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HomeMy WebLinkAbout0427DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -99 BOX 5 Ji IN T J ■ 1 ti N. 16 IN r- IN ,. 9. NO 0 Jr. 00236 L. \ \\O. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE. OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT # f­ . Ivy Located at SwA s, f PRIV6 Owner /Applicant Name 6 A M . r` Q. Town or Village P RA OA/ Tax Map 13 Block 3 Loth Formerly Subdivision Name C ORMJ A L L WILL Subd. Lot # Mailing Address 3. -(ANA G C 2 Ru A D 0 -� Cws-r r , i✓Y Zip 1 O.Coq Date Construction Permit Issued by PCHD 4--7-0-00 Separate Sewerage System built by LLC. Address 2- 'P�ztVJTR L_ Consisting of 9 r ` �o Gallon Septic Tank and t-00 L F' 2' �1 i p i4 3S o ATio N TR i N�Nc�S Other Requirements: Z' _ 0 e 13 6;KAv9 L Fl(- L , f vit TA ► 4 _t� P—A 10 Water Supply: Public' Supply From Address or: Private Supply Drilled by N L-TvJ t4i�t"fr' Address Building Type K6S I> C-6' AL Has erosion control been completed? Number of Bedrooms L4 Has garbage grinder been installed? No. Nn 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 Department of Health. Date: �� Q Certified by SNScf�c ENS /sv�ERt�G .3��vGy�'� LANy>;rgoC AReNt�'yCT ✓R� Address el.:,ro, -rrk P.E. X -R--4- License # 611-S) Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correctionbf 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 appro als are subject to modification or change when, in the judgment of the Public Health Director, such revoc tion, modificatio or change is necessary. 1? Ey: G Title: r Date: � -0/ White copy - HD File; Yeltbwkopy - Building Inspector; Pink copy - Xbwner; Orange copy - Design Professional Form CC -97 ' � i N E ; NORTHEAST LABORATORY OF DANBURY 0 �" ACCO.904 39 MILL PLAIN ROAD - DANBURY,'CT 06811 CT Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LADS www.NORTHEAST LABORATORIES.com a 1 $ LABORATORY REPORT REPORT TO: BMMD, L.L.C. DATE SAMPLE COLLECTED: 11/26/2001 2 TANAGER ROAD TINE COLLECTED: 9:30 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: BRUCE MAJOR DATE RECEIVED @ LAB: 11/26/2001 TESTED BY: LAB #11471 LAB LD. # NY -120 REPORT DATE: 11/28/2001 SAMPLE SITE: LOT #2, CORNWALL HILL ESTATES, CORNWALL HILL RD., PATTERSON, N.Y. SAMPLE POINT: BASEMENT FAUCET 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) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.34 - EPA 150.1 No designated limits • Turbidity 0.88 NTUs EPA 1.80.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 1.40 mg/L as N SM 450ONO3D 10 mg/L • Alkalinity 236.0 mg/L SM 2320B No designated limits . • Hardness 390.0 mg/L EPA 130.2 No designated limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 4.8 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.007 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L=milligrams per Liter ND =none detected MCL=Maximum Contaminant Level TNTC =Too Numerous To Count . "Notification Level I ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or ONOTPOTABLE (PER STATE. OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 11/26/2001 o 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES o� WELL COMPLETION REPORT Well Location Street Address: �� Town/Village: doh Tax Grid # Map Block Lot(s) Well Owner: Name: Address: o` a GC, CG O r' Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casing -X Open hole in bedrock Other Casing Details" Total length Length below grade _6RJ _ft. Diameter 7 in. Weight per foot lb /ft. Materials: Y Steel _ Plastic _ Other Joints: _Welded X Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: _X Yes No Liner _ Yes Y No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield -,?—Ogpm Depth Data Measure from land surface - static (specify ft) 36`4-2, During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface Q c a (j .LS e If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Lo ) Capacity _gym Depth 1Ay Model 76 50 5 Voltage 2-t a HP Yj Tank Type N Volume $ o a I Date Well Completed /6/13/4) Putnam County Certification No. QO Date I Well Driller (signature) ^� *wa- NOTE: Mact`location of well with distances to at least two permanent 9 "andinarks to be provided on a separate&eet/plan. Well Driller's Name /ia Y! p Address: ¢, � � /' A r56 /V, Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , 0*,' - WELL COMPLETION REPORT Well Location Well Owner: Street Address: Town/Village: Tax Grid# Cd h 111 , e rs • Map 13 Block 3 Lot(s)3+` Name: Add re s: LGC Use of Well: 1- rimary - secondary e . Residential Public Supply Air cond/heat pump Irrigation Business Farm c2 Testlmonitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casing A— Open hole in bedrock _ Other Casing Details Total length —2Lft. Length below grade(] ft. Diameter -7 in. Weight per foot —LZ_lb /ft. Materials: _ Steel _ Plastic. _ Other Joints: _ Welded _ Threaded _ Other Seal: _ Cement grout — Bentonite Other Drive shoe: Yes No _ Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours -. Yield 620 gpm Depth Data Measure from land surface- static (specify ft) �v -� During yield test(ft) �o�l�n -► Depth of completed well in feet 7'CJS' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ! '16 p " ' e, / , A'c If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 'Q Pump Type & .7 Capacity Z7,,,, Depth 22.0 Model 2, rar 50 •� Voltage 4 3 ..47 HP P, Tank Type ��`�"' ' Volume. ,4 aid Date Well Completed /0 It' 70C107 unty Certification No. Date of Report Well Driller (signature) NOTE: Zxact location of well with distances to at least two permanenf landmarks to be provided on a separpre sheetiplan. Well Driller's Name e x Address: /& Signature: - r Date: L' ,d White. copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM G�ix1MI) Ll,C 3 Y.vy Owner or PurchaserJof Building Tax Map Block Lot Building Constructed by Location - Street l�ESI�?r-n/- AL Building Type Town/Village C0,0, PjA &L 14l L L Subdivision Name 1- Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately. following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by, the willful or negligent act of the occupant of the building utilizing the system. Dated: Month /l Yearl&°> General Contractor (Owner) - Signatu lam, �t ✓vt Fi (—LC- Corporation 14ame (if corporation) . Address: -7, 1--Z a^- t > Signature: Title: or Corporation Name (if corporation) Address: State ��— s `�'� -r N I Zip f o S-a 1 State Zip Form GS -97 PUTNA 1 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES . _ FINAL SITE INSPECTION Street Location c:c,7z V,&/,,PZ L Town 'p,4 y-,-F2 -s4e:,,1 TM f 3 3 Date: IT '/;Z:. � Inspectefty: Owner $&yJ Z� ', L L G Permit # 7) / — t::> 'V Subdivision Lot 4 1. SeNvage System Area a. STS area located as per approved plans ........................... b.' Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc.; greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ................... ............. II. Sewage System a. Septic tank—'size -1 000 ....... , 5 .........other ................ b. Se p tic tank installed level ................ ............................... , c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. TrencFes. .. T. Tength required 5 �c'-' Length installed S 0v 2. Distance to watercourse.measured4 i ao..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 ................... 10. Pipe ends capped .................................. :.................... g. Pu_ mp or Dosed Systems 1. 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 ............ ..........�f................... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured 13 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 watercoursf g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ......................:........ i. Erosion control provided ........... :..................................... -10/24%2001 15:26 845 - 278 -6392 1NSITE ENGINEERING PAGE 01 PMAM COUN')1'X DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM �GE1�YE MU ST FOR FIN'AT. INSPECTION Fill All information must be My completed prior to aay Trenches inspections being made. PCHD Construction Permit # i " 1 t - O ° Located: Go A-v —.* c.4 k c c,t: r2a b D ! t A,1TWLSo 41.1 Owner /Applicant Name: YZ l 3 Block.__ Lot -$4. oz Formerly: Subdivision Name- gs nt- 'S Subdivision' Lot # _ Is system fill completed? !Ke5 Date: L' %ale r Is system complete? Gl Date: 4' (T-3ror Is system constructed as per plans? Is well drilled? Date: OW, AT/ ,( Is well located as per plans? Yef Are erosion control measures in place? T'62 . I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rnles and Regulations of the Putnam County Department of Health. Date: Certified by: PE X R* ----- Insite Engineering, Sury Professi Landscape Architecture, P.C. Address:. 1 435 RoL[W 22 Lie. # k f Brewster, New York 10509 Comments: Form FIR-99 BRUCE R. FOLEY Public Health Director. October 26, 2001 LORETTA MOLINARI R.N., M.S.N Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113... Jeffrey Contelmo, PE Insite Engineering Route 22 Brewster, New York 10509 Re: Field Inspection - BMMD, LLC Cornwall Hill Road, (T) Patterson Lot #2, TM# 13 -3 -34.02 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be.liaekfilled: The following comments must be corrected in the field: No comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering. Aide NOV -20 -01 01:57 PM utxz IZ FOLEy Pabho ffeakA D;ree:cr TOWN OF PATTERSON 9148782019 P.02 ,LOP -MA MOLIlvARI- RN.. NL9,N. AJJOQtQr$ Mik N-10kh DtY*ejor Dirwar of romeru sem us DEPARVYMNT OF aALTH 1 rveneva Road Brewster. Now York 10509 $47iroumefiIIl Rulth (914) VI.6130 Pm (914) 278.7921 XgMnq &Men (014)371.6!51 WIC (9L4) =7t .66 "6 FAV(914) :78.6011 Eirly I4CUT01192 p14)2',8 -6414 Pre3oh4ol (914) 271.4012 Pot(914)278-4649 0 F9—. 1 I ADDHE,SS YFHLEICATTQN Engyl OWNERS NAME: � /' "PIdg I, leg TAX MAPNC;MBER.- -1- 9 E911 ADDRESS: _ / �9 S ors'iP s coea;'r ✓E" TOWN: �� 9"1'r/�s © -c/ AUTHORIZED TOW N OI:FXCLkL: (Signature) DATE; The Putnam County Department of Health will not issue a Certificate ox 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 Complila -oce. 011LVIX-R.'V.) NA AMIRj IAAJ "M ufflmxm� ]m �+ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL ,HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 1 ' / /'Do 7 -0 � Located at COANVALL f kilo AL2 Town or Village fnrascd Subdivision name Subd. Lot # Tax Map 1'3 Blocky Lot Date Subdivision Approved AIIA Renewal �— Revision '" "A Owner /Applicant Name 68 K01 LLG Date of Previous Approval 411A _ Mailing Address -TANA6 R RoAo _[ wsT _d Zip Amount of Fee Enclosed 1'3W,00 Building Type D L Lot Area 9 G * No. of Bedrooms y— Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage S ' sy tem to consist of /2- 5 U gallon septic tank and 6190LE 2+ 'w&6 MsogP(iQ(t/ 9 ENLI FS. Other Requirements: 2' - 0" 903 GRML F&L e 71 6,u4 -W AI 29A hi To be constructed by Address Water Sunnly: Public Supply From Address or: � Private Supply Drilled by um do twd Address AMA I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original (. system or any repairs thereto. Signed: Address P.E. A -R-A. Date 3--30-00 tc9ir6ZTvaF— Z, License # .-Q931 j 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 considered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perirlit. pprov r discharge of domestic sanitarIs ge nlyy. By: Title r/' ✓ <�C� Date: I0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL /� 1 please print or type PCHD Permit # V - 4 ` n Well Location: Street Address: o illage Tax Grid # CoW wALL k i LL 'Ra PAT99S a4 Map 13 Block '3 Lot(s) Well Owner: Name: Address: i mt o ;, Li.G 2 'NJAGER A00 694W5,11 Ek ; y I05'0q Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 91- rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served __�_ Est. of Daily Usage 00 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 VIA Lot No. Water Well Contractor: UIVKNIWAI Address: JVIA Is Public Water Supply available to site? ............................... Yes No .................................. _ Name of Public Water Supply: &11A Town/Village ILA ' Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 3-30 -00 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified When considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water 1 driller certified by Putnam County. Date of Issue V/?.o d o Permit Iss ' g cial: ^� Date of Expiration Title: /,. Permit is Non-Transf6rable White copy - HD'file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS nn REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: M 0 STREET LOCATION: (;t1 6'JxAA`i' 1l1 Alai(J REVIEWED BY: AS, SRDATE: TAX MAP =: (CONFIRMED) DOCUMENTS ERMTT APPLICATION LL PERMIT OR PWS LETTER .97 ITER OF AUTHORIZATION )DESIGN DATA SHEET (DDS) N (-L)UCORPORATE RESOLUTION � Z (JUSHORT EAF - (--)(--)PLANS -THREE SETS (__)UHOUSE PLANS - TWO SETS (__)UVARIANCE REQUEST SUBDIVISION GAL SU SUBDIVISION (__) BDIVISION APPROVAL CHECKED U(::DPERC RATE )tn=nQUMED , DEPTH TAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED 9( PLANS SUBINIITTED TO DEP DELEGATED TO PCHD (__)CUDEP APPROVAL, IF REQ'D (__)UDEEP TEST HOLES OBSERVED RCS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS ;TLANDS (TOWN/DEC PERMIT REQ'D ?) .TA ON DDS PLANS & PERMIT SAME E 1969 NEIGHBOR NOTIFICATION TTER BIlZBA 1 YR. FLOOD ELEVATION W/I 200' IL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE V1TY FLOW )NSTRUCTION NOTES 1 -15 :SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING &.PROPOSED UVEWAY & SLOPES, CUT )OTING /GUTTER/CURTAIN DRAINS ;DA SOIL TYPE BOUNDARIES TLE BLOCK; OWNERS NAME ADDRESS Q #, PE/RA; NAME, ADDRESS, PHONE." kTE OF DRAWING/REVISION TUM REFERENCE ION OF WATERCOURSES, PONDS WETLANDS WITHIN 200' OF P.L. FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S WAIN 200' OF SSTS U(__)PROPERTY METES &BOUNDS COMMENTS: Y' i (REQUIRED DETAILS ON PLANS CONT'D) 0 . HOUSE SEWER- %1' FT. 4 "0'; TYPE PIPE CAST IRON (.__) NO BENDS; INLAX BENDS 450 W /CLEANOUT RENEWALS )SITE NOTE (NO CHANGE) FILL SYSTEMS 0", -0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ILL SPECS/ FILL NOTES 1 -5 ILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN 2 FEET CLAY BARRIER FILL CERTIFICATION NOTE *(—JDEPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS X100% EXPANSION PROVIDED L_)DETAIUDUST FREE CRUSHED STONE OR WASHED GRAVEL ( X )GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 0' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL TO FOUNDATION WALLS 00' TO WELL, 200' IN DLOD,150' TO PITS 00' TO STREAM, WATERCOURSE, LAKE (inc. eapan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits - 20') INTERMITTENT DRAINAGE COURSE RESERVOIR, ETC. _ 150' GALLEY SYSTEMS TO LEDGE OUTCROP . SEPTIC TANK FROM FOUNDATION; 50' TO WELL WELL -TENSIONS TO PROPERTY LINES CATION OF SERVICE CONNECTION 15' TO PROPERTY LINE SLOPE IN SSTS AREA 520 %) MED TO 15 %, IF REQUIRED DOSETUMP SYSTEMS NOTES OSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) CT AND D -BOX SHOWN & DETAILED Y STORAGE ABOVE ALARM CURTAIN DRAIN ANDPIPES, 5' BOTH SIDES, DETAIL MPit to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % - <1% MIN to CD DISCHARGE /100' with 182 cons day discharge MIN to NON- PERFORATED PIPE i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at LETTER OF AUTHORIZATION g ~4 P i L (. F( E G.L' !'Zvi!- p (9V �A Tax Map # Subdivision of IJI�4- 113 Block Lot Subdivision Lot # NfA. Filed Map # 'f A Date Filed "_/ Gentlemen: This letter is to authorize incite Engineering, surveying & L n&cape Architecture, P.C. (Jeffrey J. 'contelmo, P.E. a duly licensed Professional Engineer _x or�xxdtxzbdWxxxxxto 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. Countersigne P.E.,1.., # Mailing Add: State New York Telephone: & Ian&cape',Architecture, P.C. Route 22 y 'I 05 Prewstear, New Zip 10509 Very truly yours, Signed: (Owner of Property) Mailing Address: State N Zip 105-09 (914) 278 -4990 Telephone: 5 /4' 27 7 -3 ,!r l3 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES GL c. AFFIDAVIT - C4PdZAP4TE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 6P.4- 6 8� L-(-C- I,- 25-A dtf C,-k Ze represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V; jA4 n^. >, r G LG Having offices at: Z TK7,/ Ar&&X- tom(, (3 ax—, C, . ^) y c ° � °`► Whose Officers Are: - Name Iqo Address:: !.!/�•'7�� �•= C�ir� /� r.- rest. ent -Name: Address:' /U�.. -s��� 4* -Name: Address: lsure r -Name: Address -f t^ 6,V11 >r/T and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: z� • Title:. Jor Sworn to before me this day of j (month) o (year) otary Public PATRICIA GALBRAITH Notary Public, State of New York Corp rate,Seal No. 01GA5040308 p Qualified in Putnam County Commission Expires, March 19X2 Form CA -97 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: PLC, �RrwSTF-k Ny i o0oq 2. Name of project: SS j 5 600, B/AK04 U.C- 3. Locatior&v: Azmoy insite aigineering, Surveying & landscape 4. Design Professional: Jeffrey J. Cantehro, P.E. 5. Address: Architecture, p c 6. Drainage Basin: �AS'i bat lute 22 Braastex, -DIU y wk 10599- 7. Type of Pro'L: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted OL. 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... yo 10. Has DEIS been completed and found acceptable by Lead Agency? ............... WA 11. Name of Lead Agency NA 12. Is this project in an area under he control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Q 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: _ 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ............... :............................................................ lU 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply . /V/Q, 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 y��r�E I���aj�Sfi� CPcHn) 22. Date test holes observed , 23. Name of Health Inspector MAK(9t.9t (,ioYftiVYcOEP) 24. Project design flow (gallons per day) ............. .. 900,00 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 01NAO r 26. Has SPDES Application been submitted to local DEC office? ......................... Ni Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number .....:.:................................................... ............................... IVIA 29. Is Wetlands Permit required?..-......, .......................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? ................................. 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .....................:...... Yes/No Nd 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 0 DESCRIBE: 31 Is there a local. master plan on file with the Town or Village? 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ..................:............ 35. Are any,sewage treatment areas in excess of 15% slope? . ............................... — hk 36. Tax Map ID Number ..... ..................... .......:....................... Map)_ Block 3 Lot 3 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. Iltereby 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 Addr2�s`5:'6.'.�`':..: -.�dj. Insite Engineering, Surveying & ........ Landscape Architectur, Pe. S��iS li ?. ��,�i f1P1� 1485 Route 22 Jl.tdl70pIPI�d Brewster, New York 10509 U3A 13,, .] a : f f (II � 1 •I i - N I',�Y!, t dal r ,' loss' {ilnul Dui � t� ;•� 1 1 � h � r 1 THE SCARSDALE Second Floor u 27'8" X 48'e 2656 Sq. Ft. First Floor i � v --- J 010 -, I j O,O KITCHEN ` ( I i 12' -0" x 13'-0" DINING ROOM 13'- 9" x 13 "- 'ALL 48' I �I ii BREAKFAST W -5" x 13' -0" FAMILY ROOM 20' -0 "x 13' -0" PUTNAM COUNTY DE i Ai T dENT OF HEAL FOR BEDROOTM COUNT LIVING ROOM AL'.t ER' F ONS TO s ,.D T O. TTtE PCDOH STANDARD SCARSDALE II FEATURES • 4- Spacious Bedrooms • 2V2 Baths • Open Two -Story Entry Foyer • Formal Dining Room • Formal Living Room • Spacious Country Kitchen with Breakfast Room and Pantry • "Cottage- Style" 3056 Lower Level Windows with Architraves on Front 27'8" 27'8" [C USE 'XdVAL TE • Framingham Pediment on Front Door • Fireplace Options Available • "Boxed - out" and "Angle Bay' Options Available • Consult an Authorized Westchester Builder for a Complete List of Options • Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract No oral conditions. ESTCHESTER MODULAR ' P 0. Box 900 9 Dover Plains, NY 12522 14 -16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR u Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicanf or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME , 3. PROJECT LOCATION: Municipality Lac"I �ar� county °`- 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: Blew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: &PV5TKVCr;0/J of oA16 rWO' Rr5;vE41c6 AND �PPv��E�RNGEs =� _ 7. AMOUNT OF LAND AFFECTED: %L %� Initially �� acres Ultimately t7v acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 0-Yes ❑ No If No, describe briefly 9. WHncxtATT� IS PRESENT LAND USE IN VICINITY OF PROJECT? �tesidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?, &Yes ❑ No If yes, list agency(s) and permit/approvals PIW VA`s PCRM i r -- Towcv or PA T TEleS014 aL4 SS i S;- fviNAM C0WVrY NEAM -K DEPAQ�rAC -N 8v IQl - TOW.V or PAT 54 11. DOES ANY AS CT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permitiapproval 12. AS A RESULT F PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? C3 Yes ONO I- CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE , 5 ukvtf v� 1 AwOSC� /ktEC?� c , pis' r, 0X 1*)vc 0in� 3 T.� © � ` Applicant1sponsor name: .164N M, WdA60Y Date: _ Signature: V' If the action is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? 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. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE' FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels,. existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or tlireatened' 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..gy the proposed action? Explain briefly. CD O r rI C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. >M ;. >� C7. Other Impacts, (including changes In use of either quantity or type of energy)? Explain briefly. C'--1 CJ C7� D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it. is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic !scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ 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 andlor prepare a'positive declaration. ❑ Check this box If you have determined, based on.the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on� attachments as necessary, the reasons supporting this determination: Name of .tea Agency Print or Type Name of Responsible O icer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date r 2 /NS /TE rY ENGINEERING, SURVEYING & LANDSCAPEARCH/TECTURE, P.C. 1485 Route 22 (914) 278 -4990 Brewster, New York 10509 Fax: (914) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 LETTER OF TRANSMITTAL Date: 4 -5 -00 Job No. 99147.100 Attn: Robert Morris, P.E. Re: SSTS for BMMD Cornwall Hill Road, (T) Patterson T.M. #13. -3 -34 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Specifications COPIES DATE NO. { DESCRIPTION 4 3 -9 -00 C -1 Construction Drawing 4 3 -9 -00 C -2 Construction Drawing �1 3 -30 -00 CP -97T -LA Construction Permit 1 3 -97 CA Letter of Authorization LLC Affadavit -24 -00 _._ ......... ._ ____..._ ______.__ ._ -97 PC -97 Application for Approval of Plans for a Wastewater Treatment System 1 j 3 -30 -00 WP -97 � 1 DD -97 -------- ___-___...__._.___..___.._.._..... ...__.__._.___..._____..._ - -. -- Design Data Sheet from original "Cornwall Hill Estates" Subdivision DD -97 Design Data Sheet (Insite Testing) 1 3 -30 -00 Short EAF 1 i 3 -23 -00 1142 $300.00 Fee 2 _ Modular 4- Bedroom House Plans i THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Rob - This application is for a single individual construction permit for a single family residence that has been previously tested and witnessed as Lot 19 of the'Cornwall Hill Estates Subdivision' by both your department and the NYCDEP. Design data sheets for both the previous testing (as done by others) and Insite's testing are enclosed. The previous testing proposed 2' -0" of R.O.B. gravel fill and a T -0" curtain drain for this SSTS. We are also proposing 2' -0" of R.O.B. gravel fill and a T -0" curtain drain for this SSTS. Please call if you have any questions - John COPY TO: Lot2000.dot SIGNED: John M. Watson IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE a BNMM L.L.C. 2 Tanager Road Brewster, NY 10509 Tel- 845- 279 -3613 Fax - 845- 2791771 Date: Oct 24, 2000 From: Bruce Major To:, Robert Morris, PCBOH Subject: House Plans for Cornwall Hill Estates ZI Currently we have a plan before you for Tax Map 13 Block 3 Lot 34 dated 4/20/00 as a part of the Construction Permit for Sewage Treatment System, Permit # P11- 00. We intend to change the house plans to the attached plan. Therefore we are requesting your review for bedroom count. This lot is approved for a 4 bedroom system. 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HGT. r STORY t 1 YERI a i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address $ `4`S79ti N % 1 o sa Located at (Street) R-eO=r" Tax Map 13 Block 3 Lot 3 f-- (indicate nearest cross street) Municipality pA- 'rise••.) Drainage BasinsT �2Gy SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test If —3 - Hole No. Run No.. Time Start - Stop Elapse Time (pMin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch ?A 1 a�4-7- io:17 30 Y4, 13 2 %4 3. X0;99- ll; i9 3o I$ - 2o¢ ZY4: 13 4 5 . . to: ZZ 2 (D,jZ . --lo, 3� Z�1- 1j `�Z — 21 = 3 3 to 137 - . 4 Y 5 I . 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. ,s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. ' 2. Depth measurements to be! made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' W11 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5. 1 9.0' 9.5' 10.0' EMMMEEMM 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. -,k HOLE NO. ' �'> HOLE NO. ca CD m� dL CO rp Indicate level at which groundwater is encountered SMT e-- 3 (o`" s -� ✓L 32 " Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 30RA -M, G� J Date Design Professional Name: Jeffrey J. Contelmo, P, E. Address:Insite Engiteering &.Surveying, P.C. Rnute 22 Brewster, New Y rk 10 Signature: ` ' Design Professional's Seal t� t d x xi 1�✓ i$ Ct APPENDIX J r . _PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES (�ft/tvUS 5� P•K rffA try a,LS DESIGN D TA SHEET - SUBSUFACE S .RAGE DISPOSAL SYSTEM FILE NO. Owner Address Twe- g3 t o H Irn"-VA Ru ob=r b . PA M ,' 31.9 U Located at (Street) Sec. Block 1 Lot 19.Z f (indicate •nearest_ cross street) Municipality 0+ Gr) Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking �lll.(� s Date of Percolation Test 5 -7 _ 3D �► 6 �%4 l 8 �4 " oZ " HOLE 3 L0 ��°$ NUMBER CLAD TIME PERCOLATION JIV7, PERCOLATION Run Elapse Depth to Water Fran Water Level • No. Time Ground Surface In Inches Soil Rate Start -Stop, Min. Start Stop Drop In Min /In Drop Inches Inches Inches /2� -12- 111/Z� /LZ � 2 (00i? - �� ;�` 3D �► 6 �%4 l 8 �4 " oZ " 15 ►�4 3 L0 ��°$ '� �a A 53,2z, . JIV7, CaLA 4 61°.� -ll~'S �0(`�1� MIA,, rtcNL,ij 5 C 1 93B - �o`� µ „ W �v'' 2 �o - - ,pS1 ��,,� 1411A 163/ 3 4 . 5 1 7 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurenents to be made frcn top of hole. rev. 9/85 17 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION - 5� DESCRIPTION OF SOILS EP4MMERED IN ZEST HOLES f DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. G.L. 1 - TS-% �.,T Lo 4V%A Wiz.. UO Plyl-I 2' S t �.r L c FS 2. S L-r Y lam 3' - 5' 6` 7' 8' 9' 10' 11' 12' 13' 14.' INDICATE LEVEL AT WHICH GROUNTMAOER IS ENMUNTERFD INDICATE LEVEL TO WHICH WATER LEVEL RISES A= BEING ENC COUNTERED ''.a"T `' DEEP MOLE ' OBSERVATIONS MADE BY: V--Ai PA-TT S(t-S OtJ DATE: DESIGN Soil Rate Used l Min/I" Drop: S.D. Usable Area Provided No. of Bedrocros Septic Tank Capacity " gal's. Type' Absorption Area Provided By L.F. x 24" width trend clx.a.A Other - `7 ' Pe-Go 'PR-41r4 0�!'vo' 'n' 4 2 V.: 6 tF Name Signature Address ? 8 ruai,J SEAL 06470 ps�soc ®pm�a�.. y yep THIS SPACE FOR USE BY HEALTH DEPAR2M T ONLY: Soil Rate Approved sq.ft /gal. Checked by Date I"k /NS/ T a ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 1485 Route 22 (845) 278 -4990 Brewster, New York ,10509 Fax: (845).278-6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 11 -29 -01 Job No. 99147.302 Attn: Robert Moms, P.E. Re: SSTS for Cornwall Hill Estates - Lot 2 159 Somerset Drive, Town of Patterson TM# 13 -3-99 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. i DESCRIPTION�� 5 11 -29-01 A13-1 As -Built Drawing 1 _ 11 -29-01 CC -97 Construction Compliance 1 � 11 -20-01 E911 Address Verification 3 _ 11 -29-01 � GS -97 Guarantee 1�~ 11 -28-01 _ Water Test Resufts ~I WC-97 Well Completion Report 11 -21 -01 _ $200.00 Fee THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints For review and comment ❑ REMARKS: COPY TO: SIGNED: / �J/hn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE I0t2000.d0t F iv SCALE: 11 - Lm SCALIE�o 60' PROPOSE. '111<EXPANSION ABSORPT70NY x� TRENCH (TYP.) 19 18 17 16 15 CD rf) urx CLI61:1N)UT. (TYP.) CURTAIM DRAIN � 20, 12 /loqg .8 EXISTING DRI VE WA Y TO BE REMOVED WELL ROP BOX O............ FRENCH (TYP-) WELL SITE LOCA770N: 159 .SOMERSET DRIVE TOWN OF PA T TERSON PU TNAM COUNTY, NEW YORK. TAX MAP NO.: 13-3-9.9. NOTES: 1. THIS IS TO CERTIFY THAT THE .SEWAGE TREATMENT. SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED BY'INSITE' ENGINEERING, SURVEYING, & LANDSCAPE ARCHITECTURE,. PX, BEFORE IT WAS COVERED OVER.. THE' SYSTEM. WAS CONSTRUCTED IN GENERAL ACCORDANCE W TH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2. ALL FACILITIES EXISTING, UNLESS N07ED OTHERWISE. J. PROPERTY LINE INFORMATION SHOWN. HEREON- IS BASED ON FIELD SURVEY BY INSITE ENGINEERING, SURVEYING AND LANDSCAPE ARCHITECTURE, P.C. COMPLETED OCTOBER 25, 2001.. AS -BUILT M,EASUREN N0:. COR R; of DWELLING CORNS 'OF DOV1ING, REMARKS; 1 22.5' 52' IzSO 6ACLON SEP77C TANK 2 77.5" 4315' DROP' BOX 3 82.5' 49' DROP: sox . 4 87.5 54.5 DROP sox '5 92.5' 60' DROP BOX . '6 98' 65.5' DROP Box . •7 104' 71' DROP BOX- 8 50' 69' END of TRENCH '9,- 56' 71' END OF TRENCH - 10 61" 7,4.5' END OF' TRENCH 14', 66',--,. 77' Ervo TRENCH r TRENCH 4 13 78' 84' ENO of TRENCH .141. 119' 60' ENO of TRENCH 115 123' 65' END of TRENCH 16 127.5' 71' END OF TRENCH 17 132' 77' END of TRENCH 18 135.5' 82' END of TRENCH 19 141.5' 88.5' END OF TRENCH 20 23' 79.5' ahl BECURTAINFDRAIN� 21 137.5' 71.5' SCUD. CURTAIN 22 267' 151.5' CURTAIN DRAIN DISCHARGE