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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.10 -1 -20 BOX 3 lirm j ii or � ar - ly . . f 'R- ` ,�� 4 11 :1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 5 Buehler Drive Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: J.V. Construction, Inc., Box 449, Patterson, NY 12563 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 152 ft. Length below grade 151 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic _ Other Joints: _ Welded. X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size. Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 10 gpm Depth Data Measure from land surface - static (specify ft) 60' During yield test(ft) 285' Depth of completed well in feet 325' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 50 Drilling in overburden clay and boulders Hit rock at 50' 50 152 Drilling in rock set casing, grouted 152 325 Drilling in rock granite If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information , Pump Type Capacity Depth Model Voltage HP Tank Type o me a, ' , ;'`` `{ -� ` ' Date Well Completed 8/10/04 Putnam County Certification No. 006 Date of Report 12/22/04 Well Drill M P NUTS: Exact location of well wttn Well Driller's Name P. F. Signature: permanent tanamarxs to oe provta a separate sxccupiau. Address: 4 Putnam Avenue, Brewster, NY 10509 Date: 12/22/04 White copy: HD File; YellA copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 6i ' PUTNAM COUNTY DEPARTMENT OF HEALTH ` DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONS RUC N PV IT # �-U i � ,fir � - Located at c �1 t �� Town or Village 7 Owner /Applicant Name 7 J Ch I J �U(/- � Q Tax Map `f , I b Block Lot -Zi0 Formerly Mailing Address PO 0X 44 (1 P Date Construction Permit Issued by PCHD _ Subdivision Name Subd. Lot # /N /V Zip CZ�7 3 Separate Sewerage System built by TJ U P 5T - Address PGL v V Consisting of 0 Gallon Septic Tank and n L4- 2 T Other Requirements: i f-T to &w !4— Water Sunnly: Public Supply From Address or: Private Supply Drilled by Address Building Type W 0 0`0 "� Has erosion control been completed? Number of Bedrooms 4f Has garbage grinder been installed? 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 regul ions, f the P'tnam County De artment of Health. Date: Certified by P.E. R.A. r (Desi n Professional) -7 Address � � (I I r lVll� In � I �9 '". /,/ _ i Z- S 3 License # , � 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 pr' ater supply shall become null and void when a public water supply becomes available. Such approvals rs to modification or change when, in the judgment of the Public Health Director, such revocatign, ific o change is necessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 5 Buehler Drive Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: J.V. Construction, Inc., Box 449, Patterson, NY 12563 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipp�ent X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 152 ft. Length below grade 151 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded...X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield 'lest _ Bailed X Pumped X Compressed Air Hours 6 Yield 10 gpm Depth Data Measure from land surface- static (specify ft) 60' During yield test(ft) 285' Depth of completed well in feet 325' Well Log If more detai�d information descriptions it sieve analySS are available please attac} Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 50 Drilling in overl,urden clay and boulders Hit rock at 50' 50 152 Drilling in rock set casing, grouted 152 325 Drilling in rock granite If yield wasested at different zpths during drillig, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model , Voltage HP Tank Type o me Date Well Co Fvted 8/10 f Putnam County Certification No. 006 Date of Report 12/22/04 Well Drill vg p eal NOTE: E — location of well with Well DrM_6 Name P. F. Signatures_ White cow HD File; Y permanent landmarxs to be provtdTO a separate snemptan. Address: 4 Putnam Avenue, Brewster, NY 10509 Date: 12/22/04 copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 B?,I:C -: R FOLEY Publ:e health_ Derec:cr DEPARTivihNT OF HEALTH I fieneva Road Hraw3ter. New York 10509 LOX2TiA MOLiNAR1 ?—N., 1vLS.N. AJ.tociata PM6114 ffsaith Dirdotcr Director of Pxlvt -* Servtess 7Ea.iranmoatal Health (914) 271.6(30 Fiat (914) 271-7921 YUSU q S.r•luo (9141 277 - 6552 WIC (914; 21s -6d'2 Fox (914) 278 - 608.1 Early lmtervesdoQ (9114)273-6014 ftnc <oal (914) 218.6022 Fms (914) 273 - 6648 MX ERS NAM-. (A-)&A 1.VC'G — E911 ADDRESS: '09G& x. TOWN: AUTHORIZED TOWN oFFrczA,L: l� ► 1 - (Signature) DATE: The Putnam. County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a lecral E911 address is assigned by an authorized town official. This form is to be submitted -t�ith the application for a Certificate of Construction( Compliarace. �Z91 t vI-EVRX) SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jack Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive November 8, 2005 Re: Proposed Compliance: JV Construction South Quaker Hill Road (T) Patterson, TM # 4.10 -1 -20 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Bedroom count is to be noted on the house an the SSTS compliance plan view. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Ve tru yours, Robert Moms, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6,678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ml= milliliter mg /L= milligrams per Liter ND--none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count • "Notification Level *"Action Level <Q= Analyte detected below quantitation limits data deemed estimated. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines(. -All holding times (were) met. Approved By: Laboratory Director CT Cert. 9PH -0606 NY Cert. 0 11471 EPA Cert. 9CT -024 USDA Cert. 00976 FDA Reg. 4 3001 743 770 DEA Reg. 9624 NORTHEAST LAB ORATORIES, INC. 129 MILL STREET - BERLIN, CT 06037 -9990 ,N AeCOq [Danbury Office and Sample Drop Off Sire: 100 Mill Plain Road, Suite 342, Danbury, CT 06811] TELEPHONE: Toll Free (in CT) 800 - 826 -0105 (Outside CT) 800- 654 -1230 N 9 oy� Berlin /Hartford Area: (860) 828 -9787 Danbury Area: (203) 791 -3874 A FAX: 1,860) 829 -1050 E-mail: NELABSCT @AOL.COM www.NortheastLaboratories.com REPORT TO: PAGE I OF I JV CONSTRUCTION DATE SAMPLE COLLECTED: 10/05/2005 P.O. BOX #449 TIME COLLECTED: 10:00AM PATTERSON, NY 12563 COLLECTED BY: JERRY DATE RECEIVED @ LAB: 10/05/2005 TESTED BY: LAB #11471 DATE TESTED: 10/07/2005 LAB REPORT ID# D0505582 REPORT DATE: 10/10/2005 SAMPLE SITE: 5 DUKLEJER ROAD, PATTERSON, NY SAMPLE PO T: OUTSIDE HOSE BIB SO CE: WELL DRINKING WATER TREATMENT: NONE NOTED MAXIMUM CONTAMINANT TEST PERFORMED LEVEL (MCL) OR DATE TIME SUL S UNITS METHOD # STANDARD TESTED TESTED CHEMISTRY: • Iron 0.14 tng/L EPA 236,1 0.30 mg/L" 10/07/2005 -- ml= milliliter mg /L= milligrams per Liter ND--none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count • "Notification Level *"Action Level <Q= Analyte detected below quantitation limits data deemed estimated. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines(. -All holding times (were) met. Approved By: Laboratory Director CT Cert. 9PH -0606 NY Cert. 0 11471 EPA Cert. 9CT -024 USDA Cert. 00976 FDA Reg. 4 3001 743 770 DEA Reg. 9624 NORTHEAST LABORATORIES, INC. 129 MILL STREET - BERLIN, CT 06037 -9990 (Danbury Office and Sample Drop Off Site: 100 Mill Plain Road, Suite 342, Danbury, CT 068111 TELEPHONE: Toll Free (in CT) 800 - 826 -0105 (Outside CT) 800 - 654 -1230 Berlin /Hartford Area: (860) 828 -9787 Danbury Area: (203) 791 -3874 FAX: (860) 829 -1050 M6 E -Mail: NELABSCT @AOL.COM www.NortheastLaboratories.com REPORT TO: JV CONSTRUCTION DATE SAMPLE COLLECTED: P.O. BOX #449 TMIE COLLECTED: PATTERSON, NY 12563 COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: DATE TESTED: LAB ID# REPORT ID# REPORT DATE: SAMPLE SITE: 5 BUHLEJER ROAD, PATTERSON, NY SAMPLE POINT: OUTSIDE HOSE BIB SOURCE: WELL DRINIQNNG WATER TREATMENT: NONE NOTED MAXIMUM CONTAMINANT TEST PERFORMED LEVEL (MCL) OR RESULTS UNITS METHOD # STANDARD CHEMISTRY: • Iron 0.14 mg/L EPA 236.1 0.30 mg/L* o �p ACCpq� qN0 m f k e x PAGE 1 OF 1 10/05/2005 10:00AM JERRY 10/05/2005 LAB# 11471 10/07/2005 0505582 -01 D0505582 10/10/2005 DATE TM TESTED TESTED 10/07/2005 - -- ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " *Notification Level ** *Action Level <Q= Analyte detected below quantitation limits data deemed estimated. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (mere) met. u Approved By: 60 Laboratory Director CT Cert. #PH -0606 NY Cert. #11471 EPA Cert. #CT -024 USDA Cert. #0976 FDA Reg. #3001743770 DEA Reg. #624 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Z�y l' � i "Il ctmn 1 A/C , Building Constructed by , Location - Street F i • •" A 7r. e- r 1 . TownNillage Subdivision Name 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 0 Day Year `s Signature: 41L1 14 ,,/ Title:�ra•_„� General Contractor (Owner) - ignature Corporation Name (if corporation) Corporation Name (if corporation) Address: P01V &,�S&," State , �% Zip Address: y 9 /. 22; �t So .h . State Zip 5 Form GS -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jack Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive September 20, 2005 Re: Proposed Compliance: JV Construction South Quaker Hill Road (T) Patterson, TM # 4.10 -1 -20 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Bedroom count is to be noted on the house plan view. 2. Original SSTS guarantee is to be submitted, current code does not allow the submission of photo copies. 3. Results for iron exceed state standards. It is advised that the system is flushed and then re- tested. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V e ly yo s, sfw " Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 GOR.I2AL RIGHT � OF I l.-rAK - ow�c bs.o nBUHLEIER ���� � aa1� S l G °Z8'O o^ w 1 s'rcasu. 11 aeu aov peu •+o z Q J M � 0 J LL GI 0 0 "tC N1 0'5 R1EN Ge^,;tc shens ?, ca+led hereon itgntiy l'haT'th;s suvay ww preps" in aesad.q ctl.w t't� tae. error' vyc. dee4vfadlbe1 .ov4anJSuweysoraA -e&Jby+{+e'A -w { +�.wsraxgsseen en oc pro(ast and (,2AJ Soyveyers, Said ce rlrRca•Mons shell beval;d 0.(y r. *e party For wl'1om tAe sorvay was prcp6TSt, and oh that paflylc bc.Nau -ro-ma c.or,pany, g +vanw%avt21 agency snd(or lendtng insfTUTiJw t1S-L-d Aenaen, and '+a+he 3Ssr3nees 0Ette Ia.ell.qq insttiution, 4or«o"6jc pur'pgses -f— said party dor Nbovn +h;s eorvey toae pre f=l y 4:h, ca'tiom ere tbaddlTbe'al i4tt:luiumver Srbsa'yvevR000+ue+s. Only coptec *7'oew•the. orWn73 d We suwey vnap bew4N the sigw2Iu and av1 wiSinal of ihit land Svrvayoes tnkedorAiSCmtsescei! seal sAs ll be contidered to batnnaaa,d Valid cop=al'. in ¢A4tf;,w+, vnavthori2+ed &*rM on a• &JAMIm to a suvvey map t+cariny ettcewc.d LAPp4 Svweyorls Sea, is o vtclation 4 Sadton 7209, Suh- di451. 2, ��'M1a Row vorK State Fducatio -Low. t 'fate ioadfiWl OE uhClsryvoU td' M(roveY4en`tior evferoYhtnen'ft harem.+, 6ny .er3Y, Are nit cw.vhlRed. 24.8.00' d o� CL� M d a � d 7 a ° d N 1 n M� ur J 2 1L SURVEY OF PROPERTY PREP(A9,ED FOR J, V. CONSTRUCTION, INC. / 9 N11 G^ y T G' NA N W S kN s . � ep •y N y Gcollro S65NA -lo'co CSvRY,) W.55' S61 a 31'od'w c". -Mp6 Ec 2,L1' l� GOR.I2AL RIGHT � OF I l.-rAK - ow�c bs.o nBUHLEIER ���� � aa1� S l G °Z8'O o^ w 1 s'rcasu. 11 aeu aov peu •+o z Q J M � 0 J LL GI 0 0 "tC N1 0'5 R1EN Ge^,;tc shens ?, ca+led hereon itgntiy l'haT'th;s suvay ww preps" in aesad.q ctl.w t't� tae. error' vyc. dee4vfadlbe1 .ov4anJSuweysoraA -e&Jby+{+e'A -w { +�.wsraxgsseen en oc pro(ast and (,2AJ Soyveyers, Said ce rlrRca•Mons shell beval;d 0.(y r. *e party For wl'1om tAe sorvay was prcp6TSt, and oh that paflylc bc.Nau -ro-ma c.or,pany, g +vanw%avt21 agency snd(or lendtng insfTUTiJw t1S-L-d Aenaen, and '+a+he 3Ssr3nees 0Ette Ia.ell.qq insttiution, 4or«o"6jc pur'pgses -f— said party dor Nbovn +h;s eorvey toae pre f=l y 4:h, ca'tiom ere tbaddlTbe'al i4tt:luiumver Srbsa'yvevR000+ue+s. Only coptec *7'oew•the. orWn73 d We suwey vnap bew4N the sigw2Iu and av1 wiSinal of ihit land Svrvayoes tnkedorAiSCmtsescei! seal sAs ll be contidered to batnnaaa,d Valid cop=al'. in ¢A4tf;,w+, vnavthori2+ed &*rM on a• &JAMIm to a suvvey map t+cariny ettcewc.d LAPp4 Svweyorls Sea, is o vtclation 4 Sadton 7209, Suh- di451. 2, ��'M1a Row vorK State Fducatio -Low. t 'fate ioadfiWl OE uhClsryvoU td' M(roveY4en`tior evferoYhtnen'ft harem.+, 6ny .er3Y, Are nit cw.vhlRed. 24.8.00' d o� CL� M d a � d 7 a ° d N 1 n M� ur J 2 1L SURVEY OF PROPERTY PREP(A9,ED FOR J, V. CONSTRUCTION, INC. N7B 1 /tit THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS _r4 INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM -WAS CONSTRUCTED IN ACCORDANCE WITH ALL 'STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. T,(�� IZ 13 I� is Zd 2! 23 IS ILL Z-7 4 ��p fn i 7 Lt �o 7o qq 59 X15- 54 91 y9- 32 43 3s 3S 33 3y 3L Zg .x 3z Zb 33 23 Iiy nS' 3 11® 1 )09 1o$ IoL ion � ►b3 105 106 103 z q& 1�3 93'. ►03 as 103 Q'3 a' I OH 9lp w t25o C, PVM T (e0k -)- 12 S v c7 . SgX'c 7'K. G4Nor) -r a e s?0A 94Jb 0 A -6 gD 1133' 7, 31 ZS 5 7 IZ 13 I� is Zd 2! 23 IS ILL Z-7 4 ��p fn i 7 Lt �o 7o qq 59 X15- 54 91 y9- 32 43 3s 3S 33 3y 3L Zg .x 3z Zb 33 23 Iiy nS' 3 11® 1 )09 1o$ IoL ion � ►b3 105 106 103 z q& 1�3 93'. ►03 as 103 Q'3 a' I OH 9lp w t25o C, PVM T (e0k -)- 12 S v c7 . SgX'c 7'K. G4Nor) -r a e s?0A 94Jb 0 NORTHEAST LABORATORIES, INC. 129 MILL STREET - BERLIN, CT 06037 -9990 [Danbury Office and Sample Drop Off Site: 100 Mill Plain Road, Suite 342, Danbury, CT 06811 ] TELEPHONE: Toll Free (in CT) 800 - 826 -0105 (Outside CT) 800 - 654 -1230 Berlin /Hartford Area: (860) 828 -9787 Danbury Area: (203) 791 -3874 FAX: (860) 829 -1050 E -Mail: NELABSCTUAOL.COM www.NortheastLaboratories.com REPORT TO: JV CONSTRUCTION, INC. ATTN. JERRY P.O. BOX 449 PATTERSON, NY 12563 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: •. - Total.Coliform (Bacteria) • E. Coli (Bacteria), PHYSICALS: Color (Apparent) • Odor • pH • Turbidity CHEMISTRY: • Alkalinity • Chlorine Residual • Nitrate Nitrogen '• Nitrite Nitrogen DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: DATE TESTED: LAB ID# REPORT ID# REPORT DATE: 5 BUHLEJER ROAD, PATTERSON, NY 12563 OUTSIDE HOSE BIB WELL DRINKING WATER NONE RESULTS ABSENT NEGATIVE \N Acoop, � f PAGE 1 OF 1 03/17/2005 10:45AM JERRY 03/17/2005 LAB #11471 03/17/2005 — 03/22/2005 OSO4600 -01 D0504600 04/01/2005 10 mg/L ND mg/L 7.2 mg/L 2.8 NTUs 142 <0.05 0.21 <0.005 mg/L mg/L mg/L as N mg/L as N EPA 110.2 SM 2150 ASTM- D1293 -99 EPA 180.1 SM2320B 4500CIG EPA 353.3 EPA 354.1 • Hardness MAXIMUM CONTAMINANT mg/L EPA 130.2 • Lead LEVEL(MCL) OR' DATE TM UNITS- '° ' METHOD # STANDARD TESTED TESTED per 100 ml SM 9223 0 per 100 ml(ABSENT) 03/17/2005 4:OOPM per 100 nil' SM 9223 - Negative' 03/17/2005 -4:OOPM 10 mg/L ND mg/L 7.2 mg/L 2.8 NTUs 142 <0.05 0.21 <0.005 mg/L mg/L mg/L as N mg/L as N EPA 110.2 SM 2150 ASTM- D1293 -99 EPA 180.1 SM2320B 4500CIG EPA 353.3 EPA 354.1 • Hardness 148 mg/L EPA 130.2 • Lead <0.001 mg/L EPA 239.2 • Iron 0.35 WIL EPA 2361 • Manganese 0.07 mg/L EPA 243.1 • Sodium 4.3 mg/L EPA 273.1 15 Not to exceed value of 2 on scale of 0.5 6.4 to 10 Range 5 NTUs No defined limits* 10 mg/L 1.0 mg/L Combined limit for Nitrite plus Nitrate = 10mg/L as N 150 mg/L ** 0.015 mg/L* 0.30 MZ/E * 0.50 mg/L * ** 20.0 mg/L * *3 03/18/2005 8:30AM 03/18/2005 8:30AM 03/18/2005 8:30AM 03/18/2005 8:30AM 03/18/2005 8:30AM 03/21/2005 10:00AM 03/18/2005 12:OOPM 03/18/2005 -- 03/18/2005 - -- 03/22/2005 - -- 03/22/2005 - -- 03/22/2005 - -- ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level <Q= Analyte detected below quantitation limits data deemed estimated. 3= Water containing more than 20 mg/L of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/L of sodium should not be used for drinking by people on moderately restricted sodium diets. COMMENTS: - Sample, as received,complies with all State of New York regulatory guidelines, however, the underlined results exceed USPHS recommendations.,-.:: , . . - All'holding times (were) met. SAMPLE, AS TESTED ABOVE: X❑ OTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Appro "&44:vW P4 Y Laboratory Director CT Cert. #PH -0606 & #PH0404 NY Cert. #11471 EPA Cert. #CT -024 USDA Cert. #0976 FDA Reg. #3001743770 DEA Reg. #624 PUTNA.M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM of Owner or Purchaser of Building lz�,* " C irhl C,— Buildiny. Constructed by �' 9vej, Lam, r & aC - Location - Street Building Type Tax Map Block Lot Town/Vi lage Subdivision Name 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 y 'Z Year _ 0 General Contractor (Owner) - Si9ofure Corporation Name (if corporation) Address: State 00? 2. Zip i Corporation Name if corporation) Address: Statep Form GS -91 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building BuildLa.q Constructed by Location - Street 234 ot Building Type Tax Map Block Lot TowrWi lage Subdivision Name 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 Year General Contractor (Owner) - Si tore Corporation Name (if corporation) Address: State - -�_��' Zip Signatur V. 1 0 ".. A xv VAL, WU�44 z 7t —2& ly Title: Corporation Name Tff corporation) Address: State �w �-!. –Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM C. Owner or Purchaser ofBwilding Buildina.ConstMeted by . 5: 'gVeA Location - Street Building Type Tax Map Block Lot TownNi lage Subdivision Name 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 y / 7 Year General Contractor (Owner) - Si tore Corporation Name (if corporation) Address: State _ �' �. L' _ Zip�,�,, -, 91� PAR MAVV •�.�+ -- Corporation Name if corporation) Address: ly X&M State Zip�T' Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH t DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION °£ Date: Inspected by: Street Location sow, -w Q��w�rz }4lj L TC&A , Owner T. %J, CdAJS i Town ?AT- sa Ai Permit # *F> - o 7 -o �q TM # 4, /O — — 2-D Subdivision Lot # --- 1. Sewaze Svstem 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 ...... ............................... IL Sewage System a. Septic tank size - 1,000 ...:..e ........other ................ b. 'S eptic'tank installed level .... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1, All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. Irenches 1. Length required _ f3 z{ c;� Length installed g 2. Distance to watercourse measured 4- / © o 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 - 11/2" diameter clean ........ . .......... : 9. Depth of gravel in trench 12" minimum .......:........... _ _` a ends capped ....................... ............................. ... �: .um r Dosed Systems ize of 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/Buildi6a a. House located per, approved plans. .........f� .........:.......... b. Number of bedrooms ....................... ............:.................. IV. Well Well located as per approved plans . ......:...............:........ b. Distance from STS area measured _/ 3 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. Backfll material contains stones <4" diameter .............. e. Curtain drain & standpipes,:installed according to plan.. �f - .Curtain drain_outfall `protected & dir;to exist watercourse :=-1 g. Footing drains discharge away from STS area.. �. ...... _. h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ......................... ....... Rev. 12/02 ria d� rv. s■ C SITE INSPECTIO14 FOR FILL PAD Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Fill Pad Width Fill Pad Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable Required Length Required Width Required Depth r 11/10/2004 23:29 19142455704 J RAGUSO PAGE 01 44 -VTJ uuoJ mou. Usm. a «..,._ Va ... JO au'' ?Q f4Undo =Wd aap 3a saansTnllQV PM S%RV `$PnPtMS_ Qtp Pue MMjd panoidd3 Pug ITUUad n04.0n4sucO QH0d Pmftl 019 Tlm aouvuam ur IIagaldum SIB pa y P= pa;aadsul an#q I Pm pn=Moo suq sa mwdowoga --mp 1v VWq sa' (s)uMsAs aqj rate 4M= I '.."". twuld u[ saAmm lonuoo uozsoia aay S n L=W mod sta I*I=OT UaM sI LstMd soda powmu= umAs sl / : .. gQ S IWTdumo malsAs sl �wwl /n, :net. n'%' Lpazaldwoo HU ups sI 0-4 101 400I8:101. A. .:oumN iu"tiddd /j*umo fd #ad aal;asutsao� QH�d . , -apew Suiaq suogoadsm saq im.L 4woj joud pwalc4m AMU oq mm uoW. =ojw, ffy :iad NOV -17 -2004 WED 18:35 TEL:845 -278- "7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 rim 10 LORETTA MOLINARI . Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 John Karell, Jr., P.E. 121 Cushman Road Paterson, NY 12563 Dear Mr. Karell: ROBERT J. BONDI County Executive December 1, 2004 Re: Field Inspection: J.V. Construction South Quaker Hill Road (T) Patterson, TM# 4.10 -1 -20 The following comments must be addressed: 1. The curtain drain outlet must extend twenty feet down hill past the proposed expansion area. 2. A pump test must be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this,pepartment. If you have any further questions, please contact me at (845) 278 -6130 ext. 2661. GDR:tn Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT Of HEALTH DIVISION OF ENVIRONMENTAL I1EATLH SERVICES FIELD ACTIVITY REPORT A T) T) I Z ESS 0,'-. 'A24 Street Town State Zip PERSON IN CHARGE QR TNTFRVTPMMT)-. 64- x7—,V C:nWS7-t Date-, 2Z/3 PUMP TEST DOSE TEST o �ao 01i T ` 0, REQUIRED GALLONS ?� yam._ EL. btAKI I 17�) EL. STOP Signature and Title TZFPQR-T TZF(".F.TVP.T) RY., I acknowledge receipt of this report: SIGNATURE: 02 /9 6 Title: ,Rev. I BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD' OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by EDGEWATER ELEC. INC. JV CONSTRUCTION PO BOX 802 5 BUHLEIER ROAD HYDE PARK, NY 12538, PATTERSON, NY 12563 Located at 5 BUHLEIER RO AD PATTERSON, NY 12553 Application Number: 2009525 Certificate Number: 2009525 Section: Block: Lot: Building Permit: 784 -04 BDC: W104 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Basement, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and /or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 14th Day of March, 2005. Name QTY Rate Rating Circuit Type Miscellaneous SEPTIC PUMP AND ALARM Appliances and Accessories Exhaust Fan 5 0 110 F.H.P. Pump Motor 1 0 1 H.P. Furace 1 0 Oil Air Conditioner 2 0 42000 BTU Dish Washer 1 0 1.5 KW Clothes Dryer 1 0 4.5 KW Micro -wave 1 0 20 Amps Bell Transformer 1 0 Cooking Deck 1 0 7 KW Oven 1 0 7.5 KW Motors 2 1 2 FHP Wiring and Devices Outlet 224 0 Continued on Next Page 1 of 2 seal This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. r ` BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by EDGEWATER ELEC. INC. PO BOX 802 HYDE PARK, NY 12538, Located at 5 BUHLEIER ROAD PATTERSON, NY 12563 Application Number: 2009525 Section: Block: Lot: JV CONSTRUCTION 5 BUHLEIER ROAD PATTERSON, NY 12563 Certificate Number: 2009525 Building Permit: 784 -04 BDC: W104 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Basement, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and /or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 14th Day of March, 2005. Name QTY Rate Rating Circuit Type Miscellaneous SEPTIC PUMP AND ALARM Appliances and Accessories Exhaust Fan 5 0 110 F.H.P. Pump Motor 1 0 1 H.P. Furnace 1 0 Oil Air Conditioner 2 0 42000 BTU Dish Washer 1 0 1.5 KW Clothes Dryer 1 0 4.5 KW Micro -wave 1 0 20 Amps Bell Transformer 1 0 Cooking Deck 1 0 7 KW Oven 1 0 7.5 KW Motors 2 1 2 FHP Wiring and Devices Outlet 224 0 Continued on Next Page 1 of 2 seal This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 6 17 2.98 AC. 57.2 A g CAO k �< AC. \ • L 4L, q -- i6.._/ - -t4 y 1 - - - c? L 4L, q -- i6.._/ - -t4 D ��. l �`� .. r f !' .� % �...... � :�S ... ,� � ? ,.. _' �� ��.�� _ _ -_ __ -- J _ _________._ �_ ._.�.____.__.T._.- �...�....___- .�Q � __ -- -- .- - - - - -- - - � - _�_ �� .... -l.. a s- �- �- .--- - -. - -- -- - - - - -- '' _.. .: �...a....... �.._.: �.,.: �.. ��.... �..... ��. �._:.._ �.. �..M..: �......_....,._..... �. �,. �. �_.....�...�.._._...,...�:.__.. '0 0600 0024 -2624 2678 0 0600 0024 2624 2678 M 0, .0 m 'n M Lb. n @ -n CD m r O oj ) g r � l .4v; -NOS AllY.". 11, if ti o -V aft, now NEIGHBOR NOTIFICATION-' LETTER Date I —N — 04 . Department of Health Review of Proposed SewageTreatment System for Property Name: Address: QVAXE-< 141 LL-12-0 A-0 Town: • Tax Map #: Dear ' Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has•been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan.. If you have any questions, concerns or information which may bear on'the Health . Department's review of this application, you may.call the.Health Department.at 278- 6130."*— Very truly yours, • B. Title: Received By: By: Address: Tax Map #: August 1997 s r Date �� �`� RE: Department of Health Review of Proposed U-j A 5-5h. t ' �, f SewageTreatment System for Property Ce r1-} e�Name: Address: 69 V,4K&rZ 14 LL—'n0 A-0 Town P,* nL�2s o r`T) Tax Map #: Dear ' Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has*been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, • concerns or information which may bear on the Health Department's review of this application, you may call the Health Department. at 278 - 6130." Very truly yours, • . By: Title: Received By: Address: o Tax Map #: August 1997 NEW :1: I -sea Date S Lj �e4c RE: Department of Health Review of Proposed SewageTreatment System for Property Name: Address: OVr4K457Z C,'12x1 A-0 Town: P,¢ T,tSo Jll f-/-J Tax Map #: 44/0— / -- Z-0 Dear ' Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has'been made to the Putnam County Department of Health. Attacbed please find a copy of the latest site plan. If you have any questions, � concerns or information which may bear on the Health . Department's review of this application, you may call the Health Department. at 278- 6130.- Very truly yours... By: : t' Title: Received By: Address: Tax Map #: August 1997 r 111111111,111111 7000 0600 Ill I ' 0024 2623 9494 _ 7000 0600 0024 2623 9494 �m.A o� o ,C NZ 0 o N m O , +0 g � O m m m m � mm _ v � m N 1� G 0 3 ➢ tf IXk4j_RHK;Njv4= Date ('Mktj RE: Department of Health Review of Proposed SewageTreatment System for Property Name: Address: Q VAY-G< 1h (-L— J2-O A1_) Town: P,¢ T, SD tJ f �) Tax Map #:.! O— Dear ' Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has,beeu made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have. any questions, � concerns or information which may bear on the Health Department's review of this application, you may.call the Health Department at 278 -6130. '*-' Very truly yours, . Received By: Address: Tax Map #: By: luo"I_ Title: 4W� IA44 , August 1.997 t i t NEIGHBOR NO]HICATION LETTER . Date V (CAE: Department of Health Review of Pro osed P P SewageTreatment System for Property Name. Address: QVAYK 141 LL•)20 kO Town: Pr¢ LSD / j r7") Tax Map #: Dear Please be advised that an application for a Construction Permit relative to the construction ' of a sewage system and/or well proposed for the captioned property has•been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. • If you have any questions, • concerns or information which may bear on the Health Department's review of this application, you may.call the Health Department at 278 - 6130. '" _ Very truly yours,., B • �--- Y• . Title: Received By: Address: . Tax Map #: August 1997 r OEM 1: 1 .84MIJISLIGNIFIXIMM i Date ARE: Department of Health Review of Proposed' S ewag eTre atment System for Property Name: Address: 6QVAKU7Z 1411 -L•)2-0 A-0 Town: PA nL 50 /�l rTJ . Tax Map #: 41,10— Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan.. If you have any questions, - concerns or information which may bear on the Health _ Department's review of this application, you may.call the Health Department at 278 - 6130." Very truly yours,., . By, Y Title: Received By: Address: Tax Map #: a August 1997 i I No M "I.r. I _10WEII-M-10KIVOI)a Date `i 'N - 04 NZ. P I U 0 RE: Department of Health Review of Proposed SewageTreatment System for Property Name: Address: Q VAYG< 141 LL.124 /410 Town: • Tax Map #: 44/0— / Z Dear . Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has, been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Departmenfs review of this application, you may.call the Health Department. at 278-6139.'* Very truly yours, . By: luo"l—_ T Received By: Address: Tax Map #: August 1997 1% M1 LrI Er Er WAMMO-w- www M M I'Ll . ru Postage $ rij ni Certified Fee Return Receipt Fee OMMUM nj (Endorsement Required) rLi Restricted Delivery Fee r3 (Endorsement Required) r3 C7 Total Postage & Fees $ C3 r_3 —D —0 Re C3. M Name Fleaserint Ctea fAit'. -01.kka I - I C3: M Pt, 'orP M e, r+4 ---------------- Postmark Here ---------------- -------------------------- el-2— CIV PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #'2--n Located at 5Z OW a V4 Oue 14 lZe Subdivision name Subd. Lot # Date Subdivision Approved Owner /Applicant Name S'1'2UC%l Mailing Address P O &D X 4 4 Town or Village c %) Tax Map +16 16 Block �_ Lot ZD Renewal Revision Date of Previous Approval N Y. Zip 1Z5b 3 ® 0 Amount of Fee Enclosed �� 400 , Building Type1AMO ®i%IM k Lot Area 5,q No. of Bedrooms —+-- Design Flow GPD S6 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of [7,60 gallon septic tank and .S �Q &F lf-T- TrL �,, P c H i 2_s�) c, m P i 'T 0 6 o X Other Requirements: l y To be constructed by �TV -)`Tg G71() N Address F-() /�% /� 1 Water Supply: Public Supply From Address or: _ Private Supply Drilled by _j IA—L-t Address [A) I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem 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 date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed Address P.E. R.A. Date b �Ol o q W C05 � M A�) U W. hf4t --jM gMl , I License # & APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh con dered n essary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t A roved f charge of domestic sanitary sewa ly. By: / Title: Date: Z(© White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . APPLICATION TO CONSTRUCT A WATER WELL _ r ry please print or type PCHD Permit # O ^ V Well Location: Street Address: Town/Village Tax Grid # . Sou 6m-am 14tLl.. mww% Ohl Map 4.16 Block 1 Lot(s)) -O Well Owner: Name: TVcoPSO.Vc td Aj Address: I POW rfr Use of Well: Residential Public Supply it /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served & Est. of Daily Usage Zoo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 5( New Supply (new dwelling) Deepen Existing Well Detailed Reason rvew koo 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 K Name of subdivision Lot No. -- Water Well Contractor: Address: �7W S%I=DL eu Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to he e plan. aseparate Date: , "51 >; b Applicant Signature: s 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, y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water wel driller Nrti fled by Putnam County. f� Date of Issue Permit Issuing f al: Date of Expiration v Title: Permit is Non- Transf r able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 27'81' x 44'e 2464 Sq. Ft. 24'x 16' family room* 384 Sq. Ft. TOW —2848 Sq. Ft. 'rst Floor BOWA"Aw r 1tv'm1h" DINING R{ FAWLY R0011 - 142'X11'1 wi oors av� 16'ii7Ci1.1� i `S 11VIN Fmm 1sn*xara• NV EST Cif ES TER `i0DULAR H0'&'1L'S Second Floor O UL T 1 e oa.a ros aoorta0w 4 am so+ 1 now zr-�• •i t i � � i %#3pmv3wv6' 3 _.! PUTNAM COUNTY DEPT °_RIT11aT'NT Ali` HOUSE PLANS APPROVED F r �`{ � ���d •/ /' BEDROOIJIS P A ' O /J� N• .� i 2 sli ALL SLFr * r, �, ,, z,� r _. , . - - Sv c��s�vcT�oN cvx qfr-r'r�or) C11 -7 / - WES.TCaTER - NMI U RtarAw Mitt Rd • WingtWe, New York 12594 (800) 832 -38£tS • (914) 832 -9400 w „w-tfl•�yeht�IPr- ntnri:�ta•: nrr. Sent By: LLL; 234567 ; Jan -28 -04 12:0OPM; Page 111 CLS3iQx� • W(DAN W WIWI Cps a>l to amSRUM. 41 alnpagx o; Isaalssajold 0" agz jo tY q.sesodai alas aqf aq NA ;i'Ss. m go$ IV ssocqua ck pazabst q aa(DA R Salw!Fof u89" uolaq ;nsnbasgns tag pmc atsodsas aaogv aip flo p2seq pavelaM aq o;, paaiajap aaaq aq pafoid s j 'MOAN p= imo:�laAd m2 t+Q as ` io&A ov w $uosa l pq jai amp algsms tAee;am Y >;s4!Paooa � iaao�ssd?Q� • _ .: _'�° qo: alit tsa�ut �mm d��XAt `sao;�m6� jo �tue of �'d' psis nor jX . •asaodsas ate no pas>dq iPaisav .co Huof o%: ne tss wlbjd m >>P 1L� a��dvq d . . a� opuotd o�o�m }old udlsap atp �o dtqunodru sq; s� sI ^�^ .. :. , .. oaf osdjeoua�amo�: io1 Sm pasodola )w o -p j fnbas Itzmd aWAO Lsp1,m' * e2 000Y UM in804- 409 dt:ap SASS pasodoid .. �' o per * :)Id,*" awo*ex v io v»; 001 wa Si.SS swodom iy a to ads .�o mss o s ��o a�. i #u3 on uMtA S.LSS pasodosa to . *&q0 J*9X raaro3 spho -to Tmioplalo upq ass": p ato umm►siss pasodom ' 10 o . .. - OR Su *n o ..- -•o,` � I3D'frs u nmyc or v 3d Dili JAN -28 -2004 WED 11:35 TEL:845- 278 -7921 HAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALT H SERVICES LETTER OF AUTHORIZATION RE: Property of _ y y �� 5 V Located at , S 6 J V 1 TN N 4�✓1 d Tax Map # Block � Lot Subdivision of uA !LE '/- I l . (— 6 YZTI`� Subdivision Lot # Filed Map # Date Filed �Z�l Gentlemen: This letter is to authorize a duly licensed Professional Engineer _- �L, or R &Axd tea-� to apply for the nquiired wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and. the Putnam County Sanitary Code. Countersigned: /U-',/ P.E., R.A., 0 -- Mailing Address State R� Very truly yours, I Signed: avL/ Marling Address:f(l),i� Wy State )\j P Telephone: LP— _1F 7 —�� f y .Telephone: ��,�`� �S�J f Form LA-97 JOHN KARELL, JR., PX. '. 121 CUSHMAN ROAD - PATTERSON, NEW YORK 12563 Cd 0 ` vZL) LTI b 1\) . ELEVATION HEAD LOSSES GRADE AT PUMP PIT..:...:....... ................::............. CG r7 D BOX ELEVATION .................. ............................... tl v BOTTOM OF PUMP PIT ........... ............................... 4 -1 TOTAL HEAD LOSS ............ _........ l FRICTION LOSSES , AT 20 GPM ...... 1 1j2 INCH PIPS LENGTH OF FORCE MAIN ............... .. ............... .. 130 PUMP PIT - PIPING ..................... .............................10 FIXTURES IN PIT .:..................... .............................30 . TOTAL LENGTH AT 20 GPM WITH 1 112 INCH PIPE.---- �.� X.85 FT 1100 FEET = � TOTAL FRICTION LOSS............ TOTAL. HEAD REQUIRED .::........... 2- ,F NE VV ,gyp:, i E��, ✓�h'jr �...........� z �ROFESS�O� USE GOULD 112 HP WE05 PUMP RATED AT 26 GPM AT 40 FEET HEAD. EXACT WE05 MODEL BASED UPON ELECTRICAL SERVICE AVAILABLE TO THE PUMP STATION Friction Loss PLASTIC PIPE: FRICTION LOSS PER 100 FT. ��'� cpN 2" 1 Ft. Lbs. I I 2'/:" FL Lhs. I 1 Ft. 3" i Lbs. I 4" I 6" 1 8" I 10" I Ft. I Lbs. Ft. Lhs. I I I Ft. I Lbs. I FL i Lbs. 6 1 360 1 .101 .044' . 1 1 1 . i I I I 1 1 i 8 1 480 1 .171 .073 1 1 I I I I I I I I 10 1 600 1 .25 .108 1 .111 .0461 1 I ( I I I 1 15 1 900 1 .521 .2241 .221 .0941 1 1 1 1 I 1 20 1 1,200 1 .861 .3751 .361 .158 1 .13 .056 1 25 1 1,500 1 1.291 .5611 .541 .2341 .19 j .083 1 1 1 1 ( 1 1 1 30 1 1,800 1 1.811 .7861 .751 .3271 .261 .1141 I I I ( I 35 1 2,100 1 2.421 1.05 1 1.001 .436 1 .35 1 .151 1 .09 1 .041 1 40 1 2,400 3.11 1 1.35 1 1.281 .556.1 .441 .1911 .121 .0521 1 1 1 1 1 45 1 2,700 1 3.84 1 1.67 1 1.54 1 .668 1 .55 1 .239 .15 1 .064 1 I I I I 50 3,000 1 4.67 1 2.03 1 1.931 .839 1 .66 1 .288 1 .17 1 .076 1 1 1 1 1 - 60 1 3,600 1 6.60 i 2.87 ( 2.71 1 1.18 1 .93 1 .406 1 .25 1 .107 70 1 4,200 1 8.83 3.84 1 3.66 1 1.59 1 1.24 ( .540 1 .33 i .143 60 1 4,800 1 11.43 1 4.97 1 4.67 1 2.03 1 1.58 1 .687 1 .41 1 .180 SO .1 5,400 1 14.26 i 6.20 5.82 2.53 1 1.98 1 .861 1 .52 1 .224 100 I 6,000 ( ( 1 7.11 1.3.09 1 2.42 i 1.05 ( .63 1 .272 1 .08 .036 1 1 1 125 7,500 i 1 1 10.83 4.71 1 3.80 1.65 1 .95 1 .415 1 .13 1 055 1 I 1 150 i 9,000 I I I 1 1 5.15 ; 2.24 1 1.33 .580 r .18 1 .077 I 1 I - 175 10,500 I I I I 1 6.90 3.00 1 1.78 1 .774 1 .23 1 .102 1 1 200 1 12,000 I I 1 I 1 8.90 3.87 2.27 .985 1 .30 1 .130 I I I I 250 15,000 1 i I I i I 3.36 1.46 1 .451 .1951 .121.0511 I 300 18,000 1 1 1 1 ! 14.85 12.11 1 .63 1 .2751 .17 1 .0721 1 350 j 21,000 1 I I I I i 6.53 12.84 1 .84 1- .367 1. .22 1-.065 1 I 400 1 24,000 1 I I ( I 1 I 1 1.08 1• .471.. .28 ( .121 1 500 ! 30,000 1 1 1 1 1 1 1 1 1.66'1.- .720 �.:.42 .1S2 1 .14 1 .059 550 1 33,000 1 I I I 1 1 1 1.98 .861- .50 .219 1 .16 ( .071 600 1 36,000 1 1 1 1 1 2.35 1.02 ( ..59 .258 ( .19 1..083 700 1 42,000 I I I I I I I I I .79 .343 1 .20 1 .112 8C0 1 48.000 I 1 1 .33 1.143 900 54,000 1 1 1 i 1 1 I I 1 1.271.5541 :11_! .179 N, APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer Courts • Motels • Schools • Hospitals • 'Industry • Effluent Systems SPECIFICATIONS Pump: • Solids Handling Capabilities: 3/4" Maximum • Discharge Size: 2" NPT • Capacities: Up to 114 GPM • Total Heads: Up to 123 Feet TDH • Mechanical Seal: Carbon -Rotary Seat/Ceramic- Stationary Seat 300 Series Stainless Steel Metal Parts BUNA -N Elastomers • Temperature: 160 °F (71 °C) Maximum • Fasteners: 300 Series Stainless Steel • Capable of Running Dry Without Motor. • Single Phase:' /, HP, 115 or 230 Volt 60Hz,1750 RPM 'h HP. 115 V. 60 Hz, 3500 RPM h HP thru 1'k HP 230 V. 60 Hz. 3500 RPM Built -in Overload with Automatic Reset Class B Insulation • Three Phase: 1h HP thru 1'k HP 208/230 V. 460 V. 60 Hz, 3500 RPM Class B Insulation, Overload Protection must be Provided in Starter Unit • Shaft: Threaded, 400 Series Stainless Steel. • Bearings: Ball Bearings Upper and Lower • Power Cord: 15 Foot Standard Length (Optional Lengths Available) Single Phase: ,A and 1h HP -16/3 SJTO with three prong plug. 'Y. thru 1'h HP -14/3 STO with Bare Leads Three Phase: 1h thru 11h HP -14/4 STO with Bare Leads ; On CSA Listed Models — 20' Length SJTW and STW are Standard. FEATURES Gauids Su bme*rsible Eff luen t pumps WODEL mechanical seal protection. Sal - anced for smooth operation. Bronze impeller available as an option. Casing: Cast iron volute type for maximum efficiency. 2" NPT dis- charge adaptable for slide rail systems. Mechanical Seal: Ceramic vs carbon sealing faces. Stainless steel metal parts, BUNA -N elastomers. - Shaft: Corrosion - resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. Motor: Fully submerged in high - grade turbine oil for lubrication and efficient heat transfer. Designed for Continuous Opera- tion: Pump ratings are within the motor manufacturers recommended working fiitriits, can be'operated continobusly without damage. tea 64s: Upper and lower heavy duty ball bearing con - structiorr.- Powej Cable: Severe duty rated, oil 'and water resistant. Epoxy seal on motor -end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. O -Ring: Assures positive sealing against contaminants and oil 11/4 & 2" Discharge Slide Rail Systems Provides Easy Means of Re- moving Pump From Wet -Well by Utilizing a Quick Disconnect and Guide Assembly. Eliminates Need to Enter Wet-Well. Corrosion Resistant Design includes Stainless Steel Pails, Cross Brace, Quick Disconnect Plate, Base Plate, Lift Cable; Bronze Quick Disconnect. Adaptable to All 2 Inch NPT Vertical Discharge Efiluent and Sewage Pumps Designed for use with Horizontal Discharge Systems SYSTEM CUMPONENT9Z Basic Slide Rail Assembly includE • 80•• Long Guide Rail& • Wall Bracket • Top Pump Bracket • Quick Disconnect Adapter • Bohom Pump Bracket • Base Plate • Lining Cabia • Check Valve r� -- • Vertical Pipe l Nipples NOTE: Standard overall _ lengtholpipingis96 "...can J be cut down !o "a" minimum length. II rail length longer A10 -12, 11 /." than. 56- is needed, consult A10 -20 2" factory lot pr;6r.q. Ordering Information •1905 cov?_% Au—o :. Inc. For Use With Pump Model SIMPLEX 11- -11/.- C:SC.4ARGE 1.1- -2- C'SCHAS(jF_ Simplex System Consists of: 1 -Slide Rail. 1- Simplex Disch. Piping. Simplex Discharge Piping: H12S.1 %- �12 1t2as, 2- 1r- -1Y: ntscy:.�G� Simplex t3;; •2- DISCY:.AGE Includes: • Union • Fipe Ni;;Ies • Tee Handle • Gale Vake Simplex System ►.k Size Qly Order 11o. cL GoLilds Effluent and Selrrage Slide Rail Systems i( DUPLEE` -_- i Duplex System Consists of: 2 - Slide Rails 1- Duplex Disch. Piping. Duplex Discharge Piping: I H120, I%- 1t cAl- � 1 H200. 2- I „ i 2]:i- -2 C'SCYAAGE Duplex includes: • Fipe Nipples • Uricnt • Gate Valves • Tee H,-.nd'es • 'Elbows • F:;e Tee Oaplex Slst!m ion 11-:." Size . 'Qty Order 11o. Nscription EP03 i f 1 A10 -12 Slide Rail ' ' • 2 At0 -12 Slide Rail �4 1 H 12.S - . Disch. Piping I >4 1 H 12D Disch. Pipin 3885 3866 3651 2. 1 x:10.20 Slide Rail 1 2 A10.20 S!-de Rail 2 - 1 F120D Oi:01. Pipil: 1 H20S Disch. Piping E'::�•o 107. or Example: (A) 100 ff. of 2" plastic pipe with one (1) 90° elbow and one (1) swing check valve. 900 e!bow - Equivalent to 5.5 ft. of straight pipe Swing Check - Equivalent to 13.0 ft. of straight pipe 100 t of pipe - Equivalent to 100.0 ft of straight pipe 118.5 ft. = Total equivalent pipe Figure friction loss for 118.5 ft. of pipe. (B) Assume flow to be 80 GPM through 2" plastic pipe. 1. Friction loss table shows 11.43 ft. Iess per 100 It of pipe. 2. In step (A) above we have determined total feet.of - pipe to be 118.5 ft. 3. Convert 118.5 ft. to percentage. 118.5: 100 = .1.385:`.•':, 4. Multiply 11.43 x 1.185 13.54455 or 13.5 ft. = Total friction loss in this system. Friction - Loss EQUIVALENT NUMBER OF FEET STRAIGHT PIPE FOR DIFFERENT FITTINGS ' Size of Fittings, Inches Yz" 3/." ( 1" 1'/." 1' /z" Z" 2'/:" + 3" + 4" I 5" 6" B" 10 "- 90" Ell 1.5 2.0 I 27 3.5 I 4.3 I 5.5 I 6.5 8.0 I 10.0 14.01 i5 20 25 450 El + 0.8 1.0 1.3 1.7 I 2.0 F2.5 3.0 I 3.8 1 5.01 6.3 7.1 1 9.4 12 Lon S ::es Eil 9 p I 1.0 1.4= 1.7 23) 2.7� I 3.5 ,. 4.2 5.2 7.0 9.0 ! 1 11.01 14.0 Close Return Send 3.6 5.0 1' 6.0 8.3 10.0 13.0 15.0 1 18.0 24.0 1 31.0 1 37.0 i 39.0 Tee - Straight Run 11 12 i 2 3( 3 1 4 ( 5 - Tee -S:de Inlet or Outlet 1 3.3 I 4.5 ! 5.7 ! 7.6 9.0 , 12.0 1 14.0 .17.0 1 22.01 .27.0 I 31.0 1 40.0 GlobeYalve Open ( 17.0.1 22.0 1 27.0 36.0 1 43.0 1 55.0 67.0 82.0 1 110.0 1 140.0 ( 160.0 1 220.0 I Angle Valve Open ' 8.4 , 12.0 15.0 18.0 1 22.0 1 28.0 33.0 42.0 , 588.0 } 70.0 I 83.0 1 110.0' Gate Valve -Fully Open 0.4 0.5 ! 0.6 I 0.8 I 1.0 ( 1.2 1.4 1.7 �. 2.3 2.9 3.5 4.5 Check Valve (Swing) I. 4 ( 5 7 9 11 13 11 16 ! 20 + 26 I 33 I 39 52 . I 65 Check Valve (Spring) 4 I 6 I 8 12= ! 14 19 • 23 ' ; 32 1 43 53 Example: (A) 100 ff. of 2" plastic pipe with one (1) 90° elbow and one (1) swing check valve. 900 e!bow - Equivalent to 5.5 ft. of straight pipe Swing Check - Equivalent to 13.0 ft. of straight pipe 100 t of pipe - Equivalent to 100.0 ft of straight pipe 118.5 ft. = Total equivalent pipe Figure friction loss for 118.5 ft. of pipe. (B) Assume flow to be 80 GPM through 2" plastic pipe. 1. Friction loss table shows 11.43 ft. Iess per 100 It of pipe. 2. In step (A) above we have determined total feet.of - pipe to be 118.5 ft. 3. Convert 118.5 ft. to percentage. 118.5: 100 = .1.385:`.•':, 4. Multiply 11.43 x 1.185 13.54455 or 13.5 ft. = Total friction loss in this system. FEATURES 1. Impeller . 2 Casing 3. Mechanical 7 Seal 4. Shaft 5. Motor 6. Bearings - Upper & Lower 7. Power Cable 8. O -Ring 1 'B - .. I . 2 MODELS Series Yr=-M11L 115 K_33121 113 Z-3 p::- ►�111d 115 R_3312M za WE0511H 115 V,11a12H M Vrt:=--%2H x..31230 Vl rte,: H 112 450 'WE- 511Y.t! 115 . 1'reZ512.4H It :n,.a2• .':H 2r' /220 K= ::a;HH 453 1'.:77iG1 Z,0 k.- �7.c1i 3/4 253/2:0 V1�73:H 467 WE1012H Z3 V1 _1032H 1 2121/230 WE 1'034H 453 WEis*82H ? o WEIS:2N 22/2.:0 VrE 1 -112 4W WE1511WA 230 V._lc�"2HH 2081230 V:E153:HH 450 P "ate 1 3 1 3 1 3 1 3 1 3 1 3 . 1fiL Am;.s. -47 9.4 47 13.0 6.5 3.4 -1.7 13.0 6-5 3.3 lr' . 9.0 5.4 27 11.6 6.4 32 13.3 92 46 13.3 92 4.6 111,14 Stli:s 1750 3. °i0 I -3. PERFORMANC see.!: K,- WE0311L W ~33111 C-E-3312L v1Ew1z! H? '/s '/S V- Y. 1750 lix7 IN 70 wugltt 10 sa 65 0,111 15 60 57 20 36 45 56 c_ 25 so 3/4' 3: 3 43 a 45 SJ I5 a 60 E: 0 '- 70 7: 63 q 70 10: 110 k"0 E RA 71 W = -cs 1 ii WE ^512`.! 1,wEa:.�24 WEM-c 3av so 76 71 50 40 25 10 INGS WE0712H WE0732H WE07?.:H IV, w 87 83 78 73 67 61 52 43 30 17 6 DIMENSIONS (.1I dimensions in inches) (Co nct use for construction purr"eses.) 1- -121: EFFLUENT EJECTOR SYSTEM _ Ir Package Includes: r Efnuent ejector s)s:em Oers �j Sutmem',ble V'Iwent Pump. I - ease of orderin; and instsaa- _1J YIEC31 t� L or tv'c�t tAt, t2st. E _ Von. A sin le o(cering number V /'351 tN4 r u2► S.i: s, cifies c= mp!e e ys :m titer;ury Level Cen eesigned :t+ i for mcst resrdenuat t 1� A2 -5 (115 V). A:-6 ('r0 V) end commercul sump and easin A7 -1601s L_ elnurnt pump a;,-;;Cations. �a easin Corer A-e-161 I ( C. -tecr Vawe AS-2P S AI I STATION 'L-KICK-BACK In gallot WE1012H WE10324 WEI=H 1 35u0 lci 102 ca 94 19 8: 79 72 64 54 42 29 16 5 s ;e. -nin W:-!Si2H i1-- I-C -24 tiE)5:;H 1 114 111 ICs tlu ico 91 E6 79 72 63 53 40 26 14 4 At WF.!12 E W. 4 60 55 t-2 43 42 3- so 23 18 12 3 W?i:12=4 WE15=� H WD -t , 15 93 73 rr 7 63 ;. 66- 53 63 5.1 45 47 37 40 33 24 15 4 . �•: c ;t._il_ 11,1 ;`. I= �;Ict�.`ilt mid �( LIQUID- LEVEL. CONTROL SWITCHES Diaphragm Switches • Pressure Actuated Switch • Liquid Level Differential Permaniently Set at 6" • Rated up to 1/z HP or Conlrcl /Pilot Circuit up to 230 Volts • Mounting can be directly on pump or independ- eritly suspended. • Includes: Cast iron Body 15' Pov: er Cord Stainless Steel Strain Reref, Fasteners, and Eracke! A2 -1 Equipped with a three- pronged series plug (con- figuration per NEMA 5 -15) up to Y HP, 115 volt, single phase operation. A2 -2 Equipped with bare leads for direct connection to a magnetic contactor (A3 -2012) or a starter (A3 -5034) as a pilot switch. A2-4 Equipped with a three - pronged series plug (con- figuration per NEMA 6 -15) up to Y• HP, 208/230 volt, single phase operation. Mercury Float Switch A2 -3 • Mercury Fluid Contacts • Normally Open Design • 150 °F (65 °C) Max. Temp. • Includes: Pofyurethane Foam Float IS', SJO, Neoprene Cord Lead Weight and Mounting Strap • Suitable for Pilot Control Duty up to 230V Max. • Two Required for Simplex System (One Pump) • Three Required for Duplex System (Two Pumps) Omnidirectional Differential fviercury Switch • Mercury Fluid Contacts • Normally Open Design • 1506F (E5 °C) Max. Temp. • start /Slop Level Adjus'-ble 5 to 23 in. • UL and CSA Misted • ASS Plastic Case • 15' CordSJOW— A /SJOW with Mounting Straps • One Required for On /Off operation A2 -5 Y/i!i three - pronged series plug per NEMA 5 -15,up to Y HP, 115v. single phase operation. A2 -6 With three- pronged series plug per NEMA 6 -15 up to 3/. HP. 230 volt single phase operation. A2 -T With bare leads for dirercl:., connection to a magnetic.', contactor (A3 -2012) OF a . starter (A3 -5034) as a pBot switch. A2 -8 Reverse acting for pump -up filling operation. (Normally closed contact) Supplied with bare leads. rip Mercury Differential Switch A2 -9 • Mercury Fluid Contacts Normally Open Design • Star /Stoo Level Adjustable frcm 6" to 't • Fated for IA HIP. 115 V.. Single Phase Only • includes: Polypropylene Flcat 10' Cord Three Prong Series Flug -- NEMA 5 -15 14-164 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANTlSPONSOR 2. PROJECT NAME J Jy! -:IV G0,JSTRU( -%7l� Iv U LL 3. PROJECT LOCATION. • Municlpanty ' /4 > County N 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc.. of provide trap) i= � r b1Gtr- S < d.�14 tk=- LC_ V�-�.ST S (0 G .SOU TI � 0 eU 1 _T/4 6XH--1,. 5. IS PROPOSED ACTION: 10 New ❑ Expansion ❑ Moolleatlonfaltetatlon 6. DESCRIBE PROJECT BRIEFLY. 7. AMOUNT OF LAND AFFECTED: Initially 42,7 E acres ultimately acres 6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? �.Yas [IN' 0 It No. describe briany 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Q Resldenlbl ❑ Industrial ❑ Commercial ❑ Apricunure ❑ PvWForestlOpen apace 0 Othar Describe: to. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? WYes ❑ No It ye3.133t apenq(3) and permillapprovals It. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes *0 If y93.1331 apancy name and.p"Vapprovat 12.-AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMMAPPROVAL REQUIRE MODIFICATION? ❑ Yes lama 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE tS TRUE TO THE BEST OF MY KNOWLEDGE ADpllcsnVsponsor naTey .� �/ '" /`—�' �! �-- `���' Date. _�3164l b Slpnatute: It the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617.1? If yes. coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 6170 If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, it legible) C1. Existing air quality, surface or groundwater quality w quinlity.•noise levels. existing traffic paltems, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly. 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 ttueatened or endangered species? Explain briefly. *CI. A community's existing plans or goals as officially adopted. Or a change in use of intensity of use of land W other natural resources? Explain briefly CS. Growth, subsequent development. of related activities likely to be Induced by the proposed action? Explain Welty. C6. Long term, short term4 cumulative. or other effects not Identified in C145? Explain briefly. C7. Other Impacts (Including changes In use of either quantity or type of ene(gy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT of A CEA? ❑Yes ONO E IS THERE. OR IS THERE LIKELY TO OF, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yea ❑ No If Yes, explain briefly PART ill — DETERMINATION OF SIGNIFICANCE fro be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important cr otherwise signincant. Each effect should be assessed In connection with Its (a) setting Q.e. urban or rural; (b) probability of occurring; (c) duration; (d) Irreversibililr; (e) geographic scope; and (Q magnitude, It 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. It question D of Part 11 was checked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA ❑ Check this box it you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box it you have determined, based on the information and analysts 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: runt Or Tnw Nsnw of esponr f OfIker in Ltad aaKv pan +turf of Itesponsblq OffiCer in Lead AttnCy Han* oU-Ltjd ACeney .n• Tdo of apon fKp a"Acwt of FIV410 t d4ftotol Imm fffpon f X-C-OT i f r t -� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: V C(),Al S 77Z 0 C / —/d /y / P 0 /0) )( '77-/ 2. Name of project: ,S IiyA V 1241 LL doJS -1� 3. Location TN: %%' 7 - -S4 6t/ 4. Design Professional: j 0HJJ KW LL)-5. Address: i'L( CV, H M 4-4) %�jltl) 6. Drainage Basin: IV v 9&a M4 SAi & 7. Tyne of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... Exempt Unlisted x A/0 0 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater. 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... 19.. If yes, name of water supply A Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ )U U 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector P—ee -d 24. Project design flow (gallons per day) ................................. ............................... eg�&ro 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 111 o 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8/99 27. Is any portion of this project located within a designated Town or State wetland? A) p 28. Wetlands ID Number ........................................................... ............................... — 29. Is Wetlands Permit required? ~—' Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /J 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No �Jo 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No P 0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... ' 34. Are community water and/or sewer facilities planned to be developed within v 15 years in or adjacent to project site? 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map 10 Block_ Lot LU 37. Approved plans, are to be returned to ..... X\ Applicant Design Professional NOTE:.All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision 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 pursuant to Section 2, 0.4 of the Pena; Law. SIGNATURES & OFFICIAL TITLES: N t. Mailing Address: ................................... �'.f0� %�j 2-TbO s S. V. CONSTRUCTION, INC. 2 -92 P.O. BOX 449 PATTERSON, NY_ 12563 PAY TO THE ORDER OF Xe,. ufuam Bounty National Bank CROTON FALLS OFFICE •' CROTON FALLS, NEW YORK IOS 19 4 FOR 110004 ?6 1110 +1 :0 2 1906808j: 20 759 u� N \A-1I, 4761 50- 680/219 DATE DOLLARS u - nor PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 5o Urg a MOM- �-� /(,� /w A0 Town or Village ���5; 0 C%/ Subdivision name Date Subdivision Approved Subd. Lot # — Owner /Applicant Name �� CI'RUC7"I D Mailing Address P o ao X 4 4 q A -mss e ,l Tax Map q; • ID Block _ I Lot ZO Renewal Revision Date of Previous Approval N •y. zip )7-5k 3 o Amount of Fee Enclosed $ 400 — ' Building Type(00t) r-MM G'. Lot Area �� No. of Bedrooms + Design Flow GPD SD 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon. septic tank and Other Requirements: / To be constructed by V V G �% Address P4 d A N Water Supply: Public. Supply From Address or: Private Supply Drilled by Address ! &u) I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as. shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the 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 date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. )< R.A. Date D �b`D COS / , j2 License # S Z11 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Un Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy.- Owner; Orange copy - Design Professional Form CP -97 Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH . INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: _ STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAP #: (CONFIRMED) DOCUMENTS Y (REQUIRED DETAILS ON PLANS CONT'D) )PERMIT APPLICATION ��HOUSE SEWER -1 /" FT. 4 "0'; TYPE PIPE CAST IRON )WELL PERMIT OR PWS LETTER (_)(ENO BENDS; MAX BENDS 450 W /CLEANOUT )PC -97 RENEWALS )LETTER OF AUTHORIZATION SITE NOTE (NO CHANGE) )DESIGN DATA SHEET (DDS) FILL SYSTEMS )CORPORATE RESOLUTION 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE )SHORT EAF FILL SPECS/ FILL NOTES 1 -5 )PLANS -THREE SETS (FILL PROFILE & DIMENSIONS )HOUSE PLANS - TWO SETS FILL IN EXPANSION AREA )VARIANCE REQUEST FILL GREATER THAN2 FEET SUBDIVISION CLAY BARRIER )LEGAL SUBDIVISION FILL CERTIFICATION NOTE )SUBDIVISION APPROVAL CHECKED L3CPEPTH GAUGES )PERC RATE ; VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS )FILL REQUIRED DEPTH SEPARATION DISTANCE FROM TOE OF SLOPE )CURTAIN DRAIN REQUIRED TRENC GENERAL LF TRENCH PROVIDED 60FT MAX. )LOCATED IN NYC WATERSHED vpARAI,LEL TO CONTOURS )PLANS SUBMITTED TO DEP (100% EXPANSION PROVIDED )DELEGATED TO PCHD(fDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL )DEP APPROVAL, IF REQ'D nEGEOTEXTILE COVER )DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS ) PERCS TO BE WITNESSED 0' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL . )EX- APPROVAL SSDS ADJ, LOTS (_) 20' TO FOUNDATION WALLS )WETLANDS (TOWN/DEC PERMIT REQ'D ?) 00' TO WELL, 200' IN DLOD,150' TO PITS )DATA ME ON DDS PLANS & PERMIT SA C_)�100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) )PRE 1969 NEIGHBOR NOTIFICATION (�50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER )LETTER BI/ZBA 10' TO WATER LINE (pits - 20') )100 YR. FLOOD ELEVATION W/I200' (!,)( X50' INTERMITTENT DRAINAGE COURSE )SOIL TESTING LOTS >10 YEARS OLD L .— 200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS ItEOUIRED DETAILS ON PLANS 0101 MIN TO LEDGE OUTCROP )SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK )SSDS HYDRAULIC PROFILE L/C)10' FROM FOUNDATION; 50' TO WELL )GRAVITY FLOW WELL )CONSTRUCTION NOTES 1 -15 DIMENSIONS TO PROPERTY LINES )DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION )2' CONTOURS EXISTING & PROPOSED MIN 15' TO PROPERTY LINE )'DRIVEWAY & SLOPES, CUT SLOPE )FOOTING /GUTTER/CURTAIN DRAINS (__)C_)SLOPE IN SSTS AREA (20 %) )USDA SOIL TYPE BOUNDARIES REQUIRED REQ IF � )TITLE BLOCK; OWNERS NAME ADDRESS )�)REGRADED TO 15 %SOS, , IF REQ SYSTEMS TM#, PE/RA; NAME, ADDRESS, PHONE# PUMP NOTES )DATE OFDRA- WIivT6,REVISION DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED )DA REFERENCE DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) CATION OF TER URSE5, PONDS ITM 200' OF P.L. PIT AND D -BOX SHOWN & DETAILED - )PROPOSED FINISH FLOOR AND - C )()i DAY STORAGE ABOVE ALARM ,BASEMENT EL ATION5 .CURTAIN DRAIN LLS SD ' /IN 200' OF SSTS UUSTANDPIPES, 5' BOTH SIDES, DETAIL P Y METES &BOUNDS C�C�15' MIN to CDS = >S %, 20'-4 %; 251-3%,351-1%, 100%-<I% )EROSION CONTROL FOR HOUSE WELL & (��)20' MIN to CD DISCHARGE /100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE UU10' MIN to NON - PERFORATED PIPE COMMENTS: (REVMEET)09 /01/00 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 March 18, 2004 Jack Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 Re: Proposed SSTS: JV Construction South Quaker Hill Road (T)Patterson, TM #4.10 -1 -20 Dear Mr. Karell: ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Deep test holes must be witnessed by a representative of this Department, if not previously witnessed. 2. Neighbor notification is required. 3. A dimension of 142 feet is measured from the proposed well. Please clarify. 4. House, driveway, well and SSTS area are to be labeled as proposed. 5. All improvements, e.g., neighboring wells and SSTS shown here to be labeled as .existing or proposed. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve t ly your , Robert Morris, P.E. RM:lm Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 60A1 -,� i )ZtJGT_IyA/ Address 5oi, y Oe K,67Z Y&I, 7Z6,Wp Located at (Street) Tax Map ; 10 Block _ Lot ;. 8 (indicate nearest cross street) Municipality P'*Tr,fa!60/II Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking z /ie /ol Date of Percolation Test /✓ y . Moth: o `Water '�%Vater r Go. d e P tt erRate on No Ruh No. T ite1a se Time Ln;)::. Surfa a ()fuches) Start Stop Dropp In Inelies M�nlIuch. dole Mart .Stogy / j1 r Z/ �t� /. 4 5 1 1;56 a 30 Zw Z 2 ������i�r, -� .? J, r 2l1 4 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. G_ Indicate level at which groundwater is encountered ;N/ o A1, Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: �, KE tT y, tI , Date Design Professional Name: Address: " " "' ---- -- pC dA Signature: ,�ve 4a 6„ %Kow ,aver, Design Professional's Seal K PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project '%, 7-- County P t/ nJZM Site Location' Soa7 El 42uZe -Z ez-z -/-O E 72 /'o — I 2 �7 Building construction begun Extent Is property within NYC Watershed ?. A,1.f.. A*(nA EfYes ] No SECTION B. TOPOGRAPHY (Please heck all appropriate boxes) 1. Hilly Rolling Steep slope a Gentle .slope Flat 2. Evidence of wetlands Low area subject to flooding Bodies of water Drainage ditches a Rock outcrops 3. Property lines or corners evident ....................... ............................:.. `es No 4. Do water courses exist on or adjoin the property? . AW.4 . Yes 0 No 5. Will these affect the design of the sewage system facilities ?............ Yes 0 No 6. Do watershed regulations apply in this development ?....................... Yes a No 7 Will extensive grading be necessary? ................................................. a Yes No 8. Will extensive fill be necessary for SSTS? ......... ............................... a Yes 0 No' 9. Do filled areas exist within the SSTS area? ........ ............................... Yes No. If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: 0 Sand =Gravel Loam �y Hardpan Mixture 0--3' 3'-7` 11. Observed from: a Borings 0 Bank cut F7J Backhoe excavations 12. Soil borings /excavations observed by y z ,?7� H I on _�2— 13. Depth to groundwater k l i1/ on. 14. Depth to mottling © on 15. Are test holes representative of primary & reserve areas ...................... :.............. 16. Soil percolation tests made by , y� GOA 5 —/ s on 17. Soil percolation tests witnessed by P G- on SECTION D (on back) M Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 es No 9. Will groundwater or surface drainage require special consideration? ...................... Yes F-I No 20. Will gullies, ditches, etc., be filled and watercourses be relocated? ....................... 2 0 Yes No SECTION E. REMARKS. 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ....................................... ................. ......... No Y s e. E21/ F7 Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................................................... F71 Yes F__J ..No 23. Additional comments 24. Site observer/inspector and title t\ '<__1 25. Date(s)- of observation(s)inspection(s) Pe TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot 4 Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. - 0.5 .0.5 0.5 1.0 1.0 1.0 2.0- 2.0 2.0 3.0- 3.0 3.0- 4.0 4.0 4.0 5.0 5.0 - 5.0 6.9 6.0 6.0 7.0 7.0 8.0 8.0 8.0 9.0- 9.0 9.0 10.0 10.0 10.0 P R 0'. •P E'• R .T'.Y 0 F. H I LD EGA RD ':,BUHLEIER • is 1 ,. H.: . H L E I,E B U R, A ;A. bA V A G H R v. 5:38 ACRE,5 4 y' •r." iJv% i w VV :s _ .... .._ C 3r v'. 248' pi. IG "28'E )MAP MADE Dl' �. .: I5ASE WALTER XAMP,R.N. -c'.�. �.. l it. Ho. 3449