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HomeMy WebLinkAbout0405DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.3 -51 BOX 5 Is .. i 00214 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCrn E TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 8'�° Located atUl GQ"WA14- Rlk,t Town or Village Wr5�-�Orl) Owner /Applicant Name P4 &K 1J o R 4 Tax Map 19 Block Lot '51 Formerly /50 H Subdivision Name CMP4ZS +J a 14ej GAPP1600 Subd. Lot # 51 Mailing Address �t� �, �V�' + C��S� -� Mi Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by Address* 6LFNfOP\ AUE 0%4ML r'i OS t l- Consisting of 1��O Gallon Septic Tank and Ito I-F "C7 'r)EGA&14 Other Requirements: po51A4 S 1 f krj ' "i2-" rj 09" Water Supply: Public Supply From or: )� Private Supply Drilled by MIMN RY ATT Address Address ial S K 31t KI EWn ! I K 3 Building Type �E51D��LE Has erosion control been completed? Number of Bedrooms "r Has garbage grinder been installed? _ Yu5 No 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 ep ent of Health. Date: Certified by P.E. A R.A. �Q�. �,� ^ ,� /� (D siofpssional) (oSp°l License # Address � j� N �Y Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocati9 , odificat'on or change is necessary. By: 0 Title:, Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Q '7. 1 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 3ff7 �} 1��� Town/Village: / C Tax Grid # Map I�, Block t Lot(s) al Well Owner: Name: -J- Address: 4P C00-4-JWP VI , 41L(, (P, C,� tr)EL 0j i KJ'L Use of Well: 1- primary 2- secondary �_ Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/rhonitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing __k Open hole in bedrock Other Casing Details Total length K4 ft. Length below grade �59 ft. Diameter Tin. Weight per foot �lb /ft. Materials: _)C Steel _ Plastic _ Other Joints: _ Welded . Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: _)e, Yes No Liner _ Yes _X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped X Compressed Air Hours _ Yield LTgpm Depth Data . Measure from land surface - static (specify ft) sli t During yield test(ft) ors Depth of completed well in feet 3 �s Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(m) Formation Description ft. ft. Land Surface �' Q / 36 v d S64y nt� e (j Ailli 6t') e, If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 1116 A Pump Type 73114, Capacity Depth U Model TC7S07 Voltage b HP Tank Type X:EC 1 Volume 6d: Date Well omple d `f o Putnam County Certification No. 007 Date of Report Well Driller (signature) NOTE: ExAct location of well with distances to at least two permanent/landr arks to be provided on a separates)} eet/plan. Well Driller's Name trSn . Address: tie Ova .1 IN Signature: Date: -7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIONO . FENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building. Tax Map... Block : Lot khET-T 0* 4 -ZD0H Building Constructed by Town/Village Location.- Street Subdivision Name - - Building Type _ Subdivision Lot # _.. I represent that I am wholly and completely responsible for the location, workmanship, ma {erial, .:_.:_ construction and drainage of the sewage treatment system serving the above - described property:,.and that is has been ,constructed. as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam.County Department of Health., and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a-period - -of two _years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment'system, or any repairs made by me to such system,.. except where. the failure.to . operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not- the•failure of'the'system '.' : to operate was caused by the willful or negligent act of the occupant of the building utilizing the.' system. Date Month IN Year General Contractor (Owner) Signature Corporation Name (if corporation) -:.. Address: State ` Zip IG 5- Signature: _ " -- Title: Corporation Name (if corporation) Address: BCD GLer-CNDA A66 C-�MEL State Zip Form-GS-97 _.._ BRUCE 'R FO_F - ti L0FXrrA "'M0LINART•R.N., M.S.N. ?ubl;c Health Director dreoalate• Public Health Director Director of POW Servlcu ...- DEPARTMENT OF HEALTH ....,.. 1 00neva Roa3 Browster, New York 10509 8orlroomcaW Haltb (914) 271.6170 Pa (914) 271.7921 Nurilal Servlca (914) 271.6331 WIC(914)271-6671 .Fat (914) 271.6013 Early'1'otcrvio600�(91 /)171.6014 Fracbool (914) 273.6012 Fa (914)17f • 6641 E911 ADDRESS VERIFICATION F RM OWNERS NAME: OAI4 TAX MAP NUMBER: E911 ADDRESS: co `1}lLL • , Ord ......._. .'. T OWN: A UT HO RIZED TOWN OFRg�Cn1A1L1� , - (Signature) DATE; zaz Z The Putnam County Department of Health will not issue a Certificate of .:Construction Coin -pUnce 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. (1911 VERFRM) NE NORTHEAST LABORATORY OF DANBURY 0ONACC0g09� 39 MIU ftMN ROAD - D"WRYa CT 06811 CI' Cert; PH -4404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 g LABS www.NORTHEAST LABORATORIES.com LABORATORY REPORT REPORT TO: HYATT'S PUMP SERVICE DATE SAMPLE COLLECTED: 10/08/2002 229 SOUTH ROAD TIME COLLECTED: 10:00 AM HOLMES, NY 12531 COLLECTED BY: C.H. DATE RECEIVED Q LAB: 10/08/2002 TESTED BY: LAB #11471 & 11301 DATE TESTED: 10/08- 10/11/2002 LAB I.D. # HYATT PUMP- NY1223 REPORT DATE: 10/16/2002 SAMPLE SITE: ROBERT NOAH, 381 CORNWALL HILL ROAD, PATTERSON, NY SAMPLE POINT: NOT STATED SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 5 - EPA 110.2 15 units • Odor ND - - 3 Units • pH 7.49 - ASTM- D1293 -99 No designated limits e Turbidity 0.75 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 1.3 mg/L as N EPA 353.3 10 mg/L • Alkalinity 116 mg/L SM 2320B No designated limits e Hardness 205 mg/L EPA 130,2 No designated limits • Iron <0.03 mg/L EPA 236.1 0.30 2 mg/L • Manganese <0.01 mg/L EPA 243.1 0.30 2 mg/L 2 Combined limit for Iron plus Manganese = 0.50 n*& • Sodium 17 mg/L EPA 273.1 No designated limits 3 • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** • Chlorine Residual <0.05 mg/L - - - - -- ml= milliliter mg/L= milligrams per Liter ND=nnone detected MCL= Maximurn Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level 3 =Water containing more than 20 mg/L of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/L of sodium should not be used for drinking by people on moderately restricted sodium diets. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or �OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Quality Control Officer Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037* (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105. OUTSIDE CT: 800 - 654 -1230 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22.' Brewster, NY 10509 . Telephone (845) 279-4003 Fax (845) 2794567 December 2, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance - Robert Noah Garrison Subdivision, Lot # 4 387 Cornwall Hill Road Patterson, NY. :Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS-4, "As -Built SSTS," dated 12/2/02. 2. "Certificate of Construction Compliance for Sewage Treatment System,", dated 12/2102. 3. Three (3) copies of Guarantee of Subsurface Sewage Treatment System," dated 11/27/02. 4. Laboratory Reports, dated 10/16/02. 5. "Well Completion Report," dated 7/26/02. 6. Application Fee in the amount of $200.00 payable to, Putnam County. Health Department. 7. "E -911 Address Verification Form," dated 11/15/02. If there are any questions concerning the enclosed, please call. Veryruly yours, v Harry W. Ni ols Jr., P.E. HWN:JM:j 02- 099.00 V r n NDI° 09.20° W _ 151.00 on in O, rlrp 'o jA59 p GO „ 50 - -- • --- - - - --- L EXPANSION AREA LOT 4 AREA = 55831 5F { 12817 AC t ( ROAD WIDENING PARCEL INCLUDED I 1 ` i I , I � 1 i CORNWALL HILL ROAD Putnam County Department of Health Division of Environmental Health Services Appr ceI as noted for conformance with ap T ble Hui -s and P:eguiati ons of the am Co y Health Departms n s 12,11 �L Signature & Title bate � j I ✓ 1 � I � I I I � I I I I gl I I I I I i i I I I I I � 1 � 'o jA59 p GO „ 50 - -- • --- - - - --- L EXPANSION AREA LOT 4 AREA = 55831 5F { 12817 AC t ( ROAD WIDENING PARCEL INCLUDED I 1 ` i I , I � 1 i CORNWALL HILL ROAD Putnam County Department of Health Division of Environmental Health Services Appr ceI as noted for conformance with ap T ble Hui -s and P:eguiati ons of the am Co y Health Departms n s 12,11 �L Signature & Title bate DIMENSION CHART (in feet) Number A. 8 1 31 35 2 27 46 3 .57.6 70 4 63.6 75 5 69.6 806 6 75 .85.6 7. 81.6 91 8 87.6 96.6 9 93 102 10 99 107 11 104.6 112 C D WELL 96.1 58.1 NOTES : THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE DEPARTMENT OF HEALTH AND THE NF.W Vnov PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES / FINAL SITE INSPECTION Date: /m/2-! /o-2 Inspected by: G. 2 Street Location �.� ziv�,�,�i /;iii j 7211 Owner ��+ �„ �„ �� r r; .s k,,, Town PAZ- 7- f7Z4,y ✓ Permit # TM # 3 -- 9.- Si Subdivision Lot # �} 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 ...... ............................... II. Sewage System a. Septic tank size - 1,000 ........ .......:.other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... 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 roperly set ...... ............... ................$....... en g th re g 8 uired S Len installed 2. Distance to watercourse measured f We) 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% "'diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 1eends capped ........................ ............................... 2. .................................... `O e flow -tank ..... ................ 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. ouse ocated per approved plans .............. .......... b. Number of bedrooms ............. .................. D.t.......... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured -,o !od ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ...........................:... d. Backfill material contains stones <4" diameter .......... ..a,, f. Curtain drain outfall protected &3clir tto exist waterde g. Footing drains discharge away from STS area .............. h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 COMMENTS r/1 cal IV/I jwm� OCT -19 -2002 10:29 AM HARRY W NICHOLS , 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQ RRS„I EOR FINAL 1NSPE TON For: Fill Date: -119.- Trenches v P.03 OX-671 PCHD Construction Permit # 10 S)3 - 86 Located- (T) Y/ 1 -or,�� Owner /Applicant Name: R '61+r% 4o++4 TM. /S_ Block -$ Lot AL Formerly: C`'6, Ca rjz" k _ _ Subdivision Name: (ra+triSG'+ � a rjgr&, Subdivision Lot # Is system fill completed? — Date: Is system complete? Date: 1s system constructed as per plans? �G+ Is well drilled? _ t1* Date: 1� - 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 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: 16 - I g-cl2_ Certified by: PE Le . RA sign Professictal Address. "S-a % - ��- � /` Lic, # 56 I Z* Comments: FOR: ❑ ADAM XGENE ❑ (NAME) Form FIR -99 nrT- 1Q -PSPP FRT ln:4P TP1:A4S -P7R -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 d -BRUCE - R. TOLEY .Public: Health. Director LORETTA ' MOLINARI 'RN.;. M.S.N. w .Y ., Associate Public Health Director Director of Patient Services :DEPARTMENT ' .OF HEALTH 1 Geneva Road,. Brewster, New York-1 0509 Environmental Health (845) 278 -6130 Fax (845)-278 - 7921 Nursing Services '(845) 278-- 6558 WIC (845) 278 - 6678 'Fax (845) 278 - 6085 Early -Intervention/Preschooi (845) 278 - 6014 Fax (845) 278 - 6648 October 22, 2002 Harry Nichols, ,PE Patterson Park, Suite 106 2050-Route 22 Brewster, New York 10509 Re: Field Inspection Hoan, Formerly Garrison Cornwall.HillRoad, (T) Patterson Lot # 4, TM# 13 -3 -51 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. A pump.test needs to be witnessed by. this Department once the electrical inspection has been completed and notification of such.has been submitted to this Department. 2. Expose curtain drain outlet for inspection. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE : OCT -23 -2002 WED 12:10 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 -278 -7921 PHONE : 92794567 PAGES : 1/1 START TIME : OCT -23 12:08 ELAPSED TIME : 00'41" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... n. k -ak= R MMY CORMA MOUNAN R.N., MSN. NNk H-Uh &—tm' Aaaelak PWk Ms hh Dh-w DMwer f PM.M s nkn DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 HovMeipeaml fre,ah (843)771.6170 Fax(843)278.7921 Nenift 9arriM (843)271.6538 WIC(945)273-MA F=(847)278.6a13 tally teh're.dGW Wheel (A43)27A -6014 h■(843)273.6618 October 22, 2002 Harry Nchols, PE Patterson Park; Suite 106 2050 Route 22 Brewster, New York 10509 Re** Field Iaspectiott -Roan, Formerly Garrison Cornwall Hill Road, ('l) Patterson Lot # 4, TW 13 -3 -51 Dear Nk. Ntcho)a: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such ha3 been submitted to this Department. 2. Expose curtain drain outlet for inspection. - 1f you bave any further questions, please contact me at (845) 27" 130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Frrvironmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLH SERVICES FIELD ACTIVITY REPORT . u� _iii / r' M- m.-e Street Town State PERSON IN CHARGE nR TNTFR VTFWFn-. natp. E] PUMP TEST in., DOSE TEST A �� J fir ..:<�' /,�_ `�i�f • I(..t%'G�i Zip REQUIRED GALLONS Cl/- •D rodo X -7 . r.. If ..7 < -,/ EL. START.:._........ .__ ......:...................._ EL. STOP TN.4PF.CTOR! TFT Signature and Title RFPCQRT RF-rE.TVFT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 R Pv - Title; I: 03 0 o m �(D A �� J fir ..:<�' /,�_ `�i�f • I(..t%'G�i Zip REQUIRED GALLONS Cl/- •D rodo X -7 . r.. If ..7 < -,/ EL. START.:._........ .__ ......:...................._ EL. STOP TN.4PF.CTOR! TFT Signature and Title RFPCQRT RF-rE.TVFT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 R Pv - Title; NOV -01 -2002 10:59 AM HARRY W NICHOLS 914 279 4567 BRUCE R. FOLEY p6m'c Ngolrh , dirge$" 11 ,Rq P. 02 0; V LORSI TA MOLMAN ILK, M.S.N. ASMIals Public Xeal+h Direc$or Dkoetor of, hilint strvices OF tMAL1= • - . ...... .� I 0enevA Road _ Brewster, New York 10509 REQUEST FQR FIELD TESTING ATTEN7. ION': a ADAM STIEBEL'I G *GENE REED AJI information below must beLU completed prior to any scheduling, DATE:,�l4 31 -0� E:iNGINEER.OR FIMI: JLa. d°� PHONE #: REASON: _ DEEPS: d PERCS: a PUMP TEST: X ROADISTREET: T0NYN.- SUBDIVISION:' ptiVi�{ER::.� TAX MAPN; ! 3 3 — S— . LOTH; YES NO _._.... Mn Proposed SSTS - within the drainage basin of West Branch or B.oy& Corner Reservoirs. 0 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake, C 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. b $ Proposed SSTS design dour greater than 1000 gallonslday"or SPDZS Permit required. C Proposed SSTS IFr 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— answeredya to any or the questions, NYCDEP must 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-.ts.c.equlred'fo witness the sail testing, it will be the sole responsibility or the design professional to schedule re-witnessing of the soil testing with NYCDEP, FOR COWN USE ONLY PATE; TIME" - �r,r A A . A 7 Try . onc_��o_7001 -KICMP • PI ITNAM rill INTY nFPARTMENT OF P. 2 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 November 6, 2002 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Dorset Hollow Builders Formerly Garrison, Cornwall Hill Road (T) Patterson, Lot # 2, TM# 13. -3 -49 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. No further comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261 Sincerely, '41 2�)' Gene D. Reed GDR: cj Environmental Health Engineering Aide NO WELLS CR SEPTICS 200' THIS SIDE v N ^ti h j 1 roe' 0" / � ^ s 15 SEPARA¶ON � PROP( LOT4 o - PROPOSED 4 BEDROOM C RESIDENCE / F.F.ELEV.'- ±513.0 BASMENT ELEV - ±504.0 3 � z_ 4" CIP O Ys" P R FO ?T to 1 _ _ LOT 3 % , SEPTIC TANK \/ / ;I / _ J p%%_CHAMBER •' PRIMARY LATERAL \ _ 60• -KYP. - eF -B)-- CURTAIN DRAIN i i 28 10 MIN EXISTING WELL RESERVE LATERAL— — — — — — 8100' : =x, r'• _._Y- -* rt r..: w 5011- 15' MIN' REPUTED APPROXIMATE v y 0 �SILT ENCt CTYP.) X LOCATION OF EXISTING SSDS CENTER PROPOSED DRIVE 1 1 LOT -4 SSDS C ' STRUCTION DATA LOT ACREAGE I 1,28± ACRES No. of BEDROOMS FOUR (4) DESIGN FLOW 800 GPD SEPTIC TANK SIZE 1250 GALLONS SIPHON SIZE & DOSE 5" & 515 gol (87 %) PERCOLATION RATE 46 760 MIN /IN APPLICATION RATE 0.45 GPD SF FIELD LENGTH 889 LF DESIGN No. of .TRENCH LATERALS 18 (PRIMARY) / 18 (RESERVE) 'MAX LENGTH PER LATERAL 60 LF . %SLOPE SSDS AREA f5 PERCENT SCS SOIL CLASS LCB- LEICESTER LOAM USDA SOIL CLASS Dr1— HOLLIS AREA !NOTES: ! 1. DESIGN SOIL PERCOLA ON RATE BASED ON RESULTS OF SOIL TESTING CONDUCTED; BY ENGINEER IN 1986, AS PER PCDOH. 1. PROPERTY LINE AND TOPOGRAPHY FROM PLAN I APPROVED ON JUNE 10, 1996. 2. DATUM ELEVATION PER ABOVE REFERENCED PLAP 3. AFTER COMPLETE INSTALLATION OF TANKAGE, BC CONSTRUCTION NOTES FOR SSTS 6c WFII WATER Sl 1. ALL TREES WITHIN 10' OF THE PROPOSED SSTS 2. SSTS TO BE INSPECTED BY THE LICENSED DESIGI 3. THE SSTS AREA SHALL BE STAKED AND ROPED 4. ALL EROSION CONTROL MEASURES SHALL BE INS 5. CONSTRUCTION OF SSTS TO BE IN ACCORDANCE 6. THE WELL IS TO BE A DRILLED WELL. CONSTRUC' HAVE A MIN. SAFE YIELD OF 5 GPM. YIELDS LESS 7. THE SSTS DESIGN SHOWN HEREON DOES NOT PR PCHD. 8. PCHD APPROVAL IS BASED.ON THE LOCATION 01 PRIOR PCHD APPROVAL. UNAUTHORIZED MODIFlCAT 9. CUT OR FILL IS NOT PERMITTED IN THE SSTS AF 10. AFTER BACKFILLING THE SYSTEM, THE SSTS ARI 11. OCCUPANCY OF THIS STRUCTURE WILL NOT BE FORWARDED TO THE BUILDING INSPECTOR OF THE F 12. THIS PLAN IS APPROVED FOR SEWAGE TREATME PERMITEE. 13. THE PCHD APPROVAL EXPIRES 2 YEARS FROM REVOCABLE FOR CAUSE OR MAY BE AMENDED OR I P ••t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES pCONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ° 3 -aoJo1 Located at CORNWALL HILL ROAD Town or Village P.ATTERSON 13 Subdivision name GARRISON Subd. Lot # 4 Tax Map XX Block 3 Lot 51 Date Subdivision Approved 8/86 Renewal X Revision . X Owner /Applicant Name CHARLES & JOHN GARRISON Date of Previous Approval 6/10/96 Mailing Address 416 VILLAGE VIEW LONGWOOD, FL Zip32779 Amount of Fee Enclosed $300.00 SINGLE FAMILY Building Type RESIDENCE Lot Areal. 28ACNo. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1,250 gallon septic tank and DOSING CHAMBER WITH 889 LF (MIN).ABSORPTION TRENCH Other Requirements: _ To be constructed by N/A Address Water Supply: I Public Supply From or: X Private Supply Drilled by N/A Address 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, 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 ;wilder 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: �4, ,�. ---r'' P.E. R.A. Date '' OUTE PINEWOOD BUSINESS CENTER Address SOMERS, NEW YORK 10589 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 en onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm't. pprove r discharge of domestic sanitary sewage only. By: Title: SPA- Date: 0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design P ofessional 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 # Well Location: Street Address: Town/Village -Tax Grid # Cornwall Hill Road Patterson Map 13 Block 3 Lot(s) 6-1 Well Owner: Name: Charles & Address: John Garrison Use of Well:_ 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 5 = gpm # People Served 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 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .............................. Yes No X Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision Garrison Subdivision Lot No. 4 Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 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 wate 1 driller ertified by Putnam County. Date of Issue Permit Issuin Q Date of Expiration 3 Title:J 6� i Permit is Non-Transfeirrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 t_OT 4 A R�A{� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTALHEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address (- brtp -&a 'C4% za., Located at (Street) (-OT' `� Tax Map Block . Lot (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA . Date of Pre- soaking It-11-00 Q 4 =o, ef^ Date of Percolation Test N- 'SO —oc) Z:w pm Hole No. Run No. Time Start - Stop Ela se Time kMin.) Depth to Water > From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch A 1 I :,� 2:39 yI (PRA a,e,li 2 2'.140 3:10 30 1? (6 1 3P 4 5 3 (tg-P) 2 ?:91 3'•�� 3o Il 1� I. 30 3 (90 4 5 1 2 3 NOTES:'- 1.", Tests to be repeated at same depth until al pofbXinfhter� &qual percplatiotr• °t"afes'fte obtained at each peNol "ation test hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min for 31'= 60.minhgch) ( A ,11 data to be submtited for review. t i 2. Depth nAsdrernents to be made from top of hole. ' 4 � 41°'"` Form DD -97 i E.V A,E2rticl7 Oa/ 1�cSCrN /DEANS AS uLCO�JS _ 2 t3 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 3 {i To f> so« 0.5' Mei). 3 K. 1.0' FINE tk k-n sPtNa�l ���►• 1.5' kA,b{I Ga. 2.5' 2.5 ` �R Lr) LID AV- S4mO m 3.0' 3.5' 4.0' OLN (Sit, 4.5' n wr % �r� say► 5.0' CLAq Ne - (W1h—"1 5.5' 6.0' - 6.5' 7.0' . 7:5' 8.0' 8.5' Na a 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered POMc Indicate level at which mottling is observed a�oN Indicate level to which water level rises after being encountered . Pali f, c Deep hole observations made by: Geo,�- c c, ) XPoc -k ow (trA Date 11-30-0° Design Professional Name:, % Address: V V D Design Professional's Seal 2 .:: w: v . ::\:.:... . .....} : .:� � :•::: i:•::•i:•.�:!�•ii:: _ : i...:•:�•: • . .. .....::%•r :: \•....mil( : 1l f BATH K I . BEDROOM A ' -D[ 0 A E SS I N G BEDROOM]- WALK' 13'-0** x 10 %0- I N I CLOSET MASTER BEOROOU 6EDROOM 2 1 OPEN N 17"-0 1a'•8" 13' 0 -,k 15.-8... • —� .• c' ;.� 1 ARV V� SECOND 00 � 4828 = .-1344SF RO 10 VMS mwslg g DAB - t KITCHEN .�CJ /lr4.1 DINING ROOM p I MORNING HOOM 13* 0" • 12' 0- �-- • i _� �N OrEN �. Abo LIVING n00►1 �- / cult Y n00U _ fOYEn �• l - FI F�ST FI nn n - "^ ^" J. R. FOLCHETTI & ASSOCIATES, L.L.C. CIVIL /ENVIRONMENTAL ENGINEERS 247 Route 100 40 Railroad Avenue Pinewood Bus. Ctr. Montgomery, NY 12549 Somers, NY 10589 914 / 457 -5318 914 /232-2500 914 / 457 -9392 FAX 914 / 232 -6827 FAX TO: PUTNAM COUNTY HEALTH DEPARTMENT GENEVA ROAD ROUTE 312 BREWSTER. NY 10512 WE ARE SENDING YOU • Shop Drawings • Copy of letter IIaIe P ®IF TRAN5h=A e DATE: 05/08/01 ATTENTION: ROBERT MORRIS, P.E. RE: APPLICATION TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM AND WELL FOR A NEW SINGLE FAMILY RESIDENCE IN THE TOWN OF PATTERSON TAX MAP #13-3-51 (Lot-4) ■ Attached ❑ Under separate cover via HAND DELIVERY the following items: ❑ Prints ❑ Change order ■ Plans ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 COPY OF PCDOH LETTER OF AUTHORIZATION FOR DESIGN PROFESSIONAL (REVISED). 4 REVISED SSDS DESIGN PLANS AND DETAILS (2 SHEETS EACH SET). THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ As requested ■ For review and approval ❑ FORBIDS DUE ❑ Approved as noted ❑ Returned for corrections • Resubmit _ copies for approval • Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: REVISIONS PURSUANT TO COMMENTS RECEIVED FROM PUTNAM COUNTY DEPARTMENT OF HEALTH ON APRIL 17 2001. COPY TO: C. GARRISON SIGNED: t 7 f ✓ FILE PAUL J. PELUSIO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of CHARLES AND JOHN GARRISON Located at CORNWALL HILL ROAD T/V PATTERSON Tax Map # Subdivision of GARRISON 13 Block .5 Lot -7 Subdivision Lot 4 Filed Map # 2168 Date Filed S�i'� �'i"��c � /6� /'79T6 Gentlemen: This letter is to authorize J. ROBERT FOLCHETTI & ASSOCIATES, L.L.C. a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permits) 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 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 051011 Mailing Address 247 ROUTE 100 PINEWOOD BUSINESS CENTER SOMERS Very truly your Signed: (Owner of Property) Mailing Address: Z//� State NY Zip 10589 State L o Al Gwoo'�7,> r_�L Zip J,,2 7 7 Telephone:, 914- 232 -2500 Telephone: '/o -7 — 7 Form LA -97 LETTER OF AUTHORIZATION RE: Property of CHARLES AND JOHN GARRISON Located at CORNWALL HILL ROAD T/V PATTERSON Tax Map # Subdivision of Block -$ Lot Subdivision Lot 4 (. Filed Map # 2 i & 8 Date Filed s6 P7-6m 8crZ, 16 / G Gentlemen: /�� i ` ~� v✓(. L This letter is to authorize J. ROBERT FOLCHETTI &° ASSOCIATES L-- L-:C.-'- '------ °" -- a duly licensed Professional Engineer X 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 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. Very ly ourR� Countersigned Sign �'tl P.E., R. 051011 (weer o o ) Mailing Address 247 ROUTE 100 Mailing Address: PINEWOOD BUSINESS CENTER SOMERS a .0 Glv ooh State NY Zip 10589 State j'L- Zip 7 7 Telephone: 914 - 232 -2500 Telephone: L10 -7 - 7 S Form LA -97 r y x t z 4 . -,% BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LOREM 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 J. Robert Folchetti & Associates 274 Route 100 Somers NY 10589 Re: Proposed SSTS: Garrison Cornwall Hill Road, Lot #4 (T) Patterson, TM# 13 -3 -51 Dear Mr. Folchetti: April 13, 2001 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has.been completed. Comments are.offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. U Letter of Authorization has not been fully completed. Filed map number and date filed has not been provided. Enclosed. Deep test hole soil data submitted does not note mottling at 2.5 ft. also. / Standard notes 1 -15 have not been noted on the plan. �! USDA soil boundaries are to be shown. All future submission requiring more than one sheet are to be attached. Plans submitted with numerous sheets that are not attached will be returned to the design professional. The minimum of three sets of plans are to be submitted. Why isn't the footing /gutter drain connected to the curtain drain? Furthermore, the drains should discharge below the SSTS, V8. Please be advised that if Cornwall Hill Road has storm drains the 200 ft direct line of drainage separation distance is not applicable. a a Letter to: Mr. Folchetti - April 13, 2001 Erosion control methods for the well has not been shown. �enewal site note has not been provided. rench detail is to dimension the amount of stone required beneath and above the pe. ooseVolume itle block is to note owners name and street address. is to be noted on the plan. �l'.urtain drain standpipes are to be shown and detailed. fib! Location map is to show actual location of property off the road. -2- Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer enc. �m PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of CHARLES AND JOHN GARRISON Located at CORNWALL HILL ROAD T/V PATTERSON Tax Map # Block Lot Subdivision of GARRISON, Subdivision Lot 4 Filed Map # Gentlemen: Date Filed This letter is to authorize J ROBERT FOLCHETTI & ASSOCIATES L.L.C. a duly licensed Professional Engineer X 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 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 051011 P.E., R. Mailing Address 247 ROUTE 100 PINEWOOD BUSINESS CENTER SOMERS State NY Zip 10589 Telephone: 914- 232 -2500 Very truly your , Signed: (Owner of Property) Mailing Address: V /el L0A,-Gwoo,7,�> State /'Z— Zip 7 7 Telephone: '/0 7 — % g 3-3 F3 Form LA -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., 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 - 6 4$ 3, 2001 J. Robert Folchetti & Associates 274 Route 100 Somers NY 10589 RE: Garrison Cornwall Hill Road, Lot #4 (T) Patterson,'TM# 13 -3 -51 Reservoir Basin Dear Mr. Folchetti: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on March 16, 2001 is complete. The Department will notify you by May 7, 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. 0 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 aproj ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Letter to: Mr. Folchetti - April 13, 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 (8 45) 278 -6130 ext. 2166. Very yours, ,, Robert Morris, PE RM:tn Senior Public Health Engineer V- : ma 1y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Address CogAl"je_ Owner -7A-,m /v 144 pj� Located dt(Str-eet)-----*. Z--tL, :F2 I -- Tax Map--:l3: --,Bl.ock 3 Lot -5:y (indicate nearest cross street) Municipality - ,;>,4 r T G R -e, e eV Watershed 5,4-n;-7— SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test Z Z 9 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 1-30 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 . . ........ ...... ..... "Start"" Inc H616' . .. ........ .... ... ..... .............. .... .... ... ............ Mart 10 ft* ....... ....... .1.1, . ........ W stop es M Z 7, 13 -16, ,5. 4 5 .2 2 0 Z — //;-37 &*7, ,38 3 3/v 3/v 4 5- 1 2 .3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' wr 4.0' 4.5' 5.0' r�Jo -ff &9 92 5.5' 6.0' 6.5' 7.0' 8.0' •g ,,•Hoj4T? r 8.5' 9.0' 9.5' . Indicate level at which groundwater is encountered 41F Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: y Date p G A • a-r"v i ,-i G Design Professional Name: Address: Signature: Design Professional's Seal r N 916000 PRIVATE WAY wa 13.07 13.08 \ l a 1 Ar �a `.\`•.` / I A` AL C '•\ j _ 1319.54 � �� $Pr e / �.� I \ 9.16 AC. CAL. 10 I / 51.42 AC. CAL. ��h N 5.9 AC V \111 1 t !� • �� 1251.92 1 2 310.16 fi1S.39 \ ? 55 11 1 1.9 AC. CAL. DAC n �, ' _ `.. _ • • a 7 AC. CAL. 1•\r 4xa50o ,• 1 ' c '' 1; 78:90 AC. ' e -a m 9.1, , A; si 1.p�gj�c. j� 1 ii N l07• l AL s 8.02 AC. •\ X48 1.>a� o �• et )20.1 \ -k •� ,45� a sr 14 ' � � 20 AL 2 .3 t s E.�43. a 14 \ A 4 AC. 8 S�S4Z ` \ I 3y • 8689AG• ` j � AL 10.02 Ac. 1161.6! 141 • v Y i s 24 :AL. 41 . lo1c L .i Q 52 29.6 . AC. CAL. e1.9s 611.31 1 47.45 AC. 1s9.1s I.OB ~ 153 1 25 •� ►6 fl •1 A' 62 w O �y 16 AL J AC 56 6p 69 0 1. 40� +q 4.32 AC 11 At 81.48 AC. t oa J �?cti 18 1 / I 39� 0205 Ac^ 4).19' 6fi4.51 JL / & 3.85 AC. eA ri I 34e.1 1 y64 a 36 / 2y«9t�1.85 AC. AL A 67 •'' 1495.4 1 i e AL ' o a. 34.42 AC.. AL •' ./ 37 1 40.16 '` = 32.13 ac. j i /•� �� ,� • ` /• �` 1 y1 ten' � f �,J •'✓ � !/, „8t . a AL / N lam 34 :., a sl 4 a ;: Shect of PUTNAM COUNTY DEPARTMENT OF HEALTH = .. ` DIVISION':OF ENVIRONMENTAL HEATER SERVICES. FIELD ACTIVITY: REPQRT . j�All�'• %i4/�!r'gl•�.�. TPI t a/V, .� "{ cl ilT1R F C S. Street -.: Town: State 5� Zip ' r [ PERSON IN CHARGE' ol PR n`TRR�IEWFI �d`P?�© 1� -Coo l� 140-14 f k , Name and:`Title - —z TYPE DF.FACILITY .'- S- FLNDINGS jpr Sig I_T_' . �i1e s c% t2 t Ga- ®�`! 4 , M1 r. In t ]11I'' %TCIB TET Signdture`.and Title rTl I acknowledge receipt of this report SIGNATUREe 02196 , ..Title;.'. _R ev RECORD OF PHONE CONVERSATION DATE: ~I7 ?9 TIME: PERSON CALLING: PHONE #: REASON ` ( ) Inspection• () Deeps and /or Peres: SCHEDULED FIELD MEETING DATE: / I /A % 1 TIME: t� ��; ROAD /STREET: ©2/�/ ,� ` / Z TOWN: �/�}- �� TAX MAP #: SUBDIVISION: LOT #: OWNER: FROM PUTNAM ENGINEERING PLLIC ,, PONE NO. 914 225 2955 Sep. 17 1999 09:10AM P1 �N....'r-= k'•tt�.�y..�:te..I' 'L, gV r '� i?re =50 ter lk .,\ �• . to o Pe rc L4 3 1__ mo 10: ©o / pfd A � 1LU•� � - .�: �• ^! —..7a,a... v '.tip"- ...'.��S.t - ...�:� e k _ >w• � v .a a '�" lr`�1 O ► e —:5 l< Pe rG Mtyja eon 71r76 cam. _.1.. 8/6 / 93/7 — 1 ev ; o0 -- P K,en �re -boa k erc 5 8l6 dcL+e5 f g/7 .t /.00 /,/00 — 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: CHARLES AND JOHN GARRISON 2. Name of Project: LOT 4 SSDS 3. Location TN: PATTERSON 4. Design. Professional: J. R. Folchetti & Assoc.. LLC 5. Address: 247 Route 100 6. Drainage Basin: East Branch Croton Reservoir Somers, NY 10589 7. Type of Project: 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 Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? .............. Exempt X Unlisted 10. Has DEIS been completed and found acceptable by Lead Agency ?......... N/A 11. Name of Lead Agency ............ ............................... N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........... ............................... YES 13. If so, have plans been submitted to such authorities? ..... RS APPROVED SSDS - N/A 14. Has preliminary approval been granted by such authorities? Date Granted: N/A 15. Type of Sewage Treafinent System Discharge .... surface water X ground waters 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? ..................... NO 19. If yes, name of water supply Distance to water 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: &100 23. Name of Health Inspector: cye.-'c 26--D 24. Project design flow (gallons per day) ... ............................... 600 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required? .... NO 26. Has SPDES Application been submitted to local DEC Office? ............... Form PC -97 0a 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetland ID Number .......................... ..................... 29. Is Wetland Permit required? .............. ......................... . Has application been made to Town or Local DEC Office ? .................. 30. Does project require a DEC Stream Disturbance Permit ? ................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, Not to best of landfilling, sludge application or industrial activity? ........ Yes/No knowledge and belief 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or Not to best of any other potential known source of contamination? ......... Yes/No knowledge and belief DESCRIBE: Listed sites not currently visible. Kessman Landfill and Patterson SWMF located z 3000 feet south. 33. Is there a local master plan or file with the Town or Village? ............... N/A 34. Are community water, sewer facilities planned to be developed within 15 years NO in or adjacent to project site? 35. Are any sewage treatment areas in excess of 15% slope? ................... NO 36. Tax Map ID Number ........................ Map / 3 Block :3 Lot S 1 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 creations 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 1, the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: .................. 1-1J L C.-p �1iG lvo a Z> 3- Z 7 .7 J. R. FOLCHETTI & ASSOCIATES, L.L.C. CIP7L /ENVIRONMENTAL ENGINEERS 247 Route 100 40 Railroad Avenue Pinewood Bus. Ctr., Montgomery, NY 12549 Somers, NY 10589 914 / 457 -5318 914 / 232 -2500 914 / 457 -9392 FAX 914 / 232 -6827 FAX TO: PUTNAM COUNTY HEALTH DEPARTMENT GENEVA ROAD, ROUTE 312 BREWSTER, NY 10512 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of letter ILIEUTEIR 01F 7rIP. A OR= DATE: 03/05/01 ATTENTION: ROBERT MORRIS, P.E. RE: APPLICATION TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM AND WELL FOR A NEW SINGLE FAMILY RESIDENCE IN THE TOWN OF PATTERSON TAX MAP #13 -3 -49 (Lot -2) ■ Attached ❑ Under separate cover via US MAIL the following items: ❑ Prints ■ Plans ❑ Change order ❑ ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 CERTIFIED CHECK IN THE AMOUNT OF $300.00 1 PCDOH LETTER OF AUTHORIZATION FOR DESIGN PROFESSIONAL 1 SHORT ENVIRONMENTAL ASSESSMENT FORM 1 PCDOH APPLICATION TO•CONSTRUCT A WATER WELL 1 PCDOH APPLICATION TO CONSTRUCT A SEWAGE TREATMENT SYSTEM 1 SOIL PERCOLATION AND DEEP HOLE TEST DATA 2 HOUSE PLANS (FOR BEDROOM COUNT ONLY) 3 SETS OF SSDS DESIGN PLANS AND DETAILS (2 SHEETS EACH SET) THESE ARE TRANSMITTED as checked below: • For approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ■ For review and approval ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US • Resubmit _ copies for approval • Submit copies for distribution • Return corrected prints REMARKS: COPY TO: C. GARRISON SIGNED: FILE PAUL J PELUSIO I Rev. Mviolm CO XI M 011 FR!!fa[ FOR SEWAGE DISPOSAL COU Nr! DEPARTMM 0 TH see I��U .Y. 1/511 Roubsewbopmv lda IreIl1 JUIV ea CERTLFICAIB O7'7_� E PON / Cornwall Hill Road D.R. FOLCHETTI ASSOCIAT{- SLbalrw, Ntlitee Garrison R. S. Selid. Let / 4 ,. T" Map 1 lllack � �� 7 & 8 Ow..r/Awad Nme C.E. & . J . L. Garrison Renew Revbleo p o cne 1 soda es DOW d Proms Approvel MakeAdd a P.O. Box 374 Tows Brewster, NY ZIP 10509 Date Subdivision Approved 8/86 Fee Enclosed ❑ Amniint OMMbs Type Residential Lot Am 55,500 SP + Fm Seedem only Dept Vdleaee Nudes of Bedew ? Dedp Flow G P D 6()n PCHD NotffbYdeb b Rumbed Wbm FM b ee oplaW seplrnso seweeep S1shm a one" d 1000 Gwuw sop& Tedk .,d 667 LF of 24" Width `French To be eama nicled by Address Weer Stt *. PWWk Stippb Frets Addeeaa an X D.a..k Sop* DOW by Not yet det01.M t Od w Requ4e.e a 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate saw di eel a stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ens o ream County Department Of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be asbmttted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or anions by the builder, that said builder will DISCO in good Operating condition any part of said sewage disposal system during the period of.two (2) yews Immediately following the date Of the issu- anCe Of the approval Of the Certificate of Construction Compliance of the original system or-any pairs thereto; 2) that the drilled well described abode wM be located as shown On the approved plan and that said well will be Installed in accordance wit hif-startdards, rules and regu TrOns of the Putnam County Department Of HMith. Date, 9/7/95 Sign Adclmn P.O. I3o:,c 374%_,rewster., NY 1.0509 license No 051011 APPROVED FOR CONSTRUCTION: This approval expires two years from the dale issued unless construction of the building has boon undertaken and is revocable for cause Of may be emended or modified when considered necessary 0 e.Commissioner of Health. Any change or alteration of construction retiuires a new permit. Approved for disposal Of domestic sanitary aeeraga, rW /or pr yala�W supply only. Date 5 By ��. - Title DEPARTMENT OF HEALTH Division of Environmental Health S 4 Geneva Road, Brewster, New York (914) 278 -6130 U NMI 7 1996 L APPLICATION TO CONSTRUCT A WATER .�� SSQCIAT PCHD PERMIT #_ f' OWN %v WELL LOCATION Street Address Town/Village/City Tax Grid Number Corrn,rall Hill Road Patterson 1- 6 -7 &8. WELL OWNER Name Mailing ddress x Brewster, OPrivate C.E. & J.L. Garrison c/o J.R. Folchetti & Assoc. O Public USE OF WELL 1 `- primary 2- secondary 19 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 6 /EST. OF DAILY USAGE 450 gal ❑ REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY M NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING Domestic Water Supply WELL TYPE UDRILLED DRIVEN []GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Garrison Lot No. 4 WATER WELL CONTRACTOR: Name Not yet selected Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: >500' (`.LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 9/7/95 13ON SEPARATE SHEET (date): (si ature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under'the provisions, of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt-• (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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 groundwpter. Date of Issue : c= `-��� 19 5 � f' Date of Expiration : 19 15 pr Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: Y N DOCUMENTS U(_JPERbIIT APPLICATION IL)UWELL PERMIT OR PWS LETTER UUPC -97 UULETTER OF AUTHORIZATION U(_JDESIGN DATA SHEET (DDS) UUCORPORATE RESOLUTION UUSHORT EAF ((__)PLANS -THREE SETS (___)(__)HOUSE PLANS - TWO SETS L_)( )VARLkNCE REQUEST SUBDIVISION (_J(_JLEGAL SUBDMSION (_J(_)SUBDMSION APPROVAL CHECKED U(__)PERC RATE U(__)FILL REQUIRED DEPTH (_))CURTAIN DRAIN REQUIRED � GENERAL )LOCATED IN NYC WATERSHED YS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED ::S TO BE WITNESSED APROVAL SSDS ADJ, LOTS 'LANDS (TOWN/DEC PERMIT REQ'D ?) A ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION ,ETTER BI/ZBA 00 YR. FLOOD ELEVATION W/I 200' OIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE �GRA_)Wl–fr(—)W---\ N N S 1 -15 ;JPERC & DEEP RESULTS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT TOOTING /GUTTER/CURTAL 1 DRAINS iUSDA SOIL TYPE BOUNDARIES (TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# (DATE OF DRAWING/REVLSION TUM REFERENCE (_41 LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ( PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS L ((WELLS & SSDS'S W/IN 200' OF SSTS __)(_JPROPERTY METES & BOUNDS (_J(_JEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 TAX MAP -: (CONFIRMED) HOUSE SEWER -'/�" FT. 4 "0'; TYPE PIPE CAST IRON )0 BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS SITE NOTE (NO CHANGE) FILL SYSTENTS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS/ FILL NOTES 1 -5 PROFILE & DIMENSIONS IN EXPANSION AREA FILL GREATER THAV 2 FEET CLAY BARRIER L CERTIFICATION NOTE EPTH GAUGES OL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS EPARATION DISTANCE FROM TOE OF SLOPE TR EN F TRENCH PROVIDED . 60FT MAX. ARALLEL TO CONTOURS (. , )100% EXPANSION PROVIDED / DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL UGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL n520' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS 100 TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STOR?vIDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') 50' INTERMITTENT DRAINAGE�COURSE ZUX00' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK ( _)10' FROM FOUNDATION; 50' TO WELL WELL (�DINIENSIONS TO PROPERTY LINES ,L��LOCATION OF SERVICE CONNECTION (_JLJMLN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (S20 %) EGRADE) TO 15 %, IF REQUIRED DOSE/PUIyiP SYSTEMS (_JL�8i1hIP NOTES ADO E 75% OF PIPE VOLUME/DOSE VOLUME NOTED D AIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN �L STANDPIPES; 5' BOTH SIDES, DETAIL ( '� '15' NIIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -I %,100 % -<1% J20' MIN to CD DISCHARGE /100' with 182 cons day discharge l0'MI,N to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: C =�OI� STREET LOCATION: REVIEWED BY: AS, SRDATE: TAX MAP -: (CONFIRMED)- 13 • 3 • Y DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'Dl PERbIIT APPLICATION (_)(`___)HOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON (U�VEL T OR PWS LETTER (__)UNO BENDS; bI.AX BENDS 45° W /CLEANOUT U�) -97 RENEWALS �•/ ET F AUTHORIZATION U(_)SITE NOTE (NO CHANGE) (� GN DATA SHEET (DDS) FILL SYSTEMS. UUCORPORATE RESOLUTION (__)(__)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (_J(__)SHORT EAF (__)UFILL SPECS/ FILL NOTES 1 -5 UUPLANS -THREE SETS (__)(FILL PROFILE & DIMENSIONS UUHOUSE PLANS - TWO SETS UUFILL IN EXPANSION AREA (__)UVARIANCE REQUEST SUBDMSION FILL GREATER TH.A�'Z FEET L—)L AL SUBDMSIVI UU CLXY BARRIER U _)SUBDIVISION APPROVAL CHECKED UL JEEP CERTIFICATION NOTE (�UPERC RATE UUDEPTH GAUGES (-)(__)FILL REQUIRED DEPTH UUVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS UUCURTAIN DRAIN REQUIRED UUSEPARATION DISTANCE FROM TOE OF SLOPE GENERAL EN UULOCATED IN NYC WATERSHED UULF TRENCH PROVIDED LOFT MAX. U- � UUPLANS SUBMITTED TO DEP �UPAR-�i.LEL TO CONTOURS UUDELEGATED TO PCHD UU100% EXPANSION PROVIDED (J( )DEL APPROVAL, IF RD UUDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (�UDEEP TEST HOLES OBSERVED UUGEOTEXTILE COVER. U(�PERCS TO BE WITNESSED SEPARATION DISTANCES ON PLAN - FROM SSTS (U(__)EERCS T OBE . ITN SSE LOTS C_)(_)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL UU�VETLANDS (TOWN/DEC PERMIT REQ'D ?) C- -�U�O' TO FOUNDATION WALLS U(�DATA ON DDS PLANS & PERiti11T SAME (-- )(- -)100' TO WELL, 200' IN DLOD,150' TO PITS (___)U100' TO STREAM, WATERCOURSE, LAKE (inc. expaq) ( _)(JPRE 1969 NEIGHBOR NOTIFICATION C__)U50' TO CATCH BASIN, 35' STORi�IDRAIN, PIPED WATER UULETTER BI/ZBA (___)U10' TO WATERLINE (pits - 20') (--)U100 YR. FLOOD ELEVATION W/I200' (__)U50' INTERi\•ITITENT DRAINAGE COURSE ( _JUSOIL TESTING LOTS >10 YEARS OLD (_J(__)200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (__)U10' b1IN TO LEDGE OUTCROP WAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK (_J(__)SSDS HYDRAULIC PROFILE U(U10' FROM FOUNDATION; 50' TO WELL (_)( —JGRAVITY FLOW WELL (__)(CONSTRUCTION NOTES 1 -15 U(— DIMENSIONS TO PROPERTY LINES UUDESIGN DATA: PERC &DEEP RESULTS —) (--)( LOCATION OF SERVICE CONNECTION ( _J�)2' CONTOURS EXISTING & PROPOSED UUlvIL`115' TO PROPERTY LINE (__)(__)DRIVEWAY &SLOPES, CUT SLOPE ((__)FOOTING /GUTTER/CURTAIN DRAINS (�UUSDA SOIL TYPE BOUNDARIES UUSLOPE IN SSTS AREA (520 %) UUTITLE BLOCK; OWNERS NAME ADDRESS UUREGRADED TO 15 %, IF REQUIRED TM#, PE/RA; NAME, ADDRESS, PHONE# (—JUDATE OF DRAWLNG/REVISION ( —JUDATUM REFERENCE UULOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (__)(_)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS U(__)WELLS & SSDS'S W/IN 200' OF SSTS (__)(___)PROPERTY METES & BOUNDS (__)UEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 101 100 DOSE/PUIylP SYSTEMS UUPUMP NOTES (__)(___)DOSE 75% OF PIPE VOLUIvIE/DOSE VOLUME NOTED (_JUDETAIL FOR FORCE MAIN, (PIPE TYPX, ETC.) UUPIT AND D -BOX SHOWN & DETAILED (-)(_)l DAY STORAGE ABOVE ALARM CURTAIN DRAIN (__)( _JSTANDPIPES, 5' BOTH SIDES, DETAIL (_JU15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %, 100 %-<1% (_JU20' b1Ii ( to CD DISCHARGE /100' ivith 182 cons day discharge U(__)lU' ivlIN to NON- PERFORATED PIPE j Indicate level at which groundwater is encountered Indicate level at. which mottling is observed -;z . a " Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional's Seal d ®.2 o v i%p r,' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' DEPTH HOLE NO. HOLE NO. HOLE N0. G.L. aY. � �. 0.5' �'-- j 1.51 S..tid y lea in iw ' 2.5' 3.5' Y 5.0' , n 6.0' 6.5' 1.5' 8.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at. which mottling is observed -;z . a " Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional's Seal d ®.2 o v i%p 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 ,¢, 1 :50-4j (T M t�3�7' - R'Soef/ County JP L_1 Site Location 6oTZNGr/,41_G h/LL Building construction begun Ala Extent Is prorty within NYC Watershed ? ................. Yes a No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) I. Hilly Rolling` D.-Sleep-slope.— - -.-Gent slope--F-771 Flat _ o__ ca _ ca o 2. F__J Evidence of wetlands Low area subject to flooding - 0 Bodies of water Drainage-ditches Rock outcro s - 3. Property lines or corners evident ....................................................... a Yes No 4: --Do water courses exist on or adjoin the property. ..Yes 5. Will these affect the design of the sewage system facilities ?.:......:,.... No - - -Do watershed regulations apply m this development ?.- :................... Yes e__ _ . _:7 - --Will extensive grading be- necessary ?.:::::::::.- .::: : :::::... - - � ... s 8. Will extensive fill - 0 be necessary for SSTS ?. &,r4 //1? j�� .. ...:....... .... Yes _, .o __............ 9. Do filled areas exist within the SSTS area ? ......................... .............. Yes No If yes, what_ is_the -condition of the fill? - - - - -- -. _ - -- - -- -- -- - - -- - - -... - -- : - - - - - -- - _ - - - - -_ - - -- -- r SECTION C. SOIL OBSERVATIONS _ . -.10... Appearandd- dsoil: Sand o Gravel ::. Loam .. . Clay. -. -- Hardpan a Mixture - - 11. Observed from: .7 Borings - `J1 Bank cut- _.___0 Backhoe excavations 12. Soil borings/excavations observed by ail E___. -o_._ gj� n 13. Depth to groundwater ay N on. 14. Depth to mottling `= j " / 3 n •' on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by TT! on 17. Soil percolation tests witnessed by .%Zc on no SECTION D (on back) Form ST -1 R -:z 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? D No 19. Will groundwater or surface drainage require special consideration"? ....... ;* ........ ........ Ye F .20. Will gullies, ditches-, etc.-, be filled and watercourses be'relo'cated? ......................... F-1 Yes gNo SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed, source and facilities? ............................................................... F__J Yes No InIpection data 22. Do adjkc ................................................... _��ntvells_and/or_sewage systems exist?-- Yes No 23. Additional comments 24. Site observer/inspector and title glilmp- -Q, gagn E. A 25. Dates) �-t-o.-b-s--erv—atio-n-(s—)inspection(s) .///3 e TEST PIT PROFILES Hole Lot # ------- .—Hole #_ .---Hole#-.--.. Depth to water Depth to water Depth towater .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.. _1.0 -1.0 4.0 .4.0 5.0 5.0 5.0 6.0 6.0 6.0 TO 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0-- 10.0