HomeMy WebLinkAbout0812DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
24. -2 -39
BOX 9
I run.'
*1110
IN
1 .
Ir
i
Ir
',
I�6
-
T rL
I
1
:r
I
kt�
-
00812
| mp
/ um
111 of EnWomineited2ealth C"W. NA Enghmeer to P"
Often III
Su
'Sy" an Maine Subd. Let # Tax 111wk
PEOV111111011 '0—
ad
Malang Address - 3 V. 61�4�1 1:, RO Town Dover ki�ins NY ZIP
by er
I represent that I am w1hiolly'an , d, S:Ofv!plet,�aii9�',iioi�ni-i�le for the design *and location Of Ahill Proposed SyiiiM($i..1) that the saps - rate I sawape.,disposal system
above discribed will be. construct-6d.js shown4in the approved arendmeni there to aiid in accordance with the sia-Adirds. rules `ZnT—rsq—ura� EOns of the - Putnam
County-, department of Hoisith, prid,that,on-compleition thereof a 'Tertificiats. of c6nitru,cuori complilince-9satisfactory to the CornmissJ10par lo! Health will
place in good', . Operating::'cor4LAiO`h`:ahy Pori of 'said sewaoe'diip-osal jyitem during the period of two (2) years Immediately following thedativ I the: Inu-
ance of the approval, of'the- Certificate of Co`n1stru`c't1o1n'Co' rig!n�l system'or any repairs th above
mpliance 0 the 0 errato; 2) that the drilled well described
will be located as shown qj:,j e.appf?Xed,pl.a at,sald.wellWlil be Installed' in accordance with thq standards. rules and regZalTo—nsof ih liuina'm,
ppnO
revocable for cause or may be sAAded.or-niodified "n considered nec4saiy by the Commis . sioneir of Health. Any change or altwation of construction
- requires ' a now. permit. --
Date ~ - - r -
�� mm
Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512•(914) 225 -3641
APPLICATION TO CONSTRUCT- A .WATER WELL PCHD PERMIT # P_43_19t
WELL LOCATION
Street Address
East Branch Road
Town/Village/City Tax Grid Number
T. Patterson 17 -3 -2
WELL OWNER
Name Mailing Address.
Schmidt 31 Powell Rd., Dover Plains, NY 12522
MPrivate
O Public
USE OF WELL
1 - primary
2 - secondary
(RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
C7 INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specifq
p
AMOUNT OF USE
YIELD SOUGHT
Five gpm /# PEOPLE SERVED Six /EST. OF DAILY USAGE 600 gal
,REASON FOR
DRILLING
NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
(:)REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
O TEST /OBSERVATION
;DETAILED
REASON FOR
DRILLING
New Residence
WELL TYPE
DRILLED
DDRIVEN
0DUG
❑
GRAVEL
❑ OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.'
WATER WELL - CONTRACTOR: Name P.F. Beal & Sons Address: p,0. Box B. Brewster, NY
IS.PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY:. TOWN /VIL /CITY
DISTANCE TO- PROPERTY -FROM NEAREST WATER MAIN.: -. -• -- - -- - -- - -- -: - -- - - -- - •- -
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED See Dwg. Job #S.0.2479, By John.H. Prentiss,
ON REAR OF THIS APPLICATION [DO.. SE ARATE SHE P.E.
20 September 1988
(date) (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 s.hall:
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 Departjnent.
Date of Issue: 19
Date of Expiration: 19� Permit Issuing OffietaT
Permit is Non - Transferrable 'White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2/87 Orange copy: Well Driller
f
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH-SERVICES-
Date 20 September 1988
Re: Property of Schmidt
Located at East Branch Road
(T) Patterson Section 17 Block
Subdivision of
Subdv. Lot #
Gentlemen:
3 Lot 2
Filed Map # Date
This letter is to authorize John H. Prentiss
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 mat -ter 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.
Countersigned:
, R.A. , #
N• P
�o
1No 292° �,��►
o�
0', TNT ST "TE
Address
JONY H. PRENTISS. P.E.
RD9 FAIR ST 914 - 878 -F'•
CARMEL, NEW YORK M.
Telephone
Very truly yours,
Signed �E.. . de_ r __ - _
00her of Property
..31 Powell Road
Address
Dover Plains, NY 12522... .......... _..
TaWh
914 - 877 -6382
Telephone
PUIT• •X• JM DE2ARII-1� • BEALTH
RIVISION • ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEK FILE NO.
Owner JG.N VV% x*- � 7- Addres's : C-Aj V4.,) Q- a
Located at (Street)—kU1L4,%-W& lip, M sec. Block Lot'
(' Adicate'nearest cross street)
A-
')
Z—t-c AJ Watershed C&IC.9 7-=1
Municipality
UMN221-.1wom-mme V&�Vb,
Date of Pre-Soaking
=Wo
TO BE SUBMITTED WITH APPLICATIONS
88 , Date of Percolation Test
Run—
Elapse
Depth to Water Fran
Water Level
No.
Time
.-Ground Surface-
Inches
Soil -Rate
Start -Stop
Min.
Start stop..
Drop In
Min/In Drop
Inches Inches
Inches
--2
)o3-- Jos
3
/oS- 1oE3
4
Ice - t L-\
5
I- - 1--.- 1 1)15-
5
2
3
4
5 IA I
NOTES: 1. T6sts to be repeat�g,.at'same-. depth
.. '1� A, "I
are obtained at eadlj,-p�--rcolation t ,
for review.
2. Depth measurements to' ',lircin
rev. 9/85
it approximately equal soil rates
hole. All data to* be submitted
top: of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES '
DEP'T'H HOLE NO. I HOLE NO. HOLE NO.
G.L. i�5
1' c� M
2'
3' t�
S,
4'
5'
6'
�9- ls►al z�
7' Tw
8'
9'
10'
11'
12' -
13'
14'
INDICATE-'LEVEL AT -WHICH GROUNDWATER• IS' lawoNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED,
DEEP HOLE OBSERVATIONS MADE, BY: V DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity 10 O 0 gals , Typeo�n
Absorption Area Provided By C-) L.F. x 24" width trench
1
Other I l l� S b C : pt'il ;� ��v d. C ,
Name
RD9 FAIR ST
Address GIEt. NEW
H•
-- 4
THIS SPACE MR USE BY HEALTH'DEP , Y:292 �
OrrmE STN15-
Soil Rate Approved sq, Check(
by Date
� I
Beechwood Series
P.O. BOX 323 BERWICK, PENNSYLVANIA 18603 (717) 752-5914 2444SF
-Vel -1-wr
BEDROOM I
10'-6"x 11'-3'
-�A
Optional 314 Bath
With 2 Closets?
,3 018
2-Z. BEDROOM 1
• - - — . 1� - 15'- 0x11' -3" --'
BEDROOM 2
SUGGESTED LOWER LEVEL
Cpl. 400(
UTILITY AM Q
SINGLE CAR OAAAOE
FAMILY ROOM
1111111111 01110
4
HOIJS-E PLAIN-10'
\jj 0j
F AMILY
KITCHEN �N
-
L\1 17'-3'I I 1�_ 3 --
EDPO%j LIVING ROOM
-0 x 1 i' -3" 14'-0 'x1 1*-3'
dn. up
DEN /STUDY R9 I $T 914-78- 1* 1 j
CADRMEL. R NEW YORK 8 05 0 't'rHi ST'10
---------------------- -------------
Elevations are artist renderings and may vary to actual construction.
Floor plans and room sizes are approximate. Appliances shown are optional. Plans, Specifications and Pficeslaresubject to change without not!
yte r
JOHN 11- PRENTISS P. 0. 29.2
DEN /STUDY R9 I $T 914-78- 1* 1 j
CADRMEL. R NEW YORK 8 05 0 't'rHi ST'10
---------------------- -------------
Elevations are artist renderings and may vary to actual construction.
Floor plans and room sizes are approximate. Appliances shown are optional. Plans, Specifications and Pficeslaresubject to change without not!
yte r
APPENDIX B
PU1-NAA CCU-W-V DEPAHRMqT OF HEALTH - DIVISION OF ENT-RCUMqTAL HEALTH SERVICES
INDD-IDUAL MTER SUPPLY & SUBSURF2KE SEWA(=-, DISPCEAL SYSTEMS
(Name of Cwner)
C2: 121 =-
Ila
-AAA
1-7- trench urovidl';�
e-
0—
REVIEWS-=- CONSTR=ICN P—VPV-IT
DATE RENTEHENED:
-BY:
(Street Location)
YES
I NO
I DOCUI OUS
Penuit Application
Corporate Resolution
Plans - Three sets
s/S
Engineers Authorization
Design Data Sheet, ("DCS)
CNIVT-SICN
Deep Hole Lcg
Consistent Perc Res,—,", is
(3)
FillS�—
Paso Hole Depth
cd
4�'arellei to contours.
exp.
GOP-
FT--'- SYSTEMS t) A!-17- 1 --t- -I
1 notes
. s0e`--.
n/
200 ft".. reservoir, etc
150 ft. trigall/gall.'
51
q,
ns - Two s=-+-=
RequesIt.
�ffi
Laqal Subdivision
Subdiwision Accrcvai aecked
Ex-accrova--1 SSDS Ad- Lots Checked
wetl and (Tcwp/DEq Per? R & D)
Data Cn DDS Plans & Pe-='C� Se-,ma
REQUIRED 'DETA-= CN PLA-NIS
Se.,rage System Plan (north
Sedage System Hydraulic Profile Gravit-%7 Ficw
Fill Profile & Dimensions - VbDzme
D o<x;Trench/Gallery; Pmp pit details
,tic Tank - Size, Deta;l
Well Detail, Service Line if over
Construction Notes .(grinder rate)
Design Data: Perc and deep reaf-,ts
TWo-.Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footina /Gat4- r Curtai Ce r -
n, Drains (discharge OR)
Perc & Deep Holes Located
Representative of primary and ex-pansion
Expansion A-rea;shcwm;gra-vity flc-.q,sufiz-. size
---M Pawed Pit & D Box Shcwn & Detailed
House - No. of Bedroans N
Wells & SSCS's w/in 200 f-;L-.. of Proposed SySt---TL
Property motes & Bounds
House Setback Necessary (Tight lot)
House Seger - 1/4"/ft. 4110; Tyce pipe
No Bends; Max. Bends 45* w/cleanout
SEP-AiUMON DISTAN= SP-Pr-IFI--ED CN PLAN
Fields
101 to P.L., DriveNay, large Treesjop Of fi.
20' to Foundation Walls
1001.to Well; 200' in D.L.O.D, 150' pits
1001 to Stream, Watercourse, Lake Unc- e%Ta:
151 to Drains-C-urtain, Leader, Footing
51 catch bas4M,st-Orimdrain,piped waterccur.*
Water Line (pits-20')
;e :) t �2'. c to Water
10' from Foundation; 501 to well
15' Well to PL 9
JOHN N. CALBO
Building Inspector
Mr. Hunter R. Pollock
Old Rt. 22
Patterson, New York 12563
Dear Mr. Pollock,
TOWN OF PATTERSON
PUTNAM COUNTY
PATTERSON, NEW YORK :12563
May 24, 1993
&'49 O-L, & ?
d ,
n reciep r letter o ay 17 't regar o some site
being done on s e lands on the side o East Branch Road approximately 1i
miles from Haviland Hollow Road.
Telephone
- 878 -6319
A building permit for tion of a Single Family Detached Dwelling
for a house ocated in this area was issued in 1988 and renewed on March 22, 1993.
If this is the location, part of the lot is in fact situated in established
wetlands . and has recieved a permit from the Putnam County Department of .Health
with certain restrictions as to areas that could be worked in and those areas
that were to serve as a buffer zone.
Therefore, in the course of our inspections to be made for the construction
of the dwelling, we will check the installation of the necessary controls for
the-protection of_ the . wetlands. We_will attempt to have the__build.e.r._.comply..with
the requirements of that approval that was granted by the Health Department for
this lot. If compliance cannot be attained, we will take appr6priat&-action.
Very ruly yours,
ndrew W. Barone, P.E.
Temporary Building Inspector
AWB /cs
cc: .Town Board Members
Conservation Officer, T. Kozlowski
Putnam County Dept. of Health ✓
file
APPENDIX B
PUMPM COUNTY DEFWZA_� OF HEALTH DIVISICN OF ENVIRCNMMM HEALTH SERVICES
INDI4?DUAL WATER SUPPLY & SUBSJRFAC E SEWAGE DISPOSAL SYSTEMS
REVIEW SrIEE,T - CONSTRIICTION PE`RM.IT
/ DATE REN=1EX" D :
BY
(:lame of C wne_r) (Street Location)
C .tS
YES
I NO
I
L=.* trench provided O
reauiTw 3�l>
X60 ft. max. _ . ..
to contours
I
I
KL
FLL SYSTEMS
avbarrier
,1-0- ft.
ill notes
:e:a spec.
u es
100-'_ . flood elev.
200 ft. reservoir, etc.
150 ft. trigall /gall.
DC CUM-EWS
Permit Application
Corporate Resolution
Plans - Three sats
Engineers P_uthorizaticn
Design Data Sheet MCS)
Deep Hole Log
Consistent Perc Res-,11 is
Perc Hole Depth
s, s
'5UBDIVIS ICN
Perc
(3) Fill
c3
)House Plans - Two 52 =�
e_ pe_rm_i t;
Variance Recruest
Lard 'Subdivision
Subdivision Apgrcval Checked
Ex -a. proval SSOS Ad-;I. Lots Chec3ce3
Wetland (Tcw-n/DEC Permit R & D)
Data Cn DDS Plans & Permit Sail_
REQUIRED DETA= CN PT_A.NS
Sedage System Plan - (north arr-w)
SCaage System Hydraulic Profile - Gravity Flcw
Fill ile & Dimensions - Voll,-ne
D r x ;Trench /Gallery; Puwp'pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder rte),
Design Data: perc and deep •resyts
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footin /Gatter,Curtain Drains (discharge OK)
Perc & Deep Holes Locates
Representative of primary and eraznsion
Expansion Area; shown; gravity flcw,suff. size
If Paq)ed Pit & D Box Shown & Detailed
House -No. of Bedroons�3
Wells & SSDS's w /in 200 ft. of Proposed SystarL
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Suer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPA ATION DISTALICS. SPECIFIED 0' PLAN
Fields
10' to P.L., Driveway, Large. Trees, Too of f
20' to Foundation Walls
100'.to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. era.
15' to Drains-Curtain, Leader, Footing
35'to catch basin,stormdrain,oicei waterccur.
10' to Water Line (pia= s =201 ) (- '
50' intermittent drainage course dV
Ser)tic Tanks
10' fran Foundaticn; 50' to we-' 1
15' Well to PL 9
WCe o—
��
a
/
w
a
a
Ll
i
i
1�
r
,
r
.e
boa
el 43a