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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.14 -1 -14 BOX 3 '@N16 III � 1 .; .��.. �� T I'�� ,`,� r 1 �� rr - � ' '1'�I r �, ti ' � - UL , 00005 Sent By: TOWN OF CARMEL ENGINEERING; 9146287085; Nov -17 -00 8:49; Page 1 :AU .I N3S �$�IiIVI�11�i < � SI,N3MOD CM MMAU 103 tt3L5 tm sd �( !f HOLLYMOM log Trnoxaav X03 l J *Mo as Q3.LOH sv tT3I, jmSXM UV HS3HI liviol AioIldt2l�s3a 129mm 31va 30.L3S 331AIMS Pmaxva cmujxn ML-Ho .L90a's•f1 ssawax3 Tnmcaa (IgUl Ksimi quo Msrs .rE S9I.L3�ISiQ . WmTRA Sava sx�ta CMSOIDNII f xoa Oh rye :RIM :os rwImsxv 40 11RUT1 €99Z L 'AboA M3 `NOSU31lbd �se�- eca -sbs GVOU NbWHsno �u *�Fd ` 8r `llgbV)1 NHOr 1 t JKJOHN KARELL, JR., P.E. 121 CUSHMAN ROAD 845 -s7a -7894 PATTERSON, NEW YORK, 12563 November 16, 2000 Robert Morris, P.E. Putnam County Health Department Geneva Road Brewster, New York, 10509 Re: Consiglio Formerly Freiberg Sunset Drive Patterson(T) TM # 4.14-1-14 Dear Mr. Morris: Pursuant to our discussion today it is requested that you allow the design of the SSDS on this property to be based upon soil percolation tests conducted at eighteen inches which is the higher level allowed by the NYSDH. Please consider the following in your. decision: 1. This lot was originally approved in 1984 as lot ## 13 in the realty subdivision known as Quaker Ridge Estates, filed map # 1815K The soil percolation rate indicated on the subdivision plat was 31-45 minutes per inch. The plat also required a curtain drain and three and one half feet of ROB fill. Neighboring lots exhibited percolation rates, fill and curtain drains as follows: Q ti 2. A construction permit was issued to Freiberg for a house and SSDS on this lot in 1997. The design of the SSDS was in conformance with the requirements of the subdivision plat. 3. Mr. Consiglio who owns and lives on the adjacent lot purchased the lot from Freiberg in 2000 for the purpose of changing the lot line to add a small portion of this lot to the adjacent lot, where his home is located. The Town and the PCDH approved a lot line adjustment in August of 2000. 4. The Freiberg permit expired and therefore based upon the present regulations new peres and deeps were necessary. 5. In review of the data on the plat which required over 1000 yards of ROB fill and because of the size of the lot I decided to perform peres and deeps in the previously approved area AND a new area below the approved area as shown on the attached plan. 6. Eight(8) deep holes excavated in both areas indicated no rock or water to 7 feet however the soil is very clayey. 7. Four (4) soil percolation test holes in both areas at twenty four inches exceed 60 minutes per inch, three at 120 and one at 80. 9/E 86ed •`05 :9 00-Ll-AON .`590LONVL6 !JNIU33NION3 13RUVO 30 NMOl :AS 1UOS 2 Lot Percolation Rate Fill Curtain Drain Min /in feet 14 46 -60 2 yes 12 46-60 3.5 yes 11 31 -45 3.5 yes 10 31-45 3 yes 9 31-45 3 yes 2. A construction permit was issued to Freiberg for a house and SSDS on this lot in 1997. The design of the SSDS was in conformance with the requirements of the subdivision plat. 3. Mr. Consiglio who owns and lives on the adjacent lot purchased the lot from Freiberg in 2000 for the purpose of changing the lot line to add a small portion of this lot to the adjacent lot, where his home is located. The Town and the PCDH approved a lot line adjustment in August of 2000. 4. The Freiberg permit expired and therefore based upon the present regulations new peres and deeps were necessary. 5. In review of the data on the plat which required over 1000 yards of ROB fill and because of the size of the lot I decided to perform peres and deeps in the previously approved area AND a new area below the approved area as shown on the attached plan. 6. Eight(8) deep holes excavated in both areas indicated no rock or water to 7 feet however the soil is very clayey. 7. Four (4) soil percolation test holes in both areas at twenty four inches exceed 60 minutes per inch, three at 120 and one at 80. 9/E 86ed •`05 :9 00-Ll-AON .`590LONVL6 !JNIU33NION3 13RUVO 30 NMOl :AS 1UOS y . e. 3 Based upon the above it is requested that you authorize the performance and acceptance of the soil percolation tests at eighteen inches since that is allowed under the NYSDH regulations. This may result in an acceptable soil percolation rate for design purposes. The need for fill or a curtain drain can be based upon the results of both sets of soil percolation tests. It should be noted that the adjacent lots which were all developed with septic systems installed based on the subdivision design are presently functioning properly and apparently have been for many years. If you have any questions please call me. Very truly yours, John Karell, Jr., P.E. T- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A*1zr".X DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 4o_A1-- Address SclAl5,65-r- prejt/4� .Located at-- (Street) - T>,"o-FAV Tax Map I Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test e, 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to N submitted for review. 2. Depth measurements to be made from top of hold. Form DD-97 ... ................. - ....... ... ...... ........ ........... .. ..... ........... .............. .. ;off 2 3. 4 5 - --------- 2 a 113 q .7-0 3 0 4 ,x;57._ 3,1 /P' _3 5 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to N submitted for review. 2. Depth measurements to be made from top of hold. Form DD-97 3�1 . - PUTNAM COUNTY DEPARTMENT OF HEALTH r DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address �y e/3 C-i 7a7zi v6 Located at (Street) Tax Map y, l Block Lot' 1 (indicate nearest cross street) Municipality ?A T - ��,,,� Watershed 5me, AI t4 SOIL PERCOLATION TEST DATA r; Date of Pre-soaking Date of Percolation Test / :2.16 /c 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 �. 4 5 2 4 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 Y" BRUCE R. FOLEY Public Health Director ATTENTION: DEPARTMENT I Geneva Brewster, New OF HEALTH Road York 10509 i i 1 1 i► n ADAM STIEBELINC GENE REED LORETTA MOLINARI. R.N., M.S.N. Associate Pubhe Health Director Director of Patient Services All information below must be f, ul{y completed prior to any scheduling. DATIw: 11171,416V ENGINEER OR FIRM: -�— PRONE #: Lf ��'' 7d" y REASON: DEEPS: ❑ PERCS: X PUMP TEST: d ROAD/STREET: TOWN: �1t- /%rte /V TAX MAP #: SUBDIVISION: LOT #: /3 OWNER: ���%� 6dAl Q NYt"D r.P CRITFIUA FOR JOINT 11FVIEW AND W'ITNESSINC OF SO110 JFdSTIN . YES NO W T� d� r0 ❑ 711. Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ pal Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 13 rk- Proposed SSTS design Hew greater than 1000 gallons/day or SPDES permit required. ❑ qi� Proposed SS1'S for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yr2 to any of the questions, NYCDEP mast witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to.be Delegated based on the above response and then subsequent information indicates NYCDEP fc required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR r't UNTY USE OVLY DATE: �� �5 �� TIME: COMMF.NTy: (r-%LDTEST) t/L 86ed `.8V :9 00-OZ -AON •`980L8Z9tit6 •`JNI833NION3 13W8VO JO NMOl :As juaS -a. r P`UTNAM COUNTY DEPARTMENT OF M EALTEC ,NF:p D]IISION OF ENVIRONMENTAL HEALTH SERVICES ut DESIGN DATA SHEET - SUESUUACE SEWAGE TREATMENT SYSTEM Owner (b NS!(,L i 6 Address Located at (Street) SV O V�,j 12W Tax Map Block'____ Lot (indicate nearest cpss surest) Municilpauty _ n & L7-f-9--C OA/ Drainage Basin SOIL PERCOLATION TEST DATA Date ofPre- snaking Date ofPercolation Test //—/61-00 _ Hole No. Ron No. Time Start - Stop Eia a ?ime �Mia.) D th to Water 5,m Ground SasfIce then) Start a Stop Water I•evel Dro Ya Isla a Percolation lisle Min/tncb 1 zZs a� s 30 g zz5�s y s1� �, 5 2 3 3Z7 30 t ZZ %Y y'iL 6.7 4 5 l 22q Z S°I 30 2.1 V1, 3�. �S -16 2 3011 3 "v 3o 1,7Vq )-o% ,2 3j 1Z.6 3 4 5 3 1 )3r. 30f 36> 1 3/y 30 4 33e 30 r ;_`'y 3 `y 3 v ! i21!- Li sly z .X 3� s Syr 30 1 Z, ZLyL 5 NOTES: 1. Tests to be repeated at same death until awroximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 mift/mch, s 2 min for 31 -60 miarinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form D1}97 llt a6ea `bS:6 30" —30 0 3Q.4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 3 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address svv��T y�v Located at (Street) pAbjQ7Z,4,qA Tax Map Block _� Lot - j (indicate nearest cross street) Municipality PATrc; oAl Watershed Eot!�= BEdycH SOIL PERCOLATION TEST DATA Date of Pre - soaking /I lt3locp, Date of Percolation Test NOTES: 1. Tests to be repeated at same death 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 to VVatedr L ato Hole l�io Ruu No tne Start stop'I�n) EIa se Time From r un G o Surface (llnches) e del propp In Percola Iron l€t�te Start stop Itse7ies M IucL 1 f�4� 7 - L. 1 3 � - -'/ 0 2 a:ao - �,20 40 a- 1 o 4 Z 5 2 3 4 5 2 X26- x:'26 60 2 - 3 4 5 NOTES: 1. Tests to be repeated at same death 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. Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name: Address: Signature: Design Professional's Seal HOLE NO. Date g �1 A 4 °� a 3 a 2 0 PUTNAM COUNTY DEPARTMENT OF HEALTH b' DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM . Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed .J SOIL PERCOLATION TEST DATA Date of Pre - soaking I/ // -3 p Date of Percolation Test &1Z 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 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / HOLE NO. .2— HOLE NO., 3 G.L. _ 0.5' 5.0' 5.5' 6.0' 6.5' 8.0' 9.5' 10.0' 13 If 4�z O'Z"A3r_�„ - Indicate level at which groundwater is encountered Now - - Indicate level at wlucli mottling is _observed Indicate level to which water level rises after being encountered Deep hole observations made by: 7Z;.�a �, c _�, t-t . Date o Design Professional Name: Address: Signature:' Design Professional's Seal .1 r TEST PIT PROFILES Hole # Lot # 3 Depth to water Al v y Depth to mottling NOAI Depth to rock/imp. G.L 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 ,_ 3 2®7-�� Hole # Lot # 3 Depth to water V,0 2 r Depth to mottling. n/o,✓r- Depth to rock/imp. i1/ani� G.L 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 Hole # 6 Lot #_ Depth to water n ",o:- Depth to mottling ivovc Depth to rock/imp. G.L 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 10.0 ' 1_ /O ;z Hole # _ % Lot 3 Hole # Lot #_ Depth to water . Alo m ,�=- Depth to water Depth to mottling IVOA ,, Depth to mottling Al Depth to rock/imp. .7/�,v Depth to rock/imp. Alo y,6 G.L. _ G.L. 0.5 T�zce TS. 0.5 1.0 5 ,z{ 1C 1.0 2.0 2.0 cd , °re 3.0 _2-1 � 3.0 -; 4.0 4.0 5.0 5.0 C ' 6.0 6.0 w r-,'P,? e 7.0 7.0 v� 8.0 8.0 9.0 9.0 10.0 / 8` -�'`, �6 " 10.0 6 `-6„ (-/0 a D Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. s G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 JUN -16-00 SAT 91'08 AM BRUCE R FOLEY Pubtfc Health Dtrector PUNAM CTY ENV HEALTH FAX N0. 19142787921 P. 2 P DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.M. Assw1we Public MaM Diketor D,fraelor qj Pailew Servim ATTENTION: ❑ ADAM SMDELING $GENE REED All information below must be fuk completed prior to any scheduling. DATE: L&310 ®U ENGiNVER OR FIRM: KA -&* -L L .REASON: PRONE #: P%af-744W DEEPS: 1t PERCS: X PUMP TEST: o ROADISTR ENT: d5 tJAJ -'WEj TOWN: a %�i'F D TAX &W#-. SUBDIVISION: I Owrizit: Co"Ji 4-10 '' 'r _._.1 — /7 LOW: y3 YES NO D Proposed SSTS within the drainage basin of Wert Branch or Boyds Corner Reservoirs. o Proposed SETS within 500 feet of a reservoir, reservoir stem or control lake. a Proposed SSTS within 200 feet of a watercourse or a DEC wetland. D fiK Proposed SSTS design flow greater than 1000 gailon0day or SPDES Permit required n k Proposed SSTS for a Commerical Project. it is the responsibility of the desig$ professional to provide file above information prior to soil testing. This Department Will determine the NYCDEP project status (Joint or Delegated) based on the response. if. you answered yea to any of the questions. NYCDEP amtst Witness the soil testing. This Department wM coordinate A mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has bola determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tenting, it will be the sole responsibility of the design professional to schedule r"tnessing of the soil testing with NYCDEP. / FOR COUNTY USE ONLY /y O MUMf,NTFe (EIi;I.DTi 3T) P / I TOO a Akins I � - -- - I - I - nn r Cranber►y Mountain �• �°°` i ��. Wildlife Mi6agement Es LL �I � t/, w. z Ii i Jt Lx _2l..�._— _ - - - -�1 U Brook 12563 o fly 22 NO `��t} wifland rfrv:"� 01101w i (Mendel Pond ! 164 65 $ hlalnes Corners � .q - 61 � a _d. t � d .4o Lake } ...Cbrnum - - - -7 corn r Lost ti S #einbeck ( ► --A -i 3 Corners Lake _ .`Charles =t- O ` 22 wr. +4, • �� Q0 c� _ F S# eF r r iNOw+ rarbOk NILL — __— _����� 1iqueArea Mount Ebo Corporate ^ e 65 62 ¢• s 0 HS OES t r R fC 1 Y' �vl Corner Pond i I 777 4-86 X I 14 5 'A C -4 3 J:� 13 Al 12 3.19 AC. II 3.6; AC. ui C= 7 6 tAi RESERVED 2.56 AC. WATER SUPPLY 10 PARcEL 4.10 5 PRELIMINAR - 400' UL 4.15 MAP 4 14 4.18 4.19 TOWN OF PATTERSON SCALE 4W 24?'0 PUTNAM COUNTY. NEW YORK .4-ID•ST 04TE OF WF ... m I ... : commits w i�m IN fm 0 im PUTNAM COUNTY DEPARTMENT OF HEALTH h DIVISION OF ENVIRONMENTAL HEALTH SERVICES COpNSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PE T# Located at P LAJ 1,WD Q P—t V Subdivision name Q Q,4K44A1kjk - Subd. Lot # /3F Date Subdivision Approved Town or Vil`l`age Tax Map `s• Block —I— Lot` Renewal Revision Owner /Applicant Name 4045E';E7- Date of Previous Approval Mailing Address fV6AIL`"jl—�: /,17—X/$C0 /V Y Zip to Amount of Fee Enclosed Building Type WDdQr�� Lot Area 3, et' o. of Bedrooms 4. — Design Flow GPD 90 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 Address Water Supply: Public Supply From Address Private Supply Drilled by Address 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 s,, em 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: ° Z P.E. S 3 L-7 Date 101607 Address A0 /0®X 0 y AJ Y /05-01 License # 5 317 7 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. Ap roved for ' harge of domestic sanitary sewage only. Bye'— - � Title: - S ee--/OZz�S Date: l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rof ssional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL p .y please print or type PCHD Permit # 'p, Well Location: SWe5 dd C.�Y,�yn/Village Tax Gri��dLL# Map x}701 lock / Lot // Well Owner: Name: i� �-- Address: /O ,57 (if Use of Well: C Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage 24" gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason &-A,I A0 us for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision f (� QC 4 Tyr * %n!' _ Lot No. Water Well Contractor: %jE� -L..- Address: _ 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 contaminatio to be provide n separate sheet/plan. Date -1016 / Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. - - Date of Issue /��C// /�9j� Permit Issuing Date of Expirations Syr- Title: Permit is Non - Transferrable 7" White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT M v i gF_ 0.21&i& of Located a: PAY t W,p D R V e Subdivision name Q DMJ& / WLD Subd. Lot # ?% Date Subdivision Approved esirA7es Town or Village )0,477SZ.CPON Tax Map if y l -1 Block Lot Renewal Revision Owner /Applicant Name a. WA.—j— AG!jdgA Date of Previous Approval Mailing Address 5-3 CA"eA)7EW_ i_�- /V7—X1 SC0 /V `% Zip %o S Amount of Fee Enclosed Building Type Lot Area No. of Bedrooms '�_ Design Flow GPD !&Q D Fill Section Only _ Depth _ �� Volume PCHD N TIFICA N IS RE D M LL IS COMP JE SeRamb'%Werige v___ste_m to consist of gallon septic tank and Other Requirements: To be constructed by Address , Water Suotohc: Public Supply From Address to Private Supply Drilled by CL. Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate =5= tre=jntjy= 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 Departrnent 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: P.E. S 3 L7 7 Date /0/607 Address 1,Pt9AV X C'44W J�1 e' _License # ,13ZI 7 APPROVED FOR CONS'T'RUCTION: 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 who considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires C/C 86ed `W L 00-LZ-des `990L9Z9v16 `ONId33NION3 13WUVO 30 NM01 :A9 luaS / , 61 C 'y 044 a �. BRUCS R. FOLEY Acft Public Health Dkem DEPARTMENT OF HEALTH Division of Environmental Healrh Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Far (914) 278-7,921 lolui Kat'sli P.O. Box 644 Carmel, New York 10512 Dear .Mr. Kwell: Novembcr 7. 1997 Re: Proposed SSI)S: Friberg Quakar lodge Drove (T) Parterson Review of plans and ocher supporting documents '•L:'mlitted at this time relative to the above - captioned'proj"t has been ,;ompleted. Cotmneiuy arc offered as foilows: . -The construction of this sewage disposal system may be subject to local wetlands rcoations. You should contact local wetlands officials in this regatt" "You are referred w article 128.1 of the off- .W romp cation of Codes, Rules and ltgulatiors of the State of New York Title 10, relative to the need for approval of inditidual sewage disposal systems by the City of Nog, York. You should contact city C'ithcials in this regard." V 1) Standpipes have net been located 5 fret upgrade and donngrad: from the curtain drain.. 001&- e 2) Standpipe detail has not be.-n provided. �%)3) kale of trench tavo(At has not been noted. ill ✓4) Location map scale has not been noted. ✓11 "Title block is to note --preliminary design for fill section only". Zpan receipt of a submission revised to reflect the above, this application %till be considered further. Very tn1h- yours. Robert Morns, P, E. Public Health lrngtneer R-VVtnh watershed „..;: t 068d `8b :L 00-LZ -das `•580L8Z9b16 `JNI833NION3 13NM 30 NMOI :A8 juas DEPARTNIENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewetcr. New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 John Karen Jr., P.E. P.O. Box 644 Carnet, New York 10512 Dear Mr. Karell: BRUCE R. FOLEY Acting Public HeaM Dimcwr October 17, 1997 Re: Proposed SSDS: Friberg Quaker Ridge Drive, Lot B (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: `The construction of this sewage disposal system may be subject to local wetlands regtiiations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official cotnAation of Codes, Rules and regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." XThe nllninium distance from the SSDS to the curtain drain is 20 feet. Current codes require an increase of five (5) feet separation distance for every one percent reduction of slope under 5°.f,. Standpipes are to be shown for the curtain drain. }� All subsequent frill section submissions must have a full trench design plan, i.e., details. notes etc. ,NUctnovc or cross out J box, trench and D -box deta>Y from frill plan. �' ►ll separation distances are to be taken from the toe of the fill section, therefore, the minimum distance from the edge of the trench to the foundation is 39 Act and to the well is 119 feet. ,*,Current codes require a location map at a minimum scale of I" = 2000'_ Please revise on all subsequent submissions. --` Ty � rosion control measures for the house has not been provided. Curremt codes require that the distance from the well to the property lines be noted. 9 Current codes require that the datum reference is noted on the plan. £/Z abed `9V:L 00-LZ-daS `990L@Z9V16 r.JNId33NION3 13RUVO 30 NMOl :A9 lUeS fit. C DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York I0509 Tel, (9 14) 278 - 6130 Fax (914) 278 - 7921 John Karell P.()_ Box 644 G arninl, �idw York 10312 Dear. Adr. Karell: BRUCE R. FOLEY AWna Publio Hoalth Directot N ovenzber 7. 1997 Rc: Proposed SSDS: Fiiberg Qhlaker Ridge Drive (T) .Patterson Reidew of plans and other supporting docurnents O)tnitted at This time relative to the above - captioned projet.t has been completed. Canuuents art offered as follows; "The construction of this sewage disposal wstern may be. subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codps, Rules and regulations of the State of New York Title 10, relative to the need for approval of individual sewage disposal systems by the City of - ow York:. You should contact city Crifi;.ials i_n this regard." ✓ 1) Standpipes hai-re not been located i fect upgrade and downgrade from the curtain drain. o of-c- w 2,) Standpipe detail has not been provided. ,v/3) Scale of trench lavout has not been noted. � G ../4) location reap scale has not been noted. ✓5) 'title block is to note "pxeiirtlinary deli for fall scctioxt only". Upon receipt of a submission, rv-lsed to reflect the above, this application will be considered further. Very tnt y yours. Robert .Morris, P, E. Public Health Engineer RNVnih watershed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ko-, ez- % LG ( Address Located at (Street) Tax Map 'JV. 14 Block -L Lot (indicate nearest Greos� street). Municipality. )0k oo Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking �/ &( Date of Percolation Test % Hole No. ' Run No. Time Start -Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dro In Inc�es Percolation Rate Min/Inch 1 9 L9f1�, 36 3 t7 2 3 016 a 3 S �� ! , 3 Zt��' /D 3T 3 c� Z� 2-`( 30 4 1l 3 or- Q Z3 2 2,q/ 5 2- 1 ° 1 911 CIO 2 i (Irl,' r 3u -z- Z_ Z3 3 10 11, 10)-f V0 7-2,- 2-3 ,l L10 4 Y-0 5 1 2 3p -- 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 7i 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' 1 8.5' 9.0' 9.5' 10.0' W Aw 4W iM-5 HOLE NO. Indicate level at which groundwater is encountered ®' Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Zo � Address: pj xQX 6 y y Signature: Design Professional's Seal 2 I PUTNAA'I COLTNTY' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: ���5 . 3. Location TN: AP r7-)l 4. Design Professional:Trf7U' 5. Address: Aa6gx- 6! 6. Drainage Basin: �Q�i(/�7zi/✓50/t�/�ll�E%%�L /�%� /D�J 7. Type of Protect: X 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 Exempt Type II Unlisted ✓ 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A>b 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? ............. AlO ............................................ ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? " Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water Xgroundwater 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 — Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ AJ U 21. Name of sewage system Distance to sewage system 22. Date test holes observed °I Zr'1 23. Name of Health Inspector MUrzi2 -1SS 24. Project design flow (gallons per day) ............aS® ........ ......................:........ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 4M 26. Has SPDES Application been submitted to local DEC office? ......................... '-- Form PC -97 A 27. Is any portion of this project located within a designated Town or State wetland? N0 N 28. Wetlands ID Number ........................................................ ............................... _ 29. Is Wetlands Permit required? ....................... ....................... lU r Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? ................... - Al 3 :. 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 U 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any j other potentially known source of contamination? ............................... Yes/No /y 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 15 years in or adjacent to project site? ................................ ............... ................. 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /vii 36. Tax Map ID Number .......................... ............................... Map yV / � Block Lot 13 37. Approved plans are to. be returned to ..... Applicant X 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!121 0.4 of Pe Penal Law. SIGNATURES & OFFICIAL TITLES. � Mailing Address: ................................... C ° -��i � y Q ' (t4__ APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS / REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION J// NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE / TAX MAP # - DOCUMENTS. PERMIT APPLICATION 1 LL PERMIT EO PWS LETTER HNEERS AUTHORIZATION ;IGN DATA SHEET(DDS) ZPORATE RESOLUTION Iuw_A.Ii mi.im SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROY CHECKED ERC RATE 3 ( �L REQUIRED DEPTH W CURTAIN DRAIN REQUIRED MSTANDPIPES k ', fit lin 'j v f-4�3'' Y �P. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED )USE - NO. OF BEDROOMS ELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM METES & BOUNDS OUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE .PIPE NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS LAYBARRIER L-LJ,kO�FT HORIZONTAL: SLOPE 3:1 TO GRADE EILLL SPECS m FILL NOTES 'L CERTIFICATION NOTE EPTH GAUGES RlELL PROFILE & DIMENSIONS GENERAL VOLUME FILL IN EXPANSION AREA X- APPROVAL SSDS ADJ. LOTS LAND ( TOWN/DEC PERMIT REQ ?) TRENCH ATA ON DDS PLANS & PERMIT SAME �-J LF TRENCH PROVIDED m 60 FT MAX PRE- 1969 -NEIGHBOR NOTIFIFICATION PARALLEL TO CONTOURS LETTER BI/ZBA ® 100% EXPANSION PROVIDED m 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS FIBeDS SEWAGE SYSTEM PLAN - (NORTH ARROW) ,10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL SSDS HYDRAULIC PROFILE m GRAVITY FLOW 20' TO FOUNDATION WALLS 15' WELL TO P.L CONSTRUCTION NOTES (GRINDER NOTE) -1-16-0 TO WELL, 200' IN D.L.O.D., 150' PITS SIGN DATA: PERC AND DEEP RESULTS E.4 T'00 TO STREAM WATERCOURSE LAKE (INC.EXPAN) TWO -FOOT CONTOURS EXISTING & PROPOSED °''S0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER -DRIVEWAY & SLOPES CUT X10' TO WATER LINE (PITS -20') 9�OOTING/GUTTER/CURTAIN DRAINS 50' INTERMITTENT DRAINAGE COURSE ROSION CONTROL; HOUSE,WELL, SSDS ° _ ' 2 0 FT. RESERVOIR, ETC.=] 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE 15' MIN TO C.D. S= >5 %,201- 4 %,251- 3 %,301- 2 %,35' -1 %,100' <1% m. PERC & DEEP HOLES LOCATED Ln 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. PRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK LV1 LOCATION MAP K4 i P SG1d--C i y-- Zo°O Fi =I O' FROM FOUNDATION; 50' TO WELL IVI I IA 2 ?F-D R-Do M f - �1M Sto1J5 �� WEA-L P P•L_ COMMENTS: 01L VIEVA. ID c�� 02 illIikllJ z��t �L Vb PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 9 ray Located at OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION ,�a3�T G,eis� dUA90� l T/V �`/f Tax Map # Block / Lot 3 Subdivision of�- Subdivision Lot # 1-3 Filed Map # Date Filed Gentlemen: This letter is to authorize % IC4 Z6Z'L J a duly licensed Professional Engineer �� o to apply for the required -wastewater treatment and/or water supply permits) to serge the above -noted property il-t 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 treatment 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: P.E., R.A., # Mailin g Address State `Zip l S /� � Telephone: O Very truly yours, Signed: (Owner of Property) Mailin Address' ./� t ar k s ev (% rr' s-3-8 State A N Zip "4- Telephone __ _ . \ \ 5 d \ Pjr /✓ by °Z9lw 4/08, TIC m Q� 1- C�\ r) Z) 4� J��Ab1 CO CL .e 0 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Gut^, BRUCE R. FOLEY. R.S. Acting Public Health Director Re: ProposedSSDS: r-418f —k& Dear Ml C� �lk77Ees�� Review of plans and other supporting documents submitted at this time relative to the above - captioned 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." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1,TWD?I" µAt[ t-ror BAN t.oe-A-rtO s Frtr` vP daAnL A," w �#e WN & SrAPMAPE Ve;rA(t. t1AS VOT- 8E4.0 PeeurDrEO SC4,- of 4R Kd t-A` 4X PAS Or BE" k1OX0 LOCATwN MAP 5CAtL µp5 .wr Ile" "MD Upon receipt of a submission revised to reflect the above, this application will be considered further. S) irrW 9t. / is To AroT+r ^ P2luntrf+tl l DESrvIJ i+M Ff[L S�crtarJ oNCy 4 Very truly yours, Robert Morris, P. E. Public Health Engineer R�Njp watershed -2- 10) Fill section detail is not legible. 11) The estimated volume of fill must be noted on the plan. Curtain drain discharge is to be a minimum of 20 feet from the toe of the fill section. This is to be noted on plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer RM/mh watershed CpGa CL -< BRUCE R. FOLEY W yOa`� Acting Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Far (914) 278.7921 John Karell Jr., P.E. October 17, 1997 P.O. Box 644 Carmel, New York 10512 Re: Proposed SSDS: Friberg Quaker Ridge Drive, Lot B (T) Patterson Dear ivlr. Karell Review of plans and other supporting documents submitted at this time relative to the above - captioned 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." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." �) The minimum distance from the SSDS to the curtain drain is 20 feet. Current codes require an increase of five (5) feet separation distance for every one percent reduction of slope under 5 %. f7 2) Standpipes are to be shown for the curtain drain. 3) All subsequent fill section submissions must have a full trench design plan, i.e., details, notes .etc. Remove or cross out J -box, trench and D -box detail from fill plan. b ) All separation distances are to be taken from the toe of the fill section, therefore, the minimum distance from the edge of the trench to the foundation is 39 feet and to the well is 119 feet. 6) Current codes require a location map at a minimum scale of 1" = 2000'. Please revise on all subsequent submissions. 7) Erosion control measures for the house has not been provided. 8) Current codes require that the distance from the well to the property lines be noted. 9) Current codes require that the datum reference is noted on the plan. no ��� ►��` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE F ;SECrAEATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at ' '; 0 Q5E D )P--k V Town or Village Owner /Applicant Name 4L—!'N) h N A) Tax Map 4 t% Block Lot D 0 0-5a T I u"J 16 -5 Formerly &) W';K1tA0 Subdivision Name OV t-��— Subd. Lot # I a Mailing Address & 6N 3S-Z,- )5 E)W -0 P I OS-0 Zip Date Construction Permit Issued by PCHD 5-12-I ` D Separate Sewerage System built by Address Consisting of 11-5 0 _ Gallon Septic Tank and r5_00 L F ZPT 12�Z- u C-) , CC WC- PV,44P P��- Other Requirements: �-�'j— iJj �-1 �� q t�►� SYOS SLL-7.:�ZT- Water Supply: Public Supply From Address or: X Private Supply Drilled by Address Building Type kJCV.P Pf,4 'I 4 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- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatio s of th Putn County Depart nt of Health. Date: � 2/ Certified by R.A. (0 (Design Professional) Address 1 U. �1 Z�� License # Any person occupying remises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoc ion, modificatio or change is necessary. By: ur i Title: Date: �— White copy - HD File; to copy - Building Inspector; Pink copy - Ow0 f; Oran�opy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: °j C -4-Q'V , Quaker Ridge Estate Town/Village: Patterson Tax Grid # Map Block Lot(s) 13 Well Owner: Name: Address: Dorsett Hollow Builders 15 West Hollow Rd. Brewster, NY 10509 Use of Well: 1 -prima 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment 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 101 ft. Length below grade 100 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X— Steel Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: _ Cement groutX Bentonite Other Drive shoe: X Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed ?� First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield I o gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) 300 Depth of completed well in feet .4.05 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 4 Top Soil 4 8 Sandy C1'a 8 55 Hard Pan 55 70 Medium Hard Shalp 70 405 Hard Shale If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth BY OTHEFModel Voltage HP Tank Type Volume Date Well Completed 3/11/02 Putnam County Certification No. 2 Date of Report :3/26/02 • ell er (si NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a sepafate sheet/plan. Well Driller's Nam 1 D i I Address: 75 Putnam AVe.., Brewster, NY r Signature: Date: 2- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Sent By: LLL; aert Sy: L LL; 1234567 ; Jul -8 -04 12:30; Page 1/1 oLmilm) •aansndwo:) aIP44sa0z) jo v0paanddv aip rpp, pmpgm ag of 9! UUC4 Ru 'plowo UM04 palporpne as A palms of smppe 1163 "al 'PWaidul a q 'tauoj aeogv arp smEn a0un}idw03 nopalmsaoa jo olonplaa v me. son ma R11UH jo I=M;Iedaa �ano� meoqua aq�, (aansalms) Inya 'ESMUCIV ' i1 si,�' 1- 29m t"X'VL 1 p >ttr�•4i(ir14�!! �'ILii!'ttl {�1�N 1'10!•tfLGttl r��t�lgq � s<ror•uz MO>a t�•>ru4cQ aul� Iss�•usGtd � hlt+�u ItK-ri � �1 atr • uc GId) X11 r+�•�wa 6010! tl+r� ��K '���►a�g ptx� s,uo.p 1 xmm as mmuivdita A -volma Maw "Dw mw vus soy AWKM * b T0•d 6TBZ8180p 16 NOSMH11kid -4O HMOl WO tE:ZL Z6- 60-9Ar TI 11 - o- orarao Ti is fill • ma TPi ! P4':;- ?7R -7ga1 NAMF: PI.ITNAM COUNTY DEPARTMENT OF P. 1 PUTNA M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM CJwner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village L / i Ag ? •.ation - Street Subdivision Name * %2. Building Type Subdivision Lot # I represent that I am wholly and completely responsible. for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described .property, and that ..s has been constructed as shown on the approved plan or>approyed_amendment thereEci, and in accordance with the standards; rules and regulations of the`Putnam County Department of Health, and hereby gu#a -ntee' 161he 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 fellowing;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 determiination of the Public Health Director of the Putnam County Department of Health as tow not the failure of the system to operate was caused by the tivillful or negligent act of the ccupant the building utilizing the system. Dated: Month �6 _— Day 17 Year 0 �' S Title: a i.r2 General Contractor (Owner) . Signature Gorporati6 4rli O'corporation) Address; T4]'a 1168IsL81 T6 State Zip �. Form OS-91 7) JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET M S STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: sample's rntormation: Client: Dorsett Hollow Builders Zip: 10509 Fax: 845 - 279 -5075 Collector's Information: Name: Russ Address of site: Lot 13 Sunset Dr City: Patterson State: NY Zip: Telephone: Site: Date Collected: 6/13/02 Date Received: 6/13/02 Preservative: N/A Time Collected: 7:45 Time Received: 11:00 Temperature:. <4C Lab No.: J022277 Date Analyzed Test Name Result . MCL Method 6/13/02 15:00 Total Coliform Absent 6/13/02 Chlorine Free Residual <0.1 mg /L At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable MCL- Max. Contaminant Level Absent SMWW 92228 N/A SMWW 4500CIG mg /L- milligrams per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmentat.com JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET M S STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Collector's Information: Name: Mill Drilling Co. Client: Dorsett Hollow Builders Name: Bob Mill Address: 75 Putnam Ave Address of site: Lot 13 Sunset Dr City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Telephone: Fax: 845- 279 -5075 Telephone: Sample's Information: Site: water tank Date Collected: 6/5/02 Date Received: 6/6/02 Preservative: HNO3 Time Collected: 11:45 Time Received: 11:30 Temperature: <4C Lab No.: J022191 I Date Analyzed Test Name Result MCL Method 6/6102 15:00 Total Coliform *PRESENT Absent SMWW 92228 6/7/02 15:30 E.Coli Absent Absent SMWW 9222B 6/6/02 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 6/7/02 Color ND 15 Units SMWW 2120 B 6/7/02 Odor ND 3 TONs SMWW 2150 B 6/7/02 Iron 0.113 mg /L 0.3 mg /L SMWW 3111 B 6/7/02 Manganese 0.012 mg /L 0.3 mg /L SMWW 3111 B 6/7/02 Sodium 3.29 mg /L N/A SMWW 3111 B 6/7/02 Chloride 20.0 mg /L 250 mg /L SMWW 4500 Cl C 6/7/02 Hardness 56.0 mg /L N/A SMWW 2340 C 6/7/02 Nitrate 1.30 mg /L 10 mg /L SMWW 4500 NO3E 6/7/02 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 616/02 pH ** 6.37 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 6/7/02 Sulfate 12.9 mg /L 250 mg /L SMWW 4500 SO4F 6/7/02 Turbidity 3.91 NTU 5 NTUs SMWW 2130 B 6/7/02 Lead 1.40 ug /L 15 ug /L SMWW 3113 B Comments: * ABOVE ACTION LEVEL ** Below MCL At the time of analysis the sample WAS NOT acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU.- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com E l f i I� 0000 of -Aw P (,MP 00% t5,, of >JflhT►0r1 SvaV�� g`f. 7,3,(,GU,,05 zlslDS. -- Fo�.M�+ -Y Co.Js�cu o THIS IS TO CERTIFY THAT THE' -.,EWAGE DISPOSAL S) INDICATED ON THIS PLAN AND'WHAT THE SYSTEM WI WAS COVERED OVER. THE SYSTEM WAS CONSTRUC STANDARDS, RULES AND REGULATIONS OF THE PUT HEALTH AND THE NEW YORK S FATE DEPARTMENT 0 (NS�EC1z'D y�-t,3lotll,jl. /lot A C` 111 111 T THIS IS TO CERTIFY THAT THE : =EWAGE DISPOSAL INDICATED ON THIS PLAN AND'- HAT THE SYSTEM' WAS COVERED OVER. THE SYEiTEM WAS CONSTRI STANDARDS, RULES AND REGULATIONS OF THE 01 y HEALTH AND THE NEW YORK STATE DEPARTMENT (N 5PEUEV -AS -BUILT MEASUREMENTS N° A B' REMARKS N° B REMARKS 17 1(05 f �5 , ( .-�s �Z. I8 (p4j l� t t� UiN G rr-i •�S 7 -7Z b '7 � 3 I �o t (0 5 N k- lcvl 1�$ ---- i I Y E jr:�%/e /2of �ovn aPen 11n16pee-�`mw PUTNAM COUNTY DEPARTtiIENT-OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: lala � Inspected by. G, z e F_ p Street Location Svivs�T 7,21 Owner A //1/ot/ Town 'Ro TT,ETtso,t! Permit # _P -- 2 $-- ® / TM # 41,14-1—If Subdivision Lot # 13 1. SeNyage 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. SeN age System , a. eptic t size -1,000 .......1,2" .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation.. ... ............................... d. Distribution Box ; 1. Ail out ets at same elevation-water 'tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renc es 1. engt required 000 Length installed �l> 2. Distance to watercourse measured.-1-.! ©oFt.......... 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 314 -1%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. PumD or Dosed Systems 1. ize o pump c am er ................ ............................... 2. Overflow tank ................................... I........................ 3. Alarm, visuallaudio ..................... ............................... . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........... ..............................* .........:... ,. 6.- Cycle vritnessed by H.D.estimated flow /cycl�.i. III. House/Building a. House I ocated per approved plans .................. ......... b. Number of bedrooms ...................... .. ........... ............ . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ' 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 a dequate ...... .....................:........ NO COMMENTS I Aovrc Y � 01 K To Fe 11 V,1 Ito -7x5 -3 ele 4: Sent By: LLL; . i s � - BRUCE R FOLEY PA11c HkaM Director 1234567 ; WMIUM Amuamm Jun -3 -04 9:05; Page 2/2 Y� .LORETTA MOLWAI{I -R.N, M,SN. rluodate PubUv Xedt6 Dbwe r I Geneva Road Brewster, New. York ,10$09 A'CT MON: o ADAM STIEBELING J NE IMEp All information below must be f& completed prior to asy scheduling. DATE; f/ i/k -L-- INGMEER OR FY NI: PRONE iF: f 2L %� y REAAOir: DEEPS: 0 PERCS: o PUb>P TEST':)( ROADWHET: v IVS4;, T , l�� �. V t TOWN: ,S TAX MAPM- SUBDMSION: OWNE1 YES NO . 13 Proposed SSTS within the drainage batin of West Branch or Boyds Corner Reservoirs. o Proposed SSTS within 500 feet of a reservoir, reservoir stem or control Wit- Proposed SSTS within 200 feet of a watercourse or a DEC wetland. D Proposed SSTS design flow greater 6=4000 gallons/day or'SPDFS Permit required. o proposed SSTS for a Commeri cal Project It is the responsibility of the design professional to pro »de the above information prior to soil testing. This Department will determine the NYCDEP project states (doiut 'or Delegated) based on the response. If you awweredya to any of the questions, NYCDEY must witness the soill'testing Department will coordinate a mutually suitable time for field testing with the P ®OA, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates WYCDEP is required to witness the soil testing, it wili be the sole. responsl'bft of the design professional to schedule re- vitnessing of the soil testing with NYCDEP. - DATE. CO \i�tPl�"r5� Z:OS COV.NW USE OIZY JUN -3 -2002 MON 20:43 TEL:845 -278 -7921 J NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Or ENVIRONMENTAL HEATLII SERVICES FIELD ACTIVITY REPORT IbDR SS: Street Town State Zip PERSON IN CHARGE N J� PUMP TEST [. DOSE TEST /t-) —'4 EL. START A EL. STOP Si.Cnature and Title v RFPORT RF- r- F.TVFT) RV. I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. r� REQUIRED GALLONS �eq O Drop )e, 7C7 6 3 � I ®U O O O m J EL. START A EL. STOP Si.Cnature and Title v RFPORT RF- r- F.TVFT) RV. I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. r� REQUIRED GALLONS �eq O Drop )e, 7C7 6 3 n m to I e N m n N The v ;view York Board of Fine i,.inderwr. 3 Bureau of Electricity is in the process of issuing a ce9fifiG compliance for the electrical install. a as provided for in the application b inspection # 93 &aZ7- 1�. CIA SS rC l�lvrr�"s '.\e►v York $Hard of { ire mlt r t riters Kureau of f of lricity Inspection activity pursuant to Application has been completed and a certificate Of compliance setting forth the detail of the electrica system is being prepared. Irl��tit!r Date Z 'd dU 1NJW1ddddU A1NI IUJ WCN11 Id : dWCN jUN -16-00 SAT 9:07 AM PVKAil CTY ERV HEALTH 6dbL- 8Ld -SVU : Idl UL ; Fed NUW dW10d-bd-tld0 FAX H0. 19142787921 PUTNA,M COUNTY DEPARIMM OF HrALTH DWWON OF ENMONMNTALHmLTH SERVICES ATTENTION Cl ADAM REQj= FOR For. Fib All iefomadon muet bet* tompteted prior to any rr=hea inspections being made. P. t PCHD Coaroucdoa Permit # Located: " (� Owner /Appliceat Name: - Tid B1aok Lot,;, .., o s 1G,_i<� o Subdivisiaa Name: g' *57/- t7W-S' Fornserly: , -- SubdMsUm Lot d 3 is systemfd completed? _ `�{' -1 Dam:, �t 7-3)0-L- is system complete? ,_`� =_ Date: Yw D system eonamcted as per plan9? ` II Is won dam? .3 Date: `'I l 'L} 10 L, w.I Is well located as per plans? Are erosion, control mama in piaae? �s e I CU* that ttu gaem(s), as hsted, st the above premises has bee acted and I have inspected and verified dwk compbdoa in accordance with the =mod PCM Constwoftn Penait Ud approved p1m and the Standards, Rules and Regulations of the Putnam County Depart wl of Health. a* I Date: Certified by: Design Pcofeasional -7 Addcrss. I � t Form FIIZ 99 In abed •`6ss :s to-6u-jdv `• L99'VE2 .`lll :Ag lUgs T 'd AO 1N3WiNW30 AlNnoo WdNind :3WdN T26L- 8L2-S08 0 X31 0S : 6 t 311-L doud -Le -licit f ZUK -16 -00 SAT 9:07 All PUNA1l CTY ENV HEALTH FAX 10. 19142787921 P. I. PMAM COUNTY DEPARTMENT OF WALTH DWISION OR ENVERONMNT.AL NULTR SERVICES ATTENTION 13 ADAM 19fGENi Mg rR c•r FOR E NA . INS ECM For Fdl All information mint be Lislly -completed prior to any Trenches __ impections being made. PCM � � tr Permit # v �- pw Owmr/Applicant Name: TM Block I Lot Formedy: CQ 0 S 1 C,_1.� 0 5vrbdivlsi�anName: l �57h -5 • S 3 ' • ubd'WWOR Lot # Is system Sill completed? bate: ft I't 310 2=� Is systm completes Date: is system constructed as per plans? Is well dnRed? Date: 1,L) 1.0 �.•� Is well located as pec plea+? y f^ _. Are erosion control acs in place? I certify that rho syatem(ij es listed, at the above premises has bem constructed and I have hipected and verified their completion in aceordriuuce with the imcd PCfID Construction Permit and approved playas and the Standards, Rules and RwAeticus of to Futoam County Aepalttmeat of Health. Date: ,� Certified by pERA AddrGSS: Comments: '.lal; 1 =11421, L/G abed !off :@ to- ce-jdv •` L99VM 111 :/(g TuaS BRUCE R. FOLEY Public Health Director June 14, 2002 LORETTA 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 (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 > Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Karell Jr., PE 121 Cushman Road Patterson, New York 12563 Re: Field Inspection - Dorset Hollow Builders Sunset Drive, (T) Patterson r Lot # 13, TM# 4.14 -1 -14 Dear Mr. Karell: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. A pump test is scheduled for June 17, 2002 at 1:30 pm to complete the inspection If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj Sincerely, Gene D. Reed Environmental Health Engineering Aide Sent By: LLL; 1234567 ; UN-1 b-UU SM' 9:07 AM PUNAN GTY EHY HEA€.TB Jun -3 -04 9:05; FAX N0. 19142787921 ]PUTNAM COUNTY DEPARTiV MNT OF nALTFI DIMION OF ENVMONMZNTAL DzALTB SE vies ATTENTION D ADAM 'GENE ==T FOEIEIAL INSPECTION For, Fill All infolmattoo must be fully complated prior to any Trenches X inspections being made• PCHD Construction Permit # —� r Located: 7' CD . Ild �0 Owner /Applicant Natae: ti/ � TM 'f-lq Dlock �- ,� Lot Formerly: SubdWisioa Name: tQ V e 1 D 6 6 Subd*mw —on Lot # 10 l 3 Is system fill completed? Date: Is system complete? , � e s Date: 6 U Is system constructed as per pleat? -e S Is well &Mai? Lf 10-f Date: �/rCJ 1-- is well located as per Plana? Are erosion control measures in place?J I certify that the system(s), as listed, at the above premises hu been cousuueted and X brave inspected and wadded their tompiation in accordance with tho inued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the POW= County Departme act of Health. Date: 6p 0 ��'� Certified by: Address: ! V G comments; - . Farm FM 99 PE A PLA /ZJV C)Z7 7 Page 1/2 P. t JUN -3 -2002 MON 20:42 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P Y :'\ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #� 0( Located at S 0 A) S�T 41 y k- Town or Village jP,41 3Y-S -d ✓ (r/ Subdivision name Subd. Lot # 43 Tax Map �/ Block / Lot _ Date Subdivision Approvjd - Renewal Revision t Owner /Applicant Name JO 60)2- Date of Previous Approval Mailing Address P 0 0M 3 J 2-- J�LD RM f � Y 1.0 S70,6 Zip Amount of Fee Enclosed , Building Type '� Lot Area 3 1 No. of Bedrooms '7 Design Flow GPD�D Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 117-50 gallon septic tank and Z-L NIIf . I Z!3 0 6 • COWC t_ 5 �7 61�. Other Requirements:206 YQS 6 f-444 Z /Od >ePf To be constructed by S Q . ��-S Address Ya c Water Suuuly: Public Supply From Address or :� _Private Supply Drilled by t E _ Address ti 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 accardance 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 buider will place in good operating condition any part of said sewage treatment system during the period of two (2) years imnediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original sysem or any repairs theretgr Signed Adlres R.A. Date License # 5 3Z-7 7 AIPROVED FOR CONSTRUCTION: This approval expires tWo y s from the date issued unless construction of the seage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or malified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a nw perm i proved fo ischarge of domestic sanitary sewage only. , Title: C�� Date:. `ti '� WEite copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professio Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # Located at CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 1`1G# -1� _J own or Village Subdivision name &J Pl �1?rI Subd. Lot # 09 Tax Map 4,14 Block ! Lot Date Subdivision Approved � I t 144 El Renewal Revision X Owner /Applicant Name PKP& r Lc H616 0 6 Date of Previous Approval (& I D i Mailing Address � 1 ' >J H O 944i PAM AOH j 'Ry Zip Al Amount of Fee Enclosed f ti, 0 Building Type Lot Area '� a ?i No. of Bedrooms 4 Design Flow GPD 9100 Fill Section Only Depth Volume Separate Sewerage System to consist of �IL ey 0 gallon septic tank and .t-Q .WL Other Requirements: PL's-1P 61`�511-50 V }j j i.1 To be constructed by Address Water Supply: Public Supply From Address or: `1� Private Supply Drilled by �'�' ' BEN- Address wA70-- 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 s, tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: �'�id,��., `��r t��, P.E. � R.A. Date '� /'�) 1 4 Address u M'1' License # 5WN 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. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Consiglio Sunset Drive, Lot #13 (T)Patterson, TM# 4.14 -1 -14 Dear Mr. Nichols: April 2, 2002 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. Revised plans cannot be approved as submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve /uly yours, Robert Morris, P.E. Senior Public Health Engineer 'I 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner e--oAl-51AL10 Address 5uv5c--f- -DR, Located at (Street) Tax Map Block Lot /,5w (indicate nearest cross street) Municipality 7�,47--rgz!scA/ Watershed g!E�d _5 T 13 SOIL PERCOLATION TEST DATA Date of Pre - soaking /2 3 ZeL Date of Percolation Test 2- 3 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation. rates are obtained at each percolation test hole. (i.e. :g I min for 1-30 min/inch, -.q 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 9;17 -9'47 50 0 3 C/ 5 -2 5-1 3 0 17 Yy, t 2 3 30 18— 1 3,C) 4 --------- -- ---- --- - - ----- 2- 3 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation. rates are obtained at each percolation test hole. (i.e. :g I min for 1-30 min/inch, -.q 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 Ilk PUTNAM COUNTY DEPARTMENT OF HEALTH 7— DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner K'OA1616 Ll C7 Address :5uxt 5 _71- 7z>gj Located at�(Street) I Tax Map Block Lot (indicate nearest cross street) Municipality Watershed 4Xa S SOIL PERCOLATION TEST DATA Date of Percolation Test Date of Pre - soaking 3 /,*/ M .. ............. . .......... . Start 'T. Start St . .. .. es . .... MrnfIncb .. .... ......... . ... . ... .. .......... ... . ........ . ..... :'.. ?,27- y, 7 0 7%2 18 /y 2 5 .'7- 10' �_7 25 .60 3 3 4 5 2 10 a7 -to; 3 4 z 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 I min for 1-3.9 min/inch, :5 2 min for 31-60 min/inch) All data to b( submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 I acknowledge receipt of this repoit..' t SIGNATURE; 02%96 Title, Rev. r w JUN -16 -00 SAT 9:08 AM PUNAM CTY ENV HEALTH PAX M0. 19142.787921 P. 2 AM a� a� -c ec BRUCE R FOLEY LOREITA MOLINARI R.N., M.S.N. Public Health Director �+ Auociate Publia Health Uftceor Director of Paean, Sery&W DEPARTMENT OF HEALTH i Geneva Road Brewster, New York 10509 RFQtEST-FOR E.LILTESTiNG ATTENTION: D ADAM STIEBELING XGEN$ REED All information below must be fuk completed prior to soy scheduling. DATE: M 141 lo 1 ENGINEER OR FIRM: _ ii'f�i L� PHONE #: -, E ,l8-%6f j q REASON: DEEPS: o PEItCS: X PUN[ P TEST: 13' ROAMTUrf: 5c/, TOWN: Y �� _ TAX MAPft: SUBDIVISION: LOT#: 3 . OWNER paTF7 c.eA)-rl /j L o YES NO a F( Proposed SSTS within the drainage basin of Weft Branch. or Boyds Corner Reservoirs. o 1( Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ci Proposed SSTS within 200 feet of a watercourse or a DEC wetland. El Proposed SSTS design flow greater than 1000 gallonstday or SPDES Permit required. o Proposed SSTS for a Comonerical Project. It is the responsibility of the design professional to provide the above information prior to sell testing. This Department will determine the NVCDEP project status (Joint or Delegated) based on the response. If you answered ym to any of the questions, NYCDEP mast witness the soil testing. This Department will coordinate a muteally suitable time for gold testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule mwitnessing of the soil testing with NYCDEP. FOR CO JM UBE ONLY NLGtJ D� %'S a 0[.3 Tito (f3FiDT647) Z/Z 06ed `66 :9t tO- 2-J81N •`980LBMIL6 `JNIH33NION3 13W8VO d0 Wi :As jueS i Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 IM YA Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 March 21, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Revision Quaker Ridge Estates - Lot # 13 Sunset Drive Patterson T.M.# 44. -1 -14 P.C.H.D. Permit P -28 -01 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -13, "Pump Design," dated 3/21/02. 2. "Construction Permit for STS," dated 3/21/02. 3. Pump Design Calculations. 4. Revision fee of $150.00. 4' -," If there are any questions concerning the enclosed, please call. Very truly yours, 1 Harry W. N' ols Jr., P.E. HWN: JM: j 02- 022.00 V •' Harry W. Nichols Jr., P.E. PattersuirPark, Suite 106 2050 Route 22 Brewster, NY 10509 (843) 279 -4003; Fax 279 -4567 CONSULTING SITE ENGINEERS JOB No. "" ©1"�� -�•... SHEET No. l ... OF._ ?� COMPUTED BY -- J1'1 — .:.._..DATE' 3 �L.I D.'L CHECKED BY N WN DATE �D • 'T l.4 nl 1 _-----------...-- - - - =— .:. . µ l J_ I ..rT I w_�s <_..CC�11� ✓f_# .T...,.... P!.EJe .. .. _. ,. .. .. ... �. I .. .. ......._...... . - - ..... - -- -- _r_...._..... -- �---- �' �T� (.�-- _J��?11�..VA�C.hIT..._P1 P.� --- L, dEN: �._ T. f:E___�.::._.:_�..Z�..C�- '•_ - -- --- _..... Al.. 4,F.._ x 3,$. �=T.4 ............ ...._... _..__... __ -._. .... _.____... -.... .. ____._._..._ _. _...._...._.._._. _. ...__.___... .. - - - - - -- — -- -TD H +T -- ---- -- 1-D ( 9 _ . 2?ro _..._.. ... ... ......... f -..... Harry W. Nichols. Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 (9-lSj 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEERS JOB No. SHEET No. 2 OF Z COMPUTED BY JH DATE 3I2� 10� CHECKED BY 14 WH DATEI'1-� j D� _ 51 !i- 0 01AF._ [7S% OP 5YSTEM UOLUMEI -- — o &AL, / D 05 E _ - -- C, G"AA S )2- 1N6 -'', ArlZ SPACE r F .----- - - - - -- - -- — �}�M'�M- -D- Imo{------ _...----- -• - - -. _.�...._.__ ..... .: .......__.-------- - - - - -- . - -- u . - - - - - ------ - - -- - - -- - - - - - - - - -- — -- - - - - -- s I i 4 FINISHED GRADE 1 GAL PUMP CHAMBER (ROTONDO do . SONS INC. OR EOUALIH-2k LOADING. 1 2 Q ONE DAY'S STORAGE 2 24" DUI. OPENING IN fOP. (Q_Qo2.5o) 3 24'I.D. MANHOLE RISER — . • .. • .: 771 EL $ o3,�y i 4 MANHOLE FRAME do CAMPBELL 11 oaA OR ' EpUAt)H -20 L ADING. P.V. S GOULDS PUMP MODEL {A15o` Ste, 6 1- 1/4 "x7' INCREASER. $ac CAI. PROFILE e 7 Y H.D.P.V.C. PIPE (ONE DAY'S O 8 9 Y 90' BEND. Y STORAGE V5] ISO �oo,og') I 10 UNION. FLOAT SWITCHES FOR ON,OFF & HIGH WATER ALARM. 39° 11 LIFT CHAIN. 12 PUMP OFF Y CHECK VALVE — III 'A DEL 13 BOTTOM(El 14 2" GATE VALVE WEEP HOLE. G�' —o "X Ia'- o► VOTES 1. CONTRACTOR SHALL ELECTRICAL CABLE AND AVAILABLE VOLTAGES PROR TO ORDERING EQUIPMENT. PUMP C HAN1 B E R PUMP 2 WIRING CONFORM TO NATIONAL ELECTRICAL CODE .dc LOCAL CODE REQU REMENTS. NOT TO SCALE 3. THE POWER do CONTROL WIRING SHALL BE MADE DIRECTLY TO THE CONTROL PANEL WITHOUT ANY OUTSIDE SPLICES. CONTROL PANEL TO BE LOCATED INSIDE CALL = - 600-1(: _O_ pee ->c-7-1'- fir, O: jcj : qj_�o CaAiL. HOUSE WITH AUDIBLE ALARM do FLASHING LIGHT. G,OULDS -:; d� s yam' Si n Li e TT , 0 e o , MODEL efle n 4; 4� -- 11® I 0 olrwac� Pumas! MODEL i .w 0 Performanc Curve I METERS FEET 16— 50, MODEL SIZE 14 I. 40 T7 12 .7. Uj x lo- 77. _4 30 _j 0 8 6 — 20 _4 4— .1 T;: 7; 7 10 H 2 0 0 0 1 0 i7 "T 7- 20 40 tie 60 10. 20 30 CAPACITY PM 40 m3/hr GOULDS PUMPS* INC. SENECA FALLS NEW YCW 0148 t,1985 Goulds Pumps, Inc. Effective July, 1985 MODEL SIZE 3887 2" SOLIDS kk iTI-i T7 .7. _4 + _4 :J J 7 .1 T;: 7; 7 H 'T ttft 1 i 7 7 80 100 120 140 160 180 G 20 30 CAPACITY PM 40 m3/hr GOULDS PUMPS* INC. SENECA FALLS NEW YCW 0148 t,1985 Goulds Pumps, Inc. Effective July, 1985 -� i - e.. No3d '9 i`�(Q •�.'' �iN1�e! 41 4 r a `iL- 'b��:r",� '��s e> Q fir r . .I ; i �.► 1!� "Im rte' '�'. i _- ��� �• mm 1 M3N'�d' 1 , 1 1 'AA • .,� ��d""�'/f!+!r1� og L y� C # _ a'So8 HI arc a110 , NO NON i ' ,� � •�- � �� �� _� ����� RQ�.� .rte - ��� . : \ xt MNC2 `mow- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE FOR SEN�AGE TREATMENT SYSTEM PERMIT # Located at Town or Village Y t T RT% Q I �'� %`� Block Lot Iq Subdivision name -r Subs dl. Lot # / Tax Map Date Subdivision Approved — (v 4' `I Renewal -W Revision Owner /Applicant Name PC,+ i ,1 C (Q- C01.51!1110 Date of Previous Approval Mailing Address 91 S CIA-5 ( 001% P471&—X- OJ 1 I 1 2,563 Zip Amount of Fee Enclosed L r Building Type "6 (, F�NI6 Lot Area -3, )-A No. of Bedrooms T Design Flow GPD � Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12-50 gallon septic tank and ,F00 L4C Other Requirements: To be constructed by 7-P Address Water Supply- Public Supply From C7f40G L- /' Address or: Private Supply Drilled by Address,1�EV /U .t 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- P.E. R.A. Date Address �� �U,f� /�� �Cl '��O%l.� / Z31 � License # -77 APPROVED FOR CONSTRUCTION:, This _approval expires two years from the date issued unless construction of the sewage treatment system has been completed `arid inspected by the PCHD and is revocable for cause or may be amended or modified jwhh Lnsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe d f ischarge; of ;domestic sanitary sews a only. U Date: 2-� Q By: Title: �/� 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 PCHD Permit # — o) please print or type Well Location: Street Address: Town/Village Tax Grid # Mapq ,r Block Lot(s) Well Owner: Name: Ct�YYG�Ccr Address: , &/10 6�1 SV rnfe?- /D n&-.e- A *ei:sdvi N`{ 12-S-G 3 Use of Well: X_ Re ' ential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought_ gpm # People Served S_ Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason A. for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes k No Name of subdivision s /� G L�� . �.3 / Water Well Contractor: P�.� Address: GYP Uhl' Is Public Water Supply available to site? .................................. ............................... Yes No >_ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed we l location & sources of contamination to he provided on separate sheet/plan. Date: 170 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wa r 11 driller certified by Putnam County. Date of Issue Permit Issuing O 1: Date of Expiration 0 16 63 Title: Permit is Non- Transfe rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 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, OR, AS, SRDATE: N DOCUMENTS )(_)PERNITr APPLICATION )(WELL PERMIT OR PWS LETTER )UPC -97 )L_)LETTER OF AUTHORIZATION )L_)DESIGN DATA SHEET (DDS) )LJCORPORATE RESOLUTION )L _JSHORT EAF )C__)PLANS -THREE SETS )LJHOUSE PLANS - TWO SETS _)(VARIANCE REQUEST, SUBI)DaSLON ,(_)LEGAL SUBDIVISION ,(_)SUBDIVISION APPROVAL CHECKED ,(_)PERC RATE _)( _)FILL REQUIRED DEPTH j(_JCURTAIN DRAIN REQUIRED GENERAL _)(_)LOCATED IN NYC WATERSHED _)L_)PLANS SUBMITTED TO DEP _)(_ _)DELEGATED TO PCHD _)LJDEP APPROVAL, IF REQ'D _J(_JDEEP TEST HOLES OBSERVED _)L_,)PERCS TO BE WITNESSED _)LJEX- APPROVAL SSDS ADJ, LOTS ---)C TLANDS (TOWN/DEC PERMIT REQ'D ?) _JL_)DATA ON DDS PLANS & PERMIT SAME _J(_JPRE 1969 NEIGHBOR NOTIFICATION _JLJLETTER BI/ZBA _J(_)100 YR FLOOD ELEVATION W/I200' _J(__)SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS (_)SEWAGE SYSTEM PLAN - (NORTH ARROW) �-J )SSDS HYDRAULIC PROFILE )C. JGRAVITY FLOW -)(_)CONSTRUCTION NOTES 1 -15 �L_)DESIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED ;,�D(i)DRIVEWAY & SLOPES, CUT. (�L_JFOOTING /GUTTER/CURTAIN DRAINS (D(_)USDA SOIL TYPE BOUNDARIES Lj�)(__)TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NANIE, ADDRESS, PHONE# (_�J(_)DATE OF DRAWING/REVISION (_:,J(__)DATUIVI REFERENCE L_)( _JLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (_J�_JWELLS & SSDS'S WAN 200' OF SSTS (_:)L_JPROPERTY METES & BOUNDS COivIh1ENTS: TAX MAP1: (CONFIRMED) _Y N (REQUIRED DETAILS ON PLANS CONT'DI UUAOUSE SEWER -' /" FT. 4 "0'; TYPE PIPE CAST IRON UUNO BENDS; NIAX BENDS 45 0.W /CLEANOUT RENEWALS (_)L-)STTE NOTE (NO CHANGE) FILL SYSTEMS (--�JU 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE LSL JFML SPECS/ FILL NOTES 1 -5 C_:: (_)FILL PROFILE & DIMENSIONS (_-)C _ lei 1 EXPANSION AREA r V U(--) CLAY BApdkIER (___)(_)FILL CFA TIFICATION NOTE C_JC GAUGES C_JC_jVPL ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (--)( JSEPARATION DISTANCE FROM TOE OF SLOPE _ E C U(LJLF TRENCH PROVIDED 60FT MAX. L�(_)PARALLEL'TO CONTOURS Ci' ( —)100% EXPANSION PROVIDED U(�DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL ( _JLJGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL L�(_)20' TO FOUNDATION WALLS LL(_)100' TO WELL, 200' IN DLOD,150' TO PITS (- x(___)100' TO STREAM, WATERCOURSE, LAKE (inc. espan) (_j(__)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER LL)L_)10' TO WATER LINE (pits - 20') ( _J(_)50' INTERMITTENT DRAINAGE COURSE ( _)(^)200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (_J,LJ10' MIN TO LEDGE OUTCROP / SEPTIC TANK L�(^)IO' FROM FOUNDATION; 50' TO WELL WELL C� C-- )DIMENSIONS TO PROPERTY LINES (�L_)LOCATION OF SERVICE CONNECTION (�(JM N 15' TO PROPERTY LINE SLOPE IN SSTS AREA (520 %) L- REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS (_JLJPUMP NOT LJ JDOSE 7' o OF PIPE VOLUME/DOSE VOLUME NOTED LAUD IL FOR FORCE MAIN, (PIPE TYPE, ETC.) UU1T AND D -BOX SHOWN & DETAILED (_;)(j1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN UUSTANDPIPES, 5' BOTH SIDES, DETAIL LJL_,15' NIL 1 to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<1% L j(_j20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_,U10' MIN to NON - PERFORATED PIPE 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: At 2. Name of prcject:5l64Z-1': � �i1 '� / /G�Qf 3. Location TN: 11 hi ?W 4/y 4. Design Professional:7§- /7�O 140e5zLV45. Address: 6. DrainageBasin:C—/5�5-T 49Xc Cll 6'�SrI�% 7. Tyne_, of Project: �Z _x 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 Exempt Type II Unlisted t-- 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... lur 0 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? ........ ............................... --� 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? ........ ............................... fib �J 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ "V 0 21. Name of sewage system 91zfI V 7, Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector �2 oyyrl 24. Project design flow (gallons per day) D 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... AJ 0 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8199 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI. R.N., M.S.N. TOV Associate Public Health Director °' 1. Director of Patient Services . 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 (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June 18, 2001 John Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 RE: Consiglio Sunset Drive, Lot # 13 (T) Patterson, TM# 4.14 -1 -14 Reservoir Basin Dear Mr. Karell: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 1, 2001 is complete. The Department will notify you by July 6, 2001 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. El Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of ._s- Letter to: John Karell, Jr., P.E. - June 18, 2001 -2- Environmental Protection regarding such activities to see if ' Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166: RM:tn Very truly yours, Robert Morris,. PE Senior Public Health Engineer BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 T LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June. 18, 2001 John Karell, Jr., P.E. 121, Cushman Road Patterson NY 12563 Re: Proposed SSTS: Consiglio Sunset Drive, Lot # 13 (T) Patterson, TM# 4.14 -1 -14 Dear Mr. Karell: 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. Subdivision plat notes that 3 feet of fill is required in the SSTS area. 2. Silt fence cannot be shown perpendicular to the contours. Silt fence installed in that manner enhances erosion. 3. Dose is to be set at 75 % -85% if pipe volume. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn PUTNAM COUNTY DEPARTMENT OF HEALTH 7- DIVISION OF ENVIRONMENTAL HEALTH SERVICES --xc ! 3 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Form DD -97 Owner LOA) Address Sv�r 5 CT �7zly�. Located at (Street) Tax Map Block _� Lot /z/ (indicate nearest cross street) Municipality p/�7-7-E-n %oAl Watershed -5 ,19NG/-t SOIL PERCOLATION TEST DATA Date of Pre - soaking Z2- 3 /ol Date of Percolation Test - ` -. :. D�epth to Water .". .. '..:W .'ea . ,. ee...Vf Per any Time EI . se Time 'Surfa (Inches) Droop In to Hole No Ruu No: Start 'Slog Min) Start .Stop: Inches MinfIncl::; 1 ?,27- 9f57 -3,o 3 4 5 P 0 C3 2 3 10,37 oy 4 WIto- 1I:iLo 1 2-- y 47,;. 5 �s NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rate percolation test hole. (i.e. s 1 min for 1 -30 min%inch, s 2 min for 31 -60 minfinc be submitted for review: 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 2-07- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -sc-7- -7j2,. - Address Suv Located at (Street) Tax Map Block Z Lot (indicate nearest cross street) Municipality -A�-r7-F-EsoAl Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking �2---3 20/ Date of Percolation Test . Hole 6 . ......... . . ....... . .. ... .......... . ........ . Run No . ......... .. . ................ ......... ........ ...... e ... ".. '- #PseTime . TP rm d "S o (1 PC h us ' all Stop Water - ' f es, 'Ri t M�niInch -3/ ov- 3 4 10;5O-//:7o 0 5 1 5-/ 30 All. 2 T571 to; 2- 1 30 1e) 19 1 30 3 0,,,z:z 30 Is— 1 3 -o 4 5 - 2- 3 YAR 4 A f!, 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rate percolation test hole. (i.e. :5 1 min for 1-3.0 min/inch, -.q 2 min for 31-60 min/inc =be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRON'ME\'TAL 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 1,,L-%P =: (CONFIRMED) Y J DOCUMENTS CAD( APPLICATION ( A )WELL PERMIT OR PWS LETTER C - J,(,-)PC -97 U(__)LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) ( e JCORPORATE RESOLUTION //( 1(! )SHORT EAF (��PLANS -THREE SETS ( )(/ )HOUSE PLANS - TWO SETS 'ARLANCE REQUEST SUBDMSION EGAL SUBDIVISION LfJK SUBDIVISION APPROVAL CKED RC RATE U FILL REQUIRED DEPTH (CURTAIN DRAIN REQUIRED / ' GENERAL LOCATED IN NYC WATERSHED %lfPLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D WEEP TEST HOLES OBSERVED CS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS iTLANDS (TOWN/DEC PERMIT REQ'D ?) TA ON DDS PLANS & PERMIT SAME E 1969 NEIGHBOR NOTIFICATION- LETTER BI/ZBA 100 YR. FLOOD ELEVATION W/I 200' (-�JUSOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS SWAGE SYSTEM PLAN - (NORTH ARROW) (� DS HYDRAULIC PROFILE ( GRAVITY FLOW CONSTRUCTION NOTES 1 -15 - ( DESIGN DATA: PERC & DEEP RESULTS , �2T CONTOURS EXISTING & PROPOSED ,WAY & SLOPES, CUT ING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES E BLOCK; OWNERS NAME ADDRESS PE/RA; NAME, ADDRESS, PHONE# 'OF DRAWING/REVISION TUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS tiVELLS & SSDS'S W/IN 200' OF SSTS C -AZPROPERTY S z OUNDS EROSIO CONTROL F HOUSE, WELL & SSTS, fOSI NCO OL NOTE COMMENTS: (REVSHEET)09 /01/00 f (REQUIRED DETAILS ON PLANS CON'T'D) ( )J,::�)HOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON U(___)NO BENDS; ILAX BENDS 45° W /CLEANOUT RENEWALS SITE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (��FILL SPECS! FILL NOTES 1 -5 (FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER 7WAN 2 FEET - `CL.AY BARRIER ILL CERTIFICATION NOTE ( EPTH GAUGES (� VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & I, IPERVIO US (� SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH (_) F TRENCH PROVIDED LOFT MAX. (PARALLEL TO CONTOURS 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (�(_)GEOTEXTME COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (�F 20' TO FOUNDATION WALLS 0' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAiIM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STOl; 0vIDRALN, PIPED WATER 10' TO WATERLINE (pits -20') . 50' IlNTERl1ITTENT DRAINAGE COURSE �200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK (_,10' FROl1 FOUNDATION; 50' TO WELL WELL DIIIENSIOi 1S TO PROPERTY LINES EOCATION OF SERVICE CONNECTION liIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (9201/6) REGRADED TO 15 %, IF REQUIRED D0SE/PUN1P SYSTEMS UUP s (�( D o OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) ( SPIT AND D-BOX SHOWN & DETAILED C DAY STORAGE ABOVE ALARM / CURTAIN DRAIN �)< STANDPIPES, 5' BOTH SIDES, DETAIL �15' lIIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -I %,100 % -<1% ( 20' 11IN to CD DISCHARGE /100' with 182 cons day discharge (_)10' NlIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION S1��i U Located at S&/,5E 7- �'�/ TN + H-aS0V) Tax Map # o "-- Block Lot Subdivision of () VrA- 4Le�� PW. &_14 Subdivision Lot # 13 Filed Map # / OP%J Date Filed �f47 0 y Gentlemen: This letter is to authorize -3-c) �t o lcika& L% li /J-? a duly licensed Professional Engineer _)�,_ or Registered Architect to apply for the required 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 provi ' ns of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnayr� i UWarY Code. * Very truly urs, cc Countersigned: " �' Signed. ' P.E., RA., # (Owner of property) OFESSIO . Mailing Address 12- Mailing Address: / Svet�S % 0p-/ A 61 76 L1, r. Pal t ).e Sa A) State %V \1/ Zi p Telephone: State Zip j 2 .�� -3 Telephone: _ `�� 71--00 . 7 Form LA -97 27. Is any portion of this project located within a designated Town or State wetland? 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? .. ............................... A.) 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, A-110 landfilling, sludge application or industrial activity? ............................ Yes/No 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 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 15 years in or adjacent to project site? ................................ ............................... _ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... tid 2 36. Tax Map ID Number .......................... ....... .I....................... Map Block Lot 37. Approved plans are to be returned to ..... 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 applican t 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 pf the Penal Law. SIGNATURES & OFFICIAL TITLES; Mailing Address: ................................... s 14.16 -4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEOR Appendix C State Environmental Guallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsoo 1. APPLI ANT /SPONSOR �i4 -772 (C l�- CdA�SI� L10 2. PROJECT NAME L� IL 3. PROJECT LOCATION: PA tWd , ` U N - ,.. -I: County 4. : ,3E LOCATION (Street address and road Intersections, prominent landmarks, etc, or provide map) ftl LL- 5. IS PROPOSED ACTION: 15New O Expansion O Modlficatlon/alteratlon 6. DESCRIBE PROJECT BRIEFLY: C 6� ti IL- 4 /*�.5� j CA./LZ.L Ste) 27 C I ysT� -11 r ; 7. AMOUNT OF LAND AFFECjW.. © 7 j Q. Initially • acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ONO describe Yea If No, briefly 9. WJAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �''(�Re3ldentlal 0 M63tdal []Commercial O Aprieulture 0 ParldForest/Open space ❑ Other Describe: 9—(7/0 K le- 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) 0 Y0 o If yes, 031 agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ONO If RYes yes, 83t agency name and permitlapproval 12. AS A RESULT OF ROPOSED CTION WILL &STING PERMITIAPPROVAL REOUIRE MODIFICATION? O Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE /(J/ �i i%-z' _. ✓— j-/ A DD Ilcant/s Po nscr name: Oate: Signature: It the action Is In the Coastal Area and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 0701, PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? 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 617.6? It 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, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 0. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or intensity of use of land or other natural resources? Explain CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE.ESTABLISHMENT OF A CEA? ❑ Yes ❑ NO E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ONO It Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting p.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility, (e) geographic scope; and (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure. that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II 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 bo)t if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on'attachments as necessary, the reasons supporting this determination: Name of Lead Agency - 4- 1 'j, '110 br . . y Print Or Type Name of Responsible Officer in Lead Agency A 4 Mtno i"ise,o a Officer of Responsible Offictr in Lead Agency Signature of F7 a If different from responsi e o acer) Date 2 p aac,a�Tl o N Tla�5-T 9ES u L—T o1\4 CDfJS I6..L-1 D 40 If �1�� -►� o; q" 4 o 3 0 F z`A r u =t nt-AM COUNTY-DEPARTMENT OF -HEAI,TH�. DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DA�'�A SHEEN - S WURFACE SEWAGE TREATMENT SYSTEM tt�izll� Owner C)C3e7 Z: Address �_ 3 � Located at (Street) �► U . Tax Map Block _� Lot (indicate nearest cros street) Municipality /� - .50/l� Drainage Basin 1-6�C0r --Z2 C;yS�:ti/�!Y`ci�_ Date of Pre- soaking SOIL PERCOLATION TEST DATA Date of Percolation Test Hole No. ` Run No. Time Start - Stop Ela se Time �Nlin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Nbn/Inch 1 9 oc1q 3a 3 O i;�- q -30 1 1 2 � 3 0/ �, 0 3 s 3 1/6) 10 ST 1 3 0 z-3 2-Y 30 1 03'° 3� Z3 �'Z 2qy z 1 9 S �� 110 12-q z-f-1 1 40 I P 7—iAc ' 19 Y f_/o fl.3o I -z-z- z3 I 3 3 10 V0 7-2_ 2-3 / 40 4 a �s /i 3r a Z� . z y I <o 5 1 EW YpR Ro NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1 -30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. � I At HOLE NO. D G.L. C-- 0.51 1.01 1.5' 2.0' 2.51 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5 • 7.0' 7.5' 8.01 8.5' 9 . .01 9.5' 10.01 C,Lzf--z HOLE NO. Indicate level at which o-,roundwater is encountered NONE Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: JD /M/ Address: P Ix Sio-nature: Design Professional's Seal PUTNAM COUN'T'Y DEPARTMENT OF HEALTH GAT DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 'syv--r -ME - -- Located at (Street) P a &d2lz ASIA — Tax Map #1 L: Block ,�_ Lot 6 - (indicate nearest cross street) . Municipality 7'7 JM!0Al Watershed G,yST BRANCH P� SOIL PERCOLATION TEST DATA Date of Pre- soaking _ J / 13 / Q Date of Percolation Test '30 If —30 ty 30'` 2. percolation test bole. kl.e. S 1 111 submitted for review. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH 2 . r DIVISION OF ENVIRONMENTAL HEALTH SERVICES -'�3 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 'Address Located at (Street) 'fax Map Block _ Lot Municipality (indicate nearest cross street) Watershed 2- 91 Date of Pre -s SOIL PERCOLATION TEST DATA Date of Percolation Test percolation test dote. ki.c. s , . +.•• -�' ' - - - submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTN•A.M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner CO tJ � i! i �(a . Address Located at (Street) SO N S Gij D Q Ui5' Tax Map Block Lot (indicate nearest cross street) Municipality n A 7 -i`tffl C,I)0 Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test a , Y, Tkf_ t Ir�� -o0 Hole No. Run No. Time Start Stop Ela se Time iin.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Minllnch ni 1 Z� Lss 30 Zs�� y77 2 5- -7 3 Z7 3 0 1 2- �'1'- 6,7 3 4 5 1 Z �I 3 D 3 4 5 30 I L/ 2 30 3�ko 3o elj � Z 3 � .� 3 � � 3 /Z 7 Z /L 5 NEw ° REC ro .5( NOTES: 1. Tests to be repeated at same depth until approximately equal percolation v percolation test hole. (i.e. s 1 min for 1 -30 minfinch, s 2 min for 31 -60 mi submitted for review. 2. Depth measurements to be made from top of hole. G-) . cc ob t s. ac z tt" ado b (' 532 OFES510 Form DD-97 Jr PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ✓� AR 0,4 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _ L -� �J �L� r� Address �Sr A/ 5 7- %'l �/ Located. at (Street) P Tax Map Block —L Lot / (indicate nearest cross street) Municipality w ry�•�=C"t? ,5a d i _ Watershed _ C,#-s7 7� 7i eve 3 3" 33.1 Date of SOIL PERCOLATION TEST DATA Date of Percolation Test 1,:2 J,6/cd Percolation test hole. (i.e. s 1 min for t -3u miniinen, s L mill iv, _I 1-vv «< submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4:��r� DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM r<Ea Owner o�t/Slr G /d Address CIM3 �7r Z2�zi vF_ Located at (Street) Tax Map Y . Block �_ Lot (indicate nearest cross street) Municipality �,�T� _Watershed !��'r ���A✓C k Date of 3xI WN SOIL PERCOLATION TEST DATA Date of Percolation Test / x/ /ea submitted tor review. 2. Depth measurements to be made from top of hole. Form DD-91 2PTH L. S' 0' .5' .0' .5' .0' .5' •.0' 11.51 >.0' 5.5' 3.0' 5.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PTT DATA DESCRIPTION OF SOELS ENCOUNTERED LN TEST HOLES i:OLENO. � _ HOLENO._�� HOLE NO. Indicate level at which groundwater is encountered Q Indicate level at which mottling is observed Nf _ Indicate level to which water level rises after being encountered Deep hole observations made by: Date . Design Professional Name: v �J Address: 1 Zl C V 5h"Mh-f1 Pd Mf) o� NEW yon � o� e w Signature: � A 53 PR0Flfp- 'nacinrn Prnfnc6nna1'c .VPa1 TEST PTT DATA DESCRIPTION OF SOILS ENCOUNTEREDTYi TEST HOLES DEPTH HOLE NO. Z4 GZ,. 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' VK11 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' HOLE INTO. HOLE NO. _ _ MRIAMMMMIMM Indicate level at which groundwater is encountered N Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: KAi�� -L_ Date Design Professional Name: 0 Address: 1 �k C u S� d rT 1�-1 �TtZSO 12-563 Signature: Design Professional's Seal OF NEW y0 E ✓ is 10.1 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' ...... 4.5' 5.01..... 5.5' 6.0' 6.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 7.5' 8.0' 8.5' . .... . 9.5' 10.0' HOLE NO. i BOLE N0, 9— HOLE NO. 3 Indicate level at which groundwater is encountered Indicate level at which mottling is observed �oiy� Indicate level to which water level rises after -being encountered --� Deep hole observations made by: ej� Mg-n P, _�, t1 KAB "n Date Design Professional Name: -JO/W Address: 12 ( C vS jiM4 -A) &.A-I) P rr-ErsvA1 ti Zr� Signature:. �j Design Professional's Seal r �j• � mss,` Cr \2�F0 R 53271 A OFESS1(-A. � 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # AIA 09W 4 OAA Located at Pi- 11 L, WJ0 D L4 Vie Subdivision name QUA X4 IQllilWSubd. Lot* 1 Dale Subdivision Approved eS U 7 V5 Town or Village Tax Map's• Block Lot Renewal Revision Owner /Applicant Name JU*M'r Fif Date of Previous Approve! Mailing Address 15 C4-,- E&A)2 °a2 ht&W u f— Mt`4/ SC- 0 N y _ Zip / 0 5 3 Amount of Fee Enclosed Building Type WD Lot Areal_AeNo. of Bedrooms Design Flow GPD �Q6 Fill Section Only X_ Depth 5 Volume $epamte Sewerage Sylt m to consist of gallon septic tank and Other Requirements: To be constructed by Address Water Suttnoly: Public Supply From Address Private Supply Drilled by 6E'dL -= Address. I mpresent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the 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 threof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Dpartment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said Wider will place in good operating condition any part of said sewage treatment system during the period of two (2) years inmediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original s,vmm or any repairs thereto. Signed: P.E. S 3 Z7 7 Date W607 Address �� �� c0ot;�' /V � 1057o- License # .S 37.7 7 A?PROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the s maw treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or taoclifted when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires