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HomeMy WebLinkAbout4569DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -65 BOX 34 04569 2 kvWIN a m 6 1161 MNI NMI J ■ Ap L -ly 04569 CONSTRUCTION: PERMIT Subdivision Owner_ Buildinlj Type PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 5f12 SWAGE DISPOSAL SYSTEM L � Town or ilia Lot. � _.� .Job i� Address Lot Area Jq Number of Bedrooms o3p Design Flow Separate Sewerage System ��t^o�- consist of To be constructed by fG A9--- Water Supply: Public Supply From Private Supply to be drilled Address Other Requirements Gal. Septic Tank Total Habitable Space /.:70 0 Square Feet and t= `9 © I x-v l"i 122 F /EG/oj, Address ?� I represent that I am wholly and completely responsible for thAvIgesign and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed /ins ordance wi the standards, rules and regulations of the Putnam County Department of Health. Date igned S + P.E. R.A. Address c c� /Y� ez . 6�5�0�d License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requir/e�s�a new permit. Approved fob disposal of domestic sanitary sewage, an /or private water supply only. �^� Date / Iu o L/ 'S ��7_ By Title l�'�'l�% (,i , i - -- - - PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION. COMPLIANCE FOR SEWAGE ptSPoSAL SYSTEM'` �n Town or Village �' Yb' �S Tax Block e%� Located at r� f Map LV �1 Owner 1,/160 Tax Map Lot # CX sue. # Separate Sewerage System built by 2H Z— Address Consisting of 0., Gal. Septic Tank and other requirements Water Supply: Public Supply From Private Supply Drilled BY , A Address Building Type Has Erosion Control Been Completed? X �d'• - — No, of Bedrooms Date Permit Issued I certify that the system(s) as listed.serving the above premises were constructed essentially as shown on the plans of the completteedd work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the by the Putnam County pepaXtment of Health. Date � � r� -T— / Certifie/db�y'r Address�U P.E. R..A. License No.- `Py�a 6V 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 sewerage 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 omen available. Such approvals are subject to modificattaq or change when, in the judgment of the Commis of�Health, sucevocation, ification or change Is necessary. Date �" / BY •[J,� /�eGR Title a-^�— Mal All jw zz AAOV4 mm I `- TEFI PRI, POW" Mal All jw zz AAOV4 mm I `- AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES x...w .r.. -C ��i --:a ..'.o -, .'F:�:y `: C° i •• .r -�. -, ve ��^ix � .. -..s w� .«,.- ...�e^.�i4i' stiff- .:e`��_vn..ar•..,;a::.'.o:.� ;�S•.e.z..r,�....., -+�. .:..r�_�.. ...�.. .a —.. -. ..o ... „v ... tTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM CONSTRUCTION PERMIT # V �, 2 "q- Located at ��%� ��f �� �D. Town or Village Fa -AAA ( V4y=LQ1 Owner /Applicant Name� 47aax Map g Block �_ Lot Jr Formerly Subdivision Name :5T J-kMAS 'FILA E 1557, Subd. Lot # —7 Mailing Address F—•a, yak (per% :F_ j/ Zip/s Date Construction Permit Issued by PCHD IL5zcp Separate Sewerage Systenx built by STS T1- ;i)MS41�_Address P• V Consisting of a Gallon Septic Tank and -400 G,2' wa +,� �lb/� T�O�IC,f( Other Requirements: . Water Sup&: Public Supply From Address, or: Private Supply Drilled by J2d Address /:52 gflQ � AG� 'Boil in.p'Type<_'L_.f ! l i.= _ �Ia rosi, t n control beer completed? _ ..5 . - - . c -. . .- •e.... - ... . Number of Bedrooms ! Has garbage grinder been installed? /-CD I certify that the system(s), as listed, serving the above pre es a constru ted essentially as shown on the as- built plans (copies of which are attached), Aac. issued PC Construction Permi t and approved plans and the standards, rules an oun partment of Health. Date: /2p /19 Certified by P.E. R.A. l K El, gonal) Address lo'1 -- Cn, G- F_ i DA, rAl2MEi --, tL5f lyt ;i- License # 40&2 4 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 revoction, modificat' or change is necessary. By: ;1 ";I Title: Date: White copy - HD Vile; YU copy - Building Inspector; Pink copy - ner; ge copy - Design Professional Form CC -97 'b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �. -- �...a .:.. . 'Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name 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 serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system.. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day 2D Year 9!a ,f &17 P General Contracto (Owner) - Signature Ste. T4oma-5 As5�. Corporation Name (if corporation) Address: 2 t � I� S K{ (_L— I'DAl F State .q, Zip Signature: S�L Title: �PWE6 i Girt` 51- . -r �6� A5 As 56c-, Corporation Name (if corporation) Address: ;2( State - Zip / Form GS -97 YML ENVIRONMENTAL SERVICES 321 `Kear Street Yorktown Heights, N.Y. 10598 � . . (91f� -28<>0 s�-���^ - -�~ ��--,' � LAB #: 32.809104 CLIENT #: 9780 STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ST. THOMAS ASSOC. DATE/TIME TAKEN: 11/06/9803:10P P. O. BOX 687 DATE/TIME REC'D: 11/06/98 03:30P ATTN: JOHN LEARDI REPORT&ATE: 11/17/98 PUTNAM VALLEY, NY 10579 PHONE: (914)-528-8560 SAMPLING SITE: 30 GARDINEER RD. ALOT #7 ST. THOMAS PL ) SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10579 PRESERVATIVES: NONE COL'D BY: JOHN W._ LEARDI , TEMPERATURE..: NOTES...: KT COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 11/06/98 MF T. COLIFORM 11/06/98 LEAD (IMS) 11/06/98 NITRATE NITROG 11/06/98 NITRITE NITROG 11/06/98 IRON (Fe) 11/06/98 MANGANESE (Mn) 11/06/98 SODIUM (Na) 11/06/98 pH 11/06/98 HARDNESS,TOTAL 11/06/98 ALKALINITY (AS 11/06/98 TURBIDITY (TUR RESULT ABSENT /100 ML <1 ppb 1.76 MG/L <0.01 MG/L <0.060 MG/L <0"010 MG/L 10.0 MG/L 7.2 UNITS 112 MG/L 78.0 MG/L <1 NTU NORMAL - RANGE ABSENT 0-15 ppb 0 - 10 N/A 0-0.3 mg/1 0-0.3 mg/l N/A 6.5-8.5 N/A N/A 0-5 NTU --COMMENTSY `-' FAX TO 528-1366 ,COMMENTS: BACT THESE RESULTS INDICKE THAT THE WA K��@��T(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIHE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water 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. METHOD 1008 9101 9139 9146 2037 2037 'A� ` ' yML ENV` ONMENTAL SERVICES ' 321 Kear Street Yorktown Heights' N.Y. 10598 ' Albert H. Padovani, Directpr . LAB #: 32.809104 CLIENT#: 9780 STAT PROC PAGE 2 ST. THOMAS ASSOC. ' DATE/TIME TAKEN: 11106/98 03:10F P. O. BOX 687 DATE/TIME REC"D: 11/06/98 03:30P ATTN: JOHN LEARDI .REPORT DATE: 11/17/98 PUTNAM VALLEY, NY 10579 PHONE: (914)-528-8560 SAMPLING SITE: 30 GARDINEER RD. (LOT #7 ST. THOMAS PL ) SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10579 PRESERVATIVES: NONE COL'D BY: JOHN W . LEARDI TEMPERATURE..: NOTES...: KT - COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~°~~~~~~~~~ � � DATE FLAGFROCEDURE RESULT NORMAL RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted di/et,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14 MEASUREMENT OF� H IS ONE OF . p THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO-METAL PIPES AND ' FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. ' Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAiGNESIUM J:;QWCENTRATIQNo' WTH- EXPRESSED AS CALCIUM CARBONATE, ' IN- 8/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 ' MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) Dj 01- ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Lodation ;- .: tmi e't* dare s" ` - ' _ _ � n /Villa /j, 1. Tax Grid #' Map ock Lot(s)&47 Well Owner: N Address: Use of Well: 1- primary 2- secondary - Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade ;2-7-1 ft. Diameter _in. Weight per foot �_lb/ft. Materials: 2<' Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X 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 Z14, Compressed Air Hours?7�fl Yield to 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 analvses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface '— G' " 7i ;3 'oo If yield was tested at different depths. during drilling, list: list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type X. Capacity -!6 Depth ZM . • Model 5'90.S - / 3 Voltage ;0 O �dX HP J Tank Type �_U Volume z �' Date Well Completed A Putnam County Certification No. Date of Report Lle .Z Well Driller (signature) iNUTE: /rxactjtocation of well with aistances to at least two permanent lanamarKS to oe proviaea on a separate sneevptan. "Well Driller's N ame �r� 'L Address: f,' n � �%'»�^- Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller . Form WC -97 0 PUTNAM 1 S t 1 IVISION OENVIRONMENTAL HEALTH SERVICES . N. '� CONSTRUCT ON PERMIT FOR SEWAGE TREATMENT SYSTEM PERM PV- Town or Village PLAT"M ViAq� Tax Map 8 S' C6 Block I Lot %S Located at (A,.),AF,17I N,k — I�P*0 Subdivision name =65 Subd. Lot # Date Subdivision Approved 9� 120Z!3 O Owner /Applicant Name4r,1140MI&6 M5 • C.,r P Renewal Revision Date of Previous Approval Mailing Address P© 13o>X 69-7 PUTt A- m Zip OS 7 a Amount of Fee Enclosed Building TypeG t4&- W l L-,xi Lot Area l -4I 1 No. of Bedrooms + Design Flow GPD SCE® Fill Section Only Depth Volume PCHD NOTIFICATIQN IS REQUIRED WHEN FILL. IS COMPLETED 12j Other Requirements: to consist of I 'Zrj� gallon septic tank and To be constructed by 'fO Address Water Sup�ly: Public Supply From Address ore_ Private Supply brined gy ' I �7`` �`���. - Hddares_ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the datte of the i ce the approval of the Certificate of Construction Compliance of the original system or any re a o Signed: p P.E. R.A. Date `( �l Address 1U M EA i W-, U.0 02Cjtr--ntP-lDb License# ®(C>� �} � APPROVED FOR CONSTRUCTION: N: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Al2proved or discharge of domestic sanitary sewage only. � d"A0 By: Title: �S � �� �,� c ar� �'" Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTN z� COUNTY DEPARTMENT %--HEALTH DIVISION OF ENVIRONMENTAL HEAL,fH SERVICES APPLICATION T O TRU WATER WELL O CONSTRUCT CT A .. .. r .-.: �:'.'�., a..>. . -� ra- ip�CrSl'�ii iiiE Jt [��1C7 -'. . :.. ..«.i,..t .�. •...�-- ;: 1.. e.. - . :.e:.w.'.'�•,',•,."3[S :! �l.�:Y:�i "'h '• . / ^, .. :rQ .7:.-�� Well Location: Street Address: TownNillage Tax Grid # (o eolmw rurf'fb-1vl \4&U.46y MalJ55,o5 Block I Lot(s) §F(05 Well Owner: Name: Address: // (}� &S Assn • LTP, D B0X (v87 Pu AMY t os 1 Use of Well:_ Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ('% 5 gpm # People Served 1 E�M• Est. of Daily Usage $ gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision ST. 114vMaS 12 .A(e i✓ St�n-'M6 Lot No. Water Well Contractor: Tfl -E6 PeT, Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: TownNillage Distance to property from nearest water main: Z I Proposed well location & sources of contamination to Ve I separate eet/plan. Date:. I. _ !_ _`j Applicant Signature_ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is'clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. , APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 'U 1 'Z G 9 Permit Issuing Offici Date of Expiration 01 zt' ©L Title: rc l-h- �•. Permit is Non-Transferiable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P T,TNAM COI]IlTTY' DEPARTMENT4�T HEALTH DMSTON OF ENVIROMENINTAL HEALTH SERVICES Date Re : Property of Gentlemen: This letter is to authorize f'LTr'�H 1 t 1r --S 1W- I a duly Licensed professional engineer-4K—or registered architect (Indicate) to apply for a Construction Permic for a separate sewage system, to serge the above noted property in accordance with the standards, rule or regulations as promulagated by the Commissioner of the Putnam Cour Department of Health, and to sign all nece sary papers ._on ,.qy -behal,f:..: ,.... connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education tart' Code. he Public Health Law, and the Putnam County San! Very truly your 'r os7`a6 Signed .fop �' Owner of Property Countersigned . �UFESSI��P P.E. , R.A. , # CG7- I4& 10 A/\lL(,Elf Address 102 C-Lr-- si D,d Address GAF-("1F-L NY IoS(" -Z 2S - o&o. Telephone PATN1 4AI-\� Town (1 Telephone e a.,#-. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMMIT ...♦ .r. (. ... ...„C:-. -.. -. . .. ..r...... _ '`� i..•+a�.` -Y •:C. �. ...: /' '� .,�'� c-;�'::.� •.:' :... v.. ,,. -.. �.�T K_ STREET L!'rL STREET LOCATION 17thtFz <%� Z> r NAME OF OWNER+ _ REVIEWED BY n > J .Ju... DATE TAX MAP # DOCUMENTS APPLICATION WELL PERMIT PWS LETTER OF AUTHORIZATION DATA SHEET (DDS) ATE RESOLUTION 41 SETS OUSE PLANS - TWO SETS ARIANCE REQUEST `.pI FF. SUBDIVISION SUBDIVISION Y .OSION CONTROL:HOUSE,WELL, SSDS RC & DEEP HOLES LOCATED ;PRESENTATIVE OF PRIMARY & EXPANSION )CATION MAP !P. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE ++ PUMPED, PIT & D BOX SHO & DETAILED 1 R )USE - NO.OF BEDROOMS . -LLS & SSDS'S W/IN 200' O OPOSED SYS. TY METES & BOUNDS JSE SETBACK NECESSARY (TIGHT LOT) JSE SEWER - 1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS SUBDIVISION APPROVAL CHECKED CLAY BARRIER PERC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE V\fl FILL REQUIRED DEPTH FILL SPECS FILL NOTES CURTAIN DRAIN REQUIRED STANDPIPES FILL CERTIFICATION NOTE �- GENERAL DEPTH GUAGES LOCATED M NYC WATERSHED FILL PROFILE & DIMENSIONS frLANS SUBMITTED TO DEP VOLUME OL.EGATED TO PCHD FI L N EXPANSION AREA DEP APPROVAL, IF REQ'D TRENCH DEEP TEST HOLES OBSERVED -?AV— F,TRENCH PROVIDED 60 FT MAX. P.ERCS.WI.TNESSED, IF REQ'D. L.2'. . ELSSDS ADJ. LOTS XPANSION PROVIDED WETLANDS (TOWN/DEC PERMIT REQ'D ?) SEPARATION DISTANCES SPECIFIED 'A ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION �1✓ TER BUZBA 100.YR. FLOOD ELEVATION _30THER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED i0o 7/ DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: _wl 0 ,¢ % ON PLAN - FROM SSTS 10' TO P. L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS ^IYWELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS I00' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits -20') INTERMITTENT DRAINAGE COURSE /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS lin to CDS= >5 1/o,10'- 4 0/o,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% Zin to CD discharge /I00'with.182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL FORM ST -2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SiNVA.GE TREATMENT SYSTEMS • - .. -. _, . r ; _ ••. �.•, Y2EzIILid SIHr E']'C11Vi�I5'TRCi(31�iV PERMIT STREET LOCATION r'--Ae AJ E4E9 16A6 NAME OF OWNER ST f�S/t?irligS �.ss't�c . LTIl ZEVIEWED BY �SQf✓ DATE TAX MAP # ' -T— Y ' pOCUIDiENTS Y i PERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS PC -I PERC & DEEP HOLES LOCATED r" WELL PERMIT ^ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) C-0 RATE RESOLUTION HORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST / 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 W/IN 200' OF PROPOSED SYS. FROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) EP_APPROVAL, IF REQ'D TRENCH s %iin L'L; CT• r v` DyLl' TE,� H •ti.0; ;.,1:RVE��. 06 FffCS WITNESSED, IF REQ'DP Subd. dRALLEL TO CONTOURS EX- APPROVAL SSDS ADJ. LOTS 100% EXPANSION PROVIDED 7 SEPARATION DISTANCES SPECIFIED �EE HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION NO BENDS; MAX.BENDS 45° W /CLEANOUT �EGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL CHECKED . CLAY BARRIER R2RC RATE 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH FILL SPECS FILL NOTES CURTAIL DRAIN REQUIRED STANDPIPES FILL CERTIFICATION NOTE GENERAL DEPTH GUAGES L0 IN NYC WATERSHED FILL PROFILE & DIMENSIONS L�YS3t mTTED TO DEP VOLUME DRFLF,GATED TO PCHD FILL IN EXPANSION AREA EP_APPROVAL, IF REQ'D TRENCH s %iin L'L; CT• r v` DyLl' TE,� H •ti.0; ;.,1:RVE��. j ^'r F- i' vn'�Lii,i_/ .r.., LR i plpR�- -.� .P FffCS WITNESSED, IF REQ'DP Subd. dRALLEL TO CONTOURS EX- APPROVAL SSDS ADJ. LOTS 100% EXPANSION PROVIDED _ _LANDSy(TQWN/DEC PERMIT REQD�):;��. SEPARATION DISTANCES SPECIFIED DATA ON DDS PLANS & PERMIT SAME ON PLAN - FROM SSTS P3tF1969 NEIGHBOR NOTIFICATION 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL LETTE-1 1 /ZBA 0' TO FOUNDATION WALLS TWELL TO PL 100 YR. FLOOD ELEVATION _I 100' TO WELL, 200' IN DLOD, 150' PITS OTHER REQ'D PERMITS) 100' TO STREAM WATERCOURSE LAKE (inc. expan) REQUIRED DETAILS ON PLANS 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER $E'tjlrAGE SYSTEM PLAN - (NORTH ARROW) 0' TO WATER LINE (pits -20') SSDS HYDRAULIC PROFILE GRAVITY FLOW / 50' INTERMITTENT DRAINAGE COURSE OONSTRUCTION NOTES 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS DESIGN DATA: PERC & DEEP RESULTS 15'min to CDS= >5 1/o,10'- 4 %,25'- 3 %,30'- 2 0/o,35' -1 0/o,100' - <1% 21CONTOURS EXISTING & PROPOSED r I 120'min to CD discharge /100'with 182 cons day discharge DRIVEWAY & SLOPES, CUT SEPTIC TANK FOOTING /GUTTER/CURTAIN DRAINS F76 10' FROM FOUNDATION; 50' TO WELL COMMENTS: •_ r Leo' -A FORM ST -2 i ii 'I P..UTNAM ENGINEERING, PLLC 0 102 Gleneida Avenue Carmel, New York 10512 914 -225 -3060 .914-22 ; I� WMZWWIWAVU=��■ WE ARE SENDING YOU L Attached the following items: — Shop drawings _ Copy of letter _ Prints -k Plans _ Change order Conies Date No. Let-ter of ansmittaI Date: _ Under separate cover via _ Samples _ Specifications Descrintion # r7 M= ffl��WIWJVN r � THESE ARE TRANSNH=D as checked below: _ For approval _ Approved as submitted _ Resubmit _ copies for approval _ For your use _ Approved as noted _ Submit _ copies for distribution As requested — Retumed for corrections _ Return _ corrected prints j For review and comment — Other FOR BIDS DUE , 19 PRINTS RETURNED AFTER LOAN TO US xErrnxKS: COPY TO SIGNED: W PUTNAM ENGINEERING, PLLC LETTER OF TRANSM17TAL T02 Gleneida Avenue Dat�-- 914-225-3060 - Fax: 914-225-2955 RE: 5T T k o tA A5 F� p57� CqA-AD6\tF EF Pr->, TO: !6_n4z1:2L2/A_(G ?�aAp,A CO. j4FA�T4j We are sending you _X_ attached under separate cover, the following items: Shop drawings Specifications Plans No. of Copies Prints Copy of letter Other: Dp--;rrintinn epS-9!5 4.Xr7 Z[,AN — GE IDA(SM44-7741V F E E-0 P- � LQAT-EP-_ AAJA L_Y5 IS, 154-L-' 1--C_>G ev -3- QLLAP_Av'QT-F_i5_ ..,-,_-These are. transm itted.-, ..App!oved.-as submitterf.-.- - 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: — FROM ; PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Oct. 26 1998 04:31PM P1 NIENO TO: A pA1% i 5-noHi52JA16 FROM: PUTNAM ENGINEERING, PLLC DATE: RE: REQUEST FOR SSDS AS BUILT INSPECTION STREETADDRESS: 6^042DitAt6-OP- EOAZ2 TO": TAX M" #: PERMIT #: P\/-.2 -q5 PLEASE NOTIF Y THIS OFFICE AFTER Y-OURTNSPECTI ON. AT,(914 ) 22S-3060.-lN_-. ORDER FOR US TO NOTIFY THE CONTRACTOR/OWNER THAT BACKFILLING THE SYSTEM MAY BEGIN. AVAMJ File980022 THF- 15, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location C �` Inspected by:'. Owner VV � � � �z 4 ; _ i�- (- o�,,��3 Torn Permit # 7)\( TM r 5 _ as- Subdivision Lot # 7 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 - roperly set ................. ............................... ength required. fir' 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%" diameter clean .................... ..9.... ,D.epth.of.gravel :tr nch:l mi�-umum:: w capped. .................. g. Pump or Dosed Systems 1. Size ot pump chamber ................ ............................... 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/Build' ld 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 100 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... n_ ­- 14.16.4 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 'r } } SEOR Appendix C State Environmental Quality Review _ ....�....._.._.._:....,. _ w ORT"ENA FORM K. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant.-or Project sponsor) 1. APPLICANT /SPONSOR LTD 2. PROJECT NAME, I '5'[', TH AS P( Inc L=_9rAT GS 6-r'7 3. PROJECT LOCATION: \ /� PuTT,J,& Municipality U �/,�(,(,(_ County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) �2 Si�7 Tv Gd,ea11\JQ57a (Z.D - CSC Lo �TLc��J M� f� or✓ f��r�s � 5. IS P POSED ACTION: New El Expansion _ ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: PF2z,=;, PoS��> S� u �-c_C �i�n�l► j2ESr r��r LocisT�p otiI �xisT 1►�l� 5 u5Pf F�7(,o „1 h-1' . 7. AMOUNT OF LANq AFFECTED: d, I I I' 1 Initially acres Ultimately 1 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECTI Ees esidential ❑ Industrial ❑ Commercial El Agriculture ❑ Park/Forest/Open apace ❑ Other r lbe: •!. c-. .-� ,.... r .. r .. , n . r ., a �- ...,r� P_.'• •- as •- .. ti s C. - �.� c. st .... o,. .. -!.. . ?...� . .,�[' .. • A_. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? _ ❑ Yes ItNo If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permltlapproval 12. AS A RESULT QFPROPOSED ACTION WILL EXISTING PERMI'VAPPROVAL REQUIRE MODIFICATION? ❑ Yes JN No I- CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: U nl610 C (, C— Date: l Signature: If the action is in the Coa Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THE ""OLD IN 6 NYCRR, PART 617.12? If yes, coordln Tie review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS.PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration.- may be superseded by another Involved agency C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE' FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brieflyi C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or intensity of use of land or tither natural resources? Explain C5. Growth, subsequent development, or related activities likely to be Induced-by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1zs? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. AS THFRF_ OR IS TME,PE LIKELY TO BE- CQPITAOJFP..Sti =?E! r9TEL� TO DOTE. NT -.AL DVtRSE ENVIRONiv"i'NTA 111 MG-Ts? ` as ^' ^ ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a' positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of.Responsible officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If aifferent rom responsiGle officer) Date 2 F- O J W U o Q a U a. Gs Z W a O 7­1 F O eltf f 1 B9. J2' •n SCALE w .50 0 25 50 1 Else ( IN PST )' I inch = 50 n 1.411 Acre" 5 TOWN TAX MAP DATA: (61,483 S.F.) Section 63.05. Black 1. lot 65 Flo El ! Survey Notes• Parcel Shom Heren, Knom As Lot No. On SubdMNan Yap Entitled -ST. TNDMAS Thu Courly Clerk'. Office On August 17. Surveyed N In Po.wwlon(No limp of P Thos• Indicated). Sub.tru.ture. and /r Their Er roachmen- re Not Shom. '_'aro).ol.:t6`fa.evfb aM /r.Tetephone Can . - Myt.Fr Owslt.ed and /rUndr4aund S , i.2 othaft (Whre'Shasn) Taken to Property Crnra Staked For Bldg Corso v t h• °00000000 titan• it 4' h' Certifications Indicated Hereon Signify That Aceordance Yllth The E.I.ling Coda o1 Pra.t By The Neer York Slate Aisookflon of Prof. t. • ry ` Csrtill -Uone Shall Ron only to the P—(, �o• by F}spred and On Their behalf to the 11M. C and t Institution Listed hereon, and t m� at t.or tw, InWtutbn. GNRcollom Are Not Transfrob ���.• 1(J �C r Subwqurtt Omrs. . t(( eye 0 ,' kp AD Certhlootions Listed lfreon are Valid Fa Only H sold Yap r Cop1e. Bar the Impre. A. O U SlgnobNe Appeve Mreon. C11- Addition. r Alterations to This Map other t Co. Shot) Vold This CertlReation. .Copyright O 1996 J. Henry Carpenter t Co. All Rights Reserved. Including Rights of Rep 04 THIS SURVEY IS HEREBY C J0 O 1. ST. THOMAS ASSOCIATES, LTD. 2. 3. _. SURVEY OF- P I.ST. PREPARED THOMAS ASSC POR77ON OF LOT 11 SCHEDULED TO BE CONVEYED TO LOT 7, 0.112 Ac. .OR 4870 S.F. LOCATED TOWN OF Pa.D'U N DATE: AUG. 1 '0 P/O Lot 11 Shown AUG. c 7��!Y House u.c. OCT. 7 lk J. HENRY CARPE LAND SURVEYING YORKTOWN HEK tye. J. Henry Carpenter t Co.. Dr an Nov. 24, 11907 a Surrey of th eras Made rtd That This Map is O � l .O . . . . . . . . . . . . . . . 4 InvironmentalAsaith jervlOw DO'ged for 401dornwiDt with EkLis Wild 8OSU34tloft. of the =tr th DepLrtmmt.. 7 -77 i t t +Iih s wage s Sol 5 5f was ;,n this,plan ond,thot the system was earing, RL.L.r— before-At was covered over. >d in accordance with all standard " le Putnam Coun.ty. Deportme , nt of 5toto Deportment: of �A,A A