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HomeMy WebLinkAbout0251DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -15 BOX 3 A I 1 ' i 1 ' • WL .1 T F - L {- 1 r '� , V yL ELI ` III �'� , A I 1 *r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT # P �-°I - D 1 Located at e;q5 JARV B19W rrILL, (-OAP Town or Village Owner /Applicant Name Formerly P—y4P 14 (AA Tax Map r'D • Block I Lot Subdivision Name [3P-1PL'6 (z[P4 Subd. Lot # [ D Mailing Address 62.4 A A Lk)H LAY-t POND �l'r���1+a C0kHEC41i,U`i' Zip 06gJ D Date Construction Permit Issued by PCHD 10' 11 Separate Sewerage System built by P-YA- v V- Consisting of J 0 a Q Gallon Septic Tank and 4M Other Requirements: Water Supply: Public Supply From Address 6M AlA W LKEhi *L1- GG%10 Address or: Private Supply Drilled by P,F. bEN (,'+" �)OHI� Address' FUTOWM15 R A'Moo Building Type Ql✓riLi;—;� Has erosion control been completed? YE� Number of Bedrooms Has garbage grinder been installed? M0 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 regulations of the Putnam County D partment of Health. Date: 1211,114. Certified by t44 P.E. R.A. Address 2d S o Ar 2Z �Pr�fessio�nal) 10 Se License # '5G i 2-ff Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals^ subject to modification or change when, in the judgment of the Public Health Director, such revocation m difica ' or change is necessary. By: Title Date: % dL '4 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 13 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM V,y A VuHL-) Owner or Purchaser of Building P-i Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279.4567 December 17, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Bridle Ridge Estates - Lot # 10 North Birch Hill Road Patterson, N.Y. T.M. #5. -1 -15 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -10, "As -Built Plan," dated 12- 17 -02. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 12- 17 -02. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System," dated 12- 17 -02. 4. Laboratory Report, dated 12- 12 -02. 5. Well completion report, dated 7- 22 -88. , Y 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department.% 7. "E -911 address verification form," dated 1 -3 -02. Kindly process the enclosed at your earliest convenience. Very truly yours, Harry W. Nic ols Jr., P.E. HWN:his 00-177.00 bridle DGE ASSOC: Wr,LL 1,vliri,r,ttv►v i�t,rvAl ►� w ��4 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADORESS: WNIVI ! 1 TAX GRIO NUM8ER: Route 22 North Brewster NY Lot #10 WELL OWNER NAME: ADDRESS: Bridle ❑ PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary ❑ RESIDENTIAL O PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP 0 ABANDONED O BUSINESS O FARM 0 TEST /OBSERVATION 0 OTHER (specify) O INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY 0 MOUNT OF USE YIELD SOUGHT gpm. 1N0. PEOPLE SERVED % EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST/ OBSERVATION O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 145 ft. 1 STATIC WATER LEVEL 1 ft. DATE MEASURED 7/13/88 DRILLING EQUIPMENT ® ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING. 0 OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 21 ft. MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 20 ft. JOINTS: ❑ WELDED O THREADED D OTHER DETAILS DIAMETER 6 in. SEAL: ID CEMENT GROUT ❑ SENTONITE ❑ OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVESHOE CSYES ONO LINER:DYES 0NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) _. _DEPTH TO .SCREEN (ft) DEVELOPED? FIRST o YES 0 N HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DE,M It. WELL YIELD TEST It detailed pumping METHOD: fl PUMPED 1 tests were done is in- � O COMPRESSED A1R= formation attached? O BAILED D OTHER i ❑ YES O NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. ei0hl CE Waler 8ear- ing wd Dia- In FORMATION DESCRIPTION CODE It WELL DEPTH IL DURATION hr. min, DRAWOOWN ft. YIELD 9pm. s�;;ce 2 ;15- Dtilling in overburden clay & bldr H t ock at 22' 145 48 100 100 21 21 Dlilling in rock set casin groute . ling in -rank gra3aitp- WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED .ANALYZED? 'OYES O NO ANALYSIS ATTACHED? OYES O NO STORAGE. TANK : TYPEI— .: CAPACITY GAL. PUMP INFO MATION TYPE �� CAPACITY '�_ MAKER STUvI s DEPTH 1 v G MODEL 75- 1407`1:1Z VOLTAGE2 —ZHP_4 WELL DRILLER NAME P.F. Beal & Sons Inc D 2/6 ADDRESS PO BOX B SIGrATURE Brewster,NY 10509 �� YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.203713 CLIENT #: 56118 NON 8TAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ KING, RYAN 595 NORTH BIRCH HILL RD PATTERSON, NY 12563 SAMPLING SITE: 595 NORTH BIRCH HILL RD, COL'D BY: RYAN KING NOTES...: WELL HEAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE DATE/TIME TAKEN: 11/12/02 08:30A DATE/TIME REC'D: 11/12/02 11:20A REPORT DATE: 12/02/02 PHONE: (914)-715-1661 PATTERSQNp NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/12/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 11/12/02 LEAD (IMS) 2.1 ppb 0-15 ppb 9101 11/12 . 2 NITRATE NITROG 0.32 MG/L 0 - 10 9139 11/12y02 NITRITE NITROG <0.01 MG/L N/A 9146 11/12/02 IRON (Fe) 0.090 MG/L 0-0.3 mg/1 2037 11/12/02 MANGANESE (Mn) 0.75 MG/L 0-0.3 mg/l 2037 11/12/02 SODIUM (Na) 5.23 MG/L N/A 11/12/02 pH 7.2 UNITS 6.5-8.5 9043 11/12/02 HARDNESS,TOTAL 114 MG/L N/A 11/12/02 ALKALINITY (AS 76.0 MG/L N/A 11/12/02 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD 'HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p/ EPA Lead & Copper than 10% of their than 15 ppb and a` treatment must be potential. �blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no morp than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.203713 CLIENT #: 56118 NON STAT PROC PAGE 2 KING, RYAN DATE/TIME TAKEN: 11/12/02 08:30A 595 NORTH BIRCH HILL RD DATE/TIME REC'D: 11/12/02 11:20A PATTERSON, NY 12563 REPORT DATE: 12/02/02 PHONE: (914)-715-1661 SAMPLING SITE: 595 NORTH BIRCH HILL RD, COL'D BY: RYAN KING NOTES...: WELL HEAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PATTERSON, NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: Ml:-- RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director ELAP# 10323 CIO BRUCE R. FOLEY . * . LORETTA MOLINAW-RN., M.S.N., Public Health Director Areoeiate Public Hodsh Glnctoi ,• . Dirreior Paiknt .Strvica , DEPARTMENT OF IMAM_ _ _. -. _.- 1 Geneva. Road . _— Brewster, New �Y ' ib509 _._.._... -. _:._..... ....._. WWameoW Health (9M) 278 ;16;�a.:' F 891/) 278.7921 _:.:...:::: _� .... _...... . Nerd8"ca (914)271.6458 WIC (911)271.6678 :Fax(914) 278.6081 8krly- Toteriw6a "(91/)178.6014-., Prescb*o1'(214) 278 082 - PAx (911) 278'• 6648 f 11 ADDRESS V .RIFI -AIMN FORM O W &ERS NAME: TAX MAP NUMBER: E911 ADDRESS: we;/dpi yzac /� TOWN: - AUTHORIZED TOWN OFFICIAL: -(Signature).. 3 �Z DATE: ' The Putnam- County Department of Health will not issue---a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This -form is to.be.submitted with the application for a. Certificate of Construction Compliance. (E911 VERT:R)v6 PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . ,. FINAL SITE INSPECTION Date: //,//-3/ Inspected by: f, reooD Street Location gjDGr ZZA Owner Town Permit # TM # S , l - i Subdivision Lot # / o 1. SewaLye Svstem Area a. STS area located as per approved plans ...:....................... b. Fill section date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil. not stripped.......: ........... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... H. Sewage System a. Septic tank size - 1,000 :......:1,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from £ oundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost ..... :........................................... 3. Minimum 2 ft.Original soil.between box &..trenches Junction Box - properly set ....................... ............................... 1. Length required a 2__ Length installed 2. Distance to watercourse measured 4- /D O Ft.......... 3. Installed according to plan .......... ............................... 4. ,Slope of trench acceptable.1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft. foundations.......... 6. Depth of trench <30 inches from surface.................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1' /Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ......................... ............................... g. Pum p or Dosed Systems tems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. House located per approved plans ............. . b.. Number of bedrooms ........ ........:...................:.. ....... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured -,-I- /4O ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ...:......:................:... b. All pipes partially backfilled ............ ............................... c. All pipes flush with inside of box.. . ..............:................ d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 orm - tit�NOV -07 -2002 10:25 AM HARRY W NICHOLS 914 279 4567 P.01 ' 040 -1 ?7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RRQIJEST FOR FINAL INSPEC,110W For; Fill Date; 04 -6— Trenches L.-' PCHD Construction Permit # Located; ��� (T)) wrier/Applicant Name: «- TM .� Block Lot �. 4 Formerly: Subdivision Name; bk,444 &1,13 ,. Subdivision Lot # _� Is system fill completed? Date: Is system complete ?._ Date: )1- 64 -412_._ Is system constructed as per plans? _ Is well drilled? Date: l 1 -0�4 -a2- Is well located as per plans? �% 1 Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: �((� U a-O)_.. Certified by: E _ RA Desi rofessional Address: 42V�V Lic. # T4 12-# Comments: FOR 0-ADAM © GENE 0 (NANE) Form FM -99 -' - ��'^" -" "' • ^ --'^ T''� -r�nc ^1�P1 7!)!'7� A IAMC. M1 ITA Il11N !Ynl Il ITV 1'11�P-i/'P-rmrk IT PYC •r-1 4 a BRUCE R. FOLEY Public Health Director 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/Preschool (845) 278 - 60i4 Fax (845) 278 - 6648 November 15, 2002 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - King Bridle Ridge Rd., (T) Patterson Lot # 10, TM# 5 -1 -15 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled, No comments. If you have any further questions, please contact me at (845) 278 16130 ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide I acknowledge receipt of this re port-,:S I G A T ORE. 02/96 Title:._ OCT -06- 200241:18 AM HARRY W NICHOLS 914 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FQR FjjIAL INSEF -rTION For: Fill r/ Date; jQ ^0.1'? PCHD Construction permit # Trenches 0-177 Located: rL t�a o (T) ( PP Xra'2 Owner /Applicant'Name: 4.4ft% k►&%A TM l^ , 13t10ek Lot .� Formerly: Subdivision Name: B►- t �! �r,� aid Subdivision Lot # Is system fill completed? Date: 1 a - �` !3• Is system complete? -`— Date: Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and 1 have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: j,d "�,. Certified by: PE _Le!:L RA Dairn professional Address: _ a=- A 1�, "Q r-ds11 ni, . A%)�, Lic. # 944 Comments,- FOR: O ADAM O GENE (NAME) Form FIR -99 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 11, 2002' Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: King Bridle Ridge Road, (T) Patterson Lot # 10, TM# 5.-1-15 Dear Mr. Nichols: An inspection of the fill pad at the above referenced project has been completed. Trench plans must be submitted to this Department for final approval. Q Please note that field measurements by this Department in no way suggests the exact size, depth and location of the fill pad. If you have any further questions, please contact me at (845)- 278 -6130 ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Z -t L�y--,f -, - -� RIO hc:; Located at � e � � rr C� j own or y�e J Jewel t-, Subdivision name R iA Subd. Lot # _ j Tax Map Block Lot - Date Subdivision Approved Renewal Revision Owner /Applicant Name ) Date of Previous Approval '-7-16-01 Mailing Address 191-- pa-4 C T Zip O Amount of Fee Enclosed Building Type R-C t,441 Lot/Areajo..24 No. of Bedrooms Design Flow GPD (P-G Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of d tI o gallon septic tank and 9 2Z 4 Other Requirements: To be constructed by z R fl Address Water Supply: Public Supply From Address or: k.,,'— Private Supply Drilled by j 8 D 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: Address P.E. R.A. Date License # 5'G 1 Z4 APPROVED FOR CONSTRUCTION: This approvere&wef(@® 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 whep sidered necessary b the Public Health 1 ` n { ary y ��orT Anyite���iiri or alteration of the approved plan requires a new permi � proved discharge of domestic sanity rw. l By: `itle:� Date: �? Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fessional Form CP -97 I :. . _ _ _ 1 4 d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C NSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 2,q '01 EM p Located at (�,OAb 1 Town or Village 1-� Subdivision name Subd. Lot # 1,2 Tax Map � Block 1 Lot ;7 Date Subdivision Approved Owner /Applicant Name R 1 1-t N 1 Renewal Revision Date of Previous Approval Mailing Address b2 4 sir M-0 N -Lk S 1�— R Q NT-� Un N S 1) �,NJ 1 C. I Zip Amount of Fee Enclosed yto 0W,)0 Building Type MS \�N�`�Lot Area !03,247 No of Bedrooms Design Flow GPD UC Fill Section Only Depth -3 : ,� Volume 7 71 c PCHD NOTIFICATIO IS RE UIRED WHEN FILL IS COMPLETED( Separate Sewerage System to consist of gallon septic tank and 42 LV, W,,�m \\ v A T CZENC N Other Requirements: RR To be constructed by '-T r.J Address Water Suualy: Public Supply From Address or:_ Private Supply Drilled by T C�)�) 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 treatments stem 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: dQA !, P.E. 0/ R.A. Date 27 1 Q Address2050 L0J E 22 S U V\ G `' U1W F P, y License # % + 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 w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm't. pproved f ischarge of domestic sanitary sewage only. � VleXBy: „/ Title: ( /' �'° Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # / Zq —© % Well Location: Street Address: TownNillage Tax Grid # M%LF �%'E M P N-TVF RSOn Map Block Lots) Well Owner: Name: Address: L2 �/ R 1� �( L A kF c''O .lad 9�'N K� �� �anl�v��r, �`� QW1,10 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought L'3 gpm # People Served Est. of Daily Usage 6Q) ® gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision QR\�A� �� `'D GE U M) \ U \5A G f\/ Lot No. _ Water Well Contractor: T Pab Address: --- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: — TownfVillage Distance to property from nearest water main: --' Proposed well location & sources of contamination to be provided on sepazat sheet/plan. Dater \ Applicant Signature: i M 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 watW. well driller certified by Putnam County. Date of Issue j Permit Issuing O a): Date of Expiration I d Title: i Permit is Non-Transf&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 SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSE11 pp to24 ITV LCD aV �.!�k� �� Owner R"YA N `0 NG Address i)ANQU "i Located at (Street). G`` 1-!& Q. ) &E (ZOA \ Tax Map Block I Lo 0 (indicate nearest cross street) � ��. � �C� � � J� .M.unicipality Q l\7 �I& RSO N Watershed /V SOIL PERCOLATION TEST DATA Date of Pre - soaking ' 2A —0 Date of Percolation Test 5_-22­01 Hole No; .. �s�. `rR..a, O,R. �, . � ' � � i .fie:t� i•• �..'. rr 7t!•''••' I.y:'�:aiv �<n arfacM {�e•, f1��� .: {.Start',:?,tcP.�'�� .<; ze,;; �ss(( :��� ,.:., >•:; perc la M'Rate': 3 )D, 15 23 l 20s4" _ 4 5 i 2S 4 ►' 54 3 / 4 5.. . L(- R -A �c� S`v� b) I S) PLAN' 2 3 4 5 -- - - --- .- r - ' �»••V w rw. wit 1 or}nvA,iiva«ry eyum percolation rates are obtained at each percolation test hole. (i.e. s 1 min fog 1 -30 min/inch, s 2 min for 31 -60 mRinch) All data to be submitted for review, 2. Depth measurements to'be made from top of hole. DEPTH G.L. 0.5' 1.0' i . 5' 2.01 .5' Y, A. 5' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DE SCRIPTION'OF'SOILS ENCOUNTERED IN TEST HOLE, S HOLE N0, "� `. HOLE N0, 2-- HOLE NO. Rmlsv) ¢(zVVNN PP_n15 i0 D- e-Cwh �.i E SANS' FN 1VC sANb L(.) AM LG M IRE %1 is" U'IzowN ME i um NzGwN 9 >E Y oRoWN COMPACT Mclm u m (� m Indicate level at which groundwater is encountered NON E Indicate Ievel at which mottling is observed. NnN Indicate level to which water level rises after being encountered Deep hole observations made by: �'.AUN W,N �O1 V Date G — 2'� —�' ���► ► rroiessiona! Name: � AMA W. /V ICVYJ Address: Q0U TC—_ 2_ \vb Si parure:_ Design Professional's Seal 0 N H as <" 4L �-y No.56i24 k. PUTNAM• COUNTY DEPARTMENT OF HEALTH DVISION- -OF EN'V'IRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA' Date of Pre - soaking Date of Percolation Test Hole No ir::y; ' R}±no.•::.. �P •• '..'3;. •::a:; <y,�:'t':.. K ri, >�ybDe .051; 1.�.).•;; ;�; ?;��oy,' r��j..:..•� :i` tb o: 1R�erVI1t� - nS,umsjq .12-0493 ::;Start'f. top `v;3:.;.�. :.ti :t$es'<::Mia/Iacb :... .,. >Terctdztiu I 2 .3 4 { 5 i � 1 ' I - - 2 3 4 5 2 4 5 - -- • - -� �- •- r""•"`' o. 766v N—Ful wilt 01jelvA,►namtr oqual percolation rates are obtained at each Percolation test hole. (Le, s I min for 1 -30 min inch, s 2 min for 31.60 mt'rOnch) All data to be submitted for review, 2. Depth measurements to be made from top of hole. DEPTH G.L. 0.5' 1.0' i 5' ?.0' .5' 3.0' 5' Y, 0' A 51 5.0' 5.5' 6.0' 6.5' TQ' 7.5' 8.0' 8.5' 9.0' 9.5' ! 0.0' TEST PIT DATA DESCRE?TION'OF'SOILS ENCOUNTERED IN-TEST HOLES HOLE N0. HOLE N0, HOLE NO. (D 0ko"_Z1 1' �;��' ` t0`, - Of x„,2,0,, �. b�s�1(3�oWN �FDfl►SN t vrN 2&MSILT - - L y NT�y �L1Y SPN y 1_CAM. SAND WAP WO ��VN 60NIRCI AE�10 M, S M MEt�t 1,M Sl I I _2,6,, �RAYC)Q. 1 n d i c a I e level at which groundwater is encountered _ Indicate level at which Mottlin is Ob O 8 screed �, � Indicate level 1o.which -water level' rises aftei being encountered /` IA, Deep hole observations made by; G JyE 2CEi� a� WJ, x=22 I Design Professional Name; _ address: 22 ZOQ (�0�j� C n I Signature: Design Professional's Seal N EFL yQ� C­1��, s 14-164 (9105) —Text 12 PROJECT I.D. NUMBER 61710 SEQR Appendix C State Environmental Quality Review' SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ISPONSO .9,M -KING 2. PROJECT NAME PCZOE'�SF_� SS i S 1,0) ID a. PROJECT LOCATION: � (� 1 \I �1 ! v Munklpalltr �� \� —J County U I 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, eto., or provide map) 5. IS PROPOSED ACTION: IC! New ❑ Expansion ❑ Modlltcatlon/alteratlon a. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: i Initially eons Ultlm}tety acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR•OTHER EXISTING LAND USE RESTRICTIONS? 1ZYes ❑ No It No. describe Melly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT 5Rasldentlal 13 Industrial ❑ Commercial 13 Agriculture ❑ ParWForest/Open space ❑ Other Desue: tb � 10, DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAQ? OYes ❑ No It yes, list agencM and permlt/approvals t t . DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ 93 Ya No It Yes, uN agency name and wwuappmval 12. AS A RESULT OF PROPOSED ACTION WILL EX I8TINO PERMIT/APPROVAL RECWRE MODIFICATION? ❑ Yes C&No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE AppllcarnUsponea ,� `� c N' C 0 name: Gate: tY12_7J i Signature: If the action Is In the Coastal Area, and you are a state agency, complete the . Coastal Assessment Form before proceeding with this assessment AVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 017.4 ?' 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? If No, a negative declaration may be superseded by another. involved agency., Cl Yes ❑ No z. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Cl. Existing air quality, surface or groundwater Quality or Quantity, noise levels, existing traffic patterns, soild wool* 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 nelghborhood character? Explain briefly: C3. Vegetallon or fauna, fish, shellfish or wlldlif• 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 briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In Cl-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 ESTA13USHMENT OF A CEA? ❑ yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATEb TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, -explalri 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 oonnection with Its (a) setting (i.e. urban or. rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (Q magnitude. If necessary, add attachfents or reference supporting materials. Ensure that explanations contain sufficient detall 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 box if you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if. you"have determined, eased 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: Print or Type Name of espons ible Offkor.in Load ncy Signature of es r in Lead Agsncy Name of Lead Agency Date Title of espons t OlIket turf of reparw event rom responsible o fficev PUTNAM COUNTY DEPARTMENT OF HEALTH Dng8.1ON0F�E t ; RONM';'NTAL HEALTH.SERVICES APPLICATION FOR-APPROVAL OF PLANS FOR A WASTEWATER. TREATMENT SYSTEM 1. Name and address of app0c' ark A N X � N _ 6(2. PA�l A tON,..t�Alc� 2. Name of project: �� CEO P C�`��C�' S AS LCF, '4. LocatioA &:` 4. Design Professional: W N tiC�10L5�(,�3 'Address- 2a v L 6. Drainage Basin: . w. 7. Type of Proj _ Private/Residential Food Service Commercial Apartments „ . institutional- Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State�Enviroamental Quality Review (SEQR)? Type Status (check one).....,;. ............... ...............:........:...... • Type..I Exempt .:Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed_and found acceptable by Lead Agency? ............... I\Z� tN 11. Name of Lead Agency / 12. Is this project ftf an area under the control of local planning, zoning, or other. officials, ordinances ?.. - ..................... ........,..:.................. ........... «.............. :..:. 13... If so, have plans been submitted to such authoritiesT ::..:. ............................... Q 14: Has prelimnaryppoval been granted by such.authorities ?. i��, Date granted: 15. Type of Sewage Treatment System Discharge...:..:.:::::.:.: surface water groundwater 16. If surface water discharge, what is.the'stream. class designation? ..::...............: 17. Waters index number (surface) ::..................... - .................. ............................... ___l_._ 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name ofwater supply" A Distance to supply 20. Is project site-near a public sewage.,collection or treatment system? ........:...:.:: NO 21. Name of sewage system , �% Distance to sewage system' 22. Date test holes observed �� � 23. Name of Health Inspector �,EU) 24. Project design flow*(gallons per day). ................................. ..........................::.:. (JQQ 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... ... / 26. Has SPDES Application been submitted to local DEC office? .:....................... z 27. Is any portion of this project located within a designated Town or State wetland?_'] F— S 28. Wetlands ID Number ........... ...................0.0.0000.... feeole..e.e. oo.e oleo ........................... V (A 29. Is Wetlands Permit required? .... :... .... Ott ............ ..... ............................... '.............. �� Has application been made to Town or Local DEC office? �--- 30. Does project require a DEC Stream Disturbance Permit?. .. .............................:. 31. Is or was projecf 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 �1 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? ......................... y 34. Are community water and/or sewer facilities planned to be developed within. 15 years in or adjacent to project site? ................................ ............................... _ l� 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number .......................... ............................... 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 applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form 'is true to the best of my knowledge and belief. False statements made herein are punishable.,as a Class A misdemeanor pursuant to Section-210.45 of the Penal LaM. SIGNATURE $& OFFICIAL TITLES: Mailing Address_ ......... _ 1 2so 22 Su F 1 co 6 a V_:� V) � -) VIQ LL"I - \Q S n� June 27, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS - Lot #10 Bridle Ridge Estates Bridle Ridge Road Patterson, N.Y. T.M. # 5.1.15 Dear Robert: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 1. Two (2) prints of Drawing SS -10, "Proposed SSTS," dated 6- 25 -01. 2. Five (5) prints of Drawing SF -10, "Fill Plan," dated 6- 25 -01. 3. "Short EAF," dated 6- 27 -01. 4. "Application for Approval of Plans for a Wastewater Disposal System." 5. "Construction Permit for Sewage Disposal System," dated 6- 27 -01. 6. "Application to Construct a Water Well," dated 6- 27 -01. 7. "Design Data Sheet." 8. "Letter of Authorization." 9. Two (2) copies of residence floor Plan(s), for bedroom count only. 10. Review Fee in the amount of $300.00. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. chols Jr., P.E. .. HWN: his = 00- 177.00 - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 0 AN N ! y G - Located at�'.� TN A EZTN Tax Map # Block � _Lot Subdivision of �l U_ \b G 1L y �� �/ S' t J/T Subdivision Lot #' I O Filed Map #B Date Filed Gentlemen: This letter is to authorize \1 A Y VJ , PJ 1 C N 01,S ) P . i 0, C -_, a duly licensed Professional Engineer or Registered Architect to apply'for the required wastewater treatinent and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public lfcalth Director of the Putnam County Health Department, and to sign all necessary papers'on my behalf in connection with this manor and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article.. 145 and/or 147 of.the Education Law, the Public Health Law, and the Putnam C0_t4&_4W1t4rY Code. Countersigned: P.E., R.A., # — Mailing Address State y Zip SO) Telephone: GC9 Very truly yours, Signed: G„ (Owner of PropcM) Mailing Address: G2u M UX LhY,,E State COIN ! E CT U� T� Zip Telephone: I'. , PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENT aL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: (� STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: -17"4 DOCUMENTS PEM i 11T APPLICATION 4�NNTLL PERMIT OR PWS LETTER ) PC -7 LET9TER OF AUTHORIZATION (__) DESIGN DATA SHEET (DDS) (__)CORPORATE RESOLUTION (_JL_)SHORT EAF (_JUPLANS -THREE SETS (_J(_JHOUSE PLANS - TWO SETS C_)C__)VARLANCE REQUEST SUBDIVISION LEGAL SUBDIVISION C� "SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH ((__)CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED Lf(2 PLANS SUBMITTED TO DEP DELEGATED TO PCHD ( DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED ')PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) kDATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION kolETTER BI/ZBA 100 YR. FLOOD ELEVATION W/1200' ( L__,)SOIL TESTING LOTS >10 YEARS OLD �SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE —J/ GRAVITY FLOW CONSTRUCTION NOTES 1 -15 . DESIGN DATA: PERC & DEEP RESULTS _' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT ' FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES (__) .ITLE BLOCK; OWNERS NAME ADDRESS PE/RA; NAME, ADDRESS, PHONE# 4:) DATE OF DRAWING/REVISION (� ,KJDATUM REFERENCE OCATION OF WATERCOURSES, PONDS LAKES,WET LANDS WITHIN 200' OF P.L. ( ( PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTs (PROPERTY METES & BOUNDS )UEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (ItEVSHEET)09 /01 /00 AX l�.LAP *. (CONFIRMED) 1' ( REQUIRED DETAILS ON PLANS CO \ ?'D) (JHOUSE SEWER -'/4" FT. 4 "0'; TYPE PIPE CAST IRON U(�J\O BENDS; AI.A_X BENDS 450 WICLEANOUT 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 (�UFILL IN EXPANSION AREA FILL GREATER THAN2 FEET v(_2s'EpARATION AAY BARRIER L CERTIFICATION NOTE GAUGES L. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED LOFT MAX. PARALLEL TO CONTOURS (_)U100% EXPANSION PROVIDED ( / /��DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (�LJGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN -FRO M SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (Inc espau) (� 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER . 10' TO WATER LINE (pits - 20') y Z0' INTERMITTENT DRAINAGE COURSE U 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (__) "10' MIN TO LEDGE OUTCROP SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (S20 11/6) (_(__)REGRADED TO 15 %, IF REQUIRED DOSE/PUIVTP SYSTEMS PUMP NOTES Q(TJDOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED (__) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (__j PIT AND D -BOX SHOWN & DETAILED U 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN TANDPIPES, 5' BOTH SIDES, DETAIL (_J 15' MIN to CDS= >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % -'1% (_) 20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_JU10' MIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES z� DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) yll-L -)ZZ I Tax Map 6- Block Lot (indicate nearest cross street) Municipality %?�"rr�r✓ Watershed AW-si SOIL PERCOLATION TEST DATA Date of Pre- soakin g -Date of Percolation Test 4" to'4?t? titer Water . 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 .3 3,3 4 5. 3 2-1 -26- �� 7 2 1-7 2!- A4(. 3 �� 3 -J 7- ;2, 3 . 4 5 --- 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 S' , $'iCl b Z� tZfU� c Go IV -TEST PIT PROFILES Hole # -L- Lot # Depth to water AloAl FF Depth to mottling Depth to rock/imp. " GL 4 V) C. 1.. i? 1� Hole # r 1 Lot # Depth to water ,yar✓,='- Depth to mottling Ale Depth to rock/imp. 6-0 G.I 0.5 1.0 2.0 3.0 4.0 5.0 V -Z"' 6.0 7.0 8.0 9.0 10.0 6-/2 :2/a ,4 J�Iorq Hole # Lot # Hole # 3 Lot # Depth to water. i✓oA/jr Depth to water wv yE Depth to mottling, �/o,y Depth to mottling A10A1 Depth to rock/imp. Depth to rock/imp. 50 " G.L. G.L. 0.5 1 0.5 1.0 e ' 1.0 Z. 2.0 4. 2.0 5, 5. 1,04- VA K 1d" 3.0 3.0 4.0 �.� � C ° ►a�pe{ct 4.0 c�rney 8r� rmwi�. 5.0 5.0. 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 Hole # S Lot # Hole # Lot # Depth to water A10 AZ 4� Depth to water ,6 Depth to mottling NoNg� Depth to mottling N® ., 9de- 0-7 .Ua 4e*k, A%C7 yae, Depth to rock/imp. Depth to rock/imp. 4 2- 90-&kk its G.L. 5.0 G.L. 0.5 6.0 0.5 V) 1.0 1.0 .Ve r, Lo,n c-f 5 ` Sun 1.0 �a � wit 2.0 3.0 2-2 10.0 1 t� 4.0 c'o�p�:fi 3.0 4 V) C. 1.. i? 1� Hole # r 1 Lot # Depth to water ,yar✓,='- Depth to mottling Ale Depth to rock/imp. 6-0 G.I 0.5 1.0 2.0 3.0 4.0 5.0 V -Z"' 6.0 7.0 8.0 9.0 10.0 6-/2 :2/a ,4 J�Iorq Hole # Lot # Hole # 3 Lot # Depth to water. i✓oA/jr Depth to water wv yE Depth to mottling, �/o,y Depth to mottling A10A1 Depth to rock/imp. Depth to rock/imp. 50 " G.L. G.L. 0.5 1 0.5 1.0 e ' 1.0 Z. 2.0 4. 2.0 5, 5. 1,04- VA K 1d" 3.0 3.0 4.0 �.� � C ° ►a�pe{ct 4.0 c�rney 8r� rmwi�. 5.0 5.0. 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 Hole # S Lot # Hole # Lot # Depth to water A10 AZ 4� Depth to water ,6 Depth to mottling NoNg� Depth to mottling N® ., 9de- 0-7 .Ua 4e*k, A%C7 yae, Depth to rock/imp. Depth to rock/imp. 4 2- 90-&kk its G.L. 5.0 G.L. ey,"3 6.0 0.5 V) 7.0 1.0 .Ve r, Lo,n c-f 5 ` Sun 1.0 �a � wit 4 V) C. 1.. i? 1� Hole # r 1 Lot # Depth to water ,yar✓,='- Depth to mottling Ale Depth to rock/imp. 6-0 G.I 0.5 1.0 2.0 3.0 4.0 5.0 V -Z"' 6.0 7.0 8.0 9.0 10.0 6-/2 :2/a ,4 J�Iorq Hole # Lot # Hole # 3 Lot # Depth to water. i✓oA/jr Depth to water wv yE Depth to mottling, �/o,y Depth to mottling A10A1 Depth to rock/imp. Depth to rock/imp. 50 " G.L. G.L. 0.5 1 0.5 1.0 e ' 1.0 Z. 2.0 4. 2.0 5, 5. 1,04- VA K 1d" 3.0 3.0 4.0 �.� � C ° ►a�pe{ct 4.0 c�rney 8r� rmwi�. 5.0 5.0. 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 Hole # S Lot # Hole # Lot # Depth to water A10 AZ 4� Depth to water ,6 Depth to mottling NoNg� Depth to mottling N® ., 9de- 0-7 .Ua 4e*k, A%C7 yae, Depth to rock/imp. Depth to rock/imp. 4 2- 90-&kk its G.L. 5.0 G.L. 0.5 6.0 0.5 V) 7.0 1.0 8.0 1.0 �a � wit 9.0 2-2 10.0 Gray �t3P, 4 V) C. 1.. i? 1� Hole # r 1 Lot # Depth to water ,yar✓,='- Depth to mottling Ale Depth to rock/imp. 6-0 G.I 0.5 1.0 2.0 3.0 4.0 5.0 V -Z"' 6.0 7.0 8.0 9.0 10.0 6-/2 :2/a ,4 J�Iorq Hole # Lot # Hole # 3 Lot # Depth to water. i✓oA/jr Depth to water wv yE Depth to mottling, �/o,y Depth to mottling A10A1 Depth to rock/imp. Depth to rock/imp. 50 " G.L. G.L. 0.5 1 0.5 1.0 e ' 1.0 Z. 2.0 4. 2.0 5, 5. 1,04- VA K 1d" 3.0 3.0 4.0 �.� � C ° ►a�pe{ct 4.0 c�rney 8r� rmwi�. 5.0 5.0. 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 Hole # S Lot # Hole # Lot # Depth to water A10 AZ 4� Depth to water ,6 Depth to mottling NoNg� Depth to mottling N® ., 9de- 0-7 .Ua 4e*k, A%C7 yae, Depth to rock/imp. Depth to rock/imp. 4 2- 90-&kk its G.L. G.L. 0.5 2 0.5 1.0 S 1.0 �a � wit 2.0 2-2 2.0 It- Gray �t3P, c'o�p�:fi 3.0 3.0 e`�v ,a{ 5.0 5.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 �3or Cv r� 8•r ! 0,r PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL/COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project KIo5 MM i25v/d County Site Location ?igl DL6- -gi pg C R,y4h Building construction begun Al&) Extent Is property within NYC Watershed ? ................. F2r7Yes F--J No SECTION B. TOPOGRAPHY (Please check all appropria boxes) 1. a Hilly Rolling 0 Steep slope Gentle slope Flat 2. Evidence of wetlands Low area subject to flooding 0 Bodies of water 0 Drainage ditches Rock outcrops 0 Y s I-1 `"o Yes No s No Yes F o 0Ys No Yes F o Yes No 3. Property lines or comers evident ....................... ............................... 4. Do water courses exist on or adjoin the property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ...................... 7 Will extensive grading be necessary? ................. ............................... 8. Will extensive fill be necessary for SSTS? ......... ..................:............ 9. Do filled areas exist within the SSTS area? ........ ............................... If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 5:/ 10. Appearance of soil: EJ San Gravel. M Loam a Clay 0 Hardpan [:] Mixture 11. Observed from: Borings F--J Bank cut ® Backhoe excavations 12. Soil borings /excavations observed by z�r, 7?,6g-D tom. G". -D t on 13. Depth to groundwater A/c2A%,!-1_' on 14.. Depth to mottling fin/ © /11i—IC on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by A�. - &/, /✓ i G on 17. Soil percolation tests witnessed by taJLZa-EEC on SECTION D (on back) 0 Form ST -1 2 ti SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage require special consideration? ..................... es rZfNo 20. Will gullies, ditches, etc., be filled and watercourses be relocated ?....-*WA(r........? Yes a No SECTION E. REMARKS 21. - If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ........................:...... Yes Q No Inspection data 22. Do adjacent wells and/or sewage systems exist ? .......................... F✓k�- ............ ffYes F No 23. Additional comments 24. Site observer /inspector and title 6i r✓g D, `1Z Ee7 F . G. 1114, 25. Date(s) of observation(s)inspection(s) <Z-22- / o / TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 APR -29 -21001 211-411 AM MARRY W MI.CH01_S ..rq a> : JL FOLEY NfolrA...Ot+earor 91'A• ,27.9` 4067 R•..02 v DEPARTMENT OF HEALTH 1 Oeneva Road Bmwoter, New, York 10504 oo- 177.00 LONMA MOLINNARI LN., M.S.N. ANwkw f�,, hNk Neatth Obvetor A"CO& Qj.'fff /fMt SfrYlCtt 0 ATTENTION: C ADAM STIEBELING GENE REED All Information below must be U4 completed sior to any scheduling. DATE: 444-7 -G ) ENGINEER OR I:IRM: - r, %�� PHONE N: _.2-) i -duo REASON: DEEPS: PERCS: PUMP TEST- 0 ROAD/STREET: - - TOWN: P Div �, TAX MAP #: SUBDIVISION: LOT #: 16 OWNER: if _'___.__ 14 NYCDEP CET .RtA EQR JOIN I Rr3aRW ADM WITNESSINrx OF S,011, JESTING YES NO a Jk Proposed SSTS within the drainage basin of West Branch or Boy& Corner Reservoirs. d )I Proposed SSTS within $00 feet of a reservoir, reservoir stem or control lake. 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 0 fit, Proposed SSTS design flow greater than 1000 galiondday .or SPDES Permit required. 0 Proposed SSTS fora Commerical Project. It is the responsibility.of the design professional to provide the above intonation prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) baud on the response. If you answeredyA to any of the questions, NYCDEP trust 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 is 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. 'pfe - 5oG-i� DATE: CR.11.�IFdT.i� (MLDTEST) FOR COUNTY USE ONLY Def c- s S 6 : SCALE IN Ilia OF AN INCH TT �O m 33 10.92 AC. P A W L I N G GL DI`. ppWLING CEN1A a' � CO. 1x00 n �s 0 IESS AM CO. 31 a m 9 / CAL. II. AREA IN DISPUTE "GORE •/ El :1, :6A j, 16.94 AC. 28620 312.79 I0a63 227.10 •�••�,�L: •�.:� C. ' 19x03 tet9a 31x13 ! •\ Il r' .. ) PUTNAMCOUI SAC 291.33 tiA 112 200 30 • • 1 �� —�— i -- — — — — — — — — — H/ 8 6 - 229.2 37 TT �O m 33 10.92 AC. 8 as 8 tO1B30 _ \ GL DI`. ppWLING CEN1A a' � 1x00 n 179619 — — — — — � �NpL SCHOOL 1 — {:p51ER 9 II. 42 I ^� 44 40 AC. st 40.70 AC. CAL. \ v 496.11 EXEMF 20.37 AC. CALK. �-•• —.• P. 79 no AC. ) PUTNAMCOUI SAC %LROaa Iai63g ,�n 08&29 —�— i -- — — — — — — — — — H/ /cps Ids In 43 7 � �8 16.55 C. CAL.1 I � 2S9 '% 2It21 •—� 28.44 AC. CAL. pG ` f ' .qu 744.37 o Io.ae O — — — — — — — "' 216• — -' — — — ' — a ° 7.99AC 93 I PAUILING CENTRAL SCHOOL OIS RIOT SCH Icl•a IQ►2 9 717° .78 AC. CAL. y •i' d�'`' �•' •'J 1 211:3 22e3 SpIGOL�DI51RlGi � asp 96A I121.09\ �� CENTRAL �� 4 .,g. o- 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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: - Z-7 Z© / To: rA &411 U� /�I c GAL C� � Fax #: `7 -73 From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed No. Pages 73 (Including cover sheet) c/ Please respond Attached as requested Please call Notes/Messages `D F— C— osy S Z9-2 In the event of transmission /reception difficulties, please contact this office at (845)27 8-6130 ext. 2261. �o � o i 1 (r-o\ Putnam County Department of Health Division of'Envirop_mental Health'Services Appro d as noted for conformance with applica e 'RiAes and Heeulations of the Au Vam t&y Health Departure t.. 1- ,T-ature & Title PPos,r,rvad for PGHP Approval Stamp T. �Ll DIMENSION CHART (in feet) Number A a I7 40 2 28 37 3 36 40 4 42 45 5 4 S 6 55 SO 56 7 61 62 8 67 67 9 74 -10 78 74 63 11 76 12 76 58 55 13 77 52 14 74 15 71 49 45 16 69 I? 37 42 51 is 43 19 49 56 60 '"Vo & ACCMO b.Mn �I.INE Lof NO. 9 LorNc. 10 ALMA - 10.25 PG. t rn a j L LOf NO. I2