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Home My WebLink About4573DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.06 -1 -2 BOX 34 04573 I loll Y ) ., , ' 6 Ir IN ., koe IN sm 04573 Rev. P186 Located PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide P V 17 - 9 1 I =.. P.C.H.D. Permit # O 6 —•� is Lane & Taconic ( �cs.�� "�i�r" "aria= �r'eT�^fi •G�"_� �.:-i= .: _�:zxr..'.:�;,..._. Town or Village Tax Map 6 7 Block 4 Lot 5 Owner /applicant Name C O L I S K E Y Formerly Subdivision Name Subdv. Lot # Mailing Address 100 Columbus A v e - , T u c k a h o %p 10707 Date Permit Issued 10/29/91 Separate Sewerage System built by M c G '1 a s s o n Realty, Inc Address Carmel, N Y 10 512 Consisting of 0 Gallon Septic Tank and 400 linear feet of 2411 trench Water Supply: Public Supply From Amass or: X X X Private Supply Drilled by_ B o y d A r: P s i a n W akl& a RD 3, R t. 52, Carmel, NY Building Type 1 f a m i l y res. Has Erosion Control Been Completed? ALP e Number of Bedrooms 3 Has Garbage Grinder Been Installed? no Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work( copies of which are attached), and in accordance with the standards, rules and regulations, in �ae�pCOrdance with the fyiled plan, and the permit issued by the Putnam County Department Of Health. J 0 H R do , C U y yyy Sept 2, 1 9 9 2 Certified by �/(/ P•E•� X-XlE X• Date 61145 Address 1 Northridge R o a tl, e e S k i License No. Any person occupying premises served by the above systems) 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 sewers m shall become null and void as soon as a pubt% sanitary awe► becomes available and the approval of the private water supply shall become n nd v when a p I water supply becomes available. Such approvals are subject to mod fication-or change when, in the judgment of the rJZ o f Healt revocation, modification or change Is nepes�►Y. By Title Date - •, - - PUTNAM COUNTY DEPARTMENT OF HEALTH Permit # " /< _ .�b •- = •z` -r . Division of Health.. Services; Carmel;-N. -`s °' 91351Z.. CONTT TION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town of Putnam Valley Town or, Village Located at Dosori s Drive Tax Map 67 alock 4 Lot 5 Subdivision Lot N Renewal _0 Revision `0 Owner /Address CHARLES & FLO COLISKEY Date of Previous Approval Building Type 1 fam. frame Lot Area 42,000 Sq • ft • Fill Section only ❑ Number of Bedrooms 2 Design Flow G/P /D 400 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and. 400 1 i near feet of 24 i nch trench To be constructed by T • B. Q. Address Water Supply: Public Supply From _ X Private Supply to be drilled by Norman Anderson, Inc. Address Barger Street, Putnam Valley, NY Other Requirements 1 represent that.l_am .wholly- and - completely -responsible-for'ttfe design grid'ibcatiori o/ 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 an regu Sons o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwiil 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 thedate 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 i st led 'n a c e th the standards rules and regu a 'lons of the Putnam County Department of Health. S N� MATTHEW A. NOVIELLO, P.E. Date October 17, 1991 Signed ', `^- P.E. R.A. Address 1 Northridge Rd., Peekskill, NY 10566 License No. 061145 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 necessaryr.py the Commissioner of Health. Any change or alteration of construction requires a new Approved for disposal of domestic sanitary sewage, armor private T&zmk 'ply only. •7SFT�S✓ti_��-�-/ s• t _Trc F J • CNi��j r C rDI �S104 L-T �� zTC3 lc. as ne b_ ELI cE `iC1 - Dam cf Plac=r = ^_c w_-,-,, ��c - r - t /-r= E_ 1".Q EZ b_ s_C� C t = _k i —cc i _•iG! G_ ti e- ECX i p 1 1 C: L"-L-= -e c - — E? _:. e _C=1 - kc:_ T /f 1 I D_ =-c= C —:c_ 14 cr 1/32 I �I 20 - -_ - - 7. I I i ( i 'L II' I • - - c 1 Srg° cr /f 1 I 14 �I hcx I I i ( i 'L II' I • - - = ci rza c.cl e L1Y I —L- 1 CC__ L _'" a_ L— c- =T.'Vc= D I t O 'es L� =l ^4i:`'1 C. L'?C.cs '''�- 1.5.C° cf Lax ------------ C_ - in 1 te =i {=i < " E_ C= '_rl G"' i c =l 1 �, acc— i _r'C �O L"_ =�1 I . =E �__ Cut-fall v EC`s & C:= . t0 c-+c r -- h =ac ac=�-��` -- _ _ C- s''_CCas C ===t =Y /f 1 I �I I I i ( i 'L II' I • - - PI Lo I � � I 1 � 3 .. -- �t.t L� =.1z^� C� , =- - N- lt...! C= _mac " 1ccy�Zr�, �%"•irr�' DL1',` =L �:c Sue �Z a a=te �:; � ?.�- .:'�:: {.: � __ � -. :. c.S :� _ . _.-�,.:.^.::..:.;,f.� � 3':i�'� '��-� ae._:._�-� ::c.�'ta _ a= �+.-.. �`IO^'• � m' �,•: � yet' - Lc�= �C) i-- NO f C&— alt L�� c ON I, I C= = -�-c t & D Bcx - wi: & C ^Fc`= :C�-c- __ I X I VC c Size, _ = i i m7 se j/1:'/-=--. t - - - -_ - 10 Lo - -�- f Dr_�j�.�z - ' '- 00' to Nell 200' 100' iJ : r_ jv ..1 I I� f C&— -- - -_ L�� c ON I, I C= = -�-c t & D Bcx - wi: & C ^Fc`= :C�-c- __ se j/1:'/-=--. t - - - -_ - 10 Lo - -�- f Dr_�j�.�z - ' '- 00' to Nell 200' 100' iJ : r_ I I� f C&— I I c ON I, I se j/1:'/-=--. t - - - -_ - 10 Lo - -�- f Dr_�j�.�z - ' '- 00' to Nell 200' 100' iJ : r_ JOHN S. ROMEO, P.C. CONSULTING ENGINEERS &. LAND SURVEYORS INQR-TW-UDGE-ROAD-� MATTHEW A. NOVIELLO. PE JOHN C. HOFFMANN, LS ------- (914)737-1056 ROBERT J. ROMEO, SURVEY MANAGER FAX (914) 737-9333 September 2, 1992 PUTNAM COUNTY BOARD OF HEALTH Old Route 6 Carmel , NY 10512 Re: COLISKEY AS BUILT S.S.D.S. TM 67 - 4 - 5 TOWN OF PUTNAM VALLEY Dear Bil I : Enclosed please find the following documents, submitted for approval of the subject S.S.D.S., As Built. Included are the f ol 1 owing: 1. Three signed and sealed copies of the As Built P l a n s . 2. A signed Certificate of. Construction Compliance. 3. Three copies of a signed Guarantee of S.S.D.S. . ...... - A satisfactory well Water Test taken within the -5 5. A signed Well Log. 6. A teller's check or money order in the amount of $200. Kindly approve the system and return the Certificate of Compliance to me. cc : MISKEY I Very truly yours, JOHN S. ROMEO, P.C. by _/40A A/A , A, Matthew A. Novieflo, P.E. TijATf'V,_T�7'A 77 !f[? ' OF DIVISION OF ENVIROiZ=AL HEALTH SERVICES CHARLES & FLORENCE COLISKEY Owner or Purchaser of Building McGlasson Realty, Inc. Building Constructed by Dosoris Lane & Taconic Gate Location - Street Putnam Valley Municipality 1 family residentail Building Type - 67 4 Section Block Lot Subdivision Name Subdivision Lot # GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage, of the sewage disposal system serving the above described property, and that it 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-wh-ich- -fails -- to - - -- - _ vperal-.e -Lo: a-peticd-cam two- tea: "Certificate of Construction Compliance" for the sewage disposal 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 theL building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the to operate was caused by the willful or negligent act of the occupant of e din utilizing the system. ,.� _ Dated i day of Sept 19__92_ Signature Title Q General ac or (Owner) - Signature kkr6 S0� e a McGlasson Realty, Inc. Corporation Name (if Corp.) Carmel, NY 10512 Address rev. 9/85 mk CgL:poration Name (if Corp.) AT VA-e ( (h Y. Address - . NORTH AME ICAN LABORATORIES, INC. ANALYSIS DATA SHEET COUNTY: Putnam LOCATION: New house, DeSori's Dr., Putnam Valley, NY REPORT TO: McGlasson Realty Inc. ADDRESS: P.O. Box 610 CITY, STATE, ZIP: Carmel, NY 10512 DATE COLLECTED: 8 -31 -92 TIME COLLECTED: 12:30 COLLECTED BY: T. McGlasson REPORT DATE: 9 -02 -92 SAMPLE: DW 7580 DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent COLILERT 8 -31 -92 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS. atory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914-278-7600 / FAX 914- 278 -7754 e � z < co,. Wr;LL L;vrirLCllvly r-,nrvni DEPARTME.N.T_ , 0T HEALTH_ Division Of Environmental Health Services ��'W Y�4 PUTNAM COUNTY DEPARTMENT OF HEALTH 0 e Office Use Only B - ._ q a� __: j� WELL LOCATION STREET AOUAESS. /VILLACUMV TAX GRID NUMB R: oir s Rd vIal/lA VCLk� u ` � WELL OWNER NAME: --� ADDRESS: 1 MC G-Itu i (PA l� ce�-� P• tl� l G MOA 10SIj- ®. PRIVATE . ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary G- RESIDENTIAL 0 PUBLIC SO PLY O AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM ❑ TEST/ OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. /NO. PEOPLE SERVED EST. OF DAILY USAGE-5-0 01 gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY PaNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ASS- ft. STATIC WATER LEVEL. -1 ft. DATE MEASURED F I y DRILLING EQUIPMENT O ROTARY (LCOMPRESSED AIR PERCUSSION ❑ DUG b WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ❑ OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH -10 tL MATERIALS: ® STEEL ❑ PLASTIC O OTHER LENGTH BELOW GRADE —�� ft JOINTS: O WELDED I0 THREADED ❑ OTHER DIAMETER in. SEAL: R[CEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT _, Ib./ft. t DRIVE SHOE 9 YES ❑ NO I LINER: D YES 5LNO ,., . �CRFFN �. DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? _ _ ._ HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE. [01F AMETER PACK in. TOP DEPTH fL BOTTOM OEM It. WELL YIELD TEST if detailed pumping METHOD: ❑ PUMPED tests were done is in- 0 COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER O YES O NO WELL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- Ing Well Dia- ^1211, FORMATION DESCRIPTION CDOE tt. It WELL DEPTH It. RATION h9 min. DRAWOOWN It, YIELD gpm. Land Surface ^ of WATER D CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAM, -B0 Ct 6��mitlliwutQlaite,, DATE ADDRESS Pt) S 1St SIGf*TW —n i � , PUMP IXFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP 4 DEPARTMENT OF HEALTH Division of Environmental Health Services .TWO Q.OUNTY CENTER. -- CARMEL .N Y.. lOSl2 - 914 225 364] APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Dosoris Lane Anderson, Inc. Town Tax. Grid Number Putnam Valle 67 -4 -5 WELL OWNER Name Mailing CHARLES & FLO COLISKEY 100 Address Mrivate Columbus Ave. Tuchahoe NY 10707 O Public USE OF WELL 1 - primary 2- secondary ®(RESIDENTIAL 0.:BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify O INSTITUTIONAL 13 STAND-BY 0 AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 400 gal REASON FOR DRILLING NEW SUPPLY O REPLACE EXISTING SUPPLY, O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING New home construction. WELL TYPE DRILLED DRIVEN QDUG 11 GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES XXX NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Norman Anderson, Inc. Address :Barger St., Putnam Valley IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XXX NO i3AAiE. OFJITLI'C WATER SUPPLY; _TOWN /.VIL/ II'Y DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 10/17/91 O ON REAR OF THIS APPLICATION]X S PARATE E (date) (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 s.hall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. t. Date of Issue: 19__1' Date of Expiration: 19 —!�G�- ermit ssuing f i Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner < FUINM LL"Nl'Y Vr t'EHKIM .r Ur, t7tiWill �?IVZS:LON :'OF.: ENVIRCNMENTAL, HEALS - SERVICES P s, .• -- DESIGN:•L1P,TA.,SE�SUffiUFACE= SEWAGE MSP06AI:'SYSTFM .,. _.. -- . NO ubN� ��:il N 07, - J l --Located at (Street) . Dos oris 1 Dr ve Sec.. _67 Block ..4 Lot 5 .(indicate nearest cross street) Municipality Town of 'Putnam'Valley Watershed SOIL PEROMATION TEST DATA_dUJMRED TO BE SUBMITIED WITH APPLICATIONS :Date of Pre - Soaking 8/22/91 Date of Percolation Test 8/22/91 HOLE NUMBER (1= 'TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level -No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min,/In Drop Inches. Inches Inches # 1 1 4:55 _5:25 30 ....24 - - 25 1 30 2 5:25 5:55 -.,.30 24 25 .1 30 3...5:55....,;6:25. 30 24 - 25 1 30 4 .6:25 :6:55 30 24 25. 1 30 �f 2 _1 4:56 5:26 30 24 27 3 10 t., . .. 5 : 26 :5:55 3C 24. _ _.._ 2b _�_- �_E�_..__ _.. 2 - 3 5:56 -6:26 30 24 26 2 15 4 6:26 .6:56 30 24 26 2 15 5 # 3 1 3:30 4:00 30 24 25 1 11 45 2 4:00 4:30 30 24 24 7/8 7/8 34 ` 3 "'A:30 5.00 30 . 24 24 3/4 3/4 40 ...,24 24 3/4 _ : -3/4 40 ... . -30. _..._.._.... , .;.24 24 40 .. t .151 %. .. i... ;Tiests to be repeated at same depth until approximately equal soil rates `:`= °'are obtained at 'each percolation test :hole. "All data..to' be submit ted ..for review. .. 2 Depth measurarnnts to be made fran top of hole. rev x/85 ,Pyk*. FUINAM U)UNXX DEPAKIMWr OF HEALTH ;; SDI STnN OF ENVIRONMENTAL TEMaH SERVICES DESIGN -DATA : USUBSUFACE S&qAGE DISPOSAL 'SYSTEM FILE No. - W-R-S-K&Y, A`R L ES Locatedat-lStreet) Dosoris.Drive Sec-_67 ..Block 4 -lot 5 (indicate nearest cross street) .Municipality Town of Putnam Valley Watershed - SOIL PERCOLATION TEST DATA REOUBM To BE SuBmr= WITH APPLICATIONS Date of Pre-Soaking 8/22/91 Date of Percolation Test 8/22/91 HOLE NL14BM CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop, Inches Inches Incht7z # 1 1 4:55 5:25 30 .24 25 1 30 2 5:25 5:55 30 24 25 1 30 —.3 5:55 6:25 30 24 25 1 30 4 6:25 6:55 30 24 25 1 30 5 2 1 4:56 5:26 30 24 27 3 10 5::2-6;5:.56,,_ 3 5:56 6:26 30 24 26 2 15 4.6:26 6:56 30 24 26 2 15 5 3 1 3:30 -4:00 30 24 25 12 45 2 4:00 4:30 30 24 24 7/8 7/8 34 3'4:36, '5:,09, 30 24 24 3/4 3/4 40 06 5 ',30 '24 24 3/4 3/4 40 -3-b"! - 6 24 .24 3/4 3/4 40 N=: Tests to be repeated*at same depth until approximately equal soil rates are obtained at each percolation, test-hole. All data to' be suhrrittbd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DES( 5' 6' 7' 81 9' 10' 11, 12' 13' 14' j Y �+p�-�yy�T Nor. ... -y. � •r. _.s..lias :.�. .:..5�%E�: �� .�• i: - .1.�:K :- .ii':c.i..t•. I1>IDICATE LEVEL TO WHICH.WATER LEVEL RISES AFTER BEING ENOOUNTERED N/A DEEP HOLE OBSERVATIONS MADE BY: Matthew A. Noviello, P.E. DATE: 9/13/91 DESIGN Soil Rate Used 31 -45 Min /1" Drop: S.D. Usable Area Provided 70 x 120 No. of Bedrooms 2 Septic Tank Capacity 1000 gals. Type Concrete Absorption Area Provided By 400 L.F. x 24" width trench Other JOHN S. ROMEO,-P.C. by: :... Name MATTHEW A. NOVIELLO, P.E. Signature Address 1 Northridge Road_ _ SEAL Peekskill NY 10566. 14 737 -1056 :THIS SPACE-FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. (decked by Date FUINAM t MM11 Vt &AK MMY1' OF REALTH . SIOWOF_.: HEALTH SERVICES DESIGN -DATA SEWAGE DISPOSAL `SYSTEM FILE ND. 3;Mr -!Q - = : .m ss ::i -00. �:, �.• - Y e � .. t, >; = r :. _ -- �S 1ii bulls =�t� U�riaf1F1E�;' i'ii /'t11° Located at (Street)- Dosoris.Drive Sec. ..67 Block 4 Lot 5 (indicate nearest cross street) Municipality Town of Putnam Valley -Watershed SOIL PERCOLATION MST DATA PMOUIEW 70 BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 8/22/91 Date of PeroGiation Test 8 /22/91 HOLE 5:55 .6:25 30 24 25 1 30 4 NUMBER CL 6_:55 PERCOLATION 24 PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. _Start Stop Drop In Min/In Drop Inches -_ Inches Inches a -5-00 . S. 30 >R30 :24 -: 24 3/4 3/4 4.0 ....... . # 1 1 4:55 5:25 30 24 25 1. 30 2 5:25 .5:55 30 24 25 1 30 3 5:55 .6:25 30 24 25 1 30 4 6:25 6_:55 30 24 25 1 30 . 5 �f 2 1 4:56 5:26 30 24 27 3 10 2 5,t-26-- 5:56 30. 24: 3 5:56 6:26 30 24 26 2 15 4 6:26 6:56 .30 24 26 2 15 P, # 3 1 3:30 -4:00 - 30 24 25 12 45 2 4:00 4:30 30 24 24 7/8 7/8 34 ` 3'4:3'Q_.,_5: 00 30 24 24 3/4 3/4 40 a -5-00 . S. 30 >R30 :24 -: 24 3/4 3/4 4.0 ....... . 5 5:.30 ..'6: 00 -...-3,0 ::..' 24 ... 24 3/4 3/4 40 NOrI'ES.s 1. .;Tests to be repeated at same.depth until approximately equal soil.iates are obtained at each percolation test hole.:. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85. TEST PIT9'A DEPTH HOLE •140. ,.;gip 1� Loam. 21 3 4' 5' 6' 7° 8' 9° 10, �o 12' 13° 1 .. kHOLE NO.. 2 .: `HOLE NO.,. ' ap:_i'�.. .,�; ?-4.43..: n" �.:- 3Fs•• -.- . ,-'-a. s :.'C.- m..��-..d �:::G a... ::u� .'� ; Loam 14° 1..q- ..N'WIG- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER $SING ENCOUNTERED N/ DEEP HOLE OBSERVATIONS MADE BY: Matthew A. Novi ell o, P. E. DAM: 9/13/91 DESIGN Soil Rate Used 31 -45 Min/1" Drop: S.D. Usable Area Provided 70 x 120 No. of Bedrooms. 2 Septic Tank Capacity 1000 gals. Type Crete Absorption Area Provided By 400 L.P. x 24" width trench Other JOHN S. ROMEO, P.C. by: Name MATTHEW A. NOVIELLO, P.E. Signature Address .� 1 Northridge Road SEAL Peekskill, NY 10566 'Soil -Rate Approved sq.ft/gal. Checked by Date rc; -1 P�.T'Y'NAM COUNTY' a7►EA�A]RTI�ENT OF Y�EALTIi APPLICATION FOR APPROVAL OF PLANS FOR.•.A WASTSW�E� DTSP0,�1 SXccTF - y. � »r,: +�.�'.w ;,. .'•�:,: >'v',.:q".a`?�.,.� -.. -r 'i' .,$•^ X, ..-- ,..d3c'c. «» -- -•.... •. . ,. •.- «.a..., :'y.,..,��Y :.- �r.::.,.rr" ,A 1$;;a r'w�2&�r..;: 1. Name and. Address of Applicant: Char %s r10 Yal'skP' 2. Name of Project: co -ss 3. Location T /V-te: 6U loan Valle :Coke S, / rwtv) AC, 4. Project Engineer: ba M ii4tw A. NovPclto 5. Address: l NDfhredle' toe, el<skflljicy /0664 License-Number:. 0611K Phone: 6. Tvoe of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) T. Is this project subject to State Environmental Quality Review (SEAR)? N/4 Type Status (Check One.) T,. Exempt Type II. Unlisted 3. Is a Draft Environmental- Impact Statement (DEIS) required? ............. AVIA �. Has DEIS been completed and found acceptable by Lead Agency? ........... 1. Name of Lead Agency P . Is this project in an area under the control of local planning, zoning, ` _ .or other - offJ.cials ordinances? :_..._.:.. .o;K...._• �_ nr If so, have plans been submitted to such authorities? .................. . Has preliminary approval been granted by such authorities? Date Granted: . Type of Sewage Disposal System Discharge...... SD.S Surface Water Ground Waters If surface water discharge, what is the stream class designation ?........ Watersindex number .(surface) ........... ............................... Is project located near a public water supply system? No If yes, name of water supply Distance to water supply Is project site near a public sewage collection or disposal system ?..... Alp Name of sewage system Distance to sewage system Date observed: %� % 23. Name of Health Inspector: Project design flow (gallons per day) ....... ..............................� 22.. , Is.�St,ta. P_�:.1t.ara# rt?_i srharge El imi:na.t.an SYS.fiem :�SPgES) , Permit •requi red? .J. r Yn . . 'ice _a`x -.': ..:`. mnFw.�:� W.s.t.a ..,:• .r} •S •.n t N!•fFl Y':� ..• .- ..i�.i 'C�".' "�. ,y�: :• • w�'F;••�. W i. Has SPDES Application been submitted to local DEC Office? !. Is any portion of this project located within a designated Town or State wetland ? ............................ .... ............................... /2'69 3. Wetland ID Number ........................................................ A- ►. Is Wetland Permit required? D Has application been made to Town or Local DEC Office? .................. !. Does project require a DEC Stream Disturbance Permit? .................. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfi-lling, sludge application or industrial activity? ........ YES or NO /IVP 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: 41a . Is there a local master plan or file with the Town or Village? ........... Are community water, sewer facilities planned to be developed within 15 years? •- .?10P.�' . Tax Map ID Number .......................... ............................... e�7 Approved Plans are to be returned to: ................ Applicant _L Engineer the application is signed by a person other than the applicant shown in Item. 1, the )lication must be accompanied by a Letter of Authorization. Failure to comply with this )vision 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 belief. False statements made herein are punishable as a Class A Misdemeanor Pqrsuant to Section 210.45 of the Penal Law. 'NATURES & OFFICIAL TITLES: T 1,h S, Gwn� o, R C-1 ! 'LING ADDRESS: �e�.0 737 -los6 r:;� -=� Z� m 0 o O o \ \ z° Z 01 CP Ln y ir A •- ,ti r C-) o _ mo m> -F D i Zr ;2 BEDR00M ;.,� DWELLING J LP -NOSO ITJ R-1 JLJ ANE e . y �1 L �3 DISTANCE TO CORNER OF HOUSE SYSTEM OF HOUSE COMPONENT A B SEPTIC TANK 25' 17' JUNCTION BOX 1 36' 32' JUNCTION BOX 2 40, 39' JUNCTION BOX 3 46' 46' JUNCTION BOX 4 53' 51' WEST END 1 86' 73' WEST END 2 100, 89, WEST END 3 105' 96, WEST END 4 110, 102' WEST END 5 114' 109, EAST END 1 20' 31' EAST END 2 35' 58, EAST END 3 37' 60'