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HomeMy WebLinkAbout0805DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -30 BOX 9 No .. L !! � . . ' ,�r A .9f. _. Is of 11:1 �i"..,.cr"t ,-- •.�— —_','- .,�a- Rr;z- • ---z+• r .cam+. -� '*°sy, ' ^" "', F.�' F•- °- �'r -•-y . t / PIITNAM COUNTY DEPARTMENT OF HEALTH Rev 3 BCC;` DlvlalogofEnvlroamentalHealthSev lces,'Csirmel,NY 10512, „ ! Engineer lYgpst Provide AA 1, TMCATE OF: CONSTRUCTIWCOMPLIANCEIOR�SEWAGE DISPOSAL'SYSTEIVI 4' f� —� d• i orated TariVYep Block` Lot 'j. i� i Owner /eppllcant Name Formerly Subdivision •� ame Sabdv Lot to q _ 01 MaWngy. Address �P D Da Peemit lsened �C J i f , p rag System . baUt by C Se seats. Sews a Address I `dDO Corisleting of Gallon ptic Tank and Wster $opplys Pdbltc Supply From Address on V Private Supply Drilled Address (A E�!1 '�► . 2l1 f�la) Baltding Type Has Erosion Control Been Comp etedY. Nambei of Bedroo a Has Garbage' Grinder Been Installed? Other Regai;emeate ''' ' ' .'� I certify that,ihe.system(s) as. :listed'serving' the above�premiaes were gonat ctad asaent_ially as=ehown o e pip 'af the completed work,•( copies of which are attached); and 1n. accordance, with,the'atandarda rules end:r �. atione,:,in, cord e`with' a filed: 1 and the peimit.Ysauad by the putnam Count 'D` nt 0 Nealth Date Y�� Certified by P.E R,A. i • , - i. e • Liesnq No Addr ss .'• Anyyperson occupying premiss served by.the above systern(s) shall;promptt' a such actbn is may.ba neee�sary to' NCurethe.co►rection of any unsanitary conditions resulting'"from I such.,usage. Approval of, the gparate sswere ;sy m shall becoms• null and.vold is soon as a puk: Whitary• ewer becomes available, and the appioval of the'.privata %yater `supply shall becomd null v i0 when i - blic water ,wpply becomes ivillabN. S h _approvals are sublect °,to modif call o►,change when,. in the Judgment( of the Co a_14 al such revoeatlbn,,,modlflgtion or change I e�sYry. t / (� f, Titfs Oats _ BY, . :. Y 04 -11 -199? 11: 92P-1 FROM MILL DRILLING TO 2782658 P. 03 TARLTON ENVIRoNmFNTA L LABORATORIES INC A Division of Northecist Laboratories, Inc. CT Cent: P0.004 ABS I7ANBURY: 22 KENmA AYENm - DANBuRY, CT 06810 and .P.H-0606 13ERLIN: 129 MILL ST1 u - BERLIN, CT 06031 NY Cent: 11411 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. PUTNAM AVENUE . BREWSTEJ, N.Y. 10509 SAAVLE 9m; SAMPL G POINT• SO CE: TREATMENT: DACE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED c0 LAB: DATE(S) TESTED: TESTED BY: REPORT DATE; 8/9/95 NOT STATED BOB MILL 8/9/95 8/9/95 LA3#11741 8 /x1.195 DEMITRIOS TSEMETZIS, EAST BRANCH RD., PATTEItSON, N.X. BOTTOM OF WATER TANK . WELL- D,MIL.ED NONE TIEST' PERFORMED T: RECOMMEIVIJLD LIMIT Total. Coliform (Bacteria) ABSENT per 100 ml AMENT MIST,�tX; . Chlorine Residual ND myg/L m1= milliliter m&IL ^ milligrams per Liter ND ;=z none detected - RESULn BASED ON SAMPLES SUBMIT UID;8 /9/95 F SAM1 LE, AS MTERAfiOVE: 12POTABLE or 101NOT POTABLE (,PER STATE OF NEW YOM DEPT. OF HEALTH SERVI.CB 5iANDARDS FOR POTABLE WATER) c;-f: DAN,6MAITA (203) 748 -7903 - FAX (101) 74"52 . CT: A'Fff'M'7'.41N/ A9TFOH1_I.4P.V? (20:x) 828 -9787 - FAX (203.1329 -? Q5 Tott FREE WITHIN c r. 900 -b2C- -9.135 4 ©UTSIDE Cr: 9%"54 -1230 r 1. i� r . i 04 -1 i -VEG7 L� /C ,.. 11: 01 AI°1 FRW MILL DRILLING TO • 2782658 P.02 11J11s�.I uUc:! tt�ttt� UQW0 wr LL : �urtrt,l✓1 Lvtr rcr ru�l Office Use Only DEPAR'�'I°IENT OF . HEALTH Division Of Environmental Health Services PUTNA14 COUNTY DEPAR'ITMNT OF , HEALTH stAEET AOOpE55: ++r TNC tiAtO mUM8 A: WELL LOCATION ECI$t Brach Road, Patterson, • NY WELL OWNER 1 1161trios Tsesmetxis Route 312, Brewster,. NY 4,U PggIVATE PUBLIC USE OF WELL } }(RESIDENTIAL - O PUBLIC SUPPLY Q AIR/COND./HEAT PUMP ❑ ABANDONED MOUNT OF-USE . .YIELD SOUGHT J gpm, /NO. PEOPLE SERVED 4_ _ / EST. OF DAILY USAGE gal. REASON FOR Q QREPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑AbDITIONAL SUPPLY DEPTH DATA W WELL DEPTH it I S STATIC WATER LEVEL 25 ft. D DATE MEASURED 0l2G/95 DRILLING O O ROTARY ?041 COMPRESSED AIR PERCUSSION ❑ DUG WELL TYPE O O SCREENED O OPEN END CASING M5 OPEN HOLE IN BEDROCK O OTHER CASING L TOTAL LENGTH ft_ M MATERIALS: )I STEEL O PLASTIC O OTHER LENGTH BELOW GRADE ft, J JOiNTS: O WELDED X)Q THREADED p OTHER DIAMETER 6 In, S SEAL: XXCEMENT GROUT O BENTONITE OOTHER WEIGHT P PER FOOT lb. /It. D DRIVE SHOE Q YES D NO L LINER: OYES ONO SCREEN D DIAMETER (in) ' 'SLOT SIZE L LENGTH (11) D DEPTH TO SCREEN (IQ D DEVELOPED? 17 YES 0 NO SECOND H GRAVEL PACK 0 0 Yos G GRAVEL D DIAMETER T TOP a a0TT061 WELL YIELD TEST ' � ���� ��� it more detailed formation descriptions yr sieve analyses DEPiH FAara w C well WAr�tATtQtt 0lr5GR17n4n i iaoe WELL OEM D DURATION O ORAWDOWN Y YIELD . ` `s'nau � � � �iQt�K01 d CO�+b1'�� II U �i 2 2 - 3 300 I I 400 2 2 3® 4 400 1 1-3/4. 500 6 6 - 4 400 5 5 WATa � XCLE t TEMP. - QUALITY O aOUOY HARDNESS t7 COLORED ANAL ZED? )%*ES ONO - - --- PUMP " _fir- ?/ q7 ri a PUDNI -DI•1 COQNIY DEPA FM/IENT OF f i -h-VIE DMSION .or ENyucm'a .L AFAI,TH SERVICES O•.qner or Purchaser of Building Section Block Lot Bu' ding Constructed by � sT. 01- L C E l�l C0�5 Location - Street SUAxdivlsion Nama Ranicipality Subdivision Lot . Building Gu.aRAN_E OP S -S I.RFACE Salty -CE DISFUS-kru' SXSl 1 1 represent that i. an wholly and completely responsible for the location, workmanship, material, construction and drainage of th.es?rsmew•age disposal system serving t_he above descri.b d property . and. that it has t& en constxucte3 as shorn' on f the apDroved Dlaft or approved a_T�end:ent tiiereto� •_and yin accordance with the standards, rules and regulations of the :Putnait Co* ntym Der, rtinent of Health, anal hereby guarantee to the canner, his successors, heirs or assigns, to place in goad operating condition any part of said system constructed by me which fails to operate for a period of two years :mediately following the date of. approval• of. the "Certificate of Construction Co:�pl fiance for the sewage disposal systems or any repairs :,ace..by ne- to such systems, except where the failure to operate, properly is caused by. the willfu'1 or negligent act Of the cccucxnt .of the building utilizing the system .. The undersigned further agrees to accept'as conclusive the deteouinetion of the Director of the Division of FRviroriiienta]_ Health Services of the Putsnara County Depart-.ent o- Bealth as to whether or not• the failure of the systan to operate was caused by the willful or negligent act of the occupant of the building utilizing the systems. % Dated this day OF V,� 19 Signatures /6 - f ` Title C -nerar Contractor (Dwner) - Signature Corporation Na ,fa (if Corporation N T�&_ (if Corp.) �� � 'i •d�� F e s 1 - Address rev_ 9/as MI - zz 0 0 co u C x C\2 G �6� H a ? a E- R0A� _ NS130.8' 1 cn '•ka: S .. I X W i4 }•: Y`. EXISTING 38DR. f I RESIDENCE Q 3,,Y, � �Ga ,,t i� •..n f •.• 1000 GAL. SEPTIC TANK a S1 i .? 1, mr� : 1,F3 ^ � i�j ABS. TRENCH(TYP•) "! L4 t . r r co . P.V.C.(TYP.) d s iu�'�' }"iii . �'� 1�.� w. "- � ----�- �re,�+ 4. � , d• -- , • �k'3" iY� •'r_^•;=`..Y +,.. •• �. r��=— ��.. a�. �.. �`.": �. e�-.+�- m,H- tk=- .r_1n•.u- J. -:,.. 7'a.; rn.s - •,a..,:.. ._ -.,, -> J.B.(TYP.) ' Ito c `.' N t - 7'55 . . S 94' :BASED ON '�I�RV�Y OF g- ARED BY- TERRY B RAE fbCRFE DATED 929 -9`. (in f t.) DIMENSION CHART r � x i yo A B: 37 32 0 43`0 3 4,7, 4= 4 4 8_: o 5 2. o S 5.0 57.5 63.0 ➢ 38.0 94* .5- 4 � 8 42.'• 5 95 -0. 10 5 53::5 98:0 I Ym_T2 81:5' 32.0 THE DfSPOSAL - .SEWAGE Co As ���ea�D Nit 3 8 5. (� z 3x7:5 THE', SY�S)TEMJVdA iii �s4 (ry�� 81.0 (' 43. J R, �T Y ►AS �illYyGR�LJ3 y{ t �? ti 1 9b. 49.0 STRUCTE �N fCCOR N. DARD Rl�� ES AND 5 V4' S -PLU A- M ;"a'l./�Il DL„3" °f 3C $ �' r' •yC '. '." E ' AND fH:E. NEW: YORK - - HEAC:TH F t :BASED ON '�I�RV�Y OF g- ARED BY- TERRY B RAE fbCRFE DATED 929 -9`. r � x i i t� To `b oaweao/ad b��` —I /� i% AAA- *Mw Sa11100it pd& Sep* Ftan .. Atl�leaa en !�_Pe1dNe.Sq�t► Dtiad b� . OIMrNwb I repreaent;thet 1 em.wh*fly and corniilialy r4spon"Ist for ,the design and.licatlon �of the proposed systems) ±1) 'that the apaiia tow di YI s stets above deacribed wiil.be constructed as shown on the appiowd amenanhnt there Wind in accordance with the stindaidi6 rules a reguations of n . .i County. WpartnNiit 'of Ha M,h.- ,atW'thet on;conlpNtbnaliereof a - •Certificaa of't:onstructton Complianp" .$a isiactory to the Commiplottai of HNlthwlll be submitied to the ,Oepartmisk. and, a written quarantN wile a furnished the owner, h.is suciessoi *ir or assgiu by the builder, tint Yid builder will Plki in go" operatitg condition ' any .part of'; eta '»tinge dii"I system tiurino the period of two,(2). years Irnmediat* following'.ttoi&te'of the {sell- Mee of theapprotral; cot -the CertNkate, of Construction' Complience of the original of an :rapNkf ther ' t 2j that the.druted wdt asu10e0 a13ow win be hmited aeshown on the ipprovid Pun anil that till well will led iri rdan wRb the, a s, ides and .rpu ns •of the Putnam County OeperimMt of Health. ' Oita (p 2i _� Sid P.E.. A.A. If l� LLi3/A�i Add1.. Icense No ress, . APPROVEO FOR CONSTRUCTION: This ipp!"al "Piss two yw s Irom the data ksued unless construction of the building has been. undertaken and is revocable for cause or'rnay be 'anaitde0.or modified when,considired necessary by ,the Commissioner of Health. Any change or alteration of Construction now 911 a perm Approired for disposal of domestic unitamp ItAtri mpply only. Re-V 10/88 at. _ By M _V P k UTNAM C UNTY DEPARTME OF, HEALTH x Rev. . 3/86 `_ Divielon of Envbonmental He th Services Carmel. N Y:10512 �� to Provide Permit # on CERTIirICA Permit l OF COMPLIAN !��A CONSTRUCTION PERMIT FOR SEWAGE'._DISPOSAL SYSTEM Pa 8' Located is E_a S t 'B r a n,C h R 0 8 d Town or VNage E Branch . Wo "ods 4 / _ V. Subdivision Name Subd. Lot q ' Tax Map Block Lot Owner /Applicant Name Rit h a r d R a,p p, S T evl Renewal ❑ Rslon p Date of Previous Approval MaWng Address C / o .Scout.: ,R e a l` t y To, Ali ' Rt 1_2 2. Qrew.st:er., :NY: 10509 Bandng Type;' S t n 61 e F 'am o W el, Lof., , 2:: 2 9 6 A c• Fill BecHon Only Depth Yohwe ; Number of Bedrooms 3 Deslga Flow G /P /D 6 Q' b PCHD NotiBcatlon In Regnlred When FIB Ie completed Separate' Sewerage Syeteni;to consist of GO OGaon SopNc Tank and 'T lie contracted by T O b:e d e,t e T m i n e d Address Water'Su pPl) Pablic.S ' t From Address oPP Y or x Prlvate'Sapply Drilled by TO L7e C telTTllflErd eddress Other Requiroments represen that 1 am wholly and completely „responsib.Iefor the,deugn and location_ of, Me proposetl systems) 1) that the. separate sewage "disposal system. .above described`. will be constructed;as shown on the approved,amentlment there to and'in accordance wlth`the standards, rules an r, a �onso " e': •u tram County ',Department of "Health, and that,on completion thereof a CeitifiCate of Cor struction _Compliance "'sat_isfactoiy to the Commissioner ot.Healthwill be submitted to: the Department,' and a .wntten,giiarantee •,will De furnishetl the owner, hii successors, heirs"' assigns by the'builder, that said builder will , . place in good operating' contrition any rpart of Said sewage tl�sposaf system:durfng,t a perwd of two ears;im ediatoly following thetlate;ofthe isw- snee of.'tha approval of `f he Certifieate of Constructlon Compliance.of the,'ori in y t', or an re tfieret 2) that the drilled well described above will be located ss shown on '.the approved plan and that;sa�tl well will be installed ►tlanee il he es and, regu a ronsmf . the Putnam County Department of Health 7 Date 9/4'/86 Signed P; .� 3 , F.or B &:C; RD6 Rt , 22: Brewst -eT N;Y 1 09 Address f f_ f, 7 - License No APPROVED VO R GO STR "CTION:. This approvat,expues one year fro t e^ to issued u assconstructi n oi.' a building has been undertaken and is revocable or cause or 'ay be.a, ended. ormodified whon considered nee. say ; the Cornm1 o "r of: 14 the y hangs Alteration of constr tjon requires. n i p ved for disposal of 'domestic'sanitary'se a' d /or'.private at sup ly nl' Date. BY Tit 1 Y 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 # " gy-9�,° WELL LOCATION Street Address Town Village City Tax SG I' I Grid Number WELL OWNER ame Mailing J,40 C Address 2 Private O Public SE OF WELL - primary 2- secondary ®.RESIDENTIAL OPUBLIC SUPPLY ❑AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY OABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# 13 REPLACE EXISTING SUPPLY ®.NEW SUPPLY NEW DWELLING) PEOPLE SERVEO,5. /EST. OF DAILY USAGEC:;041 Sal O TEST/ OBSERVATION Q ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR 'DRILLING DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN ODUG GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES K NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: VfZ,"C4 iC Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 2� NO NAME OF PUBLIC WATER SUPPLY: A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PRO PON SEPARATE SHEET (date) (si nature) 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 (3 0) days of the completion of water well construction, the applicant shall: 1. PuiV.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. Subuit a Well Completion Report on a form provided by the Putnam County Health Department. During al 1 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 ead in suc a manner as not to degrade or otherwise contaminate surface or groundwater. Date of I s;ue: 19 )ate of E-Vi ation 19 Pe r—m il t IssuingOffi cial rmit is Von - Transferrable White copy: HD File Pink copy: Owner 89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS ", dated 6- 21 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". dated 6- 21 -94. 3. "Construction Permit for Sewage Disposal System ", dated 6- 21 -94. 4. "Application to Construct a Water Well ", dated 6- 21 -94. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 6- 21 -94. 7. Two (2) copies of Residence Floor Plans, fo_r "Bedroom Count Only ". The original design engineer was STEE, Freeport, N.Y. A renewal of the SSDS and well was submitted by them July 29, 1992 and the present permit expires August 10, 1994. Please review the enclosures and issue the construction permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. CRandolph Laurent, P.E. RWL:bd 94061 cc: D. Gabrielli w /enc. LAURENT ENGINEERING ASSOCIATES, P -.C: -- -- - - - - MILLBROOKE OFFICE CENTRE Route 22 S 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 July 12, 1994 Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 ATT: Mr. William Hedges RE: Proposed SSDS - PCHD Permit #P -84 -86 Diana Gabrielli - Name Change & Renewal- Lot #4 East Branch Woods East Branch Road Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS ", dated 6- 21 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". dated 6- 21 -94. 3. "Construction Permit for Sewage Disposal System ", dated 6- 21 -94. 4. "Application to Construct a Water Well ", dated 6- 21 -94. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 6- 21 -94. 7. Two (2) copies of Residence Floor Plans, fo_r "Bedroom Count Only ". The original design engineer was STEE, Freeport, N.Y. A renewal of the SSDS and well was submitted by them July 29, 1992 and the present permit expires August 10, 1994. Please review the enclosures and issue the construction permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. CRandolph Laurent, P.E. RWL:bd 94061 cc: D. Gabrielli w /enc. piJTNA COiCTNT -X- X�EPA.RTI��NT Ol;' H1EAi..')ME -X APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL.SYSTEM Lead Agency 1 . Name and Address of Applicant: f2l'A, ! c �d 2. Name of Project: ��6SED SSpS 3.._. Location T/V /C: EM M 7. 9 Project Engineer:'A�1.1�GL�1� �I . ���;�'��►r P 5. Address: 42ffi�29G7f License Number- _� 51.. Phone:27 �IC Type of Project: - _ Private /Resi-dential Food.Service.t ....Commercial Apartments Institutional Mobile Home•Park Office Building Realty. Subdivision Other .(specify) Is this project subject to State Environmental Quality Review.(SEQR)? Tape Status (Check One) Type I.. Exempt Type II. Unlisted. �C Is a Draft Environmental Impact' Statement (DEIS) required? 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, cj _.... or_oth.ar._.o.ffi.ci.aIs, ordinances? .- ??t;J1 1 12. If so, have plans been .submitted to such: author .i. tie s ?..................... 1� d 13'. Has preliminary approval' been granted by such authorities? Nbs, Date Granted: 14. Type of Sewage Disposal. System .Discharge...... Surface Water V_ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N �� :6. Waters index number (surface) ........... ............................... N �� 17. Is project located near a public water supply system? .................. N! 8. If yes, name of water supply Distance to water supply :9. Is project site near a public sewage collection or disposal system ?..... N :0. Name of sewage system Distance to sewage system N• /i� 1. Date observed: NA. 23. Name of Health Inspector: N/A d. Project design flow (gallons per day) ..................... �-,ew 2 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. �,J 0 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 ? .................... .............. ............................... 28. Wetland ID Number .. .................... ............................... 29. -Is Wetland Permit• required?. .............. ............................... Has application been made to Town or Local DEC Office? .................. _ .! 30. Does project require a DEC Stream Disturbance Permit? ................... N G 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 N D 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 rIG' DESCRIBE: 33. Is there a local master plan or file.Kith 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 154' s• lope ? ..................... ...... N 6 36. Tax Hap ID Number .... ............................... ....... .......... 37. Approved Plans are to''be: returned to: ................ Applicant _ Engineer If the application is signed by a person other than the applicant shown in Item.1, the. !PPlication 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 ursuant to Section 210.45 of the Peoa I Lair. SIGNATURES & OFFICIAL TITLES: l ,� 'LAILING ADDRESS•�NS��� PUIVAM COMM DEPARTMEWr OF r. DIVISION -OF- ENVIPMOML -Ey a• «E. DESIGN DATA SEMP- SUBSUFACE SEWAGE- DISPOSAL SYSTEM FILE NO. ' Owner NasaA • r Address ,?J )Z Ibcated at (Street) �� S Sec. Block 2 Trot (indicate nearest cross streetY •. �a ■ =• • • PERCOLATION= DATA • B• •• y TO BE.SUBMITIED WITH APPLICATIONS NOTES: 1... Tests to be repeated at same depth until apprcximately equal soil rates. are obtained .at each percolation test holes. All data to' be sukxnitt�d ' for review. 2. Depth measurements. to. be made -fran top of hole. is I =■ Date of Pre - Soaking Ey -72 Date of Percolation Test (a- 'HOLE NiIMBER (3IJCR TZME PERCOLATION . PERCOLATION Run NO.- Elapse Time Start Stop Min Depth to Water Vrcn Ground Surface Start Slop Inches Inches Water Level In inches Drop In Inches Soil Rate .. MWIn Drop �Q 2 0- ' - `f 3 30 94 '" ... 975/9 r� 5/.r 3 , a - 2' : 3d 5�8' � 'IT 4. L 2. (S - 2: 1 1 OS 3o .y 3 ,xC 4 2:20 - �.= S J 30 %y �' /g /S 5 1 NOTES: 1... Tests to be repeated at same depth until apprcximately equal soil rates. are obtained .at each percolation test holes. All data to' be sukxnitt�d ' for review. 2. Depth measurements. to. be made -fran top of hole. is I =■ TEST PIT DATA • E• /• E/ TO BE SUBMITTED WXM APPLICATION DESMPTION OF SOnS MMUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G. L. 1' o. 2r 3' 5' 6' 7' i 8' 9' 10' 11' 12'. 13' 14' .._....,..... _._. IlIDICATE LEVEL AT WfiICS GROt7ND�.7'�:R IS F�IOOUN�FtID �" - INDICATE LEVEL TO MCH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADEiBY.- DATE: DESIGN Soil Rate Used 2) Min/lit Drop: S.D. IIsable Area Provided. IOod No. of Bedrooms Septic Tank Capacity ' gals. Type faN G Absorption Area* Provided By _ L.F. x 24" width trench Other Nam:... �� V�J /� ��� �t�l� _ signs , Address SEAL THIS SPACE FOR USE BY HEALTH DEPARD9M. ONLY: Soil Rate Approved sq. f t,% I. -Checked by :. Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date' 0.21 �I4 Re: -Property of►�'j Located at 5 j' � ►�G� r3CA7 (T)'(��}%� Section 2� . Block 2 Lot %d Subdivision' ofT�,c Subdv. Lot # Filed 1,1ap ate Gentlemen: This letter is to authorize�j�QL�� -� a duly licensed professional engineer or re•gis:tered architect (Indicate) to. apply for. a Construction Permit for a separate -s=ewage system; 'to serve the above noted property in accor'd'ance with the. standards, rules• or r.egu: Ar_loris ..as pxomulagated'.by. the Commissioner of the Putnam. Comity, :.Department 'o.f Health';..and. to .sigri.al.l :.iie.cessary papers on rriy ,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. Countersignel P . E # Very truly ours, Signed I . Owner fif Property Mir� ►ce N Address Telephone q- � K'PiyS� �l'f iG"U �l T o vn Telephone �M . , '. 1 m DAVID D. BRUEN County Executive. DEPARTMENT OF HEALTH Division Of Environmental Health Services September 17, 1986 Mr. William Hurley Baldwin & Cornelius, P.C. RD #6, Rte. 22 Brewster, New York 10509 JOHN SIMMONS, M,D. Deputy Commissioner Re: Proposed SSDS East Branch Woods -Lot l East Branch Woods - Lot 4 Maggio.- Lot 7 (T) Patterson Dear Mr. Hurley: 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: East Branch Woods Lot 1 1. 'A design data sheet has not been provided 2.: -Two sets of house plans have not been, ?rovided 3. Design data is not shown on the plan, i.e.'perc rate __...._,_ .... _. soil type. 4. All sheets are not signed and sealed 5. The scale on the plan drawing is.incorrect,.1:20, not 1:100 6. The sewage area and expansion area 'is shown within 100 feet of the wetland East Branch Woods - Lot 4 See #,- bove " .Construction notes have not been provided The well has•been relocated to the front of the lot. Information as to the location of-sewage systems across Doansburg Pond within 200 feet of the well must be provided. Maggio, Lot 7 1. See #1, 2 and 4 at East Branch Lot 1. TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - 2 - Mr. William Hurley September 17, 1986 Maggio, Lot 7 (continued) 2. Fill notes have`not been provided 3. Footing and gutter drain discharges are not shown 4. Deep hole locations are not shown Extra plans for lots 4, 5 and 8 are returned. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. ou s ve y truly ohn Kar , Jr., E. irector, JKspt Environmental Health Services , cc:JK File Encl. 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMCL,,N.'Y. 10512 (DESIGN DATA SKEET- SEPARATE.SEWAGE DISPOSAL SYSTEM FILE NO. OwnerRichard L.'Rapp Sr. .I Addres'sDrewville Rd. Brewster,.NY 10509 Located at (Street )gaIIs� Sec. 15 Block 3 Lot- . 4 (Indicate nearest cross s ree Municipality Patterson Watershed Croton SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Lot. 4 . Hold Number CLOCK TIME PERCOLATION PERCOLATION Wm No. Start -Sto p . ' , apse Time � Min. Depth to Water - From'Ground Surface Start' Stop p Inches Inches, a er. _ ve in Inches Drop in Inches Soil Rate ,� Min, /in drop 1 19 .- `39... 20 24 27 3 ~..` ;.6.66 min /in 2 4'n - 65 ,:.., '25 , 24....: 27, . .3 8.33 min /in . 3 05 - 35 30 24 27 3 10.00 min. in 36 - 72 .3' 6 24 28 4 9.00 min /in .2.7 •... ..... .3....... _...;... 10.00 min /in 1 ! 31 - 61 30 .25 26.75 1.25 . 24.00 min/ in 32 30 25. 25.75 .75. .40.00 min /in. 3 3.3 __...75 -.42 . .._ 25 4 16 .46 30.' 25 26.13 1.13 - 26.5 min /ih V7 5 .47 - 18 31- 25 26.06 1.06 29.00 min /in Notes :' 1.) Tests to be repeated at same depth until a roximately equal soil .:rates-are ,obtained at each percglation test hole. A11 data to'bbe submitted for review. 2) Depth measurdments'to be made from'top of hole. TEST PIT DATA DEPTH HOLE NO. G.L. To PS() I L- - 31. . .1 4• 51 61 71- 81 91 ,UnM'tO: BE SUBMITTED WITH APPLICATION OF SOILS ENCOUVITRED IN -TEST -SOLES HOLE NO. HOLE NO. 10, 12'- 13' lV: INDICATE IME14-AT WHICH GRWNUAM IS ENCWNTERED Aloma- 0-7 INDICATE J= To WHICH WATEP, I= RISES AFTER BEING MMNTERED AlaAle 7 DEEP HOLE OBSERVATIONS MADE BY. ZA P P T e DATE: lo/lq/gf Soil Pate Used 30- -Min/1 Drop: DESIGN 9' S.D. Usable Area Provided 5 000 -5f- No. of Bearoarts 3 Septic Tank Capacity /Oao gals. Type CO3- C Absorption Area Provided By 504 L.P. x 24" width trench Other A%, (%nR AIIAI 01, Name Sig4 vv at C611 -M-EHUS, P--�& A L. BALU I Address ,C, RD 1#6, RTE .22 1980 SPACE FOR USE BY HEALTH DEPARMMU ONLY: Soil Rate Approved sq.ft/gal. Checked by Date /i�rrtt>ti Swfdtr/� S�rlti� 1i etrrlatd i uuu, titt�,S...t. _c 2uu t_t.. r 1elaS em olind" T,o be determined w:ar x ,,;�,, y To be determine 1 09, - ant`thst t' 4m whoily and, canplstssy thpons{ble.fW the din sM, kl4tion` of tM proposed wlie -(q alas+ rise►{Osd wtl1 M oonfE►uetiO is Chown en tM approved anwndma►t ,thsis to ;ari0 M accOidrnp'wtth tM q county .:O�pet nt W ?Wilth, ;'and;that on COmplstlon',tMnof i "Coif {Iicsto of ;ConstiuctI" j: Illrep": tia mailw tsd tai, tM ONrrtowd. nid i writtMi pwrsiitfas wili:M fuinhfad t",ownt►; his fucgi� 16*iki {il;jeed opwMMi/'condRbn , uyr;pa. "o dW 1a!!w/s: Ai oossl tyyttrh iWI4 tla PMbd,of two4s) in ..v �i►l- rwwn��� :�.. w..w..:Mi.�a�....�i..�.;�: i�'w�'-:::u�:�w:.�� ....i....Yr. �i 0 aetory,tolhoeClummi slona of NMlthwlll ripe t►y the bulldir, tw said t 6wor will iiinwdiatNy:followMy tNaOab of the MW ei 2l.tM IN arNlsd wNl Wraittiid d"Ve 'wMS r »uZsi Oni's of tM :putnin1 Lk/MS'NO' %/1 AM huOdini'hss `Won undsrtsksn and is Any am" w irrit{on,of:cdMt ► uetbn �' TItN A y Y, I- - -- - - - IN 14 -000 VC00 t 'It P ,PyV?w It 7fT 014 7-7 77 DEPARTMENT OF HEALTH ,AUG 4 15U Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 -- APPLICATION TO CONSTRUCT A WATER WELL - - -- ' - PCHD PERMIT Ay"�� ,WELL LOCATION Street Address Town Vzi4ege &1&y- Tax Grid Number East Branch Woods Patterson 15 -3 -4.4 WELL OWNER Name Richard L. Rapp Mailing Address CNPrivate Drewville Rd Brewster, NY 10509 O Public USE OF. WELL I - primary 2- secondary ® RESIDENTIAL 0 BUSINESS El INDUSTRIAL OPUBLIC SUPPLY OAIR /COND /HEAT PUMP 0ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT ' OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 500 gal REASON FOR i DRILLING EINEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED. REASON FOR DRILLING Applicant requires water supply for a new home to be built on lot Non - Transferrable Yellow copy: Building Inspector 2/87 Pink Copy: WELL TYPE OX DRILLED Orange copy: Well Driller DRIVEN ODUG GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: East Branch Woods Lot No. 4 WATER WELL CONTRACTOR: Name To be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY - -. -.. DISTANCE TO PROPERTY -. FROM. NEAREST WATER MAIN,:-- N /.A...._ .....__._.._ ___. _. ... _ LOCATION SKETCH & SOURCES OF CONTAMINATION PROWLDED O ON REAR OF THIS APPLICATION X SEPA EET 7 -28 -92 (date) ('s i`g6afu re) 0 So. Bergen Place 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 H lth D t t ea a ar men . Date of Issue: 19 z __7 fficia Date of Expiration: lg�' ermit ssuing � —�— white copy: H.D. File Permit.is Non - Transferrable Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller • F =•L=am - �.. - -- T= �-_ - � � Cif ..a° CN�I �. it = CD n_=? b. F= i s`C:4 barrier - L_ � f =c. �c = =- � cCL:= � iatl�T 01 tom.` C t:7- r. - t_C== i - Cwt L -- CN le E FCC. Eli t.'Emc -, 12" u•_. u u. �= C _ t_T U 2- Chi Ems'` =! C'W 4. -W ca CrC_E E=Usc well E_ C�' =i r7 G" -i ✓� cC CrCc__^_C LC- L'�' —� _ In c _' INIZ� C�1�t7bfc7.�•rr- t I I I I ^I I ( 11 i l { - l { ' i t { i f{ - 1 I 1 i _ X i I , I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AUG- 1992 _ - Date July 22, 1992 Re: Property of Richard L. Rapp Located at East Branch Road (T) Patterson Section 15 Block 3 Lot 4.4 Subdivision of East Branch Woods Subdv. Lot ## 4 Gentlemen: Filed Map ## This letter is to authorize Julius I. Cesare Date a duly licensed professional engineer. X 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._.proyisions_.o.f. Article.. 14.5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code.. Countersigned: P..E. , R.A. , ## 411 , P. C. ess 101 S. Bergen Place, Freeport, NY 11520 a. :.: 1.11 Telephone Very truly yours, Signed Owner of Proper �y� Richard L. Rapp -- 1040 Drewville Road Address Brewster, New York 10509 Town 914 - 279 -4496 Telephone 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 PCHD PERMIT # WELL LOCATION Street .Address Town i�SS� ity Tax Grid Number East Branch koad Patterson 15 - 3 - 4.4 WELL OWNER Name Mailing Address Richard L. Rapp, Drewville Road, OPrivate Brewster, New York 10509 O Public USE OF WELL 1 xx primary 2- secondary $X RESIDENTIAL 0 PUBLIC SUPPLY 0 BUSINESS 0 FARM 0 INDUSTRIAL U INSTITUTIONAL. O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION 0 OTHER (specify 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 5 /EST. OF. DAILY USAGE 500 gal O REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION Q ADDITIONAL SUPPLY >U NEW SUPPLY NEW DWELLING1 DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING 'Agglicant requires wa ter supply for a new home to be built on ' lot. WELL TYPE DRILLED DRIVEN DOG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES xx NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:' Fast Rranrh kinnri- Lot No. 4 WATER WELL CONTRACTOR: Name To be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XX NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY -- DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET 4/1/90 (date) PERMIT.TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within 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 suchl a manner as not to degrade or of ise contaminate surface or groundwater. Date of Issue: 4y 1,2- 19 V & [ -4 Date of Expiration 41/2 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVIRONMENTAL HEALTH SERVICES Date April 1, 1990 Re: Property of Richard L. Rapp, Sr. Located at East Branch Road (T) Patterson Section 15 Block 3 Lot 4.4 Subdivision of East Branch Woods Subdv. Lot ## 4 Filed Map ## 2074 Date , Gentlemen: This letter is to authorize John F. Eberle, P.E. a duly licensed professional engineer x 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, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed G1 Countersigned: Owner of PropeAy Drewville Road P..E. , R.A. , ## 66674 Address Baldwin & Cornelius, P.C. Brewster, New York Address Town RD 5, Route 22, Brewster, New York .(914) 279 -4496 (914) 279 -7115 Telephone Telephone i DIVISION OF ENVIRONMENTAL HCALTH SERVICES COUNTY OFFICE BUILDING,.: CA., L,.N• Y. 10512 DESIGN DATA SIIEW- SEPARATE SEWAGE DISPOSAL- SYSTEM FILE NO. OwnerRichard.L. Rapp Sr.. I AddressDrewville Rd.'.Bre.wster, NY 10509 Located at (Street) Sec. 15 Block 3 'Lot 4 n ca a neares - .cross s ree Municipality Patterson Watershed Croton SOIL PERCOLATION TEST DATA REaUIRED TO BE SUBMITTED WITH APPLICATIONS Lof 4 . oe nIumber CLOCK TIME. PERCOLATION PERCOLATION ttun :No.: �.' Start -Stop ivapse Time Min. mptn to water ...Water.,. Prom Ground Surface Start Stop "'Drop Inches Inches l,evei in Inches -in Inches Soil Rate Min. /in drop '1 19 .- 39 °.. 20 =24 27' 3 .... ..,:.::. •: 6.66 min /in j 40 - 65. 25 24:. 27 3 8.33 min /in 30 24 27 . 3 10.00 min.in 4 36 -: 72 .36 24 .28 4 ... 9.00 min /in 5:13 :..43 :.10 24 ..27 3... 10.00 min /in 11.31 - 61 - 30 25 26.75 1.25 24.00 min /in 2 02 - 32 30 25. 25.75 .75 40.00-min /in. - - --3 33 - 75 :42 25 26,.50 1.50 4 16 - 45 3O 25 26.13 1.13 :26.5 min /in 5 .47 - 78 31- 25 26.06. 1.06 .29.00 min /in dotes : 1) -Tests to be repeated at same depth until approximately . equal soil rates are obtained at each percglation test'hole. All data to be submitted for review. 2) Depth measurdments'to be made from top.of hole. TEST PIT DATA REQUIRED TO .BE SUBMITTED WITH APPLICATION DEPTH HOLE NO. G.L. To Pso i i 2' 31 HOLE NO. Ab HOLE NO. 13' 141 -INDICATE. LEVEL AT WHICH .GROUNEWATER IS ENCOUNTERED -7 INDICATE LEVEL To WHICH WATER LEVEL RISES A= BEING ENCOUNTERED NONE 7 DEEP HOLE OBSERVATIONS. MADE BY: I C, H-&g p Z A p p T DATE: jo/iq/t?f DESIGN Soil Rate used 'Min/1" Drop: S. D. Usable Area Provided So 0o -s No. of Bedrooms 3 Septic Tank Capacity o ao gals. Type Absorption Area'Provided, By SO4 L.F. x 24" width trench Other =M. Address yj, RD !#6- RTE .22 L3KtW,) I tRT N.Y. 1 U509 THIS SPACE FOR USE BY MALTH DEPAMON ONLY: Gf3v �: - SEAL )924L 1980 Ir Soil Rate Approved sq.ft/gal. Checked by Date I. � 1 • `U H Ih II I•: j .� U I:. I . '1. .0 t A ,t Ci II. ,• C I' A AIM r N N A b Z A n1 • i1 t �_ , C T �� h C � m7 n P I N r � ��� •pp SV �t�I, i p IRIO ii'pn',P .S f ,N Nt P, � ',.1.Y�:� r.l 1 V Y • -t '� / A:'�'�, ti � to .. •1 ��*•." S t l.�t ti I •tPr ji.� ®dapi !r t t 'k,("llf l.l. y 7, t::11 ♦�h, laf �I j�l iii �w1' .� I !' 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S194 .• 3 *ds awes •11 '' ''�J �jOC21 nli .l /n Of91 'Yll..l /n �-1n Q V' S/OS M. .M 51fs M VII W ' 2 CII�I ~ a CID lAQU- Q 3 v mli O- N cr .:YF. i• ?i'e ii' �f� •a { • r.i:'i '11 � ` It rt � aw. ` t n f G �' n�,, r- n� C •� ` ` ...III.. .. . '.: t �w .�� ;' NS ZIY �t i w1tL ti� � IZ�' G •��. 4��.�ayy :•� A.1--- Yy —Tt ifs: 5n ❑0 mac C -77 zK: -_ ___ _ --•ataa as DIVISION OF ENW..RONMENTAL. HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL,..K. Y. 10512 DESIGN DATA SIM- SEPARATE SEWAGE DISPOSAL-SYSTEM FILE NO. OwnerRichard .L. 'Rapp Sr. I AddressDrewville Rd. Brewster, NY 10509 Located at (Street�Indlcatie.nearest Sec. 15 ;Block 3 Lot- 4 c ross street) Municipality Patterson Watershed `C.roton SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Lot 4 11010 - Numbe.r - CLACK • TIME PERCOLATION PERCOLATION .,Elapse p o' a er • No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. - .Si;art . Stop Drop in Min. /in drop Inches. - Inches Inches 1.1 9, :- 39 .. -20 24 27 3 .. 6.-66 min /in 65 25 24 . 27 3 8.33 min /in 305 - 35 30 24 27 3 10.00 min.in 436 - '72• 36 :. `2.4 .28 4 ::;.'.. 9.00 min /in 5 .13° _ .43 ;..' _ 30 24'' . 27 .. _3...:.. .. 10.00 min /in 1.! 31 - 61 30 .25.• . 26.75 1.25 '24.00 min/ in 9. 02 - 32 30 - 25. 25:75 .75 40.00 min /in. _. 33 - -. 75_.... 42.... 25_ 2. 6:. 5 .0:..__...,..1- �50-�--,.-..__• .-28:00 `min /in..._...- 4 16 - 4.6 30 25 26.13 1.13 26.5 min /ih 5 .47 - 78 31- 25 26.06. ,1..06 29.00 min /in Votes: 1) Tents to be -repeated at same depth until approximatelyy equal soil rates are obtained ,.rate at each percplation test hole. All data to be submitted for review. 2) Depth measurdments'to be made from top of hole. TEST PIT REQUIRED 0 LMT WITH APPLICATION DEPTH HOLE NO. -1- - HOLE NO. G. L. 1' To PSoI L- 21 � 3' 41 YAAJOY L.a 5' WI.CCLA•y 6' 71 HOLE NO. 89 r F? �, lU t d 1j""y�� 12' 13' 141 INDICATE - LEVEL - AT -WHICH GROUNDWATER IS E 4CWNTERED -- At o�vE -- . -7. INDICATE ISVEL To WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED AloAl . 7 DEEP HOLE OBSERVATIONS MADE BY: r 1 c N11t-9 D.. J ZA P P T E- DATE: I o/ 1 q /k4 DESIGN So Soil Rate Used 3 y . Min/1" Drop: S.D. Usable Area Provided No. of Bedrocros 3 Septic Tank Capacity /oc7o gals. Type Co--c Absorption Area'Provided By L.F. x 24" width trench Other Name C �r C'(�RNELIUS. P.C. 6611NIN & o Address �' RD " #6� RTE 22 .S u2mAISTER N Y 10509 --D,�T _ VEAL C)_ �Zs r. 1980 00 THIS SPACE MR USE BY HEALTH DEPARTMENT ONLY: '��,,, ''' � ``.�•� p•4 in wio0o' Soil Rate Approved sq.ft/gal. Checked by Date A PUTNAM COUNTY DEPARTmENr OF HEALTH - DIVISION OF EiVVIROmmm HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL'SYSTEMS (Name of Owner COMMENTS REVIEW SHEET - CONSTRUCTION PERMIT DATE RZIIEWEDY'�/�_ BY: ., (Street Location) YES DOCUMENTS Permit Application rporate Resolution ans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other L/ House Plans - Two 'sets If PWS - Letter 2� fiance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions. - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data / Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area sion Area;shown;gravity flow,suff. size If Pumped Pit--&--D-Box Shown & Detailed use - No. of Bedroans Wells & SSDS's Win 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) ouse Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields i 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation. 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same A ^: BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS - LAND SURVEYORS RD 6 - ROUTE 22, BREWSTER, N.Y. 10509 (914) 279 -7115 August 29, 1986 Mr.. Michael Budzinski Putnam County Dept. of Health Division on Environmental Health Services Two County Center Carmel, New York RE: EAST BRANCH WOODS - Lot No. 4 Tax 18 - 1 - 18 Town of Patterson Dear. Mr. Budzinski: On.behalf of our client, Mr. Richard Rapp, Sr., we request approval of this SSDS Design. Each design c onsists of two (2) drawings. Drawing No. 1 'is the plan and profile of the SSDS design. The.perc hole and deep hole tests are also shown. Drawing No. 2 consists of our standard sheet for Putnam County details. All drawings are dated August 18, 1986. Please call me if you have any questions Or comments about the design. Very truly yours, BALDWIN.& CORNELIUS, P.C. William Hurley WH /b. Enclosures /: __,:. Engineer's. Authorization. Deep Hole Tests Perc Hole Tests Permit Application Well Application PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date September 4, 1986 Re: Property of RICHARD RAPP.SR. Located at EAST BRANCH ROAD (T) PATTERSON Section 18" Block 1 Lot18 Subdivision of EAST BRANCH WOODS Subdv. Lot # 4 Filed Map # Date Gentlemen: This letter is to authorize BALDWIN & CORNELIUS, P. C. a duly licensed professional engineer X or registered architect (Indicate to apply for a.Construction.Permit for a separate sewage.system, to serve-the above,noted property'in acc•ordance.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 'wi.th .the provisions of Article..145 ' or 147; Education Law, the Public Health Law, and the. Putnam County Sani- �� tary.Code. Very t Signed Countersigned: P.E. Baldwin & Cornelius, P.C. Address RD 6, RT 22. Brewster, New'York 10509 279 -7115 Telephone Drewville Road .Address Brewster,' New York 10509 Town 279 -4496 Telephone UtPAK I WENT OF ._ HEALTH Division Of Environmental HgAIth Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL pv-u6 LOCATION STAEEI S . JOWNIVILLAGEICHY IAX GRiU URUER. 1 _L East Branch Road Patterson 18 - 1 - 18 LoT ELL OWNER NAME.. ADORESIS: ` ❑ PL1VATL ❑ PUBLIC E OF WELL 0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED primary ❑BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ UNT. OF USE YIELD SOUGHT 5+ gpm. /NO. PEOPLE SERVED 3 -5 / EST. OF DAILY USAGE 450 gal. ASON FOR ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION IRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL LL TYPE I Ej DRILLED ❑ DRIVEN• DUG Ej GRAVEL OTHER WELL SITE SUBJECT TO FLOODING? YES NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:E. Branch Woods LOT NO.: 'ER WELL CONTRACTOR: Name Address: PUBLIC WATER SUPPLY AVAILABLE TO SITE: ___ YES x NO E OF PUBLIC•WATER SUPPLY: TOW -N /V /C rANCE TO PROPERTY FROM NEAREST WATER.MAIN XTION SKETCH & (date) 1 SOURCES OF CONTAMINATION. .... .. _._.. j ,Z i si.gnatur PER IT TO CONSTRUCT A WATER WELL This permit to construct one water well asset 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 for provi ed by the Putna m� ounty Health Department. to of Issue: / Pe t Issu ici -mit is Non - Transferrable (Diana Gabrielli) WELL COMPLL' HON ruxuai DEPARTMENT OF HEALTH _Division..Of. Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only. WELL LOCATION STREET ADDRESS: TowNIVILLKLICHY TAi GRID NUMBER: East Branch Road Patterson, NY WELL OWNER NAME: ADDRESS: X Dimitrios & Diana Tsesmetzis, Rte. 312, Brewster, NY PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary XU RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 / EST. OF DAILY USAGE gal. REASON FOR DRILLING E]REPLACE EXISTING SUPPLY OTEST /OBSERVATION ❑ADDITIONAL SUPPLY X ®NEW SUPPLY (NEW DWELLING) .[]DEEPEN EXISTING WELL DEPTH DATA 500 WELL DEPTH ft. 25 STATIC WATER LEVEL ft. 1/26/95 DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY XM(COMPRESSED AIR PERCUSSION O DUG O WELL POINT .❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING xMKOPEN HOLE IN REDROCK O OTHER .CASING DETAILS TOTAL LENGTH 31 ft. MATERIALS: . x0STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 30 ft. JOINTS: O WELDED xrxkTHREAOED O OTHER DIAMETER 6 in. SEALXUCEMENT.GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 -Ib. /ft. DRIVE SHOE O YES .ONO E LINER: OYES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TU SCREEN (It) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ILI BOTTOM DEPTH. it. WELL YIELD TEST If detailed pumping P P 9 METHOD: O PUMPED tests were done is in- COMPRESSED AIR , ormation attached? O BAILED O OTHER ; YES ONO WELL LOG .11 more detailed formation descriptions or Sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear. inp Well Oia- Inelcr I-0AMATION DESCRIPTION CODE ft It WELL DEPTH 1t. DURATION hr. .min. DRAWOOWN It. YIEt.D gpm. Surface 10. Hardpan & cobbles 0 500 Hard grey & .white granite 300 2 - 300 1 400 2 3' 1-3/4 500 6 - 400 5 WATER X® CLEAR TEMP, QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? XM YES ONO ANALYSISATTACHED7x0YES ONO STORAGE 'TANK: TYPE diaphragm CAPACITY 86 GA 23 WELL DRILLER NAME MILL OR G o °A 8/ 9/ 95 ADDRESS Putnam Avenue rA Brewster, NY Rob M11 rest ent PUMP INFORMATION TYPE submersible CAPACITY MAKER GOULDS DEPTH . MODEL. 7GS10412 VOLTAGE230 HP 1 0/8y J.... Alm, T TARLTON ENVIRONMENTAL LABORATORIES, INC. A Division of Northeast Laboratories, Inc. CT Cent: PH -0404 DANBURY: 22 KENOSIA AVENUE - DANBURY, CT 06810 and PH -0606 BERLIN: . 129 MILL STREET - BERLIN, CT 06037 NY Cet: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. PUTNAM AVENUE . BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: REPORT DATE: 8/9/95 NOT STATED BOB MILL 8/9/95 8/9/95 LAB #11741 8/11/95 DIMITRIOS TSEMETZIS, EAST BRANCH RD., PATTERSON, N.Y. BOTTOM OF WATER TANK WELL- DRILLED NONE TEST PERFORMED RESULT: BACTERIAL: Total Colifonn (Bacteria) ABSENT CHEMISTRY: Chlorine Residual ND m1= milWiter mg/L = milligrams per Liter ND = none detected per 100 ml mg/L RESULTS BASED ON SAMPLES SUBMMED:8 /9/95 RECOMMENDED LIMIT ABSENT SAMPLE, AS TESTED ABOVE: ❑ TOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) &a1w. Fa CT: DANBURYAREA (203) 748 -7903 - FAX (203) 748 -0652 - CT: NEWBRITAINHARTFORDAREA (203) 828 -9787 - FAX (203) 829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 - OUTSIDE CT: 800 -654 -1230 N N N N N N v r v v v 1000 /G L i ' Q SEPII TAN I I I I I 1 I a IA I I I I II II I o I I I I I I I f I I I 1\ I a qd a. v� ' O LL X W u- iI( I I I 111 im im IN im N im I U) Cr I I I I I I a vId v v 1 0w° p I I 11 I I I` 1 4 - o cc CD I J � 1 � I I S W ALE / — Putnam f Envi �eparAment of a�th ® ' r o Division of EnvironmentJl Health er! t, e$� v V p ved as noted for conformance with D.S. P��� PROPOSED WELL A aP i ble Wgu t tions of the SCALE:V =20_" LOT' #5 Fu par ent. !� Tgw r S# ature &—i Date fi..' + `A, e °�° �}3 SCALE: AS SHOWN 'P SR. B�`B1r� ®' BRANCH . tl�100.®S . ` .0 . #+ liAd t _ �" DATE: 8/18/86 .Y. .10509 .S.&M.So. PLAN - �-+T- � o� PATTERS o a, JOB NO. 575204 u - DWG. NO. 1 of 2 PUtM, -ArM COON, -4a. N YORK.'