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Home My WebLink About0773DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -81 BOX 9 17% Ll me ' IN 11--1 I � or6 '6 �' 'L` rL J I ' � N , . 1 6.21 e 1 00773 - Rev. %8g PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services,.Cermel, N.Y. 16512 Englfieer Mist Provide b P.C.H.D. Permit 0 RTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM y� . T R ., 'C,YSl7✓1,_ . , Town or V e Owner /applicant Name Ma ft Address ZIP Separate Sewerage System built by v Consisting of 1 Z6 � Gallon Septic Tank and Tax Map 29. Block --Lot SpbdiAslon ' Nameg 2 i.ei Sabdv. -Lot # Date Penult Issued & 1 / 991 0 L, 1=. /94 re j, io fu,,, / e Water Supply: Public Supply From Address �/ or:QD Private Supply Drilled by ,tl Lie Address �� _ "3 I � c+ S o,� ) , I Building Type Erosion Control Been, Completed? - . Number, of Bedrooms - -- Has Garbege Grinder Been Installed? /VQ Other Requirements I certify that the` systems) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are attached),'and in accordance with the'standards, rules and regu tions, in accordance with the fi 7pl , and the permit issued by the Putnam County DepartmenCt� Of Health. Date `2-7 _ ° - C rtifled by ` P.E. R.A. Address 'C y `t o License No. Any person occupying premises served by the above system(sl 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 sewerage system shall become null and void as soon as a pubt,: sanitary tower 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 Commissioner of Health, such revocation, modification or change Is necessary. Date ��_,f , / 7 /�.- g -`-°' _ i�� -9 TIt1. a YML Environmental } Services 321 Kear Street, Yorktown Heights, NY 10598 ELAP #10323 (914) 245 -2800 Floss Plan 25 Byram Lake Road Arntonk, New York 10504 /'0 Cr / LAB NUMBER 93.00E,140 _Lj DATE /TIME TAKEN 1 3/11/92 2: OOpm DATE /TIME RC'D 3/11/92 4:10pm' DATE REPORTED -:-) - /�- - ' Z SAMPLING Water Tank: Lot #4 -Big Elm SITE Subdividion Big Elm Road Patterson, New York12563 For Lab Use Only ,Potable _ HNO3 _ pH LT 2 _<4C _ Nonpotable _ NaOH _ pH GT 9 -` <20 >4C _ HCl _ Na2SO3 _ >20C COLD BY Poss Alan (914) 273 -9629 _ STAT! H2SO4 ZnOAc NOTES 1'ILL P/U @ CA • • • • MF MPN P/A X RESULTS OF ANALYTE RESULT UNITS ALKALINITY mg/L AMMONIA mg/L CALCIUM mglL CHLORIDE mg/L COLOR Units CONDUCTIVITY umhos /cm COPPER mg/L CORROSIVITY LSI DETERGENTS . mg/L FLUORIDE mg/L HARDNESS mg/L IRON mg/L LEAD mg/L MANGANESE mg/L MERCURY mg/L NITRATE mg/L NITRITE mg/L ODOR TON X RESULTS OF ANALYTE RESULT UNITS pH . S.U. PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ZINC mg/L SPC per 1.0 ml, TOTAL COLIFORM per 100 ml, FECAL COLIFORM per 100 mL E. COLI per 100 ml, FECAL STREP. per 100 ml, These results indicate that the water sampl [WAS] (WAS NOT) [NAJ of a satisfactory sanitary quality according to the New York State Sanitary Code, for the ters tested, at the time of sample collection. These results indicate that the water sample [WAS] (WAS NOT] [NA] a satisfactory chemical quality according to the New York State Sanitary Code, for the parameters tested, at a of sample collection. /� % = Not Applicable N = Not Present (Negative) SUBMITTED BY. ��`�' 1 1 � �'��"�� -�� j = Present (Positive) SA =See Attachment(s) �• = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than 914-098-6114 ALBERT M HYATT &!SANS l•IELL DRILLING; 012 P02 3/ ts.9 WELL GUMYLETIVN Kt:rUnl Office Use Only Ad * DEPARTMENT OF HEALTH ti Division Of Environmental. Health Services PUTNAM COUNTY DEPARTMENT Of HEALTH �a--- LOCATION SIREiT ADDRESS: TOWN/VILLAGLIC TOWN/wt, /C T a 4,46 TAX GRID NUn+9Ep: WELL R WELL OWNER NAME: ADDRESS. F IVATE !��' c 0 PUBLIC USE OF WELL RESIOENTIAL O PUBLIC SUPPLY C) AIR /COND. /HEAT PUMP ❑ ABANDONED 1 • primary : 0 BUSINESS ❑ FARM .0 TEST / OSSERVATION ❑ OTHER (specify) 2- secondary 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND -BY p MOUNT OF USE YIELD SOUGHT — gpm. /N0. PEOPLE SERVED / EST, OF DAILY USAGE �00 gal. REASON FOR EPI ACE EXISTING= SUPPLY ❑TEST /OBSERVATION � []ADDITIONAL SUPPLY DRILLING 9EW SUPPLY (NEW DWELLING) [j DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH . -19 9 ft. STATIC WATER LEVEL 01-7— ft. DATE MEASURED DRILLING 0 ROTARY COMPRESSED AIR PERCUSSION 0 DUG EQUIPMENT 0 WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH ft. MATERIALS: STEEL C PLASTIC O OTHER LENGTH BELOW GRADE ft. JOINTS;. 0 WELDED THREADED 0 OTHER CASING DIAMETER in. .� SEAL: CEMENT GROUT ❑ BENTONITE C30THER DETAILS WEIGHT, PER FOOT . _,___Z (b./it. DRIVE YES _Q NO E LINER: C YES NO EEK DIAMETER (in) - 'SLOT SIZE TH (I DEPTH N (it) DEYELOPED7 tasT . o Na kTA ILS N - . _ WU GRAVEL PACK L DIAMETER TOP f)oTT t a uos SIZE OF PACK._ In. DEPTH 1t. DEPTH ft. WELL YIELD TEST If detailed pumping P A g 1 f more detailed formation descriptions or sieve analyses WELL LOG M 00: O PUMPED tests were done IS in are available, please attach, if COMPRESSED AtR 7 formation attached, DEPTH FROM Well water SURFAGZ: 8e7r, Iha- O HAILER ❑ OTHER '13 YES C3 NO It. ft ing etcr fppMgnOk OESLRIPTIDN t:OOE WELL DEPTH DURATION DRAVlOOWN YIELD 3uitace Q It. hr;- miff, tt. opm. d 6 W08 CLEAR TEMP. ItIALITY ❑ CLOUDY HARDNESS ❑ CDLOPED ANALYZED7 Q YES t7 No ANALYSIS ATTACHED? O YES 0 N STORAGE TANK: TYPE CAPACITY GA7„ PUMP INFORMATION TYPE CAPACITY WELL DRILLER NAME DATE/ MAKER DEPTH ADABERT M. HYATT & SONS,S'vium f+l00EL VOLTAGE NP Well Drilling Rte. 311 R.R. 2 Box 171A - _ ner,•rn�nu 141CIA1 VMMV 19R93 3/ ts.9 PUTNAM-COUNTY DEPART OF HEALTH DIVISION OF ENVIRONiZENM flEALT i SERVICES Owner or Purchaser. of Building Building Constructed by Lora '• on - Street I lriunicipality Building Type _ -:2-,f, / C9 e Section Block Lot Subdivision Name Subdivision Lot # GUARANM OF SUBSURFACE SMGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal - 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 detennination of the Director of the Division of Envi roninenta , Health Services 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 this Z 0 day of 19 12- General Contractor (Owner) - Signature Signature Imo.► . A J i Title A' _.� Corporation Name (if ROJ Corp.) 2S- r �a Address rev. 9/85 mk C rporatii��n Rym (if Orp.) Address J Via: ZT" == ZCC-' -rs-• cs c? �..rc ijl -clans Civil ? i YES NIG _- ' IT G_ � G- 1 i _._am- 1 /000 ..�_C, - b t?C t�L_� -G- 1 1 -- - S.1 Ri IL i _ Cf-1 T' c'; cEa ea E. i 1 i I1! i Y I 1 I .I • I I • I I c=t �= =— - -e_ r1— we - ='- - -Z-- _ ' -J32 Me 20 • _ 1LCGC� -r C_ `- ^C-'- Ems' -= -- G _C = r Sl! c cf J. _ I c_ Cf-1 T' c'; cEa ea E. i 1 i I1! i Y I 1 I .I • I I • I I r I c_ C_= ac ^W4 f — °=a t:h Gf I < < n 2.r' -�= f. to E'�c�_1�cL= r 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL R_Yl PCHD PERMIT # WELL LOCATION reet Address Town Km 11 a City Tax Grid N tuber a�. -� -�g -6 . WELL OWNER N e M in Addre s /� Private 0 Public E OF WELL primary 12--. secondary & RESIDENTIAL ❑ IC SUPPLY D BUSINESS O FARM 0 INDUSTRIAL O INSTITUTIONAL ❑ AIR /COND /HEAT PUMP O ABANDONED 0 TEST /OBSERVATION ❑ OTHER (specify O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE p- SERVED ,� /EST. OF DAILY USAGEff gal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13. ADDITIONAL SUPPLY dNE0SuPPLYkNEw DW LLING ) Ll DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING es �A Or 'WELL TYPE I&RILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No( WATER WELL CONTRACTOR: Name 7-V7 Address: .IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __)�_NO NAME OF PUBLIC WATER SUPPLY: A)11A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED M ON SEPARATE SHEET (date) V ( Rnature 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 dril operations be contained on this property and in such 0 manner as not to degrade or of a is contami to surface or groundwater. Date of Issue: Date of Expiration 1917,J Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller P?? DDC 3 P =,:M COUI\- i_ `='��' Cr f�1, H - —SICti CF LcCi�� =*�' r, i- r—T i SzR - LIOIV7,L r, i�:` _� Sig - PLY & S� �i =aC �'rr� ?C D =S �t, S*yc' is 0� r —iced 60 ft. Max. 009 ex-D. ::Ouse P l a-ns - Two se-s S/S LION ?arc (3) fi:_ ca Wal r Variance Re 0es t —'al Subdiv_= -oil SUIDCH isi on Approval Checked x- eop_ct•al SSOS ?di. lots Checked i -� GHQ (T—.hi /,�C Permit R & D) Data On DDS Plans & ' -r-m L Seine REQU = D=, A _ O-N P :--- -NS Sewage S,-vs-Lem Plan - (north a=rcw) - - G=--: = _ = ' SF��Q� S?S�r^7 ?1 �r^,�1 'C PrO�'1° =_. .v cq j_ pr .0 i le &j Di_-•-"S -cns - 'Vol, =me D or J BCx ;,Trc -,C'? /C.l lery; ?=q pit S-4 e i= over c.- St_.,ctiOn No (c_in er rate) D•__ve aY & Sio_v =.S h.-L •✓�t11��LUi-=- ,L'�'La_ 1 Drc'_nS (d; sc.= CIO Represent t L e of p r_i =`% a_a=..ar_ cn rr� j d c .V' itGa,�ii =. �_Ze If PLr� Pit & D Bcx Sho -i & De t=i_ ed :no -1se - No. of Badrxr5 P, ails & SSUS's ,; /in 200 ft. oz 'r_ c nrty :'motes & Do•�_-:ds - - Ho- -'s? C°_ =^_.?c{ N'ecasx_y lot) Ho--,se Saner - 1/4" /.-Lt. 4='10; _ ,1 0; sy✓e pi_ - No Benas; May. Beends 43" c?a-::LrT_TON DIS i• ='�S SP32= ON P_I`: Fie, 10 to P.L., Drive, = \', Large Tr=es,T= or r!ll . 20' to i o'um-3a tion Iti-? is 100' to Well; 200' in D.L.O.D, 150' piLtZ3 100' to St_sa --, Tia`e- co,1-S =, Lej:=_ 15' to Dr=- _ ^= -C` „-`: _-, s -rde =, rat: 3J' L.7 catch 10' to Water Line 50' 1Pte.-- mittent Ci�_: a^. CJt'_T5e S :)tic Tanks 10' fray Fou- nd- atio:'_; 50' to well 15' Weil toPr 9 S ,o I I _ armi.t a cl i c= t i cn '`rperate�?escluticn Plan S - Three cats I I -n,C1-? =''3 1= 'icr -i z t? Cn I Design Da t3 Sh —t (D'-) I Deep Lole ,-) ccn =_sce:)) ?e =c yes _ts I I Perc Fole ceotn ::Ouse P l a-ns - Two se-s S/S LION ?arc (3) fi:_ ca Wal r Variance Re 0es t —'al Subdiv_= -oil SUIDCH isi on Approval Checked x- eop_ct•al SSOS ?di. lots Checked i -� GHQ (T—.hi /,�C Permit R & D) Data On DDS Plans & ' -r-m L Seine REQU = D=, A _ O-N P :--- -NS Sewage S,-vs-Lem Plan - (north a=rcw) - - G=--: = _ = ' SF��Q� S?S�r^7 ?1 �r^,�1 'C PrO�'1° =_. .v cq j_ pr .0 i le &j Di_-•-"S -cns - 'Vol, =me D or J BCx ;,Trc -,C'? /C.l lery; ?=q pit S-4 e i= over c.- St_.,ctiOn No (c_in er rate) D•__ve aY & Sio_v =.S h.-L •✓�t11��LUi-=- ,L'�'La_ 1 Drc'_nS (d; sc.= CIO Represent t L e of p r_i =`% a_a=..ar_ cn rr� j d c .V' itGa,�ii =. �_Ze If PLr� Pit & D Bcx Sho -i & De t=i_ ed :no -1se - No. of Badrxr5 P, ails & SSUS's ,; /in 200 ft. oz 'r_ c nrty :'motes & Do•�_-:ds - - Ho- -'s? C°_ =^_.?c{ N'ecasx_y lot) Ho--,se Saner - 1/4" /.-Lt. 4='10; _ ,1 0; sy✓e pi_ - No Benas; May. Beends 43" c?a-::LrT_TON DIS i• ='�S SP32= ON P_I`: Fie, 10 to P.L., Drive, = \', Large Tr=es,T= or r!ll . 20' to i o'um-3a tion Iti-? is 100' to Well; 200' in D.L.O.D, 150' piLtZ3 100' to St_sa --, Tia`e- co,1-S =, Lej:=_ 15' to Dr=- _ ^= -C` „-`: _-, s -rde =, rat: 3J' L.7 catch 10' to Water Line 50' 1Pte.-- mittent Ci�_: a^. CJt'_T5e S :)tic Tanks 10' fray Fou- nd- atio:'_; 50' to well 15' Weil toPr 9 . "VAM COUMT DEPARnyg r OF HEAI, DIVI� i OF EWnRUZENTAL HEALTH S DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL. SYSTEM FILE NO.' Owner A,14111 Address 0s,9YAgfi1 GAX� /�� R/�, ��r •(/>' /as�g Located at (Street) i1/,. 2 Z �% /C >AefY1.Rd�42 Sec. .i!� 9 Block .S Lot 7 -Z (indicate nearest cross street) 111unici pality P19 T 74Rf f 0 A Watershed Clf � TO N SOIL PERCOLATION TEST DATA REQUIRM TO BE SUBMITTED WITS APPLICATIONS Date of Pre- Soaking 7 2 8 Date of Percolation Test 7 z G HOLE NtBMM C= TIME PERCOLATION • _PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time ... .. Ground Surface ..... ' In Inches Soil Rate L �¢ _Start Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 31,39_ 4 2 4 5 1 P rev. 9/85 TEST PIT DAM REQUIRED TO BE SUBMITTED WITH APPLICATION DESC PMF ::: )N OF SOILS ENCOUNTERED IN 'JLES DEPTH HOLE NO. 4 HOLE NO. HOLE NO. G.L. 2 3 # 6A /✓DY 4' `d f1i - iit/ SA/✓� 6' 7' 9' wA 7-4W 11,14 rA�R 10' rn IlJI}fCATE LEVEL AT WHICH fQ200NDWATER IS IIQCOUNTERED IVO /c%E INDICATE LEVEL TO WHICH MM LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DESIGN Soil Rate Used / - /S— Min/1" Drop: S.D. Usable Area Proviaea 5vo No. of Bedrocans Septic Tank Capacity /? So gals. Type Absorption Area Provided By .SDv L.F. x 24" width trenoO� N W`Y Other Name signature - F ' . MI Address T? jA4191, P • I-VI V 16, SEAL t. Fd S. \��p N5.0451$ THIS SPACE FOR USE BY .fiEALTH DEPARIIENT ONLY: Soil Rate Approved sq.ft/gal... Checked by Date P U T NAM C OUNTX D E PARTMEN T O F H EA L TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: k0 SS & A 2. Name of Project: 4. Project Engineer: GIF, 7. 3. LbcatI06)v /C: aQ s 5. Address:��.J (� /�'�, a'd (/Y A. License Number. q"Al"N Phone :C�. k- 7 Private/Residential of Pro ect: Food Service Commercial Apartments Institutional Mobile Home Park. Office Building Realty Subdivision Other (specify) Is this project subject to State Environmental Quality Review (SEOR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. A) D 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 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? .................. A) 13. Has preliminary approval been granted by such authorities ?4yi* Date Granted: 14. Type of Sewage Disposal_ System Discharge...... Surface Water _iGround Waters 15. If surface water discharge, what is the stream class designation ?........ _ A)IA 16. Waters index number (surface) ......... .... ............................... 17. Is project located near a public water supply system? .................. 4li 18. If yes, name of water supply L1 Distance to water supply 19.' Is project site near a public sewage collection or disposal system ?..... AM !O. Name of sewage system 0�lfl Distance to sewage system 11., Date observed: �'5R 23. Name of Health Inspector: 7) .. 1 d r �� 4. Project design flow (gallons per day) ...... ............................... �� 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. X,20 _ 26. Has SPDES Application been submitted to local DEC Office? ............... OM 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... A)d 28. Wetland ID Number ........................ ............................... 29. I's Wetland. Permit- required? .......... W U .... ............................... Has application been made to Town or Local DEC Office? .................. A) 4 30. Does project require a.DEC Stream Disturbance Permit? ................... A)0 31. Is or was *project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal', " landfilli,ng, sludge application or industrial activity? ........ YES or NO k o 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? ........................ IV 0 36. Tax Map ID Number .................................................. ....... °�� "� 37. Approved Plans are to be returned to: ................ Applicant Engineer rf 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: v MAILIFi, S4�DRS c� rJ N _ C, 0- 4' i P, M,o cll i if AS- BUILT DIMENSION CHART 2 4G. I 15.G 3 7I .0 97 . 7 G .0 D2.1 5 (210 .0 7 48.5 75.4 8 �fi2.9 X9.8 5-7 .4 10 G3 .5 10-7 .0 I I 57 .5 101 .4 12 52.5 05.0 1 3 - 1 . 7 14 42 .D i 5 31 .3 Igo bi . 7 (7 7'D . I e)5. I 16 74 5 -T 19 -73.5 71 1 20 7 I Z Gr . Z 2 I 5D 1 58 . 7 2 2 G8 . I 1 05 . 3 Z5 85 . 1 97 . 2 THIS I5 TO GE12:TIFT THAT THE SEWAGE DISPOSAL