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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -24 BOX 7 00616 . . ., 5� ,IN% , ry- N, ; . Ir I6 r 1 . ' N N f _ r , F11" I. s . . 00616 0 PUTNAM COUNTY DEPARTMENT OF HEALTH 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICE 0 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS PCHDD CONSTRUCTION PERMIT # F 0(4 - O 1- LocdJ:P' 0' tJ1AUQS ?-a" f ourg Town or Village �Ast-Easo tit Owner /Applicant Name M ILA4EL "L' Hon S3 Jltbwu1, Tax Map Z- 3 Block z Lot z { Formerly Subdivision Name Lc,-r— A'bTavrmc —" `'`"'E — TN� rAV^.b r &K Fr}..a I•-Y Subd. Lot # 3 Mailing Address ZoS M�wla�,,�s tea, So�-� N , 'Parr�a�o,.1 Zip Iz <,G2 Date Construction Permit Issued by PCHD 10 - tZ - Q -1- Separate Sewerage System built by k Address 9,,L .st Axg_ ea, 'PArrg"oq uy' Consisting of 1 Z So Gallon Septic Tank and GPL -L.b'-Z �„,�? C►�A.�$E,� Other Requirements: 11 +�n„�. 2.d. S. FLL- Water Supply: Public Supply From Address or: Private Supply Drilled by A%.Brc a--` tJ1. a yxvr E Spas Address , -, Ea se.j , N r %zs-6 z Building Type Has erosion control been completed? � -s Number of Bedrooms 3 Has garbage grinder been installed? 1,1n 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: /4 -/7-0,0 P.E. .4,-' R.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 or change is necessary. ' z,. Title: Date: J ®_ -Building Inspector; Pink copy - Ow r; Orange copy -Design Professional Form CC -97 White copy - HD PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location. Street Address: Town/Village: Tax Map # Map a-5 Block ;�- Lot(s)9- WellOwner: Name: Address: Use of Well: Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Compressed air percussion Other(specify) Well Type _Screened _Open end casing Open hole in bedrock _Other Total Length ;-) ft. Materials: Steel Plastic Other Casing Details Length below gradejft. Joints: Welded Threaded Other Diameter Z_in. Seal: be"Ceme t grout Bentonite Other Weight per foot ) lb/ft Drive shoe: Yes _ No Liner: _Yes No Diameter in Slot Size Length ft Dept to Screen (W-ID evelo ed? Screen Details First _Yes _No Second lHours Well Yield Test Bailed Pumped Compressed Air Hours 41 Yield %d 013M Depth Date Well Log If more detailed information descriptions 'or sieve analyses are available, please attach. it yieia was tested at different depths during drilling list: Depth From Surface ft. ft. Land Surface aeons Water Bearin IF •t, I boo. eter Formation Description Pump Type k Depth R04 Voltage Tank Tvoe 6 anK rotor Capacit Model L HP_3�q Volume NOTE: Exact LocdEion of well with distances to at least two permanent landmarks to be provided on a separatFsheet/plan, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM L4 Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Location - Street Building Type TownNillage Subdivision Name 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 Day I Year Of Signature: sG Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Address: �����oays �� S State ��.f -� . 6✓ Zip I 2-5E3 Corporation Name (if corporation) Address: State Zip Form GS -97 1'MIN. EXIST. � WELL N EXIST. GRAVEL DRIVE 1250 GAL PIC CONC PUMP LIMITS OF V CHAMBER R.O.B. FILL ELECT. METER POLE W / WIRES PLAN GRAPHIC SCALE ss o is m ss 120 ( IN FEET ) I inch a SO fL ALL TRENCH ENDS I CAPPED (TYP) � I I I / R ' // I I 1250 6AL P I z SEPTIC I I TANK I = I C7 \ \� 9 B ' I e 4 "C /p \ \m� 2�>� 1250 GAL PIC CONC PUMP LIMITS OF V CHAMBER R.O.B. FILL ELECT. METER POLE W / WIRES PLAN GRAPHIC SCALE ss o is m ss 120 ( IN FEET ) I inch a SO fL ALL TRENCH ENDS I CAPPED (TYP) � I I I / R I Q I � r �I I °I — D-BOX z I pis ?.g• I'LL I I� I % It r / I I I r I r I I 1 I I I THIS IS TO CERTIF CONSTRUCTEDAI WAS INSPECTED E COVERED OVER.' WITH ALL STANGA COUNTY DEPAKn DEPARTMENT 01"I / R I r 1 I I r r 1 / � rl I I I I 1 r I I THIS IS TO CERTIF CONSTRUCTEDAI WAS INSPECTED E COVERED OVER.' WITH ALL STANGA COUNTY DEPAKn DEPARTMENT 01"I OFFSET DIMENSIONS # ITEM "A" "1311 1 ST -IN 53' 41.5' 2 STOUT 44' 51' 3 PC 45' 58' 4 D -B 121' 100' 5 TE 123' 100' 6 TE 118' 94' 7 TE 115' 8T 8 TE 110' 80' 9 TE 106' 74' 10 TE 102' 75' 11 TE 106' 83' 12 TE 111' 88' 13 TE 115' 96' 14 TE 120' 102' 15 TE 116.5' 127' 16 TE 110' 122' 17 TE 104' 115' 18 TE 97' 109' 19 TE 90' 102' 20 TE 138' 80' 21 TE 140' 84' 22 TE 143' 90' 23 TE 145' 95' 24 TE 148' 99' Sep 17 08 03:05p TOWN OF PRTTERSO 845 - 878 -2019 J r � BRUCE R. FOLEY . LORETTA MOLINARI R.N., M.S.N- 4 !'uLli< Health DirC<fOr � � � � A.uociala Public Haolr6 Dirac(or Director of Patiart Servicra DEPARTMENT OF BE- A.LTH I Geneva Road' Brewster, New York 10509 [iuvtraumcnjai I1calth (914) 278 - 6130 Fax (914) 278. 7921 Nursing Scrvdccs (914) 278 - G558 1V1C (914) 276 - 6676 Pox (914) 278 - 6085 Early lntrcvrntiou (91,1 }278 - 6014 31re1clt001 (914) 278 -6082 Fax (914) 278 - 6646 lie OWNERS NAME: o•L -A ActL ' TAX. yIAP NUMBER: E911 A )DR.ESS:. TOWNi : ?ra�ra� a.s�oJ A U' • D '!'OWN OFFICIAL: T1101•LlLL (Siguature) DATE: `7 Z__,Z2 7P �;NI� The Putnam County Department of Health. will not issue a C 'ertifacate of Constructioa Compliance %in ess the above forma is completed, i.e., a legal I✓911 Address is assigned by an authorized town official. This form is to be submitted with the application for as Certificate of Construction Compliaace. (1;91 1 VE1:I1zM) p.2 Z00 J11 S3.1V100SSV 0881H OTZ9 Z4Z VT6 131 SC :90 11111 90/10/60 09/17/08 WED 14;46 fTX /RX No 97951 acing BIBBO ASSOCIATES LLP 293 ROUTE 100 -- SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (91144)� 277 -.8�2 --10 FAX TO WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Change order ❑ Plans DATE ®— —0 JOB NO, ATTENTION _ f' � �y rC RE: �vsa� the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval ❑ For your use ❑ As-requested ❑ For review and comment FORBIDS DUE REMARKS ❑ ❑ ❑ ❑ Approved as submitted Approved as noted Returned for corrections 19 ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: If eann /ncrrroc� ewe nn� secs nnfer/ 4 /nr�/ /�r nnfl r •rc� .�I r��r.e� YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 9.801344 CLIENT #: 61080 NON STAT PROC PAGE: 1 of 2 BURDICK, MICHAEL 105 MCMANUS ROAD SOUTH PATTERSON, NY 12563 DATE /TIME TAKEN: 10/01/08 09:30 DATE /TIME RECD: 10/01/08 10:15 REPORT DATE: 10/09/08 PHONE: (845)- 494 -9481 SAMPLING SITE: 105 MCMANUS ROAD SOUTH, PATTERSON, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ---------- - --------------------------- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 10/01/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 10/08/08 LEAD (IMS) 5.1 ppb 0 -15 ppb SM 18 -19 3113B 10/08/08 NITRATE NITROG 0.65 MG /L 0 - 10 SM18- 20450ONO3 10/03/08 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 204500NO2 10/02/08 IRON (Fe) <0.060 MG /L 0- 0.3.mg /l SM 18 -20 3111B 10/09/08 MANGANESE (Mn) 0.013 MG /L 0 -0.3 mg /l SM 18 -20 3111B 10106108 SODIUM (Na) 3.89 MG /L N/A SM 18 -20 3111B 10/02/08 pH 6.2 UNITS 6.5 -8.5 SM18 -20 4500HB 10/09/08 HARDNESS,TOTAL 54.0 MG /L N/A SM 18 -20 2340C 10/09/08 ALKALINITY (AS 48.0 MG /L N/A SM 18 -20 2320B 10/09/08 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATE (WAS)THE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p, EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 9.801344 CLIENT ##: 61080 NON STAT PROC PAGE: 2 of 2 BURDICK, MICHAEL 105 MCMANUS ROAD SOUTH PATTERSON, NY 12563 DATE /TIME TAKEN: 10/01/08 09:30 DATE /TIME RECD: 10/01/08 10:15 REPORT DATE: 10/09/08 PHONE: (845)- 494 -9481 SAMPLING SITE: 105 MCMANUS ROAD SOUTH, PATTERSON, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ,------------------------------ - - - - -- ---------------------- ~---------- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONLY TO ESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: (-� kwvjo -W Albert H. adovani, M.T.(ASCP) Director ELAP## 10323 CO PUTNAM COUNTY DEPARTMENT OF HEALTH P—oq-0'7 DIVISION I+ ENVIRONMENTAL V SIGN O . iiEATLTi SERVICES FIELD ACTIVITY REPORT NAME' Street Town State Zip PERSON IN CHARGE ]� �j , n 7)bff R TNTFR VTFWFT): °r '� ` bV" I a T1atP / i M PUMP TEST fq .fha A DOSE TEST REQUIRED GALLONS I S0 c.T , IrO GAL, L4> av�, - �, 00 q. 6o � c/57 /7 : EL. START 77 /k . oel { EL. STOP O/L U�w (�r1LrlF�CL{Z� . REPORT PErE /ED RY,• — I acknowledge receipt of this report: SIGNATURE: T- -1 m id --� 0 •0 o fq .fha A DOSE TEST REQUIRED GALLONS I S0 c.T , IrO GAL, L4> av�, - �, 00 q. 6o � c/57 /7 : EL. START 77 /k . oel { EL. STOP O/L U�w (�r1LrlF�CL{Z� . REPORT PErE /ED RY,• — I acknowledge receipt of this report: SIGNATURE: T- -1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 17, 2008 Joseph Buschynski, PE Bibbo Associates Mill Pond-Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH" 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Burdick McManus Road South (T) Patterson, T.M. # 21-2 -24 A pump test was performed today and the results were satisfactory. There are no further comments or concerns. Upon receipt of a construction compliance it will be reviewed. If you have any further questions, please contact me at (845) 278 -6130. JD:kly Sin c ly, N� Jo e Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES` FINAL SITE INSPECTION . Date: ►11� Inspected by: Street Loc on !% `� Owner. t� Town S Permit # ---Q rZ, 4 ;TM # Subdivision Lot # Fk,.y 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 ...... 0 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ........:. ............................... d. Distribtuion Box 1All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction B x - roperly set.... Lend required. Length installer= x 2. Distance to watercourse measured Ft..>Aw 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe. ends capped ........................ ............................... Pump or Dosed Systems g� Size ot pump chamber ........ 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans . ............................... b. Number of bedrooms ...................... ............................... IV. Well a. Well located as per approved plans ...............f............... b. Distance from STS area measured 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.......:~....pl e. Curtain drain & standpipes installed according to plan f. Curtain drain outfall protected & dir.to exist watercourse g. Footing,,4rains discharge away from STS area ............... h. Surface water protection adequate ............... i. Erosion control provided ................. ............................... P — 1 io'7 YES f NO I COMMENTS Il ,/ 1 1 J-25-0 G-AL_ AX • \, �� \ It i I / I I 1 1 III I PRG,P 3 SEORO \ RES /DE�M FFm841E 0 . I as I\ - -2.0 \,.... 1 CO 1 , \ I FO WI NU / / / I I I I 11 1fe3L00 F IF BED / I I I I I I COWSTRU ON 1 / / I ENTRANCE 2• PFORCE �j-- ROAD � T)EM AFLCARPTICW TRFNrH /C TON uNL P/C FONC \ SEPM \ TANK \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ \\ \\ \\ P& CANC- \ \ \ \o t PUMP t CHAMBER \ \ \ \ \ \ \\ \\ \ \ \ \ \ \ \ \ \+ 1 \ \ No \ \ \ 1 I \ 17.0 \ � \\ \ FENZSE\ \\ \\ \\ \\ +� \ P \\ \ \ \ \ \ ��• 2, \ ANSION 110' 2 v mlN, / I I I 1. FILL I FOR CYC( APPF UNIX 2. SITE DOW ExCE 3. RUN FINES REDU 4. DEPT SECn S. THE I ORM 6. FILL : AND PART FILL 7. COW EN011 S. ENOI RUN-( B. THE I 1 FT. FILL : FREE PER( SOIL PERF IS AC 1' PVC FI SEPTIC T TocCHTRG.I ==I PINGED p/G R101IRW C PVC F00TD AND ROOF rNIAMS BIBBO ASSOCIATES, LLP 293 Route 100 , Suite 203 Somers, NY 10589 (914) 277 -5805 (914) 277 -8214 FAX bibbo @optonline.net FAX COVER. SHEET PLEASE DELIVER, TO: NAME L11-, 1 -k "(� FROM. SUBJECT: DATE: COMMENTS: VjkN _- MPANY UMBER (sLi'5) -2-"I-<6 — I L-Ls CK�LL �t,3� YZt/J Q S �-T1 r�L- J�� �+�► IL14. AS REQUESTED _„_ FOR YOUR APPROVAL. � FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMITTED (INCLUDING THIS PAGE) Hard copy being sent? No __ Regular Mai! Overnight If you do not receive all pages in legible condition, please call (914) 277 -5805. T00In (Md fff aii saivioossV OSSIH mq La rT6 ma 90 : vT aiu 80 /9T /60 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health F-2:!V 1% W DEPARTMENT OF HEALTH 1 Geneva Road,.Brewster, New York 10509 REQUEST FOR FIELD TESTING ROBERT .I. BONDI County Executive All information below must be f. idly completed prior to any scheduling. DATE: SC?'_' zC�Io8 ENGINEERING 1 IRM: S, As PRONE #LCTI q)- Z-1 SS os�- PERSON TO CONTACT: � A' Vr C1 I �9 NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: 0 PERCS: O PUMP TEST: ROAD /S'T'REET:���a� R.o iA �a v fi l TOWN: i�A- rr"b.� TAX MAP #: Z 3 P Z -- 7-� SUBDMSION: N1 LOT #: OWNER: �A , L-Va e "A L_ 4. NYCDEP CRI'T'ERIA FOR JOINT REVIEW AND 'WITNESSING OF SOIL TESTING YES NO p 19 Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. 0 q& Proposed SSTS within 500 feet of a reservoir, reservoir stein or control lake. ❑ i Proposed SSTS within 200 feet of a watercourse or .a DEC 'wetland. El Cr Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ C Proposed SSTS for a Commercial Project. It is the responsibility of the design -professional to provide the above information prior to soil testing. The Department will determine the NYCDEP. project status (Joint or Delegated) based on the response. If you answered yaq to any of the questions, NYCDEP must'witness the soil tests: This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated based on the above response. and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR•COUNTYUSE ONLY DATE- Tom' COMMRNPS: TLF4 Eat F.n Environmental health (845) 278 -6130 Fax (845) 278 -7921 Water Sapply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278-6558 Fax (84) 27$-6026 WIC (845) 278-6678 Nursing Rome Care Fax (845) 278 -6085 )early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 2000 QHOd EEh all sluvioossv OSSIS 0TZ8 LLZ tT6 lH,L 90:iT SELL 90/9T/60 NEW YORK ELECTRICAL INSPECTION SERVICES 54 North Central Avenue, Elmsford, NY 14523.914347.4390 �'', ,,� INSPECTION First Notice Second Notice First Fl, Second Fl,_ Third Fl, W YORK ELECTRICAL INSPECTION SERVICES I 54 North Central Avenue, Elmsford, NY 10523.914347 f1i First Second Notice Third Fl, ___- -- �_First Fl, --fond FL— --- Garage gasement,��_ Outside, .r-- -- _+multi t. c LLl' Y-! 1 rt'nv N. ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ❑ JOSEPH REQUEST FOR FINAL INSPECTZO�T ❑ GENE All information must be £ally completed prior to any inspections being made. PCHD Construction Permit # 'e> LA - a -+ For: fill Trenches %w--' Located: —,14 - (T) M ..I o wner /Applicant Name: M<<- L- gua..-tii,, TM Z3 Block Lot S-4 Formerly: Subdivision Name: Lwr 4, -,r- N6 Subdivision Lot # As_,c.e_t_. _Z Is system fill . completed? Nf Ya Is system complete? q. P_ S Is system constructed as per plans? Is well drilled? Y4- S Is well located as per plans? 7'+� Are.erosion control measures in place? Date: _- Date:'--f -S-a:-9 Date:._'- -OS� I certify that the system(s), as lasted, 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 Departrment of Health. Date: T-11-049 Certified by: Loa • PE RA esign Professional Address: 41 El er 5 fWY foS99 Lic. # ©r r9'2+ Comments: 1'Vx4r ftiS- al..Liayo,j t s -r t-- , U-) W} ? �.o l� 2�. r 4�' W �. ,-r ►tJ 4 'Foe__ I'F F_ "F LF5r_T(L%( .L_ J Z Form FIR 99 16001. F1MMIQe PUTNAM COUNTY DEPARTMENT OF HI DIVISION OF ENVIRONMENTAL HEALTH � CONSTRUCTION PERMIT FOR SEWAGE TREATMENT PERMIT # F—b'eV b - Located at _ C oz, cam} wxr arCe / Subdivision name e r Subd. Lot # Date Subdivision Approved / -,2, r- a 7 Town or Village _/- Gr`°�'.SOr► Tax Map ,;Z,3 Block 2 Lot vZ f Renewal Revision Owner /Applicant Name /YZ exae_ A -%0-nQ 3�r�lz• k Date of Previous Approval Mailing Address 39S'",���rl��` %eio% , a &ei -Saul 1 /i%.�! Zip Amount of Fee Enclosed k'�a© /0111:7r3 Building Type iga s, o% Lot Area /; No. of Bedrooms 4- Design Flow GPD $a47 Fill Section Only Depth Volume Separate Sewerage System to consist of /a?5' 42 gallon septic tank and ✓SOOLiG,',[�SoT. 7"re`►a, Other Requirements: 1���gG� �iGr�GLI r� �ler , / %P, 0:; To be constructed by T, f,0 Address Water Supply: Public Supply From Address or: Private Supply Drilled by _T" Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sy tem 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 this 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. Address 47e' /4O wit 0% y License # 4 � 'f 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 pe it. Approved for ischarge of domestic sanitary s age only. By: Title: Date: 1C." -"iJ White copy - HD Fil , Yello co y - uilding Inspector; Pink copy - Ow n copy - Design Professional Form CP -97 The Bridgeport The Bridgeport a,sep red, shows an optional double sidelight front door, window mantles, grills and cl door surround T eoptional,.,4ighpitqtldonner.\&,,ith:teardrop.sh�kts;aid�hipherroof.pi�ch,ad ru livAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # f /e gyyf' p,% f �,WA1 Map oll Block o2 Lot(s) 21- Well Owner: Name: r00, -/* Address: -, 3'75-23rr/le7`4lolaIV, Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _jJGL gpm # People Served Est. of Daily Usage3vo gal. Reason for _r Replace Existing Supply Test/Observation Additional Supply Drilling ✓'� New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes 7 No Name of subdivision ,Goj`L•i�C f��i'Hs c a t —Tie �o .- alr'c,1f l ��•,r y Lot No. �rce/ Water Well Contractor: %— ,eTf,(7 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance . to property from nearest water -main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: — S' 07 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 w ter well driller rtified by Putnam County. Date of Issue Permit Iss g Off cial: Date of Expiration Title: Permit is Non-Tr a sferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - OwnZ O e copy - Well driller Form WP -97 R OKSSOCIATES, LL.P. gineers - Planners October 5, 2007 Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 ATTN: , Michael Budzinski, P.E. RE: Burdick SSTS McManus Road South Town of Patterson Dear Mr. Budzinski: Joseph J. Buschynski, P.E. Timothy S. Allen, P.E. Sabri Barisser. P.E. John P. McNamara, P.E. Robert A. B. Howe. B.S.. Phys, Enclosed in the above matter are 4- prints of an SSTS Site Plan dated revised October 4, 2007. In accordance with your letter of October 1, 2007, we have made the following revisions: 1. Erosion controls are now shown. 2. The plan now indicates that the home is proposed for 3- bedrooms and a bonus room included over the garage to serve as a future fourth bedroom. The system is sized for 500 I.f. of fields required for a 4- bedroom design. 3. The notes have been updated to the current edition of Bulletin STA 9. 4. The requirement to set the perforated pipe and trench bottom level is now noted on the detail. 5. A detail for rip rap outlet protection for roof and footing drains is now noted. 6. Grading has been adjusted to extend the fill pad 10 feet beyond trenches. 7. The requirement for work in the pump station to be in accordance with the N.E.C. is provided in note #4 of the pump station specifications. 8. An electrical junction box is now required adjacent to the pump chamber. Planning o Site Design o Environmental Mill Pond Offices 293 Route 100, Suite 203 • Somers. NY 10589 Phone: 914- 277 -5805 Fax: 914 - 277 -8210 • E -Mail: bibbo@optonline.net 9. A note has been added to the D -box detail for a minimum of 2 -feet of solid pipe. 10. Please refer to item #2 above. Very truly yours, Joseph J. Buschynski, P.E. JJB /bs Enclosures T PUTNAM COUNTY DEPARTMENT OF HEALTH.,.`,;` DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # GPS -%%% 1�S ra'� rSfJ� Map, ,') Block o;-- Lot(s),L Well Owner: Name: Address: If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths 410a 3 Pump Type Za4S Capacity ao during drilling b ® Depth RO& Model Ch V P list: Voltage X-v HP ;ILI Tank Type 611, . Volume Date WeII Completed Well Drlllet PG � 16 Pf eport:' 31 Pump'Insfaller PC. Eertlfi te NOTE: Exact Locdtion of well with distances to at least two permanent landmarks to be provided on a separ sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 e Oi 4 -j 4 =M-j RcC 60o &Az el "'.Y l25V3 Use of Well: 1- Primary 2- Secondary Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion lCompressed air percussion Other(specify) Well Type _Screened _Open end casing Open hole in bedrock _Other Casing Details Total Length jLft. Length below grade,jQft. Diameter 7 in. Weight per foot 0 lb /ft Materials: YSteel Plastic Other Joints: Welded {Threaded Other Seal: t/'Ceme t grout Bentonite Other Drive shoe: Yes _ No Liner: _Yes No Screen Details Diameter (in) Slot Size Length ft Dept to Screen (ft) Developed? First _Yes No Hours Second Well Yield Test _Bailed _Pumped _'Compressed Air Hours �_ Yield gpm Depth Date Measure from land surface-static speafy ft) During yield test (ft) Depth of completed well in ft. 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 % U 10 If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths 410a 3 Pump Type Za4S Capacity ao during drilling b ® Depth RO& Model Ch V P list: Voltage X-v HP ;ILI Tank Type 611, . Volume Date WeII Completed Well Drlllet PG � 16 Pf eport:' 31 Pump'Insfaller PC. Eertlfi te NOTE: Exact Locdtion of well with distances to at least two permanent landmarks to be provided on a separ sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 M SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Joseph Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 1, 2007 RE: Proposed SSTS for Burdick McManus Road South (T) Patterson, TM # 23 -2 -24 Dear Mr. Buschynski: This Department has received and reviewed the submitted application and plans for the above mentioned project and the following comments are offered for your consideration. v/1. Erosion control measure for the proposed construction and site disturbances are to be added to the site plan. ✓2. The plan is to indicate the number of bedrooms in the house, and the total length of fields required. V/'3. The Putnam County Health Department SSTS notes are to be revised per Bulletin ST -19 revised July 2007. ,.A. The absorption trench detail is to be revised to specify the trench bottom and perforated pipe being level for a dosed system. . Outlet protection is to be provided for the footing and leader drain discharges. ,/6. The top of the ROB fill pad is to extend a minimum of ten (10) feet beyond the absorption trenches. ,/,*"7. The following note is to be added to the pump chamber detail: "All electrical work and material for the pump installation shall comply with the National Electrical Code ". <-8"' An all- weather junction box with an outlet and screwed cover at or above grade at the pump chamber to allow for a plug -in connection for the pump is to be provided. The distribution box detail is to be revised to specify a minimum of two (2) feet of solid pipe out of the box prior to the perforated pipe. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418, Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 The submitted house floor plan shows three (3) bedrooms although the SSTS design is for four (4) bedrooms. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:ens Respectfully, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Joe Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 1, 2007 RE: Burdick McManus Road South (T) Patterson, TM # 23 -2 -24 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on September 20, 2007 is complete. The Department will notify you by October 21, 2007 of its determination. IR The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement: If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. Michael J. Bu n , P Director of E if ring MJB:ens Environmental Health (845) 278 -6130 Fax 45) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 BRUCE K FOLEY Public Health Director no DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (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 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM wff PROJECT: f:�X) Qb/ C<G TOWN: C SE /P)K PV DATE SUB'D APPROVAL: 2S -0'7 l/ NOTICE OF COMPLETE APPLICATION DATE. /0-/-0-7 /07'`3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �/r Address -,,f55ulle,1-1411e Located at (Street) Y�,,ft7A Tax Map Z;:; Block oZ Lot (indicate nearest cross , street) Municipality Drainage Basin -5 SOIL PERCOLATION TEST DATA Date of Pre-soakinR' 7-9 -O7 Date of Percolation Test. -t:7 7 Hole No. Run No. Time Start - Stop Ela6yTime n.) Depth to Water From Ground Surface(In6he§) Start Stop Water Level Inches In es Percolation ate Min/Inch MF 2 3 /j9 ;z 5 //=07!!- 37 30 67-1-'/ 7 .2 7 3 02 2 .7— X ;z J" 0 7 4 5 Z 2 3 4 NOTES I,'-' TYests,to 2. Depth IT at same depth until approximately equal percolation rates are obtained at each (i.e. s I min for 1-30 min /inch, s 2 min for 31-60 min/inch) All data to be to be made from top of hole. I : I / Form DD-97 DEPTH G.L. 0.5' 1.01 1.51 2.0' 2.5' 3.01 3.5' 4.01 4.51 5.01 5.51' .6.01 6.51 7.0' .0 731 8.0' 8.51 9.0 9.5 10.0 TEST PIT DATA ..DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. A Rew(hl,oWn 741� e - HOLE NO. -0 Re WiTa, v, q 7,, o e, 13'�111i� e s� - /7" 7 4t Z4 C HOLE NO. 2 /4",r, e- A,0j Jn 47e, J Poel&tfl-/t) /'-.p Z__ A A, I-' Indicate level at. which groundwater is encountered -Indicate level at which mottling is observed Indicate level to which water level rises after being encountered — Deep hole observations made by: ,Y_ 04A-Zw;,_p_1r,, Date 0-/,� - o 7 Desig6Professional Name:.,rgZgWX &&4 RJAM MSOCIATFS LLP 6r. 293 t Roub , 1, 100 - Sul" 208 W) 1omef 8, NY 1 MOM, C-4 Design Professional's Seal F N W oil 100 02 41;3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner /% ' a / ���rr�, �' Address 3f S00%1e7`*16- erjvw� �IJy Located at (Street) sf1 Tax Map ,05 Block Lot (indicate nearest cross street) Municipality . /*.3yh Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test. Hole No. Run No. Time Start - Stop Ela se Mi Time n.) De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Indies Percolation Rate Min/Inch 1 2 3 .4 5 1 .2 3 4 5 1 2 3 4 NOTES: 14" Tests to be repeal � `t�percolation test h �!` submitted for rev 2; l Depttmeasurem ' 1 at same depth until approximately equal percolation rates are- "obtained at each . (i.e. s 1 min for 1 -30 min/inch, s 2 min f4' J44 min/ineh) All data to be to be made from top of hole. Form DD -97 DEPTH 0.5' 1.01 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.51 6.01 6.51 7.0' 7.51 8.0' 8.51 9.01 9.51 10.01 TEST, PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 6,1,1 e,- 7' Znj c e- ca �le, HOLE NO. /7' HOLE NO. 2 Indicate level at which groundwater is encountered 6' Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole 'observati o*ns made by:' Date g5'-1*T-07 Design Professional Name:. Address: 91880 ASSOCIATES LLP 293 Route 100 - SUIN Md. Somers, (914) 277-5805 Signature: Design Professional's Seal FO C- U55 `. JFESS /Oopd 3 a�3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) /`'% 1-4h It'ig•2�s�� S ti Tax Map Block 9- Lot 2 9`' (indicate nearest cross street) Municipality �P1CS'aA1 Drainage Basin.. z�s7` SOIL PERCOLATION TEST DATA Date of.Pre- soaking % —82-x '' Date of Percolation Test. (3 —O 7 Hole No. Run No. Time Start - Stop Ela se Time Min.) Dearth to Water From. Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 3 j0: / / -log¢/ X34 24- !�lS� 5 !/ %i3 -// ¢3 3 d l .2 3 4 5 1 2 3 4 NOTES: 1.fv Tests 'to''be' repeafei DEPTH G.L. 0.51 1.01 .1.51 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.5# -6.0' 6.51 7.0' 7.5' 8.01 8.5' 9.01 9.51 10.00 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES IV42T 6A-51C-10 107 LlSEO HOLE NO. HOLE NO. HOLE. NO. 2 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 70 ,:,"7 Deep hole observations made by: Date 67 -11 - &I Den Professional Name: Ad*ss: ..BIBBO.ASSOCIATES LLP DO - sufte 203 Somers, UY I05 FA (91.4))277 -55805 Design Professional's Seal fA Z Bibbo Associates, LLP Consulting Engineers - Planners Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Phone 914 277 5805 Fax 914 277 8210 Project: y4lf, Date: % —l'9-® 7 Design By: J7T Checked By: Page of GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools . • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: . %" maximum. ° Discharge size: 2" NPL • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH., - • Temperature: 104 °F (40 °C) continuous 140°F (60 °C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM'S available. FEATURES ■ Impeller: Cast iron, semi open, non -clog with pump- out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ■ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ■ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, _ BUNA N elastomers. ■ Shaft:, Corrosion- resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ■ Fasteners: 300 series stainless steel. A Capable of running dry without damage to components. w Designed for continuous operation when fully submerged., MOTORS 0 Fully submerged in high -grade turbine oil for lubrication and efficient heat transfer. 0 Class B insulation on '/3 -1'/2 HP models. ■ Class F insulation on 2 HP models. *C 20 0 15 0 10 FEET 13 Submersible Effluent Pump MODEL :: WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. Single phase (60 Hz): • Capacitor start motors for maximum starting torque. • Built -in overload with automatic reset. SJTOW or STOW severe duty oil and water resistant power cords. •'/3 —1 HP models have NEMA three prong grounding plugs. • 1 1/2 HP and larger units have bare lead cord ends. Three phase (60 Hz): Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ■ Designed for Continuous Operation: Pump ratings are Within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. N Bearings: Upper and lower heavy duty ball bearing construction. ■ Power Cable: Severe duty . rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ■ 0 -ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS CM® Tested to UL and CSA 22.22 10 108 St St andards By Canadian Standards Association us File #LR38549 Goulds Pumps Is ISO 9001 Registered. 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM I I I I L I 1 1 I I I 1 I 0 5 10. 15 20 25 30 35 ms /hr CAPACITY Goulds Pumps 0 2004 ITT Water Technology, Inc. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I. Name and address of applicant: 2. Name of project: Ae�R ?_-! 537--3;3. Location TN: 4. Design Professional: Address: 6. Drainage Basin: JD1,7v A-29' / OS�Bi 7. Type of Proiect: r/ 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 t--*` Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? .......................... Ak, 10. Has DEIS been com leted and found acceptable b Lead Agency? -� P P Y g Y? .............. N 11. Name of Lead Agency A,.) • 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........ ......... ............................... ... ............................... c t 13. If so, have plans been submitted to such authorities? ............ 14. Has preliminary approval been granted by such authorities? Date granted: % :2s' a 7 15. Type of Sewage Treatment System Discharge ................. surface water V"' groundwater 16. If surface water discharge, what is the stream class designation? .................... ly;l f 17. Waters index number (surface) ........................ .. .... ............................... 18. Is project located near a public water supply. system? ....... ............................... /VD 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................D. 21. Name of sewage system Distance to sewage system �.t 22. Date test holes observed %3 -0 7 23: Name of Health Inspector/`% 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? ......................... Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland ?_/t/a 28. Wetlands ID Number ............................. ............................... ...................... pl/ f 29. Is Wetlands Permit required? ...................... Has application been made to Town or.Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? :: ............................... /UD 31. Is or was project-site used for agricultural activity involving application of pesticides to. orchards or other crops; solid or hazardous waste disposal, landfilling, sludge- application or industrial activity? ................................ Yes/No /(%p 32. Is project locatedwithin 1,000.feet of existing or abandoned landfill ,hazardous waste site; salt stockpile, landfill, sludge disposal `site or.any other potentially known source of contamination.? ...:............ ............... Yes/No 0 DESCRIBE: 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 %o slope? ........................... 36. Tax-Map ID Number ... Ivlapv23 Block Lot -Z `% p .. ................... ............................... 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 ti 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 .. est of my knowledge and belief. False statements made herein are punishable as $, C149A misdemeanor pursuant to Section 210.45 of the Penal Law. RS & OFFICIAL TITLES: cC 14-164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Duality Review SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT /SPON /SOR // . 2. PROJECT NAM ;—/� (G r� 3. PROJECT LOCATION: A Municipality County d/Cffy 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) (G / 6F.'r ti f' ®G�o1 �. 'c E oc 5. IS PROPOSED ACTION: ftNew ❑ Expansion ❑ Modification /alterallon 6. DESCRIBE PROJECT BRIEFLY: ,�e dP %� cr / ci re��ic �J. fLi ✓ri��� f� ��' / AVC- 7. AMOUNT OF LAND AFFECTED: /.Z .Z^` Initially acres Ultimately acres 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? ,gResldential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesUOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STAT�rEE� OR LOCAL)? Yes n No If yes, list�aggency(s) and permit/approvals 0 74 451 01 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ArYes ❑ list No If yes, agency name and permll/approval Zc, f L a /�/;Wj.'O n -► 0" 71, .' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE ; ABOVE ApplicanUsponsor n me: h 9 % / � *,o1 Date: Signature: N If the action Is In the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by 4gency) A. DOES - ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? 11 No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In Cl•C57 Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D: IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials.. Ensure that explanations contain sufficient. detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑cighecGhis box If you have identified one or more potentially large or significant adverse impacts which MAY ;*-(gccur. jjhen proceed directly to the FULL EAF and/or prepare a•positive declaration. effCheck Ihis box If you have determined, based on the information and analysis above and any.supporting a�fFbcufrtation, that the proposed action WILL NOT result In any significant adverse environmental 'Impacts !:U?CND provide on attachments as necessary, the reasons supporting this determination: . i C-4 -Name Print or Typ Name o .Responsi le Oflicer in Lead Agency Signature of Responsible Officer in Lead Agency 2 Title of Responsible Off icer Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at T/V Tax Map # 3 Block Lot a2 d Subdivision of ,Lp f `,� �� ���, r�ir, c., �a�- %�� yq'sx/ ; :/I- Subdivision Lot # %at/vcc-1 Filed Map # &24 f 3 Date Filed Gentlemen: This letter is to authorize . L. a duly licensed Professional Engineer &.-' or Rdgistered Architect . to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: -y" P.E., R.A., Mailing Address BIBBO ASSOCIATES LLP 293 Route 100 - Suite 203 homers, NY 10589 State .:.: (014) 4 Telephone: ?Z f - 0?7 7- ,3*4:!?�j` —X /,3 Very truly yours, Y �. Si gn ed: --M (Owner of Property) Mailing Address: State Zip Telephone: Form LA -97 BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 (914) 277 -8210 FAX TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LI ECTUIR I] @7 U D d LIVCa>L1UE LI R L DATE � ^ � � O � J08 NO, ATTENTION // d �y'h RE: O r P- Air% edT�i, . C jr ❑ Samples the following items:. . ❑ Specifications COPIES DATE NO. DESCRIPTION O r P- Air% edT�i, . C jr mss/ THESE ARE TRANSMITTED as checked below: ®'For approval ❑ For your use ❑ As. requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US' SIGNED: If enclosures are not as noted kindiv nntlfv It. a• �.. PUTNAM COUNT' D]EPARTM-ENT -OF HEALTH DIVISIONOF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner .. Address M e_ ayl A U cl 5 Located at (Street) Tax Map 23, Block Q_ Lot (indicate nearest cross street) Municipality- al- r&:�ggonl Watershed /A I n 1),L g- OT2A kle- SOIL PERCOLATION TEST DATA Date of Pre- soaking, 7 L ; 0, Z' - <Date of Percolation Test 713 7 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 31,., .3/., .7 -Z - 1 °/'ji- y;;L _ /0 6ty_- 2- 5— 3 6,C) 2 `I; 3 - !o: o x.02-- 3 / 0.7 5 /1;3 7 30 �� j !/ a 12 12— 1 Y; iz — 9: ac / y V -- -t 7 3 11 7 3 lo, t o — 7 3 1 0- 9.40 2 9 :•gip- �v;i� 3 a �.� - 2.�"iy ► j''� �. 3 �-� - l 30 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 31,., .3/., .7 -Z - Sheet _of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT a r,T�n F c c • AnI US 2CA12 -PA rr��zS6A% Street Town State Zip PERSON IN CHARGE 22 j f nR TNTF.R VTGXWT)• BIZ5,80 '455.0c, T)atP' 7 / 2./ Name and Title TYPE OF FACILITY: Ito P0S�r7 5, S. T S _ FINDINGS: 2 / A��° , lt�s dam+. % / g: 07 Signature and Title REPORT RFC F.TVFT) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING ROBERT J. BONDI County Executive All information below must be fully completed prior to any scheduling. DATE: 7 ENGINEERING FIRM:-,P/-d . s<sacs. , 4GP PHONE #: 1:7/f 77- s8r s-.r r3 PERSON TO CONTACT: I�GRs'G�q�ss%ri - Z I NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: E�' PERCS: Cy' PUMP TEST: ❑ ROAD /STREET:_ TOWN:fGrfory TAX MAP #:3 SUBDIVISION: LOT #: OWNER:_ -h NYCDEP CRITERIA'FORJOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO E! 9"' Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ C� Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ �// Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Yes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of . the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: t C? C> TIME: COMMENTS: REQ. FOR FIELD TMTWC..KLY Environmental Health (845) 278 -6130 Fax'(845) 278 -7921 Water Supply Section (845) 225 -51.86 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC.(845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 (914) 277 -8210 FAX TO WE ARE SENDING YOU O Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ DATE 4�- _ r + JOB NO. ATTENTION RE: J`7: cdrf C L°S iir Orr the following items: ❑ Samples 1 ❑ Specifications COPIES DATE NO. DESCRIPTION C L°S iir Orr THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As.requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: /f enclosures are not as noted, kindly nodfivu. at once. All ` PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION. Name of Project �Icfz— _ . T (V) l County Site Location- Building construction begun Extent Is property within NYC Watershed ? ................. : ` 71 Yes F-� No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. (� Hilly Rolling Steep slope EZ Gentle slope � Flat 2. %"�" Evidence of wetlands a Low area subject to flooding F7 Bodies of water Drainage ditches Rock outcrops 3. Property lines or corners evident ....................... ............................... ® Yes a No 4. Do water courses exist on or adjoin the property? ............................ 4 0 Yes ®No 5. Will these affect the design of the sewage system facilities ?............ a Yes E . No 6. Do watershed regulations apply in this development ? ....................... ® Yes 0 No 7 Will extensive grading be necessary? ................ .........................�..... 0 Yes f7j] No 8. Will extensive fill be necessary for SSTS ? ......................... ' ........... F-x-J Yes a No 9. Do filled areas exist within the SSTS area? ........ ............................... F-1 Yes © No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand F� Gravel [�o Loam 0 Clay. F-� Hardpan E:] Mixture 11. Observed from: _ 0 Borings a Bank cut NZ Backhoe excavations 12. Soil borings /excavations observed by adz, utS(cc on 13. Depth to groundwater r on C3 -O tI 14. Depth to mottling on (,o 3 —6 15. Are test holes representative of primary & reserve areas ...... ............................... Yes 0 No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form ST -1 a 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage require special consideration? ..................... a Yes No 20. Will gullies, ditches, etc.; be filled and watercourses be relocated T ........................ F--] Yes �"No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection b e de of the existing or proposed source and facilities ? .................:...... �. F7 ........................... Yes a No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ................................ 0 Yes [$Z No 23. Additional comments 24. Site observer /inspector and title IV( • rA)6(Z/Pfs(6t 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES - Hole # Lot # Hole # _ Lot # Depth to water Depth to water V �. f Depth to mottling Depth to mottling Depth to rock/imp. `' Depth to rock/imp. G.L. G.L. 0.5 G.L.; 0.5 0.5 3J 1.0 1.0 1.0 � 3.0 2.0 4.0 2.0 A 5.0 3.0 3.0 G� 8.0 4.0 4.0 5.0 1 5.0 VV 6.0 6.0 7.0 7.0 8.0 '�v 8.0 9.0 9.0 10.0 10.0 V �. `l Hole # Lot # Depth to water Depth to mottling 1 � � "1 Depth to rock/imp.� G.L.; 0.5 3J 1.0 �L- 2.0 ,g 't � 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 RZ 06/05/07 TUE 04:47 TEL 914 277 8210 BIBBO ASSOCIATES LLP 4-+4 PCHD 2002 _.0 SHERUTA AMLER, MD, MS, FAAP Commissioner of Health LORFUTA MOLINAW, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Gmeva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING r ROBERT J. BONDY County Exeeueive . All information below must be fully completed prior to any scheduling, DATE: G' -✓'��© 7 ENGINEERING FIRM: V1 d,& Aoacs. ,, �� PRONE #- ff f o? . ii-. f c .s"-r 13 PERSON TO CONTACT: d� �d�i`C•1i�r•.s�i�i ' C N*'XW CONSTRUCTION REPAIR PROGRAM El ADDITION PROGRAM REASON: DEEPS: 0.' •PERCS: 2/ PU'N'T TEST: 0 ROAD /STREET: z!%c.s TOWN: TAX MAP #: SUROXVISION: % - LOT #: OWNER:.. �54'w ea-1 INYCDEP CRITERXA'FORJOAN'T REVIEW AND WI'T'NESSING OF SOIL TESTING YES NO 11 V' Proposed SSTS within the draipage•b'asin of West-Branch or Boyds Corner & Croton Falls Reservoirs. © 81� Proposed SSTS within 500 feet of a reservoir, reservoir stem'or control lake. ❑ Proposed SSTS within 200 feet of a watercaurse'or a DEC wetland. ❑ s Proposed SSTS,, design flow greater thant. 1000 gallons/day or SPDES Permit required. ❑ Proposed SSTS for a Commdreial Project. It is the respoasibility'of the-design professional-to provide the above information prior to soil testing. The department will deterla jAe the NYCDEP-project status.(Joint or Delegated) based on the'respon,se. If you answered ves.to -any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually sulitabletime for field testing with the Design Professional and NYIDCEP. If a- project has been determined to be Delegated based on the•above response and then subsequent information indicates NYC DEP is required to witness the soil tests, it will be the sole responsibility of . the design professional to schedule re- witnessing of the soil testing With NYCDEP. ' POR COUNTY USE ONLY DATE: _ 3"' 4V 11WE: ' ®E� COb=NTS: Water Supply Section (s4Sj 225 -5186 Fax (845) 225 -5418 - Nursing Services (845) 278-4558 Fax •(845) 278 -6026 'WIC.(845) 278 -6678 Nursing Home Care Fax (845) 278-6085 Early taterventionlPreschool(845) 278 -6014• Fax (845) 278-664S 06/05/07 TUE 04:47 TEL 914 277 8210 BIBBO.ASSOCIATES LLP 444 PCHD -° BISSO ASSOCIATES, LLP 293 Route 100 Suite 203 Somers, NY 10589 (914) 277 -5805 (914) 277 78210 FAX bibbo@optonline.net PLEASE DELIVER TO: NAME 6c=ove- 10�G° e oef FROM: , �fSC41 FAX COVER SHEET COMPANY 2001 NUMBER SUBIECT: %%. , �r �/�' /v ��edfy 11c i (,W ov i'S //IQ/, DATE: �5- -,,,5 _C7 % COMMENTS:. J,•�r�- �d ..5c �� /� r 0res_ �ee eSIP 7 AS REQUESTED FOR YOUR APPROVAL FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMITTED INCLUDING THIS PAGE Hard copy being sent? No Regular Mail Overnight If you do not receive all, pages in legible condition, please call (914) 277 -5805. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner l 6� Address Located at Street I (e�� a Block 3 Lot (Street) AC14Af1fA15 �h 4 � p (ipAicate nearest cross street) Municipality Q ° OL1 Drainage Basin JFA57- a2AA&�14 SOIL PERCOLATION TEST DATA Date of Pre - soaking 2/13Z 9 0 Date of Percolation Test 7%/��' e Hole No. Run No. Time Start - Stop Ela se Time 6Iin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 lQ -� -- �� 3- 27 `� 3 .,5 3 a l �'� —1(� I 23 2 MQ7-0- 21 :23- 2 3 7 3 ��1 - :f 23 �2 — 7 4 1/: lq- =3 - G ` 3 7- ? 1 2 3 4 5 .NOTES: 1. Tests to be repeated at same deptn unw approximatery equal percolauon rates are ovLauteu at W%, 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. 2. Depth measurements to be made froi'n top O Form DD -97 .; Sheet - of UNTX DRTENT OF HEAL C M T11 DIVISION'OF ENVIRONMENTAL"HEATLH. SERVICES tV .1i0 FIELI} ACTIVITY: REPORT VIA •� Street. Town .,. ' State Zip PERSON IN CHARGE -Name and Title TYPE OF FACILITY FINDIIJGS: O �:' �R ��� 0 IC ej f , a. s. ._. , i ai 6 .y r rTOR! Signature and Title Of I acknowledge receipt of this report. SIGNATURE; U/96 ` TTitle. RECORD OF PHONE CONVERSATION Time: 111,490 Date: - to Z / 9 0 Person calling: % heJ'e5o� `I !� ,oL'10 Phone Reason () Inspection: () Deeps and /or eres: G Vj' Scheduled Field Meetina j�r�e dal z°r � 5 Time: Date:�'... -. %{ Y N Tentative /to be confirmed () ( ) Town: Road/Street: ��� �t� 1� �_'5'/� Gi Yr✓1 Tax Map #:?� --`C - -_ -- Comments: /- ©f l0 _11a^,f Fol V � All I a .1 mff.rllr z uf J N. p mers W4 % Se Ilding 57 ul 311 \n, 12563 e own 164 `" Mendel Pond R 164 alnes Corners 312 81n to N.,th St. Brewst eights ,R lg � �- /--� � lvl A Steinbeck Corners /* I U,,'Cque An ique AreE OES q4lb- �112 lzml.