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HomeMy WebLinkAbout0444DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -9 BOX 6 I,IIS, , { also J .;1 I F ti T 'r ! � I IL r 00253 'ter a�I 'CONSTRUCTION Located at Subdivision`- -- - - 7- -=--r- — -- .. PUTNAM',COUNTY., DEPARTMENT -OF' HEALTH ENGINEER -TO PROVIDE PERMIT # �. ON 'CERT FICATE '0 COMPLI NCE. Division of Environmental Health Services Carmel,: N:` Y 10512 PERMIT _�`s f..FORSEWAGE ,DISPOSAL SYSTEM.=; %- I V.Town lage =1 =J Tax ' Wp Block - Lot Subd. Lot q. 'a Renewal _ [3 Revision —0.- f I Z V/' Date Of Previous Approval `. Building Ddt� !/ Pi11,Section Ori1 ❑ g Ype Lot Area v Numberof Bedrooms Design Flow G /P /D 16 ®f! P. C. H. D. NOtifi�c --at -ion. Require ^d �^ �r. n Separate Sewerage'.System to consist of cr� �d�0 GaI..Septic Tank. and - �/��1L�a7�� D��`7 ,L��SN�' To be ,constructed by Address r T ..1/ �(.p y/l �( /y /mot p�,� Water SuPpIY :. Public Supply. From C `� + _ / F• d, 7 Private Supply, to be drilled by •, Address- Other Requirements I Z - 1'represeht that I'am wholly and completely responsible.for. the design and locatioh "of the proposed system(s);..1) . that the separate sewage disposal system above,' describetl .will be constructed.as shown on the approved amendment there to,and in accordance with'the standards, rules an regulations o e Putnam County Department - of ` Health; -'anC that on completion thereof a ",Certificate of :Construction Compliance" satisfactory to the Commissioner of HealthwilII be submitted to the Department,` and a written guarantee.will be:furn�shed. the owner, 'his successors, heirs' assigns by the builder, that said builder will. Place -in .good operating condition'any part of said sewage disposal system during the period of two (2,) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of =the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved .Plan and that said well will be install accord ce,' ith, the standards, rules and, regu Cons of the . Putnam County Departp�meen/tgof�. ^Health. % Date _� /( ' 4 r/_ Signed ' P.E. R.A. Ada.ess �icensd't4o. APPROVED FOR CONSTRUCTION: This approval expires one, year,from the date issued_ unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when.con •dared necessary by the Co issioner •f Health. Any change o► ation of construction requires a new permit: Approved for disposal of. domestic nl se ge d /or pr ate water ' I only.* BY r , ate Title JI November 6, 1985 Mr. Robert Tutoni Putnam County Health Dept. County Office Building Carmel, New York 10512 RE: Crossroads Subdivision, NYS Rte. 311, Town of Patterson Dear Mr. Tutoni: WIM n I am.the owner..of property located adjacent to the above subdivision and identified on the Patterson Tax Map 1, Block 7, Lot 14. Certain lots within this new subdivision are being developed and it is my understanding that you are the official responsible for the review and issuance of permits for the sewage disposal system construction on each lot. I.wish to bring to your attention that the filed plot for the Crossroad Subdivision failed to show the location of our spring fed well. Enclosed is a copy of the subdivision map showing the location of our well. I am particularly concerned with the proposed disposal area on Lot #7 which is shown in closest proximity to the well location. I would very much appreciate your taking the necessary steps to insure protection of our well as applications for the nearby lots are submitted for your approval. Thank you very much. Please send any replies to Donald B. Smith, Supt. of Highways, P.O. Box 445, Patterson, New York 12563. very truly yours, Marge th MS:j Encl. Map PUTNAM COUNTY.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date {� J Re: Property of C '1fi'LiCT' 6 ghe —Ile kpt A kn'<'� Located at (T) I A' 919 2S'04 Section Block Lot Subdivision of . doss Subdv. Lot # / Filed Map, # Date Gentlemen: // This letter is to authorize ,Fr6? 1c 14,1717 Gr,�45 a duly licensed professional engineer o __c ( Indicate - -- - -- - to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules . or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on.nny behalf in connection with this matter and-to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the.Public,Health Law,.and the Putnam County Sani- tary Code. Very truly yours,' Co tersign d: (�, R.A., # �5 Ant Address s le one Signed.'X . Owner of Property Address - .Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL., N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner be Clr Address 4-1 PCA+41usehvo Q b�Qd Located at (Street Sec. Block Lot ndica e neares cross street) Municipality � �� r7y Watershed. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS PeQaA K 10 ®V eS- Number CLOCK TIME PERCOLATION PERCOLATION RIM Elapse Depth a Water a er ve No. Time From Ground Surface in.Inches Soil Rate .Start -Stop . Min. Start Stop Drop in Min. /in drop Inches Inches Inches r 2 Y Zvi ® Arr. 4,a 5 1 96 4 If 1 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 6" !� q 18" 24" 30„ 3611 42" 48" 54„ 60" 66" 72„ 78„ 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE TOW C W T R EL RISES AFTER BEING ENCOUNTERED TESTS MADE BY �� �_ Date ® ®� Soil Rate UsedO�7 M DESIGN in/1 "Drop: S.D. Usable Area Provided_ No. of Bedrooms 13 Septic Tank Capacity A Gals. @c Absorption Area provided By 10® L.F. x24" cti� �'tir E VMA -M 21A r _ THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date 4 /��, 1,-eo A i �r ! r , y ' � � i e v r'� 3y Y � .,�, .d {• -.,g \� �+.�Jjw.wn"p1 l�t�. fj �: a�,, r� � ys ,� �'� � s w ' S � 11T- :'�� �,. r. �„ a � lsk z ., � +�! ,��a r�" >�� s � �" �� �' �`"fi'�, • �yyl��°.� ,�,;�f� w} ;+,� i�t.,� i r '• ` \ �t OA �u tSitr.�'e•is`d • `�M �: Y x i b i ta\ ! 3y •,,'�'1 AS i qri d l _p} ly I k . '`,c>.w a'.�.'p.'�a,i,�•„'st� 3�.,'�'.'�ix'rxs � t��`'� . '�. ,zc_�a t���%�e '��� :�^4��. ��'�.. a�>5�� 4�� _.. 1? ;+ , :? C C a i _. . - -- - - - -- - -- - -T Ml-1162. L_��� ENERGY EFFICIENT HOME Living Area Plan 1 or 2 First Floor .............. 1,368 Sq. Ft. Second Floor ............ 1,3 Sq..Ft. S eo 2 PLEASE SPECIFY PLAN 1 OH PLAN 2 WHEN ORDERING BLUEPRINT PLANS. MASTER BEDROOM 15'-3 "x 17' -7* op{n to linnp room ROOF BEDROOM 13'-7" III'. 1 � 'D In. 'floe- •� , plan 2 ROOF C BEDROOM BEDROOM 10'x12=7 10' 10"x13'-7" j, I SECOND FLOOR ii. ......... � <f..... fn_ PATIO.' :. 64,_07 VIS FAMILY ROOM IS' -3 "� I7' -7" BREAKFAST. B'- 10 "�14'• ' �j . 0 1 i LAUNDRY bor 4x1 is = 21'-8" x 2 poetry C., O C 1 p_':: C =- r v _ n FOYER OWING ROOM / 13' -3" r 12'-7" g _a PORCH LIM RmV. . :' FIRST FLOOR PLAN 1 WITH BASEMENT PATIO - '.'•.. 64� -0° C C a i _. . - -- - - - -- - -- - -T Ml-1162. L_��� ENERGY EFFICIENT HOME Living Area Plan 1 or 2 First Floor .............. 1,368 Sq. Ft. Second Floor ............ 1,3 Sq..Ft. S eo 2 PLEASE SPECIFY PLAN 1 OH PLAN 2 WHEN ORDERING BLUEPRINT PLANS. MASTER BEDROOM 15'-3 "x 17' -7* op{n to linnp room ROOF BEDROOM 13'-7" III'. 1 � 'D In. 'floe- •� , plan 2 ROOF C BEDROOM BEDROOM 10'x12=7 10' 10"x13'-7" j, I SECOND FLOOR ii. ......... � <f..... fn_ PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER To PROVIDE PERMIT # ON CERTLFICATE �OM P IANCE, �1 Division of Environmental Health Services, Carmel, Al. Y. 10512 PERMIT # -J CONSTRUCTION ERMIT .FOR SWAGE DISPOSAL SYSTEM f ` Town or village Located at Tax Map Block Lot Subdivision ySubd. Lot q Renewal _[] Revision _( � Date Of Previous A pproval /1/ 2"" f / V OwnerAddress /- fl y r i 2_ ii Z. �J Building Type L ✓Z) Lot Area V Fill Section Only ❑ Number of Bedrooms _ Design Flow G /P /D -'y ,"' P.C. H. D. Notification Required Separate Sewerage System to consist of Gal. Se is Tank and ` o L'� Address To be constructed by c a A 3 Water Supply: iPUblic SIpp4y From _� Private Supply to be drilled by Address Other Requirements I represent that I am wholly and completely responsible. for the design,and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations oT e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance "' satisfactory -to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- once of the approval of the Certificate of _Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above Will be located as shown on the approved plan and that said well will be installed accordanc . with the standards, rules and regu aeons Hof the Putnam County Department of Health. Date P.E R.A. Address License No: APPROVED FOR CONSTRUCTION: This approval expires 'one year from th date issued unl s c struction of the building has been undertaken and is revocable for cause or may be amended or modified when co re necessary by the Commi stoner of Health. Any change or alteration of construction requires a ne permit. Approved for disposal of domes c =sanit sewage, Aad/or., rivate ater up Date-1 By Title Rev. 6/85. { [ �I( lilf/ lYlll VfY11i1 fH1il1Y{il\1111tiI�f01�{'S1ii Gil( YSNI'+ iYG7Y1fI11yTrifWlyy4GiN5111iiWiYyd�7VE I{11fi/YTilti+liitiiyyl��i3Wkrti N1yI�til7�iNIVti 7}JVi�ii\ii�YliitiI1VY13W ?�� LVV�_'.— HVI17ti+ilil+lilVly } PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTELL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEW TENT SYSTEM PCHD CONSTRUCTION PERMIT # P-�A - qq LJ Located at 11 I p`0 �L -o Town or Village �l� I T P-60 H Owner /Applicant Name P'E 'yq Formerly C10146T4L41rJH Tax Map 1"t, , 01 Block 1 Lot 1 Subdivision Name {i�-� °�� P' 0 A'QID Subd. Lot # I'l Mailing Address po j�fl 4 �_o P IkTTfF�_6() H / 1*4 Zip 12,6vJ) Date Construction Permit Issued by PCHD ` 13" 4cl Separate Sewerage System built by P -a •V4 - iAV) PJUOOH Address N ft0'' O Consisting of 10 VQ Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From (Al L-F 1'h 4i Address or:_'*X Private Supply Drilled by Mill TTDH i4 kl-_I' Address lN% P'''h" PA'W00- '%N Building Type P_e� C? i x Has erosion control been completed? Number of Bedrooms �j Has garbage grinder been installed? 1'�.D 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 regulatiops of the Putnam Copnty Department of Health. e_ Date: ri->.r l) 01� Certified by °g'1 roress 9na°) d/ Address 'b11 Gam - '� - C "AI 0 -i4r,_ _ License # P.E. X, R.A. BV-ENd 67- �PL I i-A -.� Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio dificat' or change is necessary. By: Title: &I Plhlll d—k Date: 12-J, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: p,F-.W, GONh,P-0GflOH t P��► P4 P��jO� AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFR1v1) Harry W. Nichols Jr., RE 311 Clock Tower Commons Route 22 Brewster, NY 10509 M4� Telephone (914) 279 -4003 Fax(914)279 -4567 May 17, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Crossroads Subdivision, Lot #11 Pan Road Patterson, N.Y. T.M. #13.07 -1 -9 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built Plan" dated 5- 17 -00. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 5 -17- 00. 3. "Guarantee of Subsurface Sewage Disposal System," dated 5- 17 -00. 4. Well Completion Report, dated 12- 17 -99. 5. Laboratory Report, dated 5- 11 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, Harry l. Nich is Jr., P.E. HWN:JM:his 00- 120.00 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES toto I i WELL COMPLETION REPORT Well Location Street Addre s: fi Town/Village: Tax Grid # Map l`h,61Block i Lot(s) Well Owner: Name: Address: a . ,651 c-ll,x Po 0px FMTEfioH N� Use of Well: 1- primary 2- secondary j— 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 _& Open hole in bedrock _ Other Casing Details Total length _,2j_ft. Length below grade.0 ft. Diameter Tin. Weight per foot 0 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: X. Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed Pumped X Compressed Air Hours Yield 06 gpm Depth Data Measure from land surface- static (specify ft) -`9'ee During yield test(ft) CSd/10;1111 Depth of completed well in feet 7S� o 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 /d f', Cif If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity i Depth, Model %GS%S Voltage Q HP M Tank Type XK Volume 4� 6-aA a; Date Well Completed ®-. 15 Sri Putnam County Certification No. 007 Date of Report r l7 f � Well Driller (signature) &:Lz� NOTE: Exgct location of well with distances to at least two permanent laildma/Ks to be provided on a separatepeevplan. Well Driller's Name . p i e n 11{ iAt Signature: /� , Address: %t3 %fir � -, y�� P�'Q�I 4��s Date: f ^ I 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 LoN STP-0c;T'lo k 0j, 01 . I I Owner or Purchaser of Building Tax Map Block Lot p.F-•w, C_o�k PATI't�_f -sQN Building Constructed by TownNillage Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that 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 P'1A`t' Day Year U00 Signature: Title: ST( VC T-10 H General Contra (Owner) - Siinature P,E.4 C- 01.4S P- 0C-rIDN co c10� Corporation Name (if corporation) Corporation Name (if corporation) Address: Pt P, R 0, 4%U PATrQLi0 State WP YOB Zip I 25 Address: State tj ` 4— Zip ( � Form GS -97 or .' ( NE NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 LABS (203) 748 -7903 - FAX (203) 748 -0652 CT Cert: PH -0404 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: D.E.W. CONSTRUCTION DATE SAMPLE COLLECTED: 5/8/2000 & 5/11/2000 P.O. BOX 420 TIME COLLECTED: 2:45 P.M. & 1:25 P.M. PATTERSON, N.Y. 12563 COLLECTED BY: DANNY FINNEY DATE RECEIVED @ LAB: 5/8/2000 & 5/11/2000 TESTED BY: LAB# 11471 REPORT DATE: 5/12/2000 SAMPLE SITE: LOT #11, PAN ROAD, PATTERSON, N.Y. SAMPLING POINT: KITCHEN SINK SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 11 15 Odor ND 3 Units pH 7.47 no designated limit Turbidity 3.1 NTUs 5 NTUs CHEMISTRY: Nitrite N 0.056 mg/L as N 1 mg/L as N Nitrate N 1.36 mg/L as N 10 mg/L as N Alkalinity 212.0 mg/L no designated limits Hardness 246.0 mg/L no designated limits 5/11/2000 - Iron 0.128 mg/L 0.30 mg/L Manganese 0.014 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 5/11/2000 - Sodium 23.3 ** mg/L 20 mg/L ** Lead 0.004 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:5 /8/2000 & 5/11/2000 SAMPLE, AS TESTED ABOVE: MOTABLE or aOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Y �Ii1e "jti -�jr.t 1 s, 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 EE NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: D.E.W. CONSTRUCTION P.O. BOX 420 PATTERSON, N.Y. 12563 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: CHEMISTRY: DATE SAMPLE COLLECTED: 5/8/2000 TIME COLLECTED: 2:45 P.M. COLLECTED BY: D.E.W. CONST. DATE RECEIVED @ LAB: 5/8/2000 TESTED BY: LAB #11471 REPORT DATE: 5/11/2000 LOT #11, PAN ROAD, PATTERSON, N.Y. KITCHEN SINK WELL -NEW NONE RESULT: 0 Color 11 Odor ND pH 7.47 Turbidity 3.1 Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead 0.056 1.36 212.0 246.0 0.470 0.014 53.6 ** 0.004 m1= milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED:5 /8/2000 SAMPLE, AS TESTED ABOVE: �X OTABLE or FOINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE(] WATER) Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037* (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 * OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 06 Inspecte y: S, 7?r ,e3) Street Location Owner aj 91.4 N i O,4! 6 Town Permit # P -- g_0 -- 9 % TM # 13, D 7 - / -!7 Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ....... .1,25 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ..........................:.... f. Trenches T.-I-en-g-th required G 7,9- Length installed co' 7;t- 2. Distance to watercourse measured - - / ooFt.......... 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 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. ' Pipe ends capped .................................. :..................... . g. Rump or Dosed Systems Size o pump chamber ................ ............................... 2: Overflow tank ............................. ............................... 3. Alarm, visual/ audio .............................................. :.... 4. Pump easily accessible, manhole to grade. .. ............... 5. First box baffled ............................................. :........... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans ... ............................... b. Number of bedrooms ...................... .......... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured l O 0 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 LNW. ICa INN 'emu► � rr� LNW. 0 a• BRUCE R. FOLEY Public Health Director DEPARTNIENT 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 1 I CI 1 Date: 7lD 0 if: r From: Gene D. Reed Putnam County Department of Health ?� For your information For your review As discussed Notes/Messages G ®MM r--Al 7-5 Fax #: 9 7'? — q -7 No. Pages 0- (Including cover sheet) Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL INSPECTION For: Fill Trenches _ PCHD Construction Permit #. �/ Located �u, f o (T) 96 pQ *r r o d Owner /Applicant Name C. 124 pt " -, z 3, o ` Block--L—Lot_ Formerly Subdivision Name Subdivision Lot # Is system fill completed? Is system complete? Is system constructed as per plans ?_ Is well drilled? / Is well located as per plans? �rJ Are erosion control measures in place? Y-Z� f Date Date Date 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: 12 ---66 Certified by: Zi pEZ--/RA. Des' Professional Address--3 G Comments: FOR: ❑ ADAM ❑ GENE cc"- / Z� Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 7::> Town or Village�T�i = N Subdivision name G20GsS4CcwkQ S Subd. Lot # I I Date Subdivision Approved 1 o / Z-& ha-4 Owner /Applicant Name M 5�- L G �k � 04-is Mailing Address t GL- (ro7or.l S -7. S Amount of Fee Enclosed X40 Tax MaA*3 rb7 Block k Lot 1 Renewal Revision Date of Previous Approval 1".`P Zip It003 Building Type GI P&L6 fj�,n L,� Lot Area 0.9 ZP No. of Bedrooms 3 Design Flow GPD (00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and G-72 �- ( Z� VJ 1 CSC Other Requirements: To be constructed by -rO T� �''C -` Address Water Sunaly: Public Supply From Address or:_ Private Supply Drilled by _Fb 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 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 followin�the o issuanE of the approval of the Certificate of Construction Compliance of the original system orr se o. Signed y P.E. R.A. Date L0113 Ifil Address i% tGr� -,12 L t- . U lon2 License # OC14f Lt G 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 wh onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proved ischazge of domestic sanitary sewage only. Title: Date: d3115 By: White copy - HD File; Yellow copy - Bung Inspector; Pink copy - Owner; Orange copy, - Design Professional Form CP -97 PUTNAAA C ®UNTIE HEALTH ®e�� w � �ry �� 0 2 4 9`2 3 4 Geneva Road (914)278 -6130 ' � ��` �� L " Brewster, NY 10509 , 19 � c Received of The Su =0f - r Y Dollars $ =l For- Jt J { ❑ Cash ❑Check ®M O �; Credit Card By 1 'N m I W a z 0 U y� K3 Z' rl .4 f0 V I r m Q .-1 N I)7 r-1 N Oti l' m, PUTNAM COUNTY DEPARTMENT OF HEALTH ROUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, 3 - BEDROOMS ltmmcww we" / FAT &"I Fm I•. .. 1't0 13.0-7 - t-q PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Q please print or type PCHD Permit # a 0 - Well Location: Street Address: Town/Village Tax Grid # TFC-� Map g, (?']Block Lot(s) Well Owner: Name: Address: Mail J,, Use of Well: X 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 tQ,6 gpm # People Served k st. of Daily Usage �C 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 .,,X Is well located in a realty subdivision? ...................................... ............................... Yes—/-- No Name of subdivision jc17 !J Lot No. Water Well Contractor:70 Address: Is Public Water Supply available to site? .................................. ............................... Yes No ;K, Name of Public Water Supply: NIAI Town/Village t4 f[ eJZ� Distance to property from nearest water main: ro r, 'd Proposed well location & sources of contamin '. o e n separate sheet/plan) i Date: t " v 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 wate77111, /T filler ce ified by Putnam County. Date of Issue f Permit Issuing Official: Date of Expiration _ z 11 3 1 Title: en Permit is Non- Transfefrabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Date 101 -7 Ll `'� RE: Property of Ta P" -e5 n / /Jrj Located at �P,�►�1%- (Town) ���iE &�,S 1 Section 3 ,0 Block Lot 1 Subdivision of Subdv. Lot # I Gentlemen: Filed Map # O Z Date This letter is to authorize PUTNAM ENGINEERING PLLC, a duly licensed professional engineer to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the �pF ��E4v said system or systems in conformity with the provisions of Article 145 or is Health Law, and the Putnam County Sanitary Code. Very truly yours, - �11 �Y`�/ Signed !��, -Owner of Property (Cor)-Aro4 Mode P.E.j R.A., # Q L '�61 914- 225 -3060 Telephone Address El w�oy► N '� ► c d Town 6116 7yg-- �'C5'3 Telephone 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: M E—E LC- �4 eD rJ e l oo 3 2. Name of project: M eLAC-" LONS S Sty 5 3. Location T/V: 4. Design Professional. {�Q-rNArk "(t seM 1b 5. Address: 162- 6. Drainage Basin: f.&T Q5::t- csl;�;''l Z 7. Type of Protect: Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? "Type Status (check one) ....................... ............................... Type I Exempt Type H Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... t� NrD 10. Has DEIS been completed and found acceptable by Lead Agency? ............... ��- 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ............................... �l o 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 K groundwater 16. If surface water discharge, what is the stream class. designation? .................... 1-J 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... t-J O 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage'collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 1 M + 22. Date test holes observed 10 7 23. Name of Health Inspector i'ZECr-1 24. Project design flow (gallons per day) ................................. ............................... > 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? .. N /� 27. Is any portion of this project located within a designated Town or State wetland? t--,t O 28. Wetlands ID Number ............................................:............. ............................... � a 29. Is Wetlands Permit required? .............................................. ............................... I� 0 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, �-J D landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No �'L.O DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................� 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... I� 36. Tax Map ID Number .......................... ............................... Maplttb L Block t Lot 37. Approved plans are to be returned to..... Applicant C Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form.LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 2I0.45 of the Penal Law. SIGNATURE OFFICIAL TITLES. 1 ��I J 61 .i00 66 ;+ Addr �.4 , .- t02- �N �7 Mailing ess. at�:..:•�.!,! ";1:� ............. � ious�-- - IGt� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �f�l —i L ®I�S'� Address 17 G L.I K�C"arl s'(' S LMorsr Located at (Street) Pally —{,per• 1::) Tax Map 13, d Block I Lot (indicate nearest cross street) Municipality Drainage Basin e655" -. ECAW-k-4 SOIL PER_ COLATION TEST DATA Date of Pre - soaking L l co. Date of Percolation Test �( Hole No. Run No. Time Start - Stop Ela se Time (pMin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch "j 1 113 14S % �'�l� l d 9 2 2 -► 4 ? �.�- ZG 15/4 2:1/4 i D,9 3 2: 15 2 45 �7 3 c� 4 5 1 1:10 40 3 0 2 �}- -ZS J 34D 2 1 : 0 23;/2 24 '� I `74 4—g 3 2 42 3.42 (0,C> 23Vj 24`2 !�- 48 4 5 1 2 3 4 5 NOTES: 1 _ Tectc to he renenterl nt came rienth until nnnrnx ;mntaly ann ,il non anrh - - - - - -- - - - - - -- - -- --- - - - - -- -- - - -- percolation test hole. (i.e. s 1 min for 1 -30 min/inch, < 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' 1.5' 2.0' 2.5' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' �. 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 1 HOLE NO. - *22- (�fE DlsP �3 RzrW rJ �t(-4E Snrj 0 `Ea-u 6w G-o�25� Ts `f3i25L� iJ HOLE NO. l Indicate level at which groundwater is encountered 7 + Indicate level at which mottling is observed 1� /�- Indicate level to which water level rises after being encountered Deep hole observations made by: C4E�tSG Date (v 7 cT GVY10cq -i Design Professional Name: -Fu U61 tiezv4 w, Pu.C. Address: OF NE6y� ©2 C 1 X� �%s� --f N j 4_ ` 2pJ�ap,1GHA�� C��c� f Signature: :«:P- U 0674 C? R�tc�Y33 ONN- Design Professional's Seal \ -- Q 4 r .Al iK5 - - l Indicate level at which groundwater is encountered 7 + Indicate level at which mottling is observed 1� /�- Indicate level to which water level rises after being encountered Deep hole observations made by: C4E�tSG Date (v 7 cT GVY10cq -i Design Professional Name: -Fu U61 tiezv4 w, Pu.C. Address: OF NE6y� ©2 C 1 X� �%s� --f N j 4_ ` 2pJ�ap,1GHA�� C��c� f Signature: :«:P- U 0674 C? R�tc�Y33 ONN- Design Professional's Seal \ -- 14.16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Ouslity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION:r- � � Municipality County 4.. LOCATION (Street address and road Intersections, prominent landmarks, etc., of provide map)) �PRECISE EGG (,OG..4"C'VprJ i�.13 -1° O rJ SSt:�S r ��►N 5. IS ROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: /,�PP,2��> S v� TJI v' LS r✓o.i� Lp-r 7. AMOUNT OF LAND AFFECTED: D 0r Initially •cl acres Ultimately `��— acres 8. \WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? �p Yes ❑ No If No, describe briefly 9. HAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ 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 o If yes, list agency(s) and permlVapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor Q_11! '� r 'v6UZ !' Date: 1,961 name: Signature: D If the action is in the Coastal A�a, 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 t THRESHOLD IN 6 NYCRR, PART 617.127 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, It 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 threatened or endangered species? Explain briefly: 04. 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 C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C'3 --d C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. U0 FA. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. :V N D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly 'tJ L 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 and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature o Responsible Officer in Lead Agency Name of Lead Agency Date K Title of Responsible Officer Signature of Preparer (if different from responsible officer) ExP G a 3 �r ;to" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner G tY E Address P,4& �o g Located at (Street) 5piyAI,6 Z Z_ A A F Tax Map 1'3t 07Block C Lot J/ (indicate nearest cross street) Municipality )D,4r7►',,er .,-/?��yy Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test /p% 713P,9 =Y 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 1 _ O 2 450 93' r'2 ; 3 4 5 2 --�,� 3a 2 41 -' 2- 6 /d• 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 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE N0. HOLE NO. Indicate level at which groundwater is encountered /VQ h e. Indicate level at which mottling is observed ©n Indicate level to which water level rises after being encountered Al o zz Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional's Seal 1 2 FROM : PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 �,o L at (c�z' �- - Sep. 17 1999 09:10AM P1 5' fNj met W"Myel i Oil Key Q /< , T; U V 3S DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Date: �1 7 From: Gene D. Reed Putnam County Department of Health For your information _%X For your review As discussed Notes/Messages Sle BRUCE R. FOLEY Public Health Director Fax #: 926--29:5-5- No. Pages z (Including cover sheet) Please respond Attached as requested Please call G�ctho,�5 i -Z 5cprne 41,-7 5 cz;^e /1 d9- I ? h An k5 / In the event of transmission /reception difficulties, please contact this office at M (914) 278 -6130 ext. 157. N !00000 Qr �� rl I I I I I I ��� / � :. I fi 14 I v DIMENSION CHART (in feet) Number 50 40 r3 gs 67 4 4 (c Aa .50 P, fi 14 I v r3 gs 67 7.5 P, -.7 7 i, FEi. 65