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Home My WebLink About0774DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -82 BOX 9 00774 PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICES CER I ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #.'1 -q� Located ate I`( 01� 1 Town or Village PQ�j'T'� Owner /Applicant Name 12(,ASS AL:;AbJ Tax Map 2A,_ Block Lot Formerly Subdivision Name t1& 5-,_LM Subd. Lot # 5 Mailing Address 2-* 04"M LAKS. {ZV, I ARMOt- - Zip Date Construction Permit Issued by PCHD 3 - Separate Sewerage System built by n )•Q 1:A IfI NT p2.. L"I"D Address E 5'[J�E ,W,�-! Consisting of ► 2.5 y Gallon Septic Tank and 40e L.E. MS . Other Requirements: Water Sup"I Public Supply From Address or: _ Private Supply Drilled by Address Building Type 'S I D i✓N'(1 1_ Has erosion control been completed? `(5-S Number of Bedrooms Has garbage grinder been installed? IAO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 12 - 22:0:3 Certified by J:C_' - P.E. _1(_ R.A. sign Professional) Address LL S License # 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 revocatio odification or change is necessary. By: �' 9; Title: //.I. C� Date: �— White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 NE NORTHEAST LABORATORY of DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - . DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 -FAX (203) 748 -0652 LASS LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR. ROSS ALAN 25 BYRAM LAKE ROAD ARMONK, N.Y. 10504 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: pH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 1/19/98 TIME COLLECTED: 2:30 P.M. COLLECTED BY: ROSS ALAN DATE RECEIVED @ LAB: 1/19/98 TESTED BY: LAB #11471 REPORT DATE: 1/23/98 LOT #5, BRADLEY DR., BREWSTER, N.Y. KITCHEN SINK WELL -NEW NONE RESULT: 0 6.44 0.53 0.113 6.60 109.0 120.0 0.052 0.036 13..2 <0.005 ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMIUM CONTAMINANT LEVEL . per 100 ml 0 per 100 ml no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0:30 mg/L ' [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L) mg/L 20 mg/L ** mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 1/19/98 SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 . N C.. . a W Y�� WLLL Vvr1rLL11UV AzruAl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATIONaC�r STREET AD RESS: 'N. Y1 1 TAi GRID NUMBER: WELL OWNER NAME:' ADDRESS: c SS .1._ Qni `�-'s 3 yaAw\ L.lt. '�- lL;v.u.� �. PRIVATE Q PUBLIC ffiE OF WELL primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING E;F&E EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH PtD ft. STATIC WATER LEVEL ft. DATE MEASURED S 9 7 DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED fflOPEN END CASING 0, OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH ft. MATERIALS: ❑ STEEL ❑ PLASTIC O OTHER LENGTH BELOW GRADE _ ft. JOINTS: O WELDED eHREADED ❑ OTHER DIAMETER �' in. SEAL: @fEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE MAS O NO LINER: OYES ❑ NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? DETAILS _.. FIRST ❑ YES ONO HOURS SECOND_...._ GRAVEL PACK 1 ❑ 0 GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED t tests were done is in- � r 91 OMPRESSED AIR , formation attached? O BAILED ❑ OTHER O YES O NO WELL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing We11 Oia- In FORMATION DESCRIPTION ct7CE ft. (t. WELL DEPTH It. DURATION hr. min. DRAWDOWN It. YIELD gpm. Surface M-+J L e- WATER IYCLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY 'GAS. PUMP INFORMATION TYPE MAKER MODEL - CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME q,.r5 DATE q AooaESS (�� '�� - SIOTIMRE 3 / C5 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 9055 A 1,ALj 2q- ► 80 Owner or Purchaser of Building Tax Map Block Lot S ALANfi Building ConstructeA by Location - Street )aS lot��WTIAL Building Type ?An M1 o N TownNillage ?n & ELM Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. _ _ - �_........:.. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month __,jADj- -. Day 2�3 Year ..�5 ._ General Contractor (Owner) - Signature ASS ALAW PNG Corporation Name (if corporation) Signature- _ \ C .Title: Corporation Name (if corporate ) Address:25 P�qlAM LAKE EOATp Address: e o - (3o 5 ? Q `"' S -re- State Zip State J /Vew ✓ K Zip /o Sa Form GS -9? PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet _J_ of INSPECTION NAME &C' — 2&A.41 PefyH %� ADDRESS %3RAP 4 E Y !`7?j va R4 rrg 250/6/ Al ef ;!#. --/ - 06 No. Street p Town q1 No. MAILING ADDRESS .25- P.O. Box Post Office Zip Code TELEPHONE /& PERSON IN CHARGE OR INTERVIEWED A/ Name and Title DATE //i 4 f 98 TYPE FACILITY tk6- 4uY'AfCP S TIME ARRIVED 3;)6- pej TIME LEFT -3! -3,:v FINDINGS: Orig. Routine Orig. Canplain Orig. Request Canpliance Cmplaint Canp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other eonllvl�'! s made Explain ✓ ./ / r /i , J 7--' INSPECTOR: TELEPHONE: / /� I / .� 161 D' i i ♦ . -_ � i ../ J - ! -� Signature'and - PERSON IN CHARGE OR INTERVIEWED: acknowledge this Field -•• ►' L 6/86 `� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7 Inspected by: 6e„e Street Location K 221 V6 Owner X 465 ;&. 4 V Town 6:-7Z5oAl Permit # P— Z-77 Tiv1 T — p Subdivision Lot # 1. Sewage Svstem 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 ...... 1,250 ......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............. .I................. d. Distribtuion Box . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ............... engtfi required SOS Length. installed 2. Distance to watercourse measured + 10 a Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" 7foot ............. 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'/2" diameter clean ................... 9. Depth of gravel in trench 12" minimu .. ...... ..k...... 10. Pipe ends capped ........................... r g . Pump or Dosed Svstems V� Size of pump c am er .... ............................... ..... 2. Overflow tank ............ ............................... . 3. Alarm, visual/audio .................. 4. Pump easily accessible, manhole to gra e ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildine a. house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured CCU ft........... c. Casing 18" above grade .................... I............................ d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. 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 A_,x COMMENTS I�r �r I =� - Wom I�� lid I = =�� IBM 100 Imp AM�a 001 . A_,x PUM M !Oil�iAll[ COONiT D!ARTNERr OF 1$AC18. Dt�Yw e[19lnbe�eahl BeaN6 Saeiba. Caa�ai,lli.Y. lt)61? i�yraee to twvhla Fya�it / a. Cl$111+ICATS OF MAM i®nelr. asraqM4ar sw.ira. Bh E% S ba L« r S O.o>tdApP■d�ut Value �B 5 S ff %� yl :.�i9 c- ,b�,�e�t;... DatC Subdivision-Approved id e ✓)/ 500 ft Ty" Lot Area Pm Sectipa 0a4 Depth Vabnoe Noombor d Heirootao _ DWV Flow G P D � PCi D NOiNkMioa b Regdmd when pm k oampMbd Sopoada soma& Slow= a eow" d�G.Bw So* Teak To lweeobmW by Ti3D . Ad en Wage, S"*. Fi11c S4* Fno Addi�eoe x Ira.. S•p b caged by . 7 A61? ..,.. Odw 1 represent that I am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sewalN di$posel system show described will be constructed at shown on the approved amendment there to and in accordance with the standard; rules awn requ ns o IM County Department of MMRh, 'gird Mat on compNtklethereof *. "Certificate of Construction Compliance fatisfaotory to the Commia"ner of Nealthwlll be submitted to the OpegM@nt,`and,a writtan,*Oranttia` will be furnished the owner, his successors,.hiMsor. assigns by the bulkier. that seid bulkler will place in pod opwatkg eowditlon any part of °Yid lawaee disposal system during the period of two ). years Imnwjdletely following, the date of the itsu- asm of the approval 'of the ' Certifkite of Construction Comph nce• of` original system • any r s tea► - o; that the drilled will Wfpiba0 above WO be lecated as shown on the Opp/oved plan and that aatd w' W will bran a in acoo n w A tea nds r and regulations. of the Putnam County Department of MeaRh- Oa Z �o' J / fined P.E. R.A. Address Licim, No APPROVED FOR CONSTRUCTION: TMs approval.expiias two :y ' s f nrthe dat�twed unless construction f the building has been undertaken and is revocable for cause or y W arninded'or modified Muires w per APprove0- for disposal of v. &1- 10/88 0" Man consider n levy by the' issioner of Health. Any charge or alteration of construction fomeftk sa`n pe; and /or a water supply only. By Title 1 J,C. � •IV�60 � Ac '° ' o rn �7 ' 69 Z4 22 r r W 1 � 3.12 AC. 2 r e � ..•�.x 4+ 21 12 y1►19,_ p r, 2.32 C. 5ti rAC 63.42 AC. CAL. 1.66 I O 26 20 \� 32.33 AC. CAL. 1 12.32 AC. f zzsz.SA YGRK T ' o rn �7 ' 69 Y � � f 40 AC.1Oo- 1 � 36.69 AC. r e � 1.9 K 0 12 y1►19,_ p r rAC 63.42 AC. CAL. 1.66 I O II 42.65 AC. CAL. u .! 6 7 � 4 pC, CAL. 1 SD M. 5 7s ELE6tR,c 17 30 /�• nW• 69 34 . 1 � 36.69 AC. • 1 557. t9 2 211 r;� l 24, I8' AaNO \ / ,< J 101 3.19 2.59 4C. ,,. a 102 � •• / 2.44 A 216.09 � _ .✓�� 1 / 00 yg3.15 u « f' •�s 99 V34.533AC. \' PS 2 ^ - 11..2 "A 8T • 86 n . vrs q u 35 3.25 AC. CAL -- ;tie nW• 13!1.52 3 34 . 1 � COXMOw t,wO • • 1 557. t9 2 211 r;� C. 2 24, I8' • II IJ i BS V 9 7 96 95 94 fJ f f ntv151oN5 SPECIA DISTRICT INFORMATION vn,n °w0 r , ,. e. „•, ,e,l SCHOOL •SEN. WMEL UNIRAL SLNODL.D STRICT -•• 372002 STATE LINE -- .e v,nuwo a eA.l•Vr•NgaoA Am uMCIW rN„ezo v,sne mw GIENS1El1 CENTA0. SCH00. DISiRIti ••• 373001 COUNIi LIME TOWN LINE efwJ ,IN, FINE •F FIRE FlIDTECTIOH DISTRICT NO. I VILLAGE LINE �nnesu ur /4 ,wr f40L7t L I M I T tVlefp PIIOPETTT LIM ORIGIXAL LOT IIIA •S i" 378' �1� �✓ � S tea.- p\ �1�ou�� God- � • , f r F��l 3.IB AC. ' 1_, . •/ CAL. q ° L „ ): 57 AC CAL.\\ 10 26.47 AC. 32. Y _ � I? ut 13 51• AC. CAL. .4 \\ R 9 DI A( 19 it /O LOT 17 - LEGEND -- .......... MCILf.IIDS DEVELOPEI DEED 01L'. CALCLLAT +� • -SUI ri3�, +L C •S i" 378' �1� �✓ � S tea.- p\ �1�ou�� God- � • , f r F��l 3.IB AC. ' 1_, . •/ CAL. q ° L „ ): 57 AC CAL.\\ 10 26.47 AC. 32. Y _ � I? ut 13 51• AC. CAL. .4 \\ R 9 DI A( 19 it /O LOT 17 - LEGEND -- .......... MCILf.IIDS DEVELOPEI DEED 01L'. CALCLLAT +� • -SUI ri3�, +L C - LEGEND -- .......... MCILf.IIDS DEVELOPEI DEED 01L'. CALCLLAT +� • -SUI ri3�, +L C DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 76130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #Aa-7 WELL LOCATION Street Address Town Village City Tax Grid Number WELL OWNER Name /'O S s Mailing Z c_ Address / Z`: /'orlon K XPrivate 0 Public USE OF WELL ® - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION 0 INSTITUTIONAL 0 STAND -BY 0 ABANDONED ❑ OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT gpm /# E3 REPLACE EXISTING SUPPLY XNEW SUPPLY NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE__gal ❑ TEST /OBSERVATION GL ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DDRILLED DRIVEN ODUG 13 GRAVEL ❑OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: j Lot No. S WATER WELL CONTRACTOR: Name 78 P Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO NAME OF PUBLIC WATER SUPPLY: _7_&E:) TOWN /VIL /CITY " "DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:. 1V14 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) ignature) 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 g operations be contained on this property and in such %ay manner as not to degrade or oth" w e con ta 'nate surface or groundwater. Date of Issue: l0 19- L Tl� Date of Expiration 19 it Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller j PIJTNA1 +A COUNTY DEPART'ME '.t OF HEALTH EiQtIC?? �D ,tit,; 47 Y r °x x t �• J� �Afi�if� DiningRoom 12'4" x 12' Foyer j ll� i' ii i i Family Room 13'2" x 21'4" 31� � Wood Deck 8'x12' i Living Breakfast Area 1214" x 11'4" Room . 13'x 23'4" Kitchen f 10'2„ x T8„ � - DiningRoom 12'4" x 12' Foyer j ll� i' ii i i Family Room 13'2" x 21'4" Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm Subdivision - Lot: #5 Bradley Town of Patterson, New York Dear Robert: Enclosed are the following: 1. Four (4) prints of SS -5 "Proposed SSDS - Lot #5", dated 2- 26 -97. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit of Sewage Disposal System ", dated 2- 26 -97. 4. "Application to Construct a Water Well", dated. 2 26 -97. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 2- 26 -97. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Money order in the amount of $300.00, review fee. We would appreciate your review,, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Niclos, Jr., P.E. HWN:RL:bd 88044 -5 cc: Ross Alan Inc. w /enc. j \ LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road RANDOLPH W. LAURENT, P.E. \ Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS February 26, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm Subdivision - Lot: #5 Bradley Town of Patterson, New York Dear Robert: Enclosed are the following: 1. Four (4) prints of SS -5 "Proposed SSDS - Lot #5", dated 2- 26 -97. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit of Sewage Disposal System ", dated 2- 26 -97. 4. "Application to Construct a Water Well", dated. 2 26 -97. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 2- 26 -97. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Money order in the amount of $300.00, review fee. We would appreciate your review,, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Niclos, Jr., P.E. HWN:RL:bd 88044 -5 cc: Ross Alan Inc. w /enc. O )F X--X �E.¢� APPLICATION FOR APPROVAL.,.-OF -PLANS FOR A .WASTEWATER DISPOSAL .SYSTEH Name and Address bf: Appl scant:.__ . -. 2 Name of Project. 1`r'4 )::70S 3 _• Location T/V /C: OF Mill brooke Office �i(/ /ll r /� 5. Address: Cent: 4 Project. Engineer: #,iL' �'.. iG o s �_ . -, :... :. :Br6wster, NY ..' 10509 License Nuf b r: 5G12� Phone: 014)'278_`6103'. 6.. TYDe 07 role t Private /Resident.i al Food Ser.vice Corrnercial Apartments Institutional `,...:. ..: :N6b.i•le ,Vome.:Par -k .-" Office Building. Realty.Subdivision: Other ...(specify) Y .', Is this project subject' to State Environmental Nal ity Review (SEQR)? Tvoe Status (Check One) Type I.. Exempt Type II. Unlisted. X S. Is a Draft Environ:p=ntal Impact .Statement (DE required? 9. Has DEIS been coppleted 'and found acceptable by Lead Agency?, !� 0. Flame of Lead Agency i. ,Is this project in an area under••the control of -local planning., zoning, tid or other officials, ordinances? ............... '. IT so, have plans been.suL- . ,mitted to such: author .sties ?....__. :..:.......... Has prel iminary approval beeps granted by .such -authorities? Date Granted:_ Type of Sewage Disposal. System' Discharge...... • Surface Water _Ground rs a. surface Hater discharge, what is the stream class designation? ......... _.... Raters index number (surf=ace) .................:.......... /1ll.,- �s project located near a public water supply s }'step? .................. NO _.___... yes, n._re Of 'pater supply AIJ Dis.Lance 'L water supply .Al �Ci S IL r-2, c public Sek'25e CO11 °Ci lOn or disposal S }'St i'1 ?... Of sewage system, c / / Distance t0 sewage System - 'a ':.. ObSer`'e�. / —ZT � O 23. t a., p- r2c?1Lfi !nSp'CtOr: �dZ /1�kkll' ! 5, day) ..................................... __00 G5. Is State Pollutant Discharge Elimination System (SPDES):Permit required ?..* NO 26. Has SPDES Application: been submitted'to' local DEC - Office? ............... 27. Is any portion of this project located Hith'in a des ignated`Town or* State U wetland?......... ..... 23. Wetland ID Number ......:. ........ ............................... ........ !1/- 29. 'Is Wetland Permit •required? /UD Has application been made to Town or Local DEC Office ?• ............... .. 30. Does project require a 'DEC Stream Disturbance Pe �i it? 31. Is or was, project site -used for..agr- idultural activity involving application OT pesticide4 to orchards- or other crops, solid or hazardous waste disposal;.. landfilling, sludge application or industrial activity? ... YES "o -r.kO 32. Is project located within 1;000 feet. o; ,exist ente of abandoned landfill, ;: , .;. .hazardous waste site, salt�stockpile,':1andfi,.11; sludge- .disposal s i te or, any other potential known -source 'of contanination? ......:.YES or NO /I/ DESCRIBE: 33. Is there a local master plan or file..with the Town or Village? ..... /1%0 34. Are co :unity water, sewer facilities planned to be developed within i5 years? /!%Q 35. Are any' sewage. disposal areas in excess of 15-- slope? ................... ":. . vo -:5 Tex Hap ID Number .. ............................... •-- ................ -_gU i7. Approved Plans are tobe returned to: ................. • App�li.cant _ Engin�e,- the application!is signed by a person other than the applicant shown in Item.1, the. pplication must be•accempanied by•a Letter of Authorization: Failure to comply with this rovision may be grounds for the rejection :oi: any submission. Z hereby af, ^irm, under penalty of perjury; that information provided on this rorn is true to the best of ry knoule8,ce and be .1 ief. Fa Ise st tE,�nts - ade- herein are punishable as a C7e s A Hisde,reenor pu uent to Section 210.45 of the Pena 1. Law. , I n ;AT URES OI -/-",L. TITLES: '•iillbro fle Office Centre "IX ADDRESS: Brewster, NY 1050 _.__..... DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Harry Nichols Laurent Engineering Millbrook Office Ctr. Route 22 & Millbrook Road Brewster, NY 10509 Dear Mr. Nhchols: BRUCE R. FOLEY, R.S. Acting Public Health Director March 3, 1997 Re: Proposed SSDS: Alan Inc. Bradley Drive (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 individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1. A corporate resolution has not been submitted. 2. Erosion control measures for the house and well is not shown on the plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Velvktruly yours, Robert Morris, P. E. Public Health Engineer RM/jP APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT, j �g-- STREET LOCATION i7tC d�L�iyl ... id� NAME OF OWNER BY B. HEDGES R.MORRIS r OTHER DATE '31 /3 J ! "'`TAX MAP # DOCUMENTS. t ERMIT APPLICATION LL PERMIT PWS LETTER YNGINEERS AUTHORIZATION ESIGN ATA SHE '- CORPORATE RESOLUTION S THREE SETS HOUSE PLANS -TWO SETS ",07v* VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION m SUBDIVISION APPROVAL CHECKED FT-1 PERC RATE m FILL REQUIRED DEPTH m CURTAIN DRAIN REQUIRED MSTANDPIPES GENERAL m EX- APPROVAL SSDS ADJ. LOTS ED WETLAND ( TOWN/DEC PERMIT REQ? ) FT-1 DATA ON DDS PLANS & PERMIT SAME M PRE- 1969 - NEIGHBOR NOTIFIFICATION m LETTER BI/ZBA .. m 100 YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE m GRAVITY FLOW CONSTRUCTION NOTES (GRINDER NOTE) ESIGN DATA: PERC AND DEEP RESULTS O -FOOT CONTOURS EXISTING & PROPOSED 1RIVEWAY & SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS EROSION CONTROL OUSE, L SSDS m,EROSION CONTROL PERC & DEEP HOLES LOCATED - REPRESENTATIVE OF PRIMARY AND EXPANSION LOCATION MAP [P. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED - NO. OF BEDROOMS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM METES & BOUNDS SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /47FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS YBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE GAUGES PROFILE & DIMENSIONS �L IN EXPANSION AREA TRENCH TRENCH PROVIDED L(' m60 FT MAX 'ARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL t2 0' TO FOUNDATION WALLS DJ 15' WELL TO P.1 100 TO WELL, 200' IN D.L.O.D., 150' PITS 00 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS �215'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% 0' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS, SEPTIC TANK =I O' FROM FOUNDATION; 50' TO WELL COMMENTS: PrVIM CC= DEPARIMZW OF HEALTP-_. DIVE N oFamnniENm FNLTH SERV_ S DESIGN DATA SHEET- SUBSUFAC„E SEWAGE DISPOSAL SYSTIM FILE ND. Owner 115�) sS. /J 1A ,nJ . Address 2 S 8Y1?A m G 1' 4 41 ?)yl 61,111' /V ,y oc DwA,9 Locatecl at (Street) Al,. 2-2 .1?o4P Sec.. Block S Lot (indicate nearest cross street) Municipality 7 7,t ,, S Watershed Cl?,) 7v1 SOIL, PEROOLATIC7N .TEST DATA REQMED TO BE ` SUPM:1=D WI'T'H APPLICATIONS Date of Pre- Soaking —% 31 � 9 Date of .Percolation Test 7/-?/ 16 HOLE NCMBER CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 1.33 - /4.9 1/0/ 2 24 71 3 Z; /l -z;3/ :2:� 2�i, 27'' - G.7 4 5 3 z - z� 7: l9 Z7" Z � 3 4 5 1 2 3 .. . 4 5 NOTES: 1. Tests to be repeated at same depth until apprcocimately 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 Pr'MNAM CC= DEPARTMENT OF , y r • OF-MMMMML HEALTH SERV- DESIGN DATA SHEET- SUBSUFACE S3gAGE DISPOSAL SYSTEM FILE NO. ormer sS n Z11 Al Address Rr M a KR. Na oc D!'vA,9 Located at (Street) ,A/o . 2?- � M ,A?o ,4 p . Sec. Block S lot 7 (indicate nearest cross street) Municipality 194 j� P► S Al Watershed Cl?,) Tvc./ SOIL PERCOLATION TEST DATA PBO( RID TO BE SUEMITEED WITH APPLICATICNS Date of Pre- Soaking % 3J 9 _ Date of Percolation Test 7 -?/ B HOLE NU4RM 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 4 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 neasu.ra ents to be made fran top of hole. .rev. 9/85 F3 2 27" 4 5 2 2, :l5-- Zi Z7 7( - 4 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 neasu.ra ents to be made fran top of hole. .rev. 9/85 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT. P.E. (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR.. P.E. CONSULTING SITE ENGINEERS March 6, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road. Brewster, NY 10509 RE: Proposed SSDS - Lot #5 Big Elm Subdivision Patterson, N.Y. Dear Robert: In response to your letter dated March 3, 1997 we have enclosed the following: 1) "Affidavit - Corporate Owner Application ", dated 3 -6 -97. 2) Three (3) prints of Drawing SS -5, "Proposed SSDS ", revised'3 -6 -97. If you have any questions, or should you require additional information, please contact us. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. N' ols, Jr., P.E. HWN:RL: d 88044 -5 L fj . p t, Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT -'CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED- TO .PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for I l� 4SS /_T1 40 , represent. . that .I am an officer .00r� employee of the corporation and b.m: authorized ' to act for, '_�na_(a� �✓� _ — _, :_ (me of having offices at _ ? �*fGZ Whose officers-are President o S /16Ld'I ; — - — — - — — — — — _.--- -_dme ana Addr—es— )' , Vice - President • � .- —(Name and Address) — -' '-" — _ _ - .....�: L _ Secretary - -- - - -.. ._ — — — _: _ ... - (Name and Address.) Treasurer• _ _ _• _ _ _ ,_ _ ,., , , ,•. — _ (Name and Address) and that I= am-and w� ll be individually responsible for+ any' or all aptp� . of. the- corporation with respect to the approval requested and -all .sub- sequent acts 'relating -thereto. Sworn: to iiefore me. this Today Signed �— J 1. of / a�G`� 19 �7 Title S'. -7�L_� otary R.ibli � - I < ::... B%,M I DA' RM Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . Date. 2 -26 -.97 .Re: Property of 055 /'T!'6L✓1 T", C - Located at dY�� /�� j�f Ve (T) ;Pg_ L%�er50 Section . Block Lot p� Subdivision of f Elm Subdv. Lot # rj Filed Map Date 3'2' 90 Gentlemen: This letter is to authorize 1T4 rry 14 AJi'c1d1S LT ��- a duly licensed -professional engineer or registered architect (Indicate to apply fo'r 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, t blic Health Law, and the Putnam County Sani- tary Code. C-y,�. NIC,, 14 ` Y �£ Very truly yours, aFESS1 ,:.� V� Signed No. 66.24 �� ,' Countersigned: 'DR Owner of Property 4� , R.A., m . Address LCC r 4r "lo, k Address Town i 0/4) _- or Telephone Ca-C Q Telephone January 27, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Big Elm Subd. - Lot #5 Bradley Drive (T) Patterson, NY Dear Mr. Morris: Enclosed are the following: . 1. Four (4) prints of Drawing S -5 "As -Built Plan ", dated 12- 19 =97. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 12- 22 -97. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 1- 23 -98. 4. Well Completion Report, dated 8 -5 -97. 5. Water Supply Testing Reports, dated 1 -23 -98 6. Money order in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. I LO r.6 Harry W. Nichols, Jr., P.E. HWN:TR:bd 88044 -5 LAURENT ENGINEERING j\ / _ \ ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 8 Milltown Road Brewster, New York 10509 HARRY W. NICHOLS JR., P.E. / (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS January 27, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Big Elm Subd. - Lot #5 Bradley Drive (T) Patterson, NY Dear Mr. Morris: Enclosed are the following: . 1. Four (4) prints of Drawing S -5 "As -Built Plan ", dated 12- 19 =97. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 12- 22 -97. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 1- 23 -98. 4. Well Completion Report, dated 8 -5 -97. 5. Water Supply Testing Reports, dated 1 -23 -98 6. Money order in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. I LO r.6 Harry W. Nichols, Jr., P.E. 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