVAL? { Yes No It yes, list Agency name and permitlepproval 192. AS A A450 -T OF PROPOSED ACTION WILL E ASTING PtEFMIT1APPROVAL AEOUIRE MODIFICATION? 1 cen-nFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLE XIE Date. Q� Applicarll3C0ns4r name: C., ?t the action is in the Coastal Area, and you are a state ,agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11 —ENVIRONMENTAL ASSESSMENT (To be completed by ;Coney) _ _ - a; Aa. r= tExt;eso AXy_k- ' $15jt- T4MES140Lz -IN ei WYa~RR 7AA 777., "s7 tt yaa; coordtnet® 4he review process end u58 the FULL EAF. 7 Yes M14c S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONG a NYCRR, PART 617.67 If No, a negative declaration may be superseded by another Involved agency. ❑ Yes zw C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWiNO; (Answers may be handwritten, It legible) Ct. Existing air quality, surface or groundwater quality or quantity, natse levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? ExpWn briefer - C2. Aesthetic, agriculturar, archaeological, historic, or other natural or cultural resources; or community or neighborhood eharaMer? Wialn briefly,. C3. Veseta: ion or fauna, fish, shellfish or wilditfe species, significant habitats, or threatened or endangered species? Explain briefly: Cd. A community's existing plans or goals as officially adopted, or a change in use at Intensity of use of land or other natural resources? Explain brief s" r C5. Growth, subsequent development, or related activities likely to be Induced qy the proposed action? Explain briefly. CS. Long term, short term, cumulative, or other effects not Identified in CbCS? Explain brieffy. e- C7. Other impacts (including changes In use of either quantity at type of energy)? explain briefly. D. iS THERE, OR iS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? r ❑ Yes It Yes, explain briefly PART III --- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It is substantial, large, ImpotRant Gratherwtae significant. Each effect should be assessed In connection with its (a) setting 0.e. urban or rural);,(b) probability of ocewing; (c) duration; (d; irreversibility; (v) geographic scope; and (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. ❑ Check this box it you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF andtor prepare a' positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL Nie1T result In any significant adverse environmental Impacts. AND provide on attachments as necessary, the reasons supporting this determination: Name of ea Agency Print o' Type Prame of lie7pon) a ia:tr In tt nCY rt O !lponr ! itet �� 5�snature p Rtsponsi ice( in ea Agency 6nature o reparrr i Brent rom response e a icerj `� ate t - ....... ":J�r'l��''a:: �:.'qwu'�:.... � `.., i.tl M1��.S�•r��• }.. � �� J.. r v, .. .`K� -- f`. � %w�:.� .} v :a•`iiti.4•:. ... ,.•.-,W..: . -.o � ._ .. .. PGTNAM COUNTY DEPARTMENT OF HEALTH DIVISION'OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -- SU°BSUTRFACE SEWAGE TREATMENT SY STEM owner: V /M I-e ,, -r— FPp:�� Address: Located at (street): g ��-S'� TM # Section9- f/_flock —/Lot Municipality: �' F! �`'! y� //.Oy Watershed: ,Sk* i 4 41' SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre- soaking: ` Date of Percolation Test: .? d No(es: l Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < i min for 1 -30 min /inch, <? min for 31 -60 min /inch'). All data to be submitted for review 3. Depth measurements to be made from top of hole. Form Dc 97, pg 1 )r 1 Depth to Time I Elapse water from �_. Water Percolation Bole No. Run No. Start — Time ground surface level drop i hate Stop (min,) (inches) in inches min /inch Start •Stu - __�__ -. . -• .._ -°- 2 :,.3 _ ._ ._ .. Qv ^.'._� t / �.. i 5 1 PC, 1 ° /U 2 3 4 1,29 /V'(# e1--O �o a D a 23 / vl , i ? 4 i / 1? , .2 2 ,z° "':Z_ � R 5 No(es: l Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < i min for 1 -30 min /inch, <? min for 31 -60 min /inch'). All data to be submitted for review 3. Depth measurements to be made from top of hole. Form Dc 97, pg 1 )r 1 TESTIPIT DATA "INTESTWOTLE-SV" DEPTH HOLE, # HOLE # HOLE # G L.- 0 .51 HOLE # * HOLE # sen good Gjcf-r 'TAW 9 Indicate level at which groundwater is encountered /0 4"o Indicate level at which mottling is observed p it (I-r Indicate level to which water level rises after being encountered A114.- Deep hole observations made by: A. D,*,Q.4 ^01 C. e#'ec91 Date Design. Professional Name: 0 kAl , j Do -jq,0-Ve , x Address:f,p- Signature: Design Professional = Seal Do. 4tj W OF N if p pop RRIJ M 04f ZM-*I 5 1) 14 0 y �d—*A z.0' 2. 5* 0- 3.01 3.5' ^09 C04 PAI IIFA 4.0'. 6R OYSAAD 4.5' ph 5.01 .5.51 6.01 6.51 7.0' 7.5' 8.0` 10.01 HOLE # * HOLE # sen good Gjcf-r 'TAW 9 Indicate level at which groundwater is encountered /0 4"o Indicate level at which mottling is observed p it (I-r Indicate level to which water level rises after being encountered A114.- Deep hole observations made by: A. D,*,Q.4 ^01 C. e#'ec91 Date Design. Professional Name: 0 kAl , j Do -jq,0-Ve , x Address:f,p- Signature: Design Professional = Seal Do. 4tj W OF N Performance Submersible Effluent P w 16,j aO LDS PUMPS. INC. WATER.TE¢HNOLOW 0801l11' ... ....; ....... .—_ .- c- - ,. _. - � ,. ._.. _ ..�. � . - � .. .: ..; : ' ... _. ... _.. ; =•r- a .._.:'�NEGA t= rli.i� NSA/ YOFlKd3ld8 -.,_' ..w ...._ METERS FEED 12 p SERIES: 3885 SIZE: gh` SOi.IOS i 4 yT RPM: 3450 i : .. .. ........ .I... ;.... I 1 40 - -50 _ 60_ ~ 70 80 ` ..90 ... 100 _ 110 yM 120... �I 1 U.S. GPM 0 10 20 30 M21h CAPACITY Ekecbve July, 1995 (0 1993 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN US w c C388P / 35- 11 10 30 9 25 ul 8 20- z a 15 50 O40 10 30 20 5 -. 10 OI- 0 p SERIES: 3885 SIZE: gh` SOi.IOS i 4 yT RPM: 3450 i : .. .. ........ .I... ;.... I 1 40 - -50 _ 60_ ~ 70 80 ` ..90 ... 100 _ 110 yM 120... �I 1 U.S. GPM 0 10 20 30 M21h CAPACITY Ekecbve July, 1995 (0 1993 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN US w c C388P / �I 1 U.S. GPM 0 10 20 30 M21h CAPACITY Ekecbve July, 1995 (0 1993 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN US w c C388P / SEl1L'Rl..M ANLEk Mb- MS, FAAIP Ca�riissio+aer+�jdth.� .. - - '� ai+•- ..;"u' :r sie. r'4 t: �., ..=: .:.ceS�.:r. .,-.: _�.......+, <. .. .r'' ".-r .rr .'�.;: � LORETTA MtY1;.UNAM,,10, MSN - 45306-wif Commissionee of Health DEPARTMENT OF HEALTH I Cmwvs Road, Bmwster, New Ywk 10SO9 OUIa EI FO LE-L i 1E—STING —'140384T J- wom IV'VwJWtt}'' 1 EilY'YifYF All information below must be fulil completed prior to ally scheduling. 1134.TE: 3 4Zf- ENGINEERING I'dRl�i:_�q.��EG J �Q�� k �,�.. PHONE #: PERSON! TO CONTACT: :/Pti li ! C ?icy *,o�.,e D NEW CONSTRUCTION. U- REPAIR PROGRAM Al ADDITION. PROGR.01 REASON: DEEPS4 PERCS::J PUMP TEST: 0 ROAD /STRE.tT: 42 57— TOWN: 7 r TAX MAP SUBDIVISION-, LOT OWNER: NYCDE�' C.B111RIA FOR JOIPIT REVIEW AND WITNESSING OF SOIL JESTING I ES NO 1rope ��t Sp S vithahe_lrsal $s^ �r rich c �oias ;a - , Croton Falls Reservoirs. ??� Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. 3 fif Proposed SSTS for a Commercial Project, It is the responsibility of the design professional to provide the above Information prior to, soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answemd j!" any of the questions, NYCD*EP must witness the soil tests. This Department will coordinate a ttt atually suitable time for field testing with the Design Professsional &ad N'YDC-EP. If a project h,ss been determined to be Delegated based on the above response and then subsequent information ihdicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. POR COUNTY 17SE ONLY'_,• .. _.__...___. aru w�, xit�arearma.n: • 1[dwinomenal Raab (844) 279 -6130 Fax ( $4$) 279.7421 Water Supply Sectlea (845) 225 -5186 F&%(845)225-M18 Nermin8 Servtses (845) 278 -6558 Fax (801t278-6026 W1C (649) 27& -6678 Nolift Rom Care Fax (845) 278 -6083 Early lntervaudesdFrembeel (845) 219-014 Fax (865) 278-48 0 iu ANK VERjFy THAT IT LOCATE pxISTlNG SEPTIC I AND STALLED. I Cj)*RACTOR SHALL IF NOT NEW TANK SHALL BE IN NOTE' 3TANDARDS� UNTIL NEW SYSTEM HAS BEEN TO CONFORMS TO HALL REMAIN OPERATION XISTINd SYSTEM S HEAL DEPARTMENT A- E ACCEPTED By THE COMPLETED AND '6 pill 136 mf #,q r 4e NY - vb ft, t,4 f Ilk Z� t 0 us) rA i I L - p Ab3 lfllf