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HomeMy WebLinkAbout0633DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -65 BOX 7 r� W1. Aw J L F. ■ ��� ' t T 16 11� 00633 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTI PCHD CONSTRUCTION PERMIT # Located at vt P D0v I kk) Owner /Applicant Name i ea; a e F1 Formerly COMPLIANCE TREATMENT SYSTEM U own or Village 6H 15422c k I h e Cd MS 'traC740 Tax Map y4- D Block - ca- Lot Subdivision Name Lt rLE- Pd NP 144LL- Subd. Lot # 1' Mailing Address "*� q FA-t j� Si" �,T c4,-e-m-4- NY Zip 0S-1 Date. Construction Permit Issued by PCHD (Reeck rP e Co4Sfpu 4 .11-io11 Separate Sewerage System built by Address See- 50 7,101 Consisting of 1000 Gallon Septic and 2FT lgia2cf- D -; I(z-PT Q)16 Pt LL � SV o` D S t &Dtr, 74CT 6-C1,-'-;7,9 -1A1 d 4hin/ Other Requirements: Water Supply: Public Supply From or: C Private Supply Drilled by 6 EA-L - Address Address Building. Typelk)00 0 F"rm E� Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? _ y1fs 06 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 regulati s of a Putn County De artment of Health. Date: Certified by % P.E. X R.A. / S -7 Address Cy190 Des gn Professiona License # 3Z - NY ll 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 a, su ject to modification or change when, in the judgment of the Public Health Director, such revocation di catio r change is necessary. By: Title: 69:--:::� Date: /v b White copy - HD File; Yellow copy - Building Inspector; Pink-copy - Owner; Orange copy - Design Professional Form CC -97 �, ti n. BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 5-1;2- 0.6 To: A'42e0k,:Ali Fag #: 6-1 3 - 75- i - 366$ No. Pages 2- (Including cover sheet) From: Gene D. Reed Putnam County Department of Health /For your Information Please respond ��for your review Attached as requested As discussed Please call Notes/Messages In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Mapd �) Block <'>L­- Lot(s) �Jr Well Owner: Name: Address: 18eel-1k 'a 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 Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock _ Other Casing Details Total length ft. Length below grade eft. Diameter 7 in. Weight per foot /7 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout AX Bentonite Other Drive shoe: Yes No Liner:_ ANO _ Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) IDeveloped ? First _ Yes—No I Hours Second Well Yield Test _ Bailed _ Pumped _X Compressed Air Hours -jLXL Yield -& gpm Depth Data Measure from land surface- static (specify ft) 7-1 �e��" During yield test(ft) ,Bo�% Depth of completed well in feet 3 65 �� f 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 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information U Pump Type (20, ' s Capacity I t7 6A;i Depth ��� Model Voltage_? 3L HP Tank Type �L Volume -r ur Date Well Co pleted Putnam County Certification No. Date of Pyport Well Driller (signature) NOTE:/ Exact location of well with distances to at least two permaneXt lanumarlcs to ue provided on a separattpsneevptm. Well Driller's Name Mi &l Address: /V1 Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM &PC X Tree Cogs Owner or Purchaser of Building Tax Map Block Lot epec !ITV(? Building Constructed by 3 1 Fa , Location - Street Building Type Pa flersoh Town/Village L 141 PoM0//;' // 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. Q!e,C hT�Ve (IJh<, c4 Corporation Name (if corporation) Address: a0y S State /l f0Q 4 h t 4 ke Zip j I Signature: 4d ae jitle: ,-7 Corporation Name (if corporation) Address: State Zip Form GS -97 s. YML EyXfRPNMENjQLffRVICES .ear r , e Yorktoiwn Heights, 14 : Y. 1059e (9.14). 245-2800 Albert H. Padovani-- Director LAB 93.1028013 CLIENT #.- 8641 ------------ WALLACE, DOUGLAS P.D. BOX.154 MOHEGAN LAKE, NY 10547 NON $TAT PROC PAGE I M­ NNN N N N - N N N N N N N Ar ----- ~ -------- DATE /TIME TAKEN.: 10/09/01 1100 DATE/TIME RECD: 10/09/01 12:15 REPORT DATE: 10/19/01 PHONE: (!14)--734.-1187 SAMPLING SITE: 639 FARM TO MARKET RD, PATTERSON, NY SAMPLE TYPE..*.- POTABLE KITCHEN TAP -PRESERVATIVES.- NONE COLD BY: DOUGLAS WALLACE TEMPERATURE.....- < 4C NOTES.S..- COLIFORH METH: MF -----------­-- N NIV N M NNN N N NNNN N N N N ----------- N --------- ­­­ ------- DATE FLAG PROCEDURE RESULT ..NORMAL RANGE METHOD PUTNAM CNTY PROFILE 10/09/01 MF T. COLIFORM ABSENT /100 ML ABSENT .10.08 10/09/01 LEAD (IMS) <1 ppb 0-15 ppb 9101 NITRATE NITROG <0.2 MG/L 0 - 10 9139 .10,/09/01. NITRITE NITROG <0.01 MG/L N/A .9146 10/09/01 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 10/09/01 MANGANESE (Mn) <0.010 NG/L 0--0.3 m9/1 2037 10/09/01 SODIUM (Na) 5.03 MG/L _NIA 10/09/01 PH 7.2 UNITS -6.5-8.5 9043 10/09/01.-. HARDNESSJOTAL 50.0 MG/L N/A 10/09/01. ALKALINITY (AS 48.0 MG/L N/A 10/09/01 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: ',,-PACT THESE RESULTS INDICATE THAT THE WATER (WAS) NOT) OF A SATISFACTORY SANITARY QUALITY'ACCORDIN( THE -NEW YORK STATE AND EPA FEDERAL,DkINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.. LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb And a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive motential. Fe/Mn I f 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 71 YML ENVIRONMENTAL SERVICES .321 Kear Street ,YorktoWn Heights, N.Y. 10598 ( 914 ) 245-2800 Albert H. Padov*ani, Director LAB #: 93-102808 CLIENT #:. 8641 WALLACE, DOUGLAS F.',.Q. BOX 1.54 MOHEGAN LAKE, NY 10547 SAMPLING SITE: 639 FARM TO KITCHEN TAP COL'D BY: DOUGLAS WALLACE NOTES... -*AGE 2 NON STAT,PR PAGE DATE/TIME TAKEN.-.10/09/01 11 00. DATE/TIME REC'D: 10/09/01 1205 .REPORT DATE': -10/ . 19/01 PHONE: (914)-734-.1187 MARKET RD, PATTERSON., NY SAMPLE TYPE..: POTABLE DATE FLAG PROCEDURE PRESERVATIVES: NONE TEMPERATURE...- < 4C COLIFORM METH: MF NNNNNNN N N N NNNNNNN ~mm--mmm ------ 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 I.S 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) SUBMITTED BY: Alber/+, H. Padovani, M.T.(ASC;)- Dire6tor ELAP# 10323 _ - -- : BRUCE R. FOLEY Public Health Director LORETTA MOLINARI-.R.N., M.S.N. Associate Public Health Director Director of 'Patient Services - DEPARTMENT OF HEALTH 1 Geneva Road Brewster,- New York 10509 Environmental Health (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 i E911 ADDRESS VERIFICATION FORM a The Putnam County Department of Health will not issue a -Certi&ate.-of - Constructioi CoiApliaince unless the above f6 s_ completed, - i.e:, -a legal E911 - address is assigned by an authorized town official: - This f6 is to be submitted -. with the application for a Certificate of Construction Compliance. (E911VERFM 11 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 OFFICIAL NOTICE OF PERMIT SUSPENSION CERTIFIED RETURNED RECEIPT REQUESTED John Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Suspension of Permit: Grouse Farm to Market Road, Lot 9 (T) Patterson, TM# 23 -2 -65 Dear Mr. Karell: September 13, 2001 Please be advised that the Permit P -34 -93 for the above regarded project has been suspended by this Department for the reasons noted below: 1. The fill pad has not been constructed according to the approved plans. This is a violation of the Putnam County Sanitary Code, Article III, Section 2, paragraph (c). 2. The trenches have been installed without a permit. This is a violation of the Putnam _County Sanitary Code, Article III, Section 2, paragraph (a)_ - -- - -- - ___..--- _ - - - -- - .___ -. The suspension of the permit will remain in effect until these issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit all work shall cease upon written notice served upon any person connected with or working in said system. Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. V 1y Robert Morris, P.E. RM:tn Senior Public Health Engineer cc: M. Carnazza, Building Inspector - (T) Carmel G. Reed n PUTNAM ,COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 3 Vi rig 0 Located at FA W T� •� � 1 �-(1 Mvwvmnage P+T�SdAj r7 Subdivision name jnk20 u & J4 LL Subd. Lot # I Tax Map &1-3 Block c;[-Lot ld 5 Date Subdivision Approved 41 Renewal Revision x D 00f7 1. S W hkJ -A- CE- Owner/Applicant Name C,12(�V SC eDl�1 S'T�U� -i70IJ Date of Previous Approval Mailing Address T--/u (2- CA-ZA &Z NY Zip to Amount of Fee Enclosed A-C, Building Type Ulf 0OD EgkAG. t Area I O � No. of Bedrooms Design Flow GPD / Fill Section Only Depth Volume Separate Sewerage System to consist of gallon septic tank and ,0 —31 /Z 1` T I)b r LL_ c &!t-t) Other Requirements: :7 Fr C L14j, fA) Z)&4/ A) a y V5 To be constructed by Address Water Supply: Public Supply From Address or:- Private Supply Drilled by � �� Address %Jl2�CJ `72 NY 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 F. accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate- of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. R.A. Date 1612 OI 1761 SNghA/ A*V /7 _6��aW )Uy 12-03 License # S731717 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatm stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w n co sidT ssary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proscharge of domestic sanitary sewage onl By: Title: Date: Lb E 41 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 T 'd 30 1N3WiNW30 A1NnOD WCN11_ Id : dWtiN Facsimile From the desk of: 'AarlesM. Athanasia vice President of Energy Services Date: 10 /10 /01 To: Robert Morris / Theresa Nemeth Company: Putnum County health Department Fax Number: 845- 278 -7921 Phone Number: 845278 -6130 Number of Pages: 1 (Including Cover) 6dbL-a:iL�'Sbti � Ill b L � L b UCI•I 6bbC-b b-1JU solutiom 701 Westchester Avenue • Suite 300 East White Plains, NY 10604 Phone: (914) 286 -7020 Fax: (914) 656 -1417 Athanas!aC@conedsolutions.com Comments: Robert, `Phis is -in regards to the property located on Lot_ #9 of Farm To Market Road. I am, the buyer and really need your assistance. I have experiencing delays (possibly as a result of some of the builder's apparent actions) that have resulted in an increasing financial burden of over $16,000.00 to date. My contracted . close date was July 1't. I have been living in temporary facilities since I accepted the position of VP of Energy Services on June I", I was married on July 21' and we are now expecting. My expenses were terminated after 45 days (8 /15) and we are no over 100 days past contract. I understand that you have taken on increased responsibilities as a result of the tragedy on 9/11. I am willing to do whatever is necessary to drive closure to this matter. Again, I appreciate any effort you may be able to provide and I look forward to meeting you in person. Regards, . r,,u Charles M, Athanas'a T00 /TOO In 9uoTanTOGU09TPaUOD LUT 999 VT6 YVd ZT:TT TOOZ/OT /OT 7 JI 7 Of PUTNAM- COUNTY .-DE-PARTMENT-OF HEAL T--H----- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM r -0r- 0Nvnera7zotj,,sC- co r-/o^/ Address -__hTZ14 7-0 M&ZI&EZ:' Me. Located at (Street) -Tax Map a 3 Block a Lot 9 S-- (indicate nearest cross street). Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking o/_gl g Date of Percolation Test I o Z34gy ...................... ..Vve M:. r d 0 oun .. Or Vil'. P. ............ Run No ........ Start Sto T ;H61e:1�io ............ ............. 2 Jy • 3 3V 4 ....... 10;2 9 2 _3 3 '21. 3- 4 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, :5 2 min for 31-6U mintinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 j TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Design Professional Name: Address: -1 - - --"- -- -- - - - -- I Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0. 9.0 10.0 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L: 0.5 1.0 . 2.0 10 4.0 5.0 6.0 7.0 8.0 9.0 10.0 lJole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1:0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 TEST PIT PROFILES Hole # _ /^ Lot #_ Hole # _;L- Lot # � Hole # Lot # Depth to water Alba E Depth to water Depth to water Depth to mottling Ale N E Depth to mottling. A,10 A,.� jir Depth to mottling Depth to rock/imp. ND Nip Depth to rock/imp. AAeA-16 Depth to rock/imp. e G.L. S G.L. 0.5 0.5 T 0.5 a 1.0 All C 1.0 2.0"'- y !oa-w� 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5:0 1 '5-0 5.01 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10:0 10.0 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0. 9.0 10.0 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L: 0.5 1.0 . 2.0 10 4.0 5.0 6.0 7.0 8.0 9.0 10.0 lJole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1:0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Sheet �of___ k PUTNAM COUNTY DEPARTMENT OF BEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAM • 927 -ow-56- TP1• dr T zod n2 enuak-a—z Street Town State Zip PERSON IN CHARGE OR Ih=RVIEMI); F Name and Titre TYPE OF FACILITY : 5 S 5 FINDINGS : Vic•���. Jaime- •Ct,K�'a' ¢ �' u �'.,r:�+ -► s2 ,G,__ TNSPF,r,T0R-, 4v ZaAme TFT Signature and Title RIP[ RT RFC".RY'CT>~n RY: I acknowledge receipt of this report: SIGNATURE: H 02/96 Title, Rev. Sent By: LLL; BRUCE R FOI.EY Pablic Health Dkew :4 1234567 ; 8ep -18 -01 9:37; Page 1/1 • r LORETTA MOLINAAI • RN., M.3.1R. Ammiate Public Feallh Dtrecfor Dbactor of Patient Servkei DEPAR'i'ME'i rr 4F X= AT TIU 1 'Geneva Road Biewster, New. York .10509 REQUESTMOR ATTENTION: a ADAM STIEBEIMIG GENE RMED All information below must be fy completed prior to any sched0m.a. DAZE: ENGINEER OR F M: �� (�"i'�' - PHONE #: REASON: DEEPS: 1 PERCS: Pk M1 PTEST: o ROADMUET: AI TOWN: �'i12 , G DU TAX MAP #: :Z; Z SUBDIVISION: ��� _. 1� b _'�,�� � LOT #: OWNER:,,,uS MCDEP (MITERIA FOR JOIN I• IZ-M= AM W7T', Me L TESrtty� YES NO n eUr Proposed SSTS within the drainage basin of West Branch or Boy& Corner Reservoirs. o ,�+ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake- 13 AT- Proposed SSTS within 200 feet of a watercourse or a DEC wetland. e ,a� Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. El Proposed SSTS for a Commerical Project_ It is the responsiblty of the design professional to provide the above idwia_ ation prior to soil testing. This Department will 'determine the NYCDEP project status ­ (Jaiuf "ir* Delegeied) based on the response. If you answpredy-a to any of the questions, NYCDEP must witness the soli testing:" This - -- Department will coordinate a mutually suitable time for field testing with the P.CDOD, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design. professional to schedule re- witnessing of the soil testing wM NYCAEP. FOR COUM USECRmly SEP -18 -2001 TUE 10:05 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 I TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES', DEPTH HOLE NO. HOLE NO--Lr�— HOLE NO G.L. -tn 0,;o ---------------- 0.5 1.0 1.5 20 2.' D 3.., 4.( 4., 5.( 6.0 6J 5) 7.01-7 U 7.5 8.0 8.5 9.0 -------------- 9.5 10.0 Indicate level at which . dwat groundwater is encountered Indicate level at ------- mott ing is, observed. - -- Indicate .level to which water level rises after being encountered..... ' Deep hole observations made by: —DateA1?j()j Design Professional Name: Address: Signature Design Profession'alls Seal 4 0 f/a h�j v0�� '� to h�( � v °f4 77an s x t Cl L-L r` ITV 'me, T" «r✓ e7r t �;-6 r . Lf 3 -373 --C a� Sheet of s * x- PUTNAM COUNTY DEPARTMENT OF HEALTH y� DIVISION OF ENVIRONMENTAL HEATLH SERVICES YQ FIELD ACTIVITY REPORT lek Street Town State - Zip PERSON IN CHARGE OR TNTRRVtRUiM -- T)aiP: Name. and Title TYPE OF FACILITY: FINDINGS: G G. e onkn %NSPF.I Tsil3. TF.i • Signature and Title I acknowledge receipt of this report: SIGNATURE; 02/96 Title; D- ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location fAft^! To MARKET 7,rW, Town P,frrErt5eU TM# !t3 -2 —G5- 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 ...... .......................I........ II. Sewage System a. Septic tank siz' -1,000 ... ..... 1,20 ......... other ................ b. Septic tank insta a evel ................ ......:.......................: c. 10' minimum from foundation .......... ............................... d. Pistribution Box . All outlets at same elevation -water tested ................. 2: Protected below frost .......................................... _ .. .......... 3. Minimum 2 ft.Original soil between box & trenches f. J rncionsBox -properly set ........................... :.............. T- Length required 3 4 o Length installed 340 2. Distance to watercourse measured + 1 o a Ft.......... 3. Installed according to plan ................. -4. Slope of trench acceptable 1 /16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6: Depth of trench <30 inches from surface.- .......,.,..�„ 8. Size of gravel 3/4 -1'/2" diameter clean .... :........ ....... Date. Inspected IZE�y Owner CTLov s E Permit #,, K - /l - ® / Subdivision Lot # 1 . I YE YES41 O I COMMENTS 9. Depth of gravel in.trench 12" minimum ........ :....... ... 10. Pipe ends. capped ........................ ............................... g. -PumR or Dosed Systems 1. Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... Alarm, visual/ audio ...................... .... ............................ . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ..............::............... .. 6.- Cycle witnessed by H.D.estimated flow /cycle........... III. ouse/Buildin a. House located per approved plans ..: ............................... b. Number of bedrooms...................................................... ►r��ar5,i�ovrYteP" b. Distance from STS area Y. VK1 LKWV Y14111KEi,V --Kl _ ..- KVVVYJ 1 ........................ 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.. g. roottngvrain uiscnarge away rrom nzi area ............:.. h. Surface water protection adequate...- .........::..:.... 2Y a , BRUCE R. FOLEY Public Health Director LORETfA -MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, . New' York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 6678 Fax (845).278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845).278-6082 Fax (845) 278 - 6648 FAX COVER SHEET Date: To: LEJ 1<'142EL L From: Gene D. Reed Putnam County Department of Health /For your information For your review. /As discussed Notes/Messages Fax #: 6,2-0 — 70 S 5 . No. Pages 0 - (Including cover sheet) Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. �+r SENDING CONFIRMATION DATE SEP -4 -2001 TUE 09:31 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE PAGES START TIME .ELAPSED TIME MODE RESULTS : 96287085 : 2/2 : SEP -04 09:30 : 00'32" : ECM : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... or BRUCE R FOLEY [ARBTTA MOLINARI RN., M.B.N. iLMb /i.d(h m m l .marl P.Nb M fth nDahr ah - q( PGIYN Sm7ar. DEPARTMENT OF HEALTH Road _ I l3enava Bwwsaer, New York 10509 Cn.lne....a: 9..30 n6v=(040273-7921 -613v=(040273-7921 n.�ae so,1m (141)371.61st coo: (W)xn -esw sn(84t)rn -eau t ry hu' t6. (641)M -6014 PmwMd (N6)31t6Wt rn(pa)276.6w FAX COVER SHEET Date: "/a To: 2Eywi &aJ:0 -L! Fax# 8 No. Pages (including cover sheet) From: S+RBr D. Reed Putnam County Department of Health For your information —/M. respond For your review Attached as requested A. discussed Please egg NotcdAlessagcs In the event of trummission/reception difficulties, please contact this office at (845) 278-6130 ext. 2261. BRUCE R. FOLEY Public Health Director October 19, 2001 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental, Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Karell, PE 121 Cushman Road Patterson, New York 12563 Re: Field Inspection - Grouse Farm to Market Road,(T) Patterson Lot #9, TM# 23 -2 -65 Dear Mr. Karell: The above referenced separate sewage treatmerif system can be backfilled. The following comments must be corrected in the field: 1. The location of the curtain drain (solid pipe) between the driveway and separate sewage treatment system appears to cramp the proposed expansion trenches and not maintain the required.fifteen foot separation. The as -built plan must show the existing and.proposed trenches along with the curtain drain and the alternate location of the curtain drain outflow pipe. 2. The well casing needs to be a minimum of eighteen. inches above grade. 3. A bedroom count needs to be performed (house was locked). If you have any further questions, please contact me at (845) 278 76130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide A, SENDING CONFU NATION DATE : OCT-19 -2001 FRI 16:17 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH. TEL 845 - 278 -7921 PHONE 96287085 PAGES 1�1 START TIME OCT -19 16:17 ELAPSED TIME 00'22" MODE : ECM RESULTS : OR FIRST PAGE OF RECENT DOCUMENT TRANSMITTED. BRUIM IL FOI.BY IARBTCA MOLINARI RN., M". P.Nm H-0 Dbv AarodM Po6rt fhraah D&ww Dbeaor Paept S&W- - - DEPARTMENT ..OF .HEALTH 1 Geneva Road - Browder, New Yodt 10509 aF•eaaaraul He�ab (MS7Ne -blee 9atusirn -rnt tr rdq s.nlKS (us)s7A.6!!a WIC (us)stl -6678 Fa(M)271.6015 x.rb rmnea.. (anm.mts F*W0= -sae _ F.a 01451229-59Q F- OKM222-6113 October 19, 2001 John Karell, FE 121 Cushman Road Patterson, New York 12563 Pa. Field Inspection -Grouse Farm to Market Road,(T) Patterson Lot 09, Thin 23 -2 -65 Dear Mr. Karell: The above retbteoced separate scmage treatment system can be backfillcd. The following comments must be corrected in the field: 1. The location of the curtain drain (solid pipe) between the driveway and separate sewage treatment system appears to cramp the proposed expamion trenches and not maintain the required fifteen foot separation. The as -built plan must show the existing and proposed trenches along with the curtain drain and the alternate location of the curtain drain outflow pipe. ' 2. The well casing needs to be a minimum of eighteen inches above grade. 3. A bedroom count needs to be performed (house was Wetted). a If you have any further questions, please contact me at (945) 279.6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmeniel Health Engineering Aide J sry (J LL r f •.'�?''tirrr• `'4�•�^l+ :��F� •Nr�.k��•� �:�`� ?' .. •,• - ;,t+-••r.':e •�`•F,��r;.• •..-�'•� `Tis't•��i� ^t: ~�: F • �t 'Y P .? et' tPFr . kti t• l lit 4, T i � •� +�- �ji,.'tir}� t T ti`s• °`J -.:�" �Y �' � ��i �.+. �' ��Y, � _ �`.r���� `��. 1 � �` • �' �. � �"y�r �>,�; ;�•s�,�,- •,�'�f ry„ • '�i'�1;�+•'•`Y�l. {gl�lj�i � 1�� +:►- �t�.•�c�.t�� �\` - ����F • - 4 •F < ��, "` .�!fI''ti . �d „ >� ..i ` v`1�•?• .�`? 'ty •�'�u.A'�`� St`i �`7�i1. 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' ��,�•F, ,� �a.3. l• w,. F. 1: r• lam! • �, t �:� .a �Y} rt•'��.,�� Fjr,3r�';�a; �. i�.�a• c.E:,. � 'f•.'�i�,S! � 'f.�•r� .� ;.� .�" �"';�,1••. = 7` �1��• t:�y~,�'•�•� ..r Y: �''� i, +, '!l•:��.'.,,. ..='f"° 1:' •.74� •.�iY..'�. .. . •r .a•'.. ��: ,.>Ra 3 1234587 Sep -5 -01 8:02; Page 1/1 Sent By: LLL; ' Qs IL 1p - i 4 - `•� r f I � ��,. I � 1 l is i � � � , • � � f / r l :Vim % bit r r � kInMC. DI ITAIOM mi iNTV nFPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # "Town Located at /� /� / Village�� Subdivision nameL/� )?J//1/a Y/4CSubd. Lot # Tax Map P- 3 Block 2— Lot Date Subdivision Approved 3-1 t4 7 Renewal Revision :zo 1), Owner /Applicant Namyye�� ,,�� •1 L_W_6ydt%_ v Date of Previous Approval Mailing Address /�-�v $ 9 J /Hg XTW 77 Zip ,i 2- Amount of Fee Enclosed Building Type of Area • _O No. of Bedrooms 3 Design Flow GPD 0 Fill Section Only . Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of f 000 gallon septic tank and "L a OA & EiUL .ISO Other Requirements: /V To be constructed by Gr_A INSddress Water'Suuuly: Public Supply From Address lor: %< Private Supply Drilled by 66A"t– Address a✓pwsp � /uu '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. r. Signed: 'ii P.E. R.A. Date a 00- Address Z C ��,5 e� X License #S- 327 % r2 '� 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 anew permit. Approved for-discharge .of domestic sanitary -sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES f DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner r90UJ-C CC) /USA UCL1 M) . ,' Address ►�1'/� �, C� V n,-eJ f-�l ) 05-- 11, Located at (Street) ) jj LC Tax Map 3 Block 9- -Lot indi a e nearest cross street) Municipality . S Watershed 4 SOIL PERCOLATION TEST DATA .per Date of Pre- soaking 2 -0 Date of Percolatiori Test ............. : . ......... . - _Dep .: F_ th to mater Water rom Ground Level Percolat►on Time EIa se Time Surface (Inches) drop �ntatc Hale hio ltun No Start Ston) Start stop Inches Mrn/Inch j :.:. F l 1 00 2 2 ✓20- o D 3 00 3,6 4 5 1 0-1— W -30 3 2° �2�� 2L 2 6:7 4 2... of EW NAe 3 4 * � 5 s� P 53 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates d at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/mch) All data to be submitted for review. Depth measurements to be made from top of hole. 2. .S (,J NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75 -A, IONYCRR for Individual Household Sewage Treatment Systems Name of Applicant Address Site Location esr"1641- CA 1. Reason why site does not meet 1 ONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. '°.%Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ... :........................................................................................................................................ 2. Proposed design or conditions of waiver:` .. Pq co T ................................................................................................................................................................................ ............................. .. ................................ 1 V . ...........S.5.......ao........ - ?D> - .....a!f"..........P. %DIPc�i4tr A.. .kf.......7A °G,........ .................. ........ N...... t3 °1................................... ............................................................................... ...................... I........ ......... ........................... . . .. ---------------------- - -- 3. The proposed design may have the following limitations (check appropriate box(es)): increased risk of well or spring contamination. Increased risk of surface water contamination. EJ Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) .......................................... ............................................................ I........... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the ' s uin official for a change in conditions for which this waiver was granted. ................................... ............................... REP SEMTATIVE OF CO SIONER OF HEALTH ORIGINAL . Local Health Agency COPY - Applicant/Design Professional <....v ........................ ..... �. �................. ....... , OATE /.-S./ DOH -1326 (7/92) (GEN -152) PUTNANI C ®lJP9TY' HEALTH DEPT r 0;; 2.12 6 933 ` ip t ;= ;�`❑ Check �M O '; ❑Credit Card a By t �. �� r� L. i j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWA 01, T SYSTEM PERMIT # Located at Town or Village k4TEXSdV C/J Subdivision name 1ANTUU bg La Subd. Lot # Date Subdivision Approved Owner /Applicant Name Ny6 (k�4 , 6140S� Mailing Address Tax Map Z 3 Block Z Lot Renewal X1 Revision %r Date of Previous Approval 11 t, a— /V zip /d7VL- Amount of Fee Enclosed ' 3 0-0 Yi Lot Area I o. of Bedrooms Design Flow GPD� Bwldmg Type g Fill Section Only _ Depth ® 3 : -5 Volume y D-3 RA PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED q, d Separate Sewerage System to consist of /?-J-6 gallon septic tank and Other Requirements: To be constructed by Water Supply: Public Supply From Address Address or: _ Private Supply Drilled by ZZW Address :F I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the s_parate 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 an/y� repairs thereto. L /? Signed: Address R.A. Date (a Z License # S 3 Z: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 pe A proved for discharge of domestic sanitary sewage only. By: Title: Pf'�``fi r r Date: White co y - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ( / please print or type PCHD Permit # Y - n Well Location: Street Address: TownNillage Tax Grid # PATP`- gSe � Map 1-3 Block Lot(s) �, S Well Owner: Address: +N,A )amePP: Uv 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 r" gpm # People Served Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason r for Drilling Well Type Drilled Driven Gravel Other Is well -site subject to flooding? ................................................. ............................... Yes No Is well' located in a realty subdivision? ....................... ............... ............................... Yes ;( No Name of subdivision L- I1-1'LG 0h N 141 (_ C,, Lot No. _ Water Well Contractor: 'fi'1'1",_9 Address: Is Public Water Supply avail 'to s ite? .................................. ............................... Yes No Name of Public Water Supply: TownNillage Distance to property. from nearest water main: �-- Proposed well location & sources of conlamination t e provided: n eparate sheet/plan. L na Date: Applicant Sign L,9 PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise . contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue � D T v Permit Issuinic>al: Date of Expirations - Title:), �' 6 Permit is Non -Trans err le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 e:.• _ . ' . BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-1921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648. Jack Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Proposed SSTS: Wallace September 15, 2000 Farm to Market Road, Lot 99 (T) Patterson, TM# 23 -2 -65 - - - - - - -- -Dear Mr.-Karel..- Review of plans...and other supporting documents submitted at this time relative. to the above-. regarded project.has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) All plans are to be.submitted complete, i.e., all required sheets are to be attached. This Department will not attach separate sheets, separate previous submissions, and attach sheets.to current submissions, etc. Submissions not submitted in the required manner will be returned to the design professional. . 2) Waiver request cannot be requested prior to a formal denial letter from. this Department. A formal denial letter will not be sent until all other comments have been addressed. 3) The trench plan is to be submitted complete, i.e., with all the required details. 4) The permit application notes 500 c.y. of fill is required. You are the only design' professional to add the volumes of R.O.B.; common and clay fill in the "fill section only" box. Therefore, for a complete application the volumes of each type of fill should be noted after `.`Separate sewerage system to consist of..." All other design, professionals note only the R.O.B. fill volume in the "Fill section only" box. Letter to: Jack Karell, Jr., P.E. - September 15, 2000 -2- 5) PC -97 question 35 has been answered incorrectly. The question pertains to existing, not modified soils. You are the only design professional that has contested the intent of this question. 6) The north arrow had been shown, however, it has not been labeled.. ; 7) All existing and proposed SSTS's and wells locations with 200 feet of the property lines are to be shown as per current code guidelines. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very ly yours, Robert Morns, P.E. RM:tn Senior Public Health Engineer . attach a BRUCE R. FOLEY Public Health Director August 3, 2000 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Fr LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Karell, PE 121 Cushman Road Patterson, New York 12563 Re: Proposed SSTS: Grouse Construction Farm to Market Road, Lot 9 (T) Patterson, TM# 23 -2 -65 Dear Mr. Karell: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative. of this Department. 1) Details have not been provided with trench plan. 2) SSTS profile does not correspond to the plan view. 3) Letter of Authorization does not note filed map number and date filed. 4) PC -97 question 35 has been answered incorrectly. 5) The application must be presented to the waiver committee for a slope waiver. 6) Permit application has not been fully completed. 7) Subdivision data indicates the SSTS must be based on a 8 -10 minute percolation data. 8) The required fill volume on the permit application and the plan differs. 9) North arrow has not been shown. 10) Title Block is to note the map number. 11) Datum reference must be noted on the plan. 12) All existing and proposed SSTS's and wells within 200 feet of the property are to be shown. 13) Renewal site note has not been provided. 14) All fill dimensions have not been noted on plan. 15) Curtain drain discharge has not been clearly shown. 16) SSTS profile does not show curtain drain or clay barrier. Page 2 Karell/Grouse August 3, 2000 17) - Curtain drain standpipes have not been shown. The plans and documents are incomplete and erroneous. In the future the plans will be returned to the design engineer as incomplete. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:cj Ve ly yours, Robert Morris, PE Senior Public Health Engineer o FEV; ii =-T 1. This septic plan consists of two sheets, labeled lot 1 of 2 and 2 of 2. Two sheet lot 1 of 2 have been submitted, one is the trench plan the second is the fill placement plan. The fill placement plan is in front of you now. Sheet 2 of 2 is now labeled fill placement plan. It contains all the details. Presently details for the trenched etc. are crossed out. When the trench plan is submitted this same sheet will be 2 of 2 without the details crossed out. 2. The profile is correct. I have added some spot elevation to make your review easier. 3. The filed map number and date filed has been added. 4. PC -97 asks, "are any sewage treatment areas in excess of 15% slope ". This has been answered no since the site is being regarded to 15 %. Please advise how you wish this completed. 5. Noted. It is requested that this application be added to the next agenda. 6. 1 do not see how the application is incomplete. 7. The design is based on 8 -10 and not the witnessed rate which was lower. 8. The total fill volume is 500 yd., which was shown on both the permit application and the plans. 9. North arrow was shown. 10. Tax map number was shown in the title block on sheet 2 of 2. 11. Datum reference was shown on sheet 2 of 2. 12. This septic system is shown in the exact area as approved on the Realty Subdivision. A note relative to adjacent wells & SSDS has been added to the plans. 13. The renewal site note has been added. Four (4) dimension lines for the fill pad were shown. C: stain drain discharge was clearly shown. I have added a label to make A clearer. 16. The curtain -drain and clay barriers have been added to the profile. 17. Curtain drain standpipes have been added. 1 find it difficult to understand your characterization of these plans as incomplete and erroneous given the level of detail I have provided. One never knows who obtains copies of these letters and how that may affect reputations. etc. In reviewing your comment letter in my opinion of the seventeen -(17) comments, only six require a response, the remaining eleven (11) items were items you missed or which I explained above. All the six requiring a response are very minor details. In any case plans have been revised and enclosed. Please place this letter on the next wavier agenda. f t f f t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at r *m in m �q U h-P Subdivision name jA-f j1%F QbgD M Subd. Lot # Date Subdivision Approved 31 l Town or Village PRIEX8 irV C�J Tax Map 15 Block Z Lot 3 Renewal X, Revision Owner /Applicant Name N06 (k) WAKk , 614 USA Date of Previous Approval j j � _ g m 4- 9 'C �l Cem 61(" Zip Mailin Address Amount of Fee Enclosed 3 0-0 Pro Building T Y e Lot Ara/ -0 4No. of Bedrooms Design Flow GPD Fill Section Only _ Depth 0 3, S Volume S00yD -5 PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of (2J7) gallon septic tank and Other Requirements: To be constructed by Address Water Supply: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. A/; L,.. /9 D/i/r _ / Signed: Address R.A. Date (O 2 License # S 3 Z-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. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR . A WASTEWATER TREATMENT SYSTEM 1. Name and addre; 2. Name of project; 4. Design Professic 6. Drainage Basin: 7. Tvne of Proiect: Y',-Private/Residential .Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subjectlo State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted e 9. Is .a Draft Environmental Impact Statement (DEIS) required? .......... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other U officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: v 15. Type of Sewage Treatment System Discharge ................. surface water A— gr oundwater 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? ....... ............................... A (� 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? 21. Name of sewage system -Distance to sewage system- -- 22. Date test holes observed 0 JbO 23. Name of Health Inspector '0 lot 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 7M LT. QDn'CQ A....1:....�....L Ell 2 27a, Is any portion of this project located within a designated Town or State wetland? tV 28. Wetlands ID Number .................................... ............................... >... . . ..................... 29. Is Wetlands Permit required? ................................. ............................. AJ . Has application been made to Town or Local DEC office? ........................:...... . - 1l.� 30.- Does project require a DEC Stream Disturbance Permit? .. ............................... ) 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity?..; ......................... YeslNo 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 DESCRIBE: 33. Is there a local master plan on file with the Town 6r Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within ,1 15 years in or adjacent to project site? .............................. ............................... _ ,/� e � �e S t �ifl ��- �yi _ Firs alb S I 35. Are any sewage treatment areas in excess of 1S /o slope? ..............::....... /" 36. Tax Map ID Number .......................... ............................... Map L73 Block Z Lot 6 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 stonnwate�,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, un der penalty of perjury, that information provided on this form is trite to the best of my knowledge and belief. False statements made herein are punishable as a ClassA misdemeanor pursuant tc SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of �U� w� 6�CQLI� --�-- Located at A r —� %7-AV" T/V At ��a � Tax Map # � 3 Block 2 Lot Subdivision of Subdivision Lot # q Filed Map # ;—;2-1 � Date Filed V / Gentlemen: This letter is to authorize Q hl2c) kl'Z (' a duly licensed Professional Engineer X, or 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 tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., RA., # Very truly yours, Signed: (owner of Properly) Mailing Address I U� I lW Mailing Address-/O;�_ % State N - Zip /0S�'� -- Telephone: Ve ! 6Z-5 Form LA -97 :t f BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 October 2, 2000 John Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Proposed Construction Permit: Wallace Farm to Mark Road, Lot #9 (T) Patterson Dear Mr. Karell: Review of plans dated August 10, 2000 last revision dated September 26, 2000 and other materials relative to a construction permit for the above captioned property has been completed by the Department. Based upon such review, and pursuant to the provision of Article III of the Putnam County Sanitary Code, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. 1) SSTS is proposed on a slope of approximately 20% current codes do not allow an SSTS to be designed on a slope greater than 15 %. It is your legal right to request_ a waiver of the denial based on item(s) noted above. The denial request must be submitted in writing after the receipt of this letter. The request must specifically state the waiver being sought. If you have any questions, please call me at ext. 2166. Mu , Ve ly yours, i . &. Robert Morris, P. E. Senior Public Health Engineer JKJOHN KARELL, JR., P.E. 845 -878 -7894 121 CUSHMAN ROAD . PATTERSON, NEW YORK, 12563 October 3, 2000 Robert Morris Putnam County Department of Health Geneva Road Brewster, New York, 10509 Re: Construction Permit Wallace Lot #9 Patterson (T) Dear Mr. Morris: It is hereby requested that you consider a waiver from the Putnam County Department of Health slope requirements based upon your denial dated October 2, 2000. Very truly yours, John Karell, Jr., P.E. 1.' 2.' 4. 6. 7. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR . A WASTEWATER TREATMENT SYSTEM Apartments Institutional Office Building Realty Subdivision 8. Is this project subject'to State Environmental Quality Revie%v Type Status (check one) ....................... ............................... 9.. Is .a. Draft Environmental Impact Statement (DEIS) required? _ Mobile Home Park Other (specify) (SEQR)? Type I Exempt Type II Unlisted ........................ 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project.in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ................................ 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: v 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? ........:........... 17. Waters index number (surface) .....................:.................... ............................... �1 18. Is project located near a public water supply system? ....... ............................... /u J 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 57r, f Z,� 21. Name of sewage system Distance to sewage system - �---- 22. Date test holes observed JbO . 23. Name of Health Inspector ' 24. Project design flow (gallons per day) .............. qtr............... ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDRR Annlientinn hPPn cnhmittPr1 to inral T P(' nffinP9 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................ ............................... r... 29. Is Wetlands Permit required? ............................... . ....... :........ .............................. Has application been made to Town or Local DEC office? 30., Does project require a DEC Stream Disturbance Permit? . ............................... � — 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ..:......................... Yes/No 6�0 0 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any potentially ............................... Yes/No _ other � otentiall known source of contamination? DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........:........:. 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ....... ......................... 35. Are any sewage treatment areas in excess of 15% slope? . ...............:............... �es 5w- 9w ,�� 36. Tax Map ID Number .......................... ............................... Map 23 Block 2­ Lot 1�� 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 misdemeanor pursuant to Section 210.45 the Penal Law. SIGNATURES & OFFICIAL TITLES. J . Mailing Address: ................................... /ZJ-6 i" BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845)278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Jack Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Proposed SSTS: Wallace Farm to Market Road, Lot #9 (T) Patterson, TM# 23 -2 -65 Dear Mr. Karell: September 15, 2000. Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) All plans are to be submitted complete, i.e., all required sheets are to be attached. This Department will not attach separate sheets, separate previous submissions, and �W attach sheets to current submissions, etc. Submissions not submitted in the required manner will be returned to the design professional. Waiver request cannot be requested prior to a formal denial letter from this D Department. A formal denial letter will not be sent until all other comments have been addressed. The trench plan is to be submitted complete, i.e., with all the required details. 4) The permit application notes 500 c.y. of fill is required. You are the only design professional to add the volumes of R.O.B., common and clay fill in the "fill section only" box. Therefore, for a complete application the volumes of each type of fill should be noted after "Separate sewerage system to consist of..." All other design professionals note only the R.O.B. fill volume in the "Fill section only" box. Letter to: Jack Karell, Jr., P.E. - September 15, 2000 -2- 5) PC -97 question 35 has been answered incorrectly. The question pertains to existing, not modified soils. You are the only design professional that has contested the intent � of this question. 0(lr1""� 6)� The north arrow had been shown, however, it has not been labeled. 7). All existing and proposed SSTS's and wells locations with 200 feet of the property Nines are to be shown as per current code guidelines. Upon receipt of a submission, revised -to reflect the above comments, Gds application will be 1M1 & considered further. Very ly yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer attach BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 August 3, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Karell, PE 121 Cushman Road Patterson, New York 12563 Re: Wallace, Farm to Market Road (T) Patterson, TM# 23 -2 -65, Lot 9 Reservoir Basin Dear Mr. Karell: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 29, 2000 is complete. The Department will notify you by August 24, 2000 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ 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 would 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 New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of 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 DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve truly yours, Robert Morris, PE Public Health Engineer RM:cj TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IITIOOUNPERED IN TEST HOLES ; /i'H f . HOLE NO. _Lc�-t' � `1 t 'HOLE L.a�T 8 HOLE NO. LET et .. _., :.�'%� �, : - t,• ..f.'.�'_, i.Lti~,M•.1 :.G.'tJ V' .... . .!'•. �' i. i .'i�.'1.• ..'!.. .i . - _ G.I.. o ..�N ► © 99A A-bi 1L e.aq'A.14 t C- 2' ... TA..i Lae..wc �aY•t.�ul..� ' i- �¢a�rii�t l..o..•t1 ��u owe+ �+1 3 !.. ,'. �.yec+.a is c.a T CO �•. -�e� b TQ.�at 5': 6 ...� .�.►.�u>s� 'S0ga0% _4- _...__ vu t5 PTA o .... ...0 .. 9, _.... J. INDICATE LEVEL AT.WHICH GROUNUZATER IS ENCOUNTERED INDICATE LEVEL , TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED t t DEEP HOLE OBSERVATIONS • MADE BY: c ' ,4sse G o� PL�H a.►-t DATE: 3 - L ^� • 8 DESIGN Soil Rate. -Used ' Min/1 "': Drop: .: �: 1.._. _ . S. D. Usable Area Provided �o ©o o •�- No... of . Bedroans . Septic.. Tank _ Capacity gals Absorption „Area.Provided.By j L.F.; -x 24” width trench .Other.� ... ......... .... . Nam Signa :.. _.: .......... _ . . FOR Address 'KEANE COPPELMA4 ENGINEERS, P.C. A PRo -r;ssIONAL CORPORATION THIS SPACE FOR USE BY HEALTH DEPART'4NT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date .t ... . -.-... •..._. _.._ ..,....... „,,....rte• -y • •^' �4_a u +a•r7i1 >+ef, ""wns s,rs. n e ..w � .. .... f Sfd iy K`:ap' a4f �b'1 •.. ar.,_•m......wi� <. ».,...... V Y h:.sT.,,nc° - � ' a�.Fwn n cr,�.. °.,s. �.., c. .. „�t+,46 it v- n arm � EEIk� `t� k p>f�•��.„ �•�y ' °° _.. •.,...... m.... , yk- k� r' ...". Znt =A `i'- ��'J- .P1 "3'Lal -•' _�e,.n7''..,F, > -" :::;__- ,....., +..,,,,,�.�i �E ,'k ,.� °,.. ...«.... t ' � "� ° .,,,.° 1 N t ,,,•ti a _, � ,'� .,,� � 7 Nr„h �� uq aev,�.,, �E� .. .� t ��, ;� ... ��� _ . � ;, �.. J °� - R ,� ;�bt,. ��'..."" „...„. „ U -r ti � „„ °"".,” ,...„,., ,n,.�'j�. �`�ts��,'.°`��o-„• r {, � ' ' i4L1k ty i:" dk �'tC� .,_ n '""O• °•*w� -�- `^a,•._ -..,, ^?^ -„'^� F;p w...; _.M1 1 'Ht* , L ,d.'J'#,`�,'i _ "... ..�,'` 4 2 j ". .... ""•,®e„» '+,,.r -, u��1 � ,. � „ LL <#i z� „n'an »:a<na,>,u�+a<w: >r ,."..,ou, - j y'y ��a: �� at � �S• Ji �� �11i �... h� t ,, r' � v ti ..�•'�S `" "'"'_ �._ °' , .. „°".,,n � .` � Ott `# .— i • L +, # a .. -••" .rte ._�,. �:� g •'�•� � ,fir � ° • �' d� ; x• ;� � „I , � ..M � --•.. { -, .. ,. .. E "+,_ '^+o, ,,,,„A°"'>... ^'• +n,,,.�., `"<'*w...°„„.� °w �d, �+... p «.,.,,_ � '�.1• � '11�' F.. .... ....�` °°'. +...a.. . -.. 7 A '� _ � � �- - .. _• �,�wn' � � � \ - Y'_”. "ry - ca }},rJany_::.x. YJ A- �•_• _ ^ -�_ v,�.. w..� " ^. e..... ZZ IJ pis to , � f . �. .r'. p �,,,.,,, ;� �;..��'` •-- - ._ yy. `• '4.\ _.._ ..�. � �. _- `` -- ..- _ �', 9 _ t • - 4.0 CONSTRUCTION PERMITS rr- Prior to any construction of a SSTS, plans for such system must first be approved by the L4 t+F1 Department. There are generally two types of construction permits reviewed by the Department; those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet Deep or Less ✓l . Construction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) t,/11. Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) t �K Corporate Resolution (if corporate ownership). (Appendix K} ✓ 5. Short Environmental Assessment Form (EAF).(Appendix K) ✓f6. Design Data Sheet. (Appendix K) NOTE: All submitted Department application forms shall contain original signatures (no photo copies). 7. Three (3) sets of plans bearing the seal and signature of a Design Professional, �^ licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall include, as a minimum, the following: 8. Two (2) sets of house plans with title block as specified in 7. k. above, one of which must accompany copy of approved Construction Permit to the Building CInspector of the local municipality. Upgn approval of the Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only' `)4,__If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. 10. Well Permit Application, if required. (Appendix K) Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department. is provided with proof that 12. Fee - See Appendix I. �r 4 .. � F 1.. .. ,1 .. ., �- � .. .. ... _ __7 f �. .. �. _ _.. .,. .Q _, _O PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVTRO \l: IENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT , NAME OF OWNER: STREET LOCATION: ISIA REVIEWED BY: AS, SRDATE: TAX hL4P=: (CONFIRMED) 20-- Z �6J Y e ,. DOCUMENTS Y (REQUIRED DETAILS ON PLANS CON ?'D) ( PEmkITT APPLICATION HOUSE SEWER - V.- FT. 4 "0'; TYPE PIPE CAST IRON Le ELL PER�iffT OR PWS LETTER (CPC -97 (—J LETTER OF AUTHORIZATION (!/ )DESIGN DATA SHEET (DDS) (_'CORPORATE RESOLUTION C�SHORT EAF PLANS -THREE SETS, ))HOUSE PLANS -TWO SETS UUVARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION UBDIVISION APPROVAL CHECKED PERC RATE (_J FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED V LANS SUBMITTED TO DEP ELEGATED TO PCHD EP APPROVAL, IF REQ'D EEP TEST HOLES OBSERVED ___ERCS TO BE WITNESSED APROVAL SSDS ADJ, LOTS 'LANDS (TOWN/DEC PERMIT REQ'D ?) A ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION TER BI/ZBA )100 YR. FLOOD ELEVATION W/I200' )SOIL TESTING LOTS>10 YEARS OLD REQUIRED DETAILS ON PLANS )SEWAGE SYSTEM PLAN - (NORTH ARROW) )SSDS HYDRAULIC PROFILE )GRAVITY FLOW )NSTRUCTION NOTES 1 -15 " ',SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED RIVEWAY & SLOPES, CUT )OTING /GUTTER/CURTAIN DRAINS SDA SOIL TYPE BOUNDARIES ITLE BLOCK; OWNERS NAME ADDRESS 4TM , PE/RA; NAME, ADDRESS, PHONES )DATE OF DRAWING/REVLSION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS C-!<LAKES,WETLANDS WITHIN 200' OF P.L. ( JPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/W 200' OF SSTS (__)PROPERTY METES & BOUNDS COMMENTS: \O BENDS; i`LAX BENDS 45° W /CLEANOUT RENEWALS )SITE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS / FILL NOTES 1 -5 �, FILL PROFILE & DLN ENSIONS )FILL IN EXPANSION AREA FL GREATER 7WJ N 2 FEET fCLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES (—JVOL ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS U)SEPARATION DISTANCE FROM TOE OF SLOPE / TRENCH �LF TRENCH PROVIDED 60FT AMAX. (PAP kLLEL TO CONTOURS 100% EXPANSION PROVIDED C. DETAUJDUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER * SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' L 1 DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (mc. ezpan) (50' TO CATCH BASIN, 35' STORbIDRAPi1, PIPED WATER 10' TO WATERLINE (pits -20 ( 6250'MEMMITTENT DRAINAGE COURSE '00'/500' RESERVOIR, ETC _ 150' GALLEY SYSTEMS ))10' ivI]N TO LEDGE OUTCROP SEPTIC TANK ( --Z10' FROM FOUNDATION; 50' TO WELL WELL �DLNIENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION C OX 1 `i IT TO PROPERTY LINE SLQFE )(_JSLOPE IN SSTS AREA 520 0/6) ))REGRADED TO 15 %, IF REQUIRED DOSE/PUrTP SYSTEMS OTES 75% OF PIPE VOLUME/DOSE VOLUME NOTED D L FOR FORCE MAIN, (PIPE TYPE, ETC.) PDD-BOX SHOWN & DETAILED L•f fESTORAGE ABOVE ALARM CURTAIN DRAIN (� STANDP�DS=---5 S, 5' BOTH SIDES, DETAIL 15' bIP�I -1 %,100 % -Q% (_}20' N D DISCHARGE/100' with 182 cons day discharge ))10' MIN to NON- PERFORATED PIPE q ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , �-- �9 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner WA id, &:�F_ Address Located at (Street) /Z-f , �} Tax Map 9 3 Block ;2- Lot &'5 (indicate nearest cross street) Municipality jam,} r Tr_°z —n/ Watershed J�t¢!57- RAyj_-. g SOIL PERCOLATION TEST DATA Date of Pre - soaking Ull f d® Date of Percolation Test G z e> 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. JW Form DD -97 5 1 , 3 :2 °' 027 -3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. JW Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. �'L. HOLE NO. Aloe" t', -�-o OIf r6ilual No /P le�[�"f'ivN 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: Date 16¢� Design Professional Name: Address: Signature: Design Professional's Seal rA o ,K,o n v air i- -. - CpG a - Stieet_of PUTNAM'COUNTY DEPARTMENT'OF HEALTH DIVISION OF ENVIRONM -ENTAL EEATLH.<SERVICES FIELD ACTIVITY REPORT - TPi: Nf %9 A ° n C c+ Ve 6TW T� Street To _ State Zip PERSON:IN CHARGE .� n- ig TNTFRVT.PWpT) .TlatP G�9' %da Name and lrtle TYPE OF FACILITY . FINDINGS _ — 1 7777, �. y. ;Signature an Title -_ _ _ ; -I acknowledge receipt o£ this report . S IGNATURE; CA :- .. Title• 0.2/96 - �s Sent By; TOWN OF CARMEL ENGINEERING; 9146287085; MAR- 6 -00 TUE 10:52 AM PUNA14 CTY ENY HEALTH pwic ffearrh Dfmw DEPARTMENT I Oeneva Bcewater. Now Jun -14 -00 7:09; Page 112 FAX N0, 19142787921 P. 2 LOWMA biO mmu RN., M.S.N. Anoswe P Aft lYr M D>+'earer DkWW of Pause+ &"Im OF. HEALTH Road York 10599 ATTENTION: o ADAM STIENICLING GENE REED All infora+atioa below must In fdx comptewd prior to my scheduling. DATE; ENGINEER OR FMM: TO" " 14A P-4"U . PRONE M: ` Z- W 7 REASON: DEEPS: )L PERCS: J( PUbW TEST: O :► t- i + r ors Nt MENA ME JOW Unn ANn .ISt.t'.'.'ih OF 90H. .'rt YES NO a NK PropotW &M within the drainage pain of west Branch or Boyds Corner Reservoirs. a )a Proposed SS'Y'S within 500 feet of a ramoir, reservoir stem or control Islas. t) )q Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o Proposed SETS design Bow greater than 1000 gallow/dny or SPDES Permit require& a Proposed SSYS for a Commerical Project. It is the responsibility of the design profaskmal to provide ttte above Wor>gaation prior to soil testing. This Department wOl determiu! the NYCDEP project status (Joint or Delegated) based on the response. If you answered XU to any of tits gnesdons, NYCDEP mmit witness the soil tudog This Department wilt coord me it mutttdly suiable lima for Add tuft with the PCDOH, the Design Professional and NYCDEP. If it project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDLP is roquired to witaeas the and testing, it will be the sole rapontrbilit7 of the design professional to s dWule mwituessing of the soil testing with NYCDEP. folk counyUMONLY DATii / �...ta 0 Tam - • - - - / a " !' ° c ,r4+ 56 1� o AL g �� C 45 2 54 53 .13 Ac. $ g .29 AC. � � e ' • � /4y 9 7 ACSI 1158 5 Q! tt 1 3T AC. � y�4i � X =1.12• '� AC y, . 25 y'F4 !�� I.N AC.E �° N ��6351 4s Yryl.a ' .,.•�N ry 407 a 46 % ° I 81p6B'AC.g 81.72 aC. 1.23 AC.s•► SO s y4� �2B N � I.�r 6e Ck; ,y.D o .4 1.69 AC. Awa 9r 4 18.01 AC. g6} 48 4, �8� 1 URN a g . t�Z N 311.62 �i 40 1.56 aC I.1 �S oc'ac� a•n - 31 ,o \• 4 'n.y !C a • _ I. �� ALA '9/e son n 39 '4ie io¢o1 17Ati 1101• Ina e�3.77 AC. e 13 I i Y AC 46a �.,, e, Y I.QB X38_ 3T 36 35'6 34'33 32 M 76.11 AC. CAL. 1 1.49 1.40 1.36 1.46 1.24 �.. ( \ a AC. C. AC. pC, 1.14+ 3.20 AC. I `• �• 1 ` 'rsa o.o% N Toaoo o NAC. 375.66 l Moo I Y Y 21.2 0 ° rl, . 6.26AC. 23 v 1 ' Y � Y T3g5 �• Y j :,00 � °N 3.60 AC. d \ Y _ 164 io �\fff���=�C tk ROATB'IC �L I` 4 r- 7I \ UTf , 15 AL. AL I� \ • QC. a.t, to C 1.55 PC e "ke • at I. g4 B N s e 1.49 '� • e7 p Ilk ` ROUTE366� .Mr- Han is W04 23, 12 11�7 61 45 a 1.IS A 10.41 AC. 1.36 AC. Y CAL. 62 9.21 AC. y 63 Y y� 8.33 AC. CAL Y 61 �) a Y 47 , 1 .98 AC. CAL a, SCH I AL. 7.7A4* f. CAL.. h A_ C. 6 CAL � Y s AL 9 fi 59 Y 31 11 `O� ;60 58 , 0 8 P Y� 3L fi` 61e /I 57 3 Cb 3.41 AC. ' CAL n` / I.JALac. l e► s Y Y 56 ( 6e 65 50 1z 42.0 AC. �AL. tin I Ac CAL 9 i a 16.16 AC. CAL' Y 1 6 « , AL / cult' co I = I m 0 1 It � % i 64 • ,a CA1AG 1 3 C AL • 55 un S 1.60 At 519. 2 624.T0 / / • 1.92 A4 72 Y Y 417 54 4 3.30 AC. 1C i Y 11i- 53 1 Y PUTNAM COUNTY DEPARTMENT OF HEALTH � r� DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Ott ktL- U� Address gf-D %%�> /U � Located at (Street)e" IQ M/41ZALA& Y Tax Map ;t- 3 Block 7-- Lot indicate nearest cr ss street) Municipality Drainage Basin Date of SOIL PERCOLATION TEST DATA Date of Percolation Test PAJ Hole No. Run No. Time Start - Stop Ela se Time Min.) Nth to Water from Ground Surface (Inches) Start Stop Water Level Dropp In Indies Percolation Rate Min/Inch �° a LS 30 S I 2 X30 qv 2 3 3: . 3 4 5 i 2 ( z,4 7.7 3 3 is % 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top. of hole. Form DD-97 JUN-26-00 TUE 9:08 AM PUNAM CTY ENV HEALTH FAX NO, 19142787921 P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES /-.a DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM V 1 gTA -D ��O?c I'S Owner IAZA U, AcE Address Located at (Street) . —Rt 44 Tax Map Block ;L Lot 66- (indicate nearest cross street) Municipality -?ArZ9jz6✓& Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test 4 &9 De me VP 'M S 2 30 3 5 2 3 a# 4 5 2 3 4 Tes to be repeated at same depth until approximately equal percolation rates are obtained At each NOTES: 1. for 1.30 g 2 min for 31-60 min/inch) All data to be percolation test hole. (i.e. g I min min/inch, submitted for review. 2. Depth measurements to be made from top of hole, Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3..5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED L 1 TEST BOLES HOLE NO. xoLExo. z 1,f)T HOLE NO. , • 3 W301L- \4MA Indicate level at which groundwater is encountered Indicate level at which mottling is observed N� Indicate level to which water level rises after being encountered Deep hole observations made byllz&'e- �i �- Date zz- 2Y ". Design Professional Name: 1 " a' 794L- Address:. 114 CAJJ9A1k4J 00 A19 Signature: Design Professional's Seal �F NEW Y F� 532'n PROFESS�pC� IX, JUN -26 -00 TUE 9:08 AM PUNAM CTY ENV HEALTH FAX N0, 19142787921 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLRS DEPTH G.L. 0.5' 1.0' 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' 9.51 10.0' , HOLE NO. HOLE NO, 02, HOLE NO, 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: Date ���c►r Design Professional Name: 14 Address: Signature: Resign Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMEN'T'AL HEALTH SERVICES RE: Property of I�Ibu' Located at LETTER OF AUTHORIZATION TN P& gam` Tax Map # ),3 Block Z Lot Subdivision of ICE 6 t /-k Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize khfLt--L, C, a duly licensed Professional Engineer or 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 tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very tru Countersigned: _ Signed: P.E., RA., # Mailing Address �i C�� /�/dl �� Mailing Address % State Telephone: 3 Af %d Z-5 Zip /oS Q— Form LA -97 14.16 -4 (2107) —Text 12 f_�CT 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) SEAR 1. APPLICANT !S_ PONSOR _ ' 1, W 2. PR JECT NAME 3. PROJECT LOCATION ra Municipality . County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) -SaV44 of 5. IS PR POSED ACTION: New. ❑ Expansion ❑ ModifIc.tlonlal tarot Ion 6. DESCRIBE PROJECT BRIEFLY: � l , 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSXNo CTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Apt Yes If No, describe briefly 9. WH T IS PRESENT LAND USE' IN VICINITY OF PROJECT? Resldentlal [-].Industrial C3 Commercial ❑ Agriculture ❑ Park/Forest /Open space C1 Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)l /t ❑ Yes ��j Nr` o If yes, list agency(s) and permit/approvals 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permltlapproval 12. AS A RFSULT OE PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ WI Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �`� Applicantisponsor Dale: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PAR', 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) 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? It No, a negative declaration I may be superseded by another Involved agency. n Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, It legible) Ct. 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, signiflt:ant 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 CS. 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 C1-C6? 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 (Le.' 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 It you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. • Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Polia or 1 ype Name o Regrurnd r e, r er la I ear AeeurY Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 111 o u 1(ealnnui r n n ror Signature of Preparer (if different from responsible officer) q -0 b PART II— ENVIRONMENTAL. ASSESSMENT (To be completed by agency). A. DOES ACTION EX�yfCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. C1 Yes %NO S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supersede by another Involved agency. El 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: 416 C4. A commurifty'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 M C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. 1V® C6. Long term, short term, cumulative, or other effects not identified in CI-C6? Explain briefly. M C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. rM_ D. iS THERE, OR iS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes %n 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 supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible QDtficer in lea Agency 6 '�'Sfgwt ur Respons to Officer in Lead Agency �1 6a Date 0 17r12�a.�if� _ Title of R sponsi e Office( ignature of Preparer (it different rom responsi e officer) . FOX 3 Dat "e Subdivision Apgroved TypC00040 /A" 01 Nober of Hedto•i n Se -Ift S•w•e11111e Syoben to coadd. of Date of Prevlolm C Town .tT —k .% Fee Enclos —Lot Aeat A O�/�'rO Fm Seedon d _ Deems Flow. G P D PCHD NI —�-- L /Gellon Soptk Took eml_�7 l•' r To be ca usb ueted by- Watee Supply. pol`Supply Fens Addte•e Other L;/ ` J 1 [ L "r. ♦ iV Ae N :.; 1 f•premnf,.thabl . am wholly and eompNtaly responsible for the design and location of the proposed s a ) dAL1 t� rt wa •,dis •says stem above dasc►ibed will be constructed as shown on the approved amendment there to and in accordance` dards. ►ulefv r ons of • Putnam County WWrtm•nt of Mi kjj slid. that On completion thereof a •Certificate of Construction CO 1 ,[� tisfactpcy to i dm` ssion•r of N•aKhwill a submRt•d to the O•partm•nt ana a wriftsn yu•rintp will M turnishsu the.own•r. his succ• 3 or gns bY, tM�b ikl•r that• said builder will plat• in food pperstina condition my part of said mwaee disposal system duri ha period of wo I )yYssin m•giatlsly fol 1 ' thodat• Of the issue n ,Compliance Of the orq" i em or a r vthsxbto 2) ttiat_tM d it all described allow .. -, plan and hat�aid well will b• installed ,in cdr -co will b•flocat�tm•nt .n.. nda►dif rutdS-A is rq _ of the Putnam of Health. app►'foval Date r' Spn•d f!/ / 22 Address ; . �iCe11 0 (��FF �y APPROVED FOR CONSTRUCTION: This approval expires two years from the date .issued unless construe i Lit• ti has been undertaken and is revocable for cause or maybe anionded.or modified when considered necessary by tAelCommissioner 'pr' of N•alth. nee or alteration of construction ngluir•s a new per t. Ajwovd for. diapOyI f domestic sanita ss - qe; a Sri afe- at Rev. upp1Y -eMY. oat BV, 10/88 , Title i ,A y n ittbN_ qro twileal/ n Cbeen una..t ken .ane u MMRR "::Aey d1011a O/ •RNItbA. Ot COMhYCt1011.. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL /10' PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address " � / 1d,, YO Private by D Public USE OF WELL 1 - primary 2- secondary XRESIDENTIAL ❑ PUBLIC SUPPLY O BUSINESS 0 FARM 0 INDUSTRIAL O INSTITUTIONAL 0 AIR /COND /HEAT PUMP D ABANDONED O TEST /OBSERVATION 0 OTHER (specify 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE tO49O Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION ARMEW SUPPLY NEW. DWEL_LI G 13 DEEPEN EXISTING WELL GI ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE E&RILLED DRIVEN E]DUG O GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �� NO F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A'1J Lot No. WATER WELL CONTRACTOR: Name ! 'C7,AO 4f Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L�-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /,YIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETC&k SOURCES OF CONTAMINATION PROVIDED ON s: f SEPARATE SHEET —3---- '� (date) '`'` %signature): its" PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt -y (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a m ner as not to degrade or otherwise contaminate surface or groundwater Date of Issue: Date of Expiratidnoo" 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well T '� PC -1 PU -rNAM COUNYY ®EPARYMENY OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A 'WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 1J D L-Da S . R f' /�' \� l 7� 2• Name of Project: � 3. Location T /V /C: 4. Project Engineer: TS NT'1'�.'�v�C�i1� -'I 5. Address: L- -d L% ' License Number: Z3 V Phone: 6. Tyae of Project: L _ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Tvp� Status (Check One) Type I.. Exempt Type II. Unlisted _)i� 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. _NO n 9. Has DEIS been completed and found acceptable by Lead Agency? ........... A+ 1 ,fit 10. Nara of Lead Agency 11. I sthis project in an area under the control of local planning, zoning, o rother officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Ha; preliminary approval been granted by such authorities? Date Granted: 14. T yp of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. Ifsurface water discharge, what is the stream class designation ?........ 16. W airs index number (surface) ........... ............................... 17. I s ?roject located near a public water supply system? .................. N 0 18. Ifyes, name of water supply Distance to water supply 19. I s?roject site near a public sewage collection or disposal system ?..... I 20. N as of sewage system Distance to sewage system i.� 1 +1- 7-11V1 —Zf-- OF 21. DaE test holes observed: <S� /JkO 22. Name of Health Inspector: 23. P rject design flow (gallons per day) ....... ............................... Yoo =I 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within designated • Town. or State. �� wetland? ...... ............................... . 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... rC) 30. 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 or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15% slope? ........................ �J 0 35. Tax Map ID Number ......................... ............................... 36. Approved Plans are to be returned to: Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: ni��t/wi7 /• I / DI- NY 1:0 • Y+ Y• DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM . FILE NO. OwnerP�L��S W5A�� Address Located at (Street) ,�� Sec. A�3 Block aZ-- Lot (indicate nearest cross street) Municipality Ant re t Watershed _tom 7 W.00-mWIZA76 V% 249 -% Ll live Date of Pre - Soaking Date of Percolation Test HOLD N[R' M CROCK TIME PE RC OI ATION PERCOLAT ON Run Elapse Depth to Water FYam Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 9 Si S- Sv9-0 t45;L6lmG'�!!/S 2 3 .5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be suhnitt�d for review, 2. Depth reasurements to be made from top of hole. rev. 9/85 TEST PIT • r)-- T, ri WITH APPLICATION N TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1'. 2' 3' 5' . 0 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNUKAM IS ENCOUNTERED . INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING R< _ 450 '�V� DEEP HOLE OBSERVATIONS MADE BY: DATE: 1JrJ1t3LV ow f"F+ Soil Rate Used Min/1" Drop:- S.D. Usable. Area Provided - '0C0F7- No. of Bedroans Septic Tank Capacity 1 L• 0 gals. Type Absorption Area Provided By L.F. x 24" width trench^r; Other /5 l/' 17Tf U V S) Name N�C� Signatur ; Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date -e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at F Date (T) UiilaS Section Block ?--_ Lot Subdivision of �� T - i Po /t, l) /4 L--- Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize--,TIA) 117141r&,- d r Ao- a duly licensed professional engineer ���r�- (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned P.E.,A.r:, Address Telephone Very truly yours, { �A1, Owner of Prbperty Address 3 Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL ri 3� 1 PCHD PERMIT # WELL LOCATION Street Address To Village City Tax Grid Number s � Z WELL OWNER Name Mailing Address c� OPrivate ❑ Public U,SE OF WELL 1'- primary 2- secondary GhdSIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT '""` gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 6QQ gal O REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION GI ADDITIONAL SUPPLY DifEW 5UPPLY EW DWELLING ) D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING wk g WELL TYPE WRILLED 13DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES Q--''NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: '�_,�-[�`�� -� - �jt jCA�' Lot No. 9 WATER WELL CONTRACTOR: Name -77 15 ,E , Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES yIPO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH& SOURCES, OF CONTAMINATION PROVIDED tt E ON SEPARATE SHEET 8l[PJ�9'3 (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;• (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health / Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 4 199 = y'�. Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Re: Property PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ►1/��US�' �� �237 of 6rjec_,vs1g4j v )?() L')�2- Located at (T) `� i G`� ��' LNU2MSection Subdivision of Block Lot 6 Subdv. Lot .# Filed Map # 2 Zj(p Date Gentlemen: T. MICHAEL DALY, P.E. CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize---- "- RN9fiA6i�, IVY —i ^5°� a duly licensed professional engineer V or architee (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, /�Q c � Signed ' "­7 Countersign Owner of Property P.E., R.A. , # Address T. MICHAEL DALY P.E. Y , r �` clff T aT. , Address CONSULTING ENGINEER Town P.O. BOX 243 N. Y. l0S$7 �_1A- F�Ci�-�� ;tilr'f•, ^h!;r;)�1C, j L Telephone 7 i- Telephone � - • -s�«r� - N� '6 '�' - ��'.. �"'�"�- �37:�. +� �,'�r'u,,Y rr �'c�Y�- �- ���•e �. - r" w?. x" ^(7 °:.�'���rse33�Y?e",- ;s�^�.' , 4 � wr�000�DSe�az�Nr�o��uis -, s oliwYoo�wYSool�fonbooa�o1.,N? IMU - Mti<w�Wl�wtalt/ _- x. � • OEC0I1ltJA= ` -- b COIrlIDCifOl1 /Ot now D!"OYL =- :. of TOM R lfro t`i'"Crt3a,? -ti. i Lot / T� .t..i :". it 7"' ' A 2L di n ' Otfor/I�ot Nooi���.��� •.�..�.."7"i,�� � - � . Dot ot.iefr�lw ItiN A/iw Tom' Yiii� ly�o'' Lot Aws ? '� P� SoetlMi t} r N ioe:�/ ta..�. Dootp;PNw G ! '_D M b Mulled *ilwlm b- -#t7, Q, s - a writ /�% !font Aiio - - " "oe, �.-'' *+gr her D.i b �' t �` ' • _ - Oioe �o�wh 1 0, Not that I'm WMNY •t1d eomtiNtMY �q?eMIN tp.ttN -dNi�n ana_loeation Of tM ,p011sMll syktinggt 1) tMt tM' Np<t►attt }siw' o Ni oglr f�rR«n aNw`Nwtlod wnt;M oaiRrye oa&s ;. igwn`e11 ti* apgew0 snwMAnt«ti tMn to aM to aeoe►t1�na,wttn.tlii Wn/wdi; ruNt a n- a RiRAf CMntlY coomtttwtt �ef NINNIi, Mld tltit on eoitt�Nttaiahv�et !�Gwtifitgto M f erftrndiett g*iP4, lyFAW'- tatMoetery to tM:COnt�tNNOpn N FINN11wIN M ftrfflNtM b t1N D "1MM; -aM,o wrNtM_taYMMMM wNl N turwNhw tM.gwow. Jolt UMAofWy k*$6e ot11t11 'by,•the fmodsti.'tlrt fold IMPOW wNl. E t is lMd . dam Mw/ttNw,Mtr "Nrt of OM stMt!oM t dwift-ti porm W ivw ( �.YMn Mur»NNMy tog OwMq tMMto of ttN Ittw aneo N tM aMrorM M tHF t�rtMkdo M CoitRnKttse CewtNMne� et iM eryiMl 10,1400 a ontr tMrototli ttkt tM drNNd woM doMrtko/ aMw - /tr�M..Netttd N ltoriw M tM.NMOrM Ow w4tMf nN W" wNl'M Napa M wNk wMS aM r4 tM hdeNw F Doto C ?"'1 ^y fiNtN i tip /a It./i�re . APPROVED PC* t�NiT11NC?IOMi,71ik ^%""I i-Kwa two tars trooiaM �ti itilMd unMts e6nftiirction tow tuildkw:M ttMn `unN.takin atd K rwwo>•N /t► pYN trr ftNY M',aawdM °eI 1tIMIi1M wMn ooMldstyd ift"wY kY tM t:oinmMlian► of FINN11. AnY elwteN a aNwo/gn of totttruttptt F tNrMM� i�r Iwo�N. AaMOrM hr d1odMM of deeiidk owNa►Y t�wM4 oM/o►' o►Iwto "wNw tasrNY oMfr , Y PC -1 PUTNAM COUNTY DEI�ARTMENT O>E' HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: DO 2. Name of Project: ki 3. Locatlo T,V /C: � G 4. Project Engineer: ::1—, 5. Address: t,'-Ulc License NumberArA-68 Phone: ' 6. TTyp of Project: 1/ Private /Residential Food Service Commercial Apartments Institutional Mobile Home:Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Iygg Status (Check One) Type I.. Exempt Type II. Unlisted ✓ 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. O 9. Has DEIS been completed and found acceptable by Lead Agency? ........... !0. Name of Lead Agency 1. Is this project in an area under the control of local planning, zoning,' , or, other officials, ordinances? .............................. ..........� y4L'D -.QT- 2. If so, have plans been submitted to such authorities? ...............:.. 3. Has preliminary approval been granted by such authorities? — Date Granted: -' 4. Type of Sewage Disposal System Discharge: �k'.P.) Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) ....................................... ...... 7. Is project located near a public water supply system? 0 0 8. If yes, name of water supply Distance to water supply— 9. Is project site near a public sewage collection or disposal. system ?..... 0. Name of sewage system Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) .............. ?:�:................ A 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. b 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State t� wetland? .................................. ............................... 1� 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? .... Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC.Stream Disturbance Permit? ................... C) 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 or NO 32. Is project located within 1,000 feet of existence,t)f, abandoned landfill,. hazardous waste site, salt stockpile, landfill:; sludge disposal site or any other potential known source of contamination? ..............YES or NO �f DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ...ti.................. 5 36. Tax Map ID Number ........................ ............................... , �3 -Z �� 37. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. 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 be 1 ief. False statements made herein are punishable as a Class A Misdemeanor pursuany'�to Section 210.45 of the Penal Law. A -, /) /% SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: I• •• I)NOIN 9121 U UD) Ili! • •' • P •' i 1$ kN A V •1 --A• ffi- DESIGN DATA . EET-SUBSUFACE SEWAGE DISPOSAL SYSTS • • Address _ (indicate - • street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUnm TO HE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 4- t -4-p ( Date of Percolation Test 4 -t 8.6 HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 12:Zo -ZAI 24 Zj 3 2 V41- 3202 '�1 '�$' Z17 3 -ND Z -3'.26 Z4- 5 1 2 Z. ?x9 5 Zo 7- 3 z.l 2.4 z 3 Z 4 5.5'. 33 - 3' s4 Z4- -214- '13 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. G 1' 2' 'S1Z0Wg LO^ 3' 4'� 5' 7' tAo > .GvDCA 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEINGS ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:- le�sPt�JN1 DATE: Ej DESIGN Soil Rate Used •—jQ Min /1" Drop: S.D. Usable Area Provided SWO No. of Bedroams 4 Septic Tank capacity IZ,m gals. Type (` —N Absorption Area Provided By x,44_ L.F. x 24" width trench Other -Ci '. %V Name I MICHAEL DALY, P.E. Signature UIGINEER Address P• D. BOX 243 SEAL PJ- Y. 10587 THIS SPACE FOR USE BY HEALTH DEPARTMENT' ONLY: `41 * w 04f3a60 Soil Rate Approved sq. ft/gal . Checked by Date APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PER�flT E OF OWNER STREET LOCA ON D MENTS. DATE TAXMAP # fit° PERMIT APPLICATION Cam' ISCHARGE (OK) PC-1 DEEP HOLES LOCATED WELL PERMIT P RESENTATIVE OF PRIMARY AND EXPANSION ENGINEERS A[TTHORIZATION `'o' • AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE DESIGN DATA SHEET(DDS)`ID PIT & D BOX SHOWN & DETAILED ,mss B - NO. OF BEDROOMS DEEP HOLE LOG & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM CONSISTENT PERC RESULTS (3) PERC HOLE DEPTH RO METES & BOUNDS CORPORATE RESOLUTION SE SETBACK NECESSARY (TIGHT LOT) PLANS THREE SETS OUSE SEWER - 1/4 "/FT. 4"0; TYPE PIPE © NO BENDS; MAX. BENDS 45 W /CLEANOUT HOUSE PLA►vS - I WU =13 VARIANCE REQUEST GENERAL - LEGAL SUBDIVISION SUBDMSION APPROOV CHECKED PERC RATE FILL REQUIRED e!� 3..S- r CURTAIN DRAIN REQUIRED EEf§'r4�pH1ES FILL SYSTEMS AL: SLOPE 3:1 TO GRADE H GAUGES PROFILE '& DIMENSIONS VOLUME TRENCH EX- APPROVAL SSDS ADJ. LOTS [(� _ CH PROVIDED WETLAND (TOWN/DEC PERwr R & D)_ 60 FUT. MAX . DATA ON DDS PLANS & PERMIT SAME ' PARALLEL i .i EL TO CONTOURS PRE- 1969 -NEIGHBOR NO CATION m 100% EXPANSION PROVIDED LETTERBIIZBA A SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR. FLOOD ELEVATION FIE UIRED DETAILS ON PLANS p.L, DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NO 0' FOUNDATION WALLS SSDS HYDRAUL OFILE GRAVITY FLOW 0 TO WELL, 200' IN D.L.O.D., 150'.PTTS D/ J BOX CIIiGALLEY Cr] h7AILS TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK -- SIZE, DETAIL TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 92�00- TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) TIV'IERMIT'1FNi DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS . RE SERVOIR, ETC -M 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOS SEPTIC TANKS DRIVEWAY & SLOPES CUT 1011ROM FOUNDATION; 50' TO WELL FOOTING/GUTTER/CURTAIN DRAINS WELLS [MENTS: 15' WELLTO P.L. Z-1 0 I- Y „ �( \7�/\/ • ' Putnam County Department of Health i,•eelr�. ;. _. .__ r ervioe8 v— ironmental Health S OAS-BUILT KAFA%ql IPPkAP*KIT4Z - N01 C A REMARKS 25 c .4 flow eAMy IV, .7 54. 7-0 :jf66 A 30. 5-7 In._q., 6 11 too IS l—F 2E��2� p 33� L 0 a X33 -333 J Q W a 3 V j FL-/41,N SC AL-F- 1 " = 20' puttfnYa D4AluSon of ErvScunar. A i;.b,.o rules Ycrt::,rn r,punt9 Health FL-/41,N SC AL-F- 1 " = 20'