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HomeMy WebLinkAbout0502DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -11 BOX 6 00502 1 'mM %�j 5 ' ' I T see I- r 94 ` '` � 66 IL "L� I ■ ' '� '� I 00502 0 RE: Properly of Located at T/V ax Map # g Block 1 Lot P/o Subdivision of CALF f2 Tt S Subdivision Lot # 2 Filed Map # Z47-5 Date Filed f l /z D Gentlemen: This letter is to authorize. Nl �n(,� .,a duly. licensed Professional Engineer or Registered Architect to apply for the required wastewater...treatment:and/or water supply I-permit(s) to serve the °above =noted property m 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 proyisions..of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnami County Sanitary Code.' Very truly yours, Countersigned: Signed P.E., (Owner of Property) Mailing Address. CL WX � 3 Mailing Address : M i. N OF—, ZCDA D �.f2oTo�l E U-6 I�2 n1 T�f� State Zip 1,051 State N y Zip 1 O 50 Telephone: 7 �� — 5 05 Telephone: Z7g — 1? 55, Form LA -97 BRUCE R FOIXY Acting Public Health Director DEPAR'II�ENT ' OF HEALTH Division of Environmental Health Services 4 Geneva ' Road Brewster, New York 10509 TeL (914) 278-6130 Fax (914) 278-7921 DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM T' -- I Pro j ect: y �Jl � CO4Ci =3�la TONzn: i NOTICE OF COMPLETE APPLICATION: DATE: Delegated Joint Review BIBBO ASSOCIATES, L.L.P. Consulting Engineers — Planners March 27, 1998 Putnam County Department of Health 4 Geneva Road Route 312 Brewster, NY 10509 ATTN: Robert Morris, P.E. RE: Muentener. Stage Coach Road Patterson, NY John P. McNamara, P.E. Joseph J. Buschynski, P.E. Timothy S.Allen, P.E. Leonard J. Bibbo P.E. Robert A. B. Howe, B.S. l Dear Mr. Morris: Enclosed for your review are the following items: 1. Two. (2) copies of revised sheet 2 of the architectural plans for Mr. and Mrs. . Peter 1Vluentener, prepared by the Helmes Group. 2. Four (4) copies of Peter. Muentener, Sewage Disposal System, dated 1/15/98, revised 3/27/98 in accordance with your March 2, 1998 letter. I Design Data Sheet of witnessed percolation tests. 4. Form CP -97. KC /bs Enclosures Very truly yours, Karen Counes Engineer Planning - Site Design - Environmental 589 Route 22 - P.O. Box 403 - Croton Falls, NY 10519 - (914) 277 -5805 - (914) 277 -8210 Fax DEPARTMENT OF HEALTH Division of Environmental health Services 4 Geneva Road . Brewster, New .York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 1, 1998 John McNamara Bibbo Associates P.O. Box 403 Croton Falls NY 10519 Re: Proposed SSTS: Muentener Stage Coach Road Lot #25 (T) Southeast Dear Mr. McNamara: �'b BRUCE R. FOLEY Public Health Director Review_ of _plans and other supporting documents submitted at this time. relative to the above captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Witnessing of Percolation Tests by a representative of New York City Department of Environmental Protection has not been documented. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Vegaiuly yours, h Robert Morris, PE Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH. Division of Environmental Health Services 4 Geneva. Road Brewster, New York 10509 Tel. (914) 278-6130. Fax (914) 278-7921 March 2, 1998 . John McNamara Bibbo Associates 589 Route 22 Croton Falls NY 10519 RE: Muen fen er, Stage Coach Road, Lot #25 (T) Patterson . Reservoir Basin East Branch Dear. Mr. McNamara: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on February 24, 1998 is complete. The Department will notify you by March 16,.1998.of its determination. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent, to my attention at.the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of:Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of 'Environmental Protection regarding such activities to see' if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (9'14) 278 -6130 ext. 166. Vrlz�urs, Robert Morris, PE RM:tn Public Health Engineer John McNamara, Bibbo Associates - Letter dated March 2, 1998 -2- 12) Dimensions from the well to the property lines is to be noted. I Location of the service connection, from the well to the property line is to be shown. 14) The den.on the first floor is considered a' potential bedroom. Please revise the floor plan or SSTS design to a five bedroom system. Upon receipt of a submission, revised,to reflect the above, this application will be considered further. Very truly yours, hw� Poo. Robert Morris, PE Public Health Engineer R-',\4-.tn John McNamara Bibbo Associates PO Box 403 Croton Falls NY 10519 DEPARTMENT OF HEALTH . Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509. Tel. (914) 278-6130. Fax (914) 278-7921 March 2, 1998 Re: Proposed SSTS: Muentener Stage Coach Road Lot #25 (T) Patterson TM# 8 -1 -3 P/0 1 11 BRUCE R. FOLEY Public Health Director Dear T\/Ir. McNamara: Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal. system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Percolation Tests must be witnessed by a representative of this Department if not witnessed by a representative of New York City Department of Environmental Protection. 2) Design data, i.e., Deep and Percolation Test results have not been noted on the WL plan. 3) Construction notes 1 -13 have not been provided on the plan. d� 4) Soil type boundaries must be shown on the pla 5) Datum reference must be noted on plan. 6) Location of any watercourse, ponds, lakes and wetlands withing 200 feet of the property. 7) Erosion control methods for the house, wells and SSTS must be shown and detailed. 8) A location map is to be provided. Minimum scale is 1 inch = 2000 feet. 9) The expansion area is to bCcompletely shown in the SSDS profile. 10) Property metes and bonds hAve not been provided. 11). All existing and proposed4ells and SSTS withing 200 feet of the proposed w and SSTS must be shown or a note stating none exists. 28 — rM 3� D ✓j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 71,2�/1r$ - FINAL SITE INSPECTION Date: ? l Inspected by: er Street Location i A&X Go,&eH Owner P.e+; �u e*? +ether Town P 9e Permit # p y TM r / -' 3 e 6 Subdivision Lot #S 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 ...... ............................... a. Septic t em II. a. Septi S � st � size - 1,000 ........ ,25 other ................ a b. Septic tank installed level. ..:............. ............................... c. 10' minimum from foundation ...... :................................... d. Distribtuion Box -i-� 1. Alloutlets at sam 1pvation -water tested ................. 2. Protected be :.. 3. ' Minimum 2 t.Onginal soil between box & trenches Junction Box - properly set ....:...:.............. ...........................:... ength required 'Sa O Length installed5 .2. Distance to watercourse measured - ' 2a?o Ft..:.....:. 3. Installed actor . ...................... ...... 4 a le o....... h / 5. property line ._ 2 ft..fo. dations.......... --. 6. pth of trench <3 i o e .............. 7. Room al w e p sio 0 % ......................... i 8 Si 4 - 1' /z" diameter clean.:......::::... 9. De f gravel in trench 12" minimum.......... 10. Pipe ends capped ... ............................... g. Puinp or Dosed Sj,stems . Size of pump chamber ................ . ..... . .................. 2. Overflow tank ...........................: _ .. ............................... 3. Alarm, visual / audio .................... ....:...::......:.:............ .4. Pump easily. accessible, manhole to grade.: ................ 5. First box baffled .............. ........... :I............................. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. House.16cated per approved plans . ............................... b. Number of bedrooms ..................... IV. Well a.. Well located as per approved plans . ............................... b. Distance from STS area measured v o 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 watercours�ee g. Footing drains discharge away from STS area ........... IV h. Surface water protection adequate . ............................�?: i. Erosion control provided ................. ............................... Rev. 1/97 COMMENTS. PUTNAM COUNTY. DEPARTMENT OF HEALTH. 'DIVISION `OF ENVIRONMENTAL' HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM g. 3p TaFI Tax Map Block Lot Town/Village U)T- 2 'STS t. AD STA Location-- Street Subdivision Name S� titL.�AMI �� izE�. .25 Building Type Subdivision Lot #. I represent that I am .wholly' and completely responsible for the location, workmanship, material, construction and drainage ofthe sewage.treatment system serving the above- described property; and that is has been constructed as'. shown on the approved. plan or approved amendment thereto; acid in accordance with the standards, rules and regulations of the Putnam County Department of Healtk 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 fora 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. Day Year General Contractor (Owner) - Signature Corporation Name (if corporation) � � r Zu RA([ Tut L10 ) Corporation Name (if corporation) State �jy Zip StatZea&�SM�� (CU5ZM Form GS -97 NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3. MELL P N_ROAD DANBURY, CT 06811 NY Cert: 11471 (3.03) 748 -7903 - FAX (2,03) 748. -0652 LABORATORY REPORT ~: - -' WATER' SUPPLY TESTING REPORT Td: ZURICH BUILDING CORP. DATE SAMPLE. COLLECTED: 9129/98 26 MINOR ROAD TIME COLLECTED: 4:15 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: NO: SALEM PLUMB. DATE- RECEIVED,@ LAB: 9/29/98 TESTED BY: LAB #11471 &11301. REPORT DATE: 10 /9/98 SAMPLE SITE. LOT ' #25, 241 STAGECOACH RD. PALTERSON, N.Y. SAMPLING POINT: KITCHEN FAUCET SOURCE: WELL TREATMENT: NONE TEST .PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL Total Coliform (Bacteria) 0 `per 100 ml O per 100 ml PHYSICALS :: :pH 6.48:. no, destgnated limit " Y." 7.6 NTs S NTurbidity ' CHEMISTRY: Nitrite N <0.01 mg/L as N l .mg/L as N 11301 - .Nitrate N <0,01 mg/L as N 10 mg/L as N, ' Alkalinity = `46.0 mg/L no designated limits Hardness 78.0 mg/L no designated, limits Iron 0.373 In 0.30 mg/L Manganese 0.121 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus' ' Manganese = 0.50 mg/L] Sodium .. 7.2 mg/L 20.mg/L ** Lead <0:005 mg/L 0:015 * ** ml = milliliter 'mg/L = milligrams:per Liter ND =none detected NTU =Units * *Notification Level ** *Action Level .,RESULTS BASED 'ON SAMPLES SUBMITTED:9 /29/98 SAMPLE, AS"TESTED ABOVE: OTABLE or ❑❑ NOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) n �: 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 I# E so 59 .T4 t4 LEHMF4M P E \� 4 1�. WELL COMPLETION REPORT off tc UEPAkIMENT OF HEALTH Division Of Environmental Health Services �V �0 PUTNAM COUNTY DEPARTMENT OF HEALTH it WELL I OCAiIaNI_ aeon only "Vo�ii lot number SZ01 a oath Rd.. Ptt r�pn.NY l.nt 024 new tax YD #i2 NAME: Aoo Ess: p PggIVATE WELL OWNER Stagecoali Dev. 17 River St. Wnrwick�NY 1099,0 John Letnju PU6LIC .USE OF WELL RESIDENTIAL 0 PUBLIC SUPPLY O AIRICOND.IHEAT PUMP El ABANDONED :1 primary. O BUSINESS 0 FARM O TEST/OBSERVATION ❑ OTHER (specify) 2 secondary IQ INDUSTRIAL ❑ INSYITUTIONAL ❑ STAND-8y 0* MOUNT OF USE YIELD SOUGHT �, gpm.INO. PEOPLE SERVED ___ - .,./ EST. OF .DAILY, USAGE _..,_ :,gal. 1 REASON FOR t1 NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY u O TEST/ OOSERVATION� DRILLING Q REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL IDEPTH DATA WELL DEPTH -4-6 5- ('1 STATIC WATER LEVEL _.:1(., .9 it. DATE MEASURED _:L %'19qj-0,7 DRILLING 0 ROTARY 0: COMPRESSED AIR PERCUSSION O DUG r EQUIPMENT 0 WELL POINT 0 CABLE PERCUSSION,_ Y, _ �O OTHER ( specily): �- 1 WELL TYPE 0 SCREENED . O OPE,V ENO CASING, OcOPEN ROLE IN BEDROCK 0 OTHER TOTAL'LENGTH - -J41.f._ fL MATERIALS: JaSTEEL 0 PLASTIC O OTHER CASING LENGTH .BELOW GRADE -4- 0 = ft.- JOINTS: O WELDED- �cfHREAUEO - 0 OTHER I DETAILS DIAMETER Ufa r: in._ SEAL: (R CEMENT GROUT 0 BENTONITE Q OTHER WEIGHT PER FOOT 1b./ It. DRIVE SHOEkkYES U NO LINER: 0 YES .kT NO SCACEN DIAMETER (in) . ' "SLOT SIZE LENGTH (it) DEPTN TO SCREEN (It) DEVELOPED? .._�. DETAILS FIRST (3 YES a N0 SECOND NO URS GRAVEL PACK d NO GRAVEL DIAMETER TOP. 801 -TOAI SIZE: OF PACK _ ___. in. DEPtH _. __ It VOEFTH WELL- iELQ TEST II detailed pumping��� LOG it more detailed formation descr Pons or sieve analyses i gre available, please attach. M .i, I ::1 . IVATER U 6Lf—Ah - METHOD: to PUMPED i tests were done is rl- )KCOMPRESSED.AIR ; formation attached? 0 9AILEO. ED OTHER ; O YES 0 NO pE rP H FROM SURFACE gC�It' Inq I� I1. • WELL OEM li. DURATION hr. min. DRAVJ00'NN t, YIEt.o pFm. ��r�t�ee 2b DY VOLTAGE —HP _.. �.. 41 46Y T $ M .i, I ::1 . IVATER U 6Lf—Ah TEMP. pUAEITY EJ CLOUDY HARDNESS 0 COLORED AIIALYZEDt OYES ENO _ ANALYSIS ATTACtiEDI El YES ONO _ PUMP INFORMATION TYPE CAPACITY..._.._._... MAKEA _. DEPTH .r�.. MODEL_ VOLTAGE —HP _.. �.. Oil- Meier FOAMATION 08CRIPTION in _ L11•ng in overburden cloy & r ck at 26, .0j. _ _ing— in- -taras.�A&t—_�A.Wc.. -il . ing in rock granite. r coot STORAGE TANK: TYPE— ; CAPACITY GAL. wELr. GRILLS AME P.F.. B– Sans, Inc.. _ 0AIE1 22 88 ADOAESS pD BOX D SIGiIRNRE Drewster,NY 10509 i- f BIBBO ASSOCIATES 589 Route .22 CROTON FALLS, NEW YORK 10519 (914) 277.5805 X (914) 277 -8210 TO i L�� LJ U L5Q OLr' � U ° LN�LMJ���l.;ti1l� DATE / l JOD NO. ATTE N 0 r n c DESCRIPTION -J WE ARE SENDING YOU ''Attached . ❑ Under separate cover via the following items: ❑ Shop drawings O Prints O Plans O Samples O Specifications O Copy of letter O Change order 0 COPIES DATE NO. DESCRIPTION w THESE ARE TRANSMITTED as checked below: *or approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted O Resubmit copies for approval • Approved as noted C7 Submit copies for distribution • Returned for corrections ❑ Return corrected prints 19 O PRINTS RETURNED AFTER LOAN TO US 0 r-o 0f-:,, " _ 2-43. Ta-f n+.a� A_� h .ems• -c-a -e d- - fL_P� ` ,dL4 SIGNED: If enclosures are not as noted, kindly notify us at once. DEPARTMENT OF HEALTH Division of 'Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 3, 1998 Bibbo Associates "589 Route 22 Croton Falls NY 10519 Re: Proposed Compliance Stage—Coach Road (T) Southeast, TM# 8 -1 -3 P/0 1 Dear Sir: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above- regarded project has been completed. Comments are offered as follows: 1) The water analysis result for iron exceeds state standards. Retesting is advised. 2) Distances to all junction, boxes are to be provided on the as -built plan. 3) As -built plan is not legible, furthermore, current codes requires that all documents are original, i.e., no photocopies. The four as -built plans are photocopies (P.E. stamp and signature). Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve t ly yours Robert Morris, P.E. RM:tn Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES { DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM_, .; ,, Owner F TS2 M U E t J T1=i.1 Address TZo !Vl I N O 2— w ,e f n; Located at (Street) 3TAbaCG341'_ p_..o,&,p Tax Map $ Block t Lot (indicate nearest cross street) . Municipality FAT('-5b�l.. (T-) Drainage Basin .sT g�Z�.r�fCa -I C/ZOTor! 21V�(�. SOIL PERCOLATION TEST DATA Date of Pre - soaking 3/ 25/67 9 Date of Percolation Test 2 -% 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 to Water Water rom Ground Level Percolation Hole No. Run No. Time Start - Stop Ela se Time Min.) Surface (Inches) Start Stop Drop In In Rate ]Vlin/Inch . P i 1 X0 :0/ -ld -17 / .20 Z3 3 5,33 2 lo/e- Z Zo Z3 3.33 4 - 5 Z 1 lb aZ— o: 3Z 19 _'/8 2215 Z' /4 /l 2 /0: 35- 07 32, Z10' Z2, '/Z Z ��Z ! Z - 8 3 ; �- 30 2,0 22- Z 15 4 / : - 1z;fl 3 p ZO Z2_ Z /5 5 'X' E� S% PNA Ea��y . 1 A 1: 2 '. 4 :,3 G"IS N r o 4 spry OF TH S,p 5 H5 2 l 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM. Owner PET2 M u ET,J Address Z_0 Iyl I N O 2- g��wS?�,�i Ny Located at (Street) gTA- 6a, Tax.Map _'.9- ­--,-Block-.T Lot 3 %:. I .(indicate nearest cross street) MV nicipality PAtfj��a; : . Drainage Basin CAST' P hIC# -� G/ZDTar`l il�V�i2 7,77 b SOIL PERCOLATION TEST DATA , Date of Pie .9 3 2`j g Date of Percolation Test De th to Water. Water.' r m Gro- d e tion,: - - � o � un ' • � L , vel Percpla ' Time Ela se Time Surface (inches) Dropp In Rate ° Hole No: Run. No..:. ..Start -.Stop • • Min :) - Start ":'Stop "Inc-hes Min/lnch r, .�. 1 - /7` - Z( 23 3_ 5,33":- Tf.33 Z3 Co .y ........:... - 2: /0'35. - //- 7 3Z ?moo "ZZI�z Z ��z I Z • 8 �; 40 2-6 5 4: 5 �0�4 �g10NA 3; A OF T . NOTES: 1. Tests to be repeated at same depth.until.Approximately equal percolation rates are obtained at each i i 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. i 2. Depth measurements to be made from top,of hole... 1 i Form DD -97 f0' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at i? -FACG a Subdivision name & &MC , Subd. Lot # Z� Date Subdivision Approved FM Z495 D Owner /Applicant Named iU�lj'r_ Town or Village P�T����OtJ CTS Tax Map Block Lot Renewal Revision Date of Previous Approval Mailing Address ',7,b NA113 0 fz- Vim Zip I 05Q 9 Amount of Fee Enclosed�jf�"} ��` Building Type V66I pei 1j&,Lot Area _AC- No. of Bedrooms 4— Design Flow GPD 900 Fill Section Only Depth Volume. PC-HD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 500 F, Other Requirements: n �-- /'.)Z, D. 13, EZ4.1, To be constructed by Address Water Sun nly: Public Supply From Address gam. V Private Supply Drilled by _i, T�j '�.r s Address ARA4olyf:::- , l,3i/ 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: Addres: R.A. Date Z License #27 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 n considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it pprove discharge of domestic sanitary Xsag;e only �LG Date: /,6 /v- By. Title. [ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 6113130 ASSOCIATES 589 Route 22 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277.8210 TO Pc.( r,� C��c,c��Ty WE ARE SEN ING Y ❑ Shop ❑ Copy 105cqj ❑ Attached ❑ Under separate cover via S x Prints ❑ Plans ❑ Change order ❑ LLIETTIEQ OF M ° MWOUCT11 DATE JOB NO. ATTENTION RE: L r^, 11 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 11 • ,ter �� / ' -� f /� THESE ARE TRANSMITTED as checked below: or approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested O Returned for corrections O For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS ❑ Resubmit copies for approval C7 Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO ) SIGNED: , If enclosures are not as noted, kindly notify us at once. BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Far (914) 278-7921 February 4, 1998 John McNamara Bibbo Associates Hardscrable Road Croton Falls NY 10519 RE: Application to Construct a Subsurface Sewage Treatment System at Muen Tener, Stagecoach Road, Lot f25 (T) Patterson Dear Mr. McNamara: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on February 2, 1998 is incomplete. Please be advised that the following information is required before the Department may commence its review. ✓m Short EAF has not been submitted. JO PC -1 has not been submitted. ✓0 2 sets of house plans have not been submitted. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Dept. Of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. Very truly yours, ba A 'n6, Robert Morris, P. E. RM/tn Public Health Engineer II PUTNAM COUNTY DEPARTMENT OF HEALTH /4b LVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM P HT # Located at STS Gr-- COACH IU D Town or Subdivision name SrAC,l1 CQ�C4 P&p, Subd. Lot # 7-.5 Tax Map Date Subdivision Approved STS ?42-5 M �II010 Owner /Applicant Name PTA M Ut-t 1Ts.N1 E,-1F— Mailing Address Amount of Fee Enclosed 4 340, O© Building Type J<6SI©&►Tr,4L Lot Area Fill. Section Only Separate Sewerage System to consist of n All ,.a,w-- A r, —r Other Requirements: 0 To be constructed by Water Supply: Public Supply or: V Private Supply Drilled by I represent that I am wholly and completely separate sewage treatment system described accordance with the standards, rules and re€ thereof a "Certificate of Construction Con Department, and a written guarantee will b builder will place in good operating conditi immediately following the date of the issuan system or any repairs thereto. Block Lot -3 Pfo i Revision of Previous Approval Zip /0�ad Bedrooms 4 Design Flow GPD_'eQ0 Volume gallon septic tank and 400 1- � F Address Address { sponsible for the design and location of the proposed system(s) and that the bBove will be constructed as shown on the approved amendment thereto and in ilations of the Putnam County Department of Health, and that on completion pliance" satisfactory to the Public Health Director will be submitted to the furnished the owner, his successors, heirs or assigns by the builder, that said n any part of said sewage treatment system during the period of two (2) years of the approval of the Certificate of Construction Compliance of the original Signed: / / f P.E. / Z _ V R.A. Date � Address Av13130 LCD - N License # 7/ / APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF,HVALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at ��� �s� own or Village �So& C� J Subdivision name Ems' 10" PPJP- Subd. Lot # 7is /ax Map �' Block Lot Go Date Subdivision Approved !ZC- Owner /Applicant Name Mailing Address PT-1) A Amount of Fee Enclosed f __� � Building Type ,&6►D6AJ PAL. Lot Fill Section Only Separate Sewerage System to c sist of T r -2 A 1' 1. I I A--- _ If ,-s Other Requirements: To be constructed by Water Supply: or: _ V Private Renewal Revision Date of Previous Approval Zips /rJs No. of Bedrooms Design Flow GPD FX Depth Volume K S RE UIRED WHEN FILL IS COMPLETED gallon septic tank and 590 IF, W Address Address 6 Drilled by' o9bi P� �f Address 6W K-, Ni/ I represent that I am w oily and accordance with the itandards, rules thereof a "Certifica a of Constructic Department, and a v ritten guarantee builder will place i ' good operating c immediately following the date of the system or any repa'rs thereto. Signed: Address T., 0, ely responsible for the design and location of the proposed system(s) and that the ed above will be constructed as shown on the approved amendment thereto and in regulations of the Putnam County Department of Health, and that on completion Compliance" satisfactory to the Public Health Director will be submitted to the ill be furnished the owner, his successors, heirs or assigns by the builder, that said edition any part of said sewage treatment system during the period of two (2) years ;uance of the approval of the Certificate of Construction Compliance of the original P.E. R.A. Date 4 V Y 10511 License # X2-7 /I APPROVED FOR CONSTRUCVON: This approval expires two years from the date issued unless construction of the sewage treatment sys m has been mpleted and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessar� by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. proved f scharge of domestic sanitary se ge only. By Title: R6- Date: ha White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 V UTNAM COUNTY DEPARTMENT OF HEALTH _ A SdON OF ENVIRONMENTAL HEALTH SERVICES CERTIFIC TE OF CONSTRUCTION COMPLIANCE FOR SE AGE TREATMENT SYSTEM PCHD CONS UCTION PERMIT # _ qb Located at 46 5T9,,-,G CCk� i Town or Village Owner /Applicant Name l✓N j�Gf-,TaxMap T Formerly Subdivision Name STA& P CcAc-1 � Subd. Lot # t'0T Z t:) Mailing Address S-0 M I W Q�- F—P. N"-Y Zip C) Q9 Date Construction Permit Issued by PCHD L—io—ga) Separate Sewerage System built by Consisting of J.2 Other Requirements: Address Gallon Septic Tank and 50D L-P AV7 SQ2-P- of 2,e�ZA Water Supply: Public Supply From Address or: X Private Supply Drilled by P.I - L�r �s (nl ,Address _rOy Loscq Building Type feS I PLPT- o4, Has erosion control been completed? l✓5 Number of Bedrooms 4 Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Certified by ck� *A� P.E. R.A. pm si n Proles 'onal) Address �(/ y Ua T �- 10R License # !L11111 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 approval a subject to modification or change when, in the judgment of the Public Health Director, such revocat' odific ion or change is necessary. By: Title: l!G Date: 11 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of NAME ADDRESS �JT/4GC�®i e_d - No. Street MAILING ADDRESS 2 0 M I�ALO P.O. Box TELEPHONE PERSON IN CHARG& OR INTERVIEWED DATE r,�. TIME ARRIVED 0 /TF_�f RMAerson Town K. Post Office r v 1 L) Name and Title TYPE FACILITY ,��_ TIME LEFT 16, It No. 105 �% Zip Code 2t�ie 1 INSPECTION _ Orig. Routine Orig. Complain Orig. Request _ Compliance _ Complaint Camp _ Final — Group Illness Construction Reinspection Field; Sampling Only �,_ Field Conference Other �efeale to I Pyle _ Explain FINDINGS: , i ,2 eles l �k_ 9 cle_ea j&A-erz r e- �aIee�Q o o z INSPECTOR: Sicma ure ` r PHONE: Z%8 - ((3 D - PERSON IN CHARGE OR INTERVIEWED: (� I acknowledge this Field Activity Report. SIGNATURE: 0 RECORD OF PHO \E CONVERSATION Time: l / "-, O ea- en Date: z 6 Z_ Person calling: ,j�i.ck"X ,'J�,� , Phone F. Reason () Inspection: ,Deeps and/ <9? Pere : Scheduled Field Meeting Time: Date: s2 � as t"�5c9�11� Y ,N . Tentative /to be confirmed () ( ) Town: � er :5 01'1 Road /Street: etc/ Tax Map 4: Comments: Pzf AeY /%r /ft9eY a /6 'e520 eg, ^2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner f' -Tog Address a.o P1lAtQ& &J, Located at (Street) S'fA6ge_,oAeN pjj, 4 f;1peg HILL. T,>Irax Map I Block`(_ Lot (indicate nearest cross street) Municipality pA-r C_jZSo,y Drainage Basin 1rA67- l3 A1UGN SOIL PERCOLATION TEST DATA Date of Pre - soaking x/90 Date of Percolation Test 7za - /ye Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water From Ground Surface (Inches) . Start Stop Water Level Dro In Inc�es Percolation Rate MinAnch 1 1 O,o - 0 °r /6 2-7 " - 3a�, 53 2 df '_/0i'4:1 '16- ;� „_ 30„ 3., 3 3 !/, I/ 3v ,, 3 g 4 5 1 ,o .Z- 101,34 3 14 yo ° 2 9 y % /1' sJ 2 10,'35 - ; 07 32 1 Z'/ — J{ l� ULS 3 ,o� , 4 Y 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtainea at eacn 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 131660 ASSOCIATES 589 Route 22 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 .FAX (914) 277 -8210 TO WE ARE SENDING YOU Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ r [EV CGS OCF CLTG �La Q3NUCTCuJL �I DATE —/� 9 JUI3 NU. ArrE ad ,'(QY'rL,d L aE: ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION -6 LLA-LE CJ .-0-4AJ — ^- e-vz,_4_ CC er o�u� /-e- l�-e er A c � -- 11- 3 - f? fV- C J� � THESE ARE T NSMITTED as checked below: or approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Resubmit • Approved as noted n Submit _ • Returned for corrections ❑ Return _ —copies for approval –copies for distribution corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify as at once. NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 indL 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LAW (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: ZURICH BUILDING CORP. 20 MINOR ROAD BREWS-MR, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: pH Turbidity CHEMISTRY: Nitrite N 11301 - Nitrate N Alkalinity Hardness 11/9 - Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 9/29/98 & 11 /9/98 TIME COLLECTED: 4:15 P.M. & 7:30 a.m. COLLECTED BY: peter m. ' DATE RECEIVED @ LAB: 9/29/98 & 11/9/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 11 /13/98 LOT #25,241 STAGJCOA KITCHEN FAUCET WELL NONE RESULT: 0 per 100 ml 6.48 7.6 NTUs <0.01 <0.01 46.0 78.0 <0.03 0.121 7:2 <0.005 m1= milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level RD., PATTERSON, N.Y. MAXIMUM CONTAMINANT LEVEL 0 per 100 ml no designated limit 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 :9 /29/98 & 11/9/98 SAMPLE, AS TESTED ABOVE: �X OTABLE or FEI NOT 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 J � DEPARTMENT OF HEALTH Division of Environmental. Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 3, 1998 Bibbo Associates 589 Route 22 Croton Falls NY 10519 Re: Proposed Compliance Stage-Coach Road (T) Southeast, TM# 8 -1 -3 P/0 1 Dear Sir: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1) The water analysis result for iron exceeds state standards. Retesting is advised. 2) Distances to all junction boxes are to be provided on the as -built plan. 3) As -built plan is not legible, furthermore, current codes requires that all documents are original, i.e., no photocopies. The four as- built plans are photocopies (P.E. stamp and signature). Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve , t ly yours Robert Morris, P.E. RM:tn Public Health Engineer SIs- 19'26°W 8 37,5 1000 575 °0543rW -� 30.69 9F 574 °4£3'Z6 25.47 APPENDIX C Ot`151� �RUCI' IONN ysTEMS y4q+F�'�1 WA" I' jr1iSUPPLIESS E3iYiNC'SINGLEFAMILYRFSIDENCI;R Govern ° Tlu, following notes shall be provided on all plans for individual. SSTS and well water s,uphilics.:. x Dn,ic Rea "�_ ^�rrcdNotes -• " 1 Atl trces,avitliin:to;fce"t of the proposedsubsurfScc sewage treatment system (SSTS) shnllobo removed. 2 iii S to. b:�.inspcctal_by tthrLicehual Ucsign:Profeuion:il athd the Pu_tntun County Flcaltti Dcpartiniin alter canstnrction and prior to backftll. 3. Tbc WrS area sluill'be s{almd and roped off so that no trucks . ttiachitiery, building materials, nor excavated earth shalt be all-19we& in the SSTS,arca. 3q d !M.crosioneontroC ,insm meastues slmil.bellcd prior to the start of any construction.; 970 5 Cottstruction of SSTS to,bc to accordance with these,plans, any revisions thcnxo, and the rules and t .regulaUoni gf th permit issurny govcmmcntal.agcncy. 16. . Tbc wclllis to.beadrtllcd well.. constructed n accordX=with New York State Health,CcOmnrnt Bulletin. ' -cnuticd Rtttyl.:Watcr Supply % pump tested for a minimum of 6 hours and have a mioiniam safe yield of .5 �m Yctds less am S'gpm will'lio immediately reported to the Putnam County Department of Health. 17. Tic sswdesign shown hereon does not provide for installntion of a garbage grinder.. Such installation requires additional design.n. the opproyatof the'Putntam'County Dcpanncnt of Health.' c960 • 8. Pitman County Health Dcpartmcniapproval is based an the location of the SM, well, building, scibacka. apd'drivcways -as shown on the approved "drawirig. Modifications are to have prior Putnam Coonty Health Departqunt approval. Unauthorized modifications made to this drawing after the dilc:of Putnam County `Ilcalth4D'cpar1invnt approval voids.said approval. ). Cut or fill is not permittcd'i%0ic SSTS area .cxcapt.if so specified on this plan. " 1 v . ; I o Alle, backf illiny dte systcm the SSTS arch diallbeeovcrcJ with a minimum of 6 inches 'f top soil, seeded. ,ltd mulched _ -. i t Ocfupahcy df ihL�stnrctnic wlll.not trcvcmxinod:wubdw Corutruciion Compliance Applcaiion has been tccchvataad `eppiovN�tiy1fielkniarn County Health Department and forwarded to the Balding Inspector of tlic;Tcspcctive,municipality as pan of the a Ccitiftcate of 0ccupancyAPPlication. ' 12. This plain is approved: for sewage treatment and/or water supply only, and all othcr'rcquired pennits and/or approvals are the responsibility,of the pcnnittcc. The Putnam County 1•Icatth Department approval ,expircs two (2) years from the date on the approval sarnp mid is required _tobe.rencwcd. -on or'befote the . expiration date. 'rhe approval is revocable for cause or may m be aended or niodifcd when considered necessary by the Department. FNGI NEER'S. REPORT PROPOSAL: . 4 BEDROOM RESIDENCE AOI MIN._ 126.=0 GAL P/C CoRG 5EPTIG TANK SD 61 x1Sl ELL / / N Pr2or -a�5Eo 4 (5EDROOM R 9740 / RESIDENCE 97Q>O f°F= 976.0 Id b pLt MR y 970 B�'�i. I -Ppi f•/" ,� I) NO WELLS OR _50—, WITHIN -A ZCC)' OF PROP. WELL. f PROP SDA POH05 NO WATERCOUM2 ES I SR:.T FENCE LAKES OR WETLANDS WITHIN ZOO' 3 51LT FENCE TO BE IN5TALLED / '-- TO'THE STAMT OF GON57RUCTt(DN. GO `}) SCS SOIL ial0 CHATFICt.o HOLLIS ROCK OUTCROP 5) TC)F-tX RAPHY Fta,10M 'I FINAL SUf501d15IC)N PLAT t (DATED +l J t�� A-01 rrM Pi'YLCJ' DEC. 1980 1°tZHPAt?HO f5Y a'�`� -' 5MEW5TL=RNY.F LS In 'G n .0 �� amt ►`+r+. . wFP1re°°Rp". '- cur s ra•.aRF1 ?wwa ..stM�tu -wee.+ ah�u+RT �°sw•�e. u,anv sru�a tin h.ohm,+uN >• mrwa to. m paW'n• -�a +wry ps oi�ruhwo- auesaaeMVTP+.Tw1 .mange. y nr. .,p eNaL ee r+ rues Faaw To �4P � ,w erhar.w e°ora157mrcTmn• i R / 1`IPIGAt S0.T.IE AL tO1J ti r... •xo+rhao.:r_e+ra n wuno�,rrd nr ,57f'22'�19 "� 1 ®p 1 G 20 a cl� fJRIVE; _'. • ,. o 7 L i;7W�. OC-AL 3� �____4._ r �.. P16 8- -• TANK ® /�'� * , @ - : ' THIS 2S TO CERTIFY THAT THE SEWAGE SYSTEM WAS CONSTRUCTED , AS INDICATED ON THIS PLAN AND HAS INSPECTED UNDER MY , OFF ='jL 1 p_ !;`_I1,.L�, .IONS SUPERVISION BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF -THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW.YORR STATE DEPARTMENT OF HEALTH. _ ..: i;:11LT SEWAGE DISPOSAL SY$TEiA - =_.. MUEIVTENF_R _ CC , C F2D) P F'AIZT u / L . ...... : OCK .......... ._.___�_.._LOT.��. ._. � Rt: 22 & { i `3 Y:.__ f; i" 24 = /(� SOO ti " IN. 7,l7_ TRci3Ck ...` {; Croton Fa{i .3, gpp F7x ?4 If F.WIaETNENGH �\ k}' l _'�... ..... •.. - -� ::: LAWTCDN. ADAMS OF W►TF3 7 -16 -yb "UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS DRAWING ARE A VIOLATION SCAL& r=. 3O, OF THE SECTION 7209 (2) OF THE NEW YORK-STATE EDUCATION LAW.." I ,n. -I Y: "6.89 1 144. 19 At CAL tf; 11253 At 293 AG y 11231 ¢ 1 ,. FAY]PT i( EImPI {r: WTNAY CCU MYRNA 1 12 I C ,J tT "•. 26 0 y 1.10 k L bry y\ /rr y 53.73 AG CAL 5.N B 3A`AC CAL I 8 . 30 At O ull 25.56 AC. CAL 52 14.;D AG / >° 1 Id •� 25.50 Ac. CAL. 10.26 At ` ° j 4 20.0 At `'�30 a ° /• / , / I � 9 E � Aa Ac� �•: /' 26.09 AC. CAL HAVILAND al, . - 1•�,."�.. . 25 � ". As /•—. .. I •mlR _. n n IL 11 Ac Cly is 7 1\ PO In Il I A S JT 1 0.03 AG CAL y` ry 4.53 K 11400 AG ! 5, ' AGE .. r` i; • •` Z . 99�• .50.22 AC ,T�Vptp a ! A �-..'�'..�..�`..\ l ✓� At 39.2 R 0.3. Su. r 125.17 At CAL. p!N!� 41 1.99 ,06 °ub' 42 At #�A 1 p4 °l i I I N g6I R,Z . ! t1i 39 a 33.99 AG °y� ./ 95 7 .0 Ac Aruu FOR ASSE55MENT PURPOSES ONLY REVIS ORS I SPECIAL DISTRICT INFORMAT N01 t0 BE USED FOR CORYETANCES na JAMES W. SEWALL COMIPANY 117 CEI7fER STREET OLD TOW4 MAINE 191x1. •WI• 'tllrll 1.11. VAR LM —ul aYllt U. q-:-- INpn uN IAI91A9 A1n U% Sea mula rut ° rem 350 I u 9 Akins 292 B7 r11C r. t , -. L, '_- ,a-- ._.. -,II 0i j] Idnre M eagemeM \ - t � j I '"�, ` �'d• � Q°`o �, ems" ES gz I, 12563 e � ;"'•'HW . _ . i i .,I Io.,r :'� ....ir ` y 1°pda` ' �.' rf a �Mmddl w \•. P ' j I 1I I \\� I" , Al � � ___r :,�;�•...�t..l;�I �� �� i Chm � 1 1 � \• ta ?':Sclod iF' / pm aj�! I!I I J r'r• i..�_.. n cnwc air 1 :- b .•� 9 � � rsm " j > ` 7• �\ �� �, it - - Bog Brook �o' a Resmoir � / i .d 1 1k� 1✓ IFl ners n I pr`yicem \ i i• 1 t 1 51 I 311 ;'iii it •^�" :. cost °'�' '' IJ T!N■ � ��1 aD°mv 3rew! pm aj�! I!I I J r'r• i..�_.. n cnwc air 1 :- b .•� 9 � � rsm " j > ` 7• �\ �� �, it - - Bog Brook �o' a Resmoir � / i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE, TREATMENT SYSTEMS REVIEW SIIEET FOR CONSTRUCTION PER611T STREET LOCATION S�AG� GOlfG�f KD�4D NAME OF OWNER P97 REVIEWED BY M, AS, MB, BFI DATE TAX MAP # Y IN DOCUMENTS Y N MM PERMIT APPLICATION OStOTTC75N7RaCFiOUSE ;WEGG,"_S.SDSz PERMIT _ PWS LETTER KUr- A-UJT - tORWMON -No 6& 1 DESIGN DATA SHEET (DDS) 60*?ff&rT-E RESOLUTION - THREE SETS UEST FEE SUBDIVISION LEGAL SUBDIVISION ` SUBDIVISION APPROVAL CHECKED es RC RATE ILL REQUIRED DEPTH 4URTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD ` DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED CX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME .W� -IGHBOR NOTIFICATION 6- BI/ZBA 1001 R -FLOOD ELEVATION Q+HER ft ,Q D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN- (NORTI I ARROW) SSDS IIYDRAULIC PROFILE RAVITY FLOW �/ nNST RTCS - el 1 -13 0 = >5 %,101- 4 %,25'- 3 %,30'- 2 %,35' -I %,100' - <I% (�fA PFR DEED TOURS EXISTING & PROPOSED WAY & SLOPES, CUT fG/GUITEA7CCJRTA'[N DIiA►1aS 'P:IUNI'lARTES BLOCK; OWNERS NAME,ADDRESS /RA; NAME,ADDRESS ._HONE #: OF DRAWING /REVISION �I�EFCitE1`7CE� ION nF _WA__. TER PONDS AND WETLANDS WITHIN 200 FEET ;ED FINISH FLOOR AND BASEMENT EL. & DEEP HOLES LOCATED :SENTATIVE OF PRIMARY & EXPANSION E3CP AREA:SHOWN;GRAVr, FrOW;SU1_B I E -fI/xp fo 1�eSJ;awn rv? y " OUE-PIT & D BOX SHOWN & DETAILED O.OF BEDROOMS WELLS -& SSDSYV� 0 P OPDSED7SYS:"4 1 IZ -ER,M - FS� &,,00 D$ HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE 1�0"BEM HEDIDS:43�W./Ci.EAtV�S'UL�'�" - �5-�-eA�l ui,'l) ),av� iae°na�.� FILL SYSTEMS CLAY BARRIER . HORIZONTAL;SLOPE 3:1 TO G FILL SP E OTES FILL CERTIFICATI FILL PROME & DIMENSIONS FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED PARALLEL TO CONTOURS 100% EXPANSION PROVIDED TO P.L. 60 FT MAX. E TREES, TOP OF FILL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. cxpan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTTiRMITI'EN "I' DRAINAGI? COURSE 200'/500' RESERVOIR, E "I'C. _150' GALLEY SYS•FEMS CON RIVE 'LE 4 #,P TE COMMENTS: D discharge /100'with 182 cons day discharge • SEPTIC TANK • T'10'FROM FOUNDATION; 50' TO WELL WELL M�I�IS"TO'PROPERTY•L117t;�. �:OCATION 01.SLRViCE CON (IONS PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL .HEALTH ,SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Address MI Owner`re-n Located at _4 p-4) Tax Map Block Lot ;5 t (indicate nearest cross street) Municipality V2 Drainage Basin SOIL PERCOLATION TEST DATA Date 'of Pre - soaking T, Date of Percolation. Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2.1 Depth measurements to b i e made from top of hole. Form DD-97 D t h to Water Water Vrom Ground Level Percolation Time me Ela6y Ti Surface (Inches) Drop In Rate Minfinch Start - Stop n.) Start Stop IL Inches F, owl IN I mnmlvm� mm 2! 1XX I RA, F-M -- - W-4. NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2.1 Depth measurements to b i e 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' 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. Indicate level at which groundwater is encountered 06U6 4 �� Indicate level at which mottling is observed It q Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional IN 0 •E Address: RtBaO ASS CCIA't�E5 LLP o� 9 Signature: Design Professional's Seal 6��WONAL riC�� QQ` McNA� q �'FF p Q. ,p 9 G 'dG Y. y y 1 iro � � y ///Ip � 14.16.4 (2/87)—Text 12 .: PROJECT I.D. NUMBER 617.21 ....... Appendix C ' State-Environmental Quality' Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ;PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) It the action is In the Coastal Area, and you are a state .agency; complete.the Coastal Assessment Form before proceeding with this assessment OVER 1 1. APPLICANT /SPONSOR >✓T'�rz- M u t � 2. PROJECT NAME J. PROJECT LOCATION: Municipality ATr )Q C County �(/( �%�%r� 4. PRECISE LOCATION (Street address and road Intersectlons, prominent landmarks, etc., or provide map) TH2; S►Tt✓ u�S oIv Tf- t- .VV — -F SIDS vF '5T.4Ga_ C IzAD 4P �P— c�xlNl 'T l y Z$oU •: j~��T 2.oM •'?' ¢� (�/7 `56c -n0AJ ..� . ST.4C�� C_ r4z Y,fi / D b S. IS PROPOSED ACTION: 4 , 6ew ' ❑ Expansion "❑ Modlfication /alteratlon 6. DESCRIBE PROJECT BRIEFLY: 1-5. �I�s -� �-,- - 'S INC--� L4-5 - FA 01 t I_y �?_aslo�,., .wE1.L ��D , SzP�-nc- sYs- 1-:G:nit. Pt�I.:tS G I?.4z� :1 J\►� _ . , , • 7. AMOUNT OF LAND A FECTED: ' 0 Ci 5 0'` ` " •acres ' Initially acres Ultimately, 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ ,Yes No. If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Oassidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: LEI , 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STA`T� PR LOCAL)? )E94es ❑ No 'if Y03. 113t agency(s) and permlVapprova(s ' X4 4D VL/FL_ A^JD SS AS 11. DOES ANY ASPgCT OF THE ACTON HAVE A CURRENTLY VALID. PERMIT OR APPROVAL? ❑ Yes NO ;- , If yes, list agency name and permll/approval -- 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST. OF MY KNOWLEDGE . Applicant /sponsor name:•%'` Date: Signature: It the action is In the Coastal Area, and you are a state .agency; complete.the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I 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, 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: i C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity.of use of ^land or other natural resources?,Explaln briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. M co C6. Long term, short term, cumulative, or other effects not Identified In CI-05? Explain, briefly. ; tV A 0_ —p ,CD { =C:7 C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly. .. <—•1 tn. .L5 . D. IS THERE, OR IS THERE LIKELY TO 6E, 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,and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any support ing documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lea Agency " ° Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (it different from responsi e o icer) Date N 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: (A VE-7e,N e MINO1? 1?01ZID 10509. 2. Name of project: M (A6tj T-C-,M ? 3. Location 1�V: 4. Design Professional: 61 ill ASSOC,; 4L)', 5. Address: S-rAC-:5,r-- C n&,CH R-pA t> -T 6. Drainage Basin: SST F- ,� t4 FAM EP-So� AZT 7. Type of Pro'ect: 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 s� 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............... I� 11. Name 'ofLead Agency -To W,�J 01= 24aa2snt,1 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... r✓S 13. If so, have plans been submitted to such authorities? .......................................... y S 14. Has preliminary, approval been granted by such authorities ?l - Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water V11iroundwater 16.. If.surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply Distance to water supply _ 20. Is project site near a public sewage collection or treatment system? ................ ,N n 21. Name of sewage system Distance to sewage system Se- F I l.C-D MAP 22. Date test holes. observed --tF Zz,5 23. Name of Health Inspector Jot- l,�_I.f- L_ 24. Project design flow (gallons per day) 8100 GP 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... Z� Form PC -97 2' 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ...........:............................................... ........:...................... am 29. Is Wetlands Permit required? ............................................... ............................... N110 Has application been made to Town or Local DEC office? .... :.......................... N o 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landflling, sludge application or industrial activity? ............................ Yes/No 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 40 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? ................................ ............................... �a 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO i 36. Tax Map ID Number .......................... ............................... Map_ Block Lot 3 N',4�7 °F' 1 j 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the. NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: ,�- jg--f'� Mailing Address: ................................... M l Not- KDAD g- e)(�'vJ5-7-OlL i N`I i oso� Sib °22'19" � Putn.i ount� Department of Heap blvieion o Envirormaatal Acalth S.. ApprovA c:; noted for ccnforrarco wi appl a Rine ti•l ?;a;; lationa of 1 Cw ; Tealt= pepartm t. ignaturq & Title OFFScT DIM �i (SIOIJS lid ,.A,. „ g, G ,, I(v .45' 3S — 17 50.5 42' — 18 47' — (9 —� 237 to O (D-© A. ?o , ' - 1 � ._ Vz1'30 F1•.L '3 � - :� } �_f 11 PIr– CONIC SEF'TIG a- TANK. p .. A' S D 'O 251.53 % "s N�. `A�y. T '� k S A. NEW- j'. . NTb'f4'CO2!'1M19.70` 1d'I9"(f3'4 "W OFF Sr- Di.MF-NsION5 ITEM _ °A' B �C � J -3 - --4 TF =-5 — — —� 237 to -q E -10 751 83' '74' 8& L a5 7 5.' _ THIS IS TO CERTIFY THAT THE SEWAGE SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND WAS INSPECTED UNDER MY SUPERVISION BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 91880 ASSOCIATES Cenaulting Engineers- Ptannme Rt 22 S Hardscrabble Rd. Croton Faqk N.Y. 10619 "UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS DRAWING ARE A VIOLATION OF THE SECTION 7209 (2) OF THE NEW YORK STATE EDUCATION LAW.- 'iSiLT. SEWAGE DISPOSAL SY _TEI'.: PETER MUEI IERNF-F; '. TA GE COACH RP A7-7'ERS0N SHEET ........ .8.... - 3 i PJ4RT� ........C! PLO SK FIELDS REQUIRED- SQ'O F. 2,4 IN.:: "•7 " RiENCH F1EL125INSTALLED- 500 F-Tx 224 II4.WIDETRENCH SYSTEM INSTALLED' 'i: LA jR3?-SN. .drC7AM5 `( LATE: '7- 16--!T® eC ALE: 111= 30