Loading...
HomeMy WebLinkAbout0634DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -66 BOX 7 00634 M. ' :T F'� 1 L . f• 'I r so z ,� y i i _ rol�l or y 'T a pm 00634 t, 1t PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at !//57,-4 ®0Z-,0,1.� Town or Village �'!} 71MS'd Al K7–) _ ,000k��-s W4-L A —C-& Owner /Applicant Name Tax Map Block Lot Formerl Subdivision Name' Subd. Lot # 7 Mailing Address /: JVX Al Y Zip %C7 4 Date Construction Permit Issued by PCHD Separate Sewerage System built by Consisting of % 2- 50 Other Requirements: Water Supply: Address Gallon Septic Tank and :500 7�r � Public Supply From. or: X Private Supply Drilled by Address Address Building Type GUOQD fi�4 Has erosion control been completed? Number of Bedrooms -71 Has garbage grinder been installed? A,� 0 i /M -7- : U M I L Cdr A S - Bvl tir 1P6X4J PVa- A9 -5 OZ h I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putriam County Department of Health. Date: 6 111Qe Certified by P.E. R.A. (Design Professional Address 53 6 e US ;!�Aj Al / f}�� �/�T7�1�s0/U V, License # 157 WZ7 % 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 am subject to modification or change when, in the judgment of the Public Health Director, such revocari, ificatio r change is necessary. By: _ /41�� Title• Date: / of White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ' ' YML ENVIRONMENTAL �ERVICES ''� 321 KeR Street � Vorktown Heights, N.Y. 10598 M-2800>- Albert H Padov i Di bz ' ~ a� , rec� r � � CLIENT #: 8641 NON'STAT PROC. pAGE 1' .�..~~~.°~~~~~~~~~~~~~~~~~-~~=~~~-~~~r� ' � ` LACE v �Oi�;LAS� DATE/TIME TAKENi 02126/98 1D:45A BOX 154 - DATE/TIM%,REC'D: 02/e6/9f� 12 pop". MQHEBAN LAKE, NY 10547 ~7 T DATE: 03/12/q8 ' �PHONE: (914)-734-1187� ' ' ` �^ SAMPLING SITE: LITTLE POND HILL ESTATES Ln� #7 S TVA.,: E x v ` � ' ' ` ' � I _'- - ` ' , - ' - 4t � ����* � __-_ ' ' k T_--�' URU- :{ ,NOT K[TCHEN TAP COLIFORM wETHYnF ` ' DATE FLAG PROCEDURE RESULT NORMAL '-� RANGE M�TH��' � .. � . PUTNAM CNTY PROFILE 02/h/98 MF T. COLIFORM ABSENT /100 ML NT � 1« ' �5 ---5 02/26/18 LEAD (IMS> <1 ppb 0-1 ppb 1234 . . . 02/P6/98 _ NITRATENITRO8 0.43 MG/L 0 - 10 9139 0E/26198 NITRITE NITRbG <0.01 MG/L N/A . 9146 � 02/26/98 'IRONAFe) 0"107'M /L 0-0,3 mg/l 2037 ' 011019m. <0 SE (Mn) .010 MG/L 07013 mg/l 1 2027 , {��/a6/qB� '�� ` � ��IUM 'Na) 2�5.4 M[� N/A ' .. ` �- ' ~ �_'02/26/98 ��w '. � 7~E� U!4ITS . /�,5~8.�5 904(� � - ` 02/26/98 �H��DNESS,TOTAL 78^0 N/A ` � 0��/2�/98 ALKALINITY (AS 46,0 Y1�^-'1`7 N/A . . � 02/2n9B TURUDITY (TUR <1-N& ., .' ` 0-5 NTU ' � COMMENTS ' k HIACT FA �� I E NEW YOW STATE ` OND 'E PA ` FEDER^� ^ ' D. INU<INS WATERA ' ND ARD S�� F `THE FARAMETER H� OFCOL � ^ � � T ES TED A T = �� ' Pb/Cu LEAD JAM for. pUblic schdo���are set at 15jppb. ^ EPA Lead & Copper Rule for PublicAystems roouires that no � �ha� 1�% of t�e�r dstributio! ��nts have � LEAD value �smore � than 15 ppb and a COPPER value of 1.3 mg/L, else water treatmynt mudt'be undertaken `toraduce the waters corrosive potehtlaij � Fe/Mn If both i7on and manganese are present,/their total valuv combined shall not exaeed 0.5 mg/L. Na No. li&ta for endium are proscribed. Suggested guidelines state that for people on a sodium.restricted diet,the witer shpuld contain no more than 20 mg/L of Sodium,j Forthose on a ' � moderately restricted diet, a maximum of-270 mg/L of Sodium is suggested. ` � . � � � � ` �. - ~ r� YML ENVIRONMENTAL SERVICES ' 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2808 . Albert H. padovani, Director ' LAB #: 93.015739 CLIENT #: 8641 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WALLACE, DOUGLAS DATE/TIME TAKEN: 02/26/98 10:35A P.O. BOX 154 . DATE/TIME REC'D: 02/26/98 12:30P MOHEGAN LAKE, NY 10547 REPORT DATE: 03/12/98 PHONE: (914)-734-1187 SAMPLING SITE: LOT#8 LITTLE POND HILL SAMPLE TYPE..: POTABLE ESTATES. PATTERSON, N.Y. PRESERVATIVES: NONE COL'D BY: DOUGLAS.WALLACE ' TEMPERATURE..: < 4C NOTES...: WELL TANK COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ - DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ' x�wr SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) ' Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 4, rou S e (014 s Owner or Purchaser of Building Tax Map Block Lot Crouse (0r1 S iruc yt,o 7 Building Constructed by Po W' Ve r / Location - Street 1 P V S 01h TownNillage L ks Subdivision Name Fam J\/ ra /1`ti , 7 Building Type j Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day 30 Year _" 0 "ze_ — General ont fo' r (Owner) - Signnature _Ahzta�. Corporation Name (if corporation) Address: % X /144ett4e State ke L yob k Zip _�O Y2 Corporation Name (if corporation) Address: State Zip Form GS -97 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Map,-)-,3 Block °off, Lot(s) �6 Well Owner: Name: + Address: t�fw5e'On5t t&C t 'b Use of Well: 1- primary 2- secondary _L 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 _ajj_ft. Diameter _ in. Weight per foot __L'Zlb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes _No Hours Second Well Yield Test _ Bailed _ Pumped is Compressed Air Hours _ 61 Yield _j gpm Depth Data Measurt from land surface- static specify ft) e During yield test(ft) N► Depth of com2leted well in feet 7 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 0 If yield was tested at different depths during drilling,' list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typ Capacity 19 IYl Depth � Model 6OLL14 VoltageO;16 HP Tank Type l�e�,l VolumeD Date Well Complete 111W,77 Putnam County Certification NO. 4/ 12�/q port Well Driller (signature) Aerie,/ Z§&t NO TE: Exact location of well with distlinces to at least two permanenyland/harks to be provided on a separate ptevplan. Well Drillees Name Address: a �� Qh ' "•/ J Signature: Date: l/ White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 C7 ♦ I «�i>9 nmsrr. 71" of =e! �il'1 �- O +Y.'•PA �w1�,.'I "�i< q:r V:il`:.d� I!:i IrH. bat.; �:.r. , ti na r:�u+!.x,.:.y .�r3 r.4, ', : W..,.,c �t•a -+r,. h Y I ♦ i : 1- > r r-;,h. d MOM 01 �a ,/ ,l'l. WAY" W r r .i 0 >� scmdoll 0* HIM Wmgn Fbw c p D O >pCHD N Re MWMIN4 wism FE RD on 4BObd so S T® k3 Wall= s an iPdlerafaa d 1,� �' S C 1 r resont;.that 1 am wholly and eompbtely responsiblo'for the A ®sign and location, of the propo % .y m(s) 1) "ttuft tAO;�parate Farago di sal syst®In OdM above described will , be constructed a shown on the approvod amendment there to and in accoedan `wit `fhe sia�dords, ►vies a raga, ions o 0 nam Coun4y popar4mea14 09 0-0®Ditti, .orl®,tAot on eoniplotiow ,thorod4_a':CeP4i4iCOt0 ,09 Construction pl,'nc0'� .Btisfnetory'to thorConiinissbnrnr of Hoilthuiill be submitted to f6io Do®IDltfngl4,' and .o efrittOn .guorontoo will be furnished the oamav, his die sso� holr8 Cr ;oBOi�na' by the puils0p, t01a4 said bulkier will plate in good oparatlno condition any part of isid .smvago disposal "system during tho period (2)� yoo6s imma0late follow thedato of the Illow onto of the opproaih of'tpo Cortifkato of'Conctruction Compliance of, t igma, m or l> 6 dri aroll do=ib!sd above WHO � located as shovnn on Qlea approvfd pion and that said well will 60 Ins4 a 8t r�p;, ru �o ' oilu ens of the Putnam Coun4y, Opavjtment of Hd91 rd a�' h Oats (a rl o Slanod' P.E RA. _ / q t d 23; 7 dAddross rr �'N -� ieor s .No APPROVED FOR CONSTRUCTION: This approval ettpirOS two years from the dato :issued. unless construction ra4ftile buiMing`.has boon undertaken and is revocable for couso or may be amended or modified.whan considered nccasmry by'. the Commissioner of HcAhi r'�Any,chai a or alte7ation of construction roquiros a now Per t. B+ proved ford i of domestic sanItaiy seCYa ator supply only. Rev. . - �' S 10/88 Dato�, s>r��� T:t�, DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL /0 — -3 �q PCHD PERMIT # l� WELL LOCATION Street Address own Village City Tax Grid Number WELL OWNER Name Mailing Address a ( a-Private Public USE OF WELL - primary 2- secondary "SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION O INDUSTRIAL O INSTITUTIONAL O STAND -BY D ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT _gpm /# O REPLACE EXISTING SUPPLY C4MW SEgPLY NEW WELLING ) PEOPLE SERVED _ /EST. OF DAILY USAGE (aQQ Sal O TEST /OBSERVATION GI ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE 13 KILLED DRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: — Lj__ Lot No. WATER WELL CONTRACTOR: Name -rl n , 7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,r.. NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 94 a k - SEPARATE SHEET 0 , V"�' i ?7, I�AL � 'a (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 thirty (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: /T 19 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 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL _ PCHD PERMIT #/ WELL. LOCATION Street Address ' vigi-DIZZ s To Villa a City Tax Grid Num er —dam WELL OWNER Name Mailing Address ,Private O Public USE OF WELL 1- r 2 - secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION 0 OTHER (specify ® INDUSTRIAL U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT -5— gpm /# E3 REPLACE EXISTING SUPPLY LIJEW SUPPLY NEW DWELLING PEOPLE SERVED �9_ /EST. OF DAILY USAGE60V gal ❑ TEST/ OBSERVATION 12. ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING a" WELL TYPE MZRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 14-7'I-Lt-- 51�AT Lot No. I-M WATER WELL CONTRACTOR: Name J • 6r D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES %NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: ,?t; xi LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED JZPN SEPARATE SHEET A�4ellllA� _' - _10 F (sign use) (date) 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: _ ___19 Date of Expiration .0- 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 PC -1 PUT NAM COUNTY D E PART M E N T OF H EA EY H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: .L D 2. 4. 6. Name of Project: 7 3. Location T /V /C: Project Engineer: 7E N'(l,'{�►��� -'� 5. Address: lee t'/ft" � cfl J License Number: Phone: Type of Project: _ 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 (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... (V A 10. Name of Lead Agency I 11. Is this project in an area under the control of local planning, coning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water _ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. N 0 18. If yes, name of water supply Distance to water supply tAl 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance to sewage system / +r 7-1pW 21. Date test holes observed: _ ' '_ 22. Name of Health Inspector: 23. Project design flow (gallons per day)! ............................... SO® 11/93 ' 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? ........................ 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. Fa)se statements made herein are punishable as a Class A Misdemeanor pursuant'to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: C P(esl -de 2 MAILING ADDRESS: 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 a designated Town State wetland? ........................ ............................... .or• • 27. Wetland ID Number ........................ ............................... - 28. Is Wetland Permit required? .............. ............................... I Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... �,r( 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 jam; � C` 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? ........................ 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. Fa)se statements made herein are punishable as a Class A Misdemeanor pursuant'to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: C P(esl -de 2 MAILING ADDRESS: f ••' M DI• •OY I DN &C : �• Y: / / / DESIGN DAM SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerP%L0)9G� y'�./ 1 Address &.� O " / �l�i�� / Located at (Street) V6hL �jQji 4t-f Sec. A3 Block Z- Lot t (indicate nearest cross street) Municipalit Watershed SOIL PERCOLATION TEST DATA RBounw TO BE supmnm) WIM APPLICATIONS Date of Pre - Soaking Date of Percolation Test 5 HOLE 2 mmm a= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From 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 3 4 S- SvAjo LE //Jl-IJ61/S 2 3 4 5 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 fran top of hole. rev. 9/85 DEPTH G.L. it. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUNDKATER IS ENCOUNTERED INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING E!�� DEEP ROLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Il Y Min /1" Drop: S.D. Usable. Area Provided No. of Bedroans Septic Tank Capacity 2 gals. Type CO A G Absorption Area Provided By d L.F. x 24" width trench Other' Name 11A /V1, Signatur , ; Address OF THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date Is ° PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at V D CR// (T)�- Section 1.-'77 Block -2-' Lot 6)� Subdivision of �% T - t, Aj/1: Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize --IT)All a duly licensed professional engineer E-- (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. P.E. , A—W.. , Address Telephone Very truly yours, Signed!L2�.1�'b1. J'.7GL�fZ� Owner of Property '66) Address Town le-5-111,9 Telephone APPENDIX 3 'PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER. SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION P RldIT fE OF OWNER // l G/ SIREi `T LOG ON DATE .Z.- TAX MAP # .. D NTS. � � e2 PERMIT APPLICATION Gam' ISCHARGE (0 Q DEEP HOLES LOCATED PC -1 ��.. ENTATIVE OF PRIMARY AND EXPANSION WELL PERMIT P ENGINEERS AUTHORIZATION Gr' R97.�RIEA, SHOWN; GRAVITY FLOW, SUFF.SIZE SHOWN DESIGN DATA SHEET(DDS)/'� ID PTT & D BOX & DETAILED DEEP HOLE LOG �` SF - NO. OF BEDROOMS CONSISTENT PERC RESULTS (3) 40-00 & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PERC HOLE DEPTH_ ,.�' Pi METES &BOUNDS � E SETBACK NECESSARY (TIGHT LOT) CORPORATE RESOLUTION SE SEWER - 1/4"/Fr. 4"0; TYPE PIPE PLANS THREE SETS NO BENDS; MAX. BENDS 45 W /CLEANOUT HOUSE PLANS - ISPO`SETS VARIANCE REQUEST GENERAL LEGAL SUBDIVISION SUBDIVISION APPROVV CHECKED_ PERC RATE 60 / FILL REQUIRED CURTAIN DRAIN REQUIRED STAES EX- APPROVAL SSDS ADL LOTS = -' CH PROVIDED WETLAND (TOWNMEC PEPME R & D) --�°" r 60 FT MAX DATA ON DDS PLANS & PERMIT SAME "' EUppRA i LEL TO CONTOURS PRE- 1969 - NEIGHBOR NO CATION m 100% EXPANSION PROVIDED LETTERBI/ZBA SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR. FLOOD ELEVATION UIRED DETAILS ON PLANS a - P,L, DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NO 0' FOUNDATION WALLS SSDS HYD�ROFILE GRAVITY FLOW 0 TO WELL, 200'L-4 D.LO.D., 150' PITS D/ J BOX NCWGALLEY CL� P- -TAMS XT, O STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL CATCH BASIN, 35' STORNIDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 10' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 20 . RESERVOIR, ETC -ED 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSS SEPTIC TANKS DRIVEWAY & SLOPES CUT ,� '"- 10' M FOUNDATION; 50' TO WELL FOOTING/GUTTER/CURTAIN DRAINS WELLS [MENTS: 15' WELLTO P.L. FILL SYSTEMS : SLOPE 3:1 TO GRADE Wof -I GAUGES ,FELL PROFILE & DIMEiNSIONS VOLUME TRENCH PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date l�vG,(,��f �'l 12 Re: Property ofDl� eeS ()?1er7am P/`I" Located at-1 04 olere -.S (T) `77_140 0 Section Block - Lot `O Subdivision of Subdv. Lot # Filed Map Date T. MICHAEL DALY, P.E. Gentlemen:' CONSULTING ENGINEER This letter is to authorize P. 0. BOX 243 a duly licensed professional engineer V/ or (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, _Y4 S i gn e - � /�'z/�'_' Countersign ►,� Owner of Property P.E., R.A., # Address T. MICHAEL DALY P.E. Address CONSULTING ENGINEER P. 0. BOX 243 N. Y. 10587 q 14 - & -Z/ Telephone Town (6114) N _�3 &0 Telephone DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner -mac a �At?�11 Address R �F) 2FQA QUF:�mma -r,�`E . l0 S' 1 Located at (Street) X11 b t� Mrs 1 -[�cP� S � 3 Block Z Lot Co 6 (indicate nearest cross street) Municipality �{ _.,ptJ Watershed • ■ • �1- �• F,y meam Y V-S . 8• 111 • 5+/ • -.14 1 X11 115 m h.- V-3 . • • Date of Pre- Soaking 4 - l 6 _6b 6 Date of Percolation Test 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 2 ki100 W50 'SCE 24- Z 1 O l 3.11 ©--ll'•52 '� 41 Z67 t 4 (I •y'Z- l Z�4 7� 7i4 ZC� Z 1 1 Z l 10' '55 - I[' --A Z 2 it'OG' -- tC Z* 2 S i t 2�- -' I l' �l 4- S4- 5 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 ENOOU IERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. p y G 1° 21 1Z� 3' 4' 5v t �A ` JartD�GZ- 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: 14 C / MSt - � % e DATE: - - DESIGN - - -- Soil Rate Used -k,[ -lr; Min /1" Drop: S.D. Usable Area Provided Go No. of Bedrooms,. Septic Tank Capacity 1 gals. Type '-C Absorption Area Provided By _gyp_ L.F. x 24" width trench Name T. MICHAEL DALY, P.E. t -,. i ,� -Address P. 0. BOX 243 SEAL THIS SPACE FOR USE BY HEALTH DEPAR]NT ONLY: xA�F� N Soil Rate Approved sq,ft /gal. Checked by Date PC-1 PUTNAM COUNTY DEPARTMENT OF HEALZ"H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: ]DO MAKE 2. Name of Project: 3. LocatloOTT V /C: �A 4. Project Engineer: _VA —`(T 5. Address: yx Z4- License Number: 46468 Phone: 6. TTVDee,of Project: V 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 (SEQR)? Type Status (Check One) Type I.: Exempt Type II. Unlisted ✓ S. Is a Draft Environmental Impact Statement (DEIS) required? ............. (� 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 0. Name of Lead Agency v 1. Is this project in an area under the control of local planning, zoning', .or other officials, ordinances? ......... ............................... L:D ..fir 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.��.�! 5cwt', Surface Water Ground Waters 5. If surface water discharge, what is the stream class d$signation ?........ S. Waters index number (surface) ........... ............................... _ F. Is project located near a public water supply system? .................. kt 0 1. If yes, name of water supply Distance to water supply"" 1. Is project site near a public sewage collection or disposal system ?..... 1. Name of sewage system Distance to sewage system . Date observed: 23. Name of Health Inspector: Project design flow (gallons per day) .............. 4? ................ 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. q o 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State N ib wetland? .................................. ............................... 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? ................... 1 d 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, of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO 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? ........................ 36. Tax Map ID Number ......................... ............................... 2 `� - 2 -Cain 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 belief. False statements made herein are punishable as a Class A Misdemeanor pursuantlo Section 210.45 of the Penal Law. „ I SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: I. 5e l h 111tnam County Departaent of Hearth JITUton of Environmental Health Service, Oproved as noted for conformance with tpplicaDle Hulse and Regulations -of the ttnam County Health Department.. el �p 2 .. n� o� Od �ry PR� NO All DRAIN oc °4" ,A0 - 4 a G 4" %FT. 1250 L. 520 M f k NRY P2 No 0 LOT Z 1.15 AG. 61M ,IC F1L" mA? an 5: Fova�6�ibN v�y ay "oTE- : Water containing more than 20 mg/l of sodium should not be used for drinking by people on severely restricted sodium diets. Water c I t containing more than 270 mg/l of sodium should not be used by S O _ —04 people on moderately restricted sodium diets. - �, 47 � sv� !� �jEGDS 1 wAV—vrT oAr�D Iz1414� Soo G,F 89° 2G,_.r3,t t60,.03 LOT' 7 ,Ag.r--A I.o3o36k-e,0S t df g €ait put'nam Coup th Berviao VQision of Envir I _ noted f� 4 ,Approved s- able Rule- and RBgoia a CO Y Realth Depar 19 5= AS —BUILT MEASUREMENTS rlo A B REMARKS' "This is to certify that 1-% HSI 41o'&" 143 T6BX 41. 4 q - my, constructed in accordance with all standard rules and regulations of the Health and the New York State Department of 17 Putnam County Department of I re VD- X Lt c►SIO� 50 •\,9A 0 10 tb S0 \,v �So A � G T 9 $S 511 I CR/D 10 it o, s ' o j0 -oa ,f C N iZSoy• CONC v SEPr�c -,tM'� I A' N D — ^♦ Y !i' n_ RLVCR�N9 14 �3 I S-9 I I "This is to certify that fj cz the sewage treatment system was constructed as indicated on this plan and that the system was inspected by the before it was covered over. The system was s I . D constructed in accordance with all standard rules and regulations of the Health and the New York State Department of 17 Putnam County Department of I re Health. " Ulb'i °9SD5 ,wr,tr: cr.NO. _oT# 7, V I STA DOLO 4T7 CPOND fl /LL A5, _ PATrEa5:;MI (7T) - Dow-, I.kS WAI -L17 UE'o 69OU50 CONSTl2 tl 2.V-#9,.G�i�ST�T C.IfAqge-,'NY . /,q oliNKARF+ 'DNCa 9fiL ?hC .l Ll. JR.�.E 2 P.O BOX � gaysl2'�xay .`r `° I rA