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Home My WebLink About4565DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -61 BOX 34 04565 !� . 0-i J ' IL , . „ l L. ,. 04565 PUTNAM COUNTY DEPARTMENT OF HEALTH !IYjI ION .OF ENVIRONMEN- - L- REALTL. SERVICES - TE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village 2fA kil M LIA Y Owner /Applicant Name 4�yr '111!`416 4 %0 max Map a!E� Block I Lot Formerly Subdivision Name IST —V JAOf�TLA0 Subd. Lot # 3 Mailing Address _� O_�_ (�'7 '7 �,�,�, �� Zip 10!79 Date Construction Permit Issued by PCHD 4&;/24191 ,24. *77) Separate Sewerage System built by 6T :DJbM S AS50L,, Address .2 L.[_ JApJj ac712 -jv Consisting of Gallon Septic Tank andQ� Other Requirements: —7' r urZ -0 Al J i1 0 !=F Water Supply: Public Supply From Address or: Private Supply Drilled b A is Address PP Y Y 1 �?� mill (. J?V . [ Q2ME!1 evszoii -control :becom feted? Number of Bedrooms Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of pepartment of Health. Date: ES Certified by P.E. L R.A. `�i(1„TTIANL%i�UFE/�l�o (Design Professional) Address l l�_r ,� _CAW -=&l L N c{ . ��l License # 0Co'744 C� 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, mo*ificationchange is necessary. By: Title: Date: White copy - Huilding Inspector; Pink copy - ner; range copy - Design Professional Form CC -97 PU TNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT -911 . ncateblB . °, J 7 Street Address:' ; "3 -T n/V' T ax Grid # , ap Block Lots) ell ® er: Name: � r- Address: W QZ 00 Ilse of Well: 1- primary 2- secondary Residential T Public Supply Air cond/heat pump Irriga n Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing K Open hole in bedrock _ Other Casing Details Total length rg-% ft. Length below grade '4 . Diameter in. Weight per foot 164" lb /ft. Materials: K Steel _ Plastic _ Other Joints: _ • Welded Threaded X Other Seal: _ Cement grout — Bentonite _ Other Drive shoe: >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 _ Pumped XCompressed Air Hours Yield /o gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyse-,.---:- ... . are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ' eo :..... L� - . . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type wet-L'. Capacity /,d Depth A`i® Model Voltage .23 o HP � Tank Type# ;S6 Volume / 2- G Date Well Completed Putnam County Certification No. Date o Report Well Driller (signature) 1V( TIE: -1-Aact locatlon or well wttn atsrances to at ieast <w/uUperuiai UL ,a;WIIMne w vc Y'v.navu .. " —t, r.—.. Well Driller's Name� 1 Address: /,,fA Signature: Date: ' oJ"7 j White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 � . � YML ENVIRONMENTAL SERVICES 321 Kear Street Ypr kt wn. He :� (914) 245�L5800 Albert H.,Padovaniq Director, LAB #: 32.808277 CLIENT #: 9780 NON STAT PROC PAGE 1 ST. THOMAS ASSOC. DATE/TIME TAKEN: 10/06/98 01:35P P. O. BOX 687 DATE/TIME REC'D: 10/06/98 01:45P PUTNAM VALLEY, NY 10579 REPORT DATE: 10/09/98 PHONE: (914)-528-8560 SAMPLING BITE: LOT #3 ST. THOMAS PL. GARDINEER RD. SAMPLE TYPE..: POTABLE PUTNAM VALLEYNy 10579 PRESERVATIVES: NONE COL-D BY: JOHN ' W. LEARDI TEMPERATURE..: < 4C NOTES.,.: KT ' . COLIFORM METH: .F ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE ' RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE ' 10/06/98 MF T. COLIFORM ABSENT /100 ML ' ABSENT 1008 10/06/98 LEAD (IMS) <1 ppb . 0-15 ppb 9101 10/06/98 ' NITRATE NITROG 1.18 MG/L 0 - 10 9139 10/06/98 NITRITE N%TR8G . <0.01 MG/L ./A ` 9146 10/06/98 IRbN,(Fe) <0.060 MG/L 0-0,3 mg/l 2037 10/06/98 MANGANESE (Mn) <0.010 MG/L 0-0.3 m91l 2037 10/06/98 SODIUM (Na) 11.8 MG/L N/A ' 10/06/98 pH 8.6 UNITS 6.5-8.5 9043 10/06/98 HARDNESS,T8TAL 114 MG/L N/A 10/06/98 ALKALINITY (AS MG/L N/A ~�0/06��B- �L� �� (��R�� ' �<�'^NT�~-`"~'`` ' 'C�` ---=,��'.-..~^^� _`--.~��__^-�-�vT��_-`-'�`,` COMMENTS: ` ' BACT THESE RESULTS INDICATE THAT THE WAT (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD��^THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. - ` Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead &- Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L" Na No limits for Sodium are proscribed. Suggested guide/lines state that for people on a sod ium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270mg/L of Sodium is suggested. ��ll/��9 D�� @�� "��,�x~c� w�v ' ��0 ^ ~ YML ENVIRONMENTAL SERVICES ` ' 321 Kear Street 3N�\t. 1059jD_~=�.�� ' (914) 245-2800 . Albert H. Padovani, Director LAB #: 32.808277 CLIENT #: 9780 ----------------- ~ --------------------- ' ST. THOMAS ASSOC. P. O. 'BOX 687 PUTNAM VALLEY, NY 10579 NON STAT PROC ~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: DATE/TIME REC'D: REPORT DATE: PHONE: (914)_528 PAGE 2 ~~~~~~~~~~~~~~~ 10/06./98 01:35P 10/06/98 01:45P 10/09/98 -8560 � ` SAMPLING SITE: LOT #3 ST. THOMAS PL. GARDINEER R0. ' SAMPLE TYPE..: POTABLE : PUTNAM VALLEY NY 10579 ` PRESERVATIVES: NONE COL'D BY: JOHN W. LEARD% TEMPERATURE..: < 4C NOTES...: KT ' _ CQLIFORM METH: MF ~~~~~~~~~~~~~~- ~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT. NORMAL -RANGE METHOD ` ` pH pH SCALE %N WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER-WITH A L8WjzHMIGHT BE CORROSIVE TO ,METAL PIPES AND FIXTURES. THE NQRMALRANGE OF pH %S 8.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED A'S SUM OF THE CALCIUM &,MAGNESIUM CONCENTRATIb , BOTN,EXPRES -D AS CALCIUM CARBONATE9 IN MG/L. THE 'HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L `'MG�L.-._��L��]�.��I/�E��1-��R -I 3�TIE�L��,��_--`�'� ~ HARD WATER: 140-300 MG/L1 (1 grain/gal.lon =17.2 MG/L) SUBMITTED BY: ` ^ ~ ''^ ' ~~~``~'^' M.T. ^'~~^ ' 7 DArActor ELAP# 10323 PUTNAM ENGINEERING, PLLC LETTER OF TRANSMITTAL 102 Gleneida Avenue Carmel, NY 10512 Date:- ! i. L e: 914 - 225 =3060 '- . . , an. c•j r,,. , Fax: 914 - 225 -2955 RE: 5t- Tjbb!� AS E✓S7A i LOT3 • � is � _. _ We are sending you )-4– attached Shop drawings Specifications Plans No. of Conies under separate cover, the following items: _ - Prints Copy of letter Other: I t� Desrrintinn These are transmitted: For ap Koval Approved as subm,itted.. . : For your -use __..Approved-as noted..:. _ _ _ As requested _ Returned for corrections _ For review /comment _ Resubmit copies for approval Submit _ copies for distribution REMARKS: Copies to: SIGNED: if enclosures are not as noted, kindly notify this office. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION D_ ate: - -I.- h .,. .. •ri�;�,�"�iie:.tGd�by:�^ • _ . ». ..<..- Street ,oca'ti'an -;'` "s 1.i -Owner Town Permit # TM# E3 -og Subdivision Lot # 1. Sewage System Area a. STS area located as per approved. plans ..:........................ b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c.. Natural soil not stripped .. ............................... . ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... 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 .. ............... ..............................; ength required __ Length installed 2. Distance to. watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... ends :capped,.• Puri `or Dosed S st ms' "". I ize o pump c am5er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . .................:............. b. Distance from STS area measured 1C>0 � 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 watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 4'r+3L,;;y°k#f�'•F2i.4- .+�.. n.. •i.:r i.h _ Ft :''. <�'- t y: PDITIAM CODNTY DBYAgTlrffigT OF HEALTH DNvMaw o[ HYrvbottMORW Hea116`Senloea. Camel. N 1061? n Y _: to Ptxrvide Paaslt r C)3RTII+iCATB OF CO e Poa�t r w CO N PElOM FO>t S6WAC.S:DLMOSAI. SYSTEM ' swwvvmm man ST' 76t6N1A5 I fiG -GEC ? SWW. Lot 0 Tut MapT eel —° Re, ° Ofr.edAppilsat Nlltae Date at Ftevloa. Meek AdMm 1 D Tow° ZIP a Type, � t .� wL(,cT 1,t Area 1 .25 A29=1 FM Seedoo of Dp& vabon Number d Bedraoan 4 Doalo Flow G P D O O PCHD Ndlteatlm is Rogdlred Wham FlI to oomipleled sewea.se S�.tes to oaaalrt d Al. -G.D. Saple Tank abd —� 2 w m So�CP 1'X E .lc -F To be oaaa4taated by lJ� Addreoa- Woter Sapp: PdWk Supply Pros Addleao on SW* -Del W by _trs —7 %.war -w, - \. - nea1.J 17 Odne 1 represent that 1 am wholly and completely responsible for the design and k►cation of the proposed system(s); 1) that the separate sewage disposal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regulations o ream County Department of Health, and that on completion thereof a "Ce►tifkate of Construction Compliance" satisfactory to tea Commissioner of Healthwill a submltted to the Oepertnlent, end a written guarantee will be furnished tea owner, hi aao►a. h ns by the bulkier, that said builder will piece In good operating condition 'any part of said aawaps disposal system duri pee two ) years im iately following thadate of the Inu- •nce of tea, approval of the Certificate of Construction Compliance the real Sy s y r its thereto; ) that tea drilled well described .above will be located as shown On the OPPrevad Plan and that saki well will be in i accor the andard uses and rpu MM of the Putnam County Depart ment of Health. Date Zv f� �i�, Signed P.E. Y ,�` R.A. S Ad APPROVED 1t*ylc Q� (02 &LQ1Ei� � yw•�•-'t,•-• license No Dpi A(a APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has been undertaken and is revocable for cause of may be amenrled or modified when considered necessary b tea Commissioner of Health. Any ,change or alteration of construction requires a now Permit. Approved for disposal of domestic sanitary sewp , and /or or supply only. Rev. wa,/ Z G%�1�' 43V Title 10/88 i% w� n DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WWI WELL LOCATION Street Address of-,lkfz D l 0� Town/Village/City Tax Grid Number ?O Fl D r &-6A SSA oS - -- e.0 i WELL OWNER Name Mailing Address / e>e U'[AIAM j Private 0Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL BUSINESS ® INDUSTRIAL 0 PUBLIC SUPPLY. Q AIR /COND /HEAT P ® FARM 0 TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY ® ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT M IN S gpm /# PEOPLE SERVED1l'o� /EST. OF DAILY USAGE oa al ® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION GIADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ®GRAVED 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ST. -rrsmAS ELAe� Lot No. WATER WELL CONTRACTOR: Name I 6D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A NO NAME OF PUBLIC WATER SUPPLY: I�I�� TOWN /VIL /CITY � .D STANCE--TO- PROPLRTT T OM NEAREST---WATER - MAIN:. - - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI [DON SEPARATE SHEET ( ate signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accbrdance with the requirements of the Putnam County Health Department attached to this permit. 3. Subi t a' Well Completion Rep6ft- "dn'-& 'fotm ptov de - -by' the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: '�'12 / 19 7, Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller o�. qac __.. -• '- .ti`�.e it - h'�s".yr - -. c. .- .l �r'r.i:. {, `�a.... � . � , .- F z •WJCFi' R. 'FOL,EI' Acting Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Putnam Engineering October 3, 1997 102 Glenda Avenue Cannel. "e«" fork 10512 .attention: \ -Ir. Paul Lynch Re: Construction Permit for Individual Water Supply and Subsurface Sewage Treatment System (SSTS). Leardi- Gardineer Road (T)Putnam Valley 85.05 -1 -61 Lot 3 Dear Paul: I have received and reviewed the application to construct a single family residence on the above mentiZparc The followi ng additional information and/or revisions are requested lans for the proposed residence are lacking. Please submit two (2) sets of ouse plans for review and total potential bedroom count. � B) The plans indicate that onh, one deep test hole was observed when the property was s bdi,:ided. A minimum of hvo (2) deep test holes are required. One is to be located in the expansion area and one in the primary area of the SSTS. (See enclosed map). C) Please revise the standard notes in accordance with the revised regulations. (Copy I D) The discharge of the proposed curtain drain should be carried to and tied into the street drainage. Please label the curtain drain detail as seven (7) feet minimum of depth. 11 The 4" PVC pipe from the septic tank to the first junction box should be SDR 35 or equal. �P) Cleanouts are required at every 50 feet from the septic tank to first junction box. Nlinimutn pitch must be 1!8 inch per foot. Please label. H) Stand pipe must be provided 5 feet upgradient and 5 feet downgradient of the curtain Xdrain and extend a minimum of 5 feet below the elevation of the absorption trench. (Details enclosed). Once the above mentioned revisions are received, review of this department will continue. Should you have any questions regarding these revisions, please contact me at 278 -6130 ext. 168. Very truly yours William Hedges Sr. Public Health Sanitarian WH!mh en r. revssts PU'INAM ENGINEERING; 102 Gleneida Avenue Carmel, New York 10512 914- 225 -3060 _.� ,.,:: •- �fiE'�i� 91�225 -2955' To: f 54w U WE ARE SENDING YOU I/ Attached the following items: Shop drawings —Prints L Plans _ Copy of letter _ Change order Conies Date No. Letter ansffiittal Date: (z . p1� S�f�� Ica' �.S'�•�TES — Under separate cover via Samples a Specifications Descrintion # -55 r,),,- Pc.,sr-J 2, `� ESE ARE TRANS checked below: _ For approval — Approved as submitted — Resubmit _ copies for approval _ For your use _ Approved as noted — Submit copies for distribution As requested _ Returned for corrections _ Return _ corrected prints Y For review and comment Other _ FOR BIDS DUE , 19_ PRINTS RETURNED AFTER LOAN TO US REMARKS: COPY TO S SIGNED: 4___�-j If enclosures are not as noted kindly notifv us at once. 5 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSI_ TRFACE SEyY�t F -TREAT N:.T $,YSTEM -- ' '-�'a = }` 'Owner � TtAUS LTD oAddress ro B014 Co 7,(ryrK*m VA"4P KY 1o5 '71 Located at (Street) aA -70, D I If E-L� D Tax Map%,o5Block Lot �v I (indicate nearest cross street) Municipality fU A- Nl Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No.. Run No. Time Start - Stop Ela se Time Min.) De th to Water From Ground Surface. (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 3 4 5 1 3 4 ti 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES r >µ4 �oL� ivoEPTH HOLE N4. G.L. 0.5' f`- 1.0' 09A GS 75RpV UJ 1.5' 2.0' 2.5' 3.0' �-T• Tian 3.5' �vaNJ 4.0' 4.5' 5.0'' 5.5' 6.0' � 6.5' 7.0' 8.0' 8.5' 5 10.0' Indicate level at which groundwater is encountered -7'—C � Indicate level at which mottling is observed 1--1/4' Indicate level to which water level rises after being encountered N Deep hole observations made by: K I-i — P E • P1 K— P C.. H ,Z . Date 1 i I7 Design Professional Name: Address: 02 (9 Signature Design Professional's Seal ru i,,NAM ENGINEERING, PLLC A02 Gleneida Avenue Carmel, New York 10512 914-225-3060 Fax: 914-225-2955 To: Rrrco WE ARE SENDING YOU X Attached the following items: —Shop drawings —Prints 'A Plans — Copy of letter — Change order Conies Date No. Letter of Transmittal Date: 0 / C"V&P'D1t')6n_--yL 12LD — Under separate cover via Samples Specifications Deqerintinn # 4 f -71 1 (cr-7 (_—CV-W` THESE ARE TRANSMITTED as checked below: — Fbr1pVCbVal _Approved submitted tted _ Resubmit —copies for approval ' — For your use Approved as noted — Submit copies for distribution As requested Returned for corrections _Return corrected prints For review and comment Other FORBIDS DUE PRINTS RETURNED AFTER LOAN TO US REMARKS: COPY TO D: If dqclos*ies are,- not as noted, kindly notify us at once. s. `3��J'TY�IA�i COUNTY DI�PAi�T1�ENT ®]E°° >�3�AL'I°H APPLICATION FOR APPROVE 1. Name and Address of Applicant: kL OF PLANS... SA .SYSTEM; � 3P ST�s L.�Rt� I 2. Name of Project: �'i� 'THoMas pLA� Fe L 01 3 4. Project Engineer: 1 UTN'A"ni�s�NzYt License Number: 0074440 3. Location T /V /C: cJ'rM&M 5. Address: io2 6LQ'1J (Q1 t-.vm- fos�z- Phone S. Type of Project: C,X Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X . Is a Draft Environmental Impact Statement (DEIS) required? N� Has DEIS been completed and found acceptable by Lead Agency? ........... (J /b Name of Lead Agency i. Is. this- project. in an—area -under the- control d local planning, zoning, or other officials, ordinances? .. ND If so, have plans been submitted to such authorities? .................. Nth` Has preliminary approval been granted by such authorities? Date Granted: N/A- Type of Sewage Disposal System Discharge...... Surface Water _Ground Waters If surface water discharge, what is the stream class designation ?........ N //S Watersindex number (surface) ........... ............................... tJ��- Is project located near a public water supply system? .................. NO C,t r�2 -. T1� If yes, name of water supply Distance to water supply ( M(LG- Is project site near a public sewage collection or disposal system ?..... f--to C- aAm�wl OIL IV a.J Jame of sewage system JJ 1a Distance to sewage system ( M'lf-- )ate observed: f'tLM K&P NW190 23. Name of Health Inspector: 'roject design flow (gallons per day) ....... .............................. 50 (Z) . 2. a 25.'Is State Pollutant Discharge Elimination System (SPOES) Permit required ?.. ?� 26. Has SPDES Application been submitted to local DEC Office? ........r._..:.._ _ 27. Is any portion of this project located within a designated Town or State wetland? .................................................................. h)D 28. Wetland ID Number .... ............................... 29. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. _ 30. Does project require a DEC Stream Disturbance Permit? ................... f�t0 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 or NO N0 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO D DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 1111 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15A slope ?. . N 36. Tax Map ..ID'Number ......................... ............................... J.or, -I- �Pl 17. Approved Plans are to be returned to: Applicant Engineer f the application is signed by a person other than the applicant shown in Item 1, the pplication must be accompanied by a Letter of Authorization. Failure to comply with this rovision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and be t ief. Fa lse statements made herein are punishable as a Class A H7sdameanor pursbant to Sect' 10.4 of the Pena 1 Law. V . / GNATURES & OFFICIAL TITLES: ILING ADDRESS: J dL &U54 Gr-W AJLe-- G&- e2- 1-5L1 iD�5112- V as) ;w::0 ita W- —G,_JxMM4rAq rX DESIGN rr--q'% -SUBS-Muz-310E SEPT-1 =-- DT-SPOSALL SYMMM FLT=: m Crimer t ass LCx--ted, at (S t=—+-) Block I Undica-ta nea_p-est_.=ss s-tx ;;E) 2 3 4 As ft �- FtL_-r_D j,-IA P 2-452- 2 3 4 5 TO BE A-PP==S of Date of Test 60M IFIp__ EO=- LC m recth to Water F_-Cm Wac._ Level No. C-_--=_a su=face T_- 1 -, i ch e s SC; R= stax-t--tcno Y_:, a S tart Stcm -0 zrz= ne-!--=Ci TrN 2 3 4 As ft �- FtL_-r_D j,-IA P 2-452- 2 3 4 5 1- Tests to be rem tad at sp-me-danth unt-LI a;pr=cizatelly equal soil rate-S are Obtm; "c; a- each oaraoia'ic-n tact hole. All &-t--- to* be suhnittea for review. 2. Ceptn to be TmEe fz-= t--o of hole. —�-- 0/;:= 60M IFIp__ =111 all I 1- Tests to be rem tad at sp-me-danth unt-LI a;pr=cizatelly equal soil rate-S are Obtm; "c; a- each oaraoia'ic-n tact hole. All &-t--- to* be suhnittea for review. 2. Ceptn to be TmEe fz-= t--o of hole. —�-- 0/;:= C.L. 1� 21 3' d1 5' 6' 7r $t gt io1 171 17r 13' LL71 r." aL —M-6� s. 4~ =CR=ClN OF SOILS M TEST EOLFrS H= NO. EOLB NO. NODE NO. Fr,-12—, )5 c L-ED rj4p -Lx` 821 8 /9 -7 I�t ralC` Lv+, P -�Gvr: � - E`;C~.G Tti� =C L� i TU W ;?C:= 4V= Lv= pas 5. P_ ? CJ I _O DE =? ECL•E CDa c"'-.T_A=CN5 MADE BY: M= — DE <IC�i Soil Rate Use l D M-.n/1" Drop: S-D. U�ahle A as P_:.videa &C)O0 No_ of F o y _ Selz c Tz ^_k C sac_tv P.�scrj�ior_ Ares >Provsc By L.F. x 24" width. tend Other ., QP Name E, Sicr2 e SQL w CAKMOI 067446 � EJ THIS SP.AC=. FOR USE BY EZEALTH DEPnP—'TX-=, i?' CN7 So i 1 R� �e Acorct; sc _ f t / gal _ C2, bv Pz M Ep i v� Sarc' D S11.T5 � F11� 5�ti tJ5 Fr,-12—, )5 c L-ED rj4p -Lx` 821 8 /9 -7 I�t ralC` Lv+, P -�Gvr: � - E`;C~.G Tti� =C L� i TU W ;?C:= 4V= Lv= pas 5. P_ ? CJ I _O DE =? ECL•E CDa c"'-.T_A=CN5 MADE BY: M= — DE <IC�i Soil Rate Use l D M-.n/1" Drop: S-D. U�ahle A as P_:.videa &C)O0 No_ of F o y _ Selz c Tz ^_k C sac_tv P.�scrj�ior_ Ares >Provsc By L.F. x 24" width. tend Other ., QP Name E, Sicr2 e SQL w CAKMOI 067446 � EJ THIS SP.AC=. FOR USE BY EZEALTH DEPnP—'TX-=, i?' CN7 So i 1 R� �e Acorct; sc _ f t / gal _ C2, bv Pz PUTNAM COUNTY DEPARTMENT OF HEALTH DIPISION..OF ENVIRON,%YTAL HEALTH SERITICES . _, -- _...�- �_.._._.�.'.�. - - -.- _gib:_ •- .. �. � ,....�- -,, �°._. _.._ Date c--j -4L—V I 119 -7` Re: Property of L6='4 f' 0 I. Located at (=4 � p1 /4 ISS9 ('-�p (T) FuThIAM'/ALt4L-V Section 55.Ocj Block I Lot Subdivision of aJT• rF1yMA .S PL Ct-- Subdv. Lot ,} 3 Filed Map n- 2'82. Date Gentlemen: This letter is to authorize l UTt,�&H Et4,- I fjr-7EZiW. I I a duly licensed professional engineer--Z-11.—or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rule: or regulations as promulagated by the Commissioner of the Putnam Coun- Department of Health, and to sign all necessary papers on my behalf,_r - -= - 'conriecioa with 'this ruatter and to supervise they construction of said system or systems in conformity with the provisions of Article 145 or 147, .Education �e Yo ac ublic Health Law, and the Putnam County Sani- g'�P��tuEl y tary Code. � 1 Very truly your Signed Countersigned ROfiESS10NP Owner of Property : P.E. , R.A. , # D�-% � Io2 AA1L'LF►2. RZD. Address 102 Cap D,4 A \IE�- Address G 14 -22s- O&c Telephone (- (ATeJ 4"\. y �A= AJJ r Town I I qty - 50-2�- 5gg Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SUWAGE TREATMENT SYSTEMS _ _REVIEW SHEET FOR CONSTRUCTION�tl� RMIT T • ti "° STREET LOCATION NAME OF OWNER ® o REVIEWED BY 40 DATE �j� TAX MAP # Y N DOCUMENTS PERMIT APPLICATION PC- I WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF P . HOUSWE &EQ9UESwT=::l FEE al _ moll LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE 'r— ®0 FILL REQUIRED DEPTH ZZICURTAIN DRAIN REQUIRED STANDPIPES GENERAL & 00 - CLOCATED IN NYC WATERSHED X07 PLANS SUBMITTED TO DEP �6 DELEGATED TO PCHD S N EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. 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 450 W /CLEANOUT FILL SYSTEMS ER 10- FT. HORI TAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL IFICATION NOTE D H GUAGES ILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA 1/9, DEP APPROVAL, IF REQ'D v TRENCH v DEEP TEST HOLES OBSERVED . l�� fl LF TRENCH PROVIDIyD.�FT._MA�C.., - :. _ PERC3 Wi£SSED.T °REQ'D. ;. _ . _ � _ PARAL� EL -TO CONTOURS` EX- APPROVAL SSDS ADJ. LOTS 100% EXPANSION PROVIDED WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA 100 YR. FLOOD ELEVATION ER REQ'D PERMITS) REQUIRED DETAILS ON PLANS AGE SYSTEM PLAN - (NORTH ARROW) 3 HYDRAULIC PROFILE GRAVITY FLOW INSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED 'AY & SLOPES, CUT TAIN DRAINS COMMENTS: SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SST& . 10' TO P.L., DRIVEWAY, LARGE.TREES, TOP OF FILL 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4 %,25'- 3 1/o,30'- 2 0/o,35' -1 0/o,100' - <1% 20'min to CD discharge /100'with 182 cons day discharge SEPTIC TANK ®10' FROM FOUNDATION; 50' TO WELL 111 .sue l C v Cm ri FORM ST -2 lif LVI Il r. t. �FA V. FEET 5 4 5 1�'i 12 15 t. JITWM of Mw1rannedw Heelth serftem wEls Sues uA RWI-tl— of tu WELL ,5 SILT, Am ed I It- Ma Is to ertifS tli�t the III- "'dMalt, P�,L�-. bsfor, it --.d —d— -11ti, -11 atmdard lot,— of tts Pt— county D.fzr;t of pr—..t Er;, 550S.pt, st' '� L* 'o.f. of 24" Md. b-lpt;— SURVEY NOTE! HOLrE LOCATION AND SETBACKS BASED ON SURVEY BY -T PENRY -14 "t- f C�. PREPARED;rOR: T. THO�lAS PLACE ESTATES ccToee� I'ma Ne AS-BUILT T LOT # 7 St JITWM of Mw1rannedw Heelth serftem wEls Sues uA RWI-tl— of tu WELL ,5 SILT, Am ed I It- Ma Is to ertifS tli�t the III- "'dMalt, P�,L�-. bsfor, it --.d —d— -11ti, -11 atmdard lot,— of tts Pt— county D.fzr;t of pr—..t Er;, 550S.pt, st' '� L* 'o.f. of 24" Md. b-lpt;— SURVEY NOTE! HOLrE LOCATION AND SETBACKS BASED ON SURVEY BY -T PENRY -14 "t- f C�. PREPARED;rOR: T. THO�lAS PLACE ESTATES ccToee� I'ma Ne AS-BUILT T LOT # i *µ Ww "DRING FARM SUBDIVISION /� [�[�y `Si.W'R3.D0. 4M t,.IAt 1t - _ J .(FILED MAP No. 7379) 21 AI %22 r_ NwF �--- OPEN SPACE PARCEL —LOT 12 MUTT ITRLON"IINOWw As LOT x. 3 "W suwoIV9ON LW OImLER.•SL THOMAS PPELA,�CC[ urAt[s, ra[o,a Txs CpOIIE�' CIFRRO OFFICE ON AIro. 1/, ISSO AS Wi W. EM[. . SURlCCf TO El[C/Pro ANDlW'tuENbN[ CO. EAf[N[NIS, D ANT: idl [RN[liD AND /011 IdroO1W0UND uRVRE. 3YIMkTED AS p POSSE59NN (N. Lbw. N Pan.ubn Olbv 1NPn b'dw d). .SURSIIWCfuRES R TILER ENCROACNWENTS BELOW WAGED AND/O ANr, NOT SHOWIL ,HOUSE OFFSETS TAKEN ro-SWM W TRUL '`NWFRS'I cow". STAKED FOR EIDF CONSTRUCTION IS ONLY. THIS SURVEY IS NEREDY CERTIFIED ONLY TO. • '1. ST. TI10Nis- ASSOCYTE3, LTD:. -. - J. HENRY .CARPgNTER At CO. LAND SURVEYINO�IR MAPPING YORWTOWN HE1GNTS. N.Y. w A Nr. Z CAMNS IN01GT[D HEREON SPRINT TIDY SURVEY PREPARED IN ACCORDANCE 1TIIN THE EXISTING CODE OF FRACTIOE FOR LAND SW VETO ADOPTED BY TM NEW MR R STArt A33OC'IRTION OF PROFESSIONAL LAND SURVEYORS; SAID CERTIFICATIONS SMALL RUN ONLY TO M RNSOM FOR WNW ME SURVEY IS PREPARED, AND W HIS BEHALF To THE TITLE COMPANY. GOVERNMENTAL . K.tNCY AND LENWIG INSTIIUIroN LISf[D NERCON. IND 10 MEAT EC3 Of 1M[ LLNO,NO INSiRUII(IM, CCRNKATIONS MF NDT TRANSf[RARE TO ADDITIOMAI MSTIMIOMS OR SURS[W[NT OWNERS. SURVEY OP PROPERTY PREPARED FOR ST. THOMAS ASSOCIATES. LTD. -- -. -LOCATED -M .. _- TOWN OF PUTNAM VALLEY PUTNAM COUNTY. N.Y:' .,AIM.r.. z: w WY M M — 4 M •4Flwafwwtl. LR SCALEt Y= 50' OATE• 1. AUG. "II, If35 YPCON E. M. R, I30 ii �?b n qa �l a� 61 1j ,sA t �f +i I� Sa ¢�6 •R Pz; I,I pi 7hh7rr, t Yt fi li) tl; io 3 a' W 11F �j :I i , 3: