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HomeMy WebLinkAbout0189DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.10 -1 -29 BOX 3 ki �, - * ,r, ` J 'NAM COUNTY DEPARTMENT OF HEALTH ON OF ENVIRONMENTAL HEALTH SERVICES PERMIT FOR SEWAGE TREATMENT SYSTEM Located at-S-0, rk_Q u n e. - - Town or Village j 7�-� d r✓ Subdivision name Q? 4�i, Subd. Lot # Date Subdivision Approved 'Lo /9 S- Owner/Applicant Name yJ 'T Mailing Address 'Z-.-) ( Tax Map W 16 Block —( Lot Renewal Revision Date of Previous Approval '7/2i % 7 Amount of Fee Enclosed / Building Type ka w4,7 / .^ �1ff�42� , Lot Area P 6 No. of Bedrooms Zip Design Flow GPD ,-F--' L-Fill Section Only _ Depth Volume a �' PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 2 gallon septic tank and Other Requirements: A( To be constructed by a,,vi., Address Water Supply: Public Supply From Address or., k Private Supply Drilled by lnr e z Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the soparate 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. R.A. Date License # / j'Z e 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 whe nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pern A. proved discharge of domestic sanitary sewage only. By: Title: &J.- Date: L� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster; New York 10509 TeL (914) 278-6130 Fax (914) 278-7921 November 5, 1998 Julius Cesare, PE RD 97, Blackberry Hill Brewster NY 10509 Re: Proposed SSTS: West East Land South Quaker Hill Road, Lot #5 (T) Patterson, TM# 4.10 -1 -29 Dear Mr. Cesare: C BRUCE R. FOLEY Public Health Director 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: 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 on this lot, percolation tests must be witnessed by a representative of this Department. 1) Plans submitted do not comply with current submission guidelines for. fill sections greater than 2 feet. Please review Bulletin ST -19 for submission requirements. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve/rylruly yours hMW AWW Robert Morris, P.E. RM:tn Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION REVIEWED BY RINI, GR, AS, MB, BH Y N DOCUMENTS PERMIT APPLICATION PC- I WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) PLAN - (NORM ARROW) Y N NAME OF OWNER SON CONTROL:HOUSE,WELL, SSDS & DEEP HOLES LOCATED :SENTATIVE OF PRIMARY & EXPANSION FX GRAVITY FLOW, SUFF.SIZE [F PUM , PIT & D BOX SHOWN & DETAILED MOUSE - NO.OF, BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE VO BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES TAX MAP # �FLL IN EX�N AREA TRENCH F TRENCH PROVIDED 60 FT MAX. ARALLEL TO CONTOURS 1,00% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' - <I% D_B ,�AI'A: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION M #,PE/RA; NAME,ADDRESS,PHONE# OF DRAWING/REVISION YATE M REFERENCE OCATION OF WATERCOURSES, PONDS AKES AND WETLANDS WITHIN 200 FEET ROPOSED FINISH FLOOR AND BASEMENT, EL. COMMENTS: BRUCE R. FOLEY Public Health Director Julius I. Cesare 64 Blackberry Drive Brewster NY 10509 Dear Mr. Cesare: Na *01RETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 February 1, 1999 Re: Proposed SSTS: West East Land Development South Quaker Manor Road (T) Patterson, TM# 4.10 -1 -29 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: 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. 1) Preliminary design for fill section only plans, prepared when fill is required greater than 2 feet, allows for the construction of the house, well and placement of the septic tank and requires that erosion control measures be installed. Therefore, only these details are to be shown on the fill placement only plan. If a curtain is required, the design engineer may choose to construct the curtain drain prior to the approval of the trench plan, in that case, a curtain drain and standpipes must be shown on the fill plan and the appropriate details provided. In short, only the items set forth in Bulletin ST- 19 for fill sections only are to be shown on the plan and all details are to be provided. 2) Standpipe detail is not correct. Standpipe should be surrounded with gravel and must be perforated and at a minimum depth of 7 feet. So —% Letter to: Julius I. Cesare - February 1, 1999 -2- 3) The fill plan and trench plans are two separate plans. Therefore, soil boundaries. and classifications must be provided for the fill plans. A cover sheet as provided for the trench plan is acceptable. However, be advised that trenches cannot be shown. It may be beneficial to review Putnam County Department of Health Bulletin ST -19. All requirements for fill sections greater than 2 feet have been clearly outlined. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. I �u1 Very ly yours, Robert Morris, P.E. .. Senior Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 December 18, 1998 Julius Cesare RD #7 Blackberry Hill Brewster NY 10509 Re: Proposed SSTS: West East Land South Quaker Manor, Lot #5 (T) Patterson, TM# 4.10 -1 -29 Dear Mr. Cesare: BRUCE R. FOLEY Public Health Director 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: 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. 1) Fill profile is not complete; furthermore, Clay Barrier is to be shown. tY ° e 2) The minimum of 2.5 feet of R.O.B. fill is to be shown for the entire SSTS, including expansion area. 3) Fill plan is to show well and septic tank detail only. 4) Standard notes 1 -13 have not been provided on fill plan. 5) Fill plan does not show footing/gutter drain discharge. 6) Curtain drain standpipes have not been shown nor detail provided. 7) United State Department of Agriculture soil type boundaries have not been shown. 8) Datum reference is to be noted on fill placement plan. 9) Erosion control for the house and the well have not been shown. 10) Percolation and deep test hole locations have not been shown on fill placement plan. 11) Location map has not been shown on fill placement plan. off°' -14 Letter to: Julius Cesare - December 18, 1998 -2- .12) Fill is to be shown extending 10 feet horizontally past the edge of the trench and then sloping 3:1 to grade. 13) For fill sections greater than 2 feet all separation distances are measured from the toe of the fill. Therefore, the minimum distance a trench could be from . the house foundation is 37. 5 feet. 14) Location of the water service line is to be shown. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ruly yours, Robert Moms, P.E. Public Health Engineer Julius I. Cesare, P.E. 64 Blackberry Drive Brewster, New York 10509 914 - 279 -7115 January 13, 1999 Bruce Foley, Director Putnam County Health Department ATT: Robert Morris 4 Geneva Road Brewster, New York 10509 RE: Quaker Manor #5 redo Dear Mr. Foley, Herewith transmitted are the required sets of plans for re- submission of the above noted project. These plans reflect your comment of Dec. 18, 1998. Please take particular reference to the following comments in that letter: 3. This comment seems to be inconclusive. The well is existing and we assume that you want more than these two details on the Fill.Plan. 7. Soil type boundaries are already shown on the 100 scale drawing. 9. As noted the well is existing. Thank you for your cooperation in this matter. Very truly yours, Julius I. Cesare, P.E. it ��pA J'x f P G �a v 0, 0 N orkoo i rpvl p: i P G �a v� -t- - .r 0 i '0. N .' :a QUAKER MANOR LOT 5 AS -BUILT TABLE OF DISTANCES NOTE: Point T is on Common Property Line Lots 4. &.*5 at East Property Line of Common Drive Point P is 400 feet from Point T Point O is 530 feet from Point T Points N & S are reference Points NA ,$.0 NA' 139.0 PN 113.0 NB 7'$,0 NB' 139.0 ON 122.25 NC ? ?..5 NC' 141.0 ND 77:,5 Nb' 141:5: PS 124.5 NE 78.15 NE' 142.5 OS 62.33 NF 80* 5 NF' 144.0 NG 82:5 NG' 145.5 X- Center St 30.4 NH 84.5 NH' 148.0 Y- Center St 18.0 NI 87.5 NI' 149.5 X- Center Pit 41 ".0 NJ 91.0 NJ' 151.5 Y- Center Pit 19.0 NK 95.0 NK' 155.0 NL 98.5 NL' 158.0 NM 102.5 NM' 160;0 NQ 103.0 SA 109.0 SA' 156.0.., SB 105.0 SB' 153.5 SC 101.3 SC' 1.51.0 Sb 98.0 SD' 150.0 SE 95.0 SE' 148.5 SF 92.0 SF' 147.5 SG 89.5 SG' 146.5 SH 87.5 SH' 146.0 S I 86.3 SOH 1'46.0.. Si 85.5 $j 145.0 SK 85.3 SK ' 145.0 SL 85.0 SL' 145.5 SM 84.5 SM' 146.0 SQ 79.0 :a h, O O '1� Q Q�Q U .�P �5 � \QG P� 3J a� 20 7 '1'1. T LABORATORY OF DAN CT Cert: PH-0404 -3 MILT, pLAw ROAD - DAsBuRy, CT 06$11 NY Cort: 11471 (203) '148-7903 - PAX (203)74&.0652 LABORATORY REPORT WATER SUPPLY TESTING AST LLC DATE SAMPLE COLLECTED: 4/21/99 DRiVF. TINE COLLECTED: 3.-15 P.M. 0811 i COLLECTED BY; 4/27199 DATE RECEIVED 0. LAB: 4/27/99 TESTED BY., LAB# 11471 & 11301 REPORT DATE: 5/5/4.9 LOT-4 QUAKER MANOR, SOUTH QUAKER HILL RD, PATTEkSON, N.Y. 1A, F_: KJLTC;*%,N Wj&L.L I . NOW! 1xia—) !RESIJL- MA2MfiM CON 'LEYE 111301 , M r , vm, 13 L6i lAl"linity 37.0 Color. i 0 OdQr:. ND PH. 5.81 Turbidity 0.26 Nitrite N: <005 -M�90 N ' 4 1 lAl"linity 37.0 Hgidaess 104.0 Iron i 0.047 Manganese I 0.022 per 100 ml 0 per 100 ml - no designated limit NTUs 5 NTUs mg/L as I mg/L as N mrl as N 10 mg/L as N mg/L no desig,nated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L (Nato: Combined Limit for Iron plus Manganese ;z-0,50 mg/L] :Sbdiuxit 50.2** mg/L 20 m - g/L-'** Lead 0,005 mg/L 0.015*** a ell,-i milur" *s per Liter ND - hone detected NTU-wVn.'it5 "*Aotion Ltbtl D; ON SA''LES SUBMI TTED.-4 /27199 ST K0 0 (j, V E: - 1x AOTABLE or OT.POTABLE �riPT.0FkEkLTH3zRVIM, TA.DARDS- FOR POTABLE TP_R) Laboratory Director 129 MILL $TKELT,.5ERLfN, CT 06037• (860)828-9787 -FAX (860)829-1050 T6Lt FREE WITHIN CT. 900-826-0105 * OUTSIDE CT: 900-654.1230 TOTAL P-01 --------------------------------------------- ---------------------------------------------------------- MHY -12 -99 WED 13:5-7 "CESARE— ENG... 914 278 8656 P.01 PUTNAM COUNTY D1 PARTMI NT OF HEALTH DIVISION UE ENVIRONML, NTAL I- 11`ALI'II SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Wrifi` a sir'_ Owner or Purchaser of Buildi e _W_q 4' /enq Building Constructed by Ae Location - Street 14,a,v Building Type IfI!o 2.1 Tax Map -Block 1,0( P?Z4Cs' a ow TownJVillage Qt-, #�+w 0A_ Subdivision Narne Subdivision Lot # 1 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 .Iaepartmcnt 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 year, 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 riot 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 � Dav Year" ko General Contractor (.Owner) - ignature Corporation Name (if corporation) Address: Signature: Title: Corporation Name (if corporation) Address: State _ ^ Zip _ _ _ State. _- -- -Zip .- Form (is­- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI �37T] GE TREATMENT SYSTEM PERMIT # Located at � Q c�(A Town or Village PA --TT2" v t — Subdivision name (QL « L.. MI? Subd. Lot # Tax Map Ch / G Block—/ Lot Date Subdivision Approved l 2,1-7 2!9— Renewal Revision Owner /Applicant Name��,^s"r` e441- �� L L-C Date of Previous Approval Mailing Address X I ov_, Sc_,;,;(_17_ G471cop DX 'D,9 .1 9"', on, Zip 0 � Amount of Fee'Enclosed Building Type Vq. f7f Av" F Lot Area t 05_ No. of Bedrooms �r Design Flow GPD s-°�• Fill Section Only Depth Volume -71 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 2 5 —.' gallon septic tank and Other Requirements: To be constructed by _ Address Water Suooly: Public Supply From Address or: _ Private Supply Drilled by &lyst'�•rc lg� Address CA2.►+A L't/` .P — 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. R.A. Date /7 1 License #// 2 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 rriodified 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. gy: Title: Date: 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 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address C � C4 �� (✓Z Located at (Street)S Tax Map PI /6Block� Lot (indicate nearest cross street) Municipality Su Drainage Basin SOIL PERCOLATION TEST DATA C� Date of Pre - soaking" 7 /�9 ��e Date of Percolation Test 71 /s 7 NOTES: 1. Tests to be repeated at same depth until approximately ega'al- peFea'lation 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 i' r Depth to Water Water rom Ground Level Percolation Hole No. Run No. Time Start - Stop Ela se Time Min.) Surface (Inches) Start Stop Drop n Inches Rate Min/Inch Y11 2 ; 7 17 �� l3/ l L/ 3� 3 S'� S; 7 4 5 2 t 7 2. 6 4 5 1 _ Uv yv9 3 a' h 4 5 Rq ,p�yt NOTES: 1. Tests to be repeated at same depth until approximately ega'al- peFea'lation 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 i' r pump -�4 PUTNAM COUNTY DEPARTMENT OF HEALTH b ° Z3l�14?� DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected y: a, Street Location 5&aZ& Qa a4!�r-1z Owner 4AM7) 2 L C Town NX:r7 TC 5 ©m/ Permit # ?7 TM # Y. /a - / - Subdivision Lot # 5 " Q c A Kt R MA A/oP 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ...... ..1,25 .........other ................ b. Septic 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 ........... ............................... f. Trenches T.-T-e-n—gth required 80y Length installed 8 626 2. Distance to watercourse measured +d- o o Ft.......... 3. Install c or ing to . . .............................. 4. Slo of e Eoperty cceptab /16 1/32"/foot.., ........... 5. 10 om line - 2 ft.- nd tions ........ 6 Depth tre h <3 i h fro s ac ................. 7. Ro rw ex" Sion; 0 ........ ..... ...... 8. Siz 2 la eter c e .................... 9. De el in trench 12' minimum ................... 10. Pipe ends capped ......................... ...`........................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank .......................... .................................. 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House ocated per approved plans ................................. b. Number of bedrooms ......................... ..... r ................ IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured od ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 a o Sheet of `PUTNAIVI COUNTY DEPpRT1VIENT OF HEALTH ._ DIV"ISIONOF ENVIRONMENTAL HEATLI:SERVIGES FIELD ACTIVITY- REPORT " NAME • ? i2,4 K / 1 /4 Teh AblHiES.k. !02 tQda I& - Street ToWn . ' :State ' `.; Zip PERSON IN CHARGE 9 Name "and' tle TYPE OF FACILITY: f y1�,1 g old �v �v��..- Sv. c`�` "S f2 j FINDINGS x k a ; !F ? r " 1 _ £ . .f Signature and Title $FPCIRT.RF.(''F VED RY: . I acknowledge receipt of this report SIGNATURES: ,'02/96 Title. a PLJ1'NAM COUNTY 1DEPAItT'MENT OF HEALTH DIVISION OF ENVI1tONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P '2-Y 17 Located a a G% Ir/P Town or Village Afteic � ax Map 7 �d Blok Owner /Applicant Name \At&-3r n Y - � ' Lot Formerly Mailing Address -G C-a /u ,,L Subdivision Name Subd. Lot # Zip 6 �'S-ti Date Construction Permit Issued by PCHD -2,/10191 Separate Sewerage System built by Gicffla et.c-, tjo L=4=& Address Consisting of `��� Gallon Septic Tank and FOTJ %fer analysis result for 0dit'ml ('°la) if, -.- Ytl .S d.#i! trV!lLl4lRiktl� 9U.lil",t 'G 096{afF ..«,.1 fiif'.��; 8.+ C. %i tie,. ?i.F e3R JlFlkt21�! 81t¢p. lyG: isi:4$+:d 45.T! Other Requirements: dr4 �k'.ing by People on se�e� � ;P;�. resiric; tin . ��ci;�:�y dicta. 'a�wr containing nfore Ulan :IV MQ /L OT $Od„W.IYTI LhC 010 iilOt h(2 USC O 0y PM)Pie On modomfo y Water SuRply: PublierSupplyiFrom diets. I'YJ'I'1�1ANI ('Address( DEPT OF HEALTH or: Private Supply Drilled by Address Building Type Cd Has erosion control been completed? Number of Bedrooms 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- bl alt plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: <X 6 f Certified by S�Ic� /� i �� CAS �r P.E. R.A. (D 'gn Profes Tonal) Address � A-k- Q r 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 private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio mo ificatio r change is necessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 k NORTHEAST LABORATORY OF DANBURY 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 CT Cert: PH -0404 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING . REPORT TO: PROPERTIES EAST LLC DATE SAMPLE COLLECTED: 4/27/99 20 COLONIAL DRIVE TIME COLLECTED: 3:15 P.M. DANBURY, CT 06811 COLLECTED BY: 4/27/99 DATE RECEIVED @ LAB: 4/27/99 TESTED BY: LAB# 11471 & 11301 REPORT DATE: 5/5/99 SAMPLE SITE: LOT #5, QUAKER MANOR, SOUTH QUAKER HILL RD., PATTERSON, N.Y. SAMPLING POINT: KITCHEN SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor ND pH 5.81 no designated limit Turbidity 0.26 N T Z7s 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N 11301 - Nitrate N 4.2 mg/L as N 10 mg/L as N Alkalinity 37.0 mg/L no designated limits Hardness 104.0 mg/L no designated limits Iron 0.047 mg/L 0.30 mg/L Manganese 0.022 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 50.2 ** mg/L 20 mg/L ** Lead 0.005 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTEDA /27/99 SAMPLE, AS TESTED ABOVE: AMPOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800- 654 -1230 FROM : BOYD ARTESIAN WELL CO FAX NO. : 914 225 8420 4►M COOy WELL COMPLETION REPORT DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT Of HEALTH May. 20 1999 09:58AM P2 Office Use T" =0 NuMaL : L -t 'A.2 WELL LOCATION STi{EeT AOpntSa: _ y ;I _ AMC ADDRESS: G PRIVATE '.� ' `t l'r�.: j-".. ❑ PUBLIC WELL OWNER U rv, u,� :/ USE OF WELL i'I RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED I - primary O BUSINESS O FARM ❑ TEST / OFSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL 0 STAND -BY p MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR []REPLACE. EXISTING SUPPLY ® TEST/ OBSERVATION [3 ADDITIONAL SUPPLY DRILLING ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH a( SS' tL STATIC WATER LEVEL -j , ft. DATE MEASURED DRILLING Q ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT E3 WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH _ tL MATERIALS: lm STEEL O PLASTIC Q OTHER LENGTH BELOW GRADE _.,, L_ tt. JOINTS. O WELDED 0 THREADED 0 OTHER CASING DETAILS DIAMETER __ in. SEAL: fp CEMENT GROUT D BENTONITE OOTHER WEIGHT PER FOOT _ 1b./ft. ORiVE SHOE:13 YES ❑ NO I LINER:OYES PNO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) OEYELDPED? DETAILS FIRST ___ 4 YES SECOND .PRO HOURS GRAVEL PACK o NO GRAVEL DIAMETER TOP sonw SIZE: Of PACK }n. DEPTH tL DEPiH n WELL YIELD TEST t It detailed pumping WELL LOG it more detaiied formation descriptions or sieve analyses MEi}500:il PUMPED t tests were done is in- are available. please attach. 0 CDMPRESSED AIR ; rr ation attached? 03UruACEM W't" W`II Bear- O (SAILED O OTHER i IF TES O NO D h � teeter i0R1AA11GN GESCHiFLiON CM WELL OEPM IL ' DURATION Ar_ min. ORAWDOWN 1L YIELD 4Fm. Suna cc �' / :/ :;; Ct�i WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES OND ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAIT. PUMP INFORMATION TYPE CAPACITY WELL DRILLER NAME n (0 rTS7 U �9� ►axat DEPTH IR �I �. S a h tDD>:i, VOLTAGE — HP �' GJl w►. q ( °N U, � /�i�i'✓ i ��� A 5 Id C_ zof�S;G 1)1111:; .L(: {•1 OF l*cI:v'JJ2O- .,- :-Z,:1 %1. i:.' 111:17:- •r�Zi�.l.�; ?`' w; rNJOSCD BY Met, P.C. H.D SIiL_- �t11i5:i1 tiC O-UP OLi O. �1L StSI".N 1'�,� ND.��_ _ C>-ine LOFT COrR,&sohN e2p&.3 AadrCss Lotrtc-d at (Street) S (lA kerl HILL ROOD -- Block Lot (andicm- to nearest cross street) cA ^_oality GZUAK _R MANOR 3QRDIV�9fQN wzt`. -spec CI�oTON axi. D�MUMag T� aAm Ra:c .�.n TO EE sJr - wz t nPPT.sOrzc s Date cf P- -e-Sc& ng -7/ : De to of Pe-cza ztica Test ` �°" . a 33 /y� ay3 /yn A SOLI. sa :31:.:: ` ay" i2 EER an= T--B 3fy� yo PMmr.•.MCU F= F1.2w2 Depth to wl-_te F-1-cm S -tt-e - XAVe1 210: Tim GrcUnn St ..:er 7m Incaes Soil- Rate- Sit Stco Hin. Star` -Stoo Drop xn Mirv-rn Drc o r..ncbes 1--es . riches taoa oiN `a6 ! /y` 30, V 31111 la:o3� ld, 33 -� If 31 �a:o ` �°" . a 33 /y� ay3 /yn A 1a:o�- sa :31:.:: ` ay" ay3ly• 3fy� yo a4'' 3 11,3a - taoa oiN air 4 la:o3� ld, 33 3 �, oM.�1 a y "• as 3�y` 5 1 %(Z s �g 1. C ^ . 't OR 4 =a. SEAL •°= w,._ . s 11 ',`��''..,, 7� • �.� °�,,` A 0 FESSIONP� 7t--sts to ZLe3 a fzn-- deoth until aporoc-.imatC I y C=_ual soil zaLc, are cb(:aine_i at a3ch percolatioc, tesL- bole- All data to be subni.U,36 for revie•,4. z_ (�e�C.i rneasure�l,:�t; (:n lx nos [-eT, (on oC hole_ I A PEWOUTION TEST DATA t i ima DATE Lt / 2 G Inspector Aryf,•.:_.:LA - NAG iJF_ P aC '•o. Teut Hole No": _ Teat - " -• 11010 Depth ..Soil Type Soaked TEST RUNS 1 2 3 1 4, S 3of1 J Y� S F IV%0Z. to.01.► '.S3 12: is iZ:l S �� ,�.0'1 it: �� 14 T '3 i+i ln�.- ... MIN " ,01 rlinl' :' . °I I+1•�J h .7►riV p v S �..! ...... IO.l - 41•S(f 72.01 12' T 3 rt"t. U m,nJ. t4 nrinl Min/ r d... � �(PE� 3� GS. S o 11 'C,-7 it-. (0., T 3 .0 _ `•?� OA�E .N� • CY':i T j ... ... P(�l =.,iG ... � .t _. _. �� c . .. �- LI! Z4 �i 37 S 1'2 70 �Z, t M Cs i2: 4: �c T vn "1 t � 3 0 t1r5 1 F S fo. -4 2 T »1� "i.) � rt�N. :-,sir w►�N .,�'•� t f�G J '-s :T: ',,�. ` Lrwr�i.► = . I a �. ryi x.. .S T Z....._. S YF F 11 Z. it LEO . ti". So T .2 a I It in i,.1 17 Rt t;..# g 0 Mil✓ F S T F S T _ . -.. F -i S T 0 the undersigned, certify .that. -thoue porcolation test , re done by myself or under direction according to the atandard procadurn.:' -.'ThQ ca and results resented am correct. .` OF W y0R e ced: 3 5 P� . C Signature �E y J �F icen.se too. (P.E.) (L.S.) �h� _r �._ rw NO. 411 el DEEP TEST RESULTS Date: d-p C, I G 19114 Name of property: t 1 A (C). -LO 1::::r COC—P. _JA4�1_ FoVws.... Engineer: Owner of "propqrty:n! k4i Rep: A�i �­&4f�4 Person directing'�_,teg.t:, M6,ell Z.-AZEC Hole: Lot Total Rock Water, Number- -Number ?..Ddpth Depth Dept �Soil descr ption 4C It Cr &A A vie cou 9 L4 tor•% Aur Gn vilpe F-7— P SOILS._.:: -,.,. -4 j r -7( ..... __ - 1-- ...._.. . 1. .. General remark' 4 OFESSI()N% C\ -spr nsso' streams,;etc-) VAKA Name Address PORA",- / . Signature SEAL Z A.- -4, sFAr.1 THIS SPACE MR USE By 'MAL01 K-911111, ..... �-' tILY Soil Rate Approved sq. ft/gal. d by Date L D�'TION OF SOUS FtJ000NTEEtED IN TFST HOLES ,. HOLE W. �t fit, 2' Lo e-- .30 4' mill -J: V 71 8 91 10, 1-2 131 c, I d&��a f M12:4 INDICATE LEVEL. AT GROONMATER IS EN000NTERED INDICATE I-MM, -1-IftT �'Va X)0L1?BaD?Xd1.­. 3W TER LEVM RISES.. AFTER -BEING E DEEP; H= 0W&1:M=6NS.4Qm BY zj:.e-,( t ��i DESIGN Soil Pate .Used -Drop; S.D. Usable Area, Piovided No of Bedroarts Septic Tank Capacity gals. Type Absorption AFea p=rovided By - L.F..x 24" width trench Other ...... S F L 61 —(If crz_. -51 tz5_E T OR Name Address PORA",- / . Signature SEAL Z A.- -4, sFAr.1 THIS SPACE MR USE By 'MAL01 K-911111, ..... �-' tILY Soil Rate Approved sq. ft/gal. d by Date �--v�" N emu c-o� 23 1 StiMr- SUBSUFACE SEKWE DISPOSAL SYS EM NJ. L 1 l ,, o-�'-t' Carp- I Jack F&r her !w ��• A c.. -,,, Address "ted at (Street) Sec. Block Lot (indi— to nearest cross street). . c,. DoT Municipality pn I .Mon - Watershed - CrOJO n • SOIL PERCOLATION =D= RDQUIRw m BS'suanrnm wm APPLICATIONS Date of Pre- Soaking • 0 i3 Date of Percolation Test 1 D /Z3 lV 7 a HOLE . NUMBER a-= TIME PEROQLATION PERCOLATION Run Elapse Depth to Water Fr a Water Level • No. Time Ground Surface Ii Indies Soil Rate Start-Stop Min. Start �.. Stop Drop In Mu1/In.Drop m Inches Inches Inches A 14 Z10 '30 - Z` 2-Y, 40 2210 245'. 3' 12'-1 2,1 0 S 4 qo . 3 _ < SEAS - 4 � s X980 11 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Ile, DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Glesr A4,40 J_ e Address j�.eyv%s'� ela* Located at (Street) S. (eyr3.r 91/ e-D Tax Map 7% 6 Block— Lot ^ 2� (indicate nearest cross street) Municipality �A ✓emu•- Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre-soaking s g �%� %y �fi" � ,Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinfInch 2 -2-112.1 2, 3 /l 21 Z 3 3 3j 3 4 2 5 1 2 3 4 5 1 2 3 4 of NEW y 5 NOTES: 1. Tests to be repeated at same depth until approximately equal I percolation test hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min submitted for review. 2. Depth measurements to be made from top of hole. v •�.�o D -97 at each to be SSDS DESIGN REPORT QUAKER MANOR SUBDIVISION LOT # 5 by: Julius I. Cesare, P.E. 64 Blackberry Drive Brewster, New York 10509 914- 279 -7115 Revised: October 26, 1998 QUAKER MANOR SD LOT # 5 4 Bedroom Design Design Flow: 4(200 gal /bed) = 800 Gallons Perc Rate: 31 -45 Application Rate: 0.5 Req. Area: 800/0.5 = 1600 Field Length: 1600/2 800 Septic Tank: 1250 Gallons Dosing Volume: (pi)(2/12)'(806)(.75)(7.5) RLI: 813.0 Use 13 lines, 62' long each System and Expansion 2.5 Feet Fill Required 0 = 395 0 QUAKER MANOR LOT #5 PUMP DESIGN 4 Bedroom Design Design Flow: (4)(200 gal /bed) = 800 Field Length: 800 Req. 800 Provided Dosing Volume; (pi)(2/12)2 (806)(.75)(7.5) = 395 Gallons PUMP PIT Use 4 x 6 (180 Gal /vent PT) Dose Depth = 395/180 = 2.20' 1 Day Storage 800/180 = 4.44' Pump Static Head Pump Pit Outlet 812.39 DB Inlet 833.40 21.01 Length of Force Main 190 EQ Pipe 2 90' Elbow 11.0 1 Check Valve 13.0 1 Gate Valve 1.2 25.2 Total Length of Pipe 190 + 25.2 Say 215.2 Pipe Losses Total 215.2(3.11)/100 = 6.7 Total Losses 21.01 + 6.7 = 27.7 Use Gould WE 511H 35 THD @ 40 GPM 1/2 HP 115 Volt Single Phase 3500 RPM Performance Curves METERS FEET r 90 r — r--r-- MODEL 3885 SIZE 3/4" Solids 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I I I 0 10 20 30 m3 /h CAPACITY [qGOULDS PUMPS. INC. SENECA FANS NEW YORK 13148 METERS FEET 120 35 110 100 30 90 25 80 Q 70 w X 20 J H 60 0 H 15 50 40 10 30 20 5 10 0 .0 - WE15HH MODEL 3885 SIZE 3/4" Solids 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 ml /h CAPACITY :e' 1985 Goulds Pumps, Inc. Effective July, 1985 25 80 a 70 w t 20 J H 60 0 1- 50 15 40 10 30 20 5 10 0 0 MODEL 3885 SIZE 3/4" Solids 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I I I 0 10 20 30 m3 /h CAPACITY [qGOULDS PUMPS. INC. SENECA FANS NEW YORK 13148 METERS FEET 120 35 110 100 30 90 25 80 Q 70 w X 20 J H 60 0 H 15 50 40 10 30 20 5 10 0 .0 - WE15HH MODEL 3885 SIZE 3/4" Solids 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 ml /h CAPACITY :e' 1985 Goulds Pumps, Inc. Effective July, 1985 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: Wfl- 0WE ,L,Awt> r� ol Scc"p— i 2. Name of project.aA&- S A ,tot �` 3. Location TN: T Di4 soN 4. Design Professional- Ju j% 5. Address: 6. Tyne of Project: K Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental. Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt` Type II Unlisted < 5- 8. Is a Draft Environmental Impact Statement (DEIS) required? .........................o 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 12. If so, have plans been submitted to such authorities? ........ ............................... 13. Has preliminary approval been granted by such authorities? Date granted: 14. Type of Sewage Treatment System Discharge ........... : ..... surface water a groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? ............. :........................ /va 18. If yes, name of water supply Distance to water supply _ 19. Is project site near a public sewage collection or treatment system? ................ V1. 20. Name of sewage system — Distance to sewage system '- 21. Date test holes observeoUl S 22. Name of Health Inspector & Form PC -97 2 23. Project design flow (gallons per day) ................................. ............................... _ 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /((a 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion'of this project located within a designated Town or State wetland? A% 27. Wetlands ID Number ...... ............................... 28. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town of Local DEC office? 29. Does project require a DEC Stream Disturbance Permit? .. ............................... Df�� 30. 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 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... N10 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ......................:.......... ............................... 34. Are any sewage treatment areas in excess of 15% slope? ....!.#... t........ -94.) /1d 35. Tax Map ID Number .......................... ............................... Map Block — I Lot '2 5 36. Approved plans are to be returned to ..... Applicant e'�–_ Design Professional 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 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... 0 3-D S lujer -vUTA M P(TrNAM COUNTY DEPAR'TME'NT nF HEALTH DIVISION OF ENVIRODP=AL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PU`lNAM COUNTY HEALTH DEPARTMENT TO: Cammissioner of Health In the matter of application for: I, Cm represent that I am an officer or enployee of the corporation and am authorized to act for on) having offices at 2y Whose officers are: President: Vice - President: Name and address (Name and address) Secretary: (Name and address) Treasurer: (Name and address) G' o I <i and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 4? t day Signed: of�� No Title: &01- Corporate Seal 20 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Date It 2, /9 9.< NO] Located at &'o t4 ©U,4 enl, f�i /f �• M_ VA xso.ti Section /o Block /. Lot 2'�F- Subdivision of- �%u,�'�,. R,A•yoR / Subdv. Lot # S Filed Map # 2C !J"" Date 71��9� Gentlemen: This letter is to authorize ti% �.�.�i u r 1. ( .E.SAer a duly licensed professional engineer or registered architect (Indicate) to apply for.a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with.this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign P.E. , R.A. , 2� &t:. t / Address jeI2 el-,x d6 Telephone Very truly yours, Signe ��Owner of Property Address Y AA C a �N Town "ZO T —712 Y-776 Telephone Julius I. Cesare, P.E. 64 Blackberry Drive Brewster, New York 10509 914 - 279 -7115 October 26, 1998 Bruce Foley, Director Putnam County Health Department ATT: Robert Morris 4 Geneva Road Brewster, New York 10509 RE: Quaker Manor Lot #5 Revision Dear Mr. Foley, The applicant had previously received approval from your department for an individual SSDS Design on the above noted project. The applicant is now desirous of changing the house location such that the design will now call for a pump system rather than a gravity system for the SSDS. The design of the lateral system has not changed except that we are now calling for a fill on both the system and expansion areas as required by the New York City DEP. Please be further advised that the plans have been revised to incorporate any changes to your requirements with regard to details, notes, etc., that has taken place since our last approval. Herewith submitted is a complete package of required application data and SSDS Design Report along with three sets of plans as per your requirements. Very truly yours, Julius I. Cesare, P.E. METEH5 FEE► r 90 0 10 20 30 40 50 60 70 80 90 100 tlu 1zu GPM 1 I I I 0 10 20 30 m' /h CAPACITY [qGOULDS PUMPS, INC. 5E ECA FALLS NEW Y0PK 13148 METERS FEET 1 120 MODEL 3885 25 110 80 100 30 Q 90 70 w Z 20 Q 70 W H = 60 O J H 60 H 50 50 15 15 40 40 10 10 30 30 5 20 5 0 0 10 0 0 0 10 20 30 40 50 60 70 80 90 100 tlu 1zu GPM 1 I I I 0 10 20 30 m' /h CAPACITY [qGOULDS PUMPS, INC. 5E ECA FALLS NEW Y0PK 13148 METERS FEET 1 120 MODEL 3885 0 10 20 30 40 50 60 70 80 90 100 110 . 120 GPM I I 0 - — 10 20 30 m' /h CAPACITY x1985 Goulds Pumps, Inc. Effective July, 1985 35 110 100 30 90 25 80 Q 70 W = 20 J H 60 O 50 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 . 120 GPM I I 0 - — 10 20 30 m' /h CAPACITY x1985 Goulds Pumps, Inc. Effective July, 1985 FUngAM COUNTY DEPANISIENl' OF HF.Al,TH Dlvlelae ed ivAroaasW Hedtb Services. Caney. N.Y. 10512 &%borer to Faovlde Pesasft I eo CERTD?ICATB OF CO CS CO C11ON,P,ayM,M Fait SEWAGE Dl,S/IOSAL SYSTEM � # P14-- Toone or VMqp Stfbdivmn Name fi:il�� !1? No etrbd Lot Y 7/ �O 2'S Tea Mop rya Bestetrd_ p Revhbe p Oweee /AppYfeot N�e_'I�C ^�'T'E�4-S'�` i`� "�Q.cts'� Date of Previous Approvd MaYEae Ad&. 'lW ©A>LXVIP, Z Ct 0a-11 Tom ZIP Date8ubdivision Annroved / 2 1;Z Fee Enclosed 2" Arnnii,f- 300 (� baddg 'Type W000 Arl Lot Area �. D FIR Section Only Depth 2,5_ vdume c) : nr Nwmber of Beehuams Desip Flow G P D Si_V a PCHD Notifltatioe to Regained Wheat FM Is coundeW Sepoate S -caw System to,mm d ' L<b Gwim Septic Task avl 6- L-)o To be oeentraided by Address Water SOP* PIfb& SI* Feum Addma on P" gate Sq,* Dated by ____Add . Other Re"Aremena I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage di saI s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ions o nam County DepartmMlt of Health, and that on completion thereof a'- Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner. his successors, heirs or assigns by the builder. that mid builder will Place in good operating condition any part of said sewage disposal system during the Period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compile of the orgi I stem or any repairs thereto; 2) that the drilled welt described above will be located as shown on the approved plan and that said wolf will b stalled in eon ce wit a standards, rubs and reeu aTions of the Putnam County Department of Health. Date Sign . P.E. _ R.A. Address ) 4-k,,r 7 license No APPROVED FOR CONSTRUCTION: This approval ex iras two y r the date issued unless co ruction of the building has been undertaken and is revocable for cause or may be amended or modified when consider' cc ry b Commissions of Health. Any charge or alteration of construction sequires� * pa►fmflj Approved for disposal of domestic sanit go. a / rival. water supply only. Rev. Ir(� (/ 'y/- 10/88 oats By Title PUTNAM COUNTY HEALTH DEPT. 4 Geneva Road (914) 278 -6130 . Brewster, NY. 10509 Received of The Sum Of- For ❑ Cash ❑ Check 018146 Date q-119-Fe Dollars $ 46SZ7' i�'d _ M.O: I] Credit Card YOU! D 0o0aft" 1 1 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION a /1 /I JOEL A. MIELE, SR., P.E: Commissioner PHONE (914) 742 -2001 FAX (914) 742 -2027 September 18, 1998 Mr. Julius I. Cesare, P.E. Blackberry Hill, Brewster, New York 10509 RE: Quaker Manor - Lot #5 Log # 7182 Town of Patterson, Putnam County East Branch Reservoir Dear Mr. Cesare: WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Bureau of Water Supply, Quality and Protection Enclosed please find the New York City Department of Environmental Protection's (NYCDEP) SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION for the above referenced property located on South Quaker Hill, Road in the Town of Patterson, Putnam County, New York (Tax Map# 4.10 -1 -29, Lot #5). This letter is to inform you that your application to engage in the above referenced regulated activity pursuant to the "Rules and Regulations for the Protection from Contamination, Degradation, and Pollution of the New York City Water Supply and its Sources" (Regulations) was approved on September 18, 1998. The Department reserves the right to modify, suspend, or revoke this approval based on the grounds set forth in Section 18 -26 of the Regulations. The activity proposed in your application only apply to the terms of this approval and are subject to the Regulations cited above. Failure to comply with the conditions of the approval may be the cause for suspension of this approval and initiation of an enforcement action. Should modification, suspension or revocation of an approval be necessary, NYCDEP will notify the regulated party, via certified mail or personal service, prior to modifying, suspending or revoking the approval. The notice will state the alleged facts or conduct which appear to warrant the intended action and explain the procedures to be followed. Prior to the commencement of any construction requiring a building permit, the applicant must provide at least 48 hours actual notice to the NYCDEP engineer or their representative making this determination. 465 Columbus Avenue, Valhalla, New York 10595 -1336 Mr. Julius I. Cesare, P.E. Re: Quaker Manor - Lot # 8 Page 2 of 2 September 18, 1998 A copy of this determination must be available at the project site during construction. One set of plans bearing our conditioned stamp of acceptance is enclosed. Once the project has been completed and inspected by a representative of this Department, a copy of the As -built plan shall be sent to this office. If you have any questions regarding this approval, please contact Jannine McColgan at (914) 742 -2068. Sincerely4Lloy, Margaret E. Supervisor Engineering Design & Review Encl: plans cc: Robert Morris, Putnam County Department of Health (w /Encl.) Mr. John Calbo, Building Inspector, Town of Patterson(w /Encl.) James Covey, NYSDOH Thomas Scott, owner Bxc: Sadosky H. Meltzer Lloyd /McColgan File 465 Columbus Avenue, Valhalla, New York 10595 -1336 o New York City Department of ENTALPR Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State Public Health Law; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its Sources, 15 RCNY Section 18 -39 (or Chapter 18); and 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems. New York City Department of Environmental Protection makes the following determinations with respect to the sewage disposal system(s) plan described below: Name of Project: Quaker Manor Lot 5 Tax Map Number - 4.10 -1 -29 Location: South Quaker Hill Road, Town of Patterson, Putnam County, NY Owner: Thomas Scott Address: Properties East, L.L.0 c/o Thomas Scott 20 Colonial Drive Danbury, CT 203 - 792 -4776 Drainage Basin: East Branch Reservoir Type of Sewage Treatment System and General Description: Subsurface Sewage Treatment System for a 4 bedroom residence. The system consists of a 1250 gallon septic tank and 806 lineal feet of absorption trench and is designed to treat 800 gallons per day sewage effluent. Additional area exists for 100% replacement of the absorption area. The system shall be installed in accordance with the three plans titled Quaker Manor SD Lot 5 'Plans', 'Fill Placement', and 'Profiles and Details', dated May 8, 1996, last revised September 8, 1998, prepared by Julius I. Cesare, P.E.. Dates of Site Inspections and Soils Tests Deep Hole Tests - 1994 Percolation Tests - 1994, May 1998 Page 1 465 Columbus Avenue, Valhalla, New York 10595 -1336 M SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION ( XX ) Approved ( ) Denied Conditions of Approval: There shall not be any joints where the curtain drain intersects with the effluent sewage trench. The effluent line shall, at a minimum, be encased in a PVC sleeve for 10 feet in either direction of the intersection. 2. Where fill will be placed on the subsurface treatment system area, trees shall be cut at ground level. The area shall then be plowed perpendicular to the ground slope to a depth of 8 inches. The fill shall be placed on the perimeter of the site and pushed into place in such a manner as to minimize soil compaction. Prior to the commencement of any construction requiring a building permit, the applicant must provide at least 48 hours actual notice to the NYCDEP engineer or his representative making this determination. 4. The facility shall be constructed and completed in accordance with the engineering report, plans submitted, specifications provided, which form the basis of this approval, and in accordance with the conditions of this determination. 5. This approval shall expire and thereafter be null and void unless construction is completed within two (2) years of the date of issuance or within any extended period of time approved by NYCDEP upon good cause shown. 6. The applicant will provide "as built" plans to NYCDEP, certified by the engineer. 7. When installed the system must be operated and maintained in accordance with NYCDEP Regulations and all other applicable regulations and /or standards. 8. In the event that the material submitted is inaccurate or misleading, this approval is not valid and construction of the SSTS is in violation of NYCDEP Regulations. 9. This determination constitutes approval only of the physical design of the septic system for proposed installation and operation on a watershed of the New York City Water Supply. An approval of the septic system design does not effect any existing property rights, title, or interest, including without limitation, any public or private restrictions upon the use of the land. Therefore this determination shall not be considered to be a grant or waiver of any property right. Page 2 465 Columbus Avenue, Valhalla, New York 10595 -1336 a: SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION 10. The sewage disposal system shall be constructed in conformity with the data and plans as approved or commented upon. Any change in the system must be approved in advance of construction by this Department and any other agencies with regulatory authority, including but not limited to county and state department of health. 11. The system shall receive only the domestic sewage from the structures shown on the plans. The nature and quantity of flow from the structures shall not be changed without prior approval of this Department and the Department of Health. 12. All parts of this system are to be operated and maintained properly. In no case is sewage or sludge to be exposed or any other unsanitary or unsafe condition to be created because of the use of this system. Guidance on standards is found in the Waste Treatment Handbook issued by the New York State Department of Health under New York State Code of Rules and Regulations (10 NYCRR Part 75). 13. Whenever sludge and scum shall so accumulate in any septic tank so as to occupy together at any point more than one -fourth of the distance between the bottom and the flow line, the tank shall be cleaned. 14. Whenever sludge and scum are removed from any septic or settling tank or any part of the system it shall be done in such a manner as to cause no nuisance, and the material shall be disposed of in accordance with all applicable regulations. 15. This approval shall not be construed to invalidate any rule or regulation enforceable by local authority having jurisdiction. Date: September 18, 1998 Determination in Margaret L oyd, Supervisor Engineering Design and Review Recommended for Approval: dJannine M. McColgan taff Civil Engineer Engineering Design and Review This determination letter must be maintained by the applicant and be readily available for inspection at the construction site. Page 3 465 Columbus Avenue, Valhalla, New York 10595 -1336 00.....z, a. .. I _ . 1'14`1' -11=1_ 94 1 6:41 I I1: I,INTEF D 1� wP May 10, 1994 Julius Cesare, P.E. Blackberry Hill Brewster, New York 10509 New York City Department of e: Quaker Manor SSTSs Envlronmontal (T) Patterson, Putnam County Protection Dear Mr. Cesare: Burvau or water The Department has inspected the deep boles, witnessed the percolation testis Supply & Wastewater and inspected the sites for ten proposed individual subsurface sewage disposal systems Collection (SSDS) for the proposed project. The lots are shown on the site plan labeled Final Plat Quaker Manor and dated 4/4/94. T"ne ten SSDSs for lots 1 -10 meet the requirements of 10 NYCRR Appendix 75 -A. The ten sites as located on the Final Plat are approved Sources Division for SSDSs. Requirements for final individual SSDS drawings for construction approval (914) 742.2012/3 Will follow shortly. Division or Delnking Should you have any questions, please call: 914 - 742 -2065. wator Ouallty Control (914)742.2080 Sincerely, 465 Columbus Ave. suite 350 — Valhalla, New York 1OS95. 1336 � � VY _ Ja s W. Roberts, P.E. Program Engineer Commissioner xd: Town of Patterson Planning Board Putnam County Department of Health RICHARD D. GAINER, P.E. Depstty Commissioner Julius I. Cesare, P.E. Blackberry Hill Brewster, New York 10509 914 - 279 -7115 May 1.5, 1996 Bruce Foley, Director Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 Att: William Hedges RE: SSDS Quaker Manor Lots 1 -10 Dear Mr. Hedges, We are herewith transmitting completed construction permit submission packages for the above noted 10 lots of the Quaker Manor Subdivision. This letter will serve as a transmittal letter for all 10 submissions. A copy of the letter will is included in each of the submission packages. In accordance with department requirements we are submitting the following: 1. A completed Construction Permit Application. 2. A letter of authorization for the Engineer for each lot. 3. A corporate resolution for each lot. 4. An Engineers Design Data report for each lot. 5. Three sets of plans sealed by the Engineer containing all the required data as outlined in the Departments policies. 6. As these lots are being sold unimproved but with SSDS Approval, we are not submitting specific house plans for each lot. Be advised the Lots 1 -8, and 10 are designed for four bedrooms and lot 9 for three bedrooms. We will advise buyers by providing copies of this letter that they are to provide you with house plans before start of construction. 7. We are providing Well Permit Applications on lots 1, 3, 4, 6, 8, and 10. Wells already driven page 1 1, ,i 1 will be used on lots 2, 5, 7 and 9. Logs of these wells are herewith included. 8. A certified check in the amount of $3,000.00 to cover the combined fees on all 10 lots is herewith included. The field data for lot 5 would indicate that no fill is required for the system design and a two and one half foot fill required for the expansion design. The plans are presented as such, however the toe of slope for the expansion fill will encroach upon the now to be constructed system. The two options are to build the system in fill or to request a waiver for construction of the expansion fill at this time. As the deep holes in the system area show more that sufficient depth it would not be good engineering judgment'to construct a fill. We are therefore requesting a waiver of the requirement that the expansion fill be constructed at this time. Please be advised that during the course of the subdivision design representatives of the NYCDEP did visit the site, review all available test data and determine what additional testing would be required. All that testing was completed and witnessed by them and again by your department. A copy of the NYCDEP letter is herewith included in each of the submittal packages. Thank you for your cooperation in this matter. Very truly yours, A C— Julius I. Cesare, P.E. page 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date P2 /L 2, /9 ,7c< Re: Property of Wr_- -TT 04-ST /c 1.7-y 7i2us � d v 7vr� S C-7?' Located at So---t-g Qu,44e, -A Fri /1 /4- (T) scti Section /0 Block /. Lot 2 5' Subdivision of 1,AZI A410'e Subdv. Lot # 5- Filed Map # Date Gentlemen: This letter is to authorizeS��, a duly licensed professional engineer '� or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of.the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign P.E. , R.A. , Address Telephone Very truly yours, Signed l- '�Owner of Property Address `DA11V rte, C." 'Y", Town —Z-0 T ? i Z x'77 C Telephone SSDS DESIGN REPORT QUAKER MANOR SUBDIVISION LOT # 5 QUAKER MANOR SD LOT # 5 4 Bedroom Design Design Flow: 4(200 gal /bed) = 800 Gallons Perc Rate: 31 -45 Application Rate: 0.5 Req. Area: 800/0.5 = 1600 Req. Field Length: 1600/2 = 800 Septic Tank: 1250`gallons Dosing Required Dosing Volume: (pi)(2/12)2 (806)(.75)(7.5) = 395 Dosing Chamber: SC 6 X 6 380 E = 28" RLI: 841.0 Use 13 lines, 62' long each System and Expansion 2.5 feet Fill Required on Expansion Only l -n % Is- C 2 a y� WILL L Vr1rLL,11V1Y 1cr,rvn1 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: f I WNIVIL l Y TAX GRID NUMBER:" a3 fS - - (a Vc f� zl � (till G(, CL -C,/lS 0 Ix S- P a WELL OWNER NAME: :70 to , mr 3 Q S 1214ta ADDRESS: L o W PRIVATE a PUBLIC USE OF WELL 1 - primary 2 - secondary [PRESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. /N0. PEOPLE SERVED 1� / EST. OF DAILY USAGE S-U (l(l Coal. REASON FOR DRILLING []REPLACE. EXISTING SUPPLY ❑TEST /OBSERVATION [ADDITIONAL SUPPLY [gNEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH _ SS ft. STATIC WATER LEVEL fj DATE MEASURED — DRILLING EQUIPMENT O ROTARY C9 COMPRESSED AIR PERCUSSION O DUG O WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED D OPEN END CASING 0 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH_ fL MATERIALS: Qa STEEL D PLASTIC ❑ OTHER .CASING LENGTH BELOW GRADE .1 ft. JOINTS: O WELDED . IO THREADED D OTHER DETAILS DIAMETER in. SEAL: 10 CEMENT GROUT ❑ BENTONITE 0OTHER WEIGHT PER FOOT _ 1b./ft. DRIVE SHOE 53 YES O NO I UNER: D YES ENO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (tt) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO HOURS SECOND GRAVEL PACK ❑ YES O NO . GRAVEL SIZE: DIAMETER OF PACK in, TOP DEPTH -ft. BOTTOM DEPTH It. WELL YIELD TEST 11 If detailed pumping ��-P P P 9 METHOD: LIMPED 11 tests were done is in- • COMPRESSED AIR r fp rr n!ation attached? • BAILED 0 OTHER i RYES O NO WELL LOG If more fable p formation descriptions or sieve analyses are available- lease attach. DEPTH FROM SURFACE Water Bear- in9 welt Dia- rtetcr FORMAnON DESCRIPTION Code It It WELL DEPTH tL DURATION hr- min. ORAWOOWN It. YIELD 9Cm- Land ) (l/LC� Qf� f as w� WATER 0 CLEAR TEMP, QUALITY O CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK : TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY VOLTAGE HP WELL DRILLER NAME i T OATS C/ StGuR RE �Q LtttQ -Ii Z �'► `IL�c !/� k) �`l'6�� G;r 3/89 — tlrl'L' LVLJIA 1.1 ' PUTNAM COUNTY DEPARTMENr OF HEALTH ' DIVISION OF ENVIRONmtNTAL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION ' FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPART TO:" Caunissioner of Health In the matter of application for: MAN r represent that I am an officer or employee of the y6rpomtion and am authorized w • • •• I • having offices at so- DAVIS C�le�r.oc `b2i� . we =1 C Whose officers are: President: (Name and address) Vice - President: (Name and address) Secretary: (Name and \address) Treasurer: (Name and address+ ` and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this dav of Sign -`�"�� --- Title:� -Z z Corporate Seal 20 WELL .� llEYAK'1'1`2k:tv1 Vr ttr.ALln Division Of Environmental Health Services PUTNAM. COUNTY DEPARTMENT OF HEALTH SWELL LOCATION STREET ADORESS: Wt4 /Y1L I l Y TAX GRID Numsbl: 50, Q iJAKER. HILL- PAT-t~ R,5o>\1 MAPS /3 z DoT WELL OWNER NAME: PD4)ln ADDRESS: 1-0 FT C'_0AjSTk1J0T 16n/ 2eEWS7t-,e N 8)VATE O USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING iBr NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION D REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 13 C% `� ft. STATIC WATER LEVEL _tt. DATE MEASURED 1-11-2-1 DRILLING EQUIPMENT O ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED 0 OPEN END CASING, OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH —,')– I _ fl MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH .BELOW GRADE _ _ fL JOINTS: D WELDED *(THREADED . O OTHER DIAMETER in. SEAL: 'OtEMENT GROUT ❑ BENTONITE ❑ OTHER , WEIGHT PER FOOT !b. /it. DRIVE SHOE YES D NO I LINER: O YES 0 SCREEN DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRS T DYES ❑ N0 SECOND HOURS GRAVEL PACK. o YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH tt BOTTOM DEPTH It. WELL YIELD TEST I It detailed pumping P P 9 METHOD: 0 PUMPED t tests were done is in- t )<COMPRESSED AIR , formation attached? 0 BAILED O OTHER i ❑ YES ❑ NO WELL LOG It more lableep formation descriptions or sieve analyses are available. (ease attach. DEPTH FROM SURFACE Water Btar. ing Well 0i4- In FORMAnoN oEscnarrioN CJGE It fL WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD 9Cm Ssure umac A ,aRow,� S�.4n'J 0 to To74Z IGf) JGN /ST Rf /3R04,J.v SEH�rJ 114 d MICA SCV /ST 0 __ Sf 4/�) /c/A TF�C .� 30 /r2/c19 Suv/sT WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME 0AIE �3o yD A,eT,ESi,9.(/ l��zc. Cct .zvC ADDRESS ,L6S RO UTE 'S2 SIGUATURE - -? - -7. % C fL�� 111._ �lj ,�� �c`� /L/. / 1 /C� S/ Z ,1-x.7 i19 �, - �_ n - -� .,. ;. • , . ` ,.. > -.. °�� ;:� ,.: ` ,j . ..� :.. ,, 3.."� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Inc/[ =SJ- �asr /� 1 -iz, us7`�� d� r-i S C-?T" Located at /aA (T) "4'o.ti Section /o Block /. Lot s Subdivision ofu�.�HYaR / Subdv. Lot # j Filed Map # 2C Date 7 Gentlemen: This letter is to authorize a duly licensed professional engineer '� or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Y Very truly yours, SignedC � -� J Countersign -Owner of-Pr operty P.E. , R.A. , 64124 Address AA,P- a�S A// Address 9/ 2 ?9 '7// 5, Telephone �! )r"-, c Town -ZoT -7 -7 z -77 Telephone PC -1 P U T N A M COUNT Y D E P A R T M E N T OF H E A L T H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Projectov 4, Sp 1.rse" 9599, 3. Location T /V /C: -(- fp,4' Wv 4. Project Engineer: J &'t L Z C_ FM9- 5. Address: A// License Number: Phone:ZTF-7#50' --r 6. Type of Project: k' Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted ) ,�y// B. Is a Draft Environmental Impact Statement (DEIS) required? ............. /� 9. Has DEIS been completed and found acceptable by Lead Agency? ........... •, 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? --Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? a 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... o r. 20. Name of sewage system Distance to sewage system 21. Date test holes observed - 7 22. Name of Health Inspector: /LEIS 3. Project design flow (gallons per day) ...... ............................... ° 11/9 0 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. /uo 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... �o 30. Is or was project site used for agricultural-activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. 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 DESCRIBE: 32: Is there a local master plan or file with the Town or Village? ........... 4/11 33. Are community water, sewer facilities planned to be developed within 15 years? X4 34. Are anv sewa4e disoosal areas in excess of 15% slope? ....... "o 35. Tax Map ID Number ........................ ............................... &0 - 29 36. Approved Plans are to be returned to: ................ Applicant_ Engineer if the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. 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 Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES &OFFICIAL TITLES: -c' .TILING ADDRESS: Aa- ��-^ Arrr.:auIA M PUi'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUI'NAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: I, Cm represent that I am an officer or employee of the corporation and am authorized to act for ( Name of having offices at Whose officers are: President: Vice - President: Name and address) (Name and address) Secretary: (Name and address) Treasurer: (Name and address) c G7U6s <i and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. �T Sworn .before me thisZ7'f' .. of /. a Signed: S Title: _0r� Corporate Seal 20 •. 'j�.Sl' Yl'1' lJtY" tcrA1u i ctrA-$ 1v tar. Jut Ml'1'1'1.0 W1.'121 "PlaCATION L - DESCRIPTION OF SOILS ENOOUNr�IN TEST HOLES No. 8 _2•A �, HME NO Z� HOEZ NO. 2 �t � ��. —toe 510.-1 �.� �1 ��•V�a cJ H► S,• �1'/ (.ova 1.. 1 �'1 � V/O w� Z S; r ry u Lo C- 3 ' ��d,r how►- 5��.'{ �."' 41 .. .�: 81 Y�o. 47 _ 9' 101 .. - - NCl 6r 12' . 231. .. , •2�-0 �n�elc� j•_n�n, man r'3. day►, 14' INDICATE LEVEL AT,, WRICH GROONDRATER, IS ENCOUNTERED INDICATE LEVEE M WHIC9 HATER LEVEL RISES AFTER, BEING IIJJOUNTEF2ID DEEP, HOLE OBSERVATIONS.NADE BY• DESIGN Soil Rate.Used Min/1". 'Drop: S.D. Usable Area Provided No. of Bedrooms: :' Septic Tank Capacity gals. Type Absorption Area Provided By .- L.F. x 24" width trench Other ,,..,,. F`t_ i i �. S► tz c T _,_ - .••�o. CORN „S ; %,. �w \ , Name *N G PORA Signature Address Q SEAL IWU SE.h i - �v THIS SPACE EbR USE BY EiEALTEi P1Zf; Y - N'q. _ ��" 1 �ssw Soil Rate Approved PP sq _ f t /gal . itheckod by Date / i r Lo Mew �2 3 SHIM- SUBSUFACE S3gWE DISPOSAL SYSTEM N0. Loly+ CocP•,JQck Sher ��•�' j�'�f C- -1 rE'SS 9rn/] rinr9sE ted at (Street) rj Z 15-IL t I ( Sec. Block Lot (indicdte nearest cross street). /M�Wnicipality - a I &Morn Watershed G�ci01� • SOIL PERCOLATION TEST DATA RDQi MM TO Be SUBbM= WM APPLICATIONS Date of Pre -- Soaking �0 i; Ig-7 - Date of Percolation Test 1 a'Z3 1e 7 a HOLE NUJBiER CLACK TIME PERCOLATION PERCOLATION Run • No. Start-Stop Elapse Time Min. Depth to mater From Ground Surface Start Stop Inches Inches Water Level- In Inches Drop In Inches Soil Rate Min /In Drop Qr 2210. 7- 3G' q° 5 NODS: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 -c.C) T w • ronsem 8.YMet. PX.H-b ;C.,j DVI:A S;U=- r-SJWUV --CS S PIPCZ SLS -4 143. owner I-OF-r Cop /,TohrJ F -R&&S Andress ------ ro=t--A at (S t--e-- U .9, 0 Lt A k e r, HILL Iq 0 p-D SCC. Block 1oit a3 (indicate nearest cross street) NCIT municipa-Lity (SILL 4 K-E AIJOR -SQ13j)'jVjc',9fON Watersbei—cf--, OIL PERCOUmaq �I aAm RBZ;=m TO P-17 SUEK-17= W'= Appma%ancvs 1>-t-- cf 13-re-Scaking 7I30182 Date of Percolzticn Test HOL;--- C=. M-S PERME111"MCU RLM Elzwz D-Sloth to Rater E*-#-Cm W-ate-- Level -Rat-_ NO. Tim_ GrCmd Sur face in Inches Soil SZ12x-t-Stoo Him stz_rjl- -Stop Drop In I-Sin/—Tn Dr-co inches Inches Inches It Y, 33 .a5 319' 13/y' -C 2 3 SEAL I- Tests to be at Lznya dendi until aoorccri-mate—ly equal ra te-s are.cbtaine6 at arch percolation test hole- All data to be subnittC6 for rCViC-,4- (:0 be Cron uOp OC M 3 30 13:32 D23) -�11 og LIJ111 f LI ;06 L 3 ;L 0 33 .a5 319' 13/y' -C 2 3 SEAL I- Tests to be at Lznya dendi until aoorccri-mate—ly equal ra te-s are.cbtaine6 at arch percolation test hole- All data to be subnittC6 for rCViC-,4- (:0 be Cron uOp OC 06- PEMOTATION TEST DATA iiy �V4 0 DATE '-112 6' 1, 4 ev7 rar) V'^ UU-7 \( . Inspector, A Lea Q.. A TA L, 1->T-- LO C Hole Na:'-T Hole Depth Type Soaked TEST-RUNS- 2 3 1 4 5 it 7- 12: .3 i1:: is Z" 061 I IV it 30 Vr F it1. iLA vs; T 'S en,.q. a &4 14 m-d I C '3'1' U S In, 7- it: 1*0 q9 T - '471 T YSS 1 -L' 3L-7 S -1-i T ;4 t" it a -11r— r" -3o F 10 S I a % 44 -,L, T IL tf 56 F,. MW 1,5 /v ,414v F' 'S T. F I 51-2 fZ 11 T III mid 1'7 m ij F S1 S T F S i i I. m the undersigned, cortify.that -those percolation Lest , ware done by myself or under thy .4irection according to the standard procedura-,- ;.Alfte Ida''ta and results resentaI d 'a�r�4a -3 v , correct. Nof C W O Sign ature Dated: icense N o. (P.E*)(L.S.)�A NO' 4102 . 1 General remarks ( e,'I~ ,4'. C{BS he springs; streams, etc.) OF Y�!Q GA .a p RAC" Cr i W � � MOO No. 4'1126 pROFESS10 7Y F DEEP TEST RESULTS Date: A2 Name of property: t� * L F-C� (C) •(�jA,�%c Soli,.; N• — P ✓�i.�hrv' tov�rTy Owner of 'property:c; : LOFT-..Coe—Q. — `3'tku�C- Fok4563 Engineer: Person directing test '�r�S �oia Z �u��C+Gt 'C "' Rep Aiy* Uk r.J fHL�,i. — NYP.b P t -4-Ull p - 1•lole: Lot Total Rock � • Water c; .. Number Number Depth Depth Depth `,Soil description �...' 30 % . ....... �� _ ....... . . 7-a Sots. _... vet, a �" n _..,. ., F LOAM- 1 General remarks ( e,'I~ ,4'. C{BS he springs; streams, etc.) OF Y�!Q GA .a p RAC" Cr i W � � MOO No. 4'1126 pROFESS10 �1