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HomeMy WebLinkAbout0713DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12-1-38 IN 60% 00713 1 PUTNAM COUNTY DEPARTMENT OF HEALTH .. IVISION OF ENVIRONMENTAL HEALTH SERVICES CE R I ICATE OF CONSTRUCTION OMP�IA T FOR SEWAGE TREATMENT SYSTEM PCHD C STRUCTION PERMIT # n�� Located at P6W D 1>e u 7 (v &-- Owner /ApplicantName gP,0U5t, 0.602 1VCTJQW Town or Village P'4 Tie of (-'r) Tax Map 23.17- Block Lot 3J' Formerl Subdivision Name �4' -M,67 AMID �i9LL- Subd. Lot .# 3 Mailing Address (0 Ock 15L4 && h 4fj LW N /0547__ Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by C P,005,f, C0079UCTI 0 � Address V& Consisting of 11-5 d Gallon Septic Tank and 4V0Q &YC '2-4-7- ?7U/)G'l-,�- Other Requirements: &L C-A"NdV 7— Water Supply: Public Supply From Address . , or: Private Supply Drilled by IV Y4r7- Address �. /; Building Type Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulati ns ol the P am County D partment of Health. i p Date: �1� � t �I� Certified by i P.E. R.A. Ate, � (D si rofessionala `� Address 3 3-5- C us# �/T�l% License # 6 3 '2-7 7 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director; such revocati0 odification or change is necessary. Y• B Title: r' �GL Date: hi- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy, - Design Professional Form CC -97 i ! � � | / / . ` ` Y ML. ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Haights, N.Y. 10598 (914) 245-2800 Albert H. Padovani5 Director LAB `# 93.015731 CL I ENT e 8641 41 NON ST AT F'F {OC PAGE 2 rt. fY nf.tfNN NW1Y -------------- --------------- fw.YfN;l::!.f ftf VS .V :•.•+v fJ -.•b';•J of .Vl ---- K•------ .L'fYN-- -f ----- WAi.. WALLACE, UCUSLA3 DATE/TIME TAKEN: 02/26/98 1005A 5A t A J :, BOX i54 t � /�. r�8 1; : ) E' MOHEGAN LAKE, NY 10547 REPORT DATE a M / 1 c`:_` /% PHONQ (914)-734-1187 AMPL I NG..'S 1 TE F LOT #3 LITTLE POND HILL SAMPLE TYPE..: POTABLE PRESERVATIVES NONE COL' D BY: UT-LAS WALLACE � TEMPERATURE..: < i4C. NOTES ... s WELL TANV.' :OL I F ORM METH-. �IF as K•MNNK•NN 1.11--- -'-- -- •NN.•K'f4•N.Yt K•.-------- -NA!—N.1 — ----- fYMNM h• Y:_ i' K• K•-- ------ n.•---- -------- fu`+`MII, DATE . F'LAS PROCEDURE . RESULT WORMAL '•- RANCsC;. MENU SUBMITTED E. Albert .� Dir c -tor ELAF'# 10323 YML ENYIRONMENTAL SERVICES 321 Kear Street , YurktowO Heights, N.Y" 105% `.' 0141 245-280O Albert H. Padovani, Director LAB'#: 93.015739 CLIENT #: 8641 -~~~~~~~~~~~~~~~~~~~~~~~.��~�~~ WALLACE v -DOUGLAS ' P.O. BOX 154 ' MOHEGAM LAKE, NY 10547 SAMPLING-SITE: LOT 43 LITTLE POND HILL ' : ESTATES. pATTERSONY'N.Y. COL/D BY: DOUGLAS WALLACE - NOTES """4'WELL TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~ DATE FLAG PROCEDURE ' PUTNAM CNTY 02/26/98 02/26/98 02/26/98 0E/26/98 02/26/98 02/26/98 02/26/98 ` 02/26/98 02/26/98 02/26/9B D2/26/98 PROFILE MF T. CQLIFORM LEAD (IMS) NITRATE NITROG NITRITE NITRQG IROQ (Fe) MANGANESE (Mn) SODIUM (Na) pH HARDNEG5,TOTAL ALKALINITY (AS TURBIDITY (TUR NON STAT PROC PAGE 1 --------------------------------------- RESULT ABSENT <1 U. so <0"{)1 0.102 <0"010 E4.5 6.9 48.0 <1 DATE/TIME TAKEN; 02/26/98 1005A DATE/TIME REC'D: 02/26/98 12:30P REPORT DATQ 03/12/98 PHONE: (914)-734-1187 SAMPLE TYPE".: POTABLE PRESERVATIVES: NONE-" - ' TEMP .": < 4C �OLIFORM METH: MF =~=-~~-~~~°~°~-~~~~=~~~~~ /100 ML ppb MG /L MG /L MG/L MG /L MG /L UNITS MG/L ' MG /L NA NORMAL - RANGE ABSENT 0-15 ppb 0 - 10 N/A 0-0.3 �g/l 0-0,3 mg/I NQ, 6"5-6}.5 N/A N/A 0-5 NTU COMMENTS: BAC| THESE'REGULTS INDICATE THAT THE WATER AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING 'THE NEW YORK STATE � ' AND EPA FEDERAL DRINKING WATER 'STANDARDB/ F�R THE PARAME�ER� ` ^ ° � � ` TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and v treatment must be potential" ublic schools are set at 15 ppb. Rule for Public 5ystems requires that no more distribution points have a LEAD value of more COPPER value of 10 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn.If both iron-and mangan?se are Present, their total value combined shall not excesd 0.5 mg/L1 Na No limits for Sodium are proscribed" Suglested guidelines state that for people on a sodium restricted diet;the water should contain no mbA than 20 mg/L of Sodium. For those on a moderately restricted diet; a maximum of 270 *g/L of Sodium sugge eo A i �t � . METHOD 1008 ' 12345 9139 9146 2037 9043 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM s C cr' L � 11(4 a3 , is lots or Purchaser of uilding Tax Map Block Lot 0 0 (kr- 1C, 5 111. / /a C V_ /�� r0a 5 e C 0 (4 Buildirij Constructed by f Po wde v, #;Ovm kad. Location - Street J ra M I' 1 k/ Building Type a14f s TownNillage L polld m? 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. Dari. Day l 6 Year 1 General Ontra#r (Owner) - Signature `MI vlh� Corporation Name (if corporation) Signati Title: Croa-c Corporation Name (if corporation) Address: S L. ,� Address: l'� ,Q �� IL e CIO 444, State kew y C) V, 1k Zip State a-Zip -97 Form GS A� i WELL COMYLETlUN KhruKl * * DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH 4 o-t # _q Office Use Only WELL LOCATION STREET ADDRESS. TOWN;VlCDMXrTr TAX GRIO NUMBER: P �, WELL OWNER NAME. ADDRESS: 6ro G)7 f . 0PSIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary m RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO.IHEAT PUMP O ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL O STAND -BY 0 MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE - gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION QADDITIONAL SUPPLY fffNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3K ft. STATIC WATER LEVEL 4 ft. DATE MEASURED l DRILLING EQUIPMENT 0 ROTARY VCOMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE / O SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER ® CASING DETAILS TOTAL LENGTH ^ ft. MATERIALS: STEEL O PLASTIC 0 OTHER LENGTH BELOW GRADE _ _r � ft. JOINTS: O WELDED lif THREADED ❑ OTHER DIAMETER _Z— in. SEAL: 9CEMENT GROUT O BENTONITE O OTH R WEIGHT PER FOOT 1b./ft. I DRIVE SHOE YES O NO LINER:OYES 60 SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? FIRST O YES 'ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH R. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED ; tests were done is in- COMPRESSED AIR , `. ormation attached? ❑ BAILED ❑ OTHER i ❑ YES 0 NO 'A'�LL LOG It more detailed formation descriptions or sieve analyses YY are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Ola- Meter FORMATION DESCRIPTION CODE It. It. WELL DEPTH It. DURATION hr, min. DRAWOOWN It, YIELD gpm. Surface 4 WATER YCLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAIL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELftfflIAjj _ HYA17 & SONS, INC. BATE / ADDRESS Well Drilling SIGNATURE Pte. R.R. 2 Box 1716 PATT[RI•?S 0N, N1 >4`J YORK 12563 3/89 ,7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7 Inspected by: ,:%;,., Street Location )DOWDER /:LZ A/ 'R Owner Town _. F,*Z-gMg;:n.A/ Permit # TM #_ 2?,, 12 -1 -Sig Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System - a. Septic tank size - 1,000 ......:.1,25 ........other ................ b. Septic tank installed level .............. ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box III -o ets -at same elevation -water tested................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft. Original soil between box & trenches Junction Box - properly set ....................................... ..d ...�• veX ength required #o o Length installe 2. Distance to watercourse measured+ 100 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 .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3%4 -1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum..... .. ............. 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems 1. Size o pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. -/ell located as per approved plans . ............................... b. Distance from STS area measured • too ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmansbin a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain. & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 nd 1 1 V I!�/I•� �� o �� 1. IOW , Imo® ism Imm '- Irk C° ' A � a POU)T�),��-ZzHolzlv Z— cf-2 1!4' Moor Jf also a . - -:C.'r, � qjD N `, J� fJ � 1 Z � y 2e visf�- ;h�pect;oh, �i I� �PNCP �`� in�f«!led� 5 i,9 i5 Gleavr �rot�t roaf5 cLnJ beu /dev -5, cover -3 a&4 ah6t T- 3©,e5 a►^e electb►, 70ej hu)`�deV ( bouy 7) -to r;5e well c'a5it7q 13"above grade a"d take ae SwalF f/ eLroo ,e well ,rarF/Nq wu3 not comple7LPC2 a.-/' this t;rhe. / Do e �d �� �hory GoVer atad �Vo�eh. 9 rovNA have b e en ve Dov 4,v 40vev 6Y5f-, -m 17J ez d v5 all e� J P, i5 PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: �S�i �D�/..� Inspected by: s Street Locati �r w- Town $ �-- POwner ermit TM _ _� , ! �Z —/� .3 © Subdivision Lot 4. -7 y L Sewage System Area a. STS area located as per approved plans .............. b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.DF c. Natural soil not stripped ...... ............................... d. Stone, brush, etc., greater than 15' from STS ar( e. 100' from water. course/ wetlands :....................... II. Sewage System a. eptic tank size - 1,000 .......1 2 .........other.. b. Septic tank installed level .. ............................... c. 10' minimum from foundation ........................... d. Distribution Box 1. All outlets at same elevation -water tested... 2. Protected below frost ................................... 3. Minimum 2 ft.Original soil between box & e. Junction Box - properly set .............................. L Irenches T-Leng h required Length installs 2. Distance to watercourse measured 3. Installed according to plan .......................... 4. Slope of trench acceptable 1/16 - 1 /32 " /foo 5. 10 ft. from property line - 20 ft.- foundatic 6. Depth of trench <30 inches from surface.... 7. Room allowed for expansion, 100 %........... 8. Size of gravel 3/4 - 1%" diameter clean ...... 9. Depth of gravel in trench 12" minimum..... 10. Pipe ends capped .......... ............................... g. Pum2 or Dosed Systems ISize ot pump chamber . ............................... 2. Overflow tank .............. ............................... 3. Alarm, visual/audio ..:.. .:............................. 4. Pump easily accessible, manhole to grade.. 5. First box baffled .......... ............................... 6. Cycle witnessed by H.D.estimated flow /cy III. House/Buildin a. House i ocated per approved plans ......q........., b. Number of bedrooms ....... ............................... IV. Well a. Well located as per approved plans ................. b. Distance from STS area measured c. Casing 18" above grade ... ............................... d. Surface drainage around well acceptable........ V. Overall Workmanship a. Boxes properly grouted .... .............................., b. All pipes partially backfilled .......................... c. All pipes flush with inside of box ................... d. Backfill material contains stones <4" diamet( e. Curtain drain & standpipes installed accordir. f. Curtain drain outfall. protected & dinto exist g. Footing drains discharge away from STS are, h Citrfare water nrntartinn nrlannata ®NMleeall.r� =niM NY1� b e�1r1.� ° 0 �4. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL /� n please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # ,� 5 p ' df L7 Map 7,3,12,Block Lot(s) 34K Well Owner: Name: P Address: rWM 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 5— gpm # People Served" " Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type __,&_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realt subdivision? ..................................... ............................... Yes X No � Name of subdivision (ME d PV 9 ` 0-1 i_L _ Lot No. � Water Well Contractor: 7-7 Address: Is Public Water Supply available to site? .................................. ...................:........... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be p ovided on sep ate sheet/plan.i` Date: Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l J A Permit Iss g pifficial: Date of Expiration 0 Title: p c Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 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 Town V llage City Tax Grid Number WELL OWNER Name Mailing Address ivate O Public USE OF WELL 1 - primary 2- secondary .,RESIDENTIAL 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY, O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 5'_ gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 600 Sal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY O TEST /OBSERVATION 12-ADDITIONAL SUPPLY V EW SUPPLY NEW DWELLING C3 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE ILLED DRIVEN F]DUG 13GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES P�1, NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name f 0 1z;)iI---,I 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: LOCATION SKETgM SOURCES OF CONTAMLNATfON FROVIDED f / ON SEPARATE (date) ,; (signature) PiRMITJ I ;O._�"C �S UCT A WATER WELL +� This permit to construct one wat w_ l,a;��t' forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New y:Pk< ate 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 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 APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER BY B. HEDGES R.MORRIS Y DOCUMENTS. OTHER DATE 1_1 Y APPLICATION TC -1 WELL PERMIT ED PWS LETTER AUTHORIZATION Ll D ,ESIGN DATA SHEET(DDS) ff Lj-dll RPORATE RESOLUTION S THREE SETS HOUSE PLANS - TWO SETS m VARIANCE REQUEST / SUBDIVISION LEGAL SUBDIVISION S5LIBDIVISION APPROVAL CHECKED ERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED m STANDPIPES TAX MAP # T. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED - NO. OF BEDROOMS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM tTY METES & BOUNDS SETBACK NECESSARY (TIGHT LOT) SEWER - 1 /47FT. 4 "0; TYPE PIPE DS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS 'CLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS M FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES OLL PROFILE & DIMENSIONS GENERAL L-1-4 VOLUME m �-,/ ' LL IN EXPANSION AREA � EX APPROVAL SSDS ADJ. LOTS OP-WETLAND ( TOWN/DEC PERMIT REQ ?) X; TRENCH ® PATA ON DDS PLANS & PERMIT SAME EMA. P TRENCH PROVIDED m60 FT MAX ;PRE- 1969 - NEIGHBOR NOTIFIFICATION PARALLEL TO CONTOURS R BI/ZBA 100% EXPANSION PROVIDED 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS $1WAGE SYSTEM PLAN - (NORTH ARROW) ,SSDS HYDRAULIC PROFILE m GRAVITY FLOW CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS *O -FOOT CONTOURS EXISTING & PROPOSED AY & SLOPES CUT 3 /GUTTER/CURTAIN DRAINS EROSION CONTROL; HOUSE,WELL, SSDS EROSION CONTROL NOTE PERC & DEEP HOLES LOCATED IMTRESENTATTVE OF PRIMARY AND EXPANSION yu 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS �t 15' WELL TO P.I 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER I V TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.=] 150 FT. GALLEY SYSTEMS 15' MIN TO C.D. S= >5 %,20'- 4%,25'- 3 %,30'- 2%,35' - 1%,100' <1% 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. S PTIC TANK 10' FROM FOUNDATION; 50' TO WELL COMMENTS: 612 �7?W_ A DTTTAT A AN !"l1TT1%TTV T1L'D A DTAR1VATT nZ, T1IM A T TiT (0"0 L _.............. RE: Pro..e y of " ROUS COIV. RUC77d Al p rtY _ ...... _.._.._....__. Located at Z 3 T/V Tax Map # 3 � I Z Block / Lot 3 3 .6� 3.S Subdivision of 2r 3, 571 / Subdivision Lot # 1 v{ i/1 v- Filed Map # Date Filed Gentlemen: This letter is to authorize "/U# t/ a duly licensed Professional Engineer ,X oFRegistered Ocehiteet to apply for the required wastewater treatment and/or watei supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Code. �CXREC� 0 y safer y �_ Very truly yours, P.E., R.A., # S Mailing Address A 642sl4t_— State A) Zip 10T1 1 Signed: v roa s 6 Lo K sTr wcrt A (Owner of Property) VP Mailing Address: State C4 rL&e 1I) ( Zip %0J IO2 Telephone: �y" �7� -��� �% Telephone: �. --..... - - -- - `�— �7�' ! r-0 =- - Mdba Ad Bwwbg I wa6w I r0p►esent1hal above described County Depir V be submitted place in good so" of the &I will be locartid County Depart Date ./ — oaaelat Waft Sop* DOW Aet Area Dedgn Flow G P D tGWom S%Wk Twit, d as shown on the approved amendment there to and In accordanaV46 the standards and Mulallons o e FlMnam and that on completion thereof:a 1!deitificate - of Construction CaAwl-Waiie sati0sciorytto the, Anfjwilorier of H"Ithwill 11 id a written guarantee will be.furnished the owner, his suoci s, heir's oriiisliris ij the b�=Iuit said builder will n any, Part of old "age disposal systorn. ituring the period of two n*416tily foikMio' t6edate of the Islas- Hilcati -of. Construction Compliance ', of this �oriqinal system or any I theretp.�2 that , -A A Y -A gr gpillad well described above proved plan and that mid well will be Installed In accordance t a A-""f Wn—jL-4f —the Putnam . t 6 APPROVED FOR CONSTRUCTION' This approval expires two years from the data revocable for,cause or, may be.,&'Mended or'modified'whon,cdnsid OW necessary 0 1 X.. re"uIres a new permit,,. Approved for 4iisPM­ I of domestic sanitary saw a. and Rev 10/88 D'a* By M P.E. 0_'_!�L_ R.A. ILL V o 2_30 Y . ,.license No cued' unless construction of the building has been undertaken and Is Commissioner of Health. Any change or alteration of construction p'%irater supply ohl�_ Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 22 -Mr. John Karell Tel. (914) 278 - 6130 Fax (914) 278 Oftober 1. 1997 P.O. Box 644 Carmel, New York 10512 Dear. VIr. Karell: BRUCE R. FOLEY Acting Public .Health Director Re: Proposed SSDS: Wallace Lot r3 Vista Delores (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: .'The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative to the need for approval of indi- vidual sewage disposal systems by the City of New York. You should contact cite Officials in this regard." 1) Construction permit numbers are to be provided for all renewals. 2) Soil testing must be witnessed by a repres-ntative of this department, i.e., deep test and percolation. tests. 3) Erosion control measures for the house and well are to be shown. Furthermore, the erosion control detail is not legible. 4) Standard notes do not list the requirement for wells yielding less than 5 G.P.M. 5) Well detail is not legible. 6) Location map is required on all plans. 7) Regrade the expansion area to 15% slope maximum. 8) Property metes and bounds are not complete. Upon receipt of a submission, revised to reflect the above, this application will be considered further. R./mh watershed Very truly yours, h, -Mm, Robert Morris, P. E. . Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278 - 7921 `%ur. Jolul Karell, Jr. P.E. 0111-met ToNvn Engineer Own of Cannel `.lc -Alpin Avenue Mahopac, \ew fork 10511 L ar \ fr. Karell: X/e— BRUCE R. FOLEY Acting Public Health Director October 8, 1997 Re: Proposed SSDS: Wallace Lot #3 Vista Delores (T) Patterson ;? of plans and other supporting documents submitted at this time relative to the above - oaptioned project has been completed. Comments are offered as follows: i he construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." •;Ni,ou are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of \ems- York, Title 10, relative to the need for approval of individual sewage disposal c-rstems by the City of New York. You should contact City Officials in this regard." 1) Regrade expansion area to 15% maximum. Expansion area trenches are to be shown. Hatched Iles are acceptable. 2) Erosion control detail and notes are not clear. ) Deep hole log for deep test hole #2 has not been submitted. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, . � h 4algml4o Robert Morris, P. E. Public Health Engineer RXI, mh watershed PC -1 PUTNAM COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: �� 1�►��� G�9"T �► "Ilwo-e- Iv y 1 51 2. Name of Project: i� °7 3. Location T /V /C: 4. Project Engineer: � � ��`� 1�� -' i 5. Address: T COA L � License Number: L Phone: 6. 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? ..............N 0 9. Has DEIS been completed and found.acceptable by Lead Agency? ........ N 'A 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. No A 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? NO 18. If yes, name of water supply Distance to water supply PAIL -f---S 19. Is project site near a public sewage collection or disposal system ?..... tj 20. Name of sewage system Distance to sewage system Pi LES 21. Date test holes observed: Ste' . 22. Name of Health Inspector: 23. Project design flow (gallons per day) ....... ............................... 11/93 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required?.. Lb 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within,a designated Town or State ,� /� wetland? ... ............................... ............................. !y 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... J O Has application been made to Town or Local'DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... 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: 1� 32. Is there a local master plan or file with the Town or Village? ........... / 1 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. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES i •FFICIAL T IT LE S• �' •;�� jES IJ, /� MAILING ADDRESS: �D La7#f -3 DESIGN DATA SHEEP- SUBSUFACE SEOM DISPOSAL SYS 94 FILE NO. OwnerpO /2/%(�si� /, Address.0 Located at (Street) U 1 S� D01.09k -5 sec )-3 J Zalock �_._ Lot 3 ra (indicate nearest cross street) A' mmicipality �(1 Watershed !`� Y6, Date of Pre- Soaking Date of Percolation Test 5 SOLE NOMBE•R CLOCK TIME PIICOLATION 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 a Si i- sz/Bp 2 3 4 5 .. NOTES: 1. Tests to be repeated at.sa depth until appraadmately 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 hale. • SST PIT DATA RmthmO . TO SE SLTBNIIZTED WrM APPLICATION DESCRIPTION OF SOILS ENCOUNMUM IN TEST HOLES DEPTH HOLE NO. HOLE N0. HOLE NO. G.L. . 1,. 2' 5' '/ Z2V.OW 7' s' 9' 10' 11' 12' 13' INDICATE BL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING f DEEP HOLE OBSERVATIONS M'1 DATE: DESIGN /NiM Soil Rate Used Min /1" Drop: S.D. Usable. Area Provided No. of Bedrooms Septic Tank Capacity 12,'50 gals. Type CO IV G Absorption Area Provided By 400 L.F. x 24" width tren FESSioN:a��. Other Name �� / /,/�N�C'� Signatures i� Address Z92 % �✓ S '� No 0? . ,. h OX�yyiq" A) Y F �G NE THIS SPACE FOR USE BY HEALTH DEPART(ANF ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at 11 1r> /4- CVO (T) AIIE�Sblj Section. ?/Block Lot 3 d Subdivision of Po /1" P /y" f L [.__ Subdv. Lot ## Filed Map ## Date Gentlemen: This letter is to authorize--,Tj&'A,,? ��! t �✓�[. `f /�� a duly licensed professional engineer (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 connect=ion 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. Coun ersigned: P.E. ''. V � ESSIOryq Address Telephone Very truly yours, S i zn e d Owner of Property Address 4,441-�L/ Town /aJOP 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 PCHD PERMIT # WELL LOCATION Street Address o Village City Tax Grid Number WELL OWNER Name O'fESIDENTIAL 0 BUSINESS 0 INDUSTRIAL Mailing Address ?a 50MQAoa*"r_p_t�"()7,L �J&IoSpO O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY ®Private Public 0 ABANDONED O OTHER (specify, 0 USE OF WELL primary 2- secondary AMOUNT OF USE YIELD SOUGHT 5"' gpm/ # O REPLACE EXISTING SUPPLY 1EW SUP LY NEW DWELLING ) PEOPLE SERVED_ & /EST. OF DAILY USAGE Qr gal O TEST /OBSERVATION 12 ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NOW C51 WELL TYPE DRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES /--'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: i WL> kEL- Lot No. '3 WATER WELL CONTRACTOR: Name -T—; 'F!> 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SbN SEPARATE SHEET i (date) (signs re) 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: Al_f „� e2_�� 19 Date of Expiration 19 S Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DateJi fJ� ?, Re: Property of DdueS 6yye_t.r),!;0(w bBA 6tz pl� "1Lj FjolL b6-r.. a- Located at 3 WS6 bcio'eC (T)?)zqt? Section " "� 1Z flock j Lot Subdivision of �,� �l r1o,41 14/j Subdv. Lot # 3 Filed Map �p Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER This letter is to authorize_ P. 0. BOX 243 SNCNAiiA6Y, �! =T�TA 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, � Signed Countersign Owner of Property' P.E., R.A. , ## CJ f'; �,�� =,�v 3w Address T. MICHAEL DALY, P.E. &I Lc_VC�1`1�� ��� G'� �✓� Jv � l (),�D Address CONSULTING ENGINEER Town N. 0. BOX 243 N. Y. 10587 OD 'U. Telephone Telephone PC -1 ' PUTNAM C OUN TY D E PARTMENT O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: ]DO u! 2. Name of Project: . LocatlooOTV /C: �A — 4. Project Engineer: tl 06 ;SA L= (J t:-, 5. Address: 1�vK Z4 3 iNi-'Nc u ,105 License Number: Phone: 6. Tvoe.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? ............. � U 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? ......... ............................... 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.�i-.'.F} ��- Surface Water Ground Waters 1 5'. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) ............................................ 1. Is project located near a public water supply system? .................. 3. If yes, name of water supply Distance to water supply" 3. Is project site near a public sewage collection or disposal system ?..... �} ). Name of sewage system I. Date observed: -- __ Distance to sewage system 23. Name of Health Inspector: 1. Project design flow (gallons per day) .............. !: �?U.Q................ 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 wetland? .................................. ............................... b 28. Wetland ID Number ....................................................... 29. Is Wetland Permit required? .............. ............................... �J 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 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 37. Approved Plans are to be returned to: ................ Applicant yEngineer 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 pursuan�To Section 210.45 of the Penal Law. / J SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 1:x.-05( 4-14-­5 Sl1�lo�DGC !� � /0573- DESIGN DATA SHEET- SUBSUFACE SFWAGE DISPOSAL SYSTEM ., FILE NO. Owner '��L'a cat�.l�Pa�o..) Address 'Qt) •P��D-�k.�?��11�Q.�'�'`r' Y 1051 Z� Located. at (street) GTA, '� fee:' Z3+ l Z Block I Lot (indicate nearest cross street) Municipality �ja-�-� -� Watershed SOIL PERCOLATION TEST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 4-i5 -86 Date of Percolation Test —4-Ls -a 6 HOLE NU-SER CIACR 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 1 1 1 :ma0 -1, 5-1- t� A4- 1 2 1.'JW -2' Jn 1 J' Z 4 3 I 3 Z2�l(1 --L; 19 S4- 3 � l 4 Z() --l'49 `ZI ZA �� 3 5 2 1 j:�5- x:00 l5 S4 Z 2 2 S4 z.1 3 Z 3T'l0--Z.'36 18 Z4 24- 3 � Z 4�L'.3G-'Z��- t� °L 4 Co 5 1 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 subaittt!d for review. 2. Depth measurements to be made fran 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. i HOLE NO. HOLE NO. G.L. _�r1 G 21 Ott rQfz2wj �JAT^ 1' 3' I►U�t �J�S 4' ADO. �y. GJM 6' 7.1 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:.. �Atla (.FagMAM4 DATE: -3 n h ?6 DESIGN - -- Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 4;boc9 No. of Bedrooms Septic Tank Capacity )-. gals. Type M� Absorption Area Provided By 400 L.F. x 24" width trench Other Name T. MICHAEL DALY, P.E. Signatur CONSULTING ENGINEER Cr Address P. 0. BOX 243 SEAL ,? SHENOROCK, N. Y. 10587 C� 04aA�°� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS / / REVIEW SHEET for CONSTRUCTION, P R�ICIT / IE OF OWNER �/ S SIREE;u—Z 7 ! �y� 4z (� ,__,,, ,� ►... DATE i TAX MAP # 2 :3, / •- m DTS. PERMIT APPLICATION ��' Z51SCHARGE {OK) PC -1 �� DEEP HOLES LOCATED WELL PERMT t RESEYTATIVE OF PRIMARY AND EXPANSION ENGINEERS AUTHORIZATION �� K. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE DESIGN DATA SHEET(DDS) �/� �'PMPED PIT & D BOX SHOWN & DETAILID DEEP HOLE LOG ��� pU4F - NO OF BEDROOMS CONSISTENT PERC RESULTS (3) ts►'' PERC HOLE DEPTH 4-.000 " CORPORATE RESOLUTIONjd° PLANS THREE SETS HOUSE PLANS - I WOM I S VARIANCE REQUEST GENERAL LEGAL SUBDIVISION e'a/' SUBDIVISION APPROV� CHECKED PERC RATE FILL REQUIRED j✓C�- !�– CURTAIN DRAIN REQUIRED J & SSDS'S W/IlV 200 FT. OF PROPOSED SYSTEM RO METES & BOUNDS SIJSE SETBACK NECESSARY {TIGHT LOT) MOUSE SEWER - 1/4 "/FT. 4"0; TYPE PIPE NO BENDS; MAX. BENNDS 45 W /CLEANOUT FILL SYSTEMS AL: SLOPE 3:1 TO GRADE GAUGES FILL PROFILE & DLN ENSIONS VOLUME TRENCH EX- APPROVAL SSDS ADJ. LOTS A160frMAX....... CH PROVIDED WETLAND (TOWN/DEC PERMIT R & D) r _ DATA ON DDS PLANS & PERMIT SAME pARAT �Fi_ TO CONTOURS PRE- 1969 -NEIGHBOR NO CATION m 100% AR EXPANSION PROVIDED LETTERBUZBA SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR. FLOOD ELEVATION UIRED DETAILS ON PLANS O P.L, DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NO FOUNDATION WALLS SSDS HYDRAUL OFILE GRAVTTYFLOW ir WELL, 200' L 1 D.LO.D., 150' PITS D/ J BOX �H /GALLEY m P. ETAILS STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK -SIZE, DETAIL CATCH BASIN, 35' STORMDRALN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 10' TO WATER LINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) To DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS M 200 . RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS IWO -FOOT CONTOURS EXISTING & PROPOSF�/" SEPTIC TANKS DRIVEWAY & SLOPES CUT ��' ice` 10' M FOUNDATION; 50' TO WELL FOOTING /GUrTER/CURTAIN DRAINS fMEN %21 15' WELLTO P.L DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 March 25, 1998 John Karell, Jr. P.O. Box 644 Carmel NY 10512 Re: Proposed SSTS: Grouse Construction Vista Dolores Road Lot 93 (T) Patterson TMir 23.12 -1 -38 Dear Mr. Karell: K BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: 1. Owners name and property tax map number is to be provided in title block. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, , P, G, ' # Robert Morris, PE Public Health Engineer R1YI:tn i County OWWW 4 of. NUa11A. nrt that orr •earyletbin,tamm.Ni :•�eorNrkata of Conahuetiai Cori�plMw<0' utMadory. t0 tM Comrnuawnar N MOattnwiN M wAnrtllM. tO.i a O mo tmwM. arm a written VAranao will be furmim io the owMi. Mt_weawr16 Mln or aMyMaay tM buNMr. *A QOM b~ WHO wo•' in tiiod .OWMM. riMdNktw. My fort: -N t�M °aawMa digOW .gttOrrr'OurkN tAi OKiod <N two'( =1 t knrrrodimw /oNOwMy tMdMO N.tM M� anal N .too aMrswt N tIM -Cortmate N' COnatrild CommuskO if tM wis NNl tytt«ri ar aMr iMO" t it) ibst tm grow won doarmse aioro ww;bo lose" as dmwnon tM approved tnkn.Mrd tkd.oiid we0 win .M ImuUN .In : MItk 1110 r app -!WAMW the Put"m corny► Oyortnninil`N INO1tR `^ �t,00, OMa {, j a 4 01. R.A. - AMROVEO 01041.1'W TMI aitNO.n OaoMw two Yaws ao�n tM data, ittrad rnknts eonsirueta N tM twlldw4 -!wt bon undertaken and is too@$ ki 4i aril -Of nyy.M ant ntiid Or nnedtfMd Won QOrMWa100 tneoiw:y t1Y 'lM Cennn kOienai of _Mialtn._ Any ,eMpa'a 410441160 of; C0lMtruotio n r00rN0a 0 ownnit.,'. AMrmo d�yt°w dison,aNON OinMwk onitirY nwMO. and/g.P ; waw :au00N only. ^ ��+ 5 � �a �r,,.�"° `t •�" : � �' .!'" :e^ �1► . w�"""`� ; �.. �.- ti"'"' x�, �-+'"' r'w "'���.ti`,s....•- ..'- ..."`,r .. -,..•. Tltl� °.-:::.�1�'�.. y ia DEPARTMENT OF HEALTH �. Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL 00 q, PCHD PERMIT # WELL LOCATION Street Address. (7!!O/Village/City Tax Grid Number WELL OWNER Name Mailing Address ®'Private 3 Q loSI30 Public USE OF WELL Of primary 2- secondary CKESIDENTIAL O BUSINESS 0 INDUSTRIAL 13 PUBLIC SUPPLY QAIR /COND /HEATiPUMP 0ABANDONED O FARM O TEST /OBSERVATION p OTHER (specify, M INSTITUTIONAL O STAND -BY O +' AMOUNT OF USE YIELD SOUGHT 5" gpm /# 13 REPLACE EXISTING SUPPLY 91fiEW SUPPLY (NEW DWELLING PEOPLE SERVED & /EST. OF DAILY USAGE (coo Sal O T- &ST /OBSERVATION Gt ADDITIONAL SUPPLY O bEEPENG E o ISTING' WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING 9 WELL TYPE DDRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES li'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �,,,,► "1''c�aara l��t Lot No. WATER WELL CONTRACTOR: Name 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ffON SEPARATE SHEET � kto. (date) (signs ure) 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 thirt3, (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 �a'ss not to degrade or otherwise contaminate surface or groundwater. 02- Date of Issue:. / 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 I 1005.18' �• PI n it °'11 411 of - -- — II tt Il - _ - J It ti � T tl U U 11 4" PVG I O g'o II 11 III 111 III 1 /5','/FT. O EXP NSION 11 ti 11 III A EA �i 11 I - :. 2 DH 11 11 11 t _ it . 11 II t J -fix r ii it n . t a ae e" ouT I �4� ! PRO It 11 II NO ELL It 11 N. I WIT IN II : It It 1 b MJN, - / WE tt II I� 1250 GAL. / DO' it II 11 ' It MASONRY- NO 5 D5 .11 n ,tl ii ►t SEPTIC SEPT9G '.. / 1001: cob 11 T.-ANK, to the ' R 00 F F'LAN • SCALE 1" _ 20 . - �. ;.�I�i .Y _ . -�.'�` .1- .. .- r F ;1 �L. L.i�.... - .- i -. 'sl.� .. �� s : ?. Y .• ., ..' S. I.x � ♦ .. ... _. � v - LOT '? PUTNAM COUNTY' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #-GI Located at �� J)b 1,0 �.� Subdivision name L lhi C -Subd. Lot # Date Subdivision Approved 3 "L k - 9 7 1D0uc7 -5 W AAG*C �. Owner /Applicant Name r.d g- uc,; o Al Town or Village PA�Sd� TaxMapr3•IL• Block Lot 3k Renewal �_ Revision Date of Previous Approval 9 bi Mailing Address i-AA1a f� � l��41 iL 5L CAYA e--,L . A) /G-P /2- Zip Amount of Fee Enclosed Building Type 10000 Lot Area 3 `3b No. of Bedrooms �1 Design Flow GPD S-0v Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 S-0 gallon septic tank and Other Requirements: To be constructed by '7 6 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 therpto. ' - Z� Signed: � P.E. � R.A. Date Address G Y C&RAW_ A)"' r%a L/)--i-,icense # 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 f . proved discharge f domestic sanitary sewa onlyy�. B Title: �'l /� 11w Date: �d lc) �' �` Y• White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy. - Design Professional Form CP -97 'T e - F4V -,d. A "This is to certify that the sewage treatment system was constructed as indicated on this plan and that AS—BUILT fore it was covered over. The system was ASUREMENT . S the s ystihs was inspected by me be ulations of the constructed in accordance with all standard rules — .4 "s Putnam County Department of Health and the New York State Department of Health. Li I jj i J..:-! Putnam County Department Of Health Division of Environmental Health . ServiO88 Approved as noted for Conformance with apprrjable Rules and Regulations Of the. Health Depart- t • Signature & Title r7w# 23,1 2 -1-3$ F*WV A#*P ROMA 0044- *45 -cuv-r. # -0t gt14,1 NO I --;EA � ARKS REMARKS - fv 47 '-72- ou 3 I08 101{. i -1 sax 110. roux -7 105 l30 UP 0 - 11 1. =Iq 141 -1 Ito it 135; a q-, Io q LL W,,!- L- L - L-r- R&J> -0400 400 A"VI L.r 11 1P 51 0 to Li rnc '040jvo MILA- "T-03 VISTA JORYKARELL A P.E. .W- P.a 644.' PADAjrBOX f ArVM519