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Home My WebLink About0785DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -94 BOX 9 1 ru ' �` ,7' } I 1 rr �~ ` ., „ 00785 R'V'; 3186 'E OF; CON Located McWng Address -J e" PUTNAM COUNTY DEPARTMENT OF HEALTH a Dlvielon of Environmental Health Servlcex; Carmel; N;Y 10512, Erig)?aeer.lVlast Provide _ r„ PiC H D. Permit;M STRUCTION COM' UA'NCE FOR SEWAGE DISPOSAL SYSTEM 0. E r S O n % 24• owe; or ,V Map e L- �3' Tai .Block Lot Formerly Subdivision Name %Subdv. Lot # v rd a G /j :— Zip Date_ Permit Issued Separate Sewerage System built, by Address Consisting of / L o AL 4[7 i-e?AO h Water Supply: Public Snpply�From Address ' /I ors �___;private Supply Drilled by Address Building TyPC I Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? _[yQ Other Requirements I certify that the syetem(s) as listed serving the above premises wake constructed essentially as shown,pp the plans of the completed work ( copies of which are attached), " in accozdaece with the standards, rules and reulitions, in Zcor ce'with a f ad plan, and the permit issued by the ;Putnam County Departmen�t jOff health. Date ��.� i ' (. certified by /� p r P.E.. /1_lkzrd� Address 1"� 1 ya7Yq�I[ Vt'T IC4°- �un��C , C7re_, -,S4-r , 1 9 License No. Any person occupying premises served by the above systems) 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 pubs% sanitary sower becomes avaliable and the approval of the private water supply shall become. 1 nd vold when a ublic water supply becomes available, such approvals are subject to rho ifiatlo o► change when, in the•judgment of the 1 stoner of Heslt eh revocation, modification or change b necessary. Oats By Title _.. ...... _ .. _ .... -- - _......... ti. N PUMAM COUN'L'Y DEPAFM', 'r OF HEALZE DIVISION OF ENVIROMWEAL $MTH SERVICES Owner or Purchaser of Building Building Constructed by / OG•�Y�l�I e G� a�� Location - Street' z4 / Section Block Lot Subdiv Sion Name p�� Municipality Subdivision Lot Building Type GUARANTEE OF SUBSURFACE SEWhGE 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 shoran 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. falls 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 determination of the Director of the Division of Environmental 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 12 day of 1917 General Contractor (Owner) - Signature mss �'�� - U►�,c... -- Corporation Name (if Corp.) ,t- dat:ess Signature u Title ��c-t' �tX- :Gv�c•Lc�� , � J-_ TL) U Corporation N,ame� /(if rp.) P ess J a, -< :.. * W �4 WILL UUr1rj1LiiUN AL,rUtti DEPARTMENT OF HEALTH Division Of Environmental Health Services - PUTNAM COUNTY DEPARTMENT OF. HEALTH Office Use Only — S —7:2 / \ WELL LOCATION STREET AOURESS: (f wNr I I TAX GRID NUNiSER: i- > L �3n,. eoZSn,.T WELL OWNER ME. ADDRESS: rvki vi 0L ,�. V\ LAS S ` >zAen Lv, tj o , 0 $ 0 � PRIVATE a PUBLIC U E OF WELL 1 primary - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF,USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING [1RfiPLACE EXISTING. SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WE ' DEPTH jc ft. STATIC WATER LEVEL ft. DATE MEASURED Q DRILLING EQUIPMENT ROTARY COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CA LE PERCUSSION ❑OTHER (specify): WELL TYPE O SCREENED SIOPEN END CASING O OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH — ft MATERIALS: STEEL ❑ PLASTIC O OTHER LENGTH BELOW GRADE' ft. JOINTS: WELDED P THREADED O OTHER DIAMETER in. SEAL: VCEMENTGROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT ___1_`7 1b./ft. DRIVE SHOE fl'YES ❑ NO LINER: O YES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL 'PACK O YES fiLNO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST -If detailed pumping I M '00; ar O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED O OTHER ❑ YES ❑ NO �IELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Pear- In9 Well Dia- meter In I FORMATION DESCRIPTION t:.7nE tt it. WELL DEPTH ft. DURATION hr. min. ORAWOOWN It. YIELD . gpm Land A q .�J u c�5 ti�►N. �— ��S as �V� WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP w�D�A�III NAME-- �� DATE ADDRESS D•1 ;� SIGfA(TURE 3/ 0 t A �,,a G - LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road \ Brewster, New York 10509 (914)278- 6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS September 12, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance - Lot -13 Big Elm Subdivision Courtney Lane Patterson, New York Dear Robert: Enclosed are the following: 1. Four (4) prints of Drawing S -13 "As -Built Plan ", dated 9- 11 -97. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 9- 12 -97. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 9- 12 -97. - 4. Well Completion and Well Log Report. 5. Water Analysis Report, 6. Bank Check 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. Harty W. Nichols, Jr., P.E. HWN:RTL:bd 88044 -13 I e., s O moo,. IRON P/A/ SET I PROJECT 8 /G. ELM SUBDIVISION IS/ON COURTNEY LANE - L07-013 RON P11V SET PATTERSON, NEW YORK CLIENT : ROSS ALAN 25 BYRAM LAKE ROAD ARMOA K, MEW YORK LAURENT ENGINEERING ASSOCIATES, P.C.. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE,ENGINEERS DRAWING TITLE AS -BUILT PLAN /-07-# /3 SCALE /a 30, OF NEW ' `' r09 DATE 9-//-9.7 - -- c� Q� �RAWN BY : iQ,7. -1 I * Q c CHECKED BY : HWN Uj L .. 2 JOB No.: 86 044 - 13 _ 124 �� DRAWING No. �Of ESSIONA S ®13 10/01/1997 12:10 914-278-7754 �-'NORTH AMERICAN LABORATORIES, INC. NO AMERICAN LABS CERTIFI CATS OF LABQRAJORY ANALYSIS LAB ID NUMBER: 97-5970 CLIENT- Ross Alan 2513yram Lake Rd Arnionk NY 10504 SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: BATE RECEIVED: :DATE OF REPORT: Hall bath: Lot 13, Courtney Ln, Brewster NY R. Alan 09/26/97 TIME COLLECTED: 9:20 AM 09/26/97 09/30/97 PAGE 01 :ANALYTE RESULT* UNITS. MAX CNTMT LEVEL" MMOD ANALYZED Total coliform Absent Must be "Absent" 5MI8(9223) E. Cob Absent Must be ".Absent" SM18(9223) 09/26/97 This sample, as submitted to the laboratory, and as compared to the New York State limits for drjnkdng water quality for the tests performed, was: Z ACCEPTABLE, NOT ACCEPTABLE, Richard W. Emerkh, Laboratory Djrector NYS ELAP #11218 CT Lab Approval #PH-0171 Underlined results are unacceptable accor-ding to health department anti /or US EPA codes. ** Maximum Cor,Eaminant Level (rftaximurn Permissible concentration allowed by health departinentind /or OS EPA codes). IoAr, PUTNAM COUNTY DEPARTMENT OF I?EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . FINAL SITE INSPECTION Date: 4,�� Inspected by: S ' tea.✓ Street Location v.�,�� y: Owner �1 USS M_4A," Town % %F45c):U Permit # 9� TM # Subdivision Lot #. 13 1. Sewvaee 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 ...... ........other ................ b. Septic tank installed level ................................................ c. 10' minimum from foundation .......... ............................... d. Dist 'bution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost ................. ............................... . 3. Minimum 2 ft.Original :soil between box & trenches: e. Junction Box - properly set ......................... .................... f. rT enches T.Zeg h required S_ Length installed 2. Distance to watercourse measured `t' 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%" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......::.......... 10. Pipe ends capped .......: .:.:::::::::::::::............. .. .................. g. Pump or Dosed Systems Size o 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 /cycle........... III. House/Buildi g a. house located per approved plans ............. b. Number of bedrooms ......................' c i ,- e........... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... 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" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. .............................:. Rev. 6/97 ,-- -,-- c-, 36- � 8� �g _ F0 TMM COUM DEPA4'Y11oMIT OF MULALTH Dl�blesi a[ Vital HeaNA Saevloeo.`Camel. N Y 1OS11 to Pasivlde PeesD a,. C6R1lPICATS OF CO N P FOR S6WA8B.DMMSAL SYSIBM Pewit Coated at KTAJ gy jtfiN . _ ow,. ur Swdlvlda. Natua Subd Lot a �-� Tai Map �- Hloeh Renewd_O ReAdoet -p ' OwnedAppSwo Nestle ,eO. S fH Lj4iy Date of Previous •,Approval l/ Maw Addrsia/12><im �i�iE I�TJ Town /-f H�/O�F -- z Date subdivision Annroved . �'� —�0 Fee .Enclosed amn,,,,f �D • D amiag Type . - TI / Lot Area FM Seellon 0* Depth volume . . Native of RedNM= Detl@a Flow G P D AM Notl9ntlon b R p hed Wban Fill n mnmm& ed Sepoeate Saw =V Sydm to coved al Gallon Sepdc Tali and ✓ AM I To tea caeab uded by Address Water SuP*: PtM& sup* From —rte, Addreae on, Private Sopptr RAW by ! ✓ b --Addreas Od m R6mdmwtinoa 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(Q. 1) that the separate ssw di eel s stem above described will be constructed as shown an the approved amendment there to and in accordance with the standards, rules a regu ns o ream County Department Of health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Mwlthwill tier submitted to the Department. and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier. that said builder will Piece in food operating condition any part of sa .swage disposal system during the period of two (t) years Immediately following the date of the Issu• once of. .the approval. of.: the, Certificate of 'Construction Compllenca of t,@ original system or any repairs t eto; ) that the drilled well described above valet M IoCatxO at Yiarrw on tM approwA plan and that a.ld well will be fns 1 in actor ce wit the sta ros, s red rapu a�Toei of the Putnam County IF MaaRn. Date S nod y o' -.,� q % P.E. R.A. Atldrecs / I' r' e , v Licenp No APPROVED F R CONSTRUCTION- This approval expires two years Som dad issu unless construct on of the building .has been undertaken and is revocable ��Uss or may tea amended or modified when considered by the O missioner of Health. Any change o alteration of construction raquIIP)oroved for disposal of domestic sanit and /or r star supply only. n Rev. aIL� 10/88 Data ev Title RE: Individual SSDS Big Elm Subdivision - Lot #13 Courtney Lane Town of Patterson, New York Dear Robert: Enclosed are the following: I Four (4) prints of SS43 "Proposed SSDS - Lot #13", dated 4-4-97. 2. "Application For Approval of Plans For a Wastewater Disposal System". 3. "Construction Permit for Sewage Disposal System", dated 4-7-97. 4. "Application to Construct a Water Well", dated 4-7-97. 5. "Design Data Sheet". 6. "Letter of Authorization", dated 4-7-97. 7. . "Corporate Affidavit" dated 3-6-97. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 9. 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. 1 TV L6 Harry W. hols, Jr., P.E. A A N! HWN:TR:bd ij 88044-13 cc: Ross Alan Inc. w/enc. LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278-6108 - (FAX) 278-2658 HARRY W. NICH 0 LS JR., P. E. CONSULTING SITE ENGINEERS April 8, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509, RE: Individual SSDS Big Elm Subdivision - Lot #13 Courtney Lane Town of Patterson, New York Dear Robert: Enclosed are the following: I Four (4) prints of SS43 "Proposed SSDS - Lot #13", dated 4-4-97. 2. "Application For Approval of Plans For a Wastewater Disposal System". 3. "Construction Permit for Sewage Disposal System", dated 4-7-97. 4. "Application to Construct a Water Well", dated 4-7-97. 5. "Design Data Sheet". 6. "Letter of Authorization", dated 4-7-97. 7. . "Corporate Affidavit" dated 3-6-97. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 9. 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. 1 TV L6 Harry W. hols, Jr., P.E. A A N! HWN:TR:bd ij 88044-13 cc: Ross Alan Inc. w/enc. APPLICATION FOR APPROVAL:: -OF:-PLA14S..- FOR *.A:-.WASTEWAT.ER -.01SPOSAL.SYSTEH Name and Address ..of. .,Appl. f0e, -ass . - ._ .... .... '. .'..; ..:fin- �o�;�. - n��y _ . - :.. .:. ayp—AM pew_t) S,,sv 2 Name of ProJ ect 3._-_Locatjon T/1! /C: i I I b r o o k e 'O'f f i ce Address: Cent: 4.. Project -Engineer: Bre; -istef, NY. .10509 *509 License Numiber,-- Phohe': (51 3. J 6.. Type of' 'od Servie ate/Re'�Idential, FO'* .c v Apa rt me n t s Institutional Mobile .16A 'ome" Park Office'Building ..' -Realty .`Subdivision .&he" F..(specify): V., Is.-this project. subject t o' State' Envir6nm.ental,-(�uality Review (SEQR)? TYDe Status (Check One) Type .l. .- Exemot T' - Type-11. Unlisted. X Wo Is --a Draft En'vir . onmental Impact .Statement (DEIS)..required? ....... 9. Has DETS"been completed 'and founi'd acceptable by ,Lend t'%gency?• A)M- 0. -Nanie of Lead Agency /t� f 1. Is this project in an area under - the control of -local planning., zoning, or other o-IF-IFIcials, ordinances? .......................................... ''f so, have plans been sut-.mitted to such.'author.i ties?.. ................. ep qran.te� by such-author H'as preliminary approval be' !ties? Date Gra'nted-._A�_, Type of Sewage Dis*posal: System Discharge...... Surface Vater' Ground F,F.t,ers If surface water discharge, what is the strew, class designation ?........ A) 44 Waters index.number (surface) .. . . . . . . . . ................................... Is project nee located L a publ is water supply system? .............. A) 0 yes, narze or. w ate r supply Distance to water supplv Is ;)"-Oj- cl-site f--.ear a public sewage collection or disposal ....... Of se-reage system A)IA Distance, to sewage syster. , 7 observell-J: t 11 inspector: desicfl (-allons per day) ..................................... . Z) t5: Is State Pollutant Discharge Elinination"System '(SPDES) ' Perm, it.required ?.. 26. Has SPDIES App ication been: sub,7itted "to. local :DEC'Office. , ..... . 27. Is any portion of this project .located within a_ des 9nat6 Tow'n or -State ......: .. . . .. . .. iwetland ?..... � .. . 23 Wetland..I'D..Number. .. .. ....................... ......... 29. 'Is Wet-land .Permit requ i red? .•.. .: .... ......................... 0 Has appl ication been 'made to Town or Lacal DEC Officer ..............:. Ply 30. Does project require. a DEC Stream Disturbance Perim it? ..., ...::.......... . . N� 31 . Is or was project : site - -used for- _a5r- icultural. activity involving application OT pesticides to orchards•o� other'"crops solid, or hazardous waste disposal, landfilling, sludge application or industrial activity? YES or:rh'0. 32. is project- located -,within i;000•feet.O existence of abandoned landfill, hazardous waste site,'salt.stockpil,e, landfi1.l;;sludge disposal.site-or b any other potential known •source of contanination ?...... • - - • - ...,.-.YES or h0 .DESCRIBE: 33. Is there a local master plan or file`Hith the Town or Village? ....... IUD 3;. Are co, —, unity water, sewer facilities :planned to be developed within 15 years ? - I)O 35. Are any.' sEwage disposal.. areas in excess of i5- slope? Dl) C) 16 : Tax !Hap TD Number .. ............L� r. :,pproved.Plans a re' to'be; returned to: ................. Applicant X E n 9 n .r the applicatio.niis signed by a person other than the .applican, shown in Iten.i, the. pplication must be-accompanied by•a Letter o-F Authorization: -Failure to comply with this rovision may be 9 ou"nds for the rejection °of any sub,-fl ssion. I hereby affirm, under penalty of p-erjury;. that information provided on. this fon is true to •the best -of my knouredge end be 1 r'ef. False stat�,ents 'Wade herein are ' pun ishab Ie as, a Cla s A Hisde:,-reanor punst� ant to Sect ion 210.45 of the Penai Law. .2 JJ n A- . <<;7UacS & 0; FzCir,L TITLES: -iillbro A Office Centre. !_ "itG ADDRCSS: Brewster', NY 1050; . 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 e To Village City Tax Grid Number 0% - - L' WELL OWNER Name SASS Mailing Address CIPrivate O Public 1 E OF. WELL primary '2 - secondary ORESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY . Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION' []INSTITUTIONAL O STAND -BY OTABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED � -� /EST. OF DAILY USAGE al REASON FOR ,,DRILLING O REPLACE EXISTING SUPPLY D TEST/ OBSERVATION 13 ADDITIONAL SUPPLY SINEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL !DETAILED REASON FOR DRILLING NOW K,9r, / WELL ' TYPE LARILLED Q GRAVEL [:]OTHER -IS WELL SITE SUBJECT TO FLOODING? YES. NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: i Lot No. -WATER WELL. CONTRACTOR:..._Name . - _- .-- T�j7_---- _ - _ -- -- -- _- _-- - - -... _ _ _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 ffJON SEPARATE SHEET 7'- (date) IV signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drill operations be contained on this property and in suc / manner as not to degrade or othe i co nta nate surface or groundwater. Date of Issue: L 6 19 Date of Expiration 19 Pe it Issuing Of icial Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Pu tn a "',qu n ty 1-3ee p a i tnj e.n t of - H e a I t ne Divis f Environn t al., Sdni'tail`- AFFIDAVIT CORPORATE O4 NER APPLICATION FOR PERMIT. APFiLICAT-ION SUMMED- TO .PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for represent. that J am an officer or employee of the corpor&ti'on and bm.`authoriz'ed:. to act for ---- ------ (name of corporation) having offices at L AX y Whose officers -are President A �s 1416"1 Waa�e_ Wna TdUr—ess Vice-President (Na_mea_nd_A_ddFe_ss) — — — — — - - I --Secx,6tary -- — — — — — — — — — — — — — — — — -- — (Name and Address.) — — — — — — f Treasiirer' — - - — — — — — — — — — — — — — - - — — -- I - — — — — — — — — (Name and Address) and 't�ialt I-'6rdand will be individually responsible' f66*an'j` or all sptp of• the- c.orporati on with respect to the approval requedted and-all.sub -` seque'h*t acts '.relatinig -thereto. Sworj- to befor e 'm e. this day Signed of 1997 Title _Nftla-ry Publib" Corpor4te Seal PUTNAM COUNTY-DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at (T) Pq7 j� -7 Section Block % Lot Subdivision of Subdv. Lot Filed Map #`f�, Date Gentlemen: This letter is to authorize a duly licensed.professional engineer \I- or registered architect (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, Educati tary Code. Q rA aNE �A r Countersigne R.A. , e Public Health Law, and the Putnam County Sani- 10 \9!r Very truly yours, d' No. 56124 cy� Signed p P�' Owner of Property H0 F ESStON Address I L- W9O DFP60 G�NTj2� Address Telephone /7/"- ��. jU y Town Telephone IF1M COUNTY DEPAiZ I OF DIVE .J OF HEALTH S , .. . DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTTM. FILE NO. Owner 0 5's 4,14,V Address 2 GA K,E PP.. A/ Y /6 S-0 � Located at (Street) iVo . 2-2- ,(3/ G.... EGivJ- .../QD_ .. Sec, ......Block . 5...: Lot 7 Z ( indicate nearest cross--street) _...... ....._ ..................... ..... ........_..................,,.. Municipality �i9 �iS�S '� . Watershed .. C%To 7-61V SOIL PEZOQI,ATION TEST DATA RDQUIR .TO BE SUBS WITH APPLICATIONS Date..of . Pre- Soaking . o / S .7 Date of ..Percolation Test S o I 89 HOLE_ _ _... .. NL2 . CL= TIME PERCOLATION Run .... _Elapse Depth to Water..Frcm Water.LeveZ No. Time .. Ground Surface In ..Inches ....... Soil Rate Start-Stop . Min. Start Stop _ . Drop In _... Min/In Drop Inches Inches Inches 1 2 3 4 :•;' 5 NOTES: L. Tests- _to -b6- repeated at same depth - until approximately equal soil rates are obtained at each percolation test hole. All data to'be subnitt�d for review. 2. Depth measurerents to be made from top;of hole. rev. 9/85 2 /0.39- Il;o9 =3� Z�'' 2s�� 3� �, 17 �. 5 4 5. 1 2 3 4 :•;' 5 NOTES: L. Tests- _to -b6- repeated at same depth - until approximately equal soil rates are obtained at each percolation test hole. All data to'be subnitt�d for review. 2. Depth measurerents to be made from top;of hole. rev. 9/85 TEST PIT DATA REQu= To msuammmwim _AP-PEICATION DESCRIF- '7)N OF SOILS ENCOERUWM:IN TES' DLES DEPTH HOLE NO. /-f HOLE NO. HOLE NO. G.L. 3' /c/-w S Ait/V .4! SILT. �>%z 7 . 5, 6':: 7' 10' 1114 Tzf�(/�T�P.:'. 12' 13' - ........._- . 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED 1�16ll/,C INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: C, /� (a A) ) TCAJ 6^ 6 c'1'47" DATE: ;..... DESIGN Soil Rate Used 16 Z J . Min/1" Drop: S.D. Usable Area Provided 7 0 0 0 No. of Bedroans ¢ Septic Tank Capacity 12.5-0 gals. Type c Absorption Area Provided By s7/ L.F. x 24" width trench Other DoS /X/(,- 0/0, S7! 17- op. S YST41, "44001 r,5'v Name G,gvj'.c,/ �is� < /�v�Ei,?�•ciG /�SS� �. , p, C. Signatur is S Address 7Z /--/a SEAL 1 O No. 0458 1-04 TT.Ei?S� �v ,�� / Z sG 3 `esOFESS�® THIS SPACE FOR USE .BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date • • • �, NO : • • • • Bedroom . Bedroom it 1 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE P'LANS' AF `tg0VFD F-C 50.0" � BED.M0!,i G0!jN,*r 0P.L .. c / Wood Deck j - - -- — - 7 /� 8'x12' Signature & Ti -ie ate Breakfast Area Living 12'4" x 11'4" Family Room, Room ,e�n�� .. A-41AII i i I i APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REV W SHEET for CONSTRUCTION RRMIT STREET LOCATION � Z_ NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE L& q TAX MAP # -�- DOCUMENTS. fRMIT APPLICATION -ELL PERMIT PW S LETTER 4M GINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) m RPORATE RESOLUTION 1 11 1 PLANS THREE SETS OUSE PLANS - TWO SETS VARIANCE RE Q UEST t SUBDIVISION GAL SUBDIVISION BDMSION APPROVAL CHECKED RC RATE L REQUIRED DEPTH = CURTAIN DRAIN REQUIRED =STANDPIPES GENERAL =EX-APPROVAL SSDS ADJ. LOTS = WETLAND ( TOWN/DEC PERMIT REQ? ) = DATA ON DDS PLANS & PERMIT SAME = PRE- 1969 - NEIGHBOR NOTIFIFICATION = LETTER_BI/ZBA. L-LJ 100 YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS EWAGE SYSTEM PLAN - (NORTH ARROW) 9DS HYDRAULIC PROFILE = GRAVITY FLOW NOTES (GRINDER NOTE) JN DATA: PERC AND DEEP RESULTS FOOT CONTOURS EXISTING & PROPOSED 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER EWAY & SLOPES CUT ' TO WATER LINE (PITS -20') WG /GUTTER/CURTAIN DRAINS ION CONTROL; HOUSE,WELL, SSDS [ON CONTROL NOTE & DEEP HOLES LOCATED ESENTATIVE OF PRIMARY AND EXPANSION WiTIC TANK COMMENTS: Y EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE rED PIT & D BOX SHOWN & DETAILED OUSE NO. OF BEDROOMS & SSDS'S W I' . F PROPOSED SYSTEM TY MET & O S KEa� USE SETBA C (TI HT LOT) OUSE SE - 1 E PIPE NOBENDS; S 45. FILL SYSTEMS YBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE ILL SPECS =FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH F TRENCH PROVIDED =60 PARALLEL TO CONTOURS = 100% EXPANSION PROVIDED FT MAX 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 2O' TO FOUNDATION WALLS DJ 15' WELL TO P.L 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) LOCATION MAP — �' INTERMITTENT DRAINAGE COURSE W/l,' 00 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS 5' MIN TO C.D. S= >5%,20'- 4 %,25'- 3 %,30'- 2 %,35'- 1%,100' <1% DISHARGE /100' WITH 182 CONS DAY DIS. ' FROM FOUNDATION; 50' TO WELL IN1F MIL LER $ BA /RD S 12 021 "06 W 184.18 o. "d 0 0 O O. ^n n N �\ LOT# 13 Au 4. QJo � N, :�1 0 Ott V Ell � � OG�G , • p� P• Rye AS eviL r �sa. D /MENS /ON CHART /v . 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S °r -fi' .L9., r'a �'^ t5r. i' t a.: ! ..z �i P'. _ y g �°., ti 11 a G .r: _ -'�' '�..'.trxt ka t'`a:. iy `a' a-r" , ta: Y 7 -NAM COUNT Y DEPARTMENT OF HEAL Th'r:'- �� . � �' �`< ' " ° � > � �' � �' a ;. -71 / 7 i /�/ 4 fp � a ,1 ' ��/ �EIiY YORK STATE DEPARTMENT OFHEALTH " � � a " . 11 , 7 O v� 9 7 <!o D 1. d r Y x % I . • � x r� ?OC 1T /ON BASED_�ON SURVEYGK'�PROPERTY x j je # M Sf �),,;1` ' _° �v e .;�.: °i 'z> i ,,�s�r:`� L'� ip.:•'Y �, ,�.r'"- E7t:v.. �' Z ,<t"••I �° 9 i � x'v. y.`'�`c ej'a Sr `��.Y'� y' �O�!.� r 4 ,It 0,-,,- BY TERRY BERGENDORFF COLL //US x: >�` x� , k x� n } N° 49�09'l ",' <DATED JULY 515,, /997fi X20 ��38Y -0 y 4/ .'C� ,t > r, t k 77 c --' ` :c - fir•: -� F +s 3, � a) c� a. ` '' y� ♦ �.s -•. - i t 'xf.� a N .r } Jti ,z- _. t `fix)` i , / O /� 1 �6 �, - w a = r �x ,�2 4 3 4 ,0 T $ s Sx`'s `ti. r, >apa K s .`+k,r �..,. h .+.- •P� v. a- ' r ��. h S t d °* 3I ) . 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